Prognosis By Specific Lesion Site Putaminal Hemorrhage

ICH occurs primarily in the deep portions of the cerebral hemispheres, most commonly in the putamen (~ 40%), with a broad spectrum of clinical presentations and a wide range of outcomes. In an early CT-based study of 24 cases of putaminal hemorrhage, pupillary abnormalities, disturbances in extraocular movement, and bilateral Babinski signs were associated with larger hematomas and a poor chance of survival, whereas preserved higher cortical function and partial sparing of motor function were associated with good outcome. Four patients with absent extraocular movements had massive hemorrhages and fatal outcomes. Age, gender, and admission blood pressure were unrelated to outcome (4). Predictive CT scan findings included large hemorrhage size and presence of intraventricular blood. Kanaya, on the basis of extensive experience with medically and surgically treated patients, developed a detailed classification schema based on the involvement of adjacent structures. He indicated that lesions that involve only the anterior limb of the internal capsule (Grades I and II) fare much better than those involving the posterior limb (Grades III and IV) or thalamus (Grade V) (5).

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