CTより見た高血圧性脳出血外側型の重症度分類と治療方針および予後

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The purpose of this investigation is to determine the CT grading of lateral type of ICH, by which the plan of the therapy will be decided and the prognosis will be clarified. Sixtyfour cases of lateral type of ICH were made an object of the study, but a case of postoperative reaccumulation of the hematoma, and a case of a physically handicapped were excluded. These clinical courses were followed up over a period of 6 months. These 62 cases were put in order of size of hematoma by CT findings. Then treatment and clinical course were investigated. CT grading of lateral type of ICH is shown below. Grade I: hematoma is crescent or semilunal in shape, and localized away from the internal capsule. Grade II: hematoma is oval, round or oblong in shape, located almost away from the internal capsule. Grade DI hematoma involves partially internal capsule, and there is no or little ventricular penetration. Grade IV: hematoma involves totally internal capsule, and a little penetrated into the ventricle. Grade V: hematoma destroyed a large part of the brain penetrated much into the ventricle. (Results) The case of grade I is alert or somnolent in consciousness. All the patients recovered to ADL I by medica or surgical therapy. Therefore grade I is an indication of medical treatment. The case of grade II is also alert somnolent in consciousness. Surgical treatment is better than medical treatment for functional recovery. The case of an oval shaped hematoma becomes ADL 1, but one of an oblong shape becomes ADL 2. The case of grade III is : somnolent or stuporous in consciousness. The case, in which the surgery was performed within a day, become ADL 1 or 2. But the cases, in which the medical treatment was performed or the surgery was performed after 3 days, become ADL 3 except for one case of ADL 2. Therefore this group is an indication of surgery within 2 days, and the prognosis becomes ADL 2. The case of grade IV is in stupor or semicoma in consciousness. The cases, in which the surgery was performed within 6 hours, become ADL 2. But the cases, in which the surgery was performed after 11 hours, became ADL 3 or 4 or expired. Therefore this group is in an indication of surgery within 6 hours, and prognosis becomes ADL 2. The case of grade V is semicoma with herniation sign or coma. All these cases expired. But one of these cases revealed hematoma was increasing from grade III to grade V 2 hours after onset by CT. Almost all cases of grade V revealed somnolence or stupor for 1 or 2 hours after attack. Therefore the only way to save cases of grade V is to prevent enlargement of hematoma within 3 hours.
The Japanese Society on Surgery for Cerebral Strokeの論文

CTより見た高血圧性脳出血外側型の重症度分類と治療方針および予後

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