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[Relationship between CT findings and consciousness in patients with hypertensive putamen hemorrhage]
Insights
Computed tomography (CT) findings of the suprasellar cistern and third ventricle correlate with consciousness levels in patients with hypertensive putamen hemorrhage. These CT classifications aid in predicting patient outcomes and guiding neurosurgical interventions.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Hypertensive putamen hemorrhage is a severe condition affecting consciousness.
- Accurate prognostication and timely intervention are crucial for patient outcomes.
Purpose of the Study:
- To investigate the relationship between CT findings of the suprasellar cistern (S) and third ventricle (III) and the level of consciousness in patients with hypertensive putamen hemorrhage.
- To evaluate the utility of these CT classifications in guiding neurosurgical management.
Main Methods:
- Retrospective study of 66 patients with hypertensive putamen hemorrhage.
- Classification of CT scans based on the shape of the suprasellar cistern and the visibility/involvement of the third ventricle.
- Correlation of CT findings with the patients' state of consciousness.
Main Results:
- A strong correlation was observed between CT classifications (S and III) and the state of consciousness.
- Specific CT patterns predicted varying levels of consciousness, from clear to comatose.
- In cases of initial discrepancy, conservative therapy often led to correlation between CT findings and consciousness over time.
Conclusions:
- CT-based classification of suprasellar cistern and third ventricle morphology is a valuable tool for assessing consciousness in hypertensive putamen hemorrhage.
- These findings can aid in predicting patient prognosis and informing decisions regarding immediate surgical intervention.
- Deterioration in consciousness post-initial CT evaluation may indicate rebleeding or hematoma expansion, necessitating prompt re-assessment.
Abstract:
The authors studied 66 patients with hypertensive putamen hemorrhage and noted a close relationship between the CT classification according to the shape of the suprasellar cistern (S) and the third ventricle (III), and the state of altered consciousness: when S is not deformed and III is identified in CT images, the patient may be in a clear or confusional state; if S is not deformed but III is not identified or is packed with hematoma, consciousness may be somnolent or stuporous; if S is deformed and III is not identified or is packed with hematoma, the patient may be in a semicomatose or comatose state. However, within several hours after onset there are exceptional cases in which the states of consciousness do not correlate with the CT findings. In these cases, however, with conservative therapy the state of consciousness corresponded well with the CT findings. From the neurosurgical points of view, immediate removal of the hematoma is required when the patient's consciousness is relatively good despite of large hematoma. If at the acute stage the state of consciousness, which corresponded well with the CT findings at initial examination, has deteriorated, rebleeding or enlargement of hematoma must be suspected.