Prognosis of thalamic hemorrhage with special reference to the level of consciousness and CT findings on admission.

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  • 視床出血の予後について　入院時の意識レベルとＣＴ所見の立場から
  • 入院時の意識レベルとCT所見の立場から

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The prognosis of thalamic hemorrhage was studied on the basis of neurological gradings on admission, mode of extension and hematoma size on brain CT. The subjects were 126 patients with thalamic hemorrhage who were admitted to Ashikaga Red Cross Hospital during the past ten years. Among the subjects, 120 patients (ages 64 ± 10 yr; mean ± SD) were treated with conservative therapy, and 6 patients (ages 59 ± 10 yr) with surgical therapy (ventricular drainage). Brain CT scans were done within 48 h. after onset in all patients. Neurological gradings, brain CT classification and prognosis were investigated according to the criteria of the Japanese Conference on Surgery for Cerebral Stroke.<BR>The results of conservative therapy were as follows : <BR>1) Neurological gradings on admission vs. prognosis : In the grade I group, 29 of the 39 patients (74%) recovered to full work or an independent life, and none of them died. In the grade IV and V groups, mortality rate was 86%.<BR>2) CT classification vs. prognosis : The prognosis was more unfavorable in type III than in types I and II. Twenty-six of the 36 patients (73%) with type I-a recovered to full work or an independent life. Twenty-five of the 34 patients (74%) with the type III-bdied.<BR>3) Hematoma volume vs. prognosis : Only 4 of the 75 patients (5%) with less than 10 ml of hematoma volume died. In contrast, all 14 patients with more than 25 ml of hematoma volume died.<BR>4) Ventricular rupture vs. prognosis : The mortality rate among patients with ventricular rupture (47%) was significantly higher than that among patients without ventricular rupture (2%) (p<0.001).<BR>5) Hydrocephalus vs. prognosis : The mortality rate of patients with acute hydrocephalus (83%) was significantly higher than that of patients without acute hydrocephalus (20%) (p<0.001).<BR>From the above results, it is suggested that neurological grading, brain CT classification, hematoma volume, ventricular rupture and acute hydrocephalus are important prognostic factors for thalamic hemorrhage.

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