Articles: subarachnoid-hemorrhage.
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Using logistic regression, we analyzed the predictive value of a number of entry variables with respect to the outcome variables delayed cerebral ischemia, rebleeding, and poor outcome (death or severe disability) in patients with aneurysmal subarachnoid hemorrhage. The entry variables were clinical condition on admission (grades on the Glasgow Coma Scale, Hunt and Hess system), the amount of subarachnoid and intraventricular blood and the presence of hydrocephalus on the admission computed tomogram, and antifibrinolytic treatment with tranexamic acid. We used data from a prospectively studied population of 176 patients admitted within 72 hours after subarachnoid hemorrhage. ⋯ The site of delayed cerebral ischemia was not related to the location of the subarachnoid hemorrhage. Antifibrinolytic treatment was the only entry variable (negatively) predicting the risk of rebleeding. Death or severe disability after 3 months was best predicted by the amount of subarachnoid blood and the initial clinical condition reflected by the grade on the Glasgow Coma Scale.
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Arch Neurol Chicago · Sep 1988
Warning headache in aneurysmal subarachnoid hemorrhage. A case-control study.
Thirty consecutive patients with aneurysmal subarachnoid hemorrhage (SAH), 20 patients with ischemic stroke, and 100 controls were extensively interviewed about previous episodes of sudden headache, according to a standard pro forma. Thirteen patients with SAH (43%) had a history of a forewarning headache, compared with only one of the patients with ischemic stroke and none of the controls. The interval from the warning headache to the admission rupture was between one week and two months in all patients but one with SAH. ⋯ The outcome was slightly worse in patients with a warning headache, but the differences did not reach statistical significance. These data emphasize the frequent occurrence of warning headaches in SAH. Measures to increase the recognition of sudden headaches should be considered.
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In a retrospective study the CT scans of 138 patients with the clinical diagnosis of SAH were reviewed. CT was highly sensitive in detecting blood in the CSF spaces during the 3 days following SAH, with decreasing accuracy correlated to the time interval between SAH and CT examination. Clinical state on admission and CT findings were closely related, as were the localisation of detectable blood and the site of source of bleeding. Whereas blood clots in the basal cisterns, above the convexities, and intracerebrally, as well as the finding of a brain oedema, were significantly correlated to the time of survival, hydrocephalus and ventricular haemorrhage had no bearing on the survival time.