Articles: subarachnoid-hemorrhage.
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In this cooperative study among 13 institutions, 502 patients were treated with antifibrinolytic medication (epsilon-aminocaproic acid or tranexamic acid) within a 14-day period following rupture of an intracranial aneurysm. Mortality at the end of 14 days was 11.6%; proved rebleed rate was 12.7%. Patients with an internal carotid or anterior cerebral aneurysm had the highest mortality and rebleed rate. ⋯ Significantly higher mortality was reported among patients with cerebral vasospasm, yet rebleed rate was no different among those patients with or without vasospasm. The same pattern was observed among patients with a mean blood pressure value above and below 110 mm Hg. We conclude that antifibrinolytic therapy provides beneficial treatment to patients with recent onset subarachnoid hemorrhage (SAH) following rupture of an intracranial aneurysm.
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"Spontaneous intraspinal canal hematomas' are rare clinical conditions. These are classified as epidural, subdural and subarachnoid. Especially, subarachnoid hematoma is rare only two cases being reported by Bouzarth (1968). ⋯ Etiology of the legion was not identified. The patient made an uneventful recovery. This case suggests that intraspinal canal hematoma needs an operation as soon as possible, especially with urinary retention.
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Although recent advance in neurological surgery has diminished mortality rate of aneurysmal surgery, there still exist several complex problems for the management of aneurysms. Persistent neurological deficits or clinical deterioration after subarachnoid hemorrhage can result from subsequent communicating hydrocephalus which can be treated by shunting operation. We have studied alterations in the cerebrospinal fluid (CSF) circulation after SAH in 43 patients. ⋯ Shunt operation was performed on 10 cases according to the results of cisternography, transfer curve, pneumoencephalography, and angiography. Seven cases showed improvement and 2 died of other complications soon after the shunt, and the effect of the procedure cannot be evaluated. Patients with clinical signs of NPH and abnormal cisternogram (group I) with evidence of ventricular dilatation are indicated for shunting operation.