The Functional Outcome of Spontaneous Hypertensive Supratentorial Intracerebral Haemorrhage after Surgery

Saumitra Sarkar,Saumik Sarkar,Avijit Dey,Mohammad Kamal Hossen

doi:10.15342/ijms.7.263

Abstract

This study was to determine the different parameters that affect the outcome and the functional recovery after surgical evacuation of spontaneous hypertensive supratentorial intracerebral haemorrhage. This cross-sectional analytic study was conducted in the Department of Neuro- surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh during a period of 4 years from January 2016 to December 2019 and total 96 patients were included in this study. Patients with post-traumatic hematomas, intracranial space-occupying lesions with bleeds, haemorrhagic transformation of an ischemic stroke, vascular malformations, aneurysms, and infratentorial haemorrhages were excluded from the study. Decompressive craniotomy and evacuation of clot was performed in most of the cases. The outcome of the patients was categorized according to the Glasgow Outcome Scale. Outcome was classified as “favourable” if the Glasgow Outcome Scale (GOS) score was 5 or 4, and classified as “unfavorable” if GOS score was 3 or less. The mean age of the patients was 57.99±12.74 years with male and female ratio was 1.66. The mean blood volume was 28±19.99 cc and all patients were hypertensive. There was significant difference (p <0.001) in outcome in relation of age and volume of blood. Age > 70 years, GCS < 8 on admission, clot volume above 40 cc, and intraventricular extension remain the most consistent predictors of mortality and poor outcome following surgical evacuation of spontaneous supratentorial intracerebral hematoma. The present study could only assess mortality and the functional outcome. Since a proportion of survivors had an unfavorable outcome, quality of life measures is important and need to be addressed in future studies.

Highlights

Intracerebral hemorrhages (ICH) constitute about 10% to 20% of all strokes
The world health organization (WHO) defined stroke as “rapidly developing clinical signs of focal or global disturbances of cerebral functions, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin” [Spontaneous intracerebral hemorrhage (ICH) derives from rupture of an intracerebral artery or, less frequently, vein, which results in the formation of an intraparenchymal haematoma
The presenting Glasgow Coma Score (GCS), size and site of the ICH are thought to affect the postoperative outcome of the ICH patients

Summary

Introduction

Intracerebral hemorrhages (ICH) constitute about 10% to 20% of all strokes. In comparison to the ischemic strokes,ICHs are associated with greater morbidity and mortality [1]. The world health organization (WHO) defined stroke as “rapidly developing clinical signs of focal or global disturbances of cerebral functions, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin” [Spontaneous intracerebral hemorrhage (ICH) derives from rupture of an intracerebral artery or, less frequently, vein , which results in the formation of an intraparenchymal haematoma. Hypertension is one of the most major modifiable risk factors as the rough prevalence among adults in the US has been estimated to be 45.6%; this is an increase from 31.9% based on previous denotations of hypertension [5,6].

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