Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 1997
ReviewClinical evaluation and management of aneurysmal subarachnoid hemorrhage.
As neuroradiologic techniques become more critical to the care of patients suffering from aneurysmal subarachnoid hemorrhage, a thorough understanding of the natural history and medical management of this disorder by neuroradiologists is required to insure appropriate diagnosis and therapy. This article addresses the medical and perioperative management of subarachnoid hemorrhage, with an emphasis on features relevant to neuroradiologic diagnosis and treatment.
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An estimated 1% to 5% of adults have a cerebral aneurysm. Each year, approximately 1 in 10,000 North Americans suffer an aneurysmal subarachnoid hemorrhage, with greater than 50% combined morbidity and mortality. Cerebral aneurysm formation and rupture is associated with a variety of factors, including increasing age, female gender, hypertension, alcohol, smoking, and genetic factors.
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For survivors of aneurysmal subarachnoid hemorrhage, cerebral vasospasm significantly contributes to its morbidity and mortality by causing delayed ischemic neurological deficit. Noninvasive evaluation with computed tomography, transcranial doppler and single photon emission computerized tomography helps guide clinical decisions. ⋯ Encouraging long-term clinical and transcranial artery damage following angioplasty. Despite balloon angioplasty's 2% to 5% peri-procedure mortality rate, it remains under used.
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The visual pathways and the ocular motor cranial nerves are frequently injured by expanding cerebral aneurysms. Neuro-ophthalmologic signs and symptoms may be the only indications of an aneurysm prior to rupture. ⋯ Acute or chronic visual loss may herald an aneurysm in the carotidophthalmic, supra clinoid carotid, internal carotid bifurcation, or anterior communicating artery distributions. Diplopia and retro-orbital pain may be warning signs that precede the discovery of a posterior communicating, basilar, or cavernous sinus aneurysm.