Intracranial complications of hypervolemic therapy in patients with a delayed ischemic deficit attributed to vasospasm

1993 ◽  
Vol 78 (3) ◽  
pp. 423-429 ◽  
Author(s):  
Masami Shimoda ◽  
Shinri Oda ◽  
Ryuichi Tsugane ◽  
Osamu Sato
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Cerebral Edema ◽  
Content Type ◽  
Hemorrhagic Infarction ◽  
Intracranial Complication ◽  
Intracranial Complications ◽  
Fine Print

✓ This investigation has revealed the frequency of various intracranial complications that may result from hypervolemic therapy for a delayed ischemic deficit following subarachnoid hemorrhage (SAH). Among 323 patients with SAH, 112 patients developed a delayed ischemic deficit, 94 of whom underwent hypervolemic therapy. Infarction due to vasospasm was found ultimately in 43 of these 94 patients. Twenty-six patients (28%) developed an intracranial complication during hypervolemic therapy: cerebral edema was aggravated in 18, and a hemorrhagic infarction developed in eight. In 13 of 18 patients with aggravation of edema, delayed ischemic deficit developed within 6 days after the SAH; at that time, a massive new infarction was found in four and edema in 10 patients. After hypervolemic therapy, the 18 patients with aggravation of edema deteriorated rapidly, and 14 of them died. In every case in which hemorrhagic infarction followed hypervolemic therapy, a new infarct was found on computerized tomography (CT) when the delayed ischemic deficit became apparent. Hemorrhagic infarction developed as the delayed ischemic deficit resolved, with one exception. In patients who sustained no complication from hypervolemia, the incidence of both massive new infarction and edema at the time when the delayed ischemic deficit was manifested was only 1%. In 44 of 68 patients who sustained no complication from hypervolemia, the delayed ischemic deficit was manifested on or after the 7th day following the SAH. This study suggests that hypervolemic therapy is contraindicated in a patient who is found to have a massive abnormality on CT at the time when a delayed ischemic deficit is manifested, especially when it occurs within 6 days after the SAH. To avoid hemorrhagic infarction, it is important to discontinue hypervolemic therapy as soon as the delayed ischemic deficit resolves.

Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome

2003 ◽  
Vol 98 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Cristina Mattioli ◽  
Luigi Beretta ◽  
Simonetta Gerevini ◽  
Fabrizio Veglia ◽  
Giuseppe Citerio ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Statistical Significance ◽  
Unfavorable Outcome ◽  
Content Type ◽  
Ct Findings ◽  
Traumatic Subarachnoid Hemorrhage ◽  
Injured Patients ◽  
Fine Print

Object. The goal of this study was fourfold: 1) to determine the incidence of traumatic subarachnoid hemorrhage (tSAH) in patients with traumatic brain injury (TBI); 2) to verify agreement in the diagnosis of tSAH in a multicenter study; 3) to assess the incidence of tSAH on the outcome of the patient; and 4) to establish whether tSAH itself leads to an unfavorable outcome or whether it is a sign of major brain trauma associated with severe posttraumatic lesions. Methods. Computerized tomography (CT) scans obtained in 169 head-injured patients on admission to 12 Italian intensive care units during a 3-month period were examined. The scans were collected for neuroradiological review and were used for the analysis together with data from a multicenter database (Neurolink). A review committee found a high incidence of tSAH (61%) in patients with TBI and a moderate agreement among centers (K = 0.57). Significant associations were observed between the presence and grading of tSAH and patient outcomes, and between the presence of tSAH and the severity of the CT findings. Logistic regression analysis showed that the presence of tSAH and its grading alone do not assume statistical significance in the prediction of unfavorable outcome. Conclusions. Traumatic SAH frequently occurs in patients with TBI, but it is difficult to detect and grade. Traumatic SAH is associated with more severe CT findings and a worse patient outcome.

Subependymoma presenting as subarachnoid hemorrhage

1981 ◽  
Vol 55 (4) ◽  
pp. 643-645 ◽  
Author(s):  
David G. Changaris ◽  
James M. Powers ◽  
Phanor L. Perot ◽  
G. Douglas Hungerford ◽  
George B. Neal
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Brain Tumors ◽  
Young Patient ◽  
Computerized Tomography ◽  
Content Type ◽  
Fine Print

✓ Symptomatic subarachnoid hemorrhage (SAH) in a young patient originated in a non-obstructive lateral ventricular subependymoma. A brief review of brain tumors known to cause SAH is discussed. The computerized tomography scans are presented.

Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

1999 ◽  
Vol 90 (1) ◽  
pp. 153-155 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Rolf W. Warzok ◽  
Jamal A. Assaf ◽  
Michael R. Gaab
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Balloon Catheter ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Content Type ◽  
Tomography Scanning ◽  
Fine Print

✓ In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy.This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic—peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later.Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mammillary bodies, just behind the dorsum sellae.

Does moyamoya disease cause subarachnoid hemorrhage?

1984 ◽  
Vol 60 (2) ◽  
pp. 348-353 ◽  
Author(s):  
Nobuhiko Aoki ◽  
Hiroshi Mizutani
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Intracranial Hemorrhage ◽  
Moyamoya Disease ◽  
Single Case ◽  
Saccular Aneurysm ◽  
Content Type ◽  
Per Se ◽  
Fine Print

✓ The majority of patients with intracranial hemorrhage associated with moyamoya disease have been described as having subarachnoid hemorrhage (SAH), but it seems doubtful that moyamoya disease causes primary SAH. Computerized tomography (CT) has revealed that most of the hemorrhage found in cases of moyamoya disease is intracerebral or intraventricular. The authors have reviewed 54 cases of intracranial hemorrhage confirmed by CT, including nine of their own, and found that in all but one the bleeding was intracerebral or intraventricular. The single case of SAH was due to rupture of a saccular aneurysm associated with moyamoya disease. It may be concluded from these results that moyamoya disease does not cause primary SAH per se.

Surgical anatomy of the cerebral arteries in patients with subarachnoid hemorrhage: comparison of computerized tomography angiography and digital subtraction angiography

2001 ◽  
Vol 95 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Birgitta K. Velthuis ◽  
Maarten S. van Leeuwen ◽  
Theodoor D. Witkamp ◽  
Lino M. P. Ramos ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Arteries ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. The purpose of this study was to compare computerized tomography (CT) angiography and digital subtraction (DS) angiography studies in patients with subarachnoid hemorrhage (SAH) to assess their vascular anatomy relevant to cerebral aneurysm surgery. Methods. From a prospective series of 100 patients with SAH, the authors selected 73 patients whose CT angiography studies were of adequate quality and in whom DS angiography of both carotid arteries had been performed. Eleven patients with no DS angiographic studies of the vertebrobasilar artery were only evaluated for the anterior half of the circle of Willis. Anterior communicating arteries (ACoAs), both precommunicating anterior cerebral arteries (A1 segments), both posterior communicating arteries (PCoAs), and both precommunicating posterior cerebral arteries (P1 segments) were assessed on CT angiography and DS angiography by two independent observers. Conclusions. Computerized tomography angiography compares well with DS angiography for visualizing normal-sized arteries, and is superior for visualizing ACoAs and hypoplastic A1 and P1 segments. Important preoperative aspects such as dominant A1 segments and PCoAs are equally well seen using either modality. Neither method enabled the authors to visualize more than 50% of PCoAs. Use of CT angiography can provide the required preoperative anatomical information for aneurysm surgery in most patients with SAH.

The minor leak preceding subarachnoid hemorrhage

1987 ◽  
Vol 66 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Richard Leblanc
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Lumbar Puncture ◽  
Computerized Tomography ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
A Minor ◽  
Fine Print

✓ Thirty-four of 87 consecutive patients with subarachnoid hemorrhage from a cerebral aneurysm had a premonitory minor leak. There were 12 men and 22 women, aged 25 to 73 years (mean 44.4 years). Twenty-two had a small and 12 had a large aneurysm located on the internal carotid artery (17 cases), anterior communicating artery (10 cases), middle cerebral artery (five cases), and pericallosal artery (two cases). Fifty-two percent of patients with a minor leak from an internal carotid artery aneurysm had ipsilateral, hemicranial, hemifacial, or periorbital pain. Half of the patients initially saw a physician, but in no case was the correct diagnosis made. Twenty-five patients had a major rupture within 24 hours to 4 weeks after findings suggesting a minor leak, with a mortality rate of 53%. Nine other patients were diagnosed by lumbar puncture or computerized tomography (CT) scanning after initial misdiagnosis and were operated on, without mortality, before a major rupture could occur. The CT scans were negative in 55% of patients with a minor leak, but lumbar puncture, when performed, was always positive. A minor leak prior to major aneurysmal rupture is a common occurrence and, if unrecognized, is associated with a high mortality. Computerized tomography scanning is unreliable in diagnosing this event, and lumbar puncture is the examination of choice once intracranial hypertension has been ruled out.

Traumatic subarachnoid hemorrhage and its treatment with nimodipine

1996 ◽  
Vol 85 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Albrecht Harders ◽  
Algirdas Kakarieka ◽  
Reinder Braakman ◽  
_ _
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Unfavorable Outcome ◽  
Controlled Study ◽  
Relative Reduction ◽  
Clinical Neurology ◽  
Double Blind ◽  
Content Type ◽  
Traumatic Subarachnoid Hemorrhage ◽  
Fine Print

✓ A prospective, randomized, double-blind, placebo-controlled study of nimodipine used to treat traumatic subarachnoid hemorrhage (tSAH) was conducted in 21 German neurosurgical centers between January 1994 and April 1995. One hundred twenty-three patients with tSAH appearing on initial computerized tomography (CT) scanning were entered into the study. Requirements for inclusion included age between 16 and 70 and admission into the study within 12 hours after head injury, regardless of the patient's level of consciousness. Eligible patients received either a sequential course of intravenous and oral nimodipine or placebo treatment for 3 weeks. Patients were closely monitored using clinical neurology, computerized tomography, laboratory, and transcranial Doppler ultrasound parameters. Patients treated with nimodipine had a significantly less unfavorable outcome (death, vegetative survival, or severe disability) at 6 months than placebo-treated patients (25% vs. 46%, p = 0.02). The relative reduction in unfavorable outcome in the nimodipine-treated group was even higher (55%, p = 0.002) when only patients who complied with the protocol were considered.

Multiple cerebral gummata

1983 ◽  
Vol 58 (6) ◽  
pp. 959-961 ◽  
Author(s):  
Jonathan Punt
Keyword(s):  
Intracranial Pressure ◽  
Computerized Tomography ◽  
Cerebral Edema ◽  
Ct Scanning ◽  
Raised Intracranial Pressure ◽  
Serological Testing ◽  
Serological Tests ◽  
Content Type ◽  
Fine Print

✓ The case of a patient with multiple small cerebral gummata presenting with severely raised intracranial pressure is reported. The diagnosis, which was quite unexpected, was based on positive serological tests for syphilis. Computerized tomography (CT) showed small enhancing lesions with intense cerebral edema. The patient was treated successfully with penicillin, and resolution of the lesions was observed on CT scanning over a 1-year period. The importance of “routine” serological testing is noted.

Frontal lobe perivascular schwannoma

1982 ◽  
Vol 56 (1) ◽  
pp. 154-157 ◽  
Author(s):  
Roland N. Auer ◽  
James Budny ◽  
Charles G. Drake ◽  
Melvyn J. Ball
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Frontal Lobe ◽  
Computerized Tomography ◽  
Conservative Management ◽  
Content Type ◽  
Fine Print

✓ A 15-year-old youth presented with a history and computerized tomography picture of subarachnoid hemorrhage. Conservative management was undertaken after failure to demonstrate an aneurysm. Reevaluation and operation 15 months later disclosed a firm leathery schwannoma intimately related to the frontal lobe and extending into the cortex in the Virchow-Robin spaces.

Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography

1999 ◽  
Vol 91 (5) ◽  
pp. 761-767 ◽  
Author(s):  
Birgitta K. Velthuis ◽  
Maarten S. van Leeuwen ◽  
Theodoor D. Witkamp ◽  
Lino M. P. Ramos ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Imaging Method ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

Object. The purpose of this study was to determine prospectively whether and to what extent computerized tomography (CT) angiography can serve as the sole imaging method for a preoperative workup in patients with ruptured intracranial aneurysms.Methods. During a 1-year period, all patients who presented to the authors' hospital with subarachnoid hemorrhage demonstrated by unenhanced CT scanning or lumbar puncture underwent CT angiography. Two radiologists evaluated the CT angiography source images and maximum intensity projection slabs and arrived at a consensus. They categorized the quality of the CT angiography as adequate or inadequate and classified aneurysms that were detected as definitely or possibly present. The parent artery of anterior communicating artery aneurysms was identified by asymmetrical anterior cerebral artery size and asymmetrical aneurysm location. The parent artery was indicated by the larger A1 segment in cases of asymmetrical A1 size. Only CT angiograms of adequate quality that revealed aneurysms classified as definitely present and with an unequivocal parent artery were presented to the neurosurgeons, who decided whether preoperative digital subtraction (DS) angiography should still be performed.Forty-nine of the 100 studied patients did not undergo surgery because of poor clinical condition, nonaneurysmal cause of the hemorrhage, or endovascular treatment of the ruptured aneurysm. Of the 51 patients who underwent surgery, radiologists required DS angiography in 17 patients; the imaging technique provided greater certainty in 13 instances. The neurosurgeons required DS angiography 11 times; this provided additional information in two instances. Twenty-three (45%) of the 51 patients were surgically treated successfully on the basis of CT angiography findings alone.Conclusions. Computerized tomography angiography can replace DS angiography as the preoperative neuroimaging technique in a substantial proportion of patients with ruptured intracranial aneurysms.

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