Computerized Tomography and Clinical Features of Large Cerebral Hemorrhages

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Abstract
We studied 17 consecutive patients with nonaneurysmal cerebral hemorrhages larger than 55 cm3 to determine the computerized tomographic correlates of stupor and coma. Coma was associated with 8 mm or greater pineal displacement in 8 of 14 comatose patients. An extension of the clot that occupied or displaced the lower diencephalic region explained coma in the remaining 6 patients with less than 8 mm horizontal pineal displacement. All patients with diencephalic clot were comatose. Three initially drowsy or stuporous patients had 3 mm mean pineal displacement. Massive hydrocephalus occurred in 5 patients, always associated with diencephalic clot, and therefore never independently accounting for coma. Clot volume could be estimated from: volume (cm3) = [largest clot diameter (cm) X 14] – 14. We incidentally found that at least 6 of the 17 massive hemorrhages had progressed from smaller clots.

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