Superacute Phase Blood Pressure Elevation May Relate to Massive Hematoma in Hypertensive Putaminal Hemorrhage.

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  • Isozumi Kazuo
    Department of Emergency and Critical Care Medicine School of Medicine, Keio University Department of Neurology, School of Medicine, Keio University
  • Hori Shingo
    Department of Emergency and Critical Care Medicine School of Medicine, Keio University
  • Tanahashi Norio
    Department of Neurology, School of Medicine, Keio University
  • Shinozawa Youtaro
    Department of Emergency and Critical Care Medicine School of Medicine, Keio University
  • Fujishima Seitaro
    Department of Emergency and Critical Care Medicine School of Medicine, Keio University
  • Aikawa Naoki
    Department of Emergency and Critical Care Medicine School of Medicine, Keio University

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Abstract

A restrospective clinical investigation has been performed to elucidate the relationship between hematoma size in putaminal hemorrhage and blood pressure (BP) changes during the immediate posthemorrhagic phase in the emergency room (ER). Thirty-seven adult patients brought to the emergency department by ambulance within 6 hours after onset of symptoms with a confirmed diagnosis of acute putaminal hemorrhage on CT have been involved. Two BP measurements during the superacute phase in the ER have been studied: immediately after arrival at the ER (BP-I), and immediately prior to CT examination (BP-II). Patients have been divided into 6 categories: 1) those whose BP decreased with treatment (D+), 2) those whose BP decreased without treatment (D-), 3) those whose BP increased in spite of treatment (1+), 4) those whose BP increased without treatment (I-), 5) those whose BP remained unchanged in spite of treatment (U+), and 6) those whose BP remained unchanged without treatment (U-). Hematoma size has been compared among 5 categories (D+, D-, I-, U+, U-) using factorial ANOVA (analysis of variance). The hematoma sizes have been found to be (D+) 54±44ml, (D-) 22±25ml, (I-) 102±58ml, (U+) 11±5ml, (U-) 21±9ml (mean±S.D.), respectively. (I-) has been significantly larger than any of the other categories (p<0.001-0.05). Additional ANOVA has shown that BP-II in category (I-) was significantly higher than that of the other categories. Patients with putaminal hemorrhage whose BP was elevating during the superacute phase in the ER were shown to have massive hematomas.

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