Among a series of 224 patients with aneurysmal subarachnoid haemorrhage (SAH) admitted over a period of three years, 52 patients were prospectively treated with intrathecal tissue plasminogen activator (rTPA). All of these patients were admitted and operated on within 72 h after SAH. SAH was confirmed by CT scan and the volume of blood accumulated in the basal cisterns was graded according to Fisher's scale. All patients had a SAH according to Fisher's grade III, as a prerequisite for inclusion into the study. In 21 patients additional intraventricular bleeding was detectable on CT scan. The diagnosis of a single intracerebral aneurysm as the bleeding source was established by pan-angiography, which also excluded additional cerebro-vascular malformations. The control group consisted of 68 patients, which were also treated within 72 h after SAH. Age and sex distribution as well as the clinical patterns were comparable to the rTPA group. In all patients the aneurysm was clipped using standard microsurgical techniques. After the aneurysm had been excluded from the parent vessel, 10 mg of rTPA, dissolved in 10 ml of its solution fluid, were slowly instilled into the basal cisterns in the treatment group. In patients with additional severe intraventricular bleeding, 5-10 mg of rTPA were injected into the ventricles via an intraventricular catheter at the end of the operation. Apart from the intrathecal application of the thrombolytic substance, the surgical protocol was identical in the patients of the control group. During the postoperative period, the patients in both groups were examined neurologically and by transcranial Doppler on a daily basis.(ABSTRACT TRUNCATED AT 250 WORDS)
Unexpected subarachnoid hemorrhage with a fatal outcome was seen in two patients in intensive care in association with trauma and an intracranial inflammatory abscess. The cause of SAH was disclosed at autopsy: traumatic and bacterial aneurysms of the basilar artery respectively. In the reported cases the symptoms of SAH did not suggest an origin.
We report on 146 patients with spontaneous intracerebral hemorrhage treated in the period between 1984 and 1988. The aim of this retrospective study was to point out factors for operative respectively conservative treatment. Looking for etiology, age, unconsciousness, localization and extension of hematoma as well as bleeding into the ventricles our results showed that patients over 70 years of age and/or in coma III and IV (Brussels Coma Scale) have a bad prognosis as well as patients with intraventricular bleeding. Patients seem to benefit from operation if hematoma is located in the hemisphere or cerebellar and the extension ranges from 3 to 5 cm.
In order to better define patients who might benefit from cerebral revascularization surgery, transcranial Doppler sonography was used in more than 480 patients. Thus invasive diagnostic studies could be limited to probable surgical candidates. Transcranial Doppler sonography has proven to be reliable for the study of the degree of efficacy of intracranial collateral pathways in hemodynamic borderline situations. Over the last 4 years, the application of the algorithm presented in this paper resulted in a reduction of the number of candidates for surgical revascularization to 19.
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