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At least 19 recordsLinked to original sources
PubMed2026

Safety of early discharge and abbreviated nimodipine course in patients with good-grade aneurysmal subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating cerebrovascular emergency associated with substantial morbidity and mortality. Current guidelines recommend 14-21 days of inpatient monitoring and a 21-day course of nimodipine following aSAH. This retrospective study evaluates early outcomes early discharge (≤14 days post-ictus) and an abbreviated nimodipine course in highly selected patients with good-grade aSAH managed under a standardized institutional protocol. Consecutive patients enrolled in the Vancouver Ruptured Aneurysm Database (VRAD) at Vancouver General Hospital between 2022 and 2025 were included. Inclusion criteria were good-grade aSAH (WFNS Grade I-III) and discharge home within 14 days of ictus. The primary outcome was re-presentation to emergency care within 30 days of discharge; secondary outcomes included hospital readmission and need for additional treatment. Of 333 total patients in VRAD, 49 patients met inclusion criteria. All patients received ≤ 14 days of nimodipine therapy. Forty-two patients (85.7%) were WFNS Grade I on presentation, 3 (6.1%) were WFNS Grade II, and 4 (8.2%) were WFNS Grade III. Radiographic vasospasm was reported in 18 cases (36.7%). No patients developed DCI or clinical vasospasm. Four patients (8.2%) re-presented to emergency care within 30 days of discharge, and only one patient (2%) required hospital re-admission within 30 days. While radiographic vasospasm was seen in over one third of patients, none developed clinical sequelae, supporting the premise that radiographic vasospasm alone may be insufficient to preclude early discharge in select good-grade patients.

Humans↗
PubMed1979

[Vitreous hemorrhage as a complication of subarachnoid hemorrhage (Terson's syndrome) (author's transl)].

We represent a case of vitreous hemorrhage due to subarachnoid hemorrhage from a ruptured aneurysm of the right vertebral artery to draw attention to this complication. A 53-year-old man was admitted to our hospital because of generalized headache and reduced visual acuity of both eyes. On admission the patient was alert and there were moderate nuchal stiffness and mild symmetrical hyperreflexia in the extremities. Ophthalmological consultation revealed bilateral retinal, subhyaloid and vitreous hemorrhages. Four-vessel angiography demonstrated an aneurysm of the right vertebral artery. At operation, it became clear that the aneurysm was a dissecting one. The vertebral artery was clipped at the most proximal intracranial portion. Postoperative course was smooth and uneventful except deteriorated visual acuity. His visual acuity deteriorated continuously to hand movements 18 days after subarachnoid hemorrhage. His visual acuity, however, gradually improved without specific treatment. At the time of this writing, his visual acuity is 1.0 on both sides. Vitreous hemorrhage is a rare complication following a reptured aneurysm. Pertinent literature concerning fundal hemorrhage, especially vitreous hemorrhage, associated with subarachnoid hemorrhage suggests that it may occur as a result of sudden increase of intracranial pressure.

Eye Diseases↗
PubMed1979

Subarachnoid hemorrhage.

Spontaneous subarachnoid hemorrhage is most frequently caused by rupture of an aneurysm or arteriovenous malformation. Early clinical diagnosis is important to avert fatal hemorrhage. Surgical treatment should be carried out in patients in good neurologic condition.

Adolescent↗
PubMed1979

[Spontaneous spinal subarachnoidal hemorrhages].

Spontaneous spinal subarachnoidal hemorrhages were diagnosed in 15 patients. Of these in 12 cases the diagnosis of the underlying disease was established. The main symptom of spontaneous subarachnoidal hemorrhages (SSH) is shown by the appearance of acute spinal pain, followed by meningeal and mild general cerebral disorders. Eventually most of the patients develop focal spinal symptoms. Depending upon the combinations and succession of these symptoms 4 clinical variants of SSH were distinguished. Appropriate evaluation of the anamnestic and clinical data, with the use of lumbar punctures, allows a correct diagnosis, although in an atypical development it may cause certain difficulties.

Adolescent↗
PubMed1978

[Correlation of vasospasm and intracranial metabolism under experimental subarachnoid hemorrhage--Part 1. In reference with the acid-base-balance of cerebral blood and cerebrospinal fluid].

Cerebral vasospasm, cerebral metabolism and the acid-base-balance of blood and cerebrospinal fluid of dogs were studied during and after the experimental subarachnoid hemorrhage. Subarachnoid hemorrhage was induced by infusion of fresh blood into the basal cistern through a small sraniectomy in the base of the skull. Eighty adult mongrel dogs were used. Of these a complete recording was obtained in 32 cases under the constant controlled ventilation. The samples of the blood and cerebrospinal fluid (CSF) were obtained repeatedly at the inserted 1 to 3 hours from the Polyethylene tube inserted into the cisterna magna subarachnoid space, carotid artery and internal jugular vein. During these procedures, the luminal size of the intracranial basal artery was measured angiographically. Vasoconstriction of the cerebral arteries in response to experimental subarachnoid hemorrhage had a biphasic course, an acute phase (the vasoconstrictive phenomenon which lasts less than 6 hours) and chronic phase (the revasoconstriction occured and continued more than 24 hours after the hemorrhage). The former was named "Released Group" which consists of 16 dogs and the later was named "Prolonged Group" which consists of 20 dogs. In both group, pH and bicarbonate ion concentration of CSF were found to be reduced by twenty percent of the normal value on the aveaage about three hours after subarachnoid hemorrage, apparently reflecting occurence of early cerebral vasospasm. Remarkable metabolic acidosis was seen in CSF of the prolonged group as compared with in cerebral blood. The occurrence of A-V shunt was suggested in the cerebral circulation from the blood gas findings. The experimental results indicates that prolonged cerebral vasospams phenomenon causes persistent hypoxic state in the cerebral tissue. However, cellular metabolism of cerebral tissue will be probably maintained by oxygen supply necessary to cellular respiration through the blood-brain barrier from the cerebrospinal fluid.

Acid-Base Equilibrium↗
PubMedDate not supplied

Sympathetic nervous system activity in patients with subarachnoid hemorrhage.

In patients with subarachnoid hemorrhage there were increased concentrations of plasma epinephrine and norepinephrine when compared with those concentrations in a group of patients admitted to hospital with other illness. Reassessment after a variable period showed that in patients whose eventual clinical result was poor the plasma epinephrine and norepinephrine concentrations increased further while in those with a good result those concentrations showed a decline. No such changes were evident in plasma dopamine-beta-hydroxylase activities which were within normal range. In a sub-group of patients who had neurosurgery after admission for clipping an aneurysm, the post-operative changes of plasma epinephrine and norepinephrine concentrations were related to the clinical condition of the patients.

Adolescent↗
PubMed1978

Subarachnoid hemorrhage due to intraspinal tumors.

Five cases of subarachnoid hemorrhage arising from an intraspinal tumor are presented, Three of these were ependymomas in the region of the cauda equina. One was a neurofibroma at L1. The fifth was a hemangioblastoma in the upper lumbar region. The literature dealing with subarachnoid hemorrhage due to intraspinal lesions is reviewed. The majority of cases of spinal subarachnoid hemorrhage are due to arteriovenous malformations, but 50 cases in which the bleeding developed from a neoplasm have been reported.

Adolescent↗
PubMed1977

[Changes in cardiac activity in the acute period of subarachnoid hemorrhage].

In the acute phase of subarachnoidal hemorrhages which was seen in 32 patients the author studied changes in the cardiac activity and phasic structures of cardiac contraction. The studies were supplemented by electrocardiographic and polycardiographic methods permitting to determined separate phases of cardiac contraction and quantitatively characterize the contracting function of the myocardium. In 21 patients according to the EGC data there were changes in the cardiac activity. It is assumed that the main role in the development of such changes during subarachnoidal hemorrhages belongs to diencephalic brain structures, the changed function of which lead to distrubances of central regulation of the heart activity.

Adult↗
PubMed1978

Subarachnoid hemorrhage in children.

45 cases of subarachnoid hemorrhage in children were surveyed. 73 percent of the causes were arteriovenous malformations and spontaneous intracerebral hematomata. Arteriovenous malformations in children may grow in size which may be due to the fact that besides the nidus demonstrated by angiography there are surrounding abnormal vascular groups, the reserved nidus. If one fails to extirpate this reserve nidus at the time of surgical excision of the arteriovenous malformation, it may become nidus several years later and may bleed again. The follow-up results of surgery in subarachnoid hemorrhage cases were fairly good.

Adolescent↗
PubMed1977

Subarachnoid hemorrhage following intranasal procedures.

Two cases of subarachnoid hemorrhage complicating intranasal ethmoidectomy are presented. In both, the bleeding was initally considered coincidental to the rupture of a congenital aneurysm or an arteriovenous malformation. A direct relationship between the surgical procedure and the subarachnoid hemorrhage only became evident after extensive studies or after delayed development of CSF rhinorrhea, pneumocephalus and meningitis.

Adult↗
PubMed1979

Computed tomography in aneurysmal subarachnoid hemorrhage.

Among 50 patients with subarachnoid hemorrhage (SAH) from aneurysm, computed tomography (CT) demonstrated evidence of bleeding in 28. In 12 cases, the location and configuration of the high-density blood cast visualized by CT was characteristic and predicted the site of the ruptured aneurysm. CT was reliable in identifying infarction, edema, localized hematoma, hydrocephalus, or rebleeding in patients with SAH and neurologic abnormalities. In four cases, the plain and contrast CT suggested a large intracranial aneurysm. These findings did not permit definitive diagnosis or precise anatomic detail of angiographically defined aneurysms less than 2.0 cm in size.

Brain Edema↗
PubMed1979

Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage.

Ventricular dilatation following spontaneous subarachnoid hemorrhage (SAH) is a well recognized phenomenon. Its clinical significance, however, remains controversial. Two phases are distinguished, the acute or early, occurring soon after the ictus, and the chronic or late, developing after the second week. The authors studied the ventricular size in 210 patients with spontaneous SAH through the course of their illness and convalescence by means of serial computerized tomography (CT) scans. Their findings suggest that ventricular dilatation soon after SAH is not always clinically significant and does not necessarily require shunting before definitive surgery. Delayed symptomatic ventricular enlargement (communicating hydrocephalus) occurs in 7% of the patients and can be safely diagnosed on the basis of the clinical picture and CT scan appearances. Treatment with a ventricular shunting system is almost invariably rewarding.

Cerebral Ventricles↗
PubMed1979

Computer tomography as the primary radiologic procedure in acute subarachnoid hemorrhage.

CT was performed in 149 patients with acute subarachnoid hemorrhage and clinical findings consistent with an aneurysm rupture, and was found informative in most cases when performed within one week after the hemorrhage. CT disclosed in 29 per cent of cases other causes for the hemorrhage than a ruptured aneurysm (intracerebral hemorrhage, tumor, trauma, infarct) and an extensive angiographic evaluation could be omitted. In those patients where the hemorrhage was caused by an aneurysm rupture, the distribution of extravasated blood in the subarachnoid space and the brain parenchyma usually indicated the aneurysm location--angiography could thus be restricted to the proper vessel. These capabilities of CT are sufficient to economically motivate its routine use as the primary investigation in cases with an acute subarachnoid hemorrhage.

Acute Disease↗
PubMed1979

Prinzmetal's variant angina associated with subarachnoid hemorrhage: A case report.

Prinzmetal's variant of angina occurred in a 48-year-old man who sustained two attacks of subarachnoid hemorrhage within 10 days. The first anginal pain started at the same time that the second cerebrovascular accident developed, but subsequent anginal episodes were not accompanied by other symptoms or signs that indicated new development of subarachnoid hemorrhage. Twelve days later, when nuchal rigidity was fairly improved, the episodes of chest pain ended. A vasospasm of the large coronary arteries--probably due to the derangement of the autonomic nervous system caused by subarachnoid hemorrhage--was presumed to contribute to the occurrence of the variant angina. Based on this case and on review of the literature, we propose that coronary arterial spasm is one of several causes of the cardiac changes seen in subarachnoid hemorrhage.

Angina Pectoris↗
PubMed2026

Timing of aneurysm repair and clinical outcomes after aneurysmal subarachnoid hemorrhage: a systematic review.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) causes substantial morbidity and mortality, and guidelines recommend aneurysm repair as early as feasible. However, the association between onset-to-treatment time and outcomes remains uncertain. This review synthesized evidence across multiple clinical outcomes and examined whether treatment modality modifies this association. METHODS: Searches were conducted in PubMed/MEDLINE, Scopus, and LILACS for studies comparing clinical outcomes across different onset-to-treatment windows in adults with confirmed aSAH. Findings were synthesized narratively according to the Synthesis Without Meta-analysis (SWiM) guideline. The review was prospectively registered in PROSPERO (CRD420261415084). RESULTS: Twenty reports comprising 11,096 participant records were included, with likely overlap between two reports. Treatment categories ranged from <6&#xa0;h to &#x2265;15&#xa0;days. Earlier securement likely reduced pretreatment rebleeding, particularly when untreated or markedly delayed patients were included, although treated-cohort comparisons were inconsistent. More methodologically informative adjusted analyses showed no reproducible independent association between treatment timing and functional outcome or mortality. No consistent association emerged for vasospasm or related cerebral ischemia, hydrocephalus, or length of stay. Two observational studies modeled time continuously: one found a significant U-shaped mortality association with an estimated nadir at 32.6&#xa0;h, whereas the other showed a similar but non-significant adjusted pattern with an estimated nadir near 12.16&#xa0;h. These findings are highly susceptible to confounding by indication and survivor bias and do not establish benefit from treatment delay. Three studies formally tested modality-timing interaction; one found a significant mortality interaction and two did not. Additional stratified analyses showed no consistent modality-specific pattern. Certainty of evidence for the timing-mortality association was very low because of serious risk of bias, inconsistency, and imprecision. CONCLUSION: Earlier aneurysm securement remains supported for preventing pretreatment rebleeding. The independent association of treatment timing with mortality or functional outcome remains uncertain. The observed mortality patterns are hypothesis-generating and do not define a validated therapeutic window, support intentional treatment delay, or justify changing current guideline recommendations. Prospective multicenter studies using continuous-time modeling and rigorous methods to address confounding and survivor bias are needed.

Humans↗
PubMed1979

[Role of the barrier system of the cerebral membranes in subarachnoid hemorrhage].

On the basis of literary and his own data the author distinguishes 3 stages of subarachnoidal hemorrhage, each having its own specific pathophysiological and pathomorphological features. The extracerebral barrier system can be divided into 3 structural and functional groups, such as: a) barriers between the cerebrospinal liquor and the blood; b) barriers between the liquor and the border tissues, and c) histohematic barriers. In the conditions of subarachnoidal hemorrhage accompanied with development of arterial spasm one observes disturbances of the liquor microcirculation because of blood clotting in the liquor and sticking of the blood clots in various parts of the subarachnoidal space, as well as changes in the ultrastructure of the morphological substrate of the extracerebral barrier system. All this, in the author's opinion, leads to damaging the innervation apparatus elements and smooth muscle cells of the cerebral arteries and arterioles; promotes the development of cerebral edema, etc. The data obtained make it possible to evaluate the role of the extracerebral barrier system of the meninges in cases of subarachnoidal hemorrhage with accompanying arterial spasm.

Animals↗