| Prognostic Factor Analysis of Primary Pontine Hemorrhage in Elderly Patients |
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Kyoung-Han Kim , Jung-Yul Park , Dong-Jun Lim M.D., Sang-Dae Kim , Se-Hoon Kim |
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Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea |
| 65세 이상의 자발성 뇌교부 출혈 환자에
대한 예후 인자 분석 |
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| Abstract |
Objective
Primary pontine hemorrhage (PPH) accounts approximately for about 5-10% of intracerebral hemorrhages
(ICH), and overall mortality rate in recent studies is 40-50%. Due to its high mortality, surgeons tend treat less aggressively,
especially in old age. Although old age is known as a poor prognostic factor of supratentorial hemorrhages,
there has not been extensive studies in elderly patients with brainstem hemorrhage. We tried to evaluate the prognosis and
prognostic factors in PPH patients with a special focus on elderly patients.
Methods
We analyzed the 21 patients with primary pontine hemorrhage in old age admitted to our hospital between
January 2000 and December 2007. Glasgow Coma Scale (GCS) scores were assessed on admission, and Glasgow
Outcome Scale (GOS) scores were assessed on discharge. We divided the patients into two groups according to GOS
score: Patients who had bad prognosis, and patients who had good prognosis. The two groups were compared for
age, gender, hypertension and diabetes, initial mental status, initial GCS, pupillary abnormalities, volume and location
of hemorrhage, intraventricular and extrapontine extension, need for mechanical ventilation and hydrocephalus.
Results
Twenty-one patients were aged over 65 years. Eleven patients of twenty one were classified to the bad
prognosis group. But, in this study age did not show statistical correlation. Hence, prognostic factors of old age
PPH patients were not different from adult population in general. However, significant prognostic factors found were
coma on admission, hypertension and diabetes, GCS score on admission, hematoma location, hematoma volume,
need for mechanical ventilation and intraventricular hemorrhage.
Conclusion
Although patients with PPH are associated with high mortalities and morbidities, several recent reports
indicate the existence of good prognostic groups. In our study, there was no difference in prognosis in two groups. Therefore,
physicians should not give up old aged patients but instead treat these patients aggressively as with younger patients. |
| Key Words:
Old ageㆍPrimaryㆍPontine hemorrhageㆍPrognostic factorㆍTreatment guideline |
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