SPONTANEOUS INTRACEREBRAL HEMORRHAGE :AN INSTITUTINAL EXPERIENCES REGARDING CLINICAL FEATURES,OUTCOME AND MANAGEMENT

Dr Poonia Nemichand, Dr Jain Surendra

Abstract


 Background  Spontaneous intracerebral hemorrhage (ICH) is significantaly associated with mortality and morbidity throughout the world. To improve the devastating course of ICH, various clinical trials for medical and surgical interventions have been conducted in the last 10 years. Our article  evaluate the clinical symptoms,associated factors and effect of conservative and surgical method on  outcome  following SICH .

 Materials and Methods. We retrospectively reviewed records  and   online data  of patients who admitted with ct scan proved SICH  IN  neurocare hospital jaipur  between 1st January 2017 and 31st December 2019 . we analysed following indicator – demographic profile , associated  comorbidities, Glasgow coma score (GCS) on admission, CT finding, ICH score ,treatment modality and outcome at six  months. Modified Rankin score (mRS) was used to assess the outcome at discharge and six months.

 Results. In our study group of 76 patients included 42 males and 34 females and the mean age at presentation was

63.20 years. In our  study  58 patients (76.3%) were  previously diagnosed hypertensive, of whom 32  ( 42.10%

) were on hypertensive medication. the most common site  of hematoma were capsuloganglionic thalamic region (61.84%,n = 47) followed by lobar (30.26% , n = 23), cerebellar (5.2%, n = 4), brainstem (2.63% ,n  = 2).  21(27.63%) patients had  intraventricular haemorrhage . 47 patients out of 76 were operated and remaining were managed conservatively In our study 34 (44.73 %) patients died during 6 month follow up periods. death ratio almost same in both mode of treatment .44.82% death occured in conservative and 44.68% death occured after  surgery. Among 42 survivors at six months ,11 (14.47%) patients had poor outcome  (mRS 4-5) and 31(40.78 %) patients had a favourable outcome (mRS <3).

 

 Conclusions. SICH mainly  affects a older population (>60 years). Age > 70 years, GCS < 8 on admission, clot volume above 30 ml, intraventricular extension and hydrocephalus  predictors were associated with poor outcome and death . In case of moderate to large hematomas Mortality and morbidity  can be reduced by surgical evacuation of the clot alone or combined with DC and small size hematoma can be managed conservatively.


Keywords


intracerebral hematoma, Craniotomy, decompressive craniectomy

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