Terson Syndrome: Assessment of 53 Patients with Subarachnoid Hemorrhage by a Ruptured Aneurysm

Objective Terson syndrome (TS), also known as vitreous hemorrhage, is reported in patients with subarachnoid hemorrhage caused by a ruptured aneurysm. This study aims to evaluate the presence of ocular hemorrhage in such patients, trying to identify those who could benefit from the specific treatment for visual deficit recovery. Methods Prospective study of 53 patients with spontaneous subarachnoid hemorrhage (SSAH) due to ruptured aneurysm. The patients were evaluated for vitreous hemorrhage through indirect fundoscopy with 6 to 12 months of follow-up. Results The ages of the patients ranged from 17 to 79 years-old (mean age, 45.9 11.7); 39 patients were female (73%) and 14 were male (27%). Six patients (11%) presented TS, and 83.3% had a transient loss of consciousness during ictus. Conclusions An ophthalmologic evaluation must be routinely performed in subarachnoid hemorrhage patients, especially in those with worse neurological grade. Moreover, prognosis was bad in TS patients.

Weaning rápido vs. weaning gradual de ventriculostomía externa en hidrocefalia secundaria a hemorragia subaracnoidea: Revisión sistemática de la literatura y metaanálisis / Weaning fast vs. Gradual Weaning of External Ventriculostomy in Hydrocephalus Secondary to Subarachnoid Hemorrhage: A Systematic Review of the Literature and Meta-analysis

Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.

Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning ́s groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.

Progress on the risk factors of intracranial aneurysm rupture / 中国综合临床

Intracranial aneurysm ( IA) is one of the most common cerebrovascular diseases in our lves, characterized by high morbidity, high disability rate and high fatality rate. With the extensive application and improvement of imaging techniques, more and more unruptured intracranial aneurysms can be diagnosed and treated before rupture,which reduces the incidence of subarachnoid hemorrhage caused by its rupture. However, the optimal treatment for unruptured aneurysms remains controversial,and the risk of preventive intervention must be weighed against the unknown risk of individual aneurysm rupture. Therefore,it is necessary to predict the risk of rupture before treatment for unruptured aneurysms. In this paper, the high risk factors of IA rupture were discussed through literature research and a large number of clinical data analysis,which provided the basis for the treatment of intracranial aneurysms.

Follow-up of the serum concentration of pituitary hormones after spontaneous subarachnoid hemorrhage / 中华内分泌外科杂志

Objective To explore the risk of pituitary dysfunction for spontaneous subarachnoid hemor -rhage( s-SAH) patients and to evaluate its correlation with clinical data .Methods 63 cases of patients with s-SAH were selected.Indicators(serum adrenocorti cotrophic hormone (ACTH), growth hormone(GH), insulin-like growth factor-1(IGF-1), thyroid stimulating hormone(TSH), thyroxine(T4), triiodothyronine(T3), folli-cle-stimulating hormone(FSH), luteinizing hormone(LH), total testosterone(in males), estradiol(in females) and prolactin)dynamic observation were tested 7 days, 1 year, 2 years, 3 years after the onset.Results Thirty patients( 47.6%) had some type of pituitary dysfunction .ACTH deficiency was the most frequent disorder (14.3%), followed by GH deficiency(12.7%), hypogonadatrophic(6.3%), hypothyroidism(3.2%)and high prolactin(1.6%).six patients(9.5%)showed deficiencies in more than one axis .Hormone deficiency was relat-ed to vasospasm, Fisher grade 4(P<0.05)and recovery time.Conclusions A greater incidence of hormone de-ficiency after s-SAH was related with vasospasm , Fisher grade and recovery time .Follow-up time should be ex-tended.

Impact of Admission Month on Outcomes in Spontaneous Subarachnoid Hemorrhage: Evidence Against the March Effect

OBJECTIVE: We attempted to identify the presence of a so called 'March effect (or phenomenon)' (which had long been known as a 'July effect' in western countries), a transient increase in adverse outcomes during an unskilled period for new interns and residents in a teaching hospital, among a cohort of patients with spontaneous subarachnoid hemorrhage (sSAH). METHODS: A total of 455 consecutive patients with sSAH from our department database from 2008 to 2010 were enrolled retrospectively and the admission month, patient demographics and clinical characteristics, treatment modalities and discharge outcomes were analyzed. Multivariate regression analysis was used to determine whether unfavorable discharge and in-hospital mortality showed a significant increase during the unskilled months for new interns and residents (from March to May) in a pattern suggestive of a "March effect". RESULTS: Among 455 patients with sSAH, 113 patients were treated during the unskilled period (from March to May) and the remaining 342 patients were treated during the skilled period (from June until February of the next year). No statistically significant difference in demographics and clinical characteristics was observed between patients treated during these periods. In addition, the mortality and unfavorable discharge rates of the un-skilled period were 16.8% and 29.7% and those of the skilled period were 15.5% and 27.2%, respectively. However, no statistically significant difference was observed between them. CONCLUSIONS: Findings of our study suggest that there was no 'March effect' on the mortality rate and unfavorable discharge rate among patients with sSAH in our hospital during the study period.

Application of homemade newly toilet stool in urination of SAH patients / 中国实用护理杂志

Objective To investigate the clinical effect of homemade toilet stool on bed urination in spontaneous subarachnoid hemorrhage (SAH) patients.Methods The newly admitted 80 SAH patients with 0～2 level of Hunt-Hess grade were randomly divided into the observation group and the control group with 40 cases in each group.The control group was taken ordinary toilet stools and regular monitoring methods,and the observation group was taken homemade toilet stools and regular monitoring methods.Then the rate of urination,time of induced urination,blood pressure changes during induced urination and residual urine volume of bladder were compared within these two groups.Results The rate of successful urination in the observation group were significantly higher than that in the control group,and time of induced urination,blood pressure changes during induced urination,residual urine volume of bladder in the observation group were all significantly lower than those in the control group.Conclusions Homemade toilet stool is effective in promoting bed urination,shortening the time of induced urination,reducing the fluctuation of blood pressure during induced urination and the residual urine volume of bladder.

Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

Determination of the localization of rupture aneurysms in patients with multiple cerebral aneurysms and spontaneous subarachnoid hemorrhage / 中国综合临床

Objective To discuss the reasons of false judgments of localization of the rupture aneurysms and find the way to fix this problem in patients with multiple intracranial aneurysms. Methods The clinical data of 25 consecutive patients, who presented with their first spontaneous subarachnoid hemorrhage and had multiple intracranial aneurysms from 2003 to 2009 in our hospital, were analyzed retrospectively. The rupture aneurysms were determined according to Nehls' method that reported before, and the supposed responsible rupture aneurysms w0ere clipped within 48 hours after hemorrhage in all patients. More aneurysms that could not be accessed in the same surgical session were surgically terated later. Results The location of the rupture aneurysm was verified at the time of surgery in all 25 patients. The concordance rate of the prediction and the reality of the rupture aneurysm was 80% (20/25). Four patients ( 16% ) ,in whom the ruptured aneurysm was not correctly identified,rebled after surgery,and 2 patients died as a result of the rebleeding One patients had no clear diagnosis at the end. Conclusion In the reported cases, about 80% rupture aneurysms could be correctly diagnosed before treatment according to the CT and DSA examinations. If clear diagnosis couldn't be made,additional examinations should be considered, such as CTA or MRI. Rupture aneurysms must be confirmed during the operation and the other aneurysms should be checked to exclude additional responsible aneurysms in all cases.

Clinical Analysis of Spontaneous Subarachnoid Hemorrhage with Negative Angiography / 대한뇌혈관외과학회지

OBJECTIVE: Most cases of spontaneous subarachnoid haemorrhage (SAH) are due to a ruptured cerebral aneurysm, yet sometimes the cause of bleeding can be obscure. We report here on the results of a retrospective single-center study to determine the role of the hemorrhage patterns for the patients with a negative angiogram on admission. METHODS : A total of 480 patients with spontaneous subarachnoid hemorrhage (SAH) were admitted from January 2004 to September 2008. Of these, 44 patients were included in this study because of their negative findings on their initial angiography. SAH was diagnosed by a computed tomographic scan or lumbar puncture. The clinical grade was assessed using the Hunt-Hess grading system, Fisher's grading system and the modified Rankin scale. RESULT : The overall incidence of an initially negative angiogram for patients with a spontaneous SAH was 10.2%. Based on the hemorrhage pattern on the admission CT, the most common pattern was the diffuse type (52.3%), followed by the perimesencephalic type (29.5%), the CT negative type (11.4%) and the localized non-perimesencephalic type (6.8%). The repeat angiogram revealed an aneurysm in 3 (7.7%) patients and exploration revealed a dissecting aneruysm of the vertebral artery in 1 patient. The patients with the diffuse type SAH significantly differed from the perimesencephalic group with regard to the Fisher grade (p = 0.002), the outcome at discharge (p = 0.004) and the need for EVD. CONCLUSION : Patients with SAH of an unknown cause, especially with perimesencephalic SAH, have an excellent prognosis and low mortality. We believe that digital subtraction angiogram is still the gold standard for making the diagnosis of aneurysm in patients with spontaneous SAH. A repeat angiogram is recommended for all the patients with initially angionegative SAH. For those patients with perimesencephalic SAH and a positive CSF study with a negative CT, we suggest to perform a CT angiogram as a less invasive follow-up study.

Akinetic Mutism following Spontaneous Subarachnoid Hemorrhage: A Case Report / 대한뇌혈관외과학회지

Akinetic mutism (AM) is a rare complication of spontaneous subarachnoid hemorrhage (SAH). It is characterized by mutism and general hypokinesis in a patient superficially fully awake in that the eyes remain open and follow objects. Most common cause of AM in patients with SAH is secondary infarction in the distal anterior cerebral artery (DACA) territory. Sometimes post-SAH hydrocephalus has also been implicated in a delayed form of AM because of disruption of dopaminergic pathway. We report a case of 64-year-old woman who presented with sudden bursting headache without neurologic deficit. She was referred from the other hospital with a diagnosis of spontaneous SAH on head computed tomography (CT) which showed high density on sylvian, interhemispheric fissures and basal cistern. We performed computed tomographic cerebral angiography (CTA) and trans-femoral catheter cerebral angiography (TFCA), that revealed no definitive intracranial aneurysm, arterial dissection, or other vascular abnormality of the SAH. During admission period, she developed mutism and motor weakness of all limbs without spontaneous movement. We performed brain magnetic resonance (MR) image and RI cisternography. Also we prescribed levodopa. On the 33th hospital day, she had neurological recovery with drowsy mentality and grade 4 weakness of all limbs, but she was observed to suddenly develop general weakness and became cardiac arrest on the 55th hospital day. Efforts to resuscitate her failed, no more treatment could not be applied. In our case, we couldn't find infarction in the DACA terriority, midbrain or cerebellum except communicating hydrocephalus. This case may alert neurosurgeon to recognize the possibility of such rare complication after spontaneous SAH.

Bilateral Internuclear Ophthalmoplegia Following Spontaneous Subarachnoid Hemorrhage

A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage.

Research of Ginaton in Treating Vascular Hyperkinesia after Subarachnoid Hemorrhage of Old People / 中国实用内科杂志

Objective Using Ginaton to treat old patients of vascular hyperkinesia after spontaneous subarachnoid hem- orrhage.Methods 34 patients of spontaneous subarachnoid hemorrhage were treated by Ginaton.Test the plasma en- dothelin(ET),thromboxanes(TXB2),(PGF)before and after the treatment.Results The patients using Ginaton got significantly lower ET and TXB2 after the treatment ET(52.52?18 048 )ng/L; TXB2(62.95?22.94)ng/L and higher PGF(75.98?20.78)ng/L.Conclusion Using Ginaton is a good way to treat vascular hyperkinesia after spontaneous subarachnoid hemorrhage.

Oculo-Cerebral Syndrome after Spontaneous Subarachnoid Hemorrhage

OBJECTIVE: Oculo-cerebral syndrome is an intraocular hemorrhage and related ocular symptoms caused by sudden increase in intracranial pressure. The authors investigate the clinical significance of oculo-cerebral syndrome after spontaneous subarachnoid hemorrhage and analyze the characteristics of aneurysms which caused intraocular hemorrhage in order to help the treatment of intracranial aneurysm patients. METHODS: From January 2000 to May 2001, 103 patients were admitted to our hospital and diagnosed as spontaneous subarachnoid hemorrhage. We divided the patients into two groups:81 patients without intraocular hemorrhage(non-IOH) and 22 patients with intraocular hemorrhage(IOH). The authors prospectively analyzed the prognostic factors of spontaneous subarachnoid hemorrhage by chi-square test. RESULTS: The initial neurologic state was poor in the IOH group(p<0.001). The Fisher's grade was higher than non-IOH group(p<0.001), and intracranial hemorrhage was great in the IOH group(p<0.001). The prognosis was poor in the IOH group at discharge(p<0.001). The most common rupture site in the IOH group was the anterior communicating artery(p<0.001). Frontal intracerebral hematoma was specific to intraocular hemorrhage(p<0.05). There was a positive correlation between intraocular hemorrhage and rebleeding(p<0.001). CONCLUSION: The authors suggest that oculo-cerebral syndrome is clinically significant with a poor prognostic factor in patients with spontaneous subarachnoid hemorrhage.

Preoperative Grading Systems of Spontaneous Subarachnoid Hemorrhage / 대한뇌혈관학회지

Since the first grading system of the subarachnoid hemorrhage was introduced by Botterell in 1956, various grading systems have been presented-mostly based on Botterell's or Glasgow Coma Scale-and studied for their universal validity. At the beginning, management plan for the patients solely depended on the grade of the applied grading system but after introduction of CT and microscope into the diagnosis and surgery for the aneurysmal subarachnoid hemorrhage and better understanding and management of vasospasm, the role of grading system has been changed to emphasize more on the predictability of the postsurgical outcome. The author reviewed the most popular and widely used grading systems to figure out their significance in predicting outcome and clinical applicability.

The Significance of Intraocular Hemorrhage in Spontaneous Subarachnoid Hemorrhage

A sudden increase in intracranial pressure due to spontaneous subarachnoid hemorrhage or head trauma may result in intraocular hemorrhage. To determine the prognostic implications, the incidence of this after SAH, and 157 consecutive patients with spontaneous subarachnoid hemorrhage were prospectively studied by means of indirect fundoscopy. In 20(12.7%) of these patients, intraocular hemorrhage was seen on initial examination. Mean initial Hunt and Hess and Fisher CT grades were higher in SAH patients with intraocular hemorrhage than in those without(3.57 and 3.57 ; 2.56 and 2.70, respectively, the differences were those without statistically significant. The anatomic distribution of ruptured aneurysm was different in patients with intraocular hemorrhage and thoes without. The overall mortality rate was 19%(26 of 137 patients), but 50%(10 of 20 patients) with intraocular hemorrhage died. Based on the results of the above study we can conclude that in cases of spontaneous subarachnoid hemorrhage, intraocular hemorrhage is not infrequent and that its prognosis is poor.

Clinical Significance of Intracerebral Hematoma in Patients with Spontaneous Subarachnoid Hemorrhage

To investigate the clinical significance of intracerebral hematoma(ICH) in patients with spontaneous subarachnoid hemorrhage(SAH), the authors reviewed 527 consecutive patients with SAH during the past 7 years. Computed tomography(CT) visible ICH was found in 115 patients(21.8%). In patients over 50 years old, ICH was found more frequently than patients aged 50 years or less(p<0.05). Patients with ICH had a higher incidence of intraventicular hemorrhage or rebleeding compared with patients without ICH(p<0.005). No significant association was found between pre-existing hypertension and ICH. Patients with ICH were in higher Hunt and Hess Grade(HHG) on admission(p<0.005), and had a poorer outcome compared with patients without ICH(p<0.005). Seventy-nine(20.2%) among the 392 patients with aneurysmal subarachnoid hemorrhage had ICHs, of whom the frequent site of aneurysm was the middle cerebral artery in 45.3%, anterior cerebral artery in 17.9%. The rate of good recovery in these patients was significantly low compared with patients without ICH. The mortality in 313 operated patients with aneurysmal subarachnoid hemorrhage was 36.4% in patients with ICH and 14.6% in those without ICH (p<0.005). Particulary, in the patients with middle cerebral artery or internal carotid artery aneurysm, ICH had a significant influence on the good recovery and mortality(p<0.005). Even though the surgical mortality of the patients with large hematoma more than 30 cc in amount was 64.7%, one half of the survivors showed good recovery. This study suggests that the prognosis after subarachnoid hemorrhage is poorer in patients with an ICH. Although the initial clinical grade is an important prognostic factor, the prognosis for patients in the same initial clinical grade is poorer when ICH is accompanied. In regard with an increased incidnece of rebleeding episode and an increased intracranial pressure in the patients with ICHs, we emphasize the importance of early surgical intervention.

Clinical Significance of Rebleeding and Risk Factors Affecting Rebleeding in Patients with Spontaneous Subarachnoid Hemorrhages

To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.

Causes of Mortality in Spontaneous Subarachnoid Hemorrhage

To investigate the causes of death in patients with spontaneous subarachnoid hemorrhage, 460 consecutive patients with a subarachnoid hemorrhage were reviewed. Angiography was not performed in 78 patients due to poor clinical conditions or discharge against admission. Of all these patients, 54(69.2%) died, 28 from serious clinical condition, 21 from rebleeding, 3 from pulmonary complications. 1 from vasospasm, and 1 with unknown causes. Thirty-eight patients were angiographically negative, of which 6(15.8%) died, 3 due to rebleeding, 2 due to poor clinical condition, and 1 due to cerebral infarction caused by vasospasm. Of the 344 patients who had an aneurysmal subarachnoid hemorrhage. 74 were discharged against admission or died before the surgery. The remaining 270 patients underwent aneurysm clipping. Early surgery(within 72 hours after subarachnoid hemorrhage) was performed in 151 patients, intermediate surgery (between Day 4 and 7 post SAH) in 74, and late surgery(Day 8 or later after SAH) in 45. Fifty-one patients (18.9%) died after aneurysm clipping. The remaining 270 patients underwent aneurysm clipping. Early surgery(within 72 hours after subarachnoid hemorrhage) was performed in 151 patients, intermediate surgery(between Day 4 and 7 post-SAH) in 74, and late surgery(Day 8 or later after SAH) in 45, Fifty-one patients(18.9%) died after aneurysm clipping. The causes were vasospasm in 17, complications related to surgery in 13, poor clinical condition in 12, preoperative rebleeding in 7, and other systemic condition in 2. A total of 59 patients suffered at least one rebleeding after the initial hemorrhage ; these patients had a mortality rate of 76.3% and the highest rate of rebleeding occurred within the first 24 hours after initial hemorrhage. Vasospasm and rebleeding were the leading causes of mortality in addition to the initial bleeding. Predictors for mortality included poor clinical grade, early surgery in patients aged 60 years or more, and association with intracerebral hematoam, intraventricular hemorrhage, or subdural hematoma.

Prognostic Value of Blood Glucose Level in Spontaneous Subarachnoid Hemorrhage and Head Trauma

To examine the relationship between serum glucose level and the outcome of patients suffering from spontaneous subarachnoid hemorrhage(SSAH) and head injury, the authors prospectively studied serum glucose levels in 63 patients of SSAH and in 142 patients with headtrauma admitted within 72 hours after ictus. In SSAH, glucose levels measured at admission showed a statistically significant association with Botterell grade and deposition of blood on computerized tomography(CT) scans. As assessed by the Glasgow Outcome Scale(GOS) at 1 months, good recovery occurred in 78.1% of patients with glucose level below 160mg%, good recovery was only found in 12.5% of patients with hyperglycemia(>160mg%)(p120mg%)(p<0.001). These data suggest that hyperglycemia on admission is a component of the stress response to head injury and SSAH. It serves as a useful indicator of severity of injury, and a significant predictor of outcome from SSAH and head injury.

Delayed Ischemic Deficit following Spontaneous Subarachnoid Homorrhage

Of 286 patients with spontaneous subarachnoid hemorrhage over the past 5 years, 201 patients underwent operation after confirming the ruptured aneurysms. Among the operated patients, 31 developed dealyed ischemic deficit(DID) pre-or post-operatively. DID developed as early as 4 dyas and as late as 29 dyas after the subarachnoid hemorrhage. The severity of hemorrhage based on Fisher group, subarachnoid hemorrhage assoicated with intracerebral hemorrhage and/or intraventricular hemorrhage, surgery within 3 days after the subarachnoid hemorrhage were closely related with higher incidence of DID. Inspite of vigorous therapy, 3 died but 23 recovered satisfactorily.