Assessment of Factors Associated with the Outcome in Patients with Hypertensive Putaminal Hemorrhage

Abstract

A total of 32 patients with hypertensive putaminal hemorrhage, who had been admitted within 24 hours of onset, were reviewed. Patients were divided into three groups on the basis of their outcome at hospital discharge, as follows: Group A, 11 patients who were able to walk independently with good or full recovery from hemiparesis; Group B, 9 patients who were able to walk with a cane and 2 patients in wheel chairs; and Group C, 6 patients who required evacuation of hematoma and 4 who had died. We investigated factors affecting outcome by comparing the clinical features during the acute stage and degrees of hypertensive damage to the retina, heart, and kidney of the above three groups. Furthermore, we examined interrelationships among the volume of the hematoma (as calculated from CT scan), systemic blood pressure, and urinary catecholamine excretion in 10 of these patients. The mean age in groups A, B and C was 61.4±8.1, 58.0±11.3, and 52.4±6.8, respectively. The mean volume of hematoma on admission (Day 1) in Group C (50.2±28.2ml) was significantly larger than in the other two groups (p<0.01, vs Group A: 19.5±8.8ml; p<0.05, vs Group B: 25.1±12.6ml). In Group C, the mean hematoma volume on Day 2 (98.4±39.5ml) was significantly larger than the volume on Day 1 (p<0.01). Among the three groups, the level of systemic blood pressure in Group C was the highest on Day 1 and the mean systolic blood pressure on Day 2 in Group C was significantly higher than that on Day 2 in Group A (p<0.05) and in Group B (p<0.01). There were no significant differences among the three groups in blood chemistry, blood coagulation data, or severity of hypertensive changes. Systemic blood pressure and urinary excretion of catecholamine had no correlation with the volume of hematoma. However, urinary excretion of norepinephrine showed a good correlation with mean systolic blood pressure (r=0.735, p<0.05). From the results of the present study, it is suggested that the risk of the growth of hematoma increases if the hematoma volume is more than 50ml and/or systemic blood pressure is high during the early stage of cerebral hemorrhage. Moreover, these patients appeared to be in a state of elevated sympathetic nervous function. Furthermore, our data indicate that there is no correlation between severity of hypertensive changes and development of hematoma.