(I) 高血圧性脳出血

(2) 視床出血

抄録

We have analysed the patients data of thalamic hemorrhage, which have been sbmitted from the neurological and neurosurgical clinics in Tohoku district during the period from January 1985 to December 1987. The total number of cases was 802 (430 males and 372 females). The age distribution of the patients ranged from 38 to 93 years of age and the peak of incidence occurred in the 6th decade. About 90% of the cases was admitted to hospital within 24 hours from onset and operative treatments were carried out in 160 cases (20%).
At the time of initial CT examination, about half of the cases showed minor disturbance of consciousness and herniation sign was detected in 7% of the cases. Consciousness was more impaired in the patients with larger hematoma, with extra-thalamic extension of the hematoma, or with a hematoma on the left side of the thalamus.
Symptomatology at the time of admission was as follows. Pupilar abnormality was observed in about 25% of the patients. Each of upwards gaze palsy, downwards conjugate deviation and Horner's sign was detected in 1015% of the cases and conjugate deviation of the eye balls was shown in 18% of all the cases. Motor paresis was seen in about 95%, with a high frequency in the cases with larger hematoma. On the other hand, sensory impairment was presented in about 75%, with high frequency in the patients with extrathalamic extension of the hematoma. Disturbance of speach was seen in about half of the cases. Hypertension over 160 mmHg in systolic was seen in about 66% of all the patients.
Increase of the size of the hematoma on CT followed after hospitalization was occurred in only 4% of the patients.
Removal of the hematoma was performed in 79 cases (9.9%). Of these, 9 cases were operated on by direct intracranial surgery with craniotomy and the remaining 70 cases were operated by CT or US guided aspiration. The former was done in 78% of the cases within 24 hours, whereas the latter was performed in 81% between 24 hours and 15 days after onset. As to the rate of removed hematoma, there was no significant difference between both procedures. Continuous ventricular drainage was carried out in 99 cases of the patients.
Postoperative complications occurred in 48% of the operated cases and in 30% of the non-operated cases. There were 116 deaths, namely the mortality rate was 15% for all the cases. Death due to the original disease was noted in 26 cases of the surgical cases and in 49 cases of the non surgical cases respectively.
At the time of discharge, about 60% of the surgical cases and 76% of the non surgical cases were state of clear consciousness. Thalamic pain occurred in 33 cases. Return to work and self-care 6 months after onset were seen in 31% of the surgical cases and 63% of the non surgical cases.
From the statistical analysis of outcome after 6 months from onset, surgical treatment is better than conservative therapy only in case with large hematoma on initial CT and in case of IIIb of CT classification.