Therapeutic attitude for intraparenchymal hematoma About 24 cases in Niamey

Abstract

Introduction: The management of intraparenchymal hematoma requires medical treatment at first step, but the usefulness and indications of neurosurgical treatment is still subject to debate. We propose to evaluate the therapeutic attitude of patients admitted in our department with intraparenchymal hematoma.

Method: This was a prospective study from January 2020 to December 2022 in neurosurgery and emergency department of the Niamey National Hospital.

Results: We enrolled 24 patients, 14 males and 10 females, with a ratio of 1.4. The mean age of our patients was 40.1 years, ranging from 17 to 77 years. On admission, 20 of our patients (83.33%) presented with a disturbance of consciousness; 14 patients (58.33%) had intracranial hypertension syndromes such as headache and jet vomiting. 22 patients (91.66%) had motor deficit.

Cerebral CT scans were carried out systematically in all our patients. In the supratentorial region, polar location was observed in 8 patients (33.33%) and deep basal ganglia hematoma in 14 patients (58.33%); in the sub tentorial region, hematoma involved the cerebellar hemispheres in 2 cases (08.33%).

 Therapeutically, all patients were under medical management, although 18 underwent surgery.

The surgical procedure involved evacuation of the hematoma in 7 cases, and external ventricular draining in 11 cases.

The outcome was favourable in 3 cases of polar intraparenchymal hematoma and one cerebellar hematoma, and in 2 non-operated patients with deep intraparenchymal hematoma. Overall mortality was high, 75% of those admitted for intraparenchymal hematoma.

Conclusion: Despite all the progress made in neurosurgery, notably new therapeutic methods (radiosurgery, stereotaxis, endoscopic surgery), spontaneous intraparenchymal haemorrhage remains a dreaded pathology with a poor prognosis. The attitude should always be, to treat patients with the maximum of resuscitation and surgical resources available.

KEYWORDS: Intraparenchymal hematoma, surgery, progress, Niger.