Management of hypertensive cerebral subcortical hemorrhage

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  • 大脳皮質下出血の治療

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Prognostic factors for survival and neurological recovery are assessed in 35 patients with hypertensive cerebral subcortical hemorrhage. The average age of patients is 63 years, ranging from 46 to 89. Nineteen are male and 16 female. There are 3 deaths; 2 treated conservatively (7.7%), and 1 treated surgically (9%). The overall mortality is 8.6%, which is markedly lower than the mortality reported in other series. Twenty-two of 35 patients are treated conservatively and 13 are treated surgically. Twenty-five of 35 patients had a history of hypertension (71%). Hemorrhage is located in the temporal lobe in 15 (43%), the frontal lobe in 8 (23%), the occipital lobe in 7 (20%), and the parietal lobe in 5 (14%). Twenty hemorrhages are in the right hemisphere and 15 in the left. In the present study we evaluated various factors contributory to the outcome of cerebral subcortical hemorrhage, such as the size and location of the hematoma, presence of the signs of transtentorial herniation on CT, neurological grading on admission, and treatment. And we assessed the correlation between the activity of daily life (ADL) and these factors. In the present study relatively good results for both survival and ADL have been obtained in conservatively treated patients with hypertensive cerebral subcortical hemorrhage, and we emphasize that surgical evacuation of hematoma is unnecessary in most of the patients and should be restricted only to a small groups in which a large hematoma causes rapid neurological deterioration with imminent danger of transtentorial herniation.

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