0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Recognizing and Preventing Intracerebral Hematoma Expansion

Louis R. Caplan, MD1
[+] Author Affiliations
1Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Neurol. 2016;73(8):914-915. doi:10.1001/jamaneurol.2016.1899.
Text Size: A A A
Published online

Extract

One early and dramatic clinical account of hematoma expansion concerns a man who developed a hematoma that evolved under observation in 1937.1 He was sent to the hospital because of “malignant hypertension.” While his medical history was being taken, the patient complained of weakness, dizziness, and numbness of his hands. He then reported an inability to hear, difficulty in swallowing, and dyspnea. The patient was placed on the examining table, and it was determined that his systolic blood pressure and diastolic blood pressure were 245 and 170 mm Hg, respectively. Under the eyes of several examiners, complete bilateral palsy of the sixth nerves developed; both pupils dilated, and the corneal reflexes disappeared. The patient was still able to talk, but with a bulbar speech, and he appeared almost completely deaf. His left leg became paretic, and rapid clonic movements were observed. The Babinski sign was present bilaterally. Within an hour, the patient became comatose and quadriplegic and soon died. His brainstem had been gradually destroyed by a hypertensive pontine hematoma while physicians watched helplessly. Környey1 commented that this rapidly progressive chain of events was most unpleasant to witness and produced a depressing effect on the nurses and physicians.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

465 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Supplemental Content

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Stroke, Hemorrhagic: Does This Patient Have a Hemorrhagic Stroke?

brightcove.createExperiences();