SUMMARY The long-term clinical and CT-outcome of 53 conservatively treated patients with spontaneous intracerebral hematomas (ICH) was studied in relation to the acute findings.The acute mortality of ICH was 27%. Determinant for the immediate prognosis was the level of consciousness and the volume of the hematoma. The crucial size was 50 ml with a mortality of 90% for hematomas larger and 10% for hematomas smaller than that. Intraventricular hemorrhage was a bad prognostic sign only in the ganglionic-thalamic hematomas.At follow-up at a median of 4!/j years after ICH, 30% of the total series had a completely normal neurological examination and 28% had resumed work. Thirteen per cent had minor neurological deficits and 17% had debilitating sequelae. During the follow-up period 7 patients had died, which indicates an excess mortality for ICH survivors.The CT findings at follow-up consisted of low density areas smaller than the original hematomas, focal atrophy, calcifications and porencephalic cysts. In 10% the CT scan revealed no trace of the previous hematoma.Stroke Vol 15, No 6, 1984 BEFORE THE ADVENT of cranial computer tomography (CT) the acute mortality of intracerebral hematomas (ICH) varied from 51% to 92%.'" 3 The longterm prognosis was evaluated in surprisingly few studies. Six months after ICH McKissock et aJ 1 of a total of 91 patients found that 51 % were dead ,12% had returned to full work, 22% were partially disabled and 15% were totally disabled. Out of 138 patients who had survived ICH Felger et al 4 after an observation period of 3 to 7 years found that 35% had died, 14% had recovered completely and 43% and 8% respectively were partially and totally disabled.After CT has become available the diagnosis of ICH is made more frequently and with greater accuracy.5 " 7As a probable effect of diagnosing smaller hematomas the overall acute mortality of ICH has declined to about 30%. The resolution of the hematomas as visualized by CT during the first weeks and months has been described in several studies. 38 "" The long-term outcome after 6-29 months of CT verified ICH has been evaluated in clinical studies, 12 " 16 which however, did not include concomittant follow-up CT studies.The purpose of the present paper was to study the long-term clinical and CT outcome of conservatively treated spontaneous ICH as related to the acute findings. Patients and MethodsThis series of CT-verified ICH was collected from the neurological and neurosurgical departments at Rigshospitalet, Denmark, over the years 1974 to 1982. The clinical data concerning the acute phase were compiled retrospectively from the charts. After exclusion of patients with ICH known to be due to trauma, ruptured arterial aneurysm and to hemorrhage into tumors a total of 108 patients were diagnosed as having a spontaneous ICH. Neurosurgical evacuation of the hematoma was performed in 55 patients. The remaining 53 patients who were conservatively treated for spontaneous ICH formed the object of the present study. The material is not representativ...

Psychological testing, cerebral blood flow (CBF) measurement, and computed tomographic scan were performed before and 3 months after operation in 31 patients subjected to endarterectomy of the internal carotid artery (ICA) because of transient ischemic attacks and in 11 control patients operated on for atherosclerosis of the lower extremities. In preoperative psychological testing both carotid surgery patients and controls performed somewhat below the normal level for their age group. Postoperatively, cognitive functions improved in the carotid surgery group but not in the control group. The improvement was related to the laterality of the operation, being more marked in verbal tests in patients with left ICA operation and in visuospatial tests in patients with right ICA operation. Postoperatively regional CBF improved in 2 patients only. Hence the intellectual improvement could not be related to changes in CBF. Intellectual deterioration in patients with internal carotid atherosclerosis may be delayed or terminated by surgical abolition of the source of multiple cerebral embolizations.

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The conductance to outflow of CSF (Cout) was measured in 66 patients with normal pressure hydrocephalus (NPH). All patients were investigated with computed tomography (CT); 34 of the patients also had pneumoencephalography (PEG). Periventricular hypodensity on CT indicates a low Cout. Cortical sulci smaller than 1.9 mm on CT indicate a low Cout, while wide cortical sulci do not exclude a low Cout. There was a good correlation between ventricular size on CT and PEG, but the ventricular size is unrelated to Cout. No findings on PEG indicate a low Cout.

Fifty-four patients, aged 15 to 81 years had a spontaneous intracerebral haematoma surgically removed (51 patients) or had ventricular drainage. One-third had arterial hypertension. Two thirds were alert or drowsy preoperatively and two thirds presented with hemiparesis or decerebrate rigidity. Lobar haematomas constituted 72%, deep supratentorial constituted 21% and cerebellar haematomas 7%. Volume of the haematomas ranged from 10 to 205 ml. 10 patients died in the early postoperative phase and 8 patients died later. Among 36 survivors, 35 were evaluated 15-115 months postoperatively. 10 had resumed part of their earlier occupation. Another 12 were incapacitated and the remaining 13 patients needed nursing care. No patient was neurologically or neuropsychologically intact, but 19 had only slight disabilities. CT-changes at follow-up ranged from no abnormalities at all to low-density lesions, possibly associated with dilatation of a lateral ventricle or porencephaly depending on the size of the haematoma and possible ventricular penetration. Surgical evacuation of ICH is recommended in lobar or deep supratentorial haematomas exceeding 20 ml except in patients older than 60 already unconscious. Smaller haematomas with intraventricular extension may benefit from ventricular drainage or, in the fossa posterior, even from evacuation in case of increasing brain stem compression.