Articles: subarachnoid-hemorrhage.
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To observe the outcome of surgical clipping in anterior circulation aneurysm in a modestly resourced hospital. ⋯ Surgical clipping of anterior circulation aneurysms is a safe and effective treatment, yielding favorable angiographic outcomes. Despite occasional complications, most patients achieved satisfactory results, especially in a setting having limited endovascular facilities or when coiling is not feasible. Future comparative studies with endovascular methods will further refine patient selection and surgical techniques.
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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.
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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.
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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.