Purpose—The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods—A formal literature s...

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

(1991). Applied Linear Regression Models. Journal of Quality Technology: Vol. 23, No. 1, pp. 76-77.

Applied Linear Regression Models

State-Trait Anxiety Inventoryによるペインクリニック外来患者の不安の評価

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)60439-5.pdf

Wilson's Disease

Rupture of an intracranial aneurysm is the leading cause of subarachnoid hemorrhage not due to trauma. This review summarizes both the approach to establishing the diagnosis and treatment options, including the placement of intravascular coils to arrest the bleeding. Common management problems include vasospasm, hydrocephalus, and rebleeding.

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Aneurysmal subarachnoid hemorrhage.

Background and Purpose— Thick cisternal clot on CT is a well-recognized risk factor for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). Whether intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) predisposes to DCI is unclear. The Fisher CT grading scale identifies thick SAH but does not separately account for IVH or ICH. Methods— We studied 276 consecutively admitted patients with an available admission CT scan performed within 72 hours of onset. Demographic, clinical, laboratory, and neuroimaging data were recorded, and the amount and location of SAH, IVH, and ICH on admission CT scans were quantified. The relationship between these variables and DCI was analyzed separately and in combination with multiple logistic regression. Results— DCI developed in 20% of patients (54 of 276). Among SAH variables, thick clot completely filling any cistern or fissure was the best predictor of DCI (P=0.008), and among IVH variables, blood in both lateral ventricles was most predict...

Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Fisher Scale Revisited

Background— Cognitive dysfunction is a common and disabling sequela of subarachnoid hemorrhage (SAH). Although several clinical and radiographic findings have been implicated in the pathogenesis of cognitive dysfunction after SAH, few prospective studies have comprehensively and simultaneously evaluated these risk factors. Methods— Between July 1996 and March 2000, we prospectively evaluated 113 of 248 consecutively admitted nontraumatic SAH patients alive at 3 months with a comprehensive neuropsychological evaluation. Summary scores for 8 cognitive domains were calculated to express test performance relative to the entire study population. Clinical and radiographic variables associated with domain-specific cognitive dysfunction were identified with forward stepwise multiple regression, with control for the influence of demographic factors. Results— The study participants were younger (P=0.005), less often white (P=0.006), and had better 3-month modified Rankin scores (P=0.001) than those who did not unde...

Predictors of Cognitive Dysfunction After Subarachnoid Hemorrhage

Background: Cognitive dysfunction is the most common form of neurologic impairment after subarachnoid hemorrhage (SAH). Objective: To evaluate the impact of global and domain-specific cognitive impairment on functional recovery and quality of life (QOL) after SAH. Methods: One hundred thirteen patients (mean age 49 years; 68% women) were evaluated 3 months after SAH. Three simple tests of global mental status and neuropsychological tests to assess seven specific cognitive domains were administered. Four aspects of outcome (global handicap, disability, emotional status, and QOL) were compared between cognitively impaired and unimpaired patients with analysis-of-covariance models controlling for age, race/ethnicity, and education. Multiple linear regression was used to evaluate the relative contribution of global and domain-specific cognitive status for predicting concurrent modified Rankin Scale (mRS) and Sickness Impact Profile (SIP) scores. Results: Impairment of global mental status on the Telephone Interview of Cognitive Status (TICS) was associated with poor performance in all seven cognitive domains (all p p ≤ 0.005). Cognitive impairment in four specific domains was also associated with functional disability or reduced QOL. After accounting for global cognitive impairment with the TICS, however, neuropsychological testing did not contribute additional predictive value for concurrent mRS or SIP total scores. Conclusions: Cognitive impairment impacts broadly on functional status, emotional health, and QOL after SAH. The TICS may be a useful alternative to more detailed neuropsychological testing for detecting clinically relevant global cognitive impairment after SAH.

Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage

ContextMortality and morbidity can be reduced if aneurysmal subarachnoid hemorrhage
(SAH) is treated urgently.ObjectiveTo determine the association of initial misdiagnosis and outcome after
SAH.Design, Setting, and ParticipantsInception cohort of 482 SAH patients admitted to a tertiary care urban
hospital between August 1996 and August 2001.Main Outcome MeasuresMisdiagnosis was defined as failure to correctly diagnose SAH at a patient's
initial contact with a medical professional. Functional outcome was assessed
at 3 and 12 months with the modified Rankin Scale; quality of life (QOL),
with the Sickness Impact Profile.ResultsFifty-six patients (12%) were initially misdiagnosed, including 42 of
221 (19%) of those with normal mental status at first contact. Migraine or
tension headache (36%) was the most common incorrect diagnosis, and failure
to obtain a computed tomography (CT) scan was the most common diagnostic error
(73%). Neurologic complications occurred in 22 patients (39%) before they
were correctly diagnosed, including 12 patients (21%) who experienced rebleeding.
Normal mental status, small SAH volume, and right-sided aneurysm location
were independently associated with misdiagnosis. Among patients with normal
mental status at first contact, misdiagnosis was associated with worse QOL
at 3 months and an increased risk of death or severe disability at 12 months.ConclusionsIn this study, misdiagnosis of SAH occurred in 12% of patients and was
associated with a smaller hemorrhage and normal mental status. Among individuals
who initially present in good condition, misdiagnosis is associated with increased
mortality and morbidity. A low threshold for CT scanning of patients with
mild symptoms that are suggestive of SAH may reduce the frequency of misdiagnosis.

/pdf/initial-misdiagnosis-and-outcome-after-subarachnoid-4qpg76m04l.pdf

Initial Misdiagnosis and Outcome After Subarachnoid Hemorrhage

P103 Background: Hemicraniectomy and durotomy has been shown to be a promising treatment for malignant MCA infarction, but has not been evaluated for cerebral hemorrhage. Methods: We analyzed the clinical course and outcome of 15 patients treated with decompressive surgery for space-occupying cerebral hematomas between 9/98 and 6/00. All patients were treated with duroplasty and either hemicraniectomy (n=13) or a “floating” bone flap (n=2); in some patients, hematoma (n=5) and subdural clot (n=2) evacuation was also performed. Outcomes were assessed by telephone interview using the modified Rankin scale (mRS). Results: Mean age was 49 years (range 33–66); 8 were women; the lesion was left-sided in 7. Hematoma formation was related to spontaneous aneurysmal rupture (n=7), intra-operative aneurysmal rupture (n=3), hypertensive intracerebral hemorrhage (n= 3), and hemorrhagic infarction (n=2). Surgery was peformed Conclusion: Duroplasty and hemicraniectomy, with or without concurrent hematoma evacuation, may improve survival and recovery in comatose patients with large aneurysmal, hypertensive, or infarct-related cerebral hemorrhages.

Joseph E Bates

Papers

Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Fisher Scale Revisited

Predictors of Cognitive Dysfunction After Subarachnoid Hemorrhage

Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage

Initial Misdiagnosis and Outcome After Subarachnoid Hemorrhage

Decompressive Hemicraniectomy for Massive Cerebral Hemorrhage