Clinical Outcome following Surgery for Intracerebral Hematoma associated with Ruptured Middle Cerebral Artery Aneurysm

Abstract

The clinical significance of intracerebral hematoma (ICH) following rupture of a middle cerebral artery (MCA) aneurysm was studied in 31 surgical patients having a mean age of 52 years. Sixteen patients were not included in this study, because of massive intraventricular bleeding (2), postoperative complications (7), operation trouble (5), and symptomatic vasospasm (2). One patient died in postoperative period. The remaining 30 patients were followed for a mean of 3.7 years postoperatively. Sixteen patients almost fully recovered, nine were self-sufficient with some deficits, two were partially dependent, one was fully dependent, and three died. The locations of the ICH were as follows: temporal lobe in 18 cases; frontal lobe in five; frontal and temporal lobes in three; temporal and parietal lobes in four; and temporal lobe and internal capsule in one. Fourteen patients had permanent neurological deficits. Left homonymous hemianopsia occurred in one patient who had a large hematoma in the right temporal lobe but became self-sufficient. Motor disturbances were mild in 11 cases, and severe in three (hemiplegia in two and tetraparesis in one). Six of the 11 patients with dominant hemispheric ICH experienced motor dominant aphasia and one had global aphasia. Although there was no definite correlation between hemisphere and outcome, patients with medium to large ICH in the dominant hemisphere tended to develop motor dominant aphasia. In terms of motor disturbance and aphasia due to ICH following MCA aneurysm rupture, the prognosis appears fairly good because these ICH are originally subcortical.