ZJUSAH Classification: A New Classification for Primary Brainstem Hemorrhage

Abstract

To analyze and improve ZJUSAH classification for primary brainstem hematoma, we retrospectively reviewed 211 patients with primary brainstem hemorrhage who were admitted to our institution between January 2014 and October 2020. The primary clinical outcomes were the 30-day survival rate and 90-day consciousness recovery rate, which were evaluated using the National Institutes of Health Stroke Scale score. Univariate logistic regression and multivariate Cox regression analyses were performed to evaluate the prognostic model. The overall 30-day survival rate of the 211 patients was 69.7%. The 30-day survival rate was 95% among Type 1 patients, 77.8% among Type 2 patients, and 63.2% among Type 3 patients. The 90-day consciousness recovery rate was 63.2% among Type 1 patients, 61.9% among Type 2 patients, and 30.2% among Type 3 patients. Our findings suggest that ZJUSAH classification can be optimized according to hematoma volume, with Type 3 patients with a hematoma larger than 12.4 mL tending to have a worse state of consciousness. Additionally, we discovered that ZJUSAH classification is valuable in predicting 30-day survival rates in conservative treatment patients. In conclusion, our study established and optimized a new CT-based hematoma classification system for primary brainstem hematoma, which facilitates treatment selection and prognostic prediction.

Diagnosis dan Tata Laksana Perdarahan Batang Otak Primer

“…8 Kasus dengue sekunder menyebabkan demam yang lebih tinggi, jumlah trombosit lebih rendah, dan persentase kejadian DHF atau DSS yang lebih tinggi. 9 Suatu ulasan yang dilakukan oleh Guzman, dkk. menunjukkan bahwa 98% kasus DHF/DHS merupakan infeksi dengue sekunder 10 (Tabel 1).…”

“…5 CT scan lebih dipilih karena lebih murah, lebih banyak tersedia, dan praktis. 9 CT scan kepala non-kontras dapat mengidentifikasi lokasi perdarahan di batang otak, ekspansi intraventrikular, hidrosefalus, edema, dan volume perdarahan. 9 TATA LAKSANA Prinsip tata laksana perdarahan batang otak adalah untuk mempertahankan stabilitas fungsi vital, mengurangi cedera primer, mencegah kerusakan sekunder, serta mengembalikan fungsi dan struktur neurologis semaksimal mungkin.…”

“…9 CT scan kepala non-kontras dapat mengidentifikasi lokasi perdarahan di batang otak, ekspansi intraventrikular, hidrosefalus, edema, dan volume perdarahan. 9 TATA LAKSANA Prinsip tata laksana perdarahan batang otak adalah untuk mempertahankan stabilitas fungsi vital, mengurangi cedera primer, mencegah kerusakan sekunder, serta mengembalikan fungsi dan struktur neurologis semaksimal mungkin. 1,2 Manajemen Konservatif Manajemen prehospital dan emergensi untuk PBH meliputi pemantauan ketat fungsi vital, mempertahankan patensi jalan napas, stabilisasi sirkulasi kardiovaskular, dan koreksi kelainan hemostatik.…”

“…Substansi toksik dari dekomposisi hematom dan substansi vasoaktif yang dilepaskan oleh jaringan otak yang rusak dapat memperparah kerusakan batang otak, menyebabkan kerusakan sekunder. Interaksi kedua mekanisme di atas membentuk siklus toksik yang saling memengaruhi dan memperparah PBH 5,9. DIAGNOSIS Perdarahan batang otak merupakan kasus emergensi yang memerlukan penegakan diagnosis secepatnya.…”

Vascular Diseases: Etiologic, Diagnostic, Prognostic, and Therapeutic Research

“…A new classification for primary brainstem hemorrhage (PBH), the ZJUSAH classification, is presented in the paper [ 12 ] by J. Zhou et al This classification allows the prediction of the outcomes of 90-day consciousness of the most extensive (type 3) hematoma based on its volume. Additionally, this model al allows the assessment of 30-day survival outcomes when conservative treatment is applied.…”