We conducted a survey on 1080 patients (683 males, 397 females) with putaminal hemorrhage. The cases were complied from neurological and neurosurgical clinics (53 in total) in the Tohoku districts between 1984 and 1986. The patients ranged in age from 29 to 92 with 62.5% (675 cases) being from 50 to 69 years of age. The hematoma was removed in 445 with 63.1% of the surgical cases being operated within 24 hours from onset. The size of the hematoma on computed tomography increased within 6 hours in patients with enlarged hematoma. Clarity of consciousness was more impaired in the patients with larger hematoma, with intraventricular extension or with a hematoma on the left cerebral hemisphere. Motor palsy was seen in about 97% of the cases, without difference between the upper and lower limbs. Eye balls deviated conjugately in 30%, of the patients. Herniation sign was detected in 16% of the cases. Systolic blood pressure was over 180 mmHg in about 40% and was lower than 140 mmHg in about 23% of the cases. The hematoma was removed directly with craniotomy in 266 patients, and aspirated in 122 patients. The former was done within 3 days in 90.2% of the cases, whereas the latter was done in 71.3% between 24 hours and 7 days after onset. The former was superior for total removing the hematoma. Postoperative bleeding occurred in 3.1% in the former and in 5.8% in the latter. Rehabilitation was combined in 672 (62.2%). Accidents, deuteropathy, and complications occurred in 40.7% of the surgical cases, and in 26.9% of the non-surgical cases. Death due to the original diseases was noted in 19.6% of the surgical cases within 26 days, and in 80.4% of non-surgical cases within 4 days after onset. Clear consciousness was seen in 55.0% of the surgical cases, but in 82.1% of the non-surgical cases. Return to work and self-care after 6 months were seen in 36.6% of the surgical cases, and in 68.3% of the non-surgical cases. This was considered to be related to the initial severity of the diseases. From the standpoint of outcome, surgical treatment is better than conservative therapy only in cases of 4a and 4b of neurological grading i.e. semicoma patient without and with herniation sign, with the result as far as this survey concerns.
We have analysed the patients data of thalamic hemorrhage, which have been sbmitted from the neurological and neurosurgical clinics in Tohoku district during the period from January 1985 to December 1987. The total number of cases was 802 (430 males and 372 females). The age distribution of the patients ranged from 38 to 93 years of age and the peak of incidence occurred in the 6th decade. About 90% of the cases was admitted to hospital within 24 hours from onset and operative treatments were carried out in 160 cases (20%). At the time of initial CT examination, about half of the cases showed minor disturbance of consciousness and herniation sign was detected in 7% of the cases. Consciousness was more impaired in the patients with larger hematoma, with extra-thalamic extension of the hematoma, or with a hematoma on the left side of the thalamus. Symptomatology at the time of admission was as follows. Pupilar abnormality was observed in about 25% of the patients. Each of upwards gaze palsy, downwards conjugate deviation and Horner's sign was detected in 1015% of the cases and conjugate deviation of the eye balls was shown in 18% of all the cases. Motor paresis was seen in about 95%, with a high frequency in the cases with larger hematoma. On the other hand, sensory impairment was presented in about 75%, with high frequency in the patients with extrathalamic extension of the hematoma. Disturbance of speach was seen in about half of the cases. Hypertension over 160 mmHg in systolic was seen in about 66% of all the patients. Increase of the size of the hematoma on CT followed after hospitalization was occurred in only 4% of the patients. Removal of the hematoma was performed in 79 cases (9.9%). Of these, 9 cases were operated on by direct intracranial surgery with craniotomy and the remaining 70 cases were operated by CT or US guided aspiration. The former was done in 78% of the cases within 24 hours, whereas the latter was performed in 81% between 24 hours and 15 days after onset. As to the rate of removed hematoma, there was no significant difference between both procedures. Continuous ventricular drainage was carried out in 99 cases of the patients. Postoperative complications occurred in 48% of the operated cases and in 30% of the non-operated cases. There were 116 deaths, namely the mortality rate was 15% for all the cases. Death due to the original disease was noted in 26 cases of the surgical cases and in 49 cases of the non surgical cases respectively. At the time of discharge, about 60% of the surgical cases and 76% of the non surgical cases were state of clear consciousness. Thalamic pain occurred in 33 cases. Return to work and self-care 6 months after onset were seen in 31% of the surgical cases and 63% of the non surgical cases. From the statistical analysis of outcome after 6 months from onset, surgical treatment is better than conservative therapy only in case with large hematoma on initial CT and in case of IIIb of CT classification.
Ischemic cerebrovascular disease in children is a relatively rare disease. The present study was carried out to clarify the clinical features of ischemic stroke in infants and children. Fifty-four cases of cerebral infarctions except for Moyamoya disease, experienced at 24 clinics in Tohoku districts were included in this study. The two peaks of incidence were observed in infants and junior high school students. Middle cerebral artery region was most commonly affected (90%) on CT scan. Angiography was performed in 48 cases (89%), which revealed various types of occlusive lesion, mostly affecting middle cerebral artery. Hemiparasis was the most common form of disability following ischemic stroke (89%). Inferctions and minor head traumas were frequently seen prior to ischemic strokes. The surgical treatments were carried out in 7 cases (13%). Clinical course of these cases diclosed that children tend to show better recovery after a stroke than adults. However, permanet disabilities such as hemiparasis, mental retardation, were recognized in many cases.