Articles: subarachnoid-hemorrhage.
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Acta neurochirurgica · Jan 1988
Randomized Controlled Trial Clinical TrialAcute surgery for intracerebral haematomas caused by rupture of an intracranial arterial aneurysm. A prospective randomized study.
In a randomized prospective study, 15 patients with an intracerebral haematoma caused by an intracranial aneurysm were treated concervatively and 15 operated on as an emergency. Mortality was 12/15 (80%) in the conservative group and 4/15 (27%) in the surgical group. ⋯ The deaths in the conservative group were caused by both the primary haematoma and rebleeding. The results suggest that intracerebral haematomas caused by rupture of an intracranial aneurysm should be evacuated immediately, and that the aneurysm should be clipped at the same operation.
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The nature of alpha-adrenergic receptors in human cerebral arteries was characterized, and alteration of these receptors after subarachnoid hemorrhage was examined using a radioligand binding assay. Norepinephrine content of control arteries was also analyzed and compared with that of arteries after subarachnoid hemorrhage. Norepinephrine content in human cerebral arteries in cases of subarachnoid hemorrhage was about 5% of the control group. ⋯ In cerebral arteries obtained from the subarachnoid hemorrhage group, [3H]yohimbine binding sites were of a single class with KD of 53 nM and Bmax of 456 fmol/mg protein. These results suggest that sympathetic denervation and subsequent alterations in alpha 2-adrenergic receptors occurred after subarachnoid hemorrhage in human cerebral arteries. These changes in sympathetic innervation to cerebral arteries were considered to be one of the antecedents of delayed vasospasm after subarachnoid hemorrhage.
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The influences of continuous cerebrospinal fluid (CSF) drainage on vasospasm and hydrocephalus were analyzed retrospectively in 150 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms (32 cases of grade 1, 85 cases of grade 2, and 33 cases of grade 3 by the Hunt and Hess classification). One hundred and seven of these cases received CSF drainage (cisternal, ventricular, lumbar, or a combination of these). The volume of CSF drainage within the first week after onset was 975 +/- 513 ml (mean +/- SD). ⋯ Four of 43 cases with no drainage, 26 of 67 cases with a total drainage volume of less than 2000 ml, and 24 of 40 cases with a total drainage volume of more than 2000 ml developed hydrocephalus. There was a statistically significant dose-response (drainage volume-hydrocephalus) relationship (p less than 0.005, Mantel extension method). Vasospasm and hydrocephalus were statistically associated (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta neurochirurgica · Jan 1988
Angiographic investigation of cerebral vasospasm in subarachnoid haemorrhage due to arteriovenous malformation.
Fifty (50) selected patients with arteriovenous malformation (AVM) with and without subarachnoid haemorrhage (SAH) were investigated, in respect of occurrence and course of the vasospasm. The diameters of the carotid siphon and its main branches were measured and plotted against the time elapsing between the haemorrhage and the angiographic study. ⋯ Patients with intracerebral haematoma may show vasospasm from the first day onwards. It seems that the radiologically demonstrated spasm in AVM had no impact on the clinical outcome in this series.