Articles: subarachnoid-hemorrhage.
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Four patients presented with ruptured intracranial aneurysms during pregnancy. Problems encountered during the management of these cases included delayed diagnosis, obstructive hydrocephalus, cerebral ischemia due to vasospasm and recurrent subarachnoid hemorrhage. Recent advances in the management of ruptured intracranial aneurysms, including early computerized tomographic scanning, intravascular volume expansion and induced hypertension for the management of cerebral vasospasm, and the timely obliteration of the aneurysm are applicable to the subarachnoid hemorrhage patient even if her condition is complicated by pregnancy.
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Clinical neurosurgery · Jan 1986
Antifibrinolytic therapy in the treatment of aneurysmal subarachnoid hemorrhage.
At the present time, there remains considerable uncertainty regarding the safety and efficacy of antifibrinolytic therapy in the treatment of aneurysmal SAH. Furthermore, there is little to guide us on precisely how to employ the agents. Whether to continue to use antifibrinolytic therapy after considering the results of the 1984 Cooperative Aneurysm Study trial and the Glasgow-Rotterdam-Amsterdam-London trial remains very much a philosophical decision. ⋯ Accordingly, our policy is to continue to use antifibrinolytic therapy in those patients in whom it is desired to delay surgery. Our feeling is that, while there is no demonstrated advantage in acute mortality in either of the previously mentioned series, hypertensive, hypervolemic therapy or calcium channel blocking agents might ameliorate the ischemic consequences of therapy. Accordingly, it is in the context of combined therapy that the reduction in rebleeding will significantly influence patient outcome.
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The incidence of hydrocephalus and vasospasm and the relationship between them were analyzed retrospectively in 87 patients with subarachnoid hemorrhage from ruptured intracranial aneurysms. Sixty-seven per cent of the patients showed ventricular enlargement on a computed tomographic scan done within 30 days of the hemorrhage; in patients whose first scan was done within 3 days of the hemorrhage, 63% seemed to have ventricular enlargement by a neuroradiologist's interpretation. Shunts were required in 14% of the patients because of delayed neurological deterioration or enlarging ventricles; 3% required ventriculostomy shortly after admission. ⋯ Hydrocephalus and vasospasm were significantly associated (P less than 0.01, chi2). These data document a high incidence of mild ventricular enlargement and angiographic vasospasm after subarachnoid hemorrhage. They also emphasize that these two sequelae of subarachnoid hemorrhage are closely linked, probably by the presence of blood in the basal cisterns obstructing cerebrospinal fluid flow and surrounding arteries there.
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Acta neurochirurgica · Jan 1986
Enhanced cisternal drainage and cerebral vasospasm in early aneurysm surgery.
Enhanced cisternal drainage was performed following early aneurysm surgery in patients with Hunt and Kosnik grades I-III, to effect continuous wash-out of subarachnoid blood clots and reduce symptomatic vasospasm. Following extensive evacuation of the cisternal blood clots, the Liliequist's membrane was opened extensively and a third ventriculostomy was effected by opening the lamina terminals. The drainage effect was considered as poor, moderate or fair, depending on the average amount of CSF drainage/day. ⋯ Nine patients who developed symptomatic vasospasm were treated by hypertensive/hypervolemic therapy (HHT). The HHT was effective in 7 patients with fair and moderate CSF drainage and ineffective in 2 patients with poor a drainage effect. It seems, that enhanced post-operative cisternal drainage can reduce the incidence of symptomatic vasospasm and be of benefit to the outcome of early aneurysm surgery.