Problems of grading and surgical indication in the acute stage of severe putaminal hemorrhage

概要

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Clinical analysis of the severe cases with hypertensive putaminal cerebral hemorrhage was performed, especially in relation to the reliability of neurological grading in early stage. Tow hundred fifty nine cases suffered from hypertensive intracerebral hemorrhage were admitted to our hospital within the last three years, of which 122 (47%) were putaminal hemorrhage and 78.6% of the patients were admitted within 6 hours after onset. Neurological grading of all cases were evaluated on admission. Distribution of each grade was as follows; 1 (24.6%), 2 (34.4%), 3 (9.8%), 4a (7.4%), 4b (15.6%) and 5 (8.2%). Present study was especially performed in 28 cases of grades 4a and 4b in order to evaluate clinical features and surgical indication. Outcome of these cases were unexpectedly poor in spite of intentionally performed operation in early stage. Most of these cases were transferred to our hospital shortly after the onset and it was considered that the clinical evaluation of the patients in acute stage was quite uncertain especially in relation to the severity and surgical indication. CT findings added some useful information and, as the result, we considered that timing of admission from onset should be taken in account for surgical indication for putaminal hemorrhage.
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