Articles: subarachnoid-hemorrhage.
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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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In a consecutive series of 473 patients admitted within 72 hours after a subarachnoid hemorrhage, 91 (19%) had hydrocephalus on the initial computed tomogram. Consciousness was unimpaired in 25 of the 91 (28%). In 11 more patients acute hydrocephalus developed within 1 week after subarachnoid hemorrhage. ⋯ Ventriculitis developed in 12 of the 24 patients with external drainage, mainly after greater than 3 days of drainage, and in none of the eight patients with an internal shunt. Among the 340 patients with aneurysmal subarachnoid hemorrhage and no long-term tranexamic acid treatment, the frequency of rebleeding in patients with ventricular drainage (43% of 23) was significantly higher than in hydrocephalic patients without drainage (15% of 52 patients; chi 2 = 5.009, p = 0.025) and patients without acute hydrocephalus (20% of 265 patients; chi 2 = 5.521, p = 0.019). We conclude that spontaneous improvement occurs in half of the patients with acute hydrocephalus and impaired consciousness on admission, which is usually apparent within 24 hours, and that the outcome of patients who need ventricular drainage will improve if rebleeding and infection after insertion of the ventricular drain can be prevented.
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Review Case Reports
The management of caesarean section in a patient with an intracranial arteriovenous malformation.
The anaesthetic management of elective Caesarean section in a 25-year-old woman with an inoperable intracranial arteriovenous malformation is described. The literature is reviewed.