HEMORRAGIAS DE LA CABEZA DEL NUCLEO CAUDADO

We report eight patients (four men and four women, medium age 42 years) with hemorrhages confined to the head of the caudate nucleus to outline the etiology, clinical manifestations, and outcome of this entity. The etiology of bleeding was determined in seven cases: three patients had arterial hypertension, two had saccular aneurysms, and two had arteriovenous malformations. All patients had a neurological picture of sudden onset. Most frequent clinical manifestations were: cloudiness of consciousness, headache, vomiting, focal motor deficits, and behavioral changes. In addition, two patients had seizures at the onset. CT documented the caudate bleeding in all cases, and seven patients had intraventricular extension of bleeding. Four patients died during the acute phase of the disease. Death was related to aneurysm rebleeding in two patients, to acute hydrocephalus in one, and to systemic complications in the remaining patient. We conclude that hemorrhages in the head of the caudate nucleus are more common than previously believed. Routine practice of cerebral angiography or magnetic resonance angiography is important to detect cerebral aneurysms or vascular malformations that account for an important number of causes of caudate hemorrhage.