Articles: subarachnoid-hemorrhage.
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J Comput Assist Tomogr · Jun 1981
Postcontrast computed tomography in subarachnoid hemorrhage from ruptured aneurysms.
Computed tomography (CT) scans of 49 patients with subarachnoid hemorrhage (SAH) secondary to ruptured aneurysms were reviewed. Subarachnoid blood was detected in 95% when CT was performed within 5 days after the bleeding. ⋯ Aneurysms were directly visualized in 8 cases and subarachnoid enhancement was noted in 21. In 3 cases, subarachnoid enhancement made possible a correct diagnosis of SAH in the absence of evidence of cisternal blood on precontrast CT scans.
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The records of 100 consecutive cases of subarachnoid hemorrhage due to ruptured aneurysm were reviewed to determine the incidence and the prognostic implications of seizures during the acute phase. Seizures occurred in 26% of the patients. ⋯ Most of the remaining seizures occurred immediately after rebleeding, with no greater morbidity or mortality compared to all patients who rebled. Pathogenic mechanisms of seizures associated with subarachnoid hemorrhage are proposed and discussed.
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Cerebral vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. With improvement in surgical techniques and perioperative care, the results in neurologically intact patients are generally satisfactory. However, cerebral vasospasm remains a major problem in the successful management of neurologically deteriorating patients. Until the pathophysiology of cerebral vasospasm is clarified, a reliable treatment regimen will remain elusive and the overall outlook for patients with aneurysmal subarachnoid hemorrhage will remain limited.
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Comparative Study
The role of antifibrinolytic therapy in the preoperative management of recently ruptured intracranial aneurysms.
In a retrospective study of the use of antifibrinolytic therapy in a series of patients with recently ruptured intracranial aneurysms, 131 patients were selected based on the following criteria: commencement of therapy within 3 days of the last subarachnoid hemorrhage (SAH); continuation of therapy for at least 6 days; and apparently uncomplicated surgery. Two main modalities of antifibrinolytic therapy were used: Group A, tranexamic acid (AMCA) 3 gm daily plus aprotinin k.i.u. (kallikrein inactivating units) daily (82 cases); Group B, AMCA 6 gm daily (41 cases). The remaining 8 patients were treated with epsilon-aminocaproic acid alone or in combination with aprotinin and were not considered to constitute a large enough group for statistical comparison. ⋯ The difference in the rate of severe cerebral ischemic complications was statistically significant (11 of 82 in Group A versus 12 of 41 in Group B, p less than 0.02), and in the main they were present preoperatively. The rates of rebleeding (approximately 10%) and of death from rebleeding (approximately 5%) are lower than in other published series on the natural history of this condition. In cases in which antifibrinolytics are indicated, present evidence indicates that low-dose AMCA plus aprotinin seems to be a rational combination for lowering the rebleeding, ischemic complication, and post-SAH hydrocephalus rates.
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Review
Antifibrinolytic therapy in subarachnoid hemorrhage caused by ruptured intracranial aneurysm.
There are 25 published studies on the treatment with antifibrinolytic agents of subarachnoid hemorrhage (SAH) caused by ruptured intracranial aneurysm. Twelve of these studies were uncontrolled and, except for one, all reported reduced incidence of rebleeding. ⋯ Three studies showed no effect, and three reported a higher incidence of rebleeding in treated patients. Discrepancies may be due to the multiple clinical variables of SAH and to flaws in methodology; nevertheless, the data fail to demonstrate that antifibrinolytic therapy alters the natural history of the disease.