Document Detail

Management of poor-grade patients with ruptured intracranial aneurysm.
MedLine Citation:
PMID:  9212589     Owner:  NLM     Status:  MEDLINE    
To formulate treatment strategies for poor-grade patients after aneurysmal subarachnoid hemorrhage (SAH), medical records were analyzed for 166 patients who were in Hunt and Hess Grade IV or V among 588 consecutive cases with ruptured intracranial aneurysm admitted during the past 5 years. Causes of unfavorable outcome (poor or dead) in those 166 patients were evaluated to improve the management outcome. Overall management results of the 166 poor-grade patients were favorable (good or fair) in 71 (42.8%), unfavorable in 95 (78 dead, 17 poor). Direct clipping was performed in 90 patients, and the results were favorable in 69 (76.7%) and unfavorable in 21 (23.3%). Surgery was not done in 76 patients because 41 were moribund on arrival, 15 deterioration due to rebleeding, 7 severe brain swelling, 5 serious medical illness, one severe delayed ischemic deficit (DID), and one cerebral infarction following angiography, and 6 refused surgery. Seven patients survived in non-surgery group (2 fair, 5 poor). Direct effects of aneurysm rupture (34.8%) and early rebleeding (34.8%) were the major causes of unfavorable outcome in Grade IV patients, while it was direct effect of aneurysm rupture (91.8%) in Grade V patients. It is suggested that as rebleeding is the only preventable cause of unfavorable outcome, urgent management is necessary to prevent rebleeding, especially for Grade IV patients. Grade IV patients should be treated aggressively with direct clipping for non-complex aneurysms or for patients with hematoma, and coil embolization for complex aneurysms without hematoma.
K C Lee; S K Huh; H S Park; Y S Shin; K S Lee
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Keio journal of medicine     Volume:  46     ISSN:  0022-9717     ISO Abbreviation:  Keio J Med     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-08-21     Completed Date:  1997-08-21     Revised Date:  2008-08-07    
Medline Journal Info:
Nlm Unique ID:  0376354     Medline TA:  Keio J Med     Country:  JAPAN    
Other Details:
Languages:  eng     Pagination:  69-73     Citation Subset:  IM    
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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MeSH Terms
Aneurysm, Ruptured / complications,  therapy*
Intracranial Aneurysm / complications,  therapy*
Retrospective Studies
Subarachnoid Hemorrhage / etiology,  therapy*
Treatment Outcome

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