Case-Fatality Rates and Functional Outcome After Subarachnoid Hemorrhage

Hop, Jeannette W.; Rinkel, Gabriël J.E.; Algra, Ale; Gijn, J. van

doi:10.1161/01.str.28.3.660

Cited by 989 publications

(563 citation statements)

References 37 publications

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“…1 Patients who reach the hospital alive may already be in a poor clinical condition from the initial bleeding and are at risk of complications such as rebleeding, secondary ischemia, and systemic complications. 2,3 Prevention of aneurysmal rupture therefore seems an attractive option, but surgical or endovascular occlusion of intracranial aneurysms themselves carry a risk of serious complications.…”

Section: Discussionmentioning

confidence: 99%

“…28 The reported case fatality rates after SAH vary from 21% to 44%. 2,3 We assumed a case fatality rate of 35%, that 9% who survived their bleed became permanently severely disabled, and that 15% became mildly dis-abled. 2,3 The proportion of patients with SAH who died before receiving medical attention was assumed to be 12%.…”

Section: Methods Model Structurementioning

confidence: 99%

“…2,3 We assumed a case fatality rate of 35%, that 9% who survived their bleed became permanently severely disabled, and that 15% became mildly dis-abled. 2,3 The proportion of patients with SAH who died before receiving medical attention was assumed to be 12%. 1 Patients who survived their bleed and were left disabled experience excess mortality compared with the general population.…”

Section: Methods Model Structurementioning

confidence: 99%

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Cost-effectiveness of preventive treatment of intracranial aneurysms

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Methods Model Structurementioning

confidence: 99%

Section: Methods Model Structurementioning

confidence: 99%

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Cost-effectiveness of preventive treatment of intracranial aneurysms

et al. 2009

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“…Pacijenti sa Hunt-Hess gradus I i II krvarenja na prijemu, koji su mladi, imaju dobru prognozu, dok stariji pacijenti sa Hunt-Hess gradus III i IV pri prijemu imaju veoma lošu prognozu. Generalno, oko 2/3 pacijenata ima lošu prognozu, odnosno smrtni ishod ili trajni neurološki ispad [1,7,8].…”

Section: Uvodunclassified

“…Najznačajnija i najopasnija posljedica prisustva aneurizme na krvnim sudovima mozga je pucanje (ruptura) njenog zida i krvarenje [8,9]. Aneurizme se klasifikuju prema veličini i obliku.…”

Section: Diskusijaunclassified

Gigantska aneurizma unutrašnje karotidne arterije, mogućnosti liječenja u zavisnosti od operativnog rizika

Ivanišević¹,

Saratlić

Maric

et al. 2017

Biomedicinska istraž.

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Kratak sadržajUvod. Intrakranijalne aneurizme se definišu kao gigantske ako su veće od 25 mm i rijetke su intrakranijalne lezije. Obično se manifestuju znacima subarahnoidalnog krvarenja, ili kompresivnim "mass" efektom kao tumor, epileptičnim napadom ili znacima tromboembolije. Nakon dijagnostike, kompujuterizovane tomografije i magnetne rezonance (MRI) mozga i angiografske dijagnostike, postavljaju se indikacije za mikrovaskularni kliping ili endovaskularni tretman. Opisan je slučaj 78 godina stare bolesnice sa gigantskom aneurizmom unutrašnje karotidne arterije (ACI).Prikaz bolesnika. Žena stara 78 godina, prvi put u životu je dobila epileptični napad. Pacijentkinja je srčani bolesnik sa istorijom masivnog dijafragmalnog infarkta koji je imala prije tri mjeseca. Nakon urađenog MRI mozga i MRI angiografije dokazano je postojanje gigantske aneurizme ACI desno. S obzirom na kardijalni status i visok rizik za bilo koju vrstu intervencije, odlučili smo se na konzervativni tretman uz praćenja, kontrolu krvnog pritiska, i redovnu internističku terapiju, odgovarajući režim ishrane i antiepileptičnu terapiju, te kontrolnu MRI angiografiju za 6 mjeseci.Zaključak. Uprkos prikazanim velikim serijama i analizama nije donesen konsenzus o riziku i ishodu poslije hirurškog klipinga aneurizme ili endovaskularne procedure koji se statistički ne razlikuje značajno. Samo u posebnim slučajevima, kada je rizik za bilo koji tretman gigantske nerupturirane aneurizme visok (godine starosti, kardijalni status), a uz činjenicu da je njihova sklonost rupturi mala, treba se odlučiti na praćenje uz prevenciju drugih negativnih faktora.Ključne riječi: gigantske aneurizme, krvni sudovi mozga, hiruško liječenje, endovaskularne procedure

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Predictors and Impact of Aneurysm Rebleeding After Subarachnoid Hemorrhage

et al. 2005

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Background: Aneurysm rebleeding has historically been an important cause of mortality after subarachnoid hemorrhage (SAH). Objective: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, which emphasizes early surgical or endovascular treatment. Design: Inception cohort. Setting: Tertiary care medical center. Patients: A total of 574 patients enrolled in the Columbia University SAH Outcomes Project between August 1996 and June 2002. Early aneurysm repair was performed whenever feasible. Main Outcome Measures: Rebleeding was defined by prespecified clinical and radiographic criteria, excluding prehospital, intraprocedural, and postrepair events. Functional outcome was assessed at 3 months with the modified Rankin Scale. Multiple logistic regression was used to identify predictors of rebleeding, poor functional outcome, and mortality. Results: Rebleeding occurred in 40 (6.9%) of the 574 patients; most cases (73%) occurred within 3 days of ictus. Hunt-Hess grade on admission (odds ratio [OR], 1.92 per grade; 95% confidence interval [CI], 1.33-2.75; PϽ.001) and maximal aneurysm diameter (OR, 1.07/ mm; 95% CI, 1.01-1.13; P=.005) were independent predictors of rebleeding. After controlling for Hunt-Hess grade and aneurysm size, rebleeding was associated with a markedly reduced chance of survival with functional independence (modified Rankin Scale score, Յ4; OR, 0.08; 95% CI, 0.02-0.34) at 3 months. Conclusions: Despite an aggressive management strategy, rebleeding still occurred in 6.9% of patients and was associated with a dismal outcome. Poor Hunt-Hess grade and larger aneurysm size are related to rebleeding. Pharmacologic therapy to reduce the risk of rebleeding before aneurysm repair, particularly in patients with poor grade neurologic status and large aneurysms, deserves renewed attention.

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Case-Fatality Rates and Functional Outcome After Subarachnoid Hemorrhage

Abstract: The case-fatality rate after subarachnoid hemorrhage has decreased during the last three decades. A plausible explanation for this decrease is the improved management of patients with subarachnoid hemorrhage.

Cited by 989 publications

References 37 publications

Cost-effectiveness of preventive treatment of intracranial aneurysms

Cost-effectiveness of preventive treatment of intracranial aneurysms

Gigantska aneurizma unutrašnje karotidne arterije, mogućnosti liječenja u zavisnosti od operativnog rizika

Predictors and Impact of Aneurysm Rebleeding After Subarachnoid Hemorrhage

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