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Master Thesis

Rupture d’anévrysme de l’artère cérébrale moyenne avec hématome : une série de 58 cas consécutifs

Abstract : Objective: intracerebral hematomas in patients with aneurysmal subarachnoidal hemorrhage require critical therapeutic decisions. Survival, with sometimes very poor functional outcomes, depends on emergency treatment, but there is no consensus regarding the indications. Our objective was to determine prognostic factors helping initial therapeutic decisions. Methods: we retrospectively analyzed 58 consecutive patients presenting intracerebral hematomas secondary to middle cerebral artery aneurysmal subarachnoidal hemorraghe from 2008 to 2016 in La Pitié Salpétrière neurosurgery and intensive care departments, Paris. Clinical and radiological presentation, aneurysm treatment, intracranial hypertension treatments, and outcome were examined. Survival was the principal evaluation criterion, the secondary one was functional outcome assessed by Glasgow outcome scale and modified Rankin score. Results: mortality rate was 28% (16/58 patients). Death risk was associated with initial symptoms of cerebral herniation, left-sided hematoma, and intraoperative aneurysm rupture. A one year favorable functional outcome (GOS or mRS= 1 or 2) was achieved for 38% of patients (22/58). Unfavorable outcome was associated with insular location, left-sided hematoma and initial midline shift. Treatment modalities were not associated with outcome. Conclusion: because of the poor outcome, our results tend to encourage avoiding useless treatments for patients with clinically significant cerebral herniation, initial midline shift, and left-sided or insular hematomas. However these results need to be confirmed, and the benefit of performing simultaneous embolization and surgical evacuation of hematoma needs to be assessed more precisely.
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Master Thesis
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Anaïs Chivet. Rupture d’anévrysme de l’artère cérébrale moyenne avec hématome : une série de 58 cas consécutifs. Médecine humaine et pathologie. 2017. ⟨dumas-01718873⟩

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