Articles: subarachnoid-hemorrhage.
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Acta neurochirurgica · Jan 1987
Comparative StudyThe role of ventricular and cisternal drainage in the early operation for ruptured intracranial aneurysms.
In a series of 177 patients with ruptured supratentorial aneurysms we studied retrospectively the results of early and delayed operation without aggressive removal of subarachnoid blood clots but ventricular and cisternal drainage. The early and delayed groups were comparable demographically and neurologically. The overall results for the early group were a good outcome in 65%, poor outcome in 10% and death in 24%, compared to 53, 20 and 27% respectively in the delayed group. ⋯ The mean amount of haemoglobin in the cerebrospinal fluid from cisternal drainage was 6.4 g, corresponding to about 40 ml of whole blood, during the 12-day period after SAH. The level was higher in patients with larger subarachnoid clots or with symptomatic vasospasm than in those with smaller clots or without such vasospasm. Early operation combined with ventricular and cisternal drainage is considered to be a useful surgical method for patient with a ruptured aneurysm.
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Acta neurochirurgica · Jan 1987
Resistance to cerebrospinal fluid outflow and intracranial pressure in patients with hydrocephalus after subarachnoid haemorrhage.
Resistance to CSF-outflow (Rout) and intracranial pressure (ICP) were measured in 33 patients with hydrocephalus after subarachnoid haemorrhage (SAH). Eleven patients examined between 10 to 30 days after SAH had high pressure hydrocephalus (HPH). Twenty-two patients had normal pressure hydrocephalus (NPH). ⋯ Thus, early development of hydrocephalus after subarachnoid haemorrhage is associated with a high Rout and a high ICP, whereas late (more than one month) hydrocephalus may be associated with normal ICP and high Rout. Patients with NPH and a high Rout have frequent B-waves and should be shunted. Patients with a long interval from subarachnoid haemorrhage to the diagnosis of hydrocephalus often have a normal ICP, low frequency of B-waves, normal CSF-dynamics and need no shunting.
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Acta Neurol. Scand., Suppl.c · Jan 1987
Intracranial pressure: cerebrospinal fluid dynamics and pressure-volume relations.
Continuous measurement of the intracranial pressure (ICP) is routine in todays evaluation of various intracranial diseases and increased ICP is a common therapeutical problem in neurosurgical patients. Still, very little is known about the patho-physiological and biomechanic events that lead to increased ICP. ICP is governed by 1) the resistance to absorption of cerebrospinal fluid (Rout), 2) the production rate of CSF (If) (taken together Rout and If are referred to as the "CSF dynamics"), and 3) the pressure in the Sagittal Sinus (Pss) in accordance with the equation: ICP = If X Rout + Pss. ⋯ The latter was measured by means of the PVI method and in some instances for reasons of comparison with the constant rate infusion technique and "controlled withdrawal". The main conclusions of the studies were: 1) For estimates of PVI the bolus injection technique was applicable. For Rout measurements the method was only safe at relatively low ICP levels.(ABSTRACT TRUNCATED AT 400 WORDS)
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The incidence and clinical aspects of acute hydrocephalus were examined in 200 patients with recently ruptured intracranial aneurysms. The following conclusions were reached: Acute hydrocephalus is an important complication of aneurysmal subarachnoid hemorrhage that occurs in approximately 20% of all cases and exhibits an incidence that tends to parallel clinical grade (Grade I, 3%; Grade II, 5%; "Good" Grade III, 21%; "Bad"Grade III, 40%; Grade IV, 42%; Grade V, 26%). ⋯ The computed tomographic signs of acute hydrocephalus are distinctive and consist of selective ballooning of the frontal horns, rostral-caudal enlargement of the cerebral ventricles, and a halo of periventricular hyperdensity (edema) that evolves in sequence with ventricular changes. The treatment of choice is external ventricular drainage, which results in prompt and often dramatic improvement in approximately two-thirds of the patients.
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Acta neurochirurgica · Jan 1987
Evaluation of the calcium-antagonist nimodipine for the prevention of vasospasm after aneurysmal subarachnoid haemorrhage. A prospective transcranial Doppler ultrasound study.
70 consecutive patients admitted within four days after the first aneurysmal subarachnoid haemorrhage (SAH) were evaluated by daily transcranial Doppler ultrasound (TCD) measurement of the blood flow velocities (BFVs) of both middle cerebral arteries (MCAs) and by daily recordings of their clinical grade (Hunt and Hess). Patients with no or only little subarachnoid blood in the first CT after admission were classified as low-risk for the development of symptomatic vasospasm (VSP), and patients with big subarachnoid clots or thick layers of subarachnoid blood were graded as high-risk patients for symptomatic VSP. The first series of 33 patients received no nimodipine whereas the second series of 37 patients were treated with nimodipine 2 mg/h intravenously, starting within 24 hours after the SAH in the majority of patients. 7-14 days postoperatively, the intravenous dose was changed to oral nimodipine 60 mg/q4h for one week and then discontinued. ⋯ Nimodipine given within four days after the SAH did not prevent vasospasm evaluated by TCD, but it significantly reduced the severity of the vasoconstriction, especially in high-risk patients. It reduced significantly the incidence of DIND in high-risk patients and improved their functional outcome. Although nimodipine may have a reduced efficacy in preventing vasospasm after early operation of high-risk patients, it probably protects the brain by increasing its tolerance to focal ischaemia.