Surg Neurol
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Antifibrinolytic drugs have been investigated in a series of 58 patients with recent aneurysmal subarachnoid hemorrhage. It is concluded that tranexamic acid (AMCA) provides a rational method for reducing the frequency of recurrences, and that antifibrinolytic treatment is a preliminary to surgical intervention. ⋯ There is evidence also that hydrocephalus due to adhesive arachnoiditis is a rare occurrence. The last 20 patients of the present series have been treated with very low doses of AMCA associated with parotid kallikrein inhibitor (Trasylol); this dosage has been effective in preventing recurrence and has appeared to be freer from severe side effects.
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A series of controlled animal experiments comparing the effects of one, four, and 18 hours of local hypothermia at 6 degrees C begun four hours after compression lesions to the thoracic cord in dogs is reported. Four hours of local cooling delivered by a small silastic epidural heat exchanger, without durotomy or tissue perfusion, is shown to give greater functional benefit than cooling for one hour or 18 hours. Experimental design, pathophysiological implications, and clinical relevance are discussed.
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Comparative Study
Effect of dose and dose schedule on the response of intracranial pressure to mannitol.
Analysis of monitoring records of 150 patients given over 1000 infusions of 20% mannitol delineared three variables affecting the response of intracranial pressure (ICP) to mannitol: the original ICP; the current dose; and the dose given over the preceding three hours. The level of ICP influenced the response to mannitol as much as the amount of mannitol; giving more mannitol than was required to bring ICP below 25 mm Hg led to the need for larger following doses. One hundred-milliliter-bolus doses were often as effective as larger doses. The results suggest that doses of mannitol given to control increased ICP should be kept as small as possible.
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Randomized Controlled Trial Clinical Trial
Tranexamic acid in the preoperative management of ruptured intracranial aneurysms.
A randomized, controlled clinical trial was carried out to study the effect of tranexamic acid (AMCA, trans-AMCHA) in prevention of early rebleeding after proven rupture of an intracranial aneurysm. The series comprises 46 patients admitted to the hospital within three days after the first bleeding. ⋯ Nine patients in the control group and one in the group treated with tranexamic acid had confirmed rebleeding. The incidence of vasospasm, cerebral ischemia and hydrocephalus as well as mortality and morbidity is discussed.
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The effect of duration of acute compression of the spinal cord was assessed in a new model in the rat. The spinal cord was acutely compressed for varying times by a modified aneurysm clip which produced a compression force of 180 grams. ⋯ Thus, the clinical effect of acute compression of the spinal cord injury is inversely related to duration of compression time and the relationship has been precisely quantified. These results suggest that persisting compression should be relieved as soon as possible in order to improve recovery.