Articles: subarachnoid-hemorrhage.
-
Whether there is a sex difference in the outcome of aneurysmal subarachnoid hemorrhage (aSAH) remains controversial, and clarifying the role of women in postoperative cerebral ischemic events can help us to understand its relationship with poor prognosis. Therefore, the purpose of this study was to elucidate the relationship between the three aspects of sex differences, postoperative cerebral ischemia, and poor prognosis after aSAH. ⋯ Women have a higher incidence of DCI, but there is no sex difference in outcomes after aSAH, and poor prognosis is associated with worse admission condition and perioperative complications. SRCI is a strong independent risk factor for poor prognosis, whereas DCI is not.
-
Blood in the fourth ventricle is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated (1) the prognostic significance of the amount of blood in the fourth ventricle and (2) the influence of active blood clearance and delayed cerebral ischemia prevention (ABCD). ⋯ Ballooning fourth ventricular hemorrhage (grade 4 FVH) is a powerful predictor of poor outcomes after aSAH. With the introduction of ABCD, the prognosis of these patients improved considerably and 25% reached functional independence 6 months after aSAH.
-
Classic teaching in neurocritical care is to avoid jugular access for central venous catheterization (CVC) because of a presumed risk of increasing intracranial pressure (ICP). Limited data exist to test this hypothesis. Aneurysmal subarachnoid hemorrhage (aSAH) leads to diffuse cerebral edema and often requires external ventricular drains (EVDs), which provide direct ICP measurements. Here, we test whether CVC access site correlates with ICP measurements and catheter-associated complications in patients with aSAH. ⋯ Contrary to classic teaching, we find that IJ CVC placement was not associated with increased ICP in the clinical context of the largest, quantitative data set to date. Further, IJ access was the least likely to be associated with an access-site complication when compared with SC, femoral, and PICC. Together, these data support the safety, and perhaps preference, of ultrasound-guided IJ venous catheterization in neurocritically ill patients.
-
Multicenter Study Observational Study
Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study.
People presenting to the ED with acute severe headache often undergo investigation to exclude subarachnoid haemorrhage (SAH). International guidelines propose that brain imaging within 6 hours of headache onset can exclude SAH, in isolation. The safety of this approach is debated. We sought to externally validate this strategy and evaluate the test characteristics of CT-brain beyond 6 hours. ⋯ Our data suggest a very low likelihood of SAH after a negative CT-brain scan performed early after headache onset. These results can inform shared decision-making on the risks and benefits of further investigation to exclude SAH in ED patients with acute headache.