An Option for Good Outcome of Intracerebral Hematoma

Abstract Background: Intracerebral hematoma affects about 2.5 per 10,000 people each year. The incidence is more in males and older people. The mortality rate is about 44% in the first month. 20% of cases has a good outcome. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often symptoms get worse over time. In many cases bleeding occurs in the brain tissue and the ventricles at the same time. Many procedures and techniques have been introduced for the management of intracerebral hematoma and debate always exist about the management of sizable intracerebral hematomas especially if the conscious level isn't markedly affected. Aim of Study: To evaluate the role of early evacuation of sizable intracerebral hematomas even if the conscious level isn't markedly deteriorated. Method: This is a retrospective study of 30 cases of intracerebral hematoma operated in Kasr El-Aini Hospitals and Bani Suef University Hospitals by evacuation assisted by microscope with a Glasgow Coma Scale more than 10 in most cases with a sizable intracerebral haemorrhage more than 30cc in the volume. Results: This study results was 22 (73%) male patients and 8 (27%) was female patients. The age group was 4 patients (13%) under 30 years, 22 patients (73%) were from 30-45 years and 4 patients (13%) were more than 45 years old. The Glasgow Coma Scale (GCS) on admission was 14-15 in 4 patients (13%) patients, from 10-13 was 14 patients (46%), and from 9 and less was 12 patients (41%). 20 patients (67%) case was diabetics, 23 patients (46%) cases was hypertensive, 2 patients (7%) had chronic renal failure on regular dialysis, 1 patient (3%) case was pregnant. The GCS post-operative was 14-15 in 20 patients (70%), 10-13 in 5 patients (16%), and from 9 and less in 5 (24%) cases. The operation done was evacuation in all cases, decompressive craniectomy in 8 patients (26%), ventriculosubgaleal shunt done (VSG) in 3 patients (10%). The side of the hematoma was left sided in 7 patients (24%), right in 23 patients (76%). Good out come in 25 cases (83%), recollection in 3 (10%) cases, residual hematoma in 2 (6%) of the cases, re evacuation done in 1 patient (3%). Mortality were 4 patients.
Conclusion: Sizable intracerebral hematoma (volume more than 30cc) in good Glasgow coma scale mostly obeying orders, spontaneous eye opening, and aphasic or not, to obtain a good outcome is to evacuate the hematoma not to wait for conservative management.