Treatment of Aneurysmal SAH with CRF

ABSTRACT

There are several difficulties in treating aneurysmal subarachnoid hemorrhage(SAH) with chronic renal failure(CRF). First, fluid therapy is not feasible especially in vasospasm. Second, hypertonic solution therapy used to reduce intracranial pressure(ICP) is restricted. Third, hemorrhage2) and disequilibrium syndrome1)2)9) associated hemodialysis can occur. In this article, the authors experienced two cases of aneurysmal SAH with CRF. The first patient was a 57-year old man who suffered from CRF for 8 years. Magnetic resonance angiography had demonstrated a middle cerebral artery(MCA) bifurcation aneurysm on right side. He was treated with early surgery and recovered without neurological deficits. The second patient was a 43-year old woman who suffered from CRF for 5 years. Posterior communicating artery(P-Com) aneurysm was identified on the left side and delayed surgery was performed. After operation, vasospasm occurred and she died of brain swelling from infraction on the left MCA territory. It is noteworthy that the most important factor in aneurysmal SAH with CRF is the prevention vasospasm, because the use of fluid and hypertonic solution therapy is not feasible. To prevent vasospasm, early operation is warranted for the removal of SAH during operation. Non-anticoagulant agent hemodialysis is used during pre and post operative period.