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Journal of Korean Neurosurgical Society > Volume 8(2); 1979 > Article
Journal of Korean Neurosurgical Society 1979;8(2): 351-360.
Computed Tomography and Choice of Treatment in Hypertensive Intracerepral Hemorrhage.
Kenichi Nishimura, Yukio Tomita
Department of Neurosurgery, School of Medicine, Iwate Medical University, Merioka, Japan.
Computed Tomography(CT) has been of great value in planning treatment for patients with hypertensive intracerebral hemorrhage. The patient with a moderate-sized extracapsular hematoma is usually mild. Such a patient, as a rule, should be treated conservatively. However if the patients shows progressive deterioration or mass signs on the CT, he will be subjected to surgery. The patient with putaminal hemorrhage involving the internal capsule is also indicated for surgery. The patient with a large hematoma extending to the thalamus and the hypothalamus extending to the thalamus and the hypothalamus shows poor prognosis and never indicated for surgery. From the viewpoint of hematoma volume, more than 25ml in size, indicates surgical removal. The acute hydrocephalus following intracerebral hemorrhage confirmed by CT, requires a ventricular drainage, especially if the case of ventricular component is present, in the third and/or fourth ventricles. In the management of hypertensive intracerebral hemorrhage, the choice of treatment, surgical or conservative, is a very important decision. In spite of the fact that surgical treatment of the disease has been actively carried out for the last decade in various facilities in Japan, the indication for surgery is still in controversy in the field of neurosurgery. Today, it is noted that preoperative conditions of the patient such as age, state of consciousness, location of hematoma and timing of operation are closely related to operative results3). As it is well known, computed tomography(CT) will be of great help in the choice of treatment for hypertensive intracerebral hemorrhage. CT gives us not only definite diagnosis of intracerebral hemorrhage but also shows us variable intracranial pathology. Information relating to the exact location of hematoma, estimated hematoma-volume, presence or absence of ventricular component, size of the ventricles and mass effect from displacement of midline structures on CT, will be of extremely valuable in planning further treatment.
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