Hematomas intraparenquimatosos espontâneos experiência com 134 casos

Kraemmer, Jorge L.; Bastos, Carlos A. Guimarães; Brasil, Albert V. Berthier; Paglioli Neto, Eliseu; Ferreira, Nelson Pires

doi:10.1590/S0004-282X1992000100003

Resumos

São estudados 134 casos de hematomas intraparenquimatosos espontâneos. Os pacientes são divididos em 6 grupos, obedecendo a critérios de topografia, nível de consciência e volume do hematoma. O tratamento variou segundo o grupo, sendo conservador, com ou sem monitorização da pressão intracraniana, ou cirúrgico. Os resultados mostraram maior mortalidade (p<0,05) nos pacientes que foram internados com maior comprometimento de consciência, nos acima de 50 anos e nos com hematoma quadrilateral, intraventricular ou de tronco. A mortalidade global do grupo estudado foi 26,1%.

hematomas encefálicos espontâneos; avaliação evolutiva; terapêutica

One hundred thirty four cases of spontaneous intraparenchymatous hematomas have been studied. They were separated into six groups according to criteria related to topography, level of consciousness, and hematoma volume. Treatment protocols - conservative, conservative with I.C.P. monitoring, and surgical - were different in each group. Results have shown an increased mortality (p<0.05) among patients whose level of consciousness were more severely compromised, in those older than 50 years old, and in those harbouring quadrilateral, intraventricular or brainstem hematomas. Overall mortality was 26.1%.

spontaneous brain hematomas; follow-up evaluation; therapeutics

Hematomas intraparenquimatosos espontâneos experiência com 134 casos

Spontaneous intraparenchymatous hematomas: analysis of 134 cases

Jorge L. Kraemmer^I; Carlos A. Guimarães Bastos^II; Albert V. Berthier Brasil^III; Eliseu Paglioli Neto^II; Nelson Pires Ferreira^IV

^INeurocirurgião, Mestre, Pós-graduado da Escola Paulista de Medicina. Trabalho realizado no Instituto de Neurocirurgia de Porto Alegre

^IINeurocirurgião. Trabalho realizado no Instituto de Neurocirurgia de Porto Alegre

^IIINeurocirurgião, Mestre. Trabalho realizado no Instituto de Neurocirurgia de Porto Alegre

^IVProfessor Livre-Docente em Neurocirugia, Universidade Federal do Rio Grande do Sul (UFRGS). Trabalho realizado no Instituto de Neurocirurgia de Porto Alegre

RESUMO

São estudados 134 casos de hematomas intraparenquimatosos espontâneos. Os pacientes são divididos em 6 grupos, obedecendo a critérios de topografia, nível de consciência e volume do hematoma. O tratamento variou segundo o grupo, sendo conservador, com ou sem monitorização da pressão intracraniana, ou cirúrgico. Os resultados mostraram maior mortalidade (p<0,05) nos pacientes que foram internados com maior comprometimento de consciência, nos acima de 50 anos e nos com hematoma quadrilateral, intraventricular ou de tronco. A mortalidade global do grupo estudado foi 26,1%.

Palavras chave: hematomas encefálicos espontâneos, avaliação evolutiva, terapêutica.

SUMMARY

One hundred thirty four cases of spontaneous intraparenchymatous hematomas have been studied. They were separated into six groups according to criteria related to topography, level of consciousness, and hematoma volume. Treatment protocols conservative, conservative with I.C.P. monitoring, and surgical were different in each group. Results have shown an increased mortality (p<0.05) among patients whose level of consciousness were more severely compromised, in those older than 50 years old, and in those harbouring quadrilateral, intraventricular or brainstem hematomas. Overall mortality was 26.1%.

Key words: spontaneous brain hematomas, follow-up evaluation, therapeutics.

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Dr. Jorge Luiz Kraemmer Rua 24 de Outubro 838, conj. 705 - 90510 Porto Alegre RS - Brasil.

1. Arana-Iñiguez R, Gomensoro JB, Azambuja N. Primary brain hemorrhage. Acta Neurol Latinoamer 1970, 16:44-56.
2. Arana-Iñiguez R, Wilson E, Bastarrica E, Medici M. Cerebral hematomas. Surg Neurol 1976, 6:45-52.
3. Bolander HG, Kourtopoulos H, Liliequist B, Wittboldt S. Treatment of spontaneous intracerebral haemorrhage: a retrospective analysis of 74 consecutive cases with special reference to computertomographic data. Acta Neurochir 1983, 67:19-28.
4. Bottinelli MD, Purriel JA, Arana-Iñiguez R. Hemorragia intraventricular primaria. Acta Neurol Latinoamer 1972, 18:318-328.
5. Brambila GL, Sangiovanni G, Rainoldi F. Gli ematomi intracerebrali spontanei: tratta-mento e risultati a distanza. Minerva Med 1986, 77:1209-1214.
6. Chong-zhi Z, Yao-shan W. CT classification of hypertensive intracerebral hemorrhage for prediction of prognosis and selection of treatment. Chin Med J 1986, 99:569-575.
7. Drury J, Whisnant JP, Garraway M. Primary intracerebral hemorrhage: impact of CT on incidence. Neurology 1984, 34:653-657.
8. Duff TA, Ayeni S, Levin AB, Javid M. Nonsurgical management of spontaneous intracerebral hematoma. Neurosurgery 1981, 9:387-393.
9. Ferreira NP, Chaves DL, Kraemer JL. Hematomas intraparenquimatosos espontâneos su-pratentoriais: a propósito de 28 casos. Arq Neuro-Psiquiatr (São Paulo) 1980, 38:367-374.
10. Ferreira NP, Kraemer JL. Diagnóstico da hemorragia intracerebral espontânea: uma observação de 70 casos. Rev Amrigs 1989, 3:33-35.
11. Friedrich P, Siedschlag WD. Zur Therapie intrazerebraler Hämatome. Zbl Neurochir 1983, 44:221-227,
12. Gänshirt H, Keuler R. Intracerebrale Blutungen. Nervenarzt 1980, 51:201-206.
13. Godoy J, Mendez J. Tomografia axial computadorizada en el diagnóstico de las hemorragias intracerebrales. Rev Med Chile 1983, 111:21-27.
14. Janny P, Colnet G, Georget AM, Chazal J. Intracranial pressure with intracerebral hemorrhages. Surg Neurol 1978, 10:371-375.
15. Katzin R. Intracranial pressure monitoring in patients with cerebral hemorrhage. Arch Neurol 1985, 42:1134.
16. Kraemer JL, Brasil AVB, Aspesi NV, Ferreira NP. Registro gráfico da monitorização da pressão intracraniana com tecnologia nacional: nota técnica. Arq Bras Neurocir 1987, 6:207-215.
17. Kwak R, Kadoya S, Suzuki T. Factors affecting the prognosis in thalamic hemorrhage. Stroke 1983, 14:493-500.
18. Lui TN, Faisholm DJ, Shu TF, Chang CN, Lee ST, Chen HR. Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 1985, 23:555-558.
19. Mendelow AD. Primary intracranial hematomas . Abstracts 9th International Congress of Neurological Surgery, New Delhi, 8-13 October 1989.
20. Mutlu N, Berry RG, Alpers BJ. Massive cerebral hemorrhage. Arch Neurol 1963, 8:661-664.
21. Nakajima K. Clinicopathological study of pontine hemorrhage. Stroke 1983, 14:485-493.
22. Nath FP, Nicholls D, Fraser RJA. Prognosis in intracerebral haemorrhage. Acta Neurochir 1983, 67:29-35.
23. Ojemann RG, Heros RC. Spontaneous brain hemorrhage. Stroke 1983, 14:467-468.
24. Pecker J, Ioulalen N, Brassier G, Velut S, Guegan Y, Carsin M. Place de l'artériographie dans le diagnostic étiologique des hématomes intra-cérébraux spontanés. Neurochirurgie 1986, 32:281.286.
25. Primavera A. Gli ematomi intracerebrali spontanei. Minerva Med 1986, 77:1195-1200.
26. Ropper AH, King RB. Intracranial pressure monitoring in comatose patients with cerebral hemorrhage. Arch Neurol 1984, 41:725-728.
27. Silverstein A. Primary pontine hemorrhage. Confinia Neurol 1967, 29:33-46.
28. Skvarc VA, Ladurner G, Radi B, Boné G. Prognose und Prognosekriterien des zerebralen Hämatoms. Fortschr Med 1985, 46:1059-1061.
29. Steiner L, Bergvall U, Zwetnow N. Quantitative estimation of intracerebral and intraventricular hematoma by computer tomography. Acta Radiol 1975 (Suppl), 346:143-153.
30. Volpin L,Cervellini P, Colombo F, Zanusso M, Benedetti A. Spontaneous intracerebral hematomas: a new proposal about the usefulness and limits of surgical treatment. Neurosurgery 1984, 15:663-666.
31. Waga S, Miyazaki M, Okada M, Tochio H, Matsuchima S, Tanaka Y. Hypertensive puta-minal hemorrhage: analysis of 182 patients. Surg Neurol 1986, 26:159-166.
32. Young WB, Lee KP, Pessin MS, Kwan ES, Ran WM, Caplan LR. Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 1990. 40:616-619.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Arana-Iñiguez R, Gomensoro JB, Azambuja N. Primary brain hemorrhage. Acta Neurol Latinoamer 1970, 16:44-56.

[2] 2. Arana-Iñiguez R, Wilson E, Bastarrica E, Medici M. Cerebral hematomas. Surg Neurol 1976, 6:45-52.

[3] 3. Bolander HG, Kourtopoulos H, Liliequist B, Wittboldt S. Treatment of spontaneous intracerebral haemorrhage: a retrospective analysis of 74 consecutive cases with special reference to computertomographic data. Acta Neurochir 1983, 67:19-28.

[4] 4. Bottinelli MD, Purriel JA, Arana-Iñiguez R. Hemorragia intraventricular primaria. Acta Neurol Latinoamer 1972, 18:318-328.

[5] 5. Brambila GL, Sangiovanni G, Rainoldi F. Gli ematomi intracerebrali spontanei: tratta-mento e risultati a distanza. Minerva Med 1986, 77:1209-1214.

[6] 6. Chong-zhi Z, Yao-shan W. CT classification of hypertensive intracerebral hemorrhage for prediction of prognosis and selection of treatment. Chin Med J 1986, 99:569-575.

[7] 7. Drury J, Whisnant JP, Garraway M. Primary intracerebral hemorrhage: impact of CT on incidence. Neurology 1984, 34:653-657.

[8] 8. Duff TA, Ayeni S, Levin AB, Javid M. Nonsurgical management of spontaneous intracerebral hematoma. Neurosurgery 1981, 9:387-393.

[9] 9. Ferreira NP, Chaves DL, Kraemer JL. Hematomas intraparenquimatosos espontâneos su-pratentoriais: a propósito de 28 casos. Arq Neuro-Psiquiatr (São Paulo) 1980, 38:367-374.

[10] 10. Ferreira NP, Kraemer JL. Diagnóstico da hemorragia intracerebral espontânea: uma observação de 70 casos. Rev Amrigs 1989, 3:33-35.

[11] 11. Friedrich P, Siedschlag WD. Zur Therapie intrazerebraler Hämatome. Zbl Neurochir 1983, 44:221-227,

[12] 12. Gänshirt H, Keuler R. Intracerebrale Blutungen. Nervenarzt 1980, 51:201-206.

[13] 13. Godoy J, Mendez J. Tomografia axial computadorizada en el diagnóstico de las hemorragias intracerebrales. Rev Med Chile 1983, 111:21-27.

[14] 14. Janny P, Colnet G, Georget AM, Chazal J. Intracranial pressure with intracerebral hemorrhages. Surg Neurol 1978, 10:371-375.

[15] 15. Katzin R. Intracranial pressure monitoring in patients with cerebral hemorrhage. Arch Neurol 1985, 42:1134.

[16] 16. Kraemer JL, Brasil AVB, Aspesi NV, Ferreira NP. Registro gráfico da monitorização da pressão intracraniana com tecnologia nacional: nota técnica. Arq Bras Neurocir 1987, 6:207-215.

[17] 17. Kwak R, Kadoya S, Suzuki T. Factors affecting the prognosis in thalamic hemorrhage. Stroke 1983, 14:493-500.

[18] 18. Lui TN, Faisholm DJ, Shu TF, Chang CN, Lee ST, Chen HR. Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 1985, 23:555-558.

[19] 19. Mendelow AD. Primary intracranial hematomas . Abstracts 9th International Congress of Neurological Surgery, New Delhi, 8-13 October 1989.

[20] 20. Mutlu N, Berry RG, Alpers BJ. Massive cerebral hemorrhage. Arch Neurol 1963, 8:661-664.

[21] 21. Nakajima K. Clinicopathological study of pontine hemorrhage. Stroke 1983, 14:485-493.

[22] 22. Nath FP, Nicholls D, Fraser RJA. Prognosis in intracerebral haemorrhage. Acta Neurochir 1983, 67:29-35.

[23] 23. Ojemann RG, Heros RC. Spontaneous brain hemorrhage. Stroke 1983, 14:467-468.

[24] 24. Pecker J, Ioulalen N, Brassier G, Velut S, Guegan Y, Carsin M. Place de l'artériographie dans le diagnostic étiologique des hématomes intra-cérébraux spontanés. Neurochirurgie 1986, 32:281.286.

[25] 25. Primavera A. Gli ematomi intracerebrali spontanei. Minerva Med 1986, 77:1195-1200.

[26] 26. Ropper AH, King RB. Intracranial pressure monitoring in comatose patients with cerebral hemorrhage. Arch Neurol 1984, 41:725-728.

[27] 27. Silverstein A. Primary pontine hemorrhage. Confinia Neurol 1967, 29:33-46.

[28] 28. Skvarc VA, Ladurner G, Radi B, Boné G. Prognose und Prognosekriterien des zerebralen Hämatoms. Fortschr Med 1985, 46:1059-1061.

[29] 29. Steiner L, Bergvall U, Zwetnow N. Quantitative estimation of intracerebral and intraventricular hematoma by computer tomography. Acta Radiol 1975 (Suppl), 346:143-153.

[30] 30. Volpin L,Cervellini P, Colombo F, Zanusso M, Benedetti A. Spontaneous intracerebral hematomas: a new proposal about the usefulness and limits of surgical treatment. Neurosurgery 1984, 15:663-666.

[31] 31. Waga S, Miyazaki M, Okada M, Tochio H, Matsuchima S, Tanaka Y. Hypertensive puta-minal hemorrhage: analysis of 182 patients. Surg Neurol 1986, 26:159-166.

[32] 32. Young WB, Lee KP, Pessin MS, Kwan ES, Ran WM, Caplan LR. Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 1990. 40:616-619.