Articles: subarachnoid-hemorrhage.
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That blood in the subarachnoid space could possibly produce hydrocephalus was first suggested by Bagley in 1928 (3, 4). His conclusions were based on both experimental and clinical studies even though he actually failed to demonstrate a communicating hydrocephalus. ⋯ Recently neurosurgeons have become more aware of this pathological and clinical entity and have reported excellent results in patients treated soon after its recognition (5,9,16). We report a single case of post-subarachnoid haemorrhage hydrocephalus which we feel serves to emphasize the dramatic improvement which can follow treatment of the hydrocephalus.
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Journal of neurosurgery · Nov 1977
Case ReportsThe management of ruptured intracranial aneurysm in sickle cell anemia. Case report.
The problems of sickle cell disease and its complications is discussed. Subarachnoid hemorrhage is not a common complication of sickle cell disease and should be evaluated in the same way as if it were not associated with the disease. Patients with sickle cell trait have an added risk during angiography and hypotensive anesthesia. Guidlines are given for angiography and craniotomy with hypotensive anesthesia and reduction of brain volume in these patients.
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The problem of early differentiation of "traumatic tap" from subarachnoid hemorrhage (SAH) was studied in the rabbit by determining the changes in percentage of hemolysis and in lactate concentrations in CSF within the first twenty-four hours following induced SAH. The 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF). There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method.
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CT scans have been made on 39 of 41 patients who presented with subarachnoid hemorrhage. Blood could be visualized in the cisterns of 18 of 32 examinations performed within five days of the hemorrhage all having aneurysms. ⋯ Much other information was obtained, for instance about rebleeding and infarction. CT should routinely be the primary examination, followed by selective angiography.