Sixty cases of hypertensive putaminal hemorrhage were operated on in our clinic over a period from January, 1974 to December, 1977. Thirteen cases fell into comatose state within 3 hours after the adoplectic attack. These operated fulminant cases were studied.
Five cases discharged on foot without any support. Two cases became vegetative state, and six cases were died. The patients fell into comatose state in 140 minutes in survival cases and in 93 minutes in fatal cases, on an average respectively. Carotid angiography was performed in 12 cases. Extravasation of the contrast media from the lenticulo-striate artery was seen in 9 cases. Blood pressure on admission was 230/126 mmHg in the cases with extravasation and 183/110mmHg in the cases without extravasation, on an average respectively. Blood pressure must be controlled for the prevention of extravasation.
Six fatal cases were autopsied. The cause of the death was trans-tentorial or tonsillar herniation. The hematoma penetrated to lateral ventricle in all the 6 cases. The fourth ventricle was filled with the hematoma in 3 cases. Thalamus was destroyed in 4 cases. The hematoma extended as far as the frontal subcortex in one case.
The light reflex was remained just before the operation in 5 recovered cases. In one case out of them, the light reflex had disappeared on admission and re-appeared by Mannitol rain-drops. On the other hand, the light reflex had disappeared in vegetative and fatal cases.
In survival cases, continuous ventricular drainage was performed in 3 cases, and V-P shunt was performed,in 2 cases. External decompression craniotomy was not necessary.
The life saving of the patients was possible by surgical treatment in peracute stage or within 3 hours after the apoplectic attack even in the cases of fulminant putaminal hemorrhage. For that purpose, establishment of emergency system must be achieved as soon as possible.
