Impact of Thalamic Hematoma on Six-Month Mortality and Motor and Cognitive Functional Outcome

Mori, Sakan; Sadoshima, Seizo; Ibayashi, Setsuro; Fujishima, Masatoshi; Iino, Kozo

doi:10.1161/01.str.26.4.620

Cited by 47 publications

(22 citation statements)

References 29 publications

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“…Several studies have demonstrated that patients with acute thalamic hemorrhage, particularly with extension to the ventricles, often require surgical intervention and have a poor prognosis. [23][24][25] Although the present data cannot specify the mechanism by which combined damage to the Pt and Th (the PϩT group) leads to enhanced functional outcome, there are a number of candidate regions crucial for reorganization that were not damaged. In the study patients, the areas that were commonly intact include the PMC, SMA, caudate, globus pallidus, the nucleus ventralis anterior of the Th, and the anterior limb of the internal capsule.…”

Section: Discussionmentioning

confidence: 84%

Improved Functional Outcome in Patients With Hemorrhagic Stroke in Putamen and Thalamus Compared With Those With Stroke Restricted to the Putamen or Thalamus

Miyai

Suzuki

Kang

et al. 2000

Stroke

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Background and Purpose-We analyzed the effect of late intensive inpatient rehabilitation on the functional outcome of patients with subcortical hemorrhagic stroke. Methods-Patients who were nonambulatory with hemorrhagic stroke in the internal capsule and putamen (nϭ55), the thalamus (nϭ24), or all 3 regions (nϭ15) underwent intensive inpatient rehabilitation. Patients with surgical intervention or an episode of ventricular hemorrhage were excluded. Lesion location was evaluated by MRI 4 months after the ictus. Results-Demographic data, initial disability, and impairment measures were comparable in the 3 groups. Functional outcome demonstrated significant differences in mobility subscores (PϽ0.05) of the Functional Independence Measure such that patients with injury in the 3 regions were more likely to ambulate independently than were patients in the other groups. Lesion location data demonstrated that the ventral anterior nucleus of the thalamus was always spared; the ventral posterior (lateral and medial) nucleus was always damaged, and the ventral lateral nucleus was frequently damaged. Putaminal damage always included the postcommissural area. In addition, the entire posterior half limb of the internal capsule was always damaged. Conclusions-Subcortical lesions to multiple structures in the basal ganglia-thalamocortical motor circuits permitted enhanced motor recovery. Lesion location predicted the level of independent ambulation and the rate of recovery in patients with stroke who were nonambulatory before neurorehabilitation therapy. Key Words: cerebral hemorrhage Ⅲ putamen Ⅲ rehabilitation Ⅲ thalamus O utcome and functional imaging studies have demonstrated that recovery mechanisms proceed at different rates [1][2][3][4] and as a function of lesion size and location. [5][6][7] Furthermore, they have enhanced an understanding of the pathogenesis of the late consequences of stroke by suggesting candidate brain regions that may underlie recovery. For example, recent studies have demonstrated that middle cerebral artery stroke in which damage extends to the premotor cortex (PMC) has been associated with poor functional outcome. 8,9 Clearly, damage that includes the parallel outputs from the primary motor area, PMC, and supplementary motor area (SMA) magnifies the functional disability and diminishes the response to rehabilitation efforts. 10 -12 These structure-function relationships prompted us to test whether location of damage restricted to the subcortical structures (putamen [Pt] and thalamus [Th]) differentially affected functional outcome. Neuroimaging information was obtained during a chronic stable phase after hematoma and edema resolution. Subjects and MethodsWe screened 132 consecutive patients with subcortical hemorrhage and without a previous history of cerebrovascular disease. The conventional treatment required patients to remain in the local acute care hospitals and receive some physical therapy for 2 to 3 months. Patients who remained persistently dependent and nonambulatory were transferred ...

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Section: Discussionmentioning

confidence: 84%

Improved Functional Outcome in Patients With Hemorrhagic Stroke in Putamen and Thalamus Compared With Those With Stroke Restricted to the Putamen or Thalamus

Miyai

Suzuki

Kang

et al. 2000

Stroke

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“…The remaining 78 references [24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100]described 68 different studies and 83 separate prognostic models. We classified the models on the basis of whether they were community or hospital-based, the pathological type of stroke included, and the type and timing of the outcome (table 2).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Prognostic Models in Patients with Acute Stroke

Counsell

Dennis²

2001

Cerebrovasc Dis

224

211

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Prognostic models in stroke may be useful in clinical practice and research. We systematically reviewed the methodology and results of studies that have identified independent predictors of survival, independence in activities of daily living, and getting home in patients with acute stroke. Eligible studies (published in full in English) included at least 100 patients in whom at least 3 predictor variables were assessed within 30 days of stroke onset and who were followed up for at least 30 days. We recorded 25 indicators of the validity and practicality of each model and identified variables that were consistent independent predictors of each outcome. Eighty-three separate prognostic models were found but most had potentially serious deficiencies in internal and statistical validity, many had limited generalisability, and none had been adequately validated. Only 4 studies met 8 simple quality criteria. Over 150 different predictor variables have been analysed but most were assessed in only 1 or 2 models. None of the existing prognostic models have been sufficiently well developed and validated to be useful in either clinical practice or research. Better quality models must be produced to enable, for example, adequate case-mix correction when comparing outcome among different groups of stroke patients.

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“…Thalamic hemorrhage is a severe clinical condition with in-hospital mortality rate of 19%, and symptom-free at discharge from the hospital documented in only 2.1% [15]. The mortality rate of thalamic hemorrhage ranges between 17% and 52% in the experience of different authors [14,16]. On the other hand, the mortality rate of thalamic hemorrhage is generally lower than that of brainstem hemorrhages or cerebral hemorrhages of multiple topographies, which show a very high in-hospital mortality rate usually greater than 40% [5].…”

Section: Thalamic Hemorrhagementioning

confidence: 99%

Intracerebral Hemorrhage: Influence of Topography of Bleeding on Clinical Spectrum and Early Outcome

Arboix¹,

Grivé²

2012

Neuroimaging - Methods

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Impact of Thalamic Hematoma on Six-Month Mortality and Motor and Cognitive Functional Outcome

Cited by 47 publications

References 29 publications

Improved Functional Outcome in Patients With Hemorrhagic Stroke in Putamen and Thalamus Compared With Those With Stroke Restricted to the Putamen or Thalamus

Improved Functional Outcome in Patients With Hemorrhagic Stroke in Putamen and Thalamus Compared With Those With Stroke Restricted to the Putamen or Thalamus

Systematic Review of Prognostic Models in Patients with Acute Stroke

Intracerebral Hemorrhage: Influence of Topography of Bleeding on Clinical Spectrum and Early Outcome

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