Computerized tomography and subarachnoid haemorrhage

Aneurysmal subarachnoid haemorrhage [SAH] is a cerebral catastrophy, which has been known for centuries. It was not until the 1950s that the phenomenon of SAH-induced "cerebral vasospasm" of a delayed onset after haemorrhage was recognized by a few pioneers in the clinical neurosciences. Initially, like in so many other occasions in the history of medicine, this phenomenon was met with considerable scepticism by most specialists until it finally became well-recognized. Cerebral vasospasm [CVS] has two not-necessarily reconcilable definitions, i.e., radiographic vasospasm and clinical vasospasm or delayed ischaemic dysfunction [DID]. Since only larger arteries may be visualized angiographically, the diagnosis of arterial narrowing following SAH is limited to narrowing of these vessels which helps explain why the two conditions are not necessarily reconcilable. Radiographic CVS is identified in approximately 60% of arteriograms performed around the 7th day following an aneurysmal SAH, whereas symptomatic CVS [DID] occurs in approximately 30%, in half of the latter patients [15%] the deficit becomes permanent. With the introduction of computerized tomography [CT] it has become easier to diagnose SAH and CT has demonstrated that there is a correlation between the amount of extravasated blood on CT [Fisher SAH Grade] and the risk of developing CVS and DID. The pathogenesis of CVS and DID otherwise remains poorly understood

Aneurismas: una experiencia escandinava; manejo de la ruptura de aneurismas intracraneanos; un analisis / Aneurisms: scandinavian experience; management of the intracranial aneurisms rupture; analysis

Se revisa la desalentadora historia asociada al manejo de la hemorragia subaracnoidea de los aneurismas (HSA), junto a los posibles perfeccionamientos atribuibles al progreso de la última década . Entre los nuevos avances se encuentra la introducción de técnicas micro-quirúrgicas que permiten la cirugía electiva en la etapa aguda, previniendo de este modo la repetición de las hemorragias. La operación temprana también ofrece la posibilidad de un tratamiento farmacológico anti-isquémico más agresivo. No obstante, los mejores resultados de la cirugía electiva aguda y el hecho de que el deterioro isquémico retardado (vasoespasmo cerebral sintomático) pueden estar practicamente eliminados en la actualidad, el resultado global es pesimista. A pesar de los recientes adelantos no se espera que más de una de tres personas que sufran la ruptura de un aneurisma intracraneano puedan tener una buena recuperación funcional y neurológica. La esperanza de nuevos progresos puede depender de desarrollo de técnicas que identifiquen los aneurisamas intracraneanos antes de su rompimiento y del aumento de conocimientos sobre la etiología de dichas lesiones de la pared arterial