TY  - JOUR
A1  - Archavlis, Eleftherios
A1  - Carvi y Nievas, Mario N.
T1  - Acute management of poor condition subarachnoid hemorrhage patients
T2  - Vascular health and risk management
N2  - Poor condition subarachnoid hemorrhage (SAH) patients present a high mortality and morbidity. In this study, we reviewed the acute interventional (surgical and endovascular) management of 109 SAH-poor condition patients, who were treated as early as logistically possible after confirming stable circulation parameters. Patients over the age of 70 years, without clinical response to painful stimulation were excluded. We recognized at least 3 different postinterventional therapeutic approaches: (1) Norm- or hypovolemic, normotensive hemodilution in 30 patients with space-occupying intracranial hematomas as well as in 31 cases with acute cerebro-spinal-fluid obstruction. (2) Normovolemic, hypertensive hemodilution after unilateral decompressive craniotomy in 23 surgical- and 2 endovascular-treated patients with focalized space occupying lesions and reduced cerebral perfusion. (3) Hypovolemic, normo-, or hypertensive hemodilution after bilateral decompressive craniotomy in 23 cases with massive brain-swelling. We observed a reduced mortality (21%). The overall late outcome was favorable in 56% and unfavorable in 23%. Selective aggressive treatment adapted to increase the cerebral perfusion, seems to be an effective therapy to improve the survival and outcome of several poor condition SAH-patients.
KW  - poor condition subarachnoid hemorrhage
Y1  - 2012
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/25651
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-256511
SN  - 1178-2048
SN  - 1176-6344
VL  - 3
IS  - 6
SP  - 1075
EP  - 1082
PB  - Dove Medical Press
CY  - Albany, Auckland
ER  -