Early management of aneurysmal subarachnoid hemorrhage

Abstract

The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.

Intracranial Operation Within Seven Days of Aneurysmal Subarachnoid Hemorrhage

“…11 (11) 1 (1) 18 (18) 1 (n = 23) 2 (83) 1 (6) 11 (50) 2 (40) 1 (25) 0(0) 29 (58) 6 (27) 1 (20) 0(0) 0(0) 8 (16) 0 (0) 0(0) 2(49) 1 (25) 1 (100) 4(8) 0 (0) 1 (5) 0(0) 0(0) 0(0) 1 (2) 2 (11) 4 (18) 0(0) 2(50) 0(0) …”

Treatment of acute hydrocephalus after subarachnoid hemorrhage with serial lumbar puncture.

“…- 18 On the other hand, in a large series of patients in which the occurrence of rebleeding was studied prospectively with clearly defined criteria, no association between rebleeding and the initial condition could be demonstrated. 19 We observed no such difference in the rebleeding rate between patients who underwent lumbar puncture and those who did not.…”

Antifibrinolytic Therapy To Prevent Early Rebleeding After Subarachnoid Hemorrhage

“…It was concluded that antifibrinolytics reduce the risk of rebleeding while at the same time increasing the risk of focal ischemic deficits, resulting in similar mortality rates between treated and non-treated groups. A report of the first Cooperative Aneurysm Study presented largely similar conclusions, confirming the failure of antifibrinolytics to decrease overall mortality at 90 days [41]. Two major shortcomings of ICSTAS include long duration of antifibrinolytics administration (up to 14 days) and lack of anti-vasospastic therapy.…”