Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street Suite B400, Pittsburgh, PA 15213, United States.
Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street Suite B400, Pittsburgh, PA 15213, United States.
J Clin Neurosci. 2019 Nov;69:132-138. doi: 10.1016/j.jocn.2019.08.011. Epub 2019 Aug 16.
Management of spontaneous intracerebral hemorrhage involves reversal of coagulopathy, neurological examinations and repeated imaging. Repeated imaging is employed to identify patients prior to neurological deterioration, however, there is no data to support this practice. As such, we strive to identify the utility of surveillance imaging as well as the risks factors that are associated with higher likelihood of developing a clinically significant hematoma progression.
A retrospective chart analysis of 200 consecutive patients was performed on patients with non-traumatic intracerebral hemorrhage. Patients with non-parenchymal hemorrhage, vascular malformations, patients that required surgical intervention based on the initial scan/neurological exam, and trauma were excluded. Patient demographics, blood pressure, presence of a new neurological deficit, progression of hematoma, surgical intervention and mortality were gathered from the chart.
Hematoma progression of greater than 5 mL was seen in 24 patients (12%) on repeat imaging. Large initial hematoma volume, early time from symptom onset to initial imaging, and new neurological deterioration between scans were significantly associated with significant hematoma progression. Of the 24 patients with hematoma progression greater 5 mL, five patients did not develop neurological deterioration. None of these patients required intervention.
Routine imaging in patients with spontaneous intracerebral hemorrhages does not alter clinical management. Rather, careful neurologic monitoring may be safe and more clinically useful in these patients.
自发性脑出血的治疗包括纠正凝血功能障碍、进行神经检查和重复影像学检查。重复影像学检查用于在神经恶化前识别患者，但目前没有数据支持这种做法。因此，我们努力确定监测影像学的效用，以及与更有可能发生临床显著血肿进展相关的风险因素。
对 200 例连续的非外伤性脑出血患者进行了回顾性图表分析。排除非实质血肿、血管畸形、根据初始扫描/神经检查需要手术干预的患者以及创伤患者。从图表中收集患者的人口统计学资料、血压、新的神经功能缺损、血肿进展、手术干预和死亡率。
24 名患者（12%）在重复影像学检查中出现大于 5 毫升的血肿进展。较大的初始血肿量、症状发作到初始影像学检查的时间较早、扫描之间出现新的神经功能恶化与显著的血肿进展显著相关。在 24 名血肿进展大于 5 毫升的患者中，有 5 名患者未出现神经功能恶化。这些患者中没有一人需要干预。
在自发性脑出血患者中常规进行影像学检查并不能改变临床治疗方法。相反，在这些患者中，仔细的神经监测可能更安全、更具临床意义。
