Muhammad Arshad, Muhammad Zafar Iqbal, Muhammad Yasin.
Spontaneous Intracerebral Hemorrhage; outcome of surgical treatment.
Professional Med J Jan ;9(1):13-8.

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: plain CT scan of brain followed detailed history and examination. 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 was 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.

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