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2.
Article in English | WPRIM | ID: wpr-83977

ABSTRACT

OBJECTIVE: Frameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth. METHODS: During a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study. RESULTS: Nine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas. CONCLUSION: In conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.


Subject(s)
Aspirin , Basal Ganglia Hemorrhage , Basal Ganglia , Cerebral Hemorrhage , Hematoma , Hemorrhage , Humans , Hypertension , Risk Factors , Statistics as Topic , Stereotaxic Techniques , Suction
3.
Chinese Journal of Traumatology ; (6): 247-248, 2016.
Article in English | WPRIM | ID: wpr-235736

ABSTRACT

Hemorrhage of the basal ganglia is common in hypertensive patients, and most of the cases are spon- taneous unilateral hemorrhage. Traumatic basal ganglia hemorrhage is uncommon, while bilateral hemorrhage of the basal ganglia after trauma is an extremely rare entity. This report described a rare case of bilateral hemorrhage of the basal ganglia after head trauma. We also analyzed the mechanisms and reviewed relative literatures.


Subject(s)
Basal Ganglia Hemorrhage , Diagnostic Imaging , Craniocerebral Trauma , Female , Humans , Middle Aged , Tomography, X-Ray Computed
4.
Article in English | WPRIM | ID: wpr-122138

ABSTRACT

Traumatic basal ganglia hemorrhage (TBGH) is a rare presentation of head injuries. Bilateral lesions are extremely rare. The pathophysiologic mechanism of bilateral TBGH seems to be the same as diffuse axonal injury. However, limited information about childhood bilateral TBGH is available in the literature. We report the case of a child with bilateral TBGH treated with stereotactic aspiration of hemorrhage and periodic urokinase irrigation.


Subject(s)
Basal Ganglia Hemorrhage , Basal Ganglia , Child , Craniocerebral Trauma , Diffuse Axonal Injury , Hemorrhage , Humans , Intracranial Hemorrhages , Urokinase-Type Plasminogen Activator
5.
Article in English | WPRIM | ID: wpr-189966

ABSTRACT

Intracerebral hemorrhage (ICH) is common among various types of storkes; however, it is rare in young patients and patients who do not have any risk factors. In such cases, ICH is generally caused by vascular malformations, tumors, vasculitis, or drug abuse. Basal ganglia ICH is rarely related with distal lenticulostriate artery (LSA) aneurysm. Since the 1960s, a total of 29 distal LSA aneurysm cases causing ICH have been reported in the English literature. Despite of the small number of cases, various treatment methods have been attempted : surgical clipping, endovascular treatment, conservative treatment, superficial temporal artery-middle cerebral artery anastomosis, and gamma-knife radiosurgery. Here, we report two additional cases and review the literature. Thereupon, we discerned that young patients with deep ICH are in need of conventional cerebral angiography. Moreover, initial conservative treatment with follow-up cerebral angiography might be a good treatment option except for cases with a large amount of hematoma that necessitates emergency evacuation. If the LSA aneurysm still persists or enlarges on follow-up angiography, it should be treated surgically or endovascularly.


Subject(s)
Aneurysm , Angiography , Arteries , Basal Ganglia , Basal Ganglia Hemorrhage , Cerebral Angiography , Cerebral Arteries , Cerebral Hemorrhage , Emergencies , Follow-Up Studies , Hematoma , Humans , Radiosurgery , Risk Factors , Rupture , Substance-Related Disorders , Surgical Instruments , Vascular Malformations , Vasculitis
6.
Article in English | WPRIM | ID: wpr-34162

ABSTRACT

OBJECTIVE: Treatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated. MATERIAL AND METHODS: A retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST). RESULTS: The average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 +/- 48.6 mL) and TS-TI (96.0 +/- 39.0 mL) groups than in the ST group (46.5 +/- 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms. CONCLUSION: The TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.


Subject(s)
Age Distribution , Basal Ganglia , Basal Ganglia Hemorrhage , Catheters , Cerebral Hemorrhage , Craniotomy , Drainage , Glasgow Coma Scale , Hematoma , Hemorrhage , Humans , Neurosurgery , Retrospective Studies
7.
Acta Medica Philippina ; : 18-21, 2014.
Article in English | WPRIM | ID: wpr-633629

ABSTRACT

BACKGROUND: Uncontrolled hypertension in acute intracerebral hemorrhages (ICH) may cause hematoma expansion within the first 24 hours, and increase patient mortality. We investigated whether there was an association between ICH location and the difficulty in lowering BP in patients with acute hypertensive non- lobar ICH. METHODS: This is a retrospective cohort study of adults diagnosed with non-lobar ICH admitted at a tertiary hospital over a 2-year period. We documented the time to attain target mean arterial pressure (MAP) of 110-130 mmHg, as well as the use of antihypertensive medications. RESULTS: Of 357 patients admitted for non-lobar ICH,47 patients fulfilled the study criteria. Basal ganglia hemorrhages were the most common (47%), followed by thalamic (34%), cerebellar (11%), and pontine hemorrhages (8%). While there were no significant differences in baseline MAP among the different sites of hemorrhage, those with thalamic ICH had a significantly longer time-to-target MAP (p=0.02) and required three or more classes of oral antihypertensive medications (p CONCLUSIONS: Acute thalamic intracerebral hemorrhages may require multiple classes of antihypertensives to lower blood pressure to safer levels.


Subject(s)
Humans , Male , Female , Middle Aged , Humans , Adult , Antihypertensive Agents , Blood Pressure , Tertiary Care Centers , Retrospective Studies , Basal Ganglia Hemorrhage , Cerebral Hemorrhage , Hypertension , Hematoma
8.
Article in Chinese | WPRIM | ID: wpr-299772

ABSTRACT

<p><b>OBJECTIVE</b>To observe the effect of Xingnaojing Injection combined with minimally invasive percutaneous drainage on brain edema and content of serum aquaporin-4 (AQP4) in patients with moderate hypertensive basal ganglia hemorrhage, and discuss the treatment mechanism of Xingnaojing injection combined with minimally invasive percutaneous drainage for cerebral hemorrhage.</p><p><b>METHOD</b>Forty-two patients with moderate (25-50 mL) hypertensive basal ganglia hemorrhage (< 24 h) were selected and randomly divided into two groups: the observation group (n = 22) and the control group (n = 20). The neurological severity score were evaluated by the NIHSS (national institutes of health stroke scale), the volume of brain edemas were measured by head CT, the serum levels of AQP4 were determined by ELISA method on admission and 1 and 2 weeks after treatment.</p><p><b>RESULT</b>On admission, there was no significant difference in the scores of NIHSS, the volume of brain edemas and the level of serum AQP4 between the observation group and the control group. At the end of the first week after the treatment, the score of NIHSS of the observation group were lower than that of the control group, with significant different (P < 0.05); the observation group showed reduced volume of brain edemas than that on admission (P < 0.05), whereas the control group the control group showed increased volume of brain edemas than that on admission; the control group displayed increased level of serum AQP4 than that on admission, but without significant difference; the observation group displayed decreased level of serum AQP4 than that on admission (P < 0.05). At the end of the second week after the treatment, the control group showed decreased score of NIHSS than that on admission and at the end of the first week after treatment (P < 0.05). Compared with the control group, the observation group showed a much lower score of NIHSS (P < 0.01), the control group displayed reduced volume of brain edemas than that on admission and at the end of the first week after treatment, but the observation group was even lower than the control group. Both of observation and control groups displayed significantly reduced level of AQP4 (P < 0.05), but the observation group showed a lower AQP4 level than that of the control group (P < 0.05).</p><p><b>CONCLUSION</b>The therapy of Xingnaojing injection combined with minimally invasive percutaneous drainage could remarkably reduce brain edema, and promote neural functional recovery, thus could be selected as a therapeutic regimen for patients with moderate hypertensive basal ganglia hemorrhage.</p>


Subject(s)
Aged , Aquaporin 4 , Blood , Genetics , Basal Ganglia Hemorrhage , Blood , Drug Therapy , General Surgery , Brain Edema , Blood , Drug Therapy , General Surgery , Drainage , Drugs, Chinese Herbal , Female , Humans , Hypertension , Male , Middle Aged , Treatment Outcome
9.
Article in English | WPRIM | ID: wpr-193377

ABSTRACT

OBJECTIVE: The clinico-radiologic features of the spontaneous basal ganglia hemorrhage (BGH) may often differ one from another, according to its regional location. Therefore, we attempted to classify the BGH into regional subgroups, and to extrapolate the distinct characteristics of each group of BGH. MATERIALS AND METHODS: A total of 103 BGHs were analyzed by retrospective review of medical records. BGH was classified according to four subgroups; anterior BGH; posterior BGH; lateral BGH; massive BGH. RESULTS: The most common BGH was the posterior BGH (56, 54.4%), followed by the lateral BGH (26, 25.2%), the massive BGH (12, 11.7%), and the anterior BGH (9, 8.7%). The shape of hemorrhage tended to be round in anterior, irregular in posterior, and ovoid in lateral BGH. A layered density of hematoma on initial computed tomography showed correlation with hematoma expansion (p = 0.016), which was observed more often in the postero-lateral group of BGH than in the anterior BGH group. Relatively better recovery from the initial insult was observed in the lateral BGH group than in the other regional BGH groups. The proportion of poor outcome (modified Rankin scale 4, 5, 6) was 100% in the massive, 41.1% in the posterior, 34.6% in the lateral, and 0% in the anterior BGH group. CONCLUSION: We observed that BGH can be grouped according to its regional location and each group may have distinct characteristics. Thus, a more sophisticated clinical strategy tailored to each group of BGHs can be implemented.


Subject(s)
Basal Ganglia , Basal Ganglia Hemorrhage , Classification , Hematoma , Hemorrhage , Medical Records , Retrospective Studies
10.
Acta cir. bras ; 28(3): 228-232, Mar. 2013. tab
Article in English | LILACS | ID: lil-667935

ABSTRACT

PURPOSE: To investigate the correlation between lateralization of cerebral basal ganglia hemorrhage and handedness. METHODS: Medical records and computed tomography (CT) scans for 84 patients with primary hypertensive intracerebral hemorrhage (ICH) in basal ganglia were reviewed. Data of gender, age, handedness, and location of basal ganglia hematoma were statistically analyzed. Data of age, gender, handedness, health condition, and mean blood flow velocity (BFV) in middle cerebral arteries (MCAs) and anterior cerebral arteries (ACAs) on both sides of 114 healthy individuals were statistically analyzed. RESULTS: We found out that the patients with right basal ganglia hemorrhage were mostly left-handed, while patients with left basal ganglia hemorrhage were mostly right handed (p=0.021, r=0.251). And the mean BFV in the right MCAs of left-handed ones are relatively higher, the mean BFV in the left MCAs of right-handers are relatively higher (p=0.008, r=0.248). CONCLUSION: There 's a correlation between lateralization of cerebral basal ganglia hemorrhage and handedness.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Basal Ganglia Hemorrhage/pathology , Functional Laterality , Anterior Cerebral Artery/physiopathology , Basal Ganglia Hemorrhage , Blood Flow Velocity/physiology , Middle Cerebral Artery/physiopathology , Sex Factors
11.
Article in English | WPRIM | ID: wpr-85118

ABSTRACT

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.


Subject(s)
Aged , Astrocytoma , Basal Ganglia , Basal Ganglia Hemorrhage , Biopsy , Brain , Brain Neoplasms , Cerebral Hemorrhage , Dysarthria , Female , Gadolinium , Glioma , Hemorrhage , Humans , Hydrocephalus , Hypertension , Intracranial Hemorrhage, Hypertensive , Magnetic Resonance Imaging , Paresis , Ventriculoperitoneal Shunt
12.
Acta cir. bras ; 27(10): 727-731, Oct. 2012. tab
Article in English | LILACS | ID: lil-650563

ABSTRACT

PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgical interventions (p>0.05). However, surgical interventions showed advantages of shorter hospitalization, quick removal of hematoma and obvious reduction of cost. CONCLUSION: The microinvasive craniopuncture technique to drain the hematoma within 6-48h may be a good way in treating hypertensive hemorrhage of basal ganglia region.


OBJETIVO: Comparar o efeito curativo de diferentes tratamentos da hemorragia hipertensiva cerebral de 25 a 35ml. MÉTODOS: Foram analisados 595 casos agrupados segundo tratamento conservador e evacuação com técnica de punção transcraniana dentro de 6h ou de 6 às 48h do início do quadro clínico. RESULTADOS: O seguimento após três meses e avaliado pelo Escore de Atividade de Vida Diário, indicou que não houve diferenças significantes entre os tratamentos conservador e cirúrgico (p>0.05) O tratamento cirúrgico mostrou vantagem com hospitalização mais curta e redução de custos. CONCLUSÃO: A técnica de punção transcraniana para drenagem de hematoma dos núcleos da base pode ser uma boa alternativa de tratamento.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Basal Ganglia Hemorrhage/therapy , Basal Ganglia/surgery , Intracranial Hemorrhage, Hypertensive/therapy , Neurosurgical Procedures/methods , Basal Ganglia Hemorrhage/pathology , Basal Ganglia/pathology , Chi-Square Distribution , Hematoma/surgery , Length of Stay , Punctures/methods , Time Factors , Treatment Outcome
13.
Article in English | WPRIM | ID: wpr-722491

ABSTRACT

OBJECTIVE: To investigate the effects of high frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) on visuospatial motor learning, stimulated on the premotor cortex in basal ganglia hemorrhage patients. METHOD: Nine patients were randomized to receive real and sham rTMS. We subdivided into two groups according to the integrity of the corticospinal tract measured by diffusion tensor tractography. The implicit visuospatial learning paradigm composed of numbers 1 to 4, in which 12 sequential numbers (2-3-1-4-3-2-4-1-3-4-2-1) were incorporated randomly. We obtained the mean fraction anisotrophy (FA) and apparent diffusion coefficient (ADC) values from the corticospinal tract and subdividing into two groups by calculating the relative value (laterality %). RESULTS: rTMS on the premotor cortex was effective only in simple motor learning but not in visuospatial learning in group analysis. The primary motor cortex excitability after the premotor cortex stimulation has been changed significantly. Subdividing into two groups according to the integrity of the corticospinal tract using the ADC value, the low ADC value group showed significant reduction of the visuospatial response time. CONCLUSION: High frequency rTMS on the premotor cortex was effective in simple motor learning and also in the group who maintained more integrity of the corticospinal tract in basal ganglia hemorrhage.


Subject(s)
Basal Ganglia Hemorrhage , Diffusion , Hemorrhage , Humans , Learning , Motor Cortex , Pyramidal Tracts , Salicylamides , Stroke , Transcranial Magnetic Stimulation
14.
Article in Korean | WPRIM | ID: wpr-69747

ABSTRACT

Most complications of carotid endarterectomy originate from either thrombotic or embolic ischemia. Although the incidence of hemorrhagic hyperperfusion syndrome after carotid endarterectomy is extremely rare, it can cause significant morbidity and mortality. Several mechanisms are involved in the pathophysiology of cerebral hyperperfusion syndrome including impaired cerebral autoregulation and normal pressure breakthrough. Presently, a different mechanism is suggested. Unfortunately, suggestions for prevention are limited to strict perioperative control of hypertension in patients with critical stenosis and chronic cerebral hypoperfusion. We report hypertensive-like ipsilateral basal ganglia hemorrhage after carotid endarterectomy.


Subject(s)
Basal Ganglia Hemorrhage , Cerebral Hemorrhage , Constriction, Pathologic , Endarterectomy, Carotid , Homeostasis , Humans , Hypertension , Incidence , Ischemia
15.
DMJ-Dohuk Medical Journal. 2008; 2 (1): 146-154
in English | IMEMR | ID: emr-86163

ABSTRACT

The widely accepted definition of a transient ischaemic attack [TIA] is sudden, focal neurological deficit [cerebral or retinal deficit] lasting for less than 24 hours, which is presumed to be of vascular origin. This case demonstrates that the arbitrary time limit of 24 hours did not help the correct diagnosis and management of this patient. It supports the calls to change our approach to the definition and the management of TIA [under] towards a syndrome of acute transient focal neurological deficits [acute TFND], which could only be guided by imaging


Subject(s)
Humans , Male , Basal Ganglia Hemorrhage/diagnosis , Ischemic Attack, Transient , Intracranial Hemorrhages , Tomography, X-Ray Computed
16.
Article in Chinese | WPRIM | ID: wpr-270142

ABSTRACT

<p><b>OBJECTIVE</b>To compare the therapeutic effects of aspiration via a directional soft tube and conservative treatment in patients with mild hemorrhage in the basal ganglion.</p><p><b>METHODS</b>Seventy-five patients with mild cerebral hemorrhage (10~30 ml) were randomly divided into two groups for aspiration treatment with minimally invasive directional soft tube placement (minimally invasive group, n=36) and conservative treatment (medication group, n=39). The patients in the two groups had comparable mean GCS scores of 11-15 on admission. The clinical outcomes of the patients were compared between the two groups.</p><p><b>RESULTS</b>In the minimally invasive group, complete removal or absorption of the hematoma occurred within an average of 3.8 days, significantly shortened in comparison with the 24 days in the medication group. The short-term (1 month) follow-up of the patients showed good neurological recovery in 58% of the patients in the minimally invasive group, significantly greater than the rate of 29% in the medication group; 6 months after the treatment, good neurological recovery was achieved in 50% of the patients in the minimally invasive group, but only 16% in the medication. No death occurred in the minimally invasive group, and 2 patients died in the medication group. The cost of hospitalization averaged 5136.3 Yuan in the minimally invasive group and 11843.6 Yuan in the medication group.</p><p><b>CONCLUSION</b>Compared with conservative treatment, the minimally invasive treatment with soft tube placement can significantly shorten the hospital stay, promote neurological function recovery, lower the mortality rate, and reduce the cost of hospitalization.</p>


Subject(s)
Adult , Aged , Basal Ganglia Hemorrhage , General Surgery , Catheters, Indwelling , Female , Humans , Hypertension , Male , Middle Aged , Suction , Economics , Methods , Treatment Outcome
17.
Article in Korean | WPRIM | ID: wpr-121021

ABSTRACT

A 39-year old man presented with comatose mentality. Brain computerized tomography revealed bilateral basal ganglia hemorrhage. The amount of hematoma was 35 cc each. He had no hypertension history through out regular health examination. Emergenct hematoma evacuation was performed. Histopathologic study disclosed no evidence of amyloid angiopathy or infection. He died 4 days after the operation due to myocardiac infarction. This report describe a rare case of simultaneous bilateral cerebral hemorrhages without history of hypertension.


Subject(s)
Adult , Amyloid , Basal Ganglia Hemorrhage , Basal Ganglia , Brain , Cerebral Hemorrhage , Coma , Hematoma , Humans , Hypertension , Infarction
18.
Article in English | WPRIM | ID: wpr-88657

ABSTRACT

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. This report describes a 50-year-old man with bilateral basal ganglia hemorrhage with occipital fracture of the skull after head trauma. The mechanism of development of traumatic hemorrhage of the basal ganglia has been not clear. But, it is presumed to be secondary to rupture of the lenticulostriate or anterior choroidal artery by shearing as a result of acceleration/deceleration forces. We briefly summarize our uncommon case and discuss its possible mechanisms.


Subject(s)
Arteries , Basal Ganglia Hemorrhage , Basal Ganglia , Choroid , Contusions , Craniocerebral Trauma , Hemorrhage , Humans , Middle Aged , Rupture , Skull
19.
Article in Korean | WPRIM | ID: wpr-723415

ABSTRACT

Terson's syndrome is one of the cerebro-ocular syndrome which entails the findings due to intraocular hemorrhage in association with increased intracranial pressure following subarachnoid hemorrhage. We reported a patient suffering from total blindness after basal ganglia hemorrhage, who was diagnosed as Terson's syndrome and vitrectomy was done. Our patient recovered normal visual acuity after vitrectomy, which fascilitated rehabilitative process. We also performed diffusion tensor tractography to investigate abnormalities of brain related to the visual dysfunction, which revealed decreased orientation and integrity of the right optic radiation. It is important to diagnose Terson's syndrome early because it is one of the cerebro-ocular syndrome which needs early intervention with consideration of the integrity of optic pathway.


Subject(s)
Basal Ganglia Hemorrhage , Blindness , Brain , Diffusion , Early Intervention, Educational , Hemorrhage , Humans , Intracranial Pressure , Rehabilitation , Subarachnoid Hemorrhage , Visual Acuity , Vitrectomy
20.
Pan Arab Journal of Neurosurgery. 2006; 10 (1): 39-45
in English | IMEMR | ID: emr-80250

ABSTRACT

To study and compare the effectiveness and outcome of the surgical treatment versus medical management of patients with spontaneous supratentorial intracerebral haemorrhage [SSICH]. A comprehensive review of 35 patients with spontaneous supratentorial ICH was carried out at Banha University Hospital and King Fahd General Hospital from March 1999 to September 2001. Twenty patients had surgery for clot evacuation through open craniotomy and 15 received medical management. Inclusion criteria was Glasgow Coma Score [GCS]> 5 at the time of enrollment, with focal neurological deficits and ICH volume > 20 cc on the initial brain computed tomography scan. The follow-up period was 3 months. Outcome was defined using the Glasgow Outcome Scale [GOS]. A good outcome was defined as GOS score > 3 at 3 months. Overall, the results of management of spontaneous supratentorial ICH either surgically or medically is inconclusive. Forty-six percent of the patients died [GOS 1], 34% remained severely disabled [GOS 3] and 20% became independent with moderate disability [GOS 4]. The likelihood of a good outcome [GOS>3] for the surgical treatment group differs from the medical treatment group [25% vs 13%]. There was no significant difference in mortality at 3 months [45% vs 46.6%]. At the end of the follow-up period, the median GOS score showed a nonsignificant trend towards a better outcome in the surgical treatment group against the conservative medical treatment group [56% vs 53%]. Craniotomy with clot evacuation for spontaneous supratentorial ICH may result in functional independence in approximately 25% of patients [5 out 20]. Despite this, there is no clear indication from this study for the optimal treatment of these patients, either through aggressive surgical intervention or conservative medical management


Subject(s)
Humans , Male , Female , Cerebral Hemorrhage/surgery , Intracranial Hemorrhages , Craniotomy , Basal Ganglia Hemorrhage , Intracranial Pressure
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