Articles: subarachnoid-hemorrhage.
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The medical records of 109 patients who presented to the emergency department during a five-year period with proven nontraumatic, spontaneous subarachnoid hemorrhage (SAH) were retrospectively reviewed. The clinical presentation, diagnostic modalities used, and accuracy of diagnosis by emergency physicians were analyzed. The most common historical features were headache (81 patients, or 74%), nausea or vomiting (85 patients, or 77%), and loss of consciousness (58 patients, or 53%). ⋯ The overall diagnostic accuracy by emergency physicians was 85%. The correct diagnosis was delayed in 16 patients (15%), the majority of whom had headaches and normal neurologic examinations. Atypical symptoms, the warning leak syndrome, and the need for prompt diagnosis and therapy are reviewed.
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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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Nihon Kyobu Shikkan Gakkai Zasshi · Jul 1989
Case Reports[A case of neurogenic pulmonary edema with repeated deterioration due to subarachnoid hemorrhage].
A 55-year-old male was admitted to our hospital for subarachnoid hemorrhage complicated with liver cirrhosis on Jan. 8th, 1988. Chest X-ray film on admission showed bilateral infiltrative shadows, which disappeared on Jan. 10th. However the same type of shadow reappeared on Jan. 12th. ⋯ Cardiac function evaluated by ultrasonocardiography and right cardiac catheterization, and the composition and amount of plasma protein concentration were within normal limits. Although the mechanism of repeated appearance of the shadow was not clear, the edema was thought to be neurogenic. As this case showed, the control of water balance and the use of diuretics are essential for treatment of this neurogenic pulmonary edema.
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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.