Prognosis and treatment of spontaneous intracerebral hematoma: review of the literature

摘要

The natural history of spontaneous intracerebral hematomas is difficult to precisely ascertain because of the heterogeneous nature of published series. However, the early evolution of these hematomas, within the first 24 hours, is now well known, especially with regards to predictive factors for early deterioration. Prognosic factors of longer-term evolution include alteration in the level of consciousness, as determined by the Glasgow score, the volume of the intracerebral hematoma, and the presence of intraventricular rupture. Volumetric data must be interpreted based on the location of the hematoma. Randomized studies about the management of intracerebral hematomas are rare. The beneficial value of early global management in a stroke unit (non-surgical) is undeniable and statistically proven. The value of some types of medical management (steroids, osmotherapy, preventive heparin therapy) was assessed by randomized trials with results that often were discordant. The main unknown treatment variable remains the role of surgical management. Eight randomized trials and following meta-analyses were not conclusive regarding the value of surgical management. The main difficulty does not relate to surgical technique but to the determination of clinical and radiological criteria for the selection of patients that are candidate to a surgical treatment. Available data will be reviewed.