gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Influence of large intracerebral hematoma for the outcome of patients with subarachnoid hemorrhage

Einfluss großer intrazerebraler Hämatome auf das Outcome von Patienten mit SAB

Meeting Abstract

  • corresponding author E. Güresir - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • J. Beck - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • H. Vatter - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • M. Setzer - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • R. Gerlach - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • A. Raabe - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.01.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc008.shtml

Veröffentlicht: 11. April 2007

© 2007 Güresir et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The association of intracerebral hemorrhage (ICH) with aneurysmal subarachnoid hemorrhage (SAH) is frequently considered as outcome limitation and results in restricted therapeutic efforts. However, data confirming this consideration are scarce in the literature. Thus, the aim of the present study was to analyse the influence of an ICH for the outcome in patients with SAH.

Methods: 585 consecutive patients with SAH from June 1999 to December 2005 were analysed and data were prospectively entered in a database. 50 of them (8.5%) presented with ICH larger than 50cc. ICH was diagnosed and the size was estimated by CT scan before aneurysm occlusion. Treatment decision (coil/clip/hematoma evacuation) was based on an interdisciplinary approach. Outcome was assessed according to modified Rankin scale at 6 months after SAH. For this assessment the patients were divided in good grade (H&H 1-3) versus (vs) poor grade (H&H 4-5).

Results: Overall 358 patients were in good grade; only 4 of the good grade patients presented with a large ICH (1.1%). 227 patients were poor grade at admission; 46 of the poor grade had ICH (20.3%). The rate of ICH was significantly higher in the poor grade patients (P<0.001). In good grade patients a favourable outcome (mRs 0-2) was achieved in only 1 (25%) patient with ICH but in 246 (75%) patients without ICH (RR=0.11, P=0.053). In poor grade patients a favourable outcome was achieved in 5 (12.8%) patients with ICH and in 40 (23.7%) patients without ICH (RR=0.53; P=0.19). Time to treatment was significantly shorter in patients with ICH than without (median=7 vs. median 26 hours; P=<0.001).

Conclusions: The current data confirm that presence of an ICH is a predictor of unfavourable outcome in good grade patients. In poor grade patients there was only a non significant trend for worse outcome in patients with a large (>50cc) hematoma. Despite large ICH, a significant number of patients still achieves good outcome. Although our data have to be confirmed in a larger cohort they may be used for decision making, especially in poor grade patients.