Articles: subarachnoid-hemorrhage.
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The problem of early differentiation of "traumatic tap" from subarachnoid hemorrhage (SAH) was studied in the rabbit by determining the changes in percentage of hemolysis and in lactate concentrations in CSF within the first twenty-four hours following induced SAH. The 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF). There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method.
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CT scans have been made on 39 of 41 patients who presented with subarachnoid hemorrhage. Blood could be visualized in the cisterns of 18 of 32 examinations performed within five days of the hemorrhage all having aneurysms. ⋯ Much other information was obtained, for instance about rebleeding and infarction. CT should routinely be the primary examination, followed by selective angiography.
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Post-shunt subdural hematoma was found in two patients with hydrocephalus due to subarachnoid hemorrhage. The first case was a 46-year-old man with two episodes of subarachnoid hemorrhage from anterior communicating aneurysm. Two weeks after neck-clipping for the aneurysm, a ventriculo-peritoneal shunt with Pudenz's system was performed since hydrocephalus with moderately increased pressure had been found. ⋯ After cerebral angiogram, the subdural hematoma was removed and the shunt tube was ligated. He became free of these symptoms in two weeks. The cerebrospinal fluid shunt is recommended for hydrocephalus induced by subarachnoid hemorrhage, but careful follow-up is necessary since these patients might develop post-shunt subdural hematoma, especially after head trauma as shown in our cases.
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Zh Nevropatol Psikhiatr Im S S Korsakova · Jan 1977
[Changes in cardiac activity in the acute period of subarachnoid hemorrhage].
In the acute phase of subarachnoidal hemorrhages which was seen in 32 patients the author studied changes in the cardiac activity and phasic structures of cardiac contraction. The studies were supplemented by electrocardiographic and polycardiographic methods permitting to determined separate phases of cardiac contraction and quantitatively characterize the contracting function of the myocardium. In 21 patients according to the EGC data there were changes in the cardiac activity. It is assumed that the main role in the development of such changes during subarachnoidal hemorrhages belongs to diencephalic brain structures, the changed function of which lead to distrubances of central regulation of the heart activity.