[96 cases of spontaneous medical cerebral hemorrhage. Diagnostic and therapeutic experience]

Prognosis in a homogeneous series of 96 cases of non-traumatic cerebral hemorrhage admitted to a neurosurgical department within 6 to 24 hours of onset was assessed by studying possible correlations between clinical condition (grade I: conscious; grade II: somnolent; grade III: comatose; grade IV: comatose with signs of brain stem involvement) and computed tomography findings (site, extension, size of hemorrhage; degree of edema and of mass effect; presence of hydrocephalus or ventricular hemorrhage). It was possible to distinguish effects due to destruction and/or compression of functional cerebral regions for a given clinical picture, and to apply these data to determine types of therapy and surveillance according to 3 time-periods. During the first 48 hours there was almost perfect agreement between the severity of the clinical picture and the degree of cerebral destruction (62,6 p. 100 of grade IV, 27,7 p. cent of grade III died). Only patients in grade III with temporal hemorrhage directly menacing the brain stem were operated upon. From the 3rd to the 7th day surveillance was based on clinical findings and computed tomography, repeated in principle on the 3rd and 7th days. Patients operated upon during this period were those in whom clinical signs and/or effects due to mass effect as seen on the CTscan were becoming worse. The third period, lasting from the 8th to the 21st day, was that during which the vital prognosis was generally no longer affected, and indications for surgery were functional in nature. The prognostic value of measurements of intracranial pressure is discussed.