[Clinical study of hypertensive subcortical hemorrhage: surgical indication and long-term, functional prognosis].

There has been no report available for determining surgical indications in hypertensive subcortical hemorrhage based on functional prognosis. The authors then studied the clinical results of hypertensive subcortical hemorrhage for evaluating the surgical indication in relation to functional prognosis. Sixty-five patients with hypertensive subcortical hemorrhage diagnosed by CT scan who were hospitalized to Matsue Red Cross Hospital from January 1980 up to December 1986 were studied. The 44 male and 21 female patients ranged in age from 37 to 86 years, and 38 of them were operated on. The results were as follows: 1) Patients with grade I (Kanaya's neurological grading) or a volume of hematoma less than 30 ml should be treated with conservative therapy. Those with grade II and III or a volume of hematoma = 30 - 50ml should be treated in accordance with proper therapeutic method, taking into consideration the site of the hematoma. Patients with more than grade IVa or a volume of hematoma greater than 50ml would be in danger of losing their lives unless surgical therapy was performed. 2) The follow up study of the patients' long-term prognosis after discharge revealed the majority of the patients showed aggravation of the illness and/or death due to cerebral apoplexy-like attack and re-bleeding. It is necessary to follow up these cases with careful systemic control, including monitoring of blood pressure.