Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Report on a Randomized Treatment Study

Abstract

Abstract://. Objectives and Design of Randomized Aneurvsm Studv• Four selected treatments, namely, regulated bed rest, drug-induced hypotension, caroti( ligation, and intracranial surgery, were randomly allocated with respect to location of thi aneurysm and interval following last bleed. The objective of the Study was to answer the ques tion. "What mode of treatment offers a patient with a single ruptured intracranial aneurysn during the previous three months the highest probability of optimal results with respect to sur vival, residual neurological deficit, capacity for self-care, and gainful employment?" Variou treatments were suspended at specific intervals when a particular mode of therapy became in ferior to the others.A group of 33 patients was disqualified after treatment was randomly allocated. Th numbers of protocols remaining for analysis within each treatment category were 202 fc regulated bed rest, 309 for drug-induced hypotension, 187 for carotid ligation, and 274 for ir tracranial surgery.

Diffusion- and Perfusion-Weighted Imaging in Vasospasm After Subarachnoid Hemorrhage

“…Angiography is still the standard by which arterial vasospasm has been diagnosed in patients after SAH, but it is time consuming, is not without clinical risk, and does not give direct information about tissue perfusion. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Demonstration of elevated blood flow velocity and increase in turbulent flow by TCDs can provide an early clinical awareness of vasospasm that involves the circle of Willis. Because this method is noninvasive and can be repeated as often as necessary, it is commonly used to monitor for cerebrovascular vasospasm after SAH.…”

“…Although angiography is considered to be the standard for the diagnosis of vasospasm, it is invasive, can be associated with significant morbidity after SAH, 3 and does not provide information about whether the tissue is ischemic; ie, it does not distinguish between angiographic versus symptomatic vasospasm. In recent years, TCDs has shown promise in the diagnosis of angiographic vasospasm by virtue of its ability to detect noninvasively increased middle cerebral artery (MCA) blood velocity associated with arterial narrowing.…”