Massive Brain Hemorrhage: A Review of 144 Cases and an Examination of Their Causes

A detailed clinicopathological study of the causes and locations of massive nontraumatic brain hemorrhage in 144 patients is reported. A cause of the hemorrhage, such as an aneurysm, angioma, arteritis, neoplasm or a blood dyscrasia (leukemia, hemophilia), was proved in two-thirds (95) of these patients. Twelve normotensive patients had no cause found to explain their hemorrhage. Systemic hypertension, generally mild, defined as a pre-ictal pressure of > 140/90 or by excessive heart weight, was present in 58 of the 144 patients. Twenty-one of these 58 hypertensive patients had a clear discernible cause for their brain hemorrhage (i.e., leukemia, metastatic carcinoma, angioma, aneurysm), whereas no satisfactory morphological cause could be found in only 37. Thus, in only about one-fourth of our patients could any serious claim be made that hypertension was the cause of the hemorrhage. Our data would indicate the need for a critical study of the causes of intracranial hemorrhages, and re-evaluation of the true relationship of systemic hypertension to such strokes. The widespread dogma that hypertension is the outstanding cause of nontraumatic brain hemorrhage no longer seems warranted.