Intracerebral Hemorrhage Secondary to Ruptured Middle Cerebral Artery Aneurysms: Therapeutic Consideration and Prognostic Factors Related to the Site of Hemorrhage

ABSTRACT

OBJECTIVE: The purpose of this study is to investigate the prognostic factors and appropriate treatment in patients with intracerebral hemorrhage secondary to ruptured middle cerebral artery(MCA) aneurysms. METHODS: Among 120 cases with ruptured MCA aneurysms during last 9 years from 1993 to 2002, 85 cases was analyzed according to hematoma distribution. All cases were included in one of three groups Group A(15 cases) having an intraparenchymal hematoma(IPH) larger than 5cc with or without subarachnoid hemorrhage(SAH). Group B(25 cases) having an intrasylvian hematoma(ISH) with or without SAH. Group C(45 cases) having a diffuse SAH without localized hematoma. Prognosis was evaluated postoperatively by applying Glasgow Outcome Scale(GOS) at discharge. RESULTS: In Group A, hypertension and Hunt-Hess(H-H) grade on admission, hematoma volume larger than 15cc and postoperative edema were corrleated with poor outcome. In Group B, old age, postoperative edema and delayed ischemic neurologic deficit(DIND) were related to poor outcome. Group C revealed better consciousness on admission and favourable outcome than Group A and B. CONCLUSION: We suggest that therapeutic consideration in Group A is focused on postoperative edema after early surgical intervention and in Group B is focused on postoperative edema with DIND after removal of residual clot in sylvian fisssure as much as possible by irrigation and suction.