We conducted a survey on 1080 patients (683 males, 397 females) with putaminal hemorrhage. The cases were complied from neurological and neurosurgical clinics (53 in total) in the Tohoku districts between 1984 and 1986. The patients ranged in age from 29 to 92 with 62.5% (675 cases) being from 50 to 69 years of age.
The hematoma was removed in 445 with 63.1% of the surgical cases being operated within 24 hours from onset. The size of the hematoma on computed tomography increased within 6 hours in patients with enlarged hematoma. Clarity of consciousness was more impaired in the patients with larger hematoma, with intraventricular extension or with a hematoma on the left cerebral hemisphere.
Motor palsy was seen in about 97% of the cases, without difference between the upper and lower limbs. Eye balls deviated conjugately in 30%, of the patients. Herniation sign was detected in 16% of the cases. Systolic blood pressure was over 180 mmHg in about 40% and was lower than 140 mmHg in about 23% of the cases.
The hematoma was removed directly with craniotomy in 266 patients, and aspirated in 122 patients. The former was done within 3 days in 90.2% of the cases, whereas the latter was done in 71.3% between 24 hours and 7 days after onset. The former was superior for total removing the hematoma. Postoperative bleeding occurred in 3.1% in the former and in 5.8% in the latter.
Rehabilitation was combined in 672 (62.2%). Accidents, deuteropathy, and complications occurred in 40.7% of the surgical cases, and in 26.9% of the non-surgical cases. Death due to the original diseases was noted in 19.6% of the surgical cases within 26 days, and in 80.4% of non-surgical cases within 4 days after onset.
Clear consciousness was seen in 55.0% of the surgical cases, but in 82.1% of the non-surgical cases. Return to work and self-care after 6 months were seen in 36.6% of the surgical cases, and in 68.3% of the non-surgical cases. This was considered to be related to the initial severity of the diseases.
From the standpoint of outcome, surgical treatment is better than conservative therapy only in cases of 4a and 4b of neurological grading i.e. semicoma patient without and with herniation sign, with the result as far as this survey concerns.
