日本医科大学雑誌
Online ISSN : 1884-0108
Print ISSN : 0048-0444
ISSN-L : 0048-0444
被殻出血および視床出血の予後に関する研究予後規定因子等の比較検討
若杉 洋
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ジャーナル フリー

1987 年 54 巻 1 号 p. 63-77

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The prognosis and factors affecting prognosis of 66 putaminal hemorrhage (PH) and 48 thalamic hemorrhage (TH) cases were compared. All patients were diagnosed by CT scan and treated palliatively. They were studied for six months. Functional prognosis was classified into four groups as follows according to activities of daly living (ADL): ADL1 almost full recovery, ADL2 partially dependent, ADL3 almost completely dependent, ADL4 bedridden.
The results were as follows:
1) The mortality rate for PH sufferers, 44.5%, was almost the same as for TH sufferers, 46.8%. 21 (58%) out of PH survivors were classified as ADL1 which was significantly higher than the percentage of ADL1 (23%) in the TH group (p<0.05).
2) Age was one of the major factors affecting prognosis in both the PH and TH groups. For patients in their forties and fifties functional prognosis was favourable. For those in their sixties and seventies ADL was generally poor. Patients in their eighties had an extremely poor prognosis.
3) Deterioration or improvement in consciousness level from admission to the third day of illness occurred more frequently in the PH group than in the TH group. A deterioration in consciousness level indicated a poor prognosis.
4) Anisocoria with a dilated pupil on the same side as hematoma was the worst prognostic ocular sign in both groups. The second worst sign was a non-reactive pupil.
5) None of the TH patients with a severe motor inability on admission advanced to the ADL1 category.
6) In both the PH and TH groups, the patients with bilaterally positive Babinski reflexes had a poor prognosis.
7) A close correlation between CT classification and prognosis was found in both the PH and TH groups. P1 and T1 showed a good prognosis. In patients of P2a and T2a, prognosis depended on their age. However no T2a cases advanced to the ADL1 category. In P2b, T2b, P3 and T3, prognosis was poor.
8) The estimated hematoma volume on CT had a close correlation with the prognosis in PH and TH. The maximum hematoma volume of ADL1 in the PH group was 18 ml and 3 ml in the TH group. Over 80ml was fatal in the PH group, and over 10 ml in the TH group resulted in ADL4 or death.
9) Hematoma rupture into the ventricular system occurred in cases of PH when the hematoma volume was over 25 ml, 4 ml in cases of TH. PH and TH cases with a ventricular rupture generally had a poor prognosis. None of rupture cases in PH became ADL1. A rupture into the 3rd and /or 4th ventricle resulted in an extremely poor prognosis in both the PH and TH groups. However the prognosis of rupture cases was considered to depend more on the degree of brain damage than the ventricular rupture itself.
10) The mean survival time of fatal TH cases was shorter than that of PH (5.4 days vs 9.8 days).

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