title: Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009.
abstract: BACKGROUND
  Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid.
  
  
  METHODS
  Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome.
  
  
  RESULTS
  Patients' age was 59.5 ± 7 years in 1990-1994, and 58.2 ± 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9 (4-14), respectively. Long-term follow-up was assessed at a mean of 37.1 (range 19-65) months after disease onset for the 1990-1994 cohort and at 37.4 (range 14-58) months for the 2005-2009 cohort. Compared to patients from 1990 to 1994, patients from 2005 to 2009 had a significantly better outcome (median mRS [25th and 75th percentile]: 5 [4-6] vs. 4 [2-4.5]; p < 0.01). Most patients (13/21, 62 %) treated from 1990 to 1994 had unchanged or lower GCS scores during their NCC stay in contrast to 7/22 (32 %) from 2005 to 2009. At the last follow-up, 13/21 (62 %) patients from 1990 to 1994 were dead in comparison to 4/21 (19 %) from 2005 to 2009 (p < 0.05). Negative prognostic factors were the 120 h post-admission GCS score in the 1990-1994 patient cohort (p = 0.07) and high age in the recent cohort (p = 0.04).
  
  
  CONCLUSIONS
  Patients with thalamic hemorrhage and depressed level of consciousness on admission had a worse outcome in the early 1990s compared with the late 2000s, which may at least be partially attributed to refined neurocritical care.
authors.affiliation: Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
authors.forename: Parmenion P
authors.initials: PP
authors.lastname: Tsitsopoulos
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
authors.forename: Anders
authors.initials: A
authors.lastname: Wanhainen
authors.forename: Lovisa
authors.initials: L
authors.lastname: Tobieson
authors.forename: Hans-Göran
authors.initials: HG
authors.lastname: Hårdemark
authors.forename: Niklas
authors.initials: N
authors.lastname: Marklund
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000134:cerebrospinal fluid* / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013786:Thalamic Diseases / Q000134:cerebrospinal fluid* / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome