Natural course of subarachnoid hemorrhage is worse in elderly patients / A história natural da hemorragia subaracnóide é pior em pacientes idosos

Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH) patients according to age. Method Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo) were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment. .

A idade é considerada fator de risco de mau prognóstico em pacientes com aneurismas intracranianos rotos ou não-rotos; com o aumento da idade, ficam prejudicados vários padrões fisiológicos relacionados à hemodinâmica cerebral e homeostase. Objetivo Estudar o quadro clínico, os dados radiológicos e o prognóstico nos pacientes com hemorragia subaracnóide aneurismática em relação à idade. Método Foram avaliados consecutivamente, de 2002 a 2012, 389 pacientes com hemorragia subaracnóide aneurismática oriundos de uma instituição terciária brasileira. Resultados Houve associação da idade com pior quadro clínico, radiológico e prognóstico nos pacientes com hemorragia subaracnóide aneurismática. Conclusão O curso natural da hemorragia subaracnoidea é pior em pacientes idosos. O reconhecimento adequado do perfil desses pacientes e seu prognóstico é importante para estabelecer um tratamento adequado. .

Outcome of patients of subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm after surgical clipping

This prospective study was done to determine the outcome of subarachnoid haemorrhage [SAH] due to ruptured anterior communicating artery [a Corn] aneurysm in 8 consecutive patients after craniotomy and clipping of the aneurysm. The study was conducted at Mayo Hospital, Lahore from September 1999 to January 2002. All patients presented with history and examination suggestive of SAH had CT scan brain as first radiological investigation. Patients of SAH were graded clinically according to Hung and Hess scale. After confirmation of diagnosis of SAH, four vessels cerebral angiography was done to localize site of aneurysm in patiens of Hunt and Hess grade I, II and III or after they improved to at least grade III. Craniotomy and clipping of aneursm was done only in patients with Hunt and Hess grade I, II and III. Maximum patients presented during 6th decade i.e., 38%. Male to female ratio was 6:2. Hunt and Hess grade I, II and III was observed in 5,2 and 1 patients respectively. Outcome was assessed according to G lasgow Outcome Scale [GOS]. Good outcome was present in 75% patients and moderate disability in 25%

Angiografia pela ressonância magnética nos aneurismas intracranianos: estudo comparativo com a angiografia cerebral / Magnetic resonance angiography of intracranial aneurysms: comparative study with cerebral angiography

Avaliamos por angiografia pela ressonância magnética e por angiografia cerebral 41 pacientes com 55 aneurismas intracranianos confirmados pela cirurgia. A angiorressonância detectou 52 aneurismas com sensibilidade de 94,5 por cento e a angiografia cerebral detectou 53 aneurismas com sensibilidade de 96,3 por cento. Pela näo invasibilidade, rapidez e baixo custo a angiorressonância poderá substituir a angiografia cerebral no diagnóstico de aneurismas intracranianos e no prognóstico da hemorragia subaracnóide