| Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. | |
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MedLine Citation:
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PMID: 11376176 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A modest benefit was previously demonstrated for hematoma evacuation within 12 hours of intracerebral hemorrhage onset. Perhaps surgery within 4 hours would further improve outcome. METHODS: Adult patients with spontaneous supratentorial intracerebral hemorrhage were prospectively enrolled. Craniotomy and clot evacuation were commenced within 4 hours of symptom onset in all cases. Mortality and functional outcome were assessed at 6 months. This group of patients was compared with patients treated within 12 hours of symptom onset using the same surgical and medical protocols. RESULTS: The study was stopped after a planned interim analysis of 11 patients in the 4-hour surgery arm. Median time to surgery was 180 minutes; median hematoma volume was 40 mL; median baseline NIH Stroke Scale score was 19 and Glasgow Coma Scale score was 12. Six-month mortality was 36% and median Barthel score was 75 in survivors. Postoperative rebleeding occurred in four patients, three of whom died. A relationship between postoperative rebleeding and mortality was apparent (p = 0.03). Rebleeding occurred in 40% of the patients treated within 4 hours, compared with 12% of the patients treated within 12 hours (p = 0.11). There was a clear correlation between improved outcome and smaller postsurgical hematoma volume (p = 0.04). CONCLUSIONS: Surgical hematoma evacuation within 4 hours of symptom onset is complicated by rebleeding, indicating difficulty with hemostasis. Maximum removal of blood remains a predictor of good outcome. |
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Authors:
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L B Morgenstern; A M Demchuk; D H Kim; R F Frankowski; J C Grotta |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurology Volume: 56 ISSN: 0028-3878 ISO Abbreviation: Neurology Publication Date: 2001 May |
Date Detail:
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Created Date: 2001-05-28 Completed Date: 2001-06-28 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
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Languages: eng Pagination: 1294-9 Citation Subset: AIM; IM |
Affiliation:
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Stroke Program, Department of Neurology, University of Texas-Houston Medical School, 77030, USA. Lewis.Morgenstern@uth.tmc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Brain / physiopathology, radiography, surgery Cerebral Arteries / pathology, physiopathology, surgery Cerebral Hemorrhage / physiopathology*, radiography, surgery* Craniotomy / adverse effects* Female Hematoma / physiopathology, radiography, surgery Humans Male Middle Aged Pilot Projects Postoperative Hemorrhage / prevention & control*, radiography Prospective Studies Survival Rate Tomography, X-Ray Computed Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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