Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality

Background: There is a paucity of clinical studies focused specifically on intracerebral haemorrhages of subcortical topography, a subject matter of interest to clinicians involved in stroke management. This single centre, retrospective study was conducted with the following objectives: a) to describe the aetiological, clinical and prognostic characteristics of patients with thalamic haemorrhage as compared with that of patients with internal capsule-basal ganglia haemorrhage, and b) to identify predictors of in-hospital mortality in patients with thalamic haemorrhage. Methods: Forty-seven patients with thalamic haemorrhage were included in the '' Sagrat Cor Hospital of Barcelona Stroke Registry '' during a period of 17 years. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The region of the intracranial haemorrhage was identified on computerized tomographic (CT) scans and/or magnetic resonance imaging (MRI) of the brain. Results: Thalamic haemorrhage accounted for 1.4% of all cases of stroke (n = 3420) and 13% of intracerebral haemorrhage (n = 364). Hypertension (53.2%), vascular malformations (6.4%), haematological conditions (4.3%) and anticoagulation (2.1%) were the main causes of thalamic haemorrhage. In-hospital mortality was 19% (n = 9). Sensory deficit, speech disturbances and lacunar syndrome were significantly associated with thalamic haemorrhage, whereas altered consciousness (odds ratio [OR] = 39.56), intraventricular involvement (OR = 24.74) and age (OR = 1.23), were independent predictors of in-hospital mortality. Conclusion: One in 8 patients with acute intracerebral haemorrhage had a thalamic hematoma. Altered consciousness, intraventricular extension of the hematoma and advanced age were determinants of a poor early outcome

AVALIAÇÃO NO NÍVEL DE CONSCIÊNCIA EM PACIENTES COM TRAUMATISMO CRÂNIO - ENCEFÁLICO.

A study regarding the evaluation of conscious level in 50 patients with head-injury, admitted in Neurosurgical Intensive Care Unit. For evaluation, the patient was observed and examined in his own bed, bee utilized a scale with three behaviors tables, a minimum score de 3 pointing the smaller degree of conscious level, and maximum score of 15 pointing the neurophysiologic normal state. The utilized method has demonstrated to be usefull for the precision facilities verified in evaluated answers and for the reduced time of appliance, which was around five minutes as a rule.Estudo sobre a avaliação do nível de consciência em 50 pacientes com traumatismo crânio-encefálico, internados em uma Unidade de Terapia Intensiva de Neurocirurgia. Para a avaliação, o paciente foi observado e examinado no próprio leito, e utilizou-se uma escala contendo três índices comportamentais, com escore mínimo de 3, indicando o menor grau do nível de consciência e escore máximo de 15, indicando o estado neurofisiológico normal. O método utilizado demonstrou ser passível de ser usado, pela facilidade em verificar precisão das respostas avaliadas e pelo tempo reduzido para aplicação, o qual foi em média de 5 minutos