[Clinical study on the prognostic factors of thalamic hemorrhage]

To investigate the prognostic factors, 30 cases of hypertensive primary thalamic hemorrhages with a poor or fatal outcome were studied. The age of the patients ranged from 42 to 84 years (mean: 64.4). Their level of consciousness, ocular deviations and pupillary abnormalities were analyzed in relation to the estimated volume and the extension of the hematomas. The level of consciousness was classified according to neurological grading (NG) of Kanaya et al. Twelve cases (40.0%) were above NG 4a. In high-aged patients, NG 1 or 2 often indicated a poor prognosis. A downward deviation or gasing nose (also known as 'thalamic eyes') was found in 13 cases (43.3%). Pupillary abnormalities were seen in 26 cases, and bilateral miosis (14 cases) indicated a poor prognosis. The extension of the hematoma consisted of 'downward' (type D), 'lateral' (type L) and 'upward' (type U), and combinations there of. Types U and D were thought to portend a poor prognosis. The following factors were thought to indicate a poor prognosis: (1) uncontrollable high blood pressure, (2) upward extension of the hematoma associated with large ventricular cast, (3) downward ocular deviation, bilateral miosis and downward extension of the hematoma (the first two were considered as indication of the hypothalamus and the midbrain being affected), (4) advanced age.