Indication and timing of surgery for hypertensve putaminal hemorrhage were investigated in 30 patients on the basis of changes in SEP pattern and functional outcome of hemiplegia (ADL). The patients were classified into 5 grades according to estimation of clinical severity by Mizukami. Hematoma was removed in 20 patients and ventricular drainage was performed in 2 (Table 1). Five patients of grade I, 2 of grade II and one of grade V did not have definitive surgery.
Seven patients of grade I showed normal or almost normal pattern of SEP, and restored normal walking and functional hands. Three of grade II, in whom N2-N3 components of SEP were preserved despite of a decrease in amplitude more than 6 hours after the ictus, made good recoveries following the surgery in the subacute as well as acute stage. They were evaluated in sufficient recovery to walk, and one of them restored a functional hand, the other 2 the supported hands. A patient of grade III having the similar pattern of SEP was treated conservatively, being evaluated to be in supported walk and abolished hand.A separate group of 7 patients of grade II and 4 of grade III, in whom SEP showed deficit of N2-N3 components or flat pattern, became able to walk with a cane, but lost function of the hand. Another 2 patients of grade III became totally disable. Despite of surgery within 6 hours after the ictus, prognosis of the patients of grade IV and V, who usually had flat SEP, was much poor.
It may be concluded that:(1) SEP pattern is a good indicator for deciding indication of surgery and predicting functional recovery especially of the upper limb in the cases of hypertensive putaminal hemorrhage. (2) Preservation of N2-N3 components of SEP in the cases of grade II promises sufficient recovery, if hematoma is evacuated in the subacute stage. (3) Deficit of N2-N3 components or flat pattern of SEP in grade II patients means poor functional prognosis.
