Related Experiment Videos
[Clinical study of hypertensive subcortical hemorrhage: surgical indication and long-term, functional prognosis]
H Yoshimoto1, H Fujita, K Ohta
1Department of Neurosurgery, Matsue Red Cross Hospital, Japan.
Insights
This study establishes surgical guidelines for hypertensive subcortical hemorrhage based on patient prognosis. Early-stage or small hematomas benefit from conservative treatment, while severe cases require surgery for survival.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Medicine
Background:
- Surgical indications for hypertensive subcortical hemorrhage lack clear guidelines based on functional prognosis.
- This study aimed to evaluate surgical indications by analyzing clinical outcomes in relation to functional prognosis.
Observation:
- Sixty-five patients with hypertensive subcortical hemorrhage were studied retrospectively.
- 44 males and 21 females, aged 37-86, were hospitalized between 1980-1986.
- 38 patients underwent surgical intervention.
Findings:
- Conservative therapy is recommended for Grade I or hematoma volume <30ml.
- Grade II-III or 30-50ml hematomas require tailored treatment considering hematoma location.
- Grade IVa or hematoma volume >50ml necessitates surgical intervention to prevent mortality.
Implications:
- Long-term follow-up revealed significant risks of re-bleeding and stroke-like events.
- Careful systemic control, including blood pressure monitoring, is crucial for post-discharge management.
- Establishing clear surgical criteria improves patient outcomes in hypertensive subcortical hemorrhage.
Abstract:
There has been no report available for determining surgical indications in hypertensive subcortical hemorrhage based on functional prognosis. The authors then studied the clinical results of hypertensive subcortical hemorrhage for evaluating the surgical indication in relation to functional prognosis. Sixty-five patients with hypertensive subcortical hemorrhage diagnosed by CT scan who were hospitalized to Matsue Red Cross Hospital from January 1980 up to December 1986 were studied. The 44 male and 21 female patients ranged in age from 37 to 86 years, and 38 of them were operated on. The results were as follows: 1) Patients with grade I (Kanaya's neurological grading) or a volume of hematoma less than 30 ml should be treated with conservative therapy. Those with grade II and III or a volume of hematoma = 30 - 50ml should be treated in accordance with proper therapeutic method, taking into consideration the site of the hematoma. Patients with more than grade IVa or a volume of hematoma greater than 50ml would be in danger of losing their lives unless surgical therapy was performed. 2) The follow up study of the patients' long-term prognosis after discharge revealed the majority of the patients showed aggravation of the illness and/or death due to cerebral apoplexy-like attack and re-bleeding. It is necessary to follow up these cases with careful systemic control, including monitoring of blood pressure.