No abstract available.
Diagnosis* ; Ischemia* ; Subarachnoid Hemorrhage*

No abstract available.
Latex* ; Polystyrenes* ; Potassium Channels* ; Potassium* ; Vasospasm, Intracranial*

No abstract available.
Bacteremia* ; Staphylococcus aureus* ; Staphylococcus*

The authors recently reported that over the years, the outcome of aneurysm surgery improved, and that surgical complications importantly affected this change. The present study was conducted to determine whether the incidence of symptomatic vasospasm in fact changed during the period under review, and the factors contributing to any changes. Between 1990 and 1995, 219 Hunt-Hess grade I to III patients with ruptured intracranial aneurysm underwent surgery within 3 days of subarachnoid hemorrhage ; all operations were performed by the same surgeon. Age, Hunt-Hess grade on admission, Fisher grade, hypertension, and hydrocephalus were analyzed to determine which factors were significant for syptomatic vasospasm, and for the periods 1990 to 1993, and 1994 to 1995, the distribution of each significant factor was then examined. Syptomatic vasospasm decreased significantly (p<0.05), but was seen in 28 of 124 patients(22.6%) treated beween 1990 and 1993 and 11 of 95(11.6%) treated between 1994 and 1995 ; no significant reduction of syptomatic vasospasm as a cause of mortality and morbidity (irreversible vasospasm) was seen, however, Fisher grade(p<0.05) and Hunt-Hess grade(p<0.05) significantly contributed to the development of symptomatic vasospasm, though the distribution of these two biologically significant factors was not statistically different. The question of whether or not surgery aggravates symptomatic vasospasm is controversial, and symptomatic vasospasm is, in addition, still an ill-defined disease entity. Except for the occurrence of fewer surgical complication and the fact that the incidence of reversible symptomatic vasospasm was less during the second period of treatment, no differences were found in the distribution of factors which significantly influenced symptomatic vasospasm, and this suggests that surgery affects the development of reversible symptomatic vasospasm. On the basis of increased risk of cerebral ischemia associated with surgery in vulnerable ischemic brain resulting from subarachnoid hemorrhage, the use of the term 'delayed ischemic neurologic deficit' after such hemorrhage appears to be more suitable than 'symptomatic vasospasm'.
Aneurysm* ; Brain ; Brain Ischemia ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm ; Mortality ; Neurologic Manifestations* ; Subarachnoid Hemorrhage

A case of isolated dissecting aneurysm of the posterior cerebral artery responsible for ischemic episode and subarachnoid hemorrhage is reported. Angiogram showed a fusiform dilatation of the P1-P2 segment of the right posterior cerebral artery. The dissecting aneurysm was disappeared spontaneously on follow-up angiogram. It is recommended that, in a subset of neurologically stable patient who represents fusiform dilatation angiographically, angiographic monitoring should be undertaken to assess the tendency for spontaneous resolution before planning of surgical intervention.
Aneurysm, Dissecting* ; Dilatation ; Follow-Up Studies ; Humans ; Posterior Cerebral Artery* ; Subarachnoid Hemorrhage

No abstract available.
Conus Snail* ; Foramen Magnum* ; Syringomyelia*

BACKGROUND: Postoperative triple H therapy is regarded as a mainstay for prophylaxis and treatment of delayed ischemic neurologic deficit (DIND) after subarachnoid hemorrhage (SAH). However, there are doubts about its effectiveness. This study was performed to assess hypervolemic dynamic fluid therapy in patients with ruptured cerebral aneurysms. METHODS: The authors retrospectively studied a total of 393 patients with ruptured cerebral aneurysms, consisting of early surgery with or without intraoperative ventriculostomy during a recent 5 year period (July 1998~June 2003). Hypervolemic dynamic fluid therapy was initiated postoperatively in patients with DIND. Since January 2001, however, patients were maintained in normovolemia and normotension, and when DIND had manifested, low molecular weight dextran was only added. The incidence of DIND and outcome according to Glasgow Outcome Scale at 6 months of the normovolemic group were compared with the hypervolemic group. All patients were followed for at least 14 days after the admission including clinical assessment, TCD recording, CT scanning, CVP measurements, and nimodipine infusion. RESULTS: Subjects in the two treatment groups were similar with regard to age, sex, Fisher grade, Hunt-Hess grade, aneurysm location, and aneurysm size. No differences were found between the two groups regarding the incidence of DIND (29/182: 15.9% vs 29/211: 13.7%). Surgical outcome in the normovolemic group (good, 171/211: 81.0%) was comparable to the hypervolemic group (good, 154/182: 84.6%). CONCLUSIONS: Although careful fluid management to avoid hypovolemia may reduce the risk of DIND after SAH, prophylactic hypervolemic dynamic fluid therapy is unlikely to confer an additional benefit.
Aneurysm ; Dextrans ; Fluid Therapy ; Glasgow Outcome Scale ; Humans ; Hypovolemia ; Incidence ; Intracranial Aneurysm* ; Molecular Weight ; Neurologic Manifestations ; Nimodipine ; Retrospective Studies ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed ; Ventriculostomy

This report describes five cases of cerebrospinal fluid(CSF) rhinorrhea which were caused by head injury in four cases and developed after surgical removal of brain tumor in one case. Intrathecally-enhanced brain computerized tomography(CT) with metrizamide, in addition to isotope cisternography, was helpful in localization of the CSF leakage site. All five cases which could not be managed conservatively were successfully repaired by surgical means using biological fibrin glue.
Brain ; Brain Neoplasms ; Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Craniocerebral Trauma ; Fibrin Tissue Adhesive ; Metrizamide

OBJECTIVE: We recently reported six patients with unilateral visual loss that developed immediately after cerebral aneurysm surgery. This was found to be due to retinal ischemia. PATIENTS AND METHODS: To investigate whether or not this rare occurrence results from focal compression on the ipsilateral globe due to a scalp flap retraction, the authors checked changes of orbital pressure indirectly before and after the flap retraction in seven consecutive aneurysm patients and repeated the measurement in six other patients protected with an eye shield. In addition we have used an eye protector during aneurysm surgery over a next three-year period to determine whether or not an eye shield can prevent this problem. RESULTS: The authors confirmed elevation of indirect intraorbital pressure whenever the flap was retracted, but there was no pressure elevation in the study using an eye shield. In parallel we have not experienced any visual complications since this maneuver. CONCLUSIONS: We think that inadvertent pressure placed on the eyeball with a retracted scalp flap might provoke intraocular and/or retinal ischemia resulting in visual failure after intracranial aneurysm surgery in patients with any conditions that induce marginally ischemic retina.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Ischemia ; Orbit ; Retina ; Retinaldehyde ; Scalp*

No abstract available.
Peptic Ulcer*