Relation between the Mode of Hematoma Spreading and the Prognosis for Hypertensive Intracranial Hemorrhage

Correlations between the patterns of spread of hypertensive intracranial hemorrhages and their outcome were studied. The subjects were 236 patients with hypertensive intracranial hematoma hospitalized during the period from October 1975 (when CT was introduced) through September 1981. Breakdown of the cases was: 141 (59.7%) putaminal hemorrhages, 67 (28.4%) thalamic hemorrhages, 18 (7.6%) pontine hemorrhages, and 10 (4.3%) cerebellar hemorrhages. In putaminal hemorrhage, the outcome was well correlated to the CT grading of the Japanese cooperative study groups, except in Type III (hematoma extending to the posterior limb of the internal capsule). The definition and details of Type III should therefore be reconsidered, as this type is the hematoma most indicated for surgery. The worst factor for the prognosis was extension of the hematoma to the subthalamic areas. Therefore, Type I (external capsular hematoma) and those cases in which the hematoma has spread to the subthalamic areas should not be operated. Thalamic hemorrhage were roughly divided into three groups. Outcome of the hematoma limited within the thalamus was good, while that of the hematoma extending beyond the internal capsule was poor. The hematoma reaching the internal capsule showed variable outcome, and its therapeutic principle has yet to be established. Pontine hemorrhages were classified into two groups; one localizing in the pons and the other extending to the midbrain. Generally, the hematoma extending to the midbrain showed poor outcome, but those extending upward to the midbrain unilaterally along the pons showed moderately good outcome. Some cerebellar hemorrhages treated conservatively showed good outcome, even when the diameter of the hematoma was over 3 cm. Discrepancies between CT findings and autopsy findings were 58.8% in the putaminal hemorrhages and 50% in the thalamic hemorrhages. Death was most frequent in cases with subthalamic extension.