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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Spontaneous supratentorial intracerebral hemorrhage in the elderly subpopulation: Age and GCS are the decisive prognostic factors for long-term outcome

Spontane supratentorielle intrazerebrale Blutungen bei älteren Patienten: Alter und GCS sind die entscheidenden prognostischen Faktoren für das klinische Langzeitergebnis

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  • corresponding author Eberhard Uhl - Neurochirurgische Klinik der Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • A. Muacevic - Neurochirurgische Klinik der Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • S. Zausinger - Neurochirurgische Klinik der Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • M. Ruge - Neurochirurgische Klinik der Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • F. W. Kreth - Neurochirurgische Klinik der Ludwig-Maximilians-Universität, Klinikum Großhadern, München

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.07.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0073.shtml

Published: April 23, 2004

© 2004 Uhl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

To identify prognostic factors for long-term outcome of patients with spontaneous supratentorial intracerebral hemorrhage after surgical or conservative treatment.

Methods

133 consecutively treated patients (1992-2001) were included. Surgical treatment was thought to be indicated in patients with a hematoma volume of at least 30ml (90 patients), otherwise conservative treatment was initiated (43 patients). Clinical outcome was rated at discharge and at follow-up using the Glasgow outcome scale (GOS). The prognostic impact of the Glasgow coma scale (GCS), pretreatment neurological symptoms (e.g. paresis, pupillary dilation), and neuroradiological parameters (e.g. hematoma volume, localisation, midline shift, perimesencephalic cistern affacement) was tested using logistic regression analysis.

Results

The mean age of the patients was 61±12 years. Median GCS before treatment was 9. Conservatively treated patients showed a significantly smaller hematoma volume and less often midline shift and/or compression of the perimesencephalic cistern (p<0.001). Median GOS at discharge was 3 and did not significantly improve at long-term follow-up (median follow-up: 21 weeks, median GOS 3). Treatment results after surgical and conservative treatment were not significantly different (p>0.05). Multivariate analysis revealed that age and preoperative GCS were the most important prognostic factors. Age >65 years (p<0.01) and GCS<10 (p<0.01) were associated with a bad outcome (GOS 1-3) in 94% of the cases. Patients presenting with one unfavorable prognostic factor still had a poor outcome in 80% of the cases. In contrast, 53% of the younger patients with a GCS >9 reached a GOS of 4 or 5 in both treatment arms.

Conclusions

The prognosis of supratentorial spontaneous intracerebral hemorrhage is still poor and mostly determined by pretreatment factors such as age and GCS. Surgical treatment of patients > 65 years of age with a pretreatment GCS < 10 is not recommended.