Articles: subarachnoid-hemorrhage.
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We evaluated the ability of CT performed soon after subarachnoid hemorrhage (SAH) to predict outcome. Generally, the results of CT paralleled level of consciousness in predicting mortality or good recovery. However, CT did detect some groups of patients who were at greater or lesser risk of mortality. ⋯ Intracerebral hemorrhage or local, thick, or diffuse subarachnoid deposits of blood seen on CT among alert patients were particularly related to increased mortality. CT abnormalities could be used to detect higher mortality rates among drowsy or comatose patients. CT is useful as an adjunct to the clinical examination in predicting outcome after SAH.
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Annals of neurology · Aug 1985
Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm.
We studied the sodium balance and changes in plasma volume by an isotope dilution technique in the first week after an aneurysmal subarachnoid hemorrhage in 21 patients. In 11 of the patients, the plasma volume decreased by more than 10%. This was accompanied by a negative sodium balance and hyponatremia in 6 patients, a negative sodium balance without hyponatremia in 4 patients, and a positive sodium balance in 1 patient. ⋯ Serum vasopressin was measured in 14 of the 21 patients. The values were elevated on admission and declined in the first week, regardless of the presence of hyponatremia. These findings indicate that natriuresis and hyponatremia in aneurysmal subarachnoid hemorrhage reflect salt wasting and not inappropriate secretion of antidiuretic hormone and that these changes should be corrected by fluid replacement rather than by fluid restriction.
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The authors present two cases of ruptured cerebral aneurysms in patients with sickle cell anemia. Only three previous cases with similar presentations have been reported. The various complications of sickle cell anemia and ruptured aneurysms are reviewed. The importance of early aggressive adjunctive medical management, including the use of partial exchange transfusions and surgical intervention, is emphasized.
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Journal of neurosurgery · May 1985
Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation.
The mortality rate has recently been reduced to only a small percentage of patients selected for early aneurysm surgery. Despite recovery without neurological deficits, however, a diffuse encephalopathy may remain, with emotional and psychological sequelae that will interfere with rehabilitation and social reintegration. The present study evaluates quality of life, degree of cognitive dysfunction, and adjustment of patients with a satisfactory neurological recovery after aneurysm operation in the acute stage following a major subarachnoid hemorrhage (SAH). ⋯ These findings were considerably at variance with the symptoms reported. It is stressed that, in the absence of gross neurological deficits, vital information on post-hemorrhage adjustment and impairment may easily be overlooked due to psychological defensive measures. It remains an open question whether post-SAH encephalopathy is enhanced by surgery performed in the acute stage.
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Annals of neurology · Feb 1985
Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful?
We studied retrospectively the relationship between hyponatremia and cerebral infarction in 134 consecutive patients with aneurysmal subarachnoid hemorrhage. In 44 patients sodium levels fell below 135 mmol/L on at least two consecutive days between the second and the tenth day after the hemorrhage. Twenty-five of these patients fulfilled the criteria for the syndrome of inappropriate secretion of antidiuretic hormone. ⋯ Cerebral infarctions were more often fatal in patients with hyponatremia (p less than 0.01). Twenty-six of the 44 patients had been treated with fluid restriction to correct the serum sodium levels, and infarctions developed in 21. Fluid restriction to correct hyponatremia appears to be potentially dangerous in patients with aneurysmal subarachnoid hemorrhage.