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KMID : 1001920040350010081
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Journal of Korean Neurosurgical Society
2004 Volume.35 No. 1 p.81 ~ p.87
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Significance of an Early Clinical Course during the External Ventricular Drainage in Thalamic Hemorrhage
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Kim Ra-Sun
Bae Hack-Gun
Yoon Seok-Mann
Doh Jae-Won
Lee Kyeong-Seok
Yun Il-Gyu
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Abstract
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Objective :The purpose of this study is to investigate the significance of an early clinical course during the external ventricular drainage(EVD) in patients with thal amic hemorrhage.
Methods :During the last 11 years(1990-2000), a hundred patients with thalamic hemorrhage who underwent EVD were studied. Thirty-four patients underwent temporary closing of EVD at the mean interval of 4.5 clays after EVD. The clinical course was divided into 3 groups according to change of Glasgow Coma Scale(GCS) scores of 2 or more within 3 days after EVD compared with those just before EVD : deteriorated, unchanged, and improved.
Results :The factors affecting mortality were unchanged(odds ratio [OR] 0.05, 95% confidence interval [0]0.01-0.38, p=0.0028) and deteriorated clinical course(OR 0.06, 95% Cl 0.01-0.38, p=0.0033), GCS scores at the time of admission(OR 1.3, 95% Cl 1.02-1.66, p=0.0346), amount of hematoma(OR 0.91, 95% Cl 0.83-1.00, p=0.0461) and hematoma enlargement(OR 0.06, 95% Cl 0.01-0.65, p=0.0198). The factor affecting the early clinical deterioration was the hematoma enlargement(OR 0.11, 95% Cl 0.03-0.38, p=0.0005). The shunt operation was predicted in patients who showed the clinical improvement after EVD followed by the clinical deterioration within 48 hours after temporary closing of EVD.
Conclusion :It is suggested that an early clinical course during the maintenance of EVD is important to predict mortality and necessitlf of shunt operation.
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KEYWORD
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Thalamic hemorrhage, External ventricular drainage, Hematoma enlargement, Shunt
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