Acute management of poor condition subarachnoid hemorrhage patients

  • 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.

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Metadaten
Author:Eleftherios Archavlis, Mario N. Carvi y Nievas
URN:urn:nbn:de:hebis:30:3-256511
DOI:https://doi.org/10.2147/VHRM.S
ISSN:1178-2048
ISSN:1176-6344
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/18200827
Parent Title (English):Vascular health and risk management
Publisher:Dove Medical Press
Place of publication:Albany, Auckland
Document Type:Article
Language:English
Date of Publication (online):2012/08/15
Year of first Publication:2007
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2012/08/15
Tag:poor condition subarachnoid hemorrhage
Volume:3
Issue:6
Page Number:8
First Page:1075
Last Page:1082
HeBIS-PPN:357884205
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell 3.0