Computerized Tomography and Clinical Features of Large Cerebral Hemorrhages

Ropper, Allan H.; Gress, Daryl R.

doi:10.1159/000108814

Cited by 16 publications

(6 citation statements)

References 11 publications

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“…In accordance with Allen and Siriraj scores, vomiting, a well-established ICH-related symptom as a result of increased intracranial pressure and meningismus resulting from blood in ventricles [24,25], was also isolated as a differentiating factor in the present score.…”

Section: Discussionsupporting

confidence: 79%

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Efstathiou

Tsioulos

Zacharos

et al. 2002

Journal of Internal Medicine

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Purpose. To develop a simple and reliable diagnostic tool for differentiation of cerebral infarction (CIF) from intracerebral haemorrhage (ICH) in order to aid clinicians to decide about starting antiplatelet therapy in settings where rapid access to computed tomography (CT) is lacking. Methods. Thirty variables regarding each patient admitted with acute stroke were recorded and considered in a logistic regression analysis using ICH as end-point (internal study). CT was used as the golden standard. The score derived was validated with data from the next consecutive stroke patients and was compared with the three preexisting scores (external validation study). Results. Amongst 235 patients (119 males, mean age 70.6 ± 11.2 years) of the internal study, 43 (18.3%) had ICH. Four independent correlates of ICH were identified and used for the derivation of the following integer-based scoring system: number of points ¼ 6 * (neurological deterioration within 3 h from admission) + 4 * (vomiting) + 4 * (WBC > 12 000) + 3 * (decreased level of consciousness). In the external study [168 patients, 85 males, mean age 70.2 ± 10.8 years, 31 (18.5%) with ICH], when the cut-offs £3 points for CIF and ‡11 points for ICH were used, sensitivity, specificity, and positive and negative predictive values of the score for detection of stroke type were 97, 99, 97 and 99%, respectively; exceeding noticeably the three previously proposed systems.Conclusions. The proposed model provides an easy to use tool for sufficiently accurate differentiation between haemorrhagic and nonhaemorrhagic stroke on the basis of information available to all physicians early after admission.

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Section: Discussionsupporting

confidence: 79%

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Efstathiou

Tsioulos

Zacharos

et al. 2002

Journal of Internal Medicine

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“…Unruptered intracranial aneurysm cases diagnosed outside the hospital after preliminary noninvasive investigations change the natural history of aneurysms and course of treatment (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with subarachnoid hemorrhage are usually in a very serious clinical condition and associate other factors, such as hypertension, diabetes, vascular degenerative diseases, vasospasm and other medical complications (9). This co-morbid changes lead to surgery complications and postoperative sequelae and so, prolonging time for returning to family life and intellectual abilities previously had.…”

Section: Discussionmentioning

confidence: 99%

“…Once an aneurysm is detected unruptered, decisions on the optimal management will be based on careful comparison of short-and long-term risk of rupture of the aneurysm through natural history with risks associated with the intervention itself, whether is open surgery or endovascular technique. Several factors should be carefully considered, including the size and location of the aneurysm, family history of the patient and medical history, and the availability of interventional possibilities that has an acceptable risk (9,13 …”

Section: Introductionmentioning

confidence: 99%

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Small and medium size intracranial aneurysms - a 5 years retrospective analysis trial and multimodal treatment

Münteanu¹,

Gorgan²

2015

Romanian Neurosurgery

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Clinical context. Subarachnoid hemorrhage (SAH) due to rupture of an aneurysm is one of the most common neurosurgical emergencies who account for onethird of stroke .In the SAH cases , aneurysms accounted for 70%. Aneurysms had a bleeding rate of 12 per 100,000 population per year, and in particular between 50 to 60 years of age with a high morbidity and mortality, especially in the first episode of bleeding at about 43% of cases (1,4, 14). Surgery is indicated to prevent rebleeding. 2.5% of patients in the general population may have unbroken aneurysms with a prevalence of 0.65%, with a preponderance of aneurysms in a 2: 1 in women. ACI aneurysms are more common in women and Acom aneurysms are more common in men and in 15-30% of patients with presence of multiple aneurysms. Surgical timing, the assessment in each individual case for rebleeding usage of endovascular techniques (3, 12), neurological status, the presence or absence of intraparenchymal hematoma or intraventricular hemorrhage with or without vasospasm, have an influence on the result. Over a period of 5 years from January 2010 to November 2014, 317 cases of patients with intracranial aneurysms in four clinics of neurosurgery in Bagdasar -Arseni hospital have been studied. The follow up period range between 6 month and 4 years and 3 month.

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“…estimated 40% to 50% [1][2][3]. Mortality rates are primarily related to severity of bleeding, with reported high mortality rates for large volume bleeds (eg, 60 cm 3 or greater) [21,22]. Early randomized trials testing steroids [23], glycerol [24], hemodilution treatment [25], or surgical intervention [26] failed to show any benefit on outcome in patients with ICH.…”

Section: Intracerebral Hemorrhagementioning

confidence: 99%

Critical care of intracerebral and subarachnoid hemorrhage

Bernardini

Deshaies

2001

Curr Neurol Neurosci Rep

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The acute management of primary intracerebral or aneurysmal subarachnoid hemorrhage requires a comprehensive approach involving stabilization of the patient, surgical intervention, and continued intensive care treatment of medical and neurologic complications. The are several causes of intracerebral hemorrhage (ICH), including hypertension, cerebral amyloid angiopathy, sympathomimetic drugs, and coagulopathies. More recently, use of thrombolytic agents in the treatment of acute ischemic stroke has increased the risk of ICH. Treatment of intracerebral hemorrhage is based on blood pressure control, and, in selected cases, surgical evacuation of clot. Patients with aneurysmal subarachnoid hemorrhage may experience rebleeding, symptomatic vasospasm, or hydrocephalus. Medical management in the intensive care unit with careful attention to fluid and electrolyte balance, nutrition, cardiopulmonary monitoring, and close observation for changes in the neurologic exam is vital. This review examines the diagnosis and intensive care management of patients with intracerebral or subarachnoid hemorrhage, and reviews some of the newer therapies for treatment of these disorders.

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Computerized Tomography and Clinical Features of Large Cerebral Hemorrhages

Cited by 16 publications

References 11 publications

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Small and medium size intracranial aneurysms - a 5 years retrospective analysis trial and multimodal treatment

Critical care of intracerebral and subarachnoid hemorrhage

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