Clinical Significance of Intracerebral Hematoma in Patients with Spontaneous Subarachnoid Hemorrhage

ABSTRACT

To investigate the clinical significance of intracerebral hematoma(ICH) in patients with spontaneous subarachnoid hemorrhage(SAH), the authors reviewed 527 consecutive patients with SAH during the past 7 years. Computed tomography(CT) visible ICH was found in 115 patients(21.8%). In patients over 50 years old, ICH was found more frequently than patients aged 50 years or less(p<0.05). Patients with ICH had a higher incidence of intraventicular hemorrhage or rebleeding compared with patients without ICH(p<0.005). No significant association was found between pre-existing hypertension and ICH. Patients with ICH were in higher Hunt and Hess Grade(HHG) on admission(p<0.005), and had a poorer outcome compared with patients without ICH(p<0.005). Seventy-nine(20.2%) among the 392 patients with aneurysmal subarachnoid hemorrhage had ICHs, of whom the frequent site of aneurysm was the middle cerebral artery in 45.3%, anterior cerebral artery in 17.9%. The rate of good recovery in these patients was significantly low compared with patients without ICH. The mortality in 313 operated patients with aneurysmal subarachnoid hemorrhage was 36.4% in patients with ICH and 14.6% in those without ICH (p<0.005). Particulary, in the patients with middle cerebral artery or internal carotid artery aneurysm, ICH had a significant influence on the good recovery and mortality(p<0.005). Even though the surgical mortality of the patients with large hematoma more than 30 cc in amount was 64.7%, one half of the survivors showed good recovery. This study suggests that the prognosis after subarachnoid hemorrhage is poorer in patients with an ICH. Although the initial clinical grade is an important prognostic factor, the prognosis for patients in the same initial clinical grade is poorer when ICH is accompanied. In regard with an increased incidnece of rebleeding episode and an increased intracranial pressure in the patients with ICHs, we emphasize the importance of early surgical intervention.