Outcome of Aneurysmal Subarachnoid Hemorrhage in a Hospital Population: A Prospective Study Including Early Operation, Intravenous Nimodipine, and Transcranial Doppler Ultrasound

Abstract

A total of 153 consecutive patients with proven aneurysmal subarachnoid hemorrhages (SAHs) admitted immediately after diagnosis regardless of clinical condition were managed according to the same protocol. The initial evaluation included computed tomography (CT), transcranial Doppler ultrasound (TCD), angiography-CT, and/or angiography. Intravenous nimodipine (2 mg/hour) was started after confirmation of the diagnosis. The timing of operation was determined individually according to age, clinical course, and CT and TCD findings. Twenty-one Grade V patients treated with intensive care and ventriculostomy died or did not improve within 24 hours after SAH. Three patients with life-threatening intracerebral hematomas underwent emergency operation. Operation was early in 55 good risk patients and late in 57 patients because of poor initial grade, late admission, or logistic reasons. Seventeen patients had no operation because of old age, persistent poor clinical condition, medical complication, or lethal rebleeding before operation. In the total series, 90 patients (59%) made a full recovery, the overall morbidity rate was 14% (21 of 153 cases), and the mortality rate was 27% (42 of 153). Postoperative mortality including emergency evacuation of hematomas was 7.8% and mortality after elective operation was 6.2%. The causes of disability and death were the initial effect of the hemorrhage in 25 patients (16.3%), rebleeding in 15 (9.8%), delayed cerebral infarction in 8 (5.2%), surgical complications in 7 (4.5%), hydrocephalus in 4 (2.6%), and medical complications in 4 (2.6%).

Impact of Cardio-Pulmonary and Intraoperative Factors on Occurrence of Cerebral Infarction After Early Surgical Repair of the Ruptured Cerebral Aneurysms

“…It is still unclear whether these differences in surgical outcome are due to predetermined factors, to intraoperative alterations or to postoperative management. Several reports have shown that many individual factors during surgery can increase the mortality and morbidity of such patients 14,16) . Of the known complications of SAH, vasospasm or cerebral infarction account for most cases with poor outcomes.…”

Subarachnoid Hematoma Attenuates Vasodilation and Potentiates Vasoconstriction Induced by Vasoactive Agents in Newborn Pigs

“…In adults and children, subarachnoid hemorrhage can also result from trauma, asphyxia, brain injury, or rupture of an intracranial aneurysm (4)(5)(6). In adults, one of the major complications of cerebral hemorrhage is a delayed cerebral ischemia due to abnormal vasoconstriction of large cerebral arteries that usually presents itself 4-7 d after the hemorrhage.…”

“…In adults, one of the major complications of cerebral hemorrhage is a delayed cerebral ischemia due to abnormal vasoconstriction of large cerebral arteries that usually presents itself 4-7 d after the hemorrhage. Alterations of cerebral circulation and metabolism can develop secondary to cerebral vasoconstriction, resulting in death or permanent cerebral dysfunction (4)(5)(6)(7)(8). Despite much research into the etiology of hemorrhage-induced vasoconstriction (4)(5)(6)(7)(8), our understanding of the mechanism by which cerebral arterial vasoconstriction occurs after cerebral hemorrhages is still limited.…”

Incidence of Vasospasm, Outcome, and Quality of Life after Endovascular and Surgical Treatment of Ruptured Intracranial Aneurysms: Results of a Single-Center Prospective Study in Switzerland

“…Among the patients that developed DIND in our series, 13.6% had signs of ischemic lesions on CT. The fact that these findings are higher than in previous reports might be explained due to the higher sensitivity to detect ischemic lesions using modern CT technologies [43]. More recent series reported an incidence of 19% of CT infarctions after SAH treatment [19].…”