Prognosis for patients treated conservatively for spontaneous intracerebral hematomas

The long-term clinical and CT-outcome of 53 conservatively treated patients with spontaneous intracerebral hematomas (ICH) was studied in relation to the acute findings. The acute mortality of ICH was 27%. Determinant for the immediate prognosis was the level of consciousness and the volume of the hematoma. The crucial size was 50 ml with a mortality of 90% for hematomas larger and 10% for hematomas smaller than that. Intraventricular hemorrhage was a bad prognostic sign only in the ganglionic-thalamic hematomas. At follow-up at a median of 4 1/2 years after ICH, 30% of the total series had a completely normal neurological examination and 28% had resumed work. Thirteen per cent had minor neurological deficits and 17% had debilitating sequelae. During the follow-up period 7 patients had died, which indicates an excess mortality for ICH survivors. The CT findings at follow-up consisted of low density areas smaller than the original hematomas, focal atrophy, calcifications and porencephalic cysts. In 10% the CT scan revealed no trace of the previous hematoma.