Hypertensive intracerebral hematoma is a neurosurgical emergency that has a high mortality and morbidity. Common locations include putaminal, thalamic, cerebellar, and pontine. The aim of this study is to identify easily applicable guidelines for surgical and nonsurgical treatment.
Seventy-seven cases with hypertensive intracerebral hematomas were evaluated clinically and using imaging studies. Data were analyzed and parameters suggestive of therapeutic modality were identified.
Patients with hypertensive intracerebral hematomas presented with minor stroke in 19.5%, moderate stroke in 58.5%, and major stroke in 22% of all patients. According to their morphology, hematomas were focal in 14%, regional in 26%, ruptured in 22%, dissecting in 28%, and massive in 10% of all patients. For selected patients, surgical evacuation of putaminal hematomas was performed for 53% of patients and conservative management was applied for 47% of patients. For selected patients, surgical evacuation of cerebellar hematomas was performed for 71.4% of cases and conservative management for 28.6% of cases.
Therapeutic decision for hypertensive intracerebral hematomas depends on admission Glasgow coma scale and morphology of the hematoma on computed tomography.