Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009.
Τίτλος | Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Tsitsopoulos, P. P., Enblad P., Wanhainen A., Tobieson L., Hårdemark H-G., & Marklund N. |
Journal | Acta Neurochir (Wien) |
Volume | 155 |
Issue | 11 |
Pagination | 2105-13 |
Date Published | 2013 Nov |
ISSN | 0942-0940 |
Λέξεις κλειδιά | Adult, Aged, Cerebral Hemorrhage, Drainage, Female, Glasgow Coma Scale, Humans, Intracranial Hypertension, Male, Middle Aged, Prognosis, Thalamic Diseases, Treatment Outcome |
Abstract | INTRODUCTION: Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid.METHODS: Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome.RESULTS: Patients' age was 59.5 ± 7 years in 1990-1994, and 58.2 ± 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9 (4-14), respectively. Long-term follow-up was assessed at a mean of 37.1 (range 19-65) months after disease onset for the 1990-1994 cohort and at 37.4 (range 14-58) months for the 2005-2009 cohort. Compared to patients from 1990 to 1994, patients from 2005 to 2009 had a significantly better outcome (median mRS [25th and 75th percentile]: 5 [4-6] vs. 4 [2-4.5]; p < 0.01). Most patients (13/21, 62 %) treated from 1990 to 1994 had unchanged or lower GCS scores during their NCC stay in contrast to 7/22 (32 %) from 2005 to 2009. At the last follow-up, 13/21 (62 %) patients from 1990 to 1994 were dead in comparison to 4/21 (19 %) from 2005 to 2009 (p < 0.05). Negative prognostic factors were the 120 h post-admission GCS score in the 1990-1994 patient cohort (p = 0.07) and high age in the recent cohort (p = 0.04).CONCLUSIONS: Patients with thalamic hemorrhage and depressed level of consciousness on admission had a worse outcome in the early 1990s compared with the late 2000s, which may at least be partially attributed to refined neurocritical care. |
DOI | 10.1007/s00701-013-1871-1 |
Alternate Journal | Acta Neurochir (Wien) |
PubMed ID | 24026230 |