Primary Intracerebral Hematoma (PICH): practical scale proposal for therapeutic decision

Resumo

Introdução: HICP é um sangramento intracerebral agudo, decorrente de causas primárias, principalmente hipertensão arterial sistêmica (HAS). É uma entidade comum com alta morbidade e mortalidade. No entanto, suas indicações cirúrgicas têm sido controversas até que parâmetros bem definidos fossem estabelecidos. Objetivo: estabelecer um método uniformizado, através de uma tabulação pontuada, que favoreça os pacientes com HICP, para o aumento de sobrevida e redução da morbimortalidade. Métodos: analisar parâmetros clínicos e tomográficos para classificar e pontuar pacientes com HICP como candidatos ao tratamento conservador ou cirúrgico. Aplicação da escala proposta sobre o estudo retrospectivo prévio e publicado de pacientes com HICP e HAS, de abril de 2002 a 2016 (532 casos) e os achados bibliográficos consultados31. A validação foi feita por escalas previamente consultadas, mas pontuadas. Resultados: os achados clínicos foram os principais parâmetros, seguidos pela topografia do HICP e, finalmente, não menos importante, pelo seu volume. Os resultados nos levaram à proposta da escala CTV (Clínica, Topografia e Volume) para os HICP. Conclusão: Identificamos os principais parâmetros pontuados associados à indicação do tratamento conservador versus cirúrgico e o resultado positivo. Houve fidedigna correspondência entre a Escala CTV e os achados do estudo nas séries consideradas. Inclusive sugere-se considerar a cirurgia em casos com HICP talâmico, nuclear ou lobar com 31-50 mL causando hidrocefalia hemoventricular, se estiverem com escala de coma de Glasgow pupilar (ECGP) > 3.

Palavras-chave

Hemorragia intracerebral primária; Tratamento; Escala prática

Abstract

Introduction: PICH is acute intracerebral bleeding, resulting from primary causes, especially Systemic Arterial Hypertension (SAH). The PICH is a common entity with high morbidity and mortality. However, its surgical indications have been controversial until precise defined parameters were stablished. Objective: to stablish a standardized method, through data tabulation, that favors patients with PICH, to increase survival and reduce morbidity and mortality. Methods: retrospective analysis of clinical and tomographic parameters to classify and score patients with PICH as candidates for conservative or surgical treatment. The scale proposed was applied according the prospective study published on patients with PICH and SAP, from April 2002 to 2016 (532 cases) and the consulted bibliographic findings31. The validation was done by previously consulted scales but using pointed tabulation. Results: The clinical findings were first important parameter, followed by PICH Topography and its Volume at last, but not the least. The results guided us to the proposed Clinic, Topography and Volume Scale (CTV Scale). Conclusion: The present study identified the main parameters scored associated with the indication of conservative versus surgical treatment and the positive outcome. The reliable correspondence was found between the CTV Scale and the results. Therefore, it is suggested to consider surgery in volume 31-50 mL, lobe topography, basal ganglia and thalamic PICH cases, with hemoventricle hydrocephalus, if Glasgow Coma Score and Pupils (GCSP) > 3.

Keywords

Primary intracerebral hemorrhage; Treatment; Practical scale

References

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Primary Intracerebral Hematoma (PICH): practical scale proposal for therapeutic decision

Hematoma Intracerebral Primário (HICP): proposta de escala prática para a decisão terapêutica

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