London, United Kingdom 2013 26 Acute stroke: emergency management, stroke units and complications Surgical Treatment for Hypertensive Intracerebral Hemorrhage: Is it the answer for India? S. SINGH1, M.V. PADMA2, R. BHATIA3, K. PRASAD4, V.K. RAI5, M. TRIPATHI6, M.B. SINGH7, A. SURI8 All India Institute of Medical Sciences, Ansari Nagar, New Delhi, INDIA1, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, INDIA2, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, INDIA3, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, IN-DIA4, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, INDIA5, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, INDIA6, All India Institute of Medical Sciences, An-sari Nagar, New Delhi, INDIA7, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, INDIA8 Background-Spontaneous Intracerebral Hemorrhage (ICH) almost always portends a poorer progno-sis as compared to other stroke subtypes. Decompressive surgery has failed to show consistent ben-efit in functional outcomes. No major evidence comes from developing countries. We aim to study the outcome of patients undergoing surgery for ICH its feasibility in the Indian perspective. Methods-Patients with Spontaneous ICH were recruited from Neurology Department of All India In-stitute of Medical Sciences, New Delhi. 100 patients considered to be severe strokes were included. 38 patients underwent Decompressive craniotomy with hematoma evacuation, 19 underwent Exter-nal Ventricular Drainage (EVD) and 43 were managed conservatively.Primary Outcome was death and mRS at 6 months. Results-Outcome of 93 patients was analysed. All but one patient had gangliothalamic ICH. He-matoma volume was more in the intervention group at baseline. The cumulative risk of death at 6 months was 58.8% in the evacuation group, 73.6% in the EVD group and 57.5% in the medically managed group. The Odds ratio of death in the evacuation group was 1.05 (p 0.417 ; 95%CI 0.41 to 2.66) and in the EVD group were 2.06 (p 0.234; 95% CI 0.62 to 6.85) as compared to medical group. Thirty two percent of patients achieved an mRS of 4 or less (favourable outcome) in the evacuation group as against 15.7% in the EVD and 35% in the medical group. The Odds ratio for achieving an mRS of more than 4 in the evacuation group as compared to medical group was 1.12 (p 0.810; 95% CI 0.42 to 2.96) and in the EVD group were 2.87 (p 0.138; 95% CI 0.71 to11.57). Patients with good outcomes were younger (mean age 55 yrs, p value 0.05), male (41%, p value 0.005) and with a higher GCS score (p value 0.01). A relatively lesser volume of hematoma was also associated with a better outcome (p value 0.006). Conclusions- Surgical intervention did not improve outcome at 6 months.Surgery for putaminal and thalamic ICH is presently of questionable benefit in the setting of resource poor countries like India. E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 569 Diagnoses: Number of patients (n=317) Percentage Vascular 219 69% Intracranial Haemorrhage 119 38% Cerebral infarction 99 31% Sinus thrombosis 1 0,3% Non-vascular 60 19% Tumor 31 10% Seizures 15 5% Infectious/inflammatory disease 12 4% Others 2 0.6% Unknown 38 12% Table 1: Diagnoses of all patients recommended for transfer in TEMPiS network in 2012. Reasons for transfer: Number of patients (n=317) Percentage Neurosurgical procedures 148 47% Intervention for subdural haemato-ma 38 12% Intervention for subarachnoid hae-morrhage 34 11% Haematoma evacuation in intrace-rebral haemorrhage 29 9% Biopsy/ brain tumor surgery 21 7% External ventricular drain 15 5% Craniectomy 11 3% Acute thrombectomy 67 21% Specialized neurological care 101 32% in stroke patients 29 9% in non-stroke patients 72 23% Psychiatric care 1 0.3% Table 2: Reasons for transfer of all patients recommended for transfer in TEMPiS network in 2012.
Karger_ESC London_2013
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