Hypertensive intracerebral hematoma is a serious and potentially lethal condition. The indication of surgery in this hematoma is still controversial. Authors have treated 335 cases of hypertensive intracerebral hematomas which were confirmed by computerized tomography between July 1, 1982 and June 30, 1986. The hematomas have been classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity daily living. According to our study, moderate and severe types of putaminal hematoma cases have shown better results with surgery than conservative management. Mortality was 23.7 percent in surgery and 35.3 percent in conservative management.
Hematoma* ; Mortality ; Putaminal Hemorrhage

We have analysed 144 patients with hypertensive putaminal hemorrhage, admitting from January 1992 to December 1993. Surgical treated group with Komai's stereotactic system was 71 patients and medical treated group was 73 patients. The results were as follows: 1) The patients with ventricular rupture were 36 cases(25%). According to the degree of ventricular rupture, the mortality was increased and the good outcome was decreased(P<0.01). 2) The prognosis was evaluated in favorable condition(alert and drowsy) and unfavorable condition(stuporous, semicomatose, comatose). In unfavorable condition, the mortality of surgical patients was lower than that of non-surgical patients(P<0.01). 3) Surgical patients with smaller hematoma(< or = 40ml) showed btter outcome than non-surgical patients:The statistical difference was not significant. But in larger hematoma(>40ml), the outcome in both treated group was similar. 4) According to CT classification, in class II(extending to anterior limb of internal capsule), good outcome of surgical group was better than that of non-surgical group. In class V(extending th thalamus or subthalamus), the mortality in surgical group was lower than that of non-surgical group(P<0.05) .
Classification ; Extremities ; Humans ; Mortality ; Prognosis ; Putaminal Hemorrhage* ; Rupture ; Thalamus

To compare intrahematomal pressure(IH) with epidural pressure(EP), lumbar subarachnoid pressure(LP) and intraventricular pressure(IV), 34 intracerebral hemorrhage patients from Dec. 1986 to Aug. 1987 were selected. We measured IH via stereotacically placed catheter and at the same time, we measured EP with fiberoptic sensor, LP by lumbar puncture and IV via stereotactically placed catheter during communication between hematoma and ventricle. The results obtained were as follows : 1) IH was the highest in most cases and IH, IV, LP and EP in orders by mean values. 2) In distribuion of EP, LP and IV compared with IH, EP had wide range of distribution(17~500%) compared to LP and IV. 3) There was a tendency of increased rate of higher IH than EP according to increased size of hematoma. 4) There was a tendency of increased rate of higher IH than EP in thalamic hemorrhage than putaminal hemorrhage. 5) ICP curves showed abrupt increase or decrease in cases of rebleeding or communication between hematoma and ventricle. 6) In analysis of low IH compared with EP and LP, the causes were due to checking of IH just after aspiration of large amount of hematoma(3 cases) and normal variations(6 cases). 7) In analysis of failed monitoring, EP was 5 cases(19%) and IH was 3 cases(8.8%) so more failed monitoring were found in EP than IH and there was no failed cases in LP and IV. From above results, we concluded that IH was the highest in most cases and EP was less reliable than other pressures.
Catheters ; Cerebral Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Intracranial Pressure* ; Putaminal Hemorrhage ; Spinal Puncture ; Ventricular Pressure

OBJECTIVE: The purpose of this study is to prove and quantify motor tract disruption and to correlate with motor weakness and its recovery in thalamic and putaminal hemorrhage using diffusion tensor magnetic resonance(MR) image. METHODS: We studied 24 patients with thalamic and putaminal hemorrhage with motor weakness who did not underwent surgery(hematoma volume < 25ml). We performed diffusion tensor MR image within a week, and then calculated FA(fractional anisotropy) index and FA ratio of posterior limb of internal capsule. We checked motor power of the patients at initial, 2 weeks, 1 month, 3 months and 6 months after hemorrhage. We divided patients into three groups according to FA ratio(group A: FA ratio < 50.0%, group B: FA ratio 50.0~75.0%, group C: FA ratio > 75.0%)and compared means of motor power at each time. RESULTS: The means of FA ratio were 42.5% in group A, 63.0% in group B and 88.2% in group C. The means of motor power were 1.1, 2.3 and 3.7 at initial. After 6 months the means of motor power were 3.0, 4.0 and 4.5. The group of lower FA ratio had more severe motor weakness and showed worse motor recovery clinically than the group of higher FA ratio(P < 0.01). Though patients had severe motor weakness initially, the patients with high FA ratio showed good recovery. CONCLUSION: In thalamic and putaminal hemorrhage, diffusion tensor MR image can prove the degree of motor tract damage and predict the degree of motor recovery.
Diagnosis* ; Diffusion* ; Extremities ; Hemorrhage ; Humans ; Internal Capsule ; Magnetic Resonance Imaging* ; Putaminal Hemorrhage*

The authors operated 127 cases of the spontaneous intracerebral hematoma patients who were admitted via the emergency room during the recent two years. The location, timing of operation, method of approach, mortality etc. were analyzed. The results are as follows : 1) putaminal hemorrhage was 47.3%, thalamic hemorrhage was 23.6%, subcortical hemorrhage was 18.9%, cerebellar hemorrhage was 3.9%, pontine hemorrhage was 1.6%, and IVH only was 4.7%. 2) 77.2% was operated during the first 48 hours from the onset. 3) Almost all of the procedures were transcortical and trans-sylvian approach. 4) The mortality rate was 52.0%. 5) Microsurgical technique and external ventricular drainage(or ventriculoperitoneal shunt) played an important role for the good surgical outcome.
Emergency Service, Hospital ; Hematoma* ; Hemorrhage ; Humans ; Mortality ; Putaminal Hemorrhage ; Ventriculoperitoneal Shunt

The treatment of patients with hypertensive intracerebral hemorrhage (ICH) is still controversial. Fifty-two cases with hypertensive thalamic or putaminal hemorrhage were classified into three groups on the basis of the location of the hematoma in the internal capsule on eht CT image. All the cases were confined to the anterior(Type A, 17 cases)., posterior(Type P, 25 cases) and mixed portion(Type M, 10 cases) of the posterior limb of the internal capsule, and were assigned to receive medical treatment, extraventricular drainage(EVD), or stereotactic aspiration using urokinase. This study was designed to assess the correlation between hematoma extension and the severity of motor disturbance in patients treated with stereotactic aspiration. The severity of motor weakness was found not to be related to hematoma extension, but the prognosis was frequently poor in type P and type M. The outcome was better in the stereotactic aspiration group, as compared with medical and EVD groups, especially when the hematoma was located at the posterior portion of the posterior limb of the internal capsule(p<0.05). The study suggests that stereotactic aspiration may improve the outcome of hypertensive ICH with severe motor weakness, even if the hematoma is small.
Extremities ; Hematoma ; Humans ; Internal Capsule* ; Intracranial Hemorrhage, Hypertensive* ; Prognosis ; Putaminal Hemorrhage ; Urokinase-Type Plasminogen Activator

OBJECTIVE: The aim of this study is to describe the surgical outcome and determine prognostic factors of hypertensive putaminal hemorrhage in the elderly patients. METHODS: In a retrospective study, we analyzed the surgical outcome of 61 patients under 50 year-old (the younger group) and 57 patients over 70 year-old (the older group) with hypertensive putaminal hemorrhage treated from April 1998 to May 2002 in our institution. Neurological condition, brain computed tomography characteristics, and previous disease were analysed to select prognostic factors. The Glasgow Outcome Scale after six months was used for comparison of outcome. RESULTS: Of 16 patients with an initial GCS of 3-6, six of the younger group (86%) and nine of the older group (100%) had poor outcomes (p=0.062). Of 64 patients with an initial GCS of 7-11, 24 of the younger group (73%) and 23 of the older group (74%) had good outcomes. Of 38 patients with an initial GCS of 12-15, 20 of the younger group (95%) and 16 of the older group (94%) had good outcomes. Of 58 patients with moderate hematoma (30-50ml), 23 of the younger group (79%) and 22 of the older group (76%) had good outcomes. Of 30 patients with large hematoma (>50ml), 6 of the younger group (40%) and 5 of the older group (33%) had good outcomes (P=0.144). Of 21 patients with intraventricular hemorrhage, 6 of the younger group (60%) and 10 of the older group (91%) had poor outcomes (2.6 versus 1.8: p=0.016). Of 13 patients with hydrocephalus, 4 of the younger group (67%) and 7 of the older group (100%) had poor outcomes (2.5 versus 1.4: p=0.006). The surgical outcome of hypertensive putaminal hemorrhage showed no significant difference in the older group compared with the younger group. Outcome was worse in the older group with intraventricular hemorrhage or hydrocephalus. CONCLUSION: We conclude that surgical treatment for hypertensive putaminal hemorrhage in the elderly patients without intraventricular hemorrhage or hydrocephalus is needed. Poor prognosis in elderly patients is significantly associated with intraventricular hemorrhage and hydrocephalus.
Aged* ; Brain ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Middle Aged ; Prognosis ; Putaminal Hemorrhage* ; Retrospective Studies

We traced median nerve somatosensory evoked potential(SSEP) in 57 patients with putaminal hemorrhage from February, 1986 to January, 1991 for evaluation of relationship between SSEP findings and Glasgow outcome scale. 1) All patients with normal SSEP, prolonged central condution time and low ampulitude of cortical wave at affected side with small sized putaminal hemorrhage had good recovery to grade I. 2) Nine out of 25 patients with flat cortical wave of SSEP in small sized putaminal hemorrhage recovered to grade I. 3) All patients with moderate or large sized putaminal hemorrhage had flat cortical wave at affected side, none of them improved to grade I. It suggested that SSEP tracing in putaminal hemorrhage seemed to be valuable for evaluation of prognosis.
Evoked Potentials, Somatosensory* ; Glasgow Outcome Scale ; Hemorrhage* ; Humans ; Median Nerve ; Prognosis ; Putaminal Hemorrhage

OBJECTIVE: The aim of this study was to find out the factors related to the recovery of hand motor function in patients with subcortical hemorrhage. METHOD: We investigated 21 patients with subcortical hemorrhage prospectively. We used their CT and/or MR imaging for the localization and estimation of the size of lesion. The Hand Movement Scale (HMS) was used for evaluation of the hand function. Proprioception, initial shoulder and hand recovery were also measured every month for at least 6 months during the follow up periods. RESULTS: There are 13 patients with putaminal hemorrhage and 8 patients with thalamic hemorrhage. There is no difference in general characteristics between the two groups. When recovery began within 4 weeks after onset, only thalamic hemorrhage patients showed significantly good recovery. Initial shoulder shrug, especially within 4 weeks after onset, could be one of the prognostic factors of good hand motor recovery. Putaminal hemorrhage patients, who had higher scores on the hand movement scale, showed early recovery of proprioceptive function. CONCLUSION: Among many other factors which can be involved in the recovery of hand function in patients with subcortical hemorrhage, the time of initial hand motor recovery, the time of initial shoulder shrug, and proprioceptive function were most important.
Follow-Up Studies ; Hand* ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Proprioception ; Prospective Studies ; Putaminal Hemorrhage ; Shoulder

OBJECTIVE: The purpose of this study is to investigate the risk factors for hematoma enlargement(HE) in the patients with spontaneous putaminal hemorrhage. METHODS: Among the 620 patients with putaminal hemorrhage admitted to our hospital during the period of 1990-2000, sixty patients(9.7%) had HE on the second computed tomographic(CT) scan at the interval of mean 38 hours after attack(range 1.8-168 hours). Clinical features and CT findings of these 60 patients with HE were compared with those of the remaining 560 patients without HE. RESULTS: Multivariate logistic regressional analysis revealed that the independent risk factors for HE were CT finding showing the separation of hematoma(odds ratio[OR] 3.5, 95% confidence interval [CI] 1.7-7.3, p=0.0006) or the hypodensity around or within hematoma(OR 2.5, 95% CI 1.2-5.6, p=0.0194), alcoholism(OR 4.8, 95% CI 2.0-11.7, p=0.0004), hematoma volume of 20-39cc(OR 2.54, 95% CI 1.0-6.3, p=0.0424), Glasgow Coma Scale(GCS) score of 8-11(OR 3.1, 95% CI 1.4-6.9, p=0.0046) and glutamic-pyruvic transaminase>50 IU/L(OR 6.54, 95% CI 2.1-20.5, p= 0.0013). CONCLUSION: Alcoholism and liver dysfunction appear to increase the risk of HE in putaminal hemorrhage. Particularly, careful observation for HE is needed in the patients who are GCS score of 8-11 at the time of admission, who have hematoma volume of 20-39cc and the CT finding showing the separation of hematoma or the hypodensity around or within hematoma.
Alcoholism ; Coma ; Hematoma ; Humans ; Liver Diseases ; Logistic Models ; Putaminal Hemorrhage* ; Risk Factors*