1095. Factors governing better outcome for Surgical Management of Hypertensive Intracerebral Hematoma
Authors: Ahmed Atallah Saad, MSc; Mohamed Ramadan; Amr Elsamman; Mohamed Rady (Cairo, Egypt, Arab Rep.)
Primary ICH accounts for 70-80% of cases of ICH and are caused by either chronic hypertension, which accounts for over 50% of cases, or amyloid angiopathy. High blood pressure has been reported as a major risk factor for intracerebral hemorrhage. There is a big controversy about the management of such cases, whether medical or surgical. Surgical approaches are numerous.
The current study was carried in Cairo university hospitals on 30 cases suffering from spontaneous intracerebral hemorrhage with clinical diagnosis of hypertension where we operated upon and the outcome of these cases and factors affecting the outcome were observed.
We found that; there's a significant relationship between GCS on admission and outcome. (P = 0.002), GCS preoperative is significantly correlated with GCS postoperative i.e. the better the GCS pre-op. is, the better the GCS post-op would be. (Pearson correlation coefficient "r" = 0.65, p-value <0.001 "2-tailed"), there's a highly significant relationship between Volume of hematoma and outcome (P-value = 0.01), no significant difference was detected between the outcome of cases with residual hematoma volume (≤ 20 cc.) after surgical evacuation and cases with total hematoma evacuation (P= 0.81), no statistically significant difference was detected between the outcome of the diabetic and non-diabetic patients. (P = 0.86). The best surgical results were obtained in patients who present early, hematoma size 30-60 cc, and in patients with GCS above 7.
In our study we have concluded that early evacuation before 24 hours is better, the best candidates for ICH evacuation are those with hematoma volume 30-60 cc and GCS more than 7. The emergency department staff and ICU staff need to be specially trained to deal with such cases.