[Thalamic hypertensive hemorrhage]

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Thalamic hypertensive hemorrhage (THH) is a severe stroke subtype with high mortality.
• Treatment decisions and prognosis are influenced by clinical and tomographic factors.
• Intracranial pressure monitoring is crucial for managing THH.

Purpose of the Study:

• To analyze the outcomes of conservative versus surgical (external ventricle drain - EVD) treatment for THH.
• To identify clinical and tomographic factors influencing treatment choice and prognosis in THH patients.
• To evaluate the impact of EVD on intracranial pressure and neurological status.

Main Methods:

• Statistical analysis of 23 THH patients treated conservatively or with EVD within 48 hours of stroke onset.
• Investigation of clinical factors including Glasgow Scale score, hydrocephalus, brainstem dislocation, and intraventricular hemorrhage.
• Monitoring of intracranial pressure and assessment of hemorrhage volume and location.

Main Results:

• Mortality was approximately twice lower in the EVD group (6/23) compared to the conservative group (17/23).
• Unfavorable prognostic factors for conservative treatment included low Glasgow score, obstructive hydrocephalus, brainstem dislocation, intraventricular hemorrhage, and hemorrhage volume.
• EVD indicated for unfavorable THH signs, leading to controlled intracranial pressure decrease, improved consciousness, and reduced hydrocephalus and brainstem dislocation.

Conclusions:

• EVD is a more effective treatment for severe THH, associated with significantly lower mortality rates.
• Early identification of prognostic factors guides timely EVD intervention for unfavorable THH cases.
• Controlled intracranial pressure management via EVD improves neurological outcomes in THH patients.