Articles: subarachnoid-hemorrhage.
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The necessity of cerebral angiography was assessed in patients with thunderclap headache in whom subarachnoid hemorrhage had been ruled out on CT findings and the color of cerebrospinal fluid (CSF). ⋯ Even when CT and CSF studies reveal no abnormalities in the early stage after the onset of thunderclap headache, subarachnoid hemorrhage can not be ruled out. Therefore, cerebral angiography is recommended in patients with thunderclap headache.
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We studied the predictive factors for deterioration from hydrocephalus that developed during the first 28 days after admission in 660 patients following aneurysmal subarachnoid hemorrhage (SAH). Deterioration from hydrocephalus was defined as deterioration of consciousness with no detectable cause other than hydrocephalus confirmed by a repeat CT with a bicaudate index exceeding the 95th percentile for age. ⋯ In a multivariate analysis with the Cox proportional hazards model incorporating fixed and time-dependent covariates, sum score of cisternal blood on initial CT (hazard ratio 3.15, p < 0.000001), presence of ventricular blood on initial CT (hazard ratio 1.66, p = 0.004), hydrocephalus on initial CT (hazard ratio 3.37, p < 0.000001), and long-term treatment with tranexamic acid (hazard ratio 2.40, p < 0.000001) were significantly related with the development of hydrocephalus. We conclude that a high amount of blood after SAH and delay of the resorption of cisternal and ventricular blood caused by long-term treatment with tranexamic acid increases the risk of deterioration from hydrocephalus after SAH.
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J. Am. Coll. Cardiol. · Sep 1994
Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium.
The purpose of this study was to determine whether a relation exists between electrocardiographic (ECG) abnormalities and left ventricular wall motion in patients with subarachnoid hemorrhage. ⋯ These findings suggest that patients with subarachnoid hemorrhage and ST segment elevation may demonstrate transient corresponding regional wall motion abnormalities. The mechanism of neurogenic stunned myocardium was not clearly elucidated in the present study.
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Review Comparative Study
Definition of initial grading, specific events, and overall outcome in patients with aneurysmal subarachnoid hemorrhage. A survey.
Scientific communication in medicine can be effective only if reports are based on unequivocal criteria for clinical conditions or specific diagnoses. ⋯ Reports about subarachnoid hemorrhage require closer scrutiny before publication to ascertain whether the conclusions about specific outcome events are based on unequivocal criteria.
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During 1980-85, cerebral angiography was performed as soon as possible for early operation of ruptured aneurysms. However, during that period, the incidence of rebleeding during angiography conducted within 6 hours after the initial rupture was approximately two-fold higher than the rate of rebleeding within 6 hours for the total series. Therefore, since 1986, patients with grades I-IV have been managed with complete bed rest, and angiography has been withheld during the first 6 hours after rupture, except in patients in whom emergency operation was anticipated. ⋯ In patients with grades I-IV, the percentage of patients receiving angiography within 6 hours after rupture decreased from 45% during 1980-85 to 13% during 1986-92 (p < 0.01), and the ultra-early rebleeding rate decreased from 15% during 1980-85 to 5% during 1986-92 (p < 0.01). However, with the increase in number of patients referred in the ultra-early stage, the number of rebleeding cases during transfer increased. In conclusion, in order to reduce the rate of ultra-early rebleeding, withholding aggressive management such as angiography in this stage seems to be effective, and if there is no need for emergency operation, it is better to withhold patients' transfer in this stage and commence it soon after 6 hours following subarachnoid hemorrhage.