SPONTANEOUS INTRACEREBRAL HEMORRHAGE

OUTCOME OF SURGICAL TREATMENT

Abstract

Intracerebral hemorrhage is a condition in which there is bleeding within the brain parenchyma without trauma. The
most common causes for this type of hemorrhage are hypertension, aneurysmal rupture, AVM rupture, coagulopathies
and metabolic disorders etc. OBJECTIVES: The aim of this study was to find out the out come of surgical treatment
in cases of spontaneous intracerebral hemorrhage especially due to hypertension and metabolic disorders. SETTING:
Department of Neurosurgery Quaid-e-Azam Medical College/ Bahawal Victoria Hospital Bahawalpur. PERIOD:
June 1998 to May 2000. PATIENTS & METHODS: Detailed history and examination was followed by plain CT
scan of brain. Most of these patients with hemorrhagic strokes were initially admitted in Medical ward of the same
hospital and from there they were shifted to Neurosurgery ward after initial work up and CT scanning. In majority
i.e. 25 (75%) of these patients the cause of hemorrhage was hypertension. The second most common cause in 6 (18%)
patients for hemorrhage was metabolic disorder especially renal and liver malfunction. RESULTS: Total number
of the patients were 33. Out of which 23 were males and 10 females. Mean age was 55 years (ranging from 22 to 80
years). Sudden headache followed by loss of consciousness, loss of speech and hemiplegia or hemiparesis were the
commonest presenting complaints. Most of the haematoma (75%) were found to be on left side of brain with focal
neurological deficits on right side along with aphasia or dysphasia. Common sites for hemorrhage were basal ganglia,
internal capsule and thalamic regions of the brain 25 (75%). A few 3 (9%) of these clots were found in the
cerebellum. After investigations and initial resuscitation, various procedures performed were, burr hole aspiration
3 (9.3%), craniectomy 5 (15.3%) and craniotomy 25 (75%). In 25 patients, free flap craniotomy was done with
craniotome to remove the clot. 20 (60%) out of 33 patients improved regarding their hemiparesis and dysphasia. 5
(15%) patients expired even after surgery. 8 (24%) patients remained in the same status as were before surgery.
Patients with GCS 5 or above with sizeable focal clot, were subjected to surgery. Patients with GCS below 5, deeply
comatosed, with extensor response or no response to painful stimuli and with blood in the ventricular system were
excluded from the study. CONCLUSION: Surgery is a good option, though controversial for the treatment of ICH.
It gives satisfactory results when a patient is young, without any other illness and with good GCS score i.e. more than
8. Its prognosis is bad in older patients other systemic disease or any metabolic problem along with low GCS score
i.e. below 8. There are controversies in decision making patients with ICH operate or not to operate.