Abstract
We experienced 22 operative cases of putaminal hemorrhage since 1974. Postoperative follow-up studies have been reviewed. We proposed a clinical Grading for putaminal hemorrhage according to our results. This Grading consist of level of consciousness and side of hematoma.
Grade 1: consciousness is alert
Grade 2: mild disturbance of consciousness (able to respond to verbal commands)
Grade 3: moderate to severe disturbance of consciousness (purpouseful movement can be elicited by noxious painful stimuli)
Grade 4: severe disturbance of consciousness (purposeful movement can not be elicited by noxious painful stimuli, but oculocephalic reflexes can be elicited)
Grade 5: oculocephalic reflexes can not be elicited (One grade is added when hematoma is located in dominant side)
The postoperative results showed that Grade 2 (6 cases) were good and enjoyed useful life in all cases. All cases were died in Grade 5 (5 cases). Mortality is 0% except Grade 5.
We concluded to management for hypertensive intracerebral hemmorrhage (putaminal hemorrhage) as follows.
Grade 1: conservative treatment
Grade 2: surgical treatment except cases of dominant side hematoma without aphasia
Grade 3: surgical treatment
Grade 4: surgical treatment except over 60 yrs old with dominant side hematoma
Grade 5: no indication for surgical treatment
This Grading may be useful for thalamic hemorrhage also.
