A comparative study of surgical and conservative management of intracerebral hemorrhage

Context: Intracerebral hemorrhage is a serious medical emergency because they increase intracranial pressure. The mortality rate for intraparenchymal bleeds is over 40%. ICH patients show worst outcome of all stroke subtypes (30-day mortality 30% - 50%). Aims: To find the morbidity and mortality indicators and to evaluate the correlation between the GCS, volume and prognostic outcome in ICH. To compare the outcome between conservative and surgically managed ICH. Settings and design: Retrospective analysis of 40 cases admitted between 2015 and 2016 in the Institute of Neurosurgery, Rajiv Gandhi Government General Hospital, Chennai was done. Patients admitted within 24 hours of ICH were included. Clinical and radiological data collected. Patients managed based on institutional protocol. Outcome was analysed based on GOS and Rankin score. Results: Increased incidence of ICH in men and in 40 – 50 years age (25% ). Six months mortality was 18% and 28% for surgical and medically managed patients respectively but statistically insignificant. There was minimal better outcome of good and moderate GOS in surgically treated patients. Rankin scoring showed a minimal better outcome with surgical intervention but statistically insignificant. Conclusions: ICH patients with GCS 13-15 can be safely observed. There is a strong evidence to support operating on ICH patients with GCS 9-12. For GCS < 9, surgical intervention appears to be less effective. Surgical intervention has better outcome in large hematoma. Presence of IVH significantly reduces the outcome