No shinkei geka. Neurological surgery
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A series of 610 patients who had aneurysm surgery within 7 days of the hemorrhage were analyzed as to the relationship between the preoperative Glasgow Coma Scale (GCS) score and the outcome assessed by using the Glasgow Outcome Scale (GOS) at 6 months after surgery. The patient distribution in accordance with the GCS scores in descending order from 15 to 3 was as follows: 265, 109, 44, 24, 17, 20, 25, 15, 18, 12, 16, 23, and 22 cases, respectively. In general, the larger the GCS score, the better the outcome. ⋯ As for demarcation levels along the GCS axis in terms of the GOS, a significant difference in the outcome was observed at the level of GCS scores between 15 and 14 (P < 0.0001, Wilcoxon test). However, no borderlines were evident at any GCS levels other than 15/14. The problems of applying the GCS to the grading system of aneurysmal subarachnoid hemorrhage are discussed.
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The microscopic appearance of a rat spinal cord which was acutely compressed by aneurysmal clip for one minute, was investigated 15 minutes, 30 minutes, 1 hour, 3 hours and 6 hours after the injury. Although the resulting small hemorrhagic lesion involved primarily only the central gray matter of the injured portion 15 minutes after compression injury, hemorrhage, necrosis and edema in the central gray matter enlarged progressively until 3 hours after injury. Petechial hemorrhage, necrosis and edema were observed in the surrounding area one hour after spinal compression. ⋯ Pathological findings (hemorrhage necrosis and edema) extend more prominently to the rostral side, because the direction of spinal blood flow may be rostral in the thoracic spinal cord. C. Severe disturbance of intraspinal capillary blood flow leading to grave spinal damage may be evoked, because leukocytes infiltrate into the capillary around the injured area and plug up the their lumen about 30 minutes after the injury.