高血圧性脳出血の外科的リスクからみた神経学的重症度分類

概要

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To make proper treatment in each patient with hypertensive intracerebral hemorrhage, an attempt was made to classify conditions of patients by reviewing clinical records of 113 patients treated surgically at Iwate Medical University Hospital. The classification was made as follows; Grade I: alert or somnolence, Grade II: stupor, Grade III: semicoma without signs of transtentorial herniation, Grade IV: semicoma with signs of transtentorial herniation and Grade V: deep coma. Our policy of treatment in hypertensive intracerebral hemorrhage based on the neurnlogical classification is as follows; 1. Patients in Grade I should be, as a rule, treated conservatively. However, patients showing progressive neurological deficits within 24 hours, or becoming drowsy within 3 hours after the ictus are indicated for surgery. When positive mass signs are demonstrated by cerebral angiography or computed tomography, patients are also indicated for surgery. 2. Patients in Grade II or III are absolutely indicated for surgery. 3. As to patients in Grade IV, a patient without respiratory disturbance requires surgical treatment as soon as possible. However, a patient with respiratory disturbance is not indicated for surgery. 4. Patients in Grade V are not indicated for surgery. However, patients showing improvement by rapid infusion of hypertonic solutions such as mannitol may be indicated for surgery.
The Japanese Society on Surgery for Cerebral Strokeの論文