Articles: subarachnoid-hemorrhage.
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Review Case Reports
Hypervolemic hemodilution: a new approach to subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) refers to the sudden accumulation of blood in the subarachnoid space or in the ventricular system. The hemorrhage may occur with cerebral anomalies, tumors, or trauma. The presence of SAH has been associated with decreases in cerebral blood flow (CBF), which may be attributed in part to increased blood viscosity and hematocrit. ⋯ The dosage is gradually tapered before discontinuation. Effectiveness of the therapy is measured through improvement in neurologic function and regional CBF measurements. The critical care nurse plays a vital role in administering and monitoring the therapy and in educating the family about the disease process and interventions.
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Fifty-three of 236 consecutive patients (22.5%) who suffered a proved aneurysmal subarachnoid hemorrhage and who were admitted within 72 hours after subarachnoid hemorrhage to a primary emergency hospital had at least one rebleed within 6 months after the primary bleed. Two patients later had a rebleed within a mean of 3 years follow-up. ⋯ The rebleed mortality rate was 74%, and only 19% of patients with a rebleed had a good outcome. The grade on admission, age, and sex do not affect the incidence nor the time of rebleeding.
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J. Neurol. Neurosurg. Psychiatr. · Jul 1989
Xanthochromia after subarachnoid haemorrhage needs no revisitation.
Recently it was contended that it is bloodstained cerebrospinal fluid (CSF) that is important in the diagnosis of subarachnoid haemorrhage (SAH) and not xanthochromia, and also that a normal CT scan and the absence of xanthochromia in the CSF do not exclude a ruptured intracranial aneurysm. The CSF findings were therefore reviewed of 111 patients with a proven SAH. All patients had xanthochromia of the CSF. ⋯ All 12 patients survived without disability and were not re-admitted with a SAH (mean follow up 4 years). It is concluded that it is still xanthochromia that is important in the diagnosis of SAH and not bloodstained CSF. Furthermore a normal CT scan and the absence of xanthochromia do exclude a ruptured aneurysm, provided xanthochromia is investigated by spectrophotometry and lumbar puncture is carried out between 12 hours and 2 weeks after the ictus.
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Arch Neurol Chicago · Jul 1989
Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study.
Hydrocephalus is an important complication of subarachnoid hemorrhage (SAH). We analyzed several factors possibly related to hydrocephalus following SAH in 3521 patients from the International Study on the Timing of Aneurysm Surgery. Hydrocephalus was diagnosed on admission computed tomographic (CT) scans in 15% of patients and was thought to be clinically symptomatic in 13.2% of patients. ⋯ We conclude that the development of hydrocephalus after SAH is multifactorial. Factors that compromise cerebrospinal fluid circulation acutely (eg, intraventricular hemorrhage, hemorrhage from a posterior circulation site of aneurysm, and diffuse spread of subarachnoid blood) contribute to the development of acute hydrocephalus. These same factors, plus the use of antifibrinolytic drugs preoperatively, are also important in the pathogenesis of clinical hydrocephalus, perhaps by promoting subarachnoid fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)