Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one?

Waga, Shiro; Yamamoto, Yoshisuke

doi:10.1161/01.str.14.4.480

Cited by 66 publications

(21 citation statements)

References 37 publications

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“…Our results have shown, as in other series [1][2][3]8,9,13,14 , that thalamic and ganglionar hemorrhages related to systemic hypertension are very morbid conditions 1,2 . Patients with initial pressures above 20 mmHg presented very poor outcomes, independent of the implantation of intraventricular catheters and CSF drainage.…”

Section: Discussionsupporting

confidence: 88%

“…Although we might consider that mobility in a wheelchair and communication by gesticulation do not constitute a total disability, these achievements certainly do not represent a useful quality of life 6 . In this sense, several studies have been performed in order to compare the outcome of patients submitted to surgical resection of these lesion versus the ones treated exclusively with conservative measurements [1][2][3][5][6][7]13 . It is generally accepted that surgery for the evacuation of these hematomas per se does not provide additional functional benefits and nowadays it is only indicated for patients that present rapidly clinical deteriorating conditions [5][6][7]14 .…”

Section: Discussionmentioning

confidence: 99%

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Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages

Hamani

Zanetti

Pinto

et al. 2003

Arq. Neuro-Psiquiatr.

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In the present study, we have evaluated the use of intraventricular pressure catheters in thalamic and ganglionic hemorrhages. Ten patients admitted in our Emergency Department in Glasgow Coma Scale (GCS) equal or below 13 enrolled the study (at least one point should have been lost in the eye opening score to exclude purely aphasic patients that were fully alert). After a complete clinical and neurological evaluation, computed tomography scans were obtained and the volume of the hematomas, as well as presence or absence of hydrocephalus, were considered. Intraventricular pressure catheters connected in parallel to external derivation systems were implanted and patients were thereafter sent to the ICU. Patients that presented mass effect lesions with sustained increased ICP levels or clinical and neurological deterioration were submitted in addition, to the surgical evacuation of the hematomas. Clinical evolution, complications and the rehabilitation of the patients were recorded. Clinical outcome was assessed with the Glasgow Outcome Score. In all but three patients the initial intracranial pressure levels were bellow 20 mmHg (mean for all patients was 14.1 +/- 6.5 mmHg). Notwithstanding, these three patients were extremely difficult to treat. For this group of patients mortality was 100%. Among the patients that presented ICP levels bellow 20 mmHg, 04 developed hydrocephalus and 03 did not display ventricular dilation. As expected, the major benefits concerning the intraventricular pressure catheters connected in parallel with external derivation systems were observed in the group of patients that presented ICP levels bellow 20 mmHg and had hydrocephalus. Mild non-statistically significant correlations for all the three groups were achieved either when the initial GCS and ICP levels (r=-0.28, p=0.43) or when ICP levels and the volumes of the hematomas were compared (r=0.38, p=0.28). In addition, no significant correlations were observed concerning the final outcome of the patients and the variables previously evaluated.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages

Hamani

Zanetti

Pinto

et al. 2003

Arq. Neuro-Psiquiatr.

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“…In fact, 39.8% of patients that were presented in an unconscious state died within 30 days of PICH, and only 5.8% achieved FR after 90 days. Furthermore, it has also been reported on several occasions that level of consciousness is consistently associated with outcome after PICH 32,44,45) . Limb paresis was not found to be an independent predictor of 30-day mortality, but was found to powerfully predict 90-day FR (p=0.000, OR=6.927).…”

Section: Discussionmentioning

confidence: 91%

“…Despite the increasing prevalence of ischemic stroke attributed to a rapid westernization of lifestyle, PICH is still relatively common in South Korea and in other Far Eastern countries 23,33) . Several studies have identified predictors of outcome in PICH patients 4,9,16,19,27,31,36,45,46) , but the majority of these have been performed in western countries or Japan. Therefore, the factors related to death and functional recovery after PICH in Koreans have not been well defined.…”

Section: Introductionmentioning

confidence: 99%

Predictors of 30-Day Mortality and 90-Day Functional Recovery after Primary Intracerebral Hemorrhage : Hospital Based Multivariate Analysis in 585 Patients

Kim

2009

J Korean Neurosurg Soc

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Objective : The purpose of this study was to identify independent predictors of mortality and functional recovery in patients with primary intracerebral hemorrhage (PICH) and to improve functional outcome in these patients. Methods : Data were collected retrospectively on 585 patients with supratentorial PICH admitted to the Stroke Unit at our hospital between 1st January 2004 and the 31st July 2008. Using multivariate logistic regression analysis, the associations between all selected variables and 30-day mortality and 90-day functional recoveries after PICH was evaluated. Results : Ninety-day functional recovery was achieved in 29.1% of the 585 patients and 30-day mortality in 15.9%. Age (OR=7.384, p=0.000), limb weakness (OR=6.927, p=0.000), and hematoma volume (OR=5.293, p=0.000) were found to be powerful predictors of 90-day functional recovery. Furthermore, initial consciousness (OR=3.013, p=0.014) hematoma location (lobar, OR=2.653, p=0.003), ventricular extension of blood (OR=2.077, p=0.013), leukocytosis (OR=2.048, p=0.008), alcohol intake (drinker, OR=1.927, p=0.023), and increased serum aminotransferase (OR=1.892, p=0.035) were found to be independent predictors of 90-day functional recovery after PICH. On the other hand, a pupillary abnormality (OR=4.532, p=0.000) and initial unconsciousness (OR=3.362, p=0.000) were found to be independent predictors of 30-day mortality after PICH. Conclusion :The predictors of mortality and functional recovery after PICH identified during this analysis may assist during clinical decisionmaking, when advising patients or family members about the prognosis of PICH and when planning intervention trials.

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“…The treatment of choice is still controversial and may be surgical or nonsurgical (conservative). [1][2][3][4][5][6][7][8] Theoretically, clot removal is beneficial because it reduces hematoma volume 9 -11 and may therefore also lower intracranial pressure, 12 reduce the chance of edema formation, and improve perfusion in the affected hemisphere. [13][14][15][16] The effect on perifocal ischemia resulting from hypoperfusion is unclear, as such an ischemia itself is refuted by a recent publication.…”

mentioning

confidence: 99%

Stereotactic Treatment of Intracerebral Hematoma by Means of a Plasminogen Activator

Teernstra

Evers

Lodder

et al. 2003

Stroke

289

181

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Background and Purpose-Treatment of intracerebral hematoma (ICH) is controversial. An advantage of neurosurgical intervention over conservative treatment of ICH has not been established. Recent reports suggest a favorable effect of stereotactic blood clot removal after liquefaction by means of a plasminogen activator. The SICHPA trial was aimed at investigating the efficacy of this treatment. Methods-A stereotactically placed catheter was used to instill urokinase to liquefy and drain the ICH in 6-hour intervals over 48 hours. From 1996 to 1999, 13 centers entered 71 patients into the study. Patients were randomized into a surgical group (nϭ36) and a nonsurgical group (nϭ35). Admission criteria were the following: age Ͼ45 years, spontaneous supratentorial ICH, Glasgow Eye Motor score ranging from 2 to 10, ICH volume Ͼ10 cm 3 , and treatment within 72 hours. The primary end point was death at 6 months. As secondary end points, ICH volume reduction and overall outcome measured by the modified Rankin scale were chosen. The trial was prematurely stopped as a result of slow patient accrual. Results-Seventy patients were analyzed. Overall mortality at day 180 after stroke was 57%; this included 20 of 36 patients (56%) in the surgical group and 20 of 34 patients (59%) in the nonsurgical group. A significant ICH volume reduction was achieved by the intervention (10% to 20%, PϽ0.05). Logistic regression analysis indicated the possibility of efficacy for surgical treatment (odds ratio, 0.23; 95% confidence interval, 0.05 to 1.20; Pϭ0.08). The odds ratio of mortality combined with modified Rankin scale score 5 at 180 days was also not statistically significant (odds ratio, 0.52; 95% confidence interval, 1.2 to 2.3; Pϭ0.38). Conclusions-Stereotactic aspiration can be performed safely and in a relatively uniform manner; it leads to a modest reduction of 18 mL of hematoma reduction over 7 days when compared with control, which has a 7-mL reduction, and therefore may improve prognosis.

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Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one?

Cited by 66 publications

References 37 publications

Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages

Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages

Predictors of 30-Day Mortality and 90-Day Functional Recovery after Primary Intracerebral Hemorrhage : Hospital Based Multivariate Analysis in 585 Patients

Stereotactic Treatment of Intracerebral Hematoma by Means of a Plasminogen Activator

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