Hematomas intracerebral espontâneos estudo de 121 casos

Abstract

Results are reported on the study of 121 patients committed by spontaneous intracerebral haematomas (HIE): mean age 53.4 years, 62.8% males, mean admission time of 36 hours (3 hours to 12 days) from onset; 63.5% were graded over 7 in the Glasgow scale and 81.9% were graded 3 or over in the Boterell scale. The HIE location was 45.5% in the basal ganglia, multilobar in 14.7%, lobar in 22.8%, brain stem in 4%, and cerebellum in 2%. The mean diameter was 46.6 mm (16-93) and mean area was 1422.9 mm2 (60-4818). CSF in 67 cases showed mean opening pressure of 234 mmH20 and mean protein content of 416.9 mg/dl. Treatment was conservative in 107 cases and surgical in 14; 55.8% cases survived. The majority of patients who died were graded 3 in the Boterell scale and below 9 in the Glasgow scale. It was found a statistical correlation between death and: low Glasgow and high Boterell scales grading, motor ocular nerve palsy, motor deficit, decerebration signs, bronchopneumonia, large diameter and area of hematomas. No statistical correlation was found regarding survival and treatment with dexamethasone, antifibrinolytics, anticonvulsants, antihypertensive drugs and diuretics. Use of mannitol, fall in the systolic blood pressure and surgical therapy increased the mortality rate. From 14 patients who underwent surgical drainage, 11 died. The main complication who lead to death was bronchopneumonia. A discussion is made on HIE pathogenesis, localization, present day incidence, clinical findings, death causes, size of hematomas and type of treatment used.

Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage

“…in Portuguese, the use of mannitol 20%, surgical treatment and drugs that lower blood pressure had increased mortality rate. [14] Thus, with respect to studies conducted by other researchers[15] as well as this study, injection of hyperosmolar mannitol 20% indicates that mean volume of ICH only decreased in 17% of patients, and 61% patients had increased in hemorrhage volume, and following the above changes, after the use of mannitol 20%, the CGS is decreased in 19.5% of patients after the first 3 days of hemorrhage. In fact, mannitol does not cross the intact blood-brain barrier in adults.…”

“…[1213] Hence, beside therapeutic effect of conservative treatment the large number of such patients in our community, we decided to do a study method to evaluate the effects of mannitol 20% on outcome of patients with ICH in patients admitted to Isfahan's Al-Zahra Hospital. Because of many controversies in effectiveness of surgery (craniectomy) in treatment of ICH, the surgical trial in intracerebral hemorrhage investigated early surgical removal of hematoma versus medical therapy and failed to show benefit in the surgical arm),[14] medical treatment is an important part of treatment in these patients. In addition, because of many controversies in use of mannitol in text books, this study was done to understand of better treatment in our patients.…”

Hemorragia intraparenquimatosa encefálica espontânea: achados à tomografia computadorizada

“…9 os hematomas putaminais e holobasais foram os mais freqüentemente observados. Alguns autores, quando são mais precisos quanto à localização topográ-fica do hematoma, relatam que o putâmen e a cáp-sula interna são as regiões mais comumente acometidas 2,5,7,8,[10][11][12][13][14][15][16] . O lobo mais comumente afetado no HIP neste levantamento, tal como nos trabalhos de Furlan 17 e Dourado 18 , foi o parietal, observado em 26 casos como o único lobo acometido e em 36 casos associado a sangramento de outros lobos.…”

“…Tais resultados são semelhantes quando comparados a outros trabalhos 2,8,9,[21][22][23][24][25][26] .…”

Hematoma intraparenquimatoso cerebral espontâneo: aspectos à tomografia computadorizada

“…Estudos nacionais a este respeito ainda são escassos (1,2) , o que então estimulou o prosseguimento da pesquisa, através de um estudo retrospectivo e, por fim, compará-lo com estudos internacionais.…”