Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively

The late natural history of ruptured intracranial aneurysms was studied in 568 cases reported to the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage from 1958 to 1965. The patients had been selected for conservative management of their aneurysms at the time of diagnosis. A follow-up search in 1981 and 1982 revealed 378 known deaths; 40% had occurred within six months of hemorrhage. During the next two decades, the patients' survival probabilities were significantly worse than those of a matched US population. Multiple aneurysms did not differ prognostically from single aneurysms, but posterior circle aneurysms carried a better prognosis after ten-year survival. The rate of probable recurrent bleeding after six months was 2.2% per year for the first 9 1/2 years and 0.86% per year for the second decade. Reported rebleeding episodes were fatal in 78%.     

Ruptured intracranial aneurysms - clinical aspects of subarachnoid hemorrhage management and the International Subarachnoid Aneurysm Trial

The last 14 years has seen a revolution in the management of intracranial aneurysms; endovascular coil treatment has moved from a minority marginal treatment applicable to a few patients in a few centers to become the mainstay of treatment of ruptured intracranial aneurysms. This article highlights new information learned from the International Subarachnoid Aneurysm Trial.     

Exome sequencing in 38 patients with intracranial aneurysms and subarachnoid hemorrhage

Journal of Neurology - Genetic risk factors for unruptured intracranial aneurysms (UIA) and aneurysmal subarachnoid hemorrhage (aSAH) are poorly understood. We aimed to verify recently reported...     

Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage.

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. Most rebleeds occurred between the sixth and eleventh days following the initial bleed. 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.     

The 100 most influential publications pertaining to intracranial aneurysms and aneurysmal subarachnoid hemorrhage

The study of intracranial aneurysms has grown at an astounding rate since Sir Charles Symond’s association of hemorrhage within the subarachnoid space to intracranial aneurysms in 1923. These associations led to the first surgical treatment of an intracranial aneurysm with wrapping by Norman Dott in 1931, and shortly thereafter, clip ligation by Walter Dandy in 1938. Surgical outcomes were improved by the introduction of the operative microscope in the 1960s and perioperative care utilizing induced hypertension, hypovolemia, and hemodilution (“HHH therapy”). Recent monumental advancements, such as coil embolization in 1990 by Guglielmi, have continued to advance the field forward. The authors hope to highlight some of the most seminal and influential works. Herein, we utilize the technique of citation analysis to assemble a list of the 100 most influential works pertaining to aneurysmal subarachnoid hemorrhage published between the years 1900 and 2015 to honor these individuals and to provide guidance to current and future researchers in the field. We additionally calculate the effects of author, journal, topic, and study design on the overall influence of publications in this field.     

Health outcomes 1 year after subarachnoid hemorrhage: An international population-based study. The Australian Cooperative Research on Subarachnoid Hemorrhage Study Group

BACKGROUND: There is limited information about the long-term consequences of subarachnoid hemorrhage (SAH). METHODS: Data were obtained from a population-based study of aneurysmal SAH conducted in Australia and New Zealand between 1995 and 1998. The authors report health outcomes for survivors 1 year after the onset of SAH. RESULTS: From a total of 432 first-ever cases of SAH (76% due to confirmed cerebral aneurysm rupture) registered in four cities in Australia and New Zealand, 242 (56%) were alive approximately 1 year later (mean time 1.2 years), with 230 (95%) available for interview. Of those interviewed, 105 (46%) reported an incomplete recovery, with ongoing problems with memory (50%), mood (39%), speech (14%), and self-care (10%). Compared with age- and sex-adjusted Australian population norms, health-related quality of life, as determined by Short Form-36, was significantly lower for cases in the domains of role limitations that result from physical problems. However, there were no patient or disease characteristics that predicted complete recovery from SAH. CONCLUSIONS: A high proportion of long-term survivors of SAH experience ongoing deficits in high level (neuropsychological) functioning. These deficits result in impairment in social roles.     

动脉瘤性蛛网膜下腔出血并发心肌顿抑误诊一例

患者女,55岁,因突发倒于路边,呼之不应并呼吸困难3 h于2009年5月23日收入海口市人民医院ICU.患者咳大量粉红色泡沫样痰,查体:BP 70/50mm Hg,P 140次/min,R 35次/min,T 37.2℃,浅昏迷,双瞳3.0 mm,光反应(+),口唇紫绀,口腔、鼻腔粉红色泡沫样痰,心律齐,无杂音,双肺大量水泡音,四肢末端发绀湿冷,刺痛定位,肌张力、肌力正常,巴氏征(-),颈抗(+).     

多发动脉瘤并发蛛网膜下腔出血患者预后相关因素分析

目的 探讨多发动脉瘤(MIA)并发蛛网膜下腔出血(SAH)患者预后的影响因素. 方法 南方医科大学珠江医院神经外科自2000年1月至2011年1月共收治MIA并发SAH患者93例,分析其临床资料并对影响患者预后的因素进行单因素、多元线性回归分析. 结果 单因素分析结果显示患者性别、是否治疗及是否有高血压病史、Hunt-Hess分级、治疗方式对预后的影响具有统计学意义(P＜0.05);多元线性回归分析结果显示Hunt-Hess分级、治疗方式是影响MIA并发SAH患者预后的独立危险因素(P＜0.05). 结论 MIA并发SAH患者的预后受Hunt-Hess分级、治疗方式2个因素影响.早期对破裂动脉瘤判别并处理,对非破裂动脉瘤随访观察、适度干预,大多数患者都可获得满意的预后.     

三维CT血管造影术在急性蛛网膜下腔出血颅内动脉瘤诊断中的应用

目的探讨三维CT血管造影术（3D-CTA）在急性蛛网膜下腔出血（SAH）颅内动脉瘤诊断中的应用。方法采用3D-CTA和DSA对26例非外伤性SAH患者进行检查，3D-CTA通过最大密度投影（MIP）、表面遮盖法重建（SSD）和容积重建术（VRT）方法获得图像．根据3D-CTA和DSA所获得的关于动脉瘤的位置、大小等进行术前评估。结果在26例中24例3D-CTA检测出27个动脉瘤，瘤体直径3-2mm，1例后交通动脉瘤3D-CTA不能证实，1例未检出动脉瘤；14例行DSA检查，其中1例未检出动脉瘤而通过3D-CTA发现，1例右椎动脉梭形动脉瘤因DSA行右椎动脉造影失败而通过3D-CTA发现。12例仅凭3D-CTA手术，3D-CTA在检查动脉瘤的位置、大小、瘤体方向及对载瘤动脉和分支动脉的形态描述均优于DSA，它在诊断颅内动脉瘤的敏感性和特异性分别为96％和100％。结论3D-CTA是一种准确、价廉、非侵袭性的诊断颅内动脉瘤SAH的方法，在动脉瘤的急诊手术时较DSA更具优越性。     

Lobar intracerebral hemorrhage: etiology and a long-term follow-up study of 32 patients

Thirty-two patients with lobar hematoma were encountered during a period of six and a half years. Of these patients, 13 had arterial hypertension, 7 had other etiologies, and the remaining 12 were without apparent etiology. In 5 of these patients, cryptic angiomas were suspected from angiograms and CT scans. In one young patient, there was a later recurrence of hemorrhage that resulted in death. Our experience in this series and a review of the literature have led us to conclude that, in young normotensive patients with lobar hematoma, surgical intervention may be a reasonable consideration so that evacuation of the hematoma may be accomplished and a detailed search for small angiomatous malformations may be carried out with a view to preventing recurrences.