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4 results

Ruptured Supratentorial Cerebral Artery Aneurysm with Large Intracerebral Haematoma

Ruptured Supratentorial Cerebral Artery Aneurysm with Large Intracerebral Haematoma
  • Samuel Hall, Diederik Bulters
  • Published online:
    01 December 2024
    Print publication:
    12 December 2024
    • Element
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  • The ruptured aneurysm with an intracerebral haematoma is a commonly encountered neurosurgical emergency. The options for management of this situation have evolved with the changes in neurovascular surgery training and widespread use of endovascular techniques for aneurysm occlusion. This Element will discuss the differences between subarachnoid haemorrhage with or without an intracerebral haematoma including presentation, imaging and outcomes. The authors present their preferred surgical strategy including practical guidance on how to handle difficult situations such as the intra-operative rupture.

  • Comorbidities and Medical Complications in Hospitalized Subarachnoid Hemorrhage Patients

  • Solon Schur, Dimitra Panagiotoglou, Salvatore Di Maio, David Buckeridge
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 49 / Issue 4 / July 2022
    Published online by Cambridge University Press:
    19 July 2021, pp. 569-578
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  • Background:

    Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with a case fatality of 36% at 30 days. Risk factors for mortality in SAH patients include patient demographics and the severity of the neurological injury. Pre-existing conditions and non-neurological medical complications occurring during the index hospitalization are also risk factors for mortality in SAH. The magnitude of the effect on mortality of pre-existing conditions and medical complications, however, is less well understood. In this study, we aim to determine the effect of pre-existing conditions and medical complications on SAH mortality.

    Methods:

    For a 25% random sample of the Greater Montreal Region, we used discharge abstracts, physician billings, and death certificate records, to identify adult patients with a new diagnosis of non-traumatic SAH who underwent cerebral angiography or surgical clipping of an aneurysm between 1997 and 2014.

    Results:

    The one-year mortality rate was 14.76% (94/637). Having ≥3 pre-existing conditions was associated with increased one-year mortality OR 3.74, 95% CI [1.25, 9.57]. Having 2, or ≥3 medical complications was associated with increased one-year mortality OR, 2.42 [95% CI 1.25–4.69] and OR, 2.69 [95% CI 1.43–5.07], respectively. Sepsis, respiratory failure, and cardiac arrhythmias were associated with increased one-year mortality. Having 1, 2, or ≥3 pre-existing conditions was associated with increased odds of having medical complications in hospital.

    Conclusions:

    Pre-existing conditions and in-hospital non-neurological medical complications are associated with increased one-year mortality in SAH. Pre-existing conditions are associated with increased medical complications.

  • Chapter 15 - Aneurysmal Subarachnoid Haemorrhage

  • from Part II - Neurosurgery-Specific Bioethics
  • Edited by Stephen Honeybul
  • Book:
    Ethics in Neurosurgical Practice
    Published online:
    29 May 2020
    Print publication:
    18 June 2020, pp 145-153

  • Summary

    Acute aneurysmal subarachnoid haemorrhage (aSAH) is associated with significant morbidity and mortality. The worldwide incidence is approximately 9 per 100,000 per year; however, there are regional differences. Accurate, timely diagnosis and treatment is imperative to avoid aneurysmal re-rupture, which has a mortality in the region of 80%. For patients that survive the initial aSAH, the re-rupture rate is approximately 5% in the first 24 hours and thereafter, approximately 1% per day. Patient outcome may be further compromised by complications such as seizures, cerebral vasospasm, cerebral infarction, electrolytes disturbances and hydrocephalus. Definitive treatment of patients admitted with acute aSAH is based on early exclusion of the aneurysm from the circulation in order to prevent rebleeding and for many years, the treatment of choice was an open craniotomy and surgical clipping of the aneurysm. However, over recent years the development of interventional neuroradiological techniques has provided alternative less invasive management options that raise a number of ethical issues that must be considered when faced with a patients with an acute aSAH.

  • Case 21 - Subarachnoidhemorrhage during aneurysm coiling

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 70-72

  • Summary

    Subarachnoid hemorrhage (SAH) is a complex disease with high morbidity and mortality. Management of patients with SAH requires a multisystem approach. This chapter presents a case study of a 45-year-old female who had presented to an outside hospital with a 1-month history of progressive right-sided facial and body numbness that had worsened acutely over the week prior to her admission. The patient underwent definitive correction of the aneurysm the following day. Aneurysmal SAH is a neurologic emergency, resulting from blood extravasation into the subarachnoid space normally filled with cerebrospinal fluid (CSF), that requires complex treatment and monitoring. Patients present for elective clipping of an unruptured aneurysm or emergent surgery following SAH. Thorough assessment of the patient, effective organ support and correction of pathophysiology are vital prior to leaving the intensive care unit (ICU) for what may be a challenging case in the operating room.