Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage

1993 ◽  
Vol 78 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Joseph P. Broderick ◽  
Thomas Brott ◽  
Thomas Tomsick ◽  
Rosemary Miller ◽  
Gertrude Huster
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
Annual Incidence ◽  
Laboratory Research ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Fine Print

✓ The authors report a study of all instances of spontaneous intracerebral hemorrhage (ICH) (188 cases) and subarachnoid hemorrhage (SAH) (80 cases) that occurred in the Greater Cincinnati area during 1988. Adjusted for age, sex, and race, the annual incidence of ICH was 15 per 100,000 population (95% confidence interval 13 to 17) versus six per 100,000 for SAH (95% confidence interval 5 to 8). The incidence of ICH was at least double that of SAH for women, men, and whites and approximately 1½ times that for blacks. The 30-day mortality rate of 44% for ICH was not significantly different from the 46% mortality rate for SAH. Despite the evidence that ICH is more than twice as common and the disorder just as deadly as SAH, clinical and laboratory research continues to focus primarily on SAH.

Surgical experiences with giant intracranial aneurysms

1984 ◽  
Vol 61 (6) ◽  
pp. 1009-1028 ◽  
Author(s):  
Lindsay Symon ◽  
Janos Vajda
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Visual Loss ◽  
Considerable Improvement ◽  
Brain Circulation ◽  
Content Type ◽  
Space Occupying Lesion ◽  
Fine Print

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.

CT infusion scanning for the detection of cerebral aneurysms

1989 ◽  
Vol 71 (2) ◽  
pp. 175-179 ◽  
Author(s):  
David W. Newell ◽  
Peter D. LeRoux ◽  
Ralph G. Dacey ◽  
Gary K. Stimac ◽  
H. Richard Winn
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Cerebral Aneurysms ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Spontaneous Hemorrhage ◽  
Fine Print

✓ Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.

Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states

2003 ◽  
Vol 99 (5) ◽  
pp. 810-817 ◽  
Author(s):  
DeWitte T. Cross ◽  
David L. Tirschwell ◽  
Mary Ann Clark ◽  
Dan Tuden ◽  
Colin P. Derdeyn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Hospital Volume ◽  
High Volume ◽  
Mortality Rates ◽  
Case Volume ◽  
Content Type ◽  
Hospital Case ◽  
Fine Print

Object. The goal of this study was to determine whether a hospital's volume of subarachnoid hemorrhage (SAH) cases affects mortality rates in patients with SAH. For certain serious illnesses and surgical procedures, outcome has been associated with hospital case volume. Subarachnoid hemorrhage, usually resulting from a ruptured cerebral aneurysm, yields a high mortality rate. There has been no multistate study of a diverse set of hospitals to determine whether in-hospital mortality rates are influenced by hospital volume of SAH cases. Methods. The authors conducted an analysis of a retrospective, administrative database of 16,399 hospitalizations for SAH (9290 admitted through emergency departments). These hospitalizations were from acute-care hospitals in 18 states representing 58% of the US population. Both univariate and multivariate analyses were used to assess the case volume—mortality rate relationship. The authors used patient age, sex, Medicaid status, hospital region, data source year, hospital case volume quartile, and a comorbidity index in multivariate generalized estimating equations to model the relationship between hospital volume and mortality rates after SAH. Patients with SAH who were treated in hospitals in which low volumes of patients with SAH are admitted through the emergency department had 1.4 times the odds of dying in the hospital (95% confidence interval 1.2–1.6) as patients admitted to high-volume hospitals after controlling for patient age, sex, Medicaid status, hospital region, database year, and comorbid conditions. Conclusions. Patients with a diagnosis of SAH on their discharge records who initially presented through the emergency department of a hospital with a high volume of SAH cases had significantly lower mortality rates. Concentrating care for this disease in high-volume SAH treatment centers may improve overall survival.

The prognosis in subarachnoid hemorrhage of unknown etiology

1984 ◽  
Vol 61 (6) ◽  
pp. 1029-1031 ◽  
Author(s):  
Vagn Eskesen ◽  
Ebbe B. Sørensen ◽  
Jarl Rosenørn ◽  
Kaare Schmidt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Functional Capacity ◽  
Unknown Etiology ◽  
Vertebral Angiography ◽  
Content Type ◽  
Moderate Reduction ◽  
Bilateral Carotid ◽  
Fine Print

✓ The mortality rate, risk of rebleeding, relevant subjective and objective symptoms, and daily functional capacity after a verified subarachnoid hemorrhage (SAH) of unknown etiology were evaluated in 44 patients treated during a 5-year period (1978 to 1983). A vascular basis for the SAH had been excluded by bilateral carotid and vertebral angiography and computerized tomography. The patients were interviewed at a follow-up examination from 3 to 64 months (median 36 months) after the bleed. The results revealed a 5% mortality rate and a 7% risk of rebleeding. Persisting headache and fatigue were found in 40% of patients, 29% had mild demential symptoms, and 5% had persisting and severe objective neurological symptoms. None had developed epilepsy. A normal daily functional capacity was enjoyed by 84%, while 14% had a moderate reduction in these functions, but were independent of help from other persons. One patient (2%) was not fully assessed.

Cerebral angiomas: the sequelae of surgical treatment

1972 ◽  
Vol 37 (5) ◽  
pp. 571-575 ◽  
Author(s):  
A. Loren Amacher ◽  
John M. Allcock ◽  
Charles G. Drake
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Mortality Rate ◽  
Content Type ◽  
Postoperative Death ◽  
Operative Results ◽  
Intractable Seizures ◽  
Indications For Operation ◽  
Fine Print

✓ Fifty patients underwent 55 operations upon intracerebral angiomas; 86% had suffered intracerebral or subarachnoid hemorrhage, 8% intractable seizures, and 6% intractable headache and progressive ischemic symptoms. There was one postoperative death, a mortality rate of 2%. The operative results are considered in relation to the indications for operation and the degree of removal. The importance of postoperative angiography is stressed.

Surgical treatment of spontaneous intracerebral hemorrhage

1973 ◽  
Vol 39 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Jean E. Paillas ◽  
Bernard Alliez
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Cerebral Hemorrhage ◽  
Preoperative Diagnosis ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.

Two types of spontaneous intracerebral hemorrhage due to hypertension

1972 ◽  
Vol 37 (5) ◽  
pp. 509-513 ◽  
Author(s):  
Vladimír Beneš ◽  
František Koukolík ◽  
Dagmar Obrovsk´
Keyword(s):  
Intracranial Pressure ◽  
Conservative Treatment ◽  
Intracerebral Hemorrhage ◽  
Surrounding Tissue ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hypertensive Patients ◽  
Content Type ◽  
Initial Shock ◽  
Postmortem Examinations ◽  
Fine Print

✓ Analysis of 150 postmortem examinations indicates that spontaneous intracerebral hemorrhage in hypertensive patients develops in two ways. In the first, hemorrhage crushes the surrounding tissue, tamponades the ventricles, and produces a fatal increase in intracranial pressure. Operation on such patients does not improve the results obtained by conservative treatment. In the second type, the hemorrhage is self-limited; the hematoma that frequently develops behaves as an expanding lesion, and operative treatment can be helpful after the initial shock interval has passed. Diagnostic differentiation of the two types is not possible immediately after the stroke.

Hematoma enlargement in spontaneous intracerebral hemorrhage

1994 ◽  
Vol 80 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Yukihiko Fujii ◽  
Ryuichi Tanaka ◽  
Shigekazu Takeuchi ◽  
Tetsuo Koike ◽  
Takashi Minakawa ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Liver Dysfunction ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Hematoma Enlargement ◽  
Coagulation Abnormalities ◽  
Hematoma Growth ◽  
Low Levels ◽  
Fine Print

✓ In order to evaluate the incidence and risk factors of hematoma enlargement in spontaneous intracerebral hemorrhage (ICH), 419 cases of ICH were reviewed. The first computerized tomography (CT) scan was performed within 24 hours of onset and the second within 24 hours of admission; a blood sample was taken for laboratory examination within 1 hour of admission. In 60 patients (14.3%) the second CT scan showed an enlarged hematoma. The incidence of enlargement significantly decreased with time (p < 0.05) and significantly increased with the severity of liver dysfunction and the volume of the hematoma on the first CT scan. Patients with an irregularly shaped hematoma had a higher risk of hematoma growth than those with a round hematoma. In addition, patients with hematoma enlargement were more likely to have coagulation abnormalities (low platelet counts and low levels of fibrinogen, α2-antiplasmin activity and platelet aggregation). Moreover, hematoma growth was associated with a poor clinical outcome. It is concluded that patients admitted to a hospital within 6 hours of onset of ICH, especially those admitted within 2 hours, and patients with liver dysfunction or irregularly shaped large hematomas should be closely observed for at least 6 hours after onset in preparation for emergency surgery, since the risk of hematoma growth in these circumstances is high.

Measurements of brain-stem auditory evoked potentials in patients with spontaneous intracerebral hemorrhage

1984 ◽  
Vol 60 (3) ◽  
pp. 548-552 ◽  
Author(s):  
Christianto B. Lumenta
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Evoked Potentials ◽  
Brain Stem ◽  
Auditory Evoked Potentials ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Different Types ◽  
The Brain ◽  
Fine Print

✓ Brain-stem auditory evoked potentials (BAEP's) were recorded in 19 patients with spontaneous intracerebral hemorrhage. More than half of the patients were deeply comatose. There was no correlation between BAEP changes and different types of spontaneous intracerebral hemorrhage or between BAEP's and coma grading by the Glasgow Coma Scale. However, BAEP's were a significant prognostic aid in these cases and useful in indicating the level of the brain-stem lesion.

Improved survival after aneurysmal subarachnoid hemorrhage: review of management during a 12-year period

1999 ◽  
Vol 90 (4) ◽  
pp. 664-672 ◽  
Author(s):  
Kristina G. Cesarini ◽  
Hans-Göran Hårdemark ◽  
Lennart Persson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Clinical Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Favorable Outcome ◽  
Monitoring Methods ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. Based on the concept that unfavorable clinical outcome after aneurysmal subarachnoid hemorrhage (SAH), to a large extent, is a consequence of all ischemic insults sustained by the brain during the acute phase of the disease, management of patients with SAH changed at the authors' institution in the mid-1980s. The new management principles affected referral guidelines, diagnostic and monitoring methods, and pharmacological and surgical treatment in a neurointensive care setting. The impact of such changes on the outcome of aneurysmal SAH over a longer period of time has not previously been studied in detail. This was the present undertaking.Methods. The authors analyzed all patients with SAH admitted to the neurosurgery department between 1981 and 1992. This period was divided in two parts, Period A (1981–1986) and Period B (1987–1992), and different aspects of management and outcome were recorded for each period. In total, 1206 patients with SAH (mean age 52 years, 59% females) were admitted; an aneurysm presumably causing the SAH was found in 874 (72%).The 30-day mortality rate decreased from 29% during the first 2 years (1981–1982) to 9% during the last 2 years (1991–1992) (Period A 22%; Period B 10%; p < 0.0001) and the 6-month mortality rate decreased from 34 to 15% (Period A 26%; Period B 16%; p < 0.001). At follow-up review conducted 2 to 9 years (mean 5.2 years) after SAH occurred, patients were evaluated according to the Glasgow Outcome Scale. Subarachnoid hemorrhage—related poor outcome (vegetative or dead) was reduced (Period A 30%; Period B 18%; p < 0.001). There was an increase both in patients with favorable outcome (good recovery and moderate disability) (Period A 61%; Period B 66%) and in those with severe disability (Period A 9%; Period B 16%; p < 0.01).Conclusions. This study provides evidence that the prognosis for patients with aneurysmal SAH has improved during the last decades. The most striking results were a gradual reduction in mortality rates and improved clinical outcomes in patients with Hunt and Hess Grade I or II SAH and in those with intraventricular hemorrhage. The changes in mortality rates and the clinical outcomes of patients with Hunt and Hess Grades III to V SAH were less conspicuous, although reduced incidences of mortality were seen in some subgroups; however, few survivors subsequently appeared to attain a favorable outcome.

Sign in / Sign up

Export Citation Format

Share Document