Hypertensive putaminal hemorrhage: Analysis of 182 patients

Waga, Shiro; Miyazaki, Masao; Okada, Masahiko; Tochio, Hiroshi; Matsushima, Satoshi; Tanaka, Yutaka

doi:10.1016/0090-3019(86)90369-1

Cited by 48 publications

(17 citation statements)

References 11 publications

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“…The natural course of "compromised cerebral blood flow velocities" in one case excluded from our protocol: In serial TCD recordings, (A) "compromised cerebral BFVs and PI values" were recorded before clinical worsening, but her family declined our advice for surgical intervention later. (B-D) Although somewhat global hypaeremia, (E) she had low BFVs one week later and has maintained in a vegetative state in a follow-up period of 6 months not achieve a decreased morbidity and mortality [14,16,26,27]. There seems to be no difference in late results between surgical and conservative groups, although patients in surgical groups were generally in a worse condition and had larger haematoma [8,26,27].…”

Section: Discussionmentioning

confidence: 99%

“…The optimal mode of treatment for hypertensive putaminal haemorrhage (HPH) remains a controversial subject despite the improvement of diagnostic and therapeutic modalities [2,4,8,9,14,17,26]. The principal problem that a strict comparison between surgical and conservative treatment is difficult gave the stratification of severity of the disease [7,16,24,25].…”

Section: Introductionmentioning

confidence: 99%

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Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

Lee¹,

Chio²,

Lin³

et al. 1996

Acta neurochir

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From May 1992 to February 1993, 22 cases of hypertensive putaminal haemorrhage (HPH) treated at our hospital were serially measured with transcranial Doppler (TCD) sonography. Among them, 13 patients underwent surgical intervention (3 stereotaxic surgery and 10 craniotomies), and 9 were conservatively treated. Most of the patients of the two operative groups had larger haematomas and developed clinical and/or neurological deterioration, which was the indication for subsequent surgery. Therefore the groups represent different clinical and physiological entities. On admission, the peak MCA velocities (Vs) in the surgical group (stereotaxic and craniotomy) were significantly lower than those in the conservative group (mean +/- S.E.M.: 38.33 +/- 4.26 and 42.00 +/- 2.62 cm/sec vs. 57.22 +/- 3.23 cm/sec; p < 0.005, respectively). The surgical group also had significantly lower diastolic (Vd) and mean (Vm) velocities than those of the conservative group (p < 0.001). Rather, the admission pulsatility indices (PI = (Vs-Vd)/Vm) in the surgical group were significantly higher than those of the conservative group (mean +/- S.E.M.: 1.42 +/- 0.04 and 1.31 +/- 0.09 vs. 0.95 +/- 0.01; p < 0.005, respectively). Time course velocity curves reached a peak around the 3rd hospital day in all the 3 groups. The Glasgow coma scale (GCS) scores positively correlated with the mean MCA velocities (n = 22; r = 0.63, p < 0.005; y = 2.04 x + 8.74), but negatively with PI values on admission (n = 22; r = -0.53, p < 0.05; y = 1.68-0.053 x). On the 7th hospital day, 2 patients with peak MCA velocities below 50 cm/sec had an unfavourable outcome. All the 3 patients in the stereotaxic group had higher peripheral resistance, as compared with those in conservative craniotomy groups (mean +/- S.E.M.: 1.28 +/- 0.13 vs. 0.99 +/- 0.07 and 0.87 +/- 0.06; p < 0.05, respectively). Our study supports TCD as a safe and valid monitoring method in patients with HPH. "Compromised cerebral haemodynamic status" (Vs < 50 cm/sec, Vd < 15 cm/sec, Vm < 25 cm/sec, PI > 1.15) may offer an aid in the decision for surgical intervention in HPH. Postoperatively, patients who made a favourable recovery had a significant increment in the MCA velocities in contrast to those severely disabled, whose MCA velocities remained low.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

Lee¹,

Chio²,

Lin³

et al. 1996

Acta neurochir

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“…Accurate selection of cases for surgical treatment is the most important factor in post-surgical prognosis. Although there have been many studies on this subject, deficient data comparing medical and surgical treatments published from the same source, insufficient follow-up on the cases, and the absence of a common classification of this type hematomas adopted by all authors has made the indications for surgical treatment a controversial topic (1,2). In this study the relationship between etiology, clinical symptoms, surgical treatment indications, treatment approaches, and mortalities of 72 cases with spontaneous intracerebral hematomas treated between 1997-2009 were reviewed and evaluated.…”

Section: Introductionmentioning

confidence: 99%

Cerrahi Tedavi Uygulanan Spontan İntraserebral Hematomlar ve Mortalite İlişkisi: 72 Olgunun Retrospektif Değerlendirilmesi

Karatay¹,

Mehmetoğlu²,

Yavuz³

et al. 2012

Tnd

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Sum maryObjective: In this study we investigated the relationship between mortality and various factors discovered during the surgical treatment of spontaneous intracerebral hematoma in cases presented to our clinic. Ma te ri al and Met hod: Between 1997 and 2009, there were 72 cases of spontaneous intracerebral hemorrhage presenting with non-traumatic intracerebral hemorrhage who underwent surgical treatment at our clinic and were evaluated retrospectively. Re sults: Among the 72 cases, 41 (57%) were males, and 31 (43%) were females. The etiology in 52 (72%) of the cases was hypertension. Regarding the location of the hematoma, 27 (37%) of the cases were lobar, 30 cases (41%) were thalamic, 13 (18%) were cerebellar and 2 cases (4%) were in the putaminal location. The mortality rate in cases that received surgery within the first 8 hours was 41% (18 cases), and the rate was 61% (14 cases) in patients that received surgery between 8-24 hours. If surgery was performed between 24-48 hours following the initial hematoma, the mortality rate was 80% (4 cases). Dis cus si on: In spontaneous intracerebral hematoma, surgical treatment performed as quickly as possible following consideration of the initial neurological examination, age, volume of hematoma and its localization reduces mortality. Clinically there is no advantage in using surgical treatment over medical treatment in cases with a poor neurological condition. (Turkish Journal of Neurology 2012; 18:83-7) Key Words: Intracerebral hematoma, surgical treatment, GCS (Glasgow Coma Scale), mortality Özet Amaç: Bu çalışmada kliniğimizde spontan intraserebral hematom nedeniyle cerrahi tedavi uygulanan olgularda yer alan faktörlerin mortaliteyle olan ilişki-leri araştırıldı. Ge reç ve Yön tem: 1997 ile 2009 yılları arasında nontravmatik intraserebral hemoraji nedeni ile başvuran ve cerrahi yöntemler ile tedavi edilmiş 72 spontan intraserebral hemoraji olgusu retrospektif olarak incelenmiştir. Bulgular: İncelenen 72 olgunun 41'i (%57) erkek, 31'i (%43) kadın'dı. Elli iki olguda (%72) etiyoloji hipertansiyondu. Hematom lokalizasyonu olarak 27 olgu (%37) lober, 30 olgu (%41) talamik, 13 olgu (%18) serebellar, 2 olgu (%4) putaminal yerleşimliydi. İlk 8 saatte cerrahiye alınan olgularda mortalite oranı %41 (18 olgu), 8 ile 24 saat arasında cerrahiye alınan olgularda mortalite oranı %61 (14 olgu), 24 ile 48 saat arasında cerrahiye alınan olgularda mortalite oranı %80 (4 olgu) olarak bulundu. Sonuç: Spontan intraserebral hematom olgularında ilk nörolojik muayene, yaş, hematom volümü, hematomun lokalizasyonu ve cerrahiye alınma süresi göz önüne alınarak yapılacak olan cerrahi tedavi mortaliteyi azaltır. Klinik olarak kötü nörolojik durumdaki olgularda uygulanacak cerrahi tedavinin medikal tedaviye üstün-lüğü yoktur. (Türk Nöroloji Dergisi 2012; 18:83-7) Anah tar Ke li me ler: İntraserebral hematom, cerrahi tedavi, GKS (Glaskow Koma Skalası), mortalite

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“…The management of hypertensive intracerebral hemorrhage is still controversial [1][2][3][4]. Some authors doubt the efficacy of craniotomy which was only indicated in limited cases of putaminal, subcortical, and cerebellar hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Controlled Aspiration Surgery for Hypertensive Intracerebral Hemorrhage

Hondo

Uno

Sasaki

et al. 1990

Stereotact Funct Neurosurg

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To overcome the disadvantages of conventional surgery, we developed our own method of computed tomography controlled stereotactic aspiration surgery for hypertensive intracerebral hemorrhage. A new ultrasonic surgical aspirator was also developed to facilitate aspiration of a dense clot in the acute stage. Between 1980 and 1988, 437 patients with hypertensive intracerebral hemorrhage underwent aspiration surgery. Computed tomography controlled stereotactic aspiration surgery can be performed in hematomas of any site or any stage with minimal tissue damage, even in aged patients. Aspiration surgery led to a favorable clinical experience and outcome, especially in the acute stage.

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Hypertensive putaminal hemorrhage: Analysis of 182 patients

Cited by 48 publications

References 11 publications

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage

Cerrahi Tedavi Uygulanan Spontan İntraserebral Hematomlar ve Mortalite İlişkisi: 72 Olgunun Retrospektif Değerlendirilmesi

Computed Tomography Controlled Aspiration Surgery for Hypertensive Intracerebral Hemorrhage

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