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Journal of Korean Neurosurgical Society 2002;32(3): 204-210.
Risk Factors for Enlargement of Spontaneous Putaminal Hemorrhage.
Eun Sung Kim, Hack Gun Bae, Seok Man Yoon, Jae Won Doh, Kyeong Seok Lee, Il Gyu Yun
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
The purpose of this study is to investigate the risk factors for hematoma enlargement(HE) in the patients with spontaneous putaminal hemorrhage.
Among the 620 patients with putaminal hemorrhage admitted to our hospital during the period of 1990-2000, sixty patients(9.7%) had HE on the second computed tomographic(CT) scan at the interval of mean 38 hours after attack(range 1.8-168 hours). Clinical features and CT findings of these 60 patients with HE were compared with those of the remaining 560 patients without HE.
Multivariate logistic regressional analysis revealed that the independent risk factors for HE were CT finding showing the separation of hematoma(odds ratio[OR] 3.5, 95% confidence interval [CI] 1.7-7.3, p=0.0006) or the hypodensity around or within hematoma(OR 2.5, 95% CI 1.2-5.6, p=0.0194), alcoholism(OR 4.8, 95% CI 2.0-11.7, p=0.0004), hematoma volume of 20-39cc(OR 2.54, 95% CI 1.0-6.3, p=0.0424), Glasgow Coma Scale(GCS) score of 8-11(OR 3.1, 95% CI 1.4-6.9, p=0.0046) and glutamic-pyruvic transaminase>50 IU/L(OR 6.54, 95% CI 2.1-20.5, p= 0.0013).
Alcoholism and liver dysfunction appear to increase the risk of HE in putaminal hemorrhage. Particularly, careful observation for HE is needed in the patients who are GCS score of 8-11 at the time of admission, who have hematoma volume of 20-39cc and the CT finding showing the separation of hematoma or the hypodensity around or within hematoma.
Key Words: Putaminal hemorrhage; Hematoma enlargement; Risk factor; Alcoholism; Liver dysfunction
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