Spontan İntraparenkimal Kanama Tedavisi: Konservatif veya Cerrahi Uygulanan 19 Olgunun Retrospektif Analizi

Amaç: Spontan intraparenkimal hematomlarda tedavi yaklaşımlarının değerlendirilmesi. Materyal ve Metot: Nöroloji ve Nöroşirurji kliniklerine bir yıl boyunca başvuran on dokuz ( Nöroloji 9, Nöroşirürji 10 ) spontan intraparenkimal hematomlu ( SİPH ) hastanın konservatif veya cerrahi tedavilerinin retrospektif analizi yapıldı. Bulgular: Nöroloji kliniğine başvuran 9 olgunun 6’sı erkek, 3’ü ise kadındı. Ortalama yaş 64.5 (48-76 yaş). idi. Başvuru sırasında 4 olgunun Glasgow Koma Skoru (GKS) 14-15, 5 olgunun ise 7 ve altı idi. Hematom hacmi ortalama 16.1 cc (2.5-45.5 cc) idi. Başvuru GKS’u 14-15 olan 4 olgu Glasgow çıkış skoru (GOS) 4 veya 5 ile taburcu olurken; GKS’u 7 ve altında olan 5 olgunun hepsinin GOS’u 1 idi. Nöroşirürji kliniğine başvuran 10 olgunun 6’sı erkek, 4’ü ise kadındı. Ortalama yaş 60.3 (47-73 yaş) idi. Başvuru sırasında 4 olgunun GKS’u 9-12, 6 olgunun ise GKS’u 3-7 arasındaydı. Hematom hacmi ortalama 96.5 cc (56-248 cc) idi. Giriş GKS’u 9-12 arasında olan 4 olgudan 3’ü GOS 5 ve 1 olgu GOS 4 olarak taburcu edildi. GKS’u 3-7 arasında olan 6 olgudan üçünün GOS’u 3 veya 2, ikisinin GOS’u 1 idi. Diğer hasta postop. 7. ayda pulmoner emboli gelişmesi nedeniyle öldü. Sonuç: İntraparankimal hematomların konservatif tedavilerinin planlanmasında ve düzenlenmesinde amaç; kan basıncının kontrolü, intrakranial basınç ve serebral perfüzyon basıncının düzenlenmesi normovolemik tutulması ve epileptik (konvulsif) nöbet proflaksisi olmalıdır. Cerrahide ise amaç; hematomun kitle etkisini azaltmak ve potansiyel olarak sekonder beyin hasarının en aza indirilmesi olmalıdır. Hastanın nöroşirürji ve nöroloji kliniklerince beraberce değerlendirilmesinin ve oluşturulacak ortak tedavi protokollerinin hastalara daha yararlı olacağı düşünülmektedir

Anahtar Kelimeler:

İntraparenkimal kanama, spontan, tedavi

Management of spontaneous intraparenchymatous hemorrhage: Retrospective analysis of 19 cases treated conservatively or surgery

Objective: The aim of this study was to assess the treatment modalities of spontaneous intraparenchymatous hematomas. Material and Method: The retrospective analysis of nineteen patients, who attended the neurology or neurosurgery department with spontaneous intraparenchymatous hematoma, was carried out. Results: Of the 9 patients in neurology department, 6 were male and 3 were female. Mean age was 64.5 . The Glasgow Coma Score (GCS) at presentation was 14-15 in four patients and ≤ 7 in 5 patients. Mean hematoma volume was 16.1cc ( 2.5-45.5cc). While 4 patients with GCS 14-15, were discharged with Glasgow Outcome Scale (GOS) 4 or 5, GOS was 1 in all of the patients with GCS ≤ 7. Of the ten patients in neurosurgery department, 6 were male and 4 were female. Mean age was 60.3 . Initial GCS was 9-12 in 4 patients and 3-7 in 6 patients. The hematoma volume varied from 56 cc to 248 cc (mean 96.5 cc). The GOS values at the time of hospital discharge were 5 in 3 patients and 4 in 1 patient in the subgroup of patients with GCS 9-12; while GOS values were 3 or 2 in 3 patients and 1 in 2 patients in group with initial GCS ≤ 7. However, the remaining 1 patient died because of pulmonary embolus at postoperative 7th month. Conclusion: The aim of the conservative treatment in intraparenchymatous hematoma should be the control of blood pressure, maintenance of normal intracranial pressure and cerebral perfusion, and prophylaxis of convulsions. The purpose of surgery is to lessen the mass effect of hematoma and minimize the potential brain damage. The patients can be treated better if collaborative evaluation of neurosurgery and neurology departments can be carried out

Keywords:

Intraparenchymatous hemorrhage, spontaneous, therapy,

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