Articles: subarachnoid-hemorrhage.
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Acta neurochirurgica · Jan 1995
The use of computed tomography in the prediction of delayed cerebral infarction following acute aneurysm surgery for subarachnoid haemorrhage.
In order to predict the occurrence of cerebral infarction after aneurysmal surgery in patients with subarachnoid haemorrhage, we measured the amount of subarachnoid blood on initial and on postoperative computed tomograms. We used a reliable grading method to estimate the amount of blood on computed tomograms in 24 patients with infarction due to vasospasm and 45 patients without cerebral infarction, all of whom underwent aneurysmal surgery within 48 hours after the ictus. The total amount of subarachnoid blood on admission and on the day after operation was more in the cerebral infarction group than in the non-infarction group. ⋯ Therefore, we propose this range to be an indication for the occurrence of cerebral infarction in postoperative patients due to cerebral vasospasm. The presence of intracerebral haematoma and the amount of ventricular blood and their clearance by surgery were also estimated for the prediction of delayed cerebral infarction after aneurysmal surgery. However, they had no relation to the occurrence of cerebral infarction due to vasospasm.
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Acta neurochirurgica · Jan 1995
Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms.
Twenty-three patients with aneurysmal subarachnoid haemorrhage (SAH), who showed an ST segment elevation in their electrocardiograms (ECG), were examined. There were 12 males and 11 females, with a mean age of 61 years. The clinical condition on admission was Hunt and Kosnik grade II in four, III in seven, IV in one, and V in 11 patients. ⋯ These results suggest that ST segment elevation in the acute stage of SAH reflects transient cardiac dysfunction rather than myocardial injury. In some patients, however, the elevated serum levels of myocardial enzymes or T wave inversion suggested the presence of myocardial injury. Close follow-up seems to be necessary in such cases.
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Comparative Study Clinical Trial
[Japan coma scale in the prediction of outcome after early surgery for aneurysmal subarachnoid hemorrhage].
The value of the 10-grade Japan Coma Scale (JCS) as a means of evaluating patients undergoing early aneurysm surgery was assessed in terms of its relationship to surgical outcome. The 13-grade Glasgow Coma Scale (GCS) was also assessed, and comparisons were made between the two. A series of 765 patients who underwent aneurysm surgery within 7 days after hemorrhage were evaluated both by JCS and GCS immediately prior to surgery, and outcome was assessed by the Glasgow Outcome Scale (GOS) 6 months postoperatively. ⋯ There was no significant difference between the correlation coefficients for outcome of the JCS and GCS. In general, the better the JCS or GCS score was, the better the surgical outcome was, however, outcome among those with a JCS score of 3 was poorer than among those with a score of 10, 20, or 30. The results of this study indicate that both JCS and GCS are useful in predicting surgical outcome, but the GCS may be better than the JCS because of the problem with the score of 3 in the latter.
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Acta neurochirurgica · Jan 1995
Influence of aneurysm location on the development of chronic hydrocephalus following SAH.
The incidence of chronic hydrocephalus was analysed in a series of 204 patients with aneurysmal subarachnoid haemorrhage (SAH). Its development was significantly related to the quantity of subarachnoid blood, but even more to the location of the haemorrhage and to the aneurysm site. Hydrocephalus was more frequent in patients under poor initial condition. ⋯ Surprisingly, in our series a shunt was never needed in patients with aneurysms of the middle cerebral artery (MCA). SAH from an aneurysm of the internal carotid artery (ICA) also never caused a shunt-dependent hydrocephalus except in cases with accompanying intraventricular haemorrhage. The percentage of chronic hydrocephalus was relatively high (19%) in patients with anterior communicating artery (ACoA) aneurysms but definitely highest in patients with an aneurysm of the vertebrobasilar (VB) system (53%).
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Acta neurochirurgica · Jan 1995
The haemodynamic effect of transcranial Doppler-guided high-dose nimodipine treatment in established vasospasm after subarachnoid haemorrhage.
Eleven patients (7 females) with aneurysmal subarachnoid haemorrhage (SAH) and transcranial Doppler (TCD) signs of vasospasm during prophylactic intravenous nimodipine treatment (2 mg/h) were treated with TCD-guided high-dose (4 mg/h) intravenous nimodipine. The patients were followed clinically and with serial TCD investigations. Increasing nimodipine to high-dose treatment led to a reduction of the abnormally elevated mean flow velocities (FV) in all patients. ⋯ The individual effect of nimodipine treatment can be monitored by the use of serial TCD investigations. TCD-guided high-dose nimodipine treatment appears to be an effective treatment in SAH patients developing vasospasm despite prophylactic standard dose treatment. The data give support for a direct vascular effect of nimodipine on cerebral vasospasm.