| Intracranial complications of hypervolemic therapy in patients with a delayed ischemic deficit attributed to vasospasm. | |
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MedLine Citation:
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PMID: 8433144 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This investigation has revealed the frequency of various intracranial complications that may result from hypervolemic therapy for a delayed ischemic deficit following subarachnoid hemorrhage (SAH). Among 323 patients with SAH, 112 patients developed a delayed ischemic deficit, 94 of whom underwent hypervolemic therapy. Infarction due to vasospasm was found ultimately in 43 of these 94 patients. Twenty-six patients (28%) developed an intracranial complication during hypervolemic therapy: cerebral edema was aggravated in 18, and a hemorrhagic infarction developed in eight. In 13 of 18 patients with aggravation of edema, delayed ischemic deficit developed within 6 days after the SAH; at that time, a massive new infarction was found in four and edema in 10 patients. After hypervolemic therapy, the 18 patients with aggravation of edema deteriorated rapidly, and 14 of them died. In every case in which hemorrhagic infarction followed hypervolemic therapy, a new infarct was found on computerized tomography (CT) when the delayed ischemic deficit became apparent. Hemorrhagic infarction developed as the delayed ischemic deficit resolved, with one exception. In patients who sustained no complication from hypervolemia, the incidence of both massive new infarction and edema at the time when the delayed ischemic deficit was manifested was only 1%. In 44 of 68 patients who sustained no complication from hypervolemia, the delayed ischemic deficit was manifested on or after the 7th day following the SAH. This study suggests that hypervolemic therapy is contraindicated in a patient who is found to have a massive abnormality on CT at the time when a delayed ischemic deficit is manifested, especially when it occurs within 6 days after the SAH. To avoid hemorrhagic infarction, it is important to discontinue hypervolemic therapy as soon as the delayed ischemic deficit resolves. |
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Authors:
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M Shimoda; S Oda; R Tsugane; O Sato |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of neurosurgery Volume: 78 ISSN: 0022-3085 ISO Abbreviation: J. Neurosurg. Publication Date: 1993 Mar |
Date Detail:
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Created Date: 1993-03-17 Completed Date: 1993-03-17 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 423-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Volume* Brain Concussion / etiology Brain Diseases / etiology*, radiography Brain Edema / etiology Female Fluid Therapy* Humans Ischemic Attack, Transient / etiology, radiography, therapy* Male Middle Aged Postoperative Complications Subarachnoid Hemorrhage / complications* Tomography, X-Ray Computed |
| Comments/Corrections | |
Comment In:
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J Neurosurg. 1993 Oct;79(4):638
[PMID:
8410241
]
J Neurosurg. 1993 Nov;79(5):798-800 [PMID: 8410266 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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