The expansion of the hematoma during the acute stage of putaminal hemorrhage: The effect of hemodynamic factors

The expansion of the hematoma during the very acute stage of putaminal hemorrhage was detected by repeated CT measurements in 7 patients. We examined whether the changes in blood pressure during the initial 24 hours after admission have any effect on the expansion of the hematoma. Clinical and CT studies were made during the very acute stage in 46 patients with hypertensive putaminal hemorrhage which were graded as IVb or better according to the Criteria of the Japanese Conference on Surgery for Cerebral Stroke. Blood pressure on admission was not significantly different between the progressive group (in which the hematoma became expanded) and the nonprogressive group. In the nonprogressive group, blood pressure gradually decreased with time following admission whether the initial size of hematoma was large or small. In the progressive group, the increase in blood pressure occurred both during the 3rd hour and the 24th hour after admission. The initial elevation of blood pressure was considered to be responsible for the expansion of the hematoma, while the later elevation of blood pressure seemed to be the consequence of the increase in the intracranial pressure. Our data suggested that blood pressure should be controlled in patients with hypertensive putaminal hemorrhage if blood pressure continued to increase after admission.