The Meaning of the Prognostic Factors in Ruptured Middle Cerebral Artery Aneurysm with Intracerebral Hemorrhage

Abstract

ObjectiveThis study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment.MethodsEnrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale.ResultsAge and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway.ConclusionEven if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.

Ruptured Anterior Communicating Artery Aneurysms Concomitant with Small Intracranial Hematoma: Evacuating Hematoma or Not?

“…Aneurysmal SAH accompanied by ICH is associated with poor functional outcome. 4 , 7–11 The rate of unfavorable outcomes in our study was 44.8%, which is in accordance with the range of 21.4% to 76.2% as reported in previous studies. 1 , 2 , 5 , 7 , 10 , 14 , 16–19 The poor initial clinical conditions, age, occurrence of spontaneous infarction, symptomatic vasospasm, ICH volume, aneurysm size, and midline shift are predictors of prognosis in patients with ICH secondary to aneurysms.…”

“… 1 , 2 , 5 , 7 , 10 , 14 , 16–19 The poor initial clinical conditions, age, occurrence of spontaneous infarction, symptomatic vasospasm, ICH volume, aneurysm size, and midline shift are predictors of prognosis in patients with ICH secondary to aneurysms. 1 , 5 , 7 , 18 The clot evacuation is considered an important predictor of prognosis in ruptured MCA aneurysms concomitant with ICH, especially in large hematomas. 14 , 15 However, the volume of ICH secondary to ruptured AcomA aneurysms is smaller than that of MCA aneurysms, which results in lesser occupying effect.…”

Hubungan Tekanan Darah dengan Volume Pendarahan Intraserebral pada Pasien Stroke Hemoragik di Ruang Rawat Inap Saraf Rumkital Dr Ramelan Surabaya

“…Volume pendarahan intraserebral pada penelitian ini dikelompokkan berdasarkan perjalanan klinis penyakitnya menjadi volume diatas 31 ml dan dibawah 31 ml. Digunakan nilai cut-off 31 ml karena pada batas jumlah volume pendarahan 31 ml, ditemukan hasil nilai spesifisitas dan sensitivitas tertinggi untuk hubungan antara volume pendarahan intraserebral dengan prognosis penyakit, yang berarti perbedaan presentase pasien dengan outcome klinis baik dan pasien dengan outcome klinis buruk paling besar pada nilai cut-off 31 ml (Oh, et al, 2012) (Grysiewicz, et al, 2008).…”

Comparative Results of the Patients with Intracerebral and Intra-sylvian Hematoma in Ruptured Middle Cerebral Artery Aneurysms

“…Prat et al9) categorized hematomas into temporal ICH and ISH, and observed better outcomes in patients with temporal. Oh et al7) grouped hematomas into frontal ICH, temporal ICH, and ISH, and found that temporal ICH had more favorable clinical outcome when compared to the other hematoma groups.…”