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Comparative study of traumatic and spontaneous intracerebral hemorrhage
M Shahid Siddique1, Barbara A Gregson, Helen M Fernandes
1Department of Neurosurgery, University of Newcastle, Newcastle General Hospital, Newcastle-upon-Tyne, United Kingdom.
Insights
Traumatic intracerebral hemorrhage (TICH) affects younger patients and has a better prognosis than spontaneous intracerebral hemorrhage (SICH). Surgical indications for both TICH and SICH remain unclear.
Area of Science:
- Neurosurgery
- Neurology
- Trauma Surgery
Background:
- Spontaneous intracerebral hemorrhage (SICH) and traumatic intracerebral hemorrhage (TICH) are significant neurological conditions.
- Understanding their distinct pathological and clinical characteristics is crucial for effective management.
Purpose of the Study:
- To compare the clinical and pathological features of TICH and SICH.
- To investigate factors influencing outcomes and surgical intervention indications for both hemorrhage types.
Main Methods:
- Prospective databases of patients with head injury (since 1987) and SICH (since 1993) were analyzed.
- Demographic, clinical, radiological, and outcome data from 90 TICH and 440 SICH patients were extracted.
- Statistical analysis was performed to compare patient groups and outcomes.
Main Results:
- TICH patients were younger (median 51 years) than SICH patients (median 65 years).
- TICH demonstrated significantly better outcomes (67% favorable) compared to SICH (24% favorable).
- Younger age and higher Glasgow Coma Scale scores correlated with better outcomes for both TICH and SICH.
Conclusions:
- TICH and SICH exhibit distinct features, with TICH having a younger demographic and superior prognosis.
- Current indications for surgical intervention in both TICH and SICH are poorly defined and inconsistently applied.
- Further clinical trials are recommended to clarify the role of surgery in managing TICH and SICH.
Object:
Spontaneous intracerebral hemorrhage (SICH) and traumatic intracerebral hemorrhage (TICH) are common disorders. The authors planned to study how these two types of hemorrhage behave pathologically and clinically to gain further insight into their causes, pathogeneses, indications for surgical intervention, and prognoses.
Methods:
Prospectively filled databases of demographic, clinical, radiological, and outcome details have been maintained for all patients admitted to the Regional Neurosciences Centre with head injury since 1987 and with SICH since 1993. Of the 5686 patients whose case information was included in the head-injury database, 90 were found to suffer from an isolated intracerebral hemorrhage (ICH) as the only major abnormality observed on computerized tomography scans (subdural and extradural hematomas were excluded). Case details on these 90 patients and the 440 patients from the SICH database were extracted and analyzed using a statistical software program. The median age of patients with TICH was lower than the median age of patients with SICH (51 years compared with 65 years, respectively), but it was much higher than the median age of the entire head-injury group (21 years). Among patients younger than 45 years of age, 0.8% of patients who experienced trauma suffered from an ICH compared with 4.3% of patients older than 45 years of age. Irrespective of intervention, much better outcomes were achieved by patients with TICH compared with those with SICH (67% favorable outcomes compared with 24% in patients with SICH). Following trauma, there was no significant relationship between the severity of injury and the development of ICH. At presentation the median Glasgow Coma Scale (GCS) score for both groups was 13. Younger age and higher GCS score at presentation were strongly related to a favorable outcome for both types of hemorrhage. There was no significant difference in patient age, presenting GCS score, or outcomes of patients who underwent surgery compared with those who did not for either type of hemorrhage. No conclusions can be drawn about the efficacy of surgery from such observational studies.
Conclusions:
On the basis of these data the authors suggest that TICH and SICH have different features: TICH affects a slightly younger age group and carries a much better prognosis compared with SICH. In addition, indications for surgical intervention are not well defined for either type of hemorrhage. Practice is subjective and inconsistent. The International Surgical Trial in Intracerebral Haemorrhage may resolve the dilemma for SICH. A similar trial in which surgery is compared with conservative management should be considered for cases of TICH.