Neurosurgery and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea.
Medicine (Baltimore). 2022 Dec 2;101(48):e32000. doi: 10.1097/MD.0000000000032000.
Spontaneous intracerebral hemorrhage (ICH) causes profound neurological sequelae in survivors. The patient's prognosis is closely linked to the location and amount of hemorrhage. Therefore, we explored the relationship between the hemorrhage location within the basal ganglia, including the thalamus, and its clinical outcomes in patients with spontaneous intracerebral hemorrhage. A retrospective analysis of consecutively enrolled patients with basal ganglia and thalamic intracerebral hemorrhage treated conservatively at a single tertiary neurosurgical center was conducted between January 2014 and December 2020. Patients were divided into 2 groups according to the lateralization of the right or left hemisphere hemorrhage. Furthermore, baseline patient demographics, hematoma volume, location of the hemorrhage (i.e., caudate nucleus, globus palidus, putamen, internal capsule anterior limb, internal capsule posterior limb, thalamus), and clinical outcomes were evaluated. Clinical outcomes were assessed using the modified Rankin scale at the 1-year follow-up. An modified Rankin scale score between 3 and 6 was considered a poor outcome. In the analysis according to location, the prognosis was poor when the ICH was localized to the posterior limb of the internal capsule (P < .000) and globus palidus (P = .001) in the right hemisphere. Similarly, the prognosis was also poor when the ICH was localized to the posterior limb of the internal capsule (P < .000), globus palidus (P < .000), putamen (P = .018), and thalamus (P < .000) of the left hemisphere. In the spontaneous intracerebral hemorrhages of the basal ganglia and thalamus, hemorrhaging within the internal capsule and the left thalamus's bilateral posterior limbs is associated with a poor prognosis. Multivariable logistic analysis showed that hematoma volume (odds ratio [OR] = 70.85, 95% confidence interval [CI]: 1.95-60.53, P = .007) and the posterior limb of the internal capsule (OR = 10.98, 95% CI:1.02-118.49, P = .048) were independent predictors of poor outcomes in the right hemisphere, while hematoma volume (OR = 70.85, 95% CI: 1.95-60.53, P = .007), the posterior limb of the internal capsule (OR = 10.98, 95% CI:1.02-118.49, P = .048) and thalamus (OR = 10.98, 95% CI:1.02-118.49, P = .048) were independent predictors of poor outcomes in the left hemisphere.
自发性脑出血（ICH）会给幸存者带来严重的神经后遗症。患者的预后与出血部位和出血量密切相关。因此，我们探讨了基底节区（包括丘脑）内出血部位与自发性脑出血患者临床结局的关系。对 2014 年 1 月至 2020 年 12 月在一家三级神经外科中心接受保守治疗的基底节和丘脑脑出血的连续患者进行了回顾性分析。根据右侧或左侧半球出血的偏侧性将患者分为 2 组。此外，评估了患者的基线人口统计学特征、血肿量、出血部位（尾状核、苍白球、壳核、内囊前肢、内囊后肢、丘脑）和临床结局。采用改良 Rankin 量表在 1 年随访时评估临床结局。改良 Rankin 量表评分为 3 至 6 分被认为是预后不良。根据位置分析，当右侧内囊后肢（P<0.000）和苍白球（P=0.001）的 ICH 定位时，预后较差。同样，当左侧内囊后肢（P<0.000）、苍白球（P<0.000）、壳核（P=0.018）和丘脑（P<0.000）的 ICH 定位时，预后也较差。在基底节和丘脑的自发性脑出血中，内囊和左侧丘脑双侧后肢的出血与预后不良相关。多变量逻辑分析显示，血肿量（优势比[OR] = 70.85，95%置信区间[CI]：1.95-60.53，P=0.007）和内囊后肢（OR = 10.98，95% CI：1.02-118.49，P=0.048）是右侧半球预后不良的独立预测因素，而血肿量（OR = 70.85，95% CI：1.95-60.53，P=0.007）、内囊后肢（OR = 10.98，95% CI：1.02-118.49，P=0.048）和丘脑（OR = 10.98，95% CI：1.02-118.49，P=0.048）是左侧半球预后不良的独立预测因素。
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