Articles: subarachnoid-hemorrhage.
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Diagnostic and therapeutic management options in cases of subarachnoid hemorrhage secondary to aneurysm rupture are discussed. Particular emphasis is given to the diagnosis, medical treatment and timing of surgery. The problems raised by the presence of an intracerebral hematoma, acute hydrocephalus and multiple aneurysms are reviewed. The author also discusses the management of incidental aneurysms, partially treated lesions, familial and genetic aneurysms, lesions which ruptured during pregnancy or associated with arterio-venous malformations, and the question of a negative angiogram in cases of subarachnoid hemorrhage.
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Journal of neurosurgery · Feb 1993
Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage.
The authors report a study of all instances of spontaneous intracerebral hemorrhage (ICH) (188 cases) and subarachnoid hemorrhage (SAH) (80 cases) that occurred in the Greater Cincinnati area during 1988. Adjusted for age, sex, and race, the annual incidence of ICH was 15 per 100,000 population (95% confidence interval 13 to 17) versus six per 100,000 for SAH (95% confidence interval 5 to 8). ⋯ The 30-day mortality rate of 44% for ICH was not significantly different from the 46% mortality rate for SAH. Despite the evidence that ICH is more than twice as common and the disorder just as deadly as SAH, clinical and laboratory research continues to focus primarily on SAH.
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Journal of neurosurgery · Feb 1993
Use of transcranial Doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage.
Blood flow velocity was recorded from the middle or anterior cerebral and extracranial internal carotid arteries using transcranial Doppler sonography (TCD) in 121 unselected consecutive patients with acute aneurysmal subarachnoid hemorrhage (SAH). Recordings were made daily or every 2nd day after SAH for a 14-day period. The highest recorded velocity was greater in the 47 patients who developed a delayed ischemic neurological deficit (186 +/- 6 cm sec-1; mean +/- standard error of the mean) than in the 74 patients who did not develop a neurological deficit (149 +/- 5 cm sec-1) (p < 0.001, Mann-Whitney test). ⋯ A rise of more than 50 cm sec-1 24 hrs-1 identifies those patients who are most likely to develop a delayed ischemic neurological deficit after SAH. This can be applied prospectively to individual cases. Serial TCD studies in the early period after SAH are thus of value to identify patients who can be selected for prophylactic therapy, which may prevent or ameliorate development of delayed ischemic neurological deficits.
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To assess the efficacy of nimodipine in preventing delayed ischaemic deficit in aneurysmal subarachnoid haemorrhage. ⋯ In our experience, nimodipine appears to have substantially reduced the incidence of delayed ischaemic deficits in patients with aneurysmal subarachnoid haemorrhage, with a resultant improvement in overall patient outcome.