![]() | Only 14 pages are availabe for public view |
Abstract Strokes is the most common senous neurological condition in clinical practice it is the third leading cause of death throughout the industrialized world, after heart disease and cancer. The aim of this study is to answer in a more or less definite scientific and if possible measurable way the questions raised by the patient and family about prognosis and prognostic factor of intracerebral hemorrhage. In this study we included prospectively (100) patients with hemorrhagic strokes, 48 of them were males and 52 of them were females within the 151 30 hours from onset. Their ages varied from 25 years to above 65 years old. 58 cases live in rural area and 42 cases in urban areas. All patients subjected to full general physical examination, full neurological examination, neurological assessment on arrival using the following scales, Glasgow coma scale, Mini-mental state, Canadian neurological scales and National institute of health (NIH) scale. All patient were tested for the following blood glucose level, red blood corpuscles, platelet count, white blood corpuscles, hematocrit, cholesterol triglycerides, blood urea and serum creatinine. All patients were subjected to CAT scan to define the etiology. Follow up assessment were attempted on all living at out-patient clinic in Benha university hospital or at patients home twelve months after the onset. Functional outcome after one year assessed by the -- -- --- - ---- --- --- - - --- --- ------- ------ - --- SUMMA/?Y following scales. Motoricity index, Functional ambulating categories, Barthel ADL scale, 4 Point scale. Regarding to the aetiology : Hypertension was the most prevalent a etiological factors for intracerebral hemorrhage and it was responsible for large percent of our cases , followed by ruptured aneurysm , anticoagulant then vasculitis . In this study inspite of all investigations performed we could not reach to a proper aetiology in 29.0 % of cases. Regarding to the risk factors: This study showed that hypertension was the first and most important risk factors followed by aspirin and non steriodal anti-inflammatory, stress factor, obesity, smoking, diabetes, cardiac cases , oral contraceptive pilles then alcohol. There was statistically significant difference between both groups males and females regarding smoking, obesity and oral contraceptive pilles . Regarding to the prognosis :This study showed that 16.0 % of our patients had a good prognosis, 28.0 % had a moderate prognosis and 56.0 % had a worse prognosis. Regarding to age : Our results concluded that the older the patient including in this study the worse was the prognosis and we consider age one of the prognostic factors in hemorrhagic strokes. Regarding to the sex: There was no statistically significant differences between males and females in relation to prognosis. Regarding to the residence: Our study concluded that residence is one of the prognostic factors in long term outcome. Regarding to the level of consciousness: our results concluded that the prognosis was related to deteriorating level of consciousness and the =======--r’[ ’=l15050~1DJ========= -- ~~- -- - - -~- -- - ---- SU/I,fMA /I r level of consciousness represent the most important predictor of outcome (short term outcome and long term outcome). Regarding to the use of mechanical ventilation: We concluded that the use of mechanical ventilation is one of the prognostic factors in hemorrhagic strokes. Regarding to the relation between brain oedema and mass effect: This study found that brain oedema is an important cause of mass effect in intracerebral hemorrhage and it is one the predictors of outcome. Regarding to intraventricular hemorrhage: Our results fount that the presence of intraventricular hemorrhage as one of the predictor of outcome and it leads to large number of cases with worse prognosis. Regarding to the site of treatments: In this study we found that cases treated III general medical words carry more worse prognosis than those treated III strokes units so we concluded that the site of treatment is one of the prognostic factors in hemorrhagic strokess. Regarding to associated diabetes or cardiac comorbiditys: This study found that presence of diabetes or cardiac diseases carry more worse A. prognosis) so we conclude ,that tl1e diabetes and cardiac diseases are factors which affect the prognoses of hemorrhagic strokes. Regarding to the incontinence: This study found that incontinence of urine is one of the prognostic factors in hemorrhagic strokes. Regarding to the higher cerebral dysfunction: This study found that large number of cases who had higher cerebral dysfunction had worse prognosis so it is considered as one of predictor for prognosis. Regarding to the degree of muscle flaccidity and paralysis: Our results found that the degree of muscle flaccidity on paralyzed side correlate ------------------------t -lSl-jDF--------- = SUMMARY positively with the short term outcome and long term outcome, and there is linear correlation between degree of paralysis and prognosis in a sense that increase the degree of paralysis is usually associated with worse prognosis. So, we considered muscle flaccidity and paralysis are factors affecting the prognosis of hemorrhagic strokes. Regarding to the speech disorders: Patient with aphasia had worse prognosis than dysarthria and patient with no speech disorder. So, we concluded that global aphasia is one of the predictor of outcome in hemorrhagic strokes. Regarding to the S.B.P. and D.B.P.· This study found that higher blood pressure at admission is one of the prognostic factors in hemorrhagic strokes. |