Articles: subarachnoid-hemorrhage.
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Medical notes of 123 patients with subarachnoid haemorrhage were examined. No patient deteriorated at the time of lumbar puncture. ⋯ Two of 30 patients with meningitis were initially diagnosed as subarachnoid haemorrhage, and one died without lumbar puncture. If consciousness is not markedly impaired and focal signs are absent, lumbar puncture is safe in patients with subarachnoid haemorrhage.
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An unusual case of spontaneous spinal subarachnoid haematoma (SAH) is reported. A 42-year-old man developed sudden and excruciating back pain immediately after sitting up from a supine position, and meningeal irritation and spinal cord compression signs of then appeared. ⋯ After prompt surgical evacuation neurological function was totally regained. Physiopathology and diagnosis are discussed with reference to similar cases in literature.
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A case-control analysis is used to examine the relation of cigarette smoking, hypertension and the risk of subarachnoid hemorrhage in men and women aged 35-64 years. 45 men and 70 women with subarachnoid hemorrhage were identified as part of a large community based study of stroke, and the controls, 1017 men and 569 women, came from a survey of cardiovascular risk factors conducted in the same community. Cigarette smokers, after adjusting for age, had a significantly increased risk of subarachnoid hemorrhage compared with nonsmokers with relative risks of 3.0 for men and 4.7 for women. ⋯ Those who both smoked and had a history of hypertension had an increased risk of subarachnoid hemorrhage of almost 15 fold compared to those who neither smoked nor had been treated for hypertension. The estimated population attributable risk of subarachnoid hemorrhage associated with cigarette smoking (43%) was greater than that of hypertension (28%) in this population.
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Neurological research · Sep 1986
Outcome of ruptured intra-cranial aneurysm treated by a deferred operation. Review of 345 consecutive cases treated over a period of 12 years.
This paper reports experience with 345 patients admitted to a neurosurgical department after an aneurysm rupture. At the time of admission, patients were separated into two groups: the patients unsuitable for planned surgery and called 'unoperable'; the patients planned for surgery and called 'operable patients' (328 patients). The general management attitude consisted of deferred surgery according to the clinical status of the patients and the risk of vasospasm and ischaemia. ⋯ The cause of death was vasospasm and ischaemia in 10 cases and recurrence of haemorrhage in 8 cases. 310 patients were actually operated upon. Their final outcome was: good 70%, fair 9.6%, poor 7.7%, death 12.5%. This paper discusses the risk of SAH recurrence and the risk of vasospasm and ischaemia during the waiting time before surgery, in the attitude of deferred surgery which was elected in most cases of this series and compares the outcome with other published series.