Benign brainstem hemorrhage simulating transient ischemic attack

Rapid spontaneous resolution of neurological signs and cerebral herniation caused by intracerebral hemorrhage -case report-

A 47-year-old man presented with sudden consciousness disturbance and left hemiplegia caused by intracerebral hemorrhage. Initial computed tomography (CT) showed a massive subcortical right temporoparietal lobe hematoma and signs of impending uncal herniation. However, he became alert and his hemiplegia improved considerably in the course of 2 hours, so conservative treatment was preferred over surgical intervention. Follow-up CT acquired on the next day revealed dramatic diminution of the intracerebral hemorrhage. Small intracerebral hemorrhages occasionally produce transient symptoms with or without disappearance of the hematoma, but the present patient had a large hematoma that decreased in size within a short time with rapid improvement of the symptoms attributed to the hematoma. The mechanism underlying the diminution of the hematoma may be related to redistribution by cerebrospinal fluid flow.

The importance of identifying intracranial haemorrhage as a cause of transient focal neurological symptoms

Until recently, there have been no reports of intracerebral haemorrhage presenting with transient neurological symptoms. We present two cases of intracerebral haemorrhage presenting as transient ischaemic attacks and discuss the radiological changes on early and late CT scans. It would seem justified to scan most patients presenting with TIA early to institute appropriate secondary prevention measures.