Minerva anestesiologica
-
Minerva anestesiologica · Apr 1998
Review[Reasons in favor of lumbar puncture diagnosis (or lavage)].
In patients with strong suspicion of SAH, CT is the initial diagnostic procedure of choice. A lumbar puncture (LP) should be done if a CT is not available. If the patient has no focal deficit or papilloedema there is a little risk in LP. ⋯ The accuracy of CT in documenting SAH diminishes after 24 hours: thereafter, diagnosis is often dependent on LP. In some cases LP can be useful because the procedure may alleviate headache and remove some blood. LP can also quantify cerebro-spinal fluid (CSF) pressure, provide a baseline for future CSF determination, and allow the study of some parameters like arachidonate metabolites, lactic acid, fibrinogen degradation products (FDP) and thrombin-antithrombin complex (TAT).
-
Minerva anestesiologica · Apr 1998
[Physiopathology of non-traumatic subarachnoid hemorrhage: loss of consciousness].
The mechanisms underlying the loss of consciousness following the SAH can be only hypothesized at present time. The more convincing hypothesis appears to be the role of a cerebral circulatory insufficiency. ⋯ Different cerebral regions can be affected by the ischemia according to the prevalent location of the SAH, as for instance brain stem or telencephalon; consequently, different pathophysiological modalities can be responsible for the consciousness impairment. The entity of the SAH and of the consequent events responsible for the cerebral ischemia, influence the severity and reversibility of the loss of consciousness.