Articles: subarachnoid-hemorrhage.
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We analyzed early aneurysmal rebleeding in 150 consecutive patients who suffered an aneurysmal subarachnoid hemorrhage (SAH) and who were admitted within 6 hours of the initial SAH. Of these patients, 33 patients rebled. The first rebleed occurred within 24 hours in 29 patients, among whom 23 cases rebled within 6 hours. ⋯ Rebleeding developed during angiography conducted within 6 hours from the initial SAH in four cases. This is approximately twofold higher than the rebleeding rate within 6 hours for the total series. It is concluded that rebleeding in the acute stage is predominant within 6 hours from the initial SAH and that this rebleeding rate is higher the more severe the initial SAH is.
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Subarachnoid hemorrhage during pregnancy is a rare neurological event which, due to the time of onset and clinical findings, may be mistaken for eclampsia, a purely obstetric complication. Timely specific diagnosis will lead to consultation of the neurosurgeon who, on the basis of non-invasive techniques, determines the optimal timing for surgery to ensure a favourable prognosis for mother and child. The clinical aspects, and the diagnostic and therapeutic procedures are illustrated by three clinical cases at various stages of pregnancy and on the basis of a short review of the literature.
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The frequency and severity of cardiac arrhythmias were studied in 70 patients with spontaneous subarachnoid hemorrhage investigated prospectively with 24-hour Holter monitoring. Patients were less than 70 years old and without clinical and/or ECG signs of previous heart disease; Holter monitoring was initiated within 48 hours of subarachnoid hemorrhage. Arrhythmias were detected in 64 of the 70 patients (91%). ⋯ Serious ventricular arrhythmias were associated with QTc prolongation and hypokalemia. No correlation was found between the frequency and severity of cardiac arrhythmias and the neurologic condition, the site and extent of intracranial blood on computed tomography scan, or the location of ruptured malformation. The extremely high incidence of cardiac arrhythmias, sometimes serious, in the acute period after subarachnoid hemorrhage and the absence of clinical and radiologic predictors make systematic continuous ECG monitoring compulsory to improve the overall results of subarachnoid hemorrhage, irrespective of early or delayed surgical treatment.