CT像からみた高血圧性脳出血の病態と手術時期:-とくに基底核部出血例について-

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A consecutive series of a hundred and six cases of hypertensive intracerebral hemorrhages have been treated in our service from June 1976 to April 1978. The diagnosis were made by CT and angiographies in all cases. There were 91 cases of basal ganglia hematomas, 8 cases of subcortical hematomas, 4 cases of pontine hemorrhages and 3 cases of intracerebellar hematomas. Out of 91 cases of basal ganglia hematomas, evacuation of the hematomas were carried out in 48 cases. Remaining 43 cases were managed with conservative treatment, 28 cases of the conservative treatment had had frequent CT examination for non-invasive observation of their hematomas. Observation of serial CT examination in these cases and our experiences of operative cases led to us following suggestion: 1) The choise of treatment of the hypertensive intracerebral hemotoma of the basal ganglia and subcortical area was seemed to evacuate it within 24 hours after the attack if possible. Because the hematomas are still fluid state and has no perifocal edema around it. 2) Untill the fourth day after the attack, the hematoma may be changed into solid state with some amount of the perifocal edema. However, evacuation of the hematomas is still effective as acute surgery. 3) After the fourth day, the perifocal edema may develop rapidly, so the surgery should be done with decompressive management. 4) Appearance of contrast enhancement was noted from around two weeks after the hemorrhage. Therefore, risk for rebleeding was expected at this time. Actually two such cases were experienced in our series.
The Japanese Society on Surgery for Cerebral Strokeの論文

CT像からみた高血圧性脳出血の病態と手術時期:-とくに基底核部出血例について-

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