Prognosis for patients treated conservatively for spontaneous intracerebral hematomas.

Abstract

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...

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

“…The median GCS score was 10 (range 9-11), the median mRS score was 5 (range , and the median NIHSS score was 22 (range [17][18][19][20][21][22][23][24][25][26][27]. All patients' GCS scores improved by at least 2 points.…”

“…Management was in accordance with the most recent American Heart Association guidelines for the treatment of ICH. 18,29 Midline shift was measured at the level of the foramina of Monro.…”

Decompressive Hemicraniectomy in Hypertensive Basal Ganglia Hemorrhages

“…The mortality rates for patients undergoing such intervention in these studies were considerably better than the natural history, as the mortality of the latter approaches 86%. 3,9 Moreover, the results for concurrent DHC and clot evacuation were favorable compared with results for patients managed with craniotomy and clot evacuation, suggesting a therapeutic effect of decompression. 11,12 Clinical outcomes for decompressive hemicraniectomy with clot evacuation have been reported for a total of 138 patients in the literature, rendering an overall 29% mortality rate and 51% favorable outcome rate, with follow-up duration ranging from discharge to 2 years (Table II gained functional independence at 6 months.…”

Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

“…Medical management of these patients results in unacceptable morbidity and mortality. Only 48-65% of ICH victims are alive at one-month follow up and only 10% of these patients are living independently (4)(5)(6)9). The natural course of acute ICH is not static (10).…”