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March 2011

Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage

Author Affiliations

Author Affiliation: Department of Neurology, Govind Ballabh Pant Hospital, Delhi, India.

Arch Neurol. 2011;68(3):395-399. doi:10.1001/archneurol.2011.9

The article by Goldstein et al1 is interesting; however, there are certain areas of concern.

In Table 4, the authors highlighted the intracerebral hematoma (ICH) size, further expansion in size, and outcome. Of 20 patients, 6 had an ICH of less than 10 mL and one, 15.7 mL. Only 2 of the 7 patients had an increase in hematoma size, and for 2 patients, no data on expansion was available. In the remaining 3 patients, ICH size decreased on repeated neuroimaging. Five of the 7 patients died, and 2 received rehabilitation. The size of the hematoma is an important predictor of death and prognosis in intracerebral hematoma. Any ICH with a volume less than 30 mL carries a better prognosis.2 Thus, significantly high mortality in patients with a small ICH volume is unusual. Any large-volume ICH carries high mortality and, in this study, all 7 patients with more than 100 mL of ICH died. The mortality rate in symptomatic ICH cases is 47%, but in this study it was 75%, which is high.3

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