Influence of presurgical cerebral and extracerebral factors on lethality in surgical treatment of hemorrhagic stroke
Keywords:hemorragic strokes, lethality, cerebral and extracerebral factors, organs’ disfunction, multiorgan unsufficiency
Introduction. Hemorrhagic strokes are one of principal causes of mortality. As a rule, it is caused by a rupture of arterial aneurisms – in 78.5% patients, arteriovenous malformations – in 8.5%, formation of intracerebral hematomas – in 13%.
Methods. To establish main causes of a stroke 224 patients were examined, of whom 119 survived and 105 died. Surgical treatment of hemorrhagic stroke revealed the highest lethality among patients with intracerebral haematomas, which is attributable to patient’s old age and a large volume of haematomas.
Results. There are primary and secondary cerebral determining factors. The main cause of death among patients was primary cerebral factors i.e. volume and localization of hematomas. Lethality is higher in case of intracerebral hematomas and definitely lower in case of subarachnoid hemorrhages. As secondary cerebral factors, brain edema and axial tonsilla herniation play a decisive role a decision role. Expressed extracerebral dysfunction is observed only in 1.3% of the dead patients (3 points according to the Sequential Organ Failure Assessment (SOFA) score, and somewhat more often in patients with organ dysfunction (1–2 points).
Conclusions. The most objective marker of lethality is the sum of SOFA score points. If it exceeded 7 points, lethality reached 90%, and at 0–3 points — only 44%. The above data show that that the basic treatment and preventive hospital interventions should be aimed at eliminating secondary cerebral factors: improvement of cerebral perfusion and oxygenation, and brain edema management.
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Copyright (c) 2012 Olga Kamenska, Leonard Chepkiy, Orest Tsimeyko, Volodymyr Moroz
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