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A PROPOSAL OF CLINICAL GRADING FOR HYPERTENSIVE CEREBELLAR HEMORRHAGE Keizo Matsumoto 1 , Fumio Shichijo 1 1Department of Neurological Surgery, School of Medicine, The University of Tokushima pp.55-62
Published Date 1982/1/1
DOI https://doi.org/10.11477/mf.1406204879
  • Abstract
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Hypertensive intracerebellar hematomas are now readily diagnosed with CT examination and are considered to be one of the good indication for surgical intervention except for extremely severe cases. On the other hand, it has been known that there are also experienced benign cases treated conservatively with good prognosis. Therefore, it seemed to be necessary a certain proposal of the criteria for the choice of the management of them whether conservative treatment or surgical removal of the hematoma should be selected.

For the last 4 years a consecutive series of 16 cases of hypertensive intracerebellar hematomas were treated in our group of neurosurgical services. The clinical sympotms and CT findings in acute stage of these cases were analized and correlated with their clinical course and prognosis retrospec-tively. And plannings of their management were discussed with the review of previous literatures concerned with the grading or classification of this hematoma. As a conclusion of this paper, following clinical classification were obtained and proposed.

1) Mild type : Consciousness is alert or somnolence. Brain stem symptoms and ventricular dilatation are absent. The diameter of the hematoma is less than 3 cm by CT examination. This type can be expected full recovery only with con- servation treament. Immediate surgical inter- vention should be avoided.

2) Moderate type : Consciousness is alert or somno- lence. The diameter of the hematoma is more than 3 cm by CT examination. Brain stem symptoms or ventricular dilatation may be ob- served. Choice of the treatment of this type would be either conservative or surgical. However, the latter seems to be preferable be- cause of early amelioration of the symptoms and better functional prognosis.

3) Severe type : Consciousness level is stupor or semicoma. Cases of progressive lowering of the consciousness is included. This type is indicated surgical. Suboccipital craniectomy with evacua- tion of the hematoma or/and continuous ventri- cular drainage are indicated.

4) Fulminant type : Consciousness is coma in early acute stage. Surgery may be difficult in many cases of this type because of rapid deterioration. However, merrit of operation seems to be ex- isted, because there are sporadic successful cases reported.


Copyright © 1982, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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