Early mortality in spontaneous supratentorial intracerebral haemorrhage

Abstract

SummaryBackground. Spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. Despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. We report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival.Methods. Population based, ten year prospective observational study directed to patients consecutively admitted to the Intensive Care Unit (ICU) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. Patients were distributed in five groups according to the Glasgow Coma Score (GCS) at admission. Haemorrhages were classified as deep-seated or superficial. All patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. Primary endpoint was early mortality defined as dead occurred by any cause during the admission in the ICU.Findings. During the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. Of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. Low GCS was strong predictor of early mortality. Despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all GCS subgroups. Maximal benefit was observed in patient with admission GCS of 4-8. Superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases.Conclusions. Our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. Surgery seems specially useful in patients with admission GCS between 4 and 8, and in those with superficial haemorrhages.

Functional Outcome of Spontaneous Hypertensive Supratentorial Intracerebral Haemorrhage after Surgery

“…Reichart R et al stated that patients suffering from medium-sized lobar hemorrhage should undergo surgery, especially if GCS was less than 7 [20]. In STICH II trial the fatality at 6 months follow-up was 18% in the early surgery group when set side by side with 24% observed in early conservative group and deduced that early surgery in patients with superficial spontaneous ICH had better chance of survival [21,22]. The STICH Trial done in 2005 showed that 26% of the patients randomised to early surgery had a better prognosis compared with 24% of the patients randomised to initial conservative treatment having a better prognosis.…”

A randomized study of urgent computed tomography–based hematoma puncture and aspiration in the emergency department and subsequent evacuation using craniectomy versus craniectomy only

“…These results were comparable to those in earlier studies. [6][7][8]13,16 Hematoma puncture and aspiration were initially applied when treating ICH patients in whom the hematoma volume was 40 ml or less. 18 Studies have proven that up to 80% of the hematoma would become a dense clot within a few hours after ictus, 9 and minimally invasive aspiration with subsequent fibrinolytic therapy requires days to evacuate a dense clot.…”

Descripción de los pacientes con hemorragia intracerebral espontánea en el Hospital San José de Bogotá

“…65 ( 55-74) en recientes publicaciones siendo el principal factor asociado y desencadenante de la HIE 6,7 . Lo encontrado en este estudio no es divergente a los resultados mostrados por lo diferentes estudios latinoamericanos, norteamericanos y europeos, se encontró una mortalidad del 12% durante toda la estancia hospitala-ria muy cercana a lo referenciado por Samphron et al 16 , encontramos que hipertensión arterial y la localización de los sangrados, fue diferente, se encontró como antecedentes único la HTA en un 38% y sumada a otras patologías un 7% y sin referir ningún antecedente hasta el 40% de esta población. Se propone realizar estudios que determi-nen si una deficiente información a los acompañantes y a los pacientes en la prevención primaria secundaria de la HTA es determinante en el desarrollo posterior de HIE y se espera que la hipertensión arterial sea descrita como antecedente principal único o acompañado de otros.…”