Conservative Treatment of Hypertensive Cerebral Hemorrhage : Results of 104 patients of acute stage.

Abstract

Mortality and morbidity are reviewed in cases of cerebral hemorrhage patients who were transported to and were treated conservatively at the Research Institute of Brain and Blood Vessels, Akita, from May, 1969 through April, 1974. Of 104 cases, there were 85 cases with hematoma of basal ganglia, 15 cases of pontine hemorrhage, and four cases of cerebellar hemorrhage. Of the total 74 cases (71%) were admitted within the first day of stroke. The level of consciousness on admission was semicomatose or comatose in 54 cases (52 %).
Most of the cases were transported to the hospital by a hospital ambulance with a doctor, and a nurse as soon as possible after the onset of stroke. Patients were treated in the NCUs (Neurovascular Care Units) or sub-NCUs, depending on the type of stroke and the severity.
The survival rates within one month in the hospital was 59 % for patients with hematoma of basal ganglia, 27 % for patients with pontine hemorrhage, and none for patients with cerebellar hemorrhage, or 52 % for all 104 cases. One-month survival rates was 39 % for cases admitted within the first day of attack, 78 % for those transported between two to three days, 87 % for cases admitted between four to seven days, and 100 % for those transported between eight to fourteen days, following stroke.
Among 104 cases, 12 cases (11 %) died within the first day after the attack, 37 cases (35 %) within seven days, 50 cases (48 %) within one month, 54 cases (52 %) within six months, and 58 cases (56%) within one year following the stroke.
Survival rates of one week, one month, six months, and one year, were 41 %, 20 %, 17 %, and 13 %, respectively, in the semicomatose or comatose patients group, 86 %, 81 %, 76 %, and 73 %, respectively, in the somnolent or stuporous patients group. All cases but one, who died of other than cerebrovascular disease, survived in the group with clear consciousness upon admission. Therefore, it can be concluded that there is good correlation between the level of consciousness upon admission and the prognosis in this series.
Morbidity of one year after the onset in 50 patients who survived more than one month, are as follows : eleven patients improved well enough to live and work without any difficulty, sixteen were capable of taking care of themselves in dialy chores, but incapable of work, eight needed on other's aid, nine were confined to their beds, and six patients died.
Patients who were in disturbed consciousness three months following cerebral hemorrhage, could not get alert both six months and one year after the incident of apoplexy. Of 50 survivers with basal ganglionic hemorrhage, four cases (8 %) were in akinetic mutism or apallic state. All survivors with pontine hemorrhage were always in the state of akinetic mutism.
Of 50 autopsies, 42 cases (84 %) of complicated ventricular bleeding were observed, 19 cases (38%) of uncal or cingulate or tonsillar herniation, and 13 cases (19%) of pontine bleeding secondary to basal ganglionic hemorrhage. The incidence of systemic complications in 50 autopsied cases were gastrointestinal abnormalities (61%), pneumonia (23%), and urinary tract infection (19 %). In other words, complications were found most markedly in the gastrointestinal tract and frequency of infections appeared to be relatively lower.