gms | German Medical Science

Objective: The aim of this study was to present the data of a large cohort of patients with spontaneous supratentorial intracerebral hemorrhage (ICH), who were treated in our department and give a current overview considering special clinical characteristics, performed therapy and different predictive factors for morbidity and mortality.

Methods: We reviewed the data of all patients with spontaneous ICH, who were admitted to our department during 2000 and 2010 through an analysis of our prospective database. Patients with spontaneous supratentorial ICH were included in the study. Patients with hemorrhage associated to vascular malformation or to cerebral stroke were excluded. The clinical performance at time of admission and discharge were scored using the Glasgow coma scale (GCS) and the Glasgow outcome scale (GOS). The patient cohort was divided into an operative and a conservative treated group. Statistical analysis (Analysis of Variance (ANOVA) and χ²-Test) was done for various parameters to analyze their impact on morbidity and mortality.

Results: In total, we analyzed the data of 817 patients (364 female and 453 male). 261 patients (32%) were treated conservatively and 556 patients (68%) underwent surgical procedures, i.e. CSF drainage in 110 (19.8%), craniotomy in 338 (60.7%) and application of both methods in 108 patients (19.4%). GCS < 8, age over 70 years, hemorrhage in the basal ganglia, cumadin medication, combination of co-morbidities (hypertension, coronary heart disease, cerebrovascular disease, diabetes mellitus), hypertensive hemorrhage and postoperative re-bleeding were statistically significant risk factors for worse outcome (GOS 1&2) in the operated group. Similar to the observations of the operated group, GCS < 8, age over 70 years and cumadin medication were statistically significant for worse outcome in the conservative group. In contrast, bi-lobar and multi-lobar hemorrhages were the most significant factors for worse outcome in the conservative group.

Conclusions: Treatment recommendations of ICH remain an unsolved issue. The consideration of the GCS grade at admission is the most important predictive factor. Old age is not an absolute contraindication for surgery, but cumulative multi-morbidity, especially cerebrovascular and cardiovascular diseases should be regarded critically in view of surgical treatment. Further prospective studies considering different predictive factors are needed to illustrate the estimated success of the chosen therapy.