Neurosurgery
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The records of 100 consecutive cases of subarachnoid hemorrhage due to ruptured aneurysm were reviewed to determine the incidence and the prognostic implications of seizures during the acute phase. Seizures occurred in 26% of the patients. ⋯ Most of the remaining seizures occurred immediately after rebleeding, with no greater morbidity or mortality compared to all patients who rebled. Pathogenic mechanisms of seizures associated with subarachnoid hemorrhage are proposed and discussed.
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Light and electron microscopic studies of the cut sciatic nerve in the rat showed typical neuroma formation. If the nerve was cut and the proximal segment was ligated as a whole, the neuromatous process appeared to be even more severe than that in the simply cut nerve. ⋯ The mechanism by which fascicle ligation limits axonal regeneration is unknown, but could involve peripheral as well as central mechanisms. Such a limitation of neuroma formation by fascicle ligation as was found in the rat might also apply to painful human neuromas.
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A clinical and light and electron microscopic study of three cases of painful neuroma, surgically resected, was made. It was found (a) that painful neuromas contain large numbers of small diameter, unmyelinated fibers, in an apparently much larger proportion than myelinated fibers and (b) that a consistent, unrestrained growth of perineurial cells parallels the constant regeneration of axis cylinders. ⋯ It is suggested that the increased numbers of unmyelinated axis cylinders in traumatic neuromas could be related to the painful symptoms in some patients. It is further postulated that the unrestricted growth of perineurial cells is an attempt to contain the regeneration of axis cylinders and that the maintenance of perineurial integrity by fascicle ligation is important in the relief of painful human neuromas.
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Randomized Controlled Trial Clinical Trial
Antifibrinolysis with tranexamic acid in aneurysmal subarachnoid hemorrhage: a consecutive controlled clinical trial.
A randomized controlled clinical trial was carried out to study the effect of tranexamic acid (AMCA, Cyklokapron; AB Kabi, Stockholm, Sweden) in the prevention of early rebleeding after the rupture of an intracranial aneurysm. The incidence of vasospasm, hydrocephalus, cerebral ischemic and thromboembolic complications, morbidity, and mortality was also evaluated. The series comprises 59 patients, 30 treated with tranexamic acid and 29 controls. ⋯ Five patients in each group died from rebleeding. Five additional treated patients and 2 controls died from cerebral ischemic dysfunction. The results suggest that tranexamic acid may protect patients with ruptured aneurysms from rebleeding for 1 or 2 weeks, but that it also may produce cerebral ischemic complications.