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Original Investigation |

Transient Neurological Symptoms in Patients With Intracerebral Hemorrhage

Sandeep Kumar, MD1,2; Magdy Selim, MD, PhD1,2; Sarah Marchina, PhD1; Louis R. Caplan, MD1,2
[+] Author Affiliations
1Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2Harvard Medical School, Boston, Massachusetts
JAMA Neurol. 2016;73(3):316-320. doi:10.1001/jamaneurol.2015.4202.
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Published online

Importance  Transient symptoms from an intracerebral hemorrhage (ICH) are not well recognized and have previously not been reported.

Objective  To describe the clinical presentations and neuroimaging findings in a subset of patients with ICH presenting with transient neurological signs and symptoms.

Design, Setting, and Participants  Clinical case series in which the hospital database of a large academic center in Boston, Massachusetts, was searched using International Classification of Diseases, Ninth Revision code 431 from June 1, 2000, to August 31, 2014, to identify patients with ICH who had transient deficits that resolved completely within 24 hours of symptom onset.

Main Outcomes and Measures  Clinical presentation, neuroimaging findings, and prognosis.

Results  Among 3207 consecutive patients with ICH initially screened, 17 fulfilled study criteria (median age, 65 years [interquartile range, 56-73 years]; 11 male). In most patients, recovery from neurological symptoms started within a few hours after onset. Most hemorrhages in this cohort were small, with a mean (SD) hematoma volume of 17 (9.9) mL, and were subcortical in location. One patient died of hemorrhage recurrence.

Conclusions and Relevance  Patients with ICH can present with rapidly resolving deficits resembling transient ischemic attacks. Recognition of these instances is important to avoid delays in investigations and to manage these cases appropriately.

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Figure.
Computed Tomographic Scans Demonstrating Characteristic Brain Hemorrhages in the Patient Cohort

A, Patient with left-sided hemiparesis that resolved within 6 hours. B, Patient with left-sided hemiparesis that resolved within 12 hours. C, Patient with severe anomia that resolved in 30 minutes. D, Patient with recurrent right-sided paresthesias lasting less than 24 hours. E, Patient with speech arrest that largely resolved within 15 minutes. F, Patient with right-sided hemiparesis and aphasia that resolved within 8 hours.

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