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Journal of Korean Neurosurgical Society > Volume 2(1); 1973 > Article
Journal of Korean Neurosurgical Society 1973;2(1): 21-36.
Clinical Observation and Assessment on the Treatment of the Hypertensive Intracerebral Hemorrhage.
Yeung Keun Lee, Jin Un Song
Department of Neurosurgery, Catholic Medical College, Seoul, Korea.
We have experienced 43 cases of the hypertensive intracerebral hemorrhage who were admitted to the Catholic medical Center, Seoul from November 1969 to February 1973. All these cases were diagnosed by clinical findings and cerebral angiography and assessed the prognostic factors on the result of treatment. The results of the analysis were summarized as follows: 1. Age distribution was ranged from 26 to 67, and 79 per cent of them were in fourth and fifth decade. The ratio of male to female was about 3 to 1. 2. The most frequent site of the hypertensive intracerebral hemorrhage was in the basal ganglia in 76.7 per cent, 27.2 percent of them in the thalamic hemorrhage and 39.5 per cent in the external capsular hemorrhage. The remainder were 9.3 per cent in the subcortical hemorrhage, 11.6 per cent in the pontine hemorrhage and 2.4 per cent in the cerebellar hemorrhage. 3. In the past history, hypertension was noted in 88.3 per cent of them. Simple chest X-ray showed cardiomegaly in 58.1 per cent and left ventricular hypertrophy was found in 41.1 per cent on E.C.G. findings. 4. All of 43 cases had unconscious state with various level at the onset of illness. For 43 cases, 46.5 per cent was in transient impairment of consciousness or drowsy state and 53.6 per cent in stuporous or comatous state. Headache was experienced in 81.3 per cent and 58.1 per cent of them was associated with vomiting. 5. During hospital course improvement of conscious level to alert state was found in 25.6 per cent and drowsy state in 18.6 per cent of all cases. On the aspect of the site of hemorrhage, 81.3 % of the thalamic hemorrhage and all pontine hemmorhage cases had shown stuporous or comatous conscious level. On the other hand, 70.6 per cent of the external capsular hemorrhage and all of the subcortical hemorrhage was found in alert or drowsy state. 6. On the neurological findings, anisocoria was noted in 18.8 per cent, miotic pupil in 20.7 per cent of all cases and pin-point pupils in pontine hemorrhage exclusively. Normal extraocular movement was noted in 60.4 per cent, conjugate deviation in 9.7 per cent of all cases. Inward and downward deviation of the eye-ball was found in 50 per cent of the thalamic hemorrhage. Dissociated eye-ball movement and occular bobbing were noted in the pontine hemorrhage. Motor impairment developed in all cases except one of the subcortical hemorrhage. Hemiplegia or hemiparesis was noted in 86.1 per cent of all cases and quadriplegia in 60 per cent of the pontine hemorrhage. Speech disturbance was noted in 27.9 per cent of all cases. 7. In the hypertensive intracerebral hemorrhage 24 cases were treated surgically and 19 cases were managed conservatively. Mortality and disability rate increased steadily with deepening of level of consciousness. The result of surgical treatment was better in alert and drowsy patients. 8. In addition to conscious level, the site of intracerebral hemorrhage did strongly influence to surgical outcome. Surgical treatment of 9 cases of thalamic hemorrhage resulted 8 death and one with severe disability. On the other hand, of 17 patients of the external capsular hemorrhage 12 were treated surgically and 8 cases showed improvement. 5 patients of pontine hemorrhage was managed conservatively but resulted fatal outcome in 2 cases. 9. There is a conflict of opinion as to the optimal time to operate the hypertensive intracerebral hemorrhage. Early surgery after ictus probably increase the mortality rate. Of 10 cases who were treated with surgical intervention within 48 hours following ictus, seven cases were succumbed. On the contrary, 0f 12 cases who had received operative treatment after 72 hours following ictus, 9 showed improvement and 3 death. 10. The amount of the hematoma seem to somewhat influence to surgical result.
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