Presentation and outcomes of primary spontaneous intracerebral haemorrhage at Charlotte Maxeke Johannesburg Academic Hospital

Khohomela, Rambelani
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AIM: To determine the presentation and outcomes of patients with primary spontaneous intracerebral haemorrhage referred for neurosurgical management in Charlotte Maxeke Johannesburg Academic Hospital. METHOD: This was a 6-month prospective study of 45 patients referred to the CMJAH Neurosurgical Unit with a CT scan confirmed diagnosis of spontaneous intracerebral haemorrhage. Patients who met the inclusion criteria were then assessed for relevant data such as demographic, clinical and radiological data. Outcome was then assessed and prognostic factors for poor outcomes were analysed. RESULTS: There were 13 (28.89%)female patients and 32 (71.11%) male patients. The mean age was 52± 11.44 yrs. 32 (71.11%) patients were black, 8 (17.78%) were White,4 (8.89%) were Coloured and 1 (2.22%) was Indian. Collapse and weakness were the most common modes of presentation and occurred in 19 (42.22%) and 18 (40%) patients respectively. Supratentorial bleeds accounted for 35 (77.78%) patients while 10 (22.22%) patients suffered infratentorial bleeds. The anatomical location of the haemorrhages was: putamen 23 (51.11%), cortical 6 (13.33%), Pontine 5 (11.11%), thalamus 6 (13.33%), cerebellum 5 (11.11%).Craniotomy was performed in 3 (6.67%) patients and 4 (8.89%) patients had EVD inserted. There was poor outcome in 35(77.78%) patients with 22 (48.89%) dead, 1 (2.22%) vegetative and 12 (26.67%) severely disabled. Results from logistic regression showed that; age, GCS, mass effect, IVH, ICH volume and hydrocephalus were significantly associated with poor outcome. CONCLUSION: Our study has shown that spontaneous ICH presents a common clinical problem in our environment with associated significant morbidity and mortality
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirement for the degree of Master of Medicine in the Department of Neurosurgery, 2020