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  • SPontaneous Nontraumatic Intracerebral Hemetoma: Review from Tertiary Care Hospital in a Rural Setup

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    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Spontaneous non-traumatic intracerebral hemorrhage is a stroke subtype accounts for about 10% of all strokes (1). The hematoma locations are deep or ganglionic, lobar, cerebellar and brain stem in descending order of frequency. Intracerebral hemorrhage occurs twice as common as SAH and is equally as deadly. Risk factors for ICH include hypertension, angiopathy, advanced age, antithrombotic therapy and history of cerebrovascular disease. Surgical evacuation of ICH is of unproven benefit though a subset of well selected patients may have improved outcomes (2). A multidisciplinary approach is recommended, with participation of neurosurgeon, neurologist, critical care and rehabilitation as mainstay.

    Methods: 70 cases of spontaneous intracerebral hematoma were studied. All cases admitted over a period of 12 months between March 2016 to February 2017 were included in study. In our institute we perform decompressive craniotomy, evacuation of hematoma, external ventricular drainage (EVD) for cases of ICH. We normally employ CT scan as initial investigation followed by MRI scan if needed. Patients were stratified according to ICH scale based on Volume, GCS,Intra ventricular extension, age and infratentorial origin. Treatment outcomes were evaluated on the basis of patients initial assessment of neurological status, patients outcome, mortality and recurrence.

    Results: Based on ICH scores, patients outcome were compared. 60% of patients were above the age of 70 years. 29% of the patients were conservatively managed, remaining 71% surgically treated. Of the surgical interventions done, 60% were Decompressive surgery, 16% EVD, 24% Decompression & evacuation. Mortality rates were comparable with the standard rates as per ICH scoring sytem.

    Conclusions: ICH warrents for early aggressive care. Decompressive craniectomy without haematoma evacuation should be considered as the first line of surgery. The decision whether to perform evacuation should be individualized to the patients ICH score, considering factors such as the hematoma size, degree of midline shift and intraoperative brain swelling.

    Patient Care: 1. outcome on basis of ICH score ad other important findings like size of hematoma, midline shift, need to be considered. 2. intraoperative brain condition like swelling, massive SAH or assualt needs to be given importance while calculating outcome.

    Learning Objectives: 1. to analyse the various surgical options in the treatment of spontaneous intracerebral hematoma be able for residents to counsel the attendents of patients aboutr the prognosis of patient , need for surgery at initial assesment


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