Abstract
Authors treated the patients with basal ganglionic hemorrhage by our operative criteria. The criteria is based on clinical grading according to the level of consciousness within 24 hours after onset.
Grade 1°: alert-somnolent
Grade 2°: stuporous
Grade 3°: semicomatose
Grade 4°: comatose (the reversible function of brain stem)
Grade 5°: deep comatose (the irreversible function of brain stem)
We reviewed 44 patients with basal ganglionic hemorrhage which were operated between Jan. 1974 and Dec. 1976. Computed tomography (CT) was performed in 13 patients of them. Three of 44 patients died within 1 month after operation. The follow up studies were carried out in the other cases over 3 months. Sixty-five percent of patients in our grade 1°, 20% of patient in grade 2°, 31% of papients in grade 3° showed good results (1°-2°) in the activities of daily living (ADL). None of patients in grade 4° and 5° showed good results in ADL. It is sure that ADL depends on the amount of hematoma, the level of consciousness within 24 hours after onset, the cerebral dominancy and the intraventricular hematoma. But, the most striking fact we would stress in this paper is that ADL of those patients depends on the location and extension of hematoma, which was evidenced by CT.
As illustrated in Fig. 1, the location and extension of hematoma are expressed in four groups (L, M, A, S). The correlation between ADL and the location and extension of hematoma evidenced by CT, is showed in Fig. 2.
So, we made a new clinical grading according to the level of consciousness within 24 hours after onset and the findings of CT.
We concluded as to management of the disease as follows.
Grade 1°: medical treatment surgical treatment for deteriorating cases
Grade 2°-4°: surgical treatment
Grade 5°: medical treatment
