Chitrambalam, S (2009) A study of Spontaneous intracerebral haemorrhage - Clinical profile and outcome. Masters thesis, Madras Medical College, Chennai.
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Abstract
The word stroke is used to refer to a clinical syndrome, of presumed vascular origin, typified by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24 hours or leading to death (World Health Organisation 1978)33. It affects between 174 and 216 people per 100,000 population in the UK each year (Mant [et al.]2004), and accounts for 11% of all deaths in England and Wales. Cerebral infarction accounts for 69% of strokes, primary haemorrhage for 13%, subarachnoid haemorrhage for 6%, and 12% are of uncertain type (Wolfe [et al.] 2002). The risk of recurrent stroke within five years of a first stroke is between 30% and 43% (Mant [et al.] 2004). Extravasation of blood into the brain parenchyma was recognized as early as 1658 by Wepfer61, although he saw the clot as an obstruction of ‘vital spirits’ rather than as the disease in itself, and subsequently by Morgagni62. The cause remained obscure, and to a large extent it still is.77 We have come a long way since the time when Charcot (1881) felt “that if apoplexy was not immediately fatal, most survivors only retained life at the expense of deplorable infirmities and perpetual confinement to bed.” 1.Males predominate among patients of ICH with a ratio of 5:2.,the male predominance is probably attributable to the high prevalence of alcohol among males. 2.Hypertension is the most important causative factor for ICH. 3.Alcohol ingestion not only increases the incidence of ICH but also the mortality, especially in those with a recent binge. 4.Among patients of ICH, headache is reported by 44% of patients, vomiting by 56% and both headache and vomiting by 35%. 5.Patients presenting with significant loss of consciousness have a poor outcome with an mRS of 5 or 6. 6. NIHSS score is an indication of severity of the ICH and those with very severe score( >22 ) have about 63% probability of mortality in the first month after the ictus. 8. Patients with the ICH score of 0 usually survive and the 30 day mortality increases steadily with ICH score. 9.The frequency of ICH location is as follows : Putamen- 54.5% ; Thalamus-25.9% ; Lobar ICH- 7.8% ; Pons- 5.2% ; Cerebellum – 3.9% ; Caudate nucleus- 2.6% . 10.Almost all patients of putaminal haemorrhage who had seizures have fairly large haematomas with volume being in excess of 40ml and consequently a poorer outcome. Putaminal haemorrhage is the most common form of ICH and a putaminal haematoma that directly extends into the ventricle is usually of large size and is associated with high mortality. 11.Though larger thalamic haematomas are associated with poorer outcome, it is not strictly linear. Similarly presence or absence of IVH in thalamic haematomas does not clearly predict the prognosis.With regard to pontine haematoma,it is the volume and not the presence or absence of IVH that predicts the outcome but a volume more than 10 ml and intraventricular extension are indicators of bad prognosis in cerebellar haemorrhage.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Spontaneous intracerebral haemorrhage; Clinical profile; outcome. |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 28 Jun 2017 11:08 |
| Last Modified: | 28 Jun 2017 11:08 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/565 |
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