Published online before print June 14, 2007, doi: 10.1161/STROKEAHA.107.488338
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(Stroke. 2007;38:2217.)
© 2007 American Heart Association, Inc.
Editorials |
Prognostic Factors and Targets for Intervention After Subarachnoid Hemorrhage
From the Division of Neurosurgery, The University of British Columbia, Vancouver, BC, Canada.
Correspondence to Dr Gary J. Redekop MD, MSc, FRCSC, Head, Division of Neurosurgery, The University of British Columbia, 3100-910 West 10th Avenue, Vancouver, BC, Canada, V5Z 4E3. E-mail gary.redekop@ubc.ca
Key Words: aneurysm • outcomes • subarachnoid hemorrhage
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
See related article, pages 2315–2321.
Aneurysmal subarachnoid hemorrhage is associated with a high risk of morbidity and mortality. Treatment requires early aneurysm repair to prevent catastrophic rebleeding and intensive medical care to manage associated problems including hydrocephalus, cerebral vasospasm, electrolyte disorders, infection, and seizures. Prognosis after SAH is determined in part by factors that are present from the outset and not modifiable, but recent evidence suggests potential opportunities to improve outcomes.
Rosengart et al1 analyzed a large series of patients with ruptured aneurysms and determined that the most important factors leading to unfavorable outcome were cerebral infarction, worse clinical grade on admission, advanced age, fever, and symptomatic vasospasm. Other significant variables were greater clot thickness on admission CT scan, posterior circulation aneurysms, large aneurysms, intraventricular or intracerebral hemorrhage, anticonvulsant use, and not using hypertensive hypervolemic therapy.
This analysis expands on previous studies using multivariable analysis to determine prognostic factors in SAH,2–4 and has the advantage of a large patient population treated with more contemporary medical management. However, the patients studied were enrolled in 4 randomized trials of tirilazad mesylate in aneurysmal subarachnoid hemorrhage,5–8 and therefore represent a selected population. Exclusion criteria included severe concomitant medical or neurological illness, uncontrolled hypertension, recent myocardial infarction, congestive heart failure, and patients taking corticosteroids or calcium antagonists other than nimodipine. Most important, patients whose aneurysms were repaired with endovascular techniques were also excluded.
The superiority of endovascular treatment over clipping for ruptured aneurysms suitable for either approach9 has led to marked changes in
Related Article:
Stroke 2007 38: 2315-2321.