Management problems in acute hydrocephalus after subarachnoid hemorrhage.

Hasan, D.; Vermeulen, M.; Wijdicks, E.F.M.; Hijdra, A.; Gijn, J. van

doi:10.1161/01.str.20.6.747

Cited by 270 publications

(92 citation statements)

References 32 publications

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“…This is in agreement with one report in which 18 of 21 such patients improved rapidly 7 and another report in which such improvement occurred in seven of 11 patients. 6 The disappointing aspect of the data of Hasan et al, 1 however, is that ventriculitis developed in 50%…”

Section: Acute Hydrocephalus After Subarachnoid Hemorrhagementioning

confidence: 98%

“…The data of Hasan et al, 1 derived from a careful study of 473 consecutive patients with SAH admitted within 72 hours after ictus, are interesting in several respects. They show that hydrocephalus, defined as a bicaudate index on computed tomogram (CT scan) exceeding the 95th percentile for age, occurs in approximately 20% of patients, which is in agreement with previous studies in which similar criteria were used.…”

Section: Acute Hydrocephalus After Subarachnoid Hemorrhagementioning

confidence: 99%

“…They have true "acute" hydrocephalus and are the subject of the report in this issue of Stroke by Hasan and colleagues. 1 These authors prefer not to place a ventricular drain in these patients immediately because some will improve spontaneously and because the authors encountered a high rate of infection and rebleeding in drained patients. Hasan et al 1 recommend delaying ventricular drainage for at least 24 hours in the majority of these patients and then considering drainage only in those who fail to improve or deteriorate.…”

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confidence: 99%

“…Also, in contrast to the approach of Hasan et al, 1 I would drain patients with massive intraventricular hemorrhage, most often using a different catheter for each lateral ventricle. In my experience, an occasional patient can be salvaged with this maneuver.…”

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confidence: 99%

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Acute hydrocephalus after subarachnoid hemorrhage.

Heros

1989

Stroke

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Section: Acute Hydrocephalus After Subarachnoid Hemorrhagementioning

confidence: 98%

Section: Acute Hydrocephalus After Subarachnoid Hemorrhagementioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Acute hydrocephalus after subarachnoid hemorrhage.

Heros

1989

Stroke

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“…Take the management for acute hydrocephalus after subarachnoid haemorrhage [6]. How much deterioration in the level of consciousness should be allowed before cerebrospinal fluid is artificially removed?…”

Section: There May Be No Trial At Allmentioning

confidence: 99%

From Randomised Trials to Rational Practice

Gijn

2005

Cerebrovasc Dis

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From the age of Enlightenment onwards, philosophical thinking has become increasingly influenced by empiricism: observations lead to theories, but experiments are needed to put the reasoning to the test. However, it was not until the middle of the 20th century that well-designed experiments were at last introduced in medical treatment, in the form of randomised controlled clinical trials. This design is now standard in medicine, but in everyday practice a multitude of management decisions must still be taken without good evidence. There are several reasons for this: there may not be a trial at all or only a single trial; trial results may be equivocal; patients may be different from those enrolled in trials; new procedures require practice, or a trial may not be feasible. ‘Logical reasoning’, with all its fallacies, is still required – not only to fill the gaps in empirical knowledge but also to interpret existing evidence and to plan new trials. In fact, the generation of new knowledge is a continuous, cyclical process in which newly gained insights in pathophysiology give rise to new therapeutic experiments, the results of which generate fresh hypotheses, and so on. Compassion, curiosity and doubt are the essential forces that keep the cycle moving. Conversely, the progress is slowed down by present-day legalism, which distorts investigator accountability and patient autonomy.

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Predictors and Impact of Aneurysm Rebleeding After Subarachnoid Hemorrhage

et al. 2005

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Background: Aneurysm rebleeding has historically been an important cause of mortality after subarachnoid hemorrhage (SAH). Objective: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, which emphasizes early surgical or endovascular treatment. Design: Inception cohort. Setting: Tertiary care medical center. Patients: A total of 574 patients enrolled in the Columbia University SAH Outcomes Project between August 1996 and June 2002. Early aneurysm repair was performed whenever feasible. Main Outcome Measures: Rebleeding was defined by prespecified clinical and radiographic criteria, excluding prehospital, intraprocedural, and postrepair events. Functional outcome was assessed at 3 months with the modified Rankin Scale. Multiple logistic regression was used to identify predictors of rebleeding, poor functional outcome, and mortality. Results: Rebleeding occurred in 40 (6.9%) of the 574 patients; most cases (73%) occurred within 3 days of ictus. Hunt-Hess grade on admission (odds ratio [OR], 1.92 per grade; 95% confidence interval [CI], 1.33-2.75; PϽ.001) and maximal aneurysm diameter (OR, 1.07/ mm; 95% CI, 1.01-1.13; P=.005) were independent predictors of rebleeding. After controlling for Hunt-Hess grade and aneurysm size, rebleeding was associated with a markedly reduced chance of survival with functional independence (modified Rankin Scale score, Յ4; OR, 0.08; 95% CI, 0.02-0.34) at 3 months. Conclusions: Despite an aggressive management strategy, rebleeding still occurred in 6.9% of patients and was associated with a dismal outcome. Poor Hunt-Hess grade and larger aneurysm size are related to rebleeding. Pharmacologic therapy to reduce the risk of rebleeding before aneurysm repair, particularly in patients with poor grade neurologic status and large aneurysms, deserves renewed attention.

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Management problems in acute hydrocephalus after subarachnoid hemorrhage.

Cited by 270 publications

References 32 publications

Acute hydrocephalus after subarachnoid hemorrhage.

Acute hydrocephalus after subarachnoid hemorrhage.

From Randomised Trials to Rational Practice

Predictors and Impact of Aneurysm Rebleeding After Subarachnoid Hemorrhage

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