抄録
The anatomical site and the size of intracerebral hematoma should be definitely classified. However, it is the most important in order to determine ADL (activities of daily living) of the patient whether the pyramidal tract, speech center et al. are destroyed or not. We have to know many clinical symptoms depending upon either the irreversible destruction by hematoma or the reversible dysfunction by perifocal edema around the hematoma.
When CT shows much clot in the ventricle obstruct the foramen of Monro or aqueduct, the aspiration of hematoma or washing out clot in the lateral ventricle and external drainage is necessary. This procedure makes the prognosis better.
Some cerebellar hemorrhage may make internal hydrocephalus due to block of cerebrospinal fluid. In such a case vetriculo-peritoneal shunt is necessary.
The midline shift of the brain is not determining prognostic factor. Any findings of descending tentorial herniation indicate the worst prognosis.
It is summarized as follows: Determining prognostic factors of intracerebral hemorrhage are 1) the destruction of functional center or tracts, for examples, the site keeping consciousness, pyramidal tracts and speech centers, 2) internal hydrocephalus due to block of cerebrospinal fluid, and 3) descending tentorial herniation.
