Articles: subarachnoid-hemorrhage.
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The role of computed tomography (CT) in the management of vasospasm from subarachnoid hemorrhage was evaluated in 242 consecutive cases with CT performed within 7 days after hemorrhage. Only 20% of these cases did not show a detectable subarachnoid hemorrhage on CT. Subsequent angiograms showed vessel narrowing in 56% of the cases; associated clinical deterioration was noted in 34% of the cases. ⋯ The persistence of subarachnoid blood more than 72 hours after hemorrhage probably increases the risk of vasospasm, although our data are not conclusive. The definition of a CT scan "at risk" for vasospasm--based on the previous findings--gives practical advantages: proper selection of patients in regard to timing of operation, closer observation and the possibility of prophylactic treatment in patients "at risk," and more adequate evaluation of different therapeutic modalities for vasospasm. With regard to the last point, the incidence of vasospasm was not statistically different between two groups of patients uniformly "at risk": the first group submitted to early operation and the second awaiting operation.
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Randomized Controlled Trial Clinical Trial
Antifibrinolytic treatment in subarachnoid hemorrhage.
We enrolled 479 patients with subarachnoid hemorrhage in a multicenter, randomized, double-blind, placebo-controlled trial to determine whether treatment with the antifibrinolytic agent tranexamic acid improves outcome by preventing rebleeding. At three months there was no statistical difference between the outcomes in the tranexamic acid group and the control group. ⋯ This absence of effect was not due to a lack of antifibrinolytic action, since the rate of rebleeding was reduced from 24 per cent in the control group to 9 per cent in the tranexamic acid-treated group (chi-square = 18.07, P less than 0.001), but resulted from a concurrent increase in the incidence of ischemic complications (15 per cent in the control group and 24 per cent in the tranexamic acid group; chi-square = 8.07, P less than 0.01). We conclude that until some method can be found to minimize ischemic complications, tranexamic acid is of no benefit in patients with subarachnoid hemorrhage.
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An autopsied case of ruptured saccular aneurysm at the junction of posterior inferior cerebellar artery and vertebral artery with which the aneurysm and basilar artery were occluded was reported. A 20-year-old female was admitted to our hospital because of consciousness disturbance and convulsion. CT scan revealed subarachnoid hemorrhage. ⋯ On autopsy, a ruptured saccular aneurysm at the junction of right vertebral and posterior inferior cerebellar arteries, and occlusion with thrombosis of vertebrobasilar artery were found. We discussed how the aneurysm and main arteries were embolized just after the attack of subarachnoid hemorrhage. It is considered that the severe increased intracranial pressure in posterior fossa after subarachnoid hemorrhage and decreased blood pressure caused hemostasis of ruptured aneurysm while spreading the thrombosis in main trunks of vertebrobasilar artery.