Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one?

Seventy-four patients with hypertensive putaminal hemorrhage (HPH) were followed at least 6 months after treatment and estimated by ADL. They were graded according to the state of consciousness on admission. The grading consists of 6 grades: Grade 1, fully conscious; Grade 2, somnolent; Grade 3, stuporous; Grade 4, semi-comatose; and Grade 5, deeply comatose. Removal of HPH was performed in 18 patients and conservative treatment was done in 56 patients. The mortality in surgically treated group was 28% while that in conservatively treated group was 14%. The patients who returned to full work or independent life without disability and with minimal disability after surgical treatment were, 50% in Grade 1, 33% in Grade 2, and 50% in Grade 3. The patients without disability and with minimal disability after conservative treatment were; 87% in Grade 1, 80% in Grade 2, and 22% in Grade 3. None below Grade 4 returned to full work or independent life in both groups. There was good correlation between the state of consciousness and CT findings on admission. There was no correlation between good recovery and the side of HPH. Our results do not support the view that the surgical treatment is superior to the conservative one in the management of HPH.