Spontaneous subarachnoid hemorrhage (SAH) is asso ciated with high morbidity and mortality. Primary con servative or preoperative management in the intensive care unit aims at prevention, early detection, and treat ment of complications. In this article we review the literature on the value of initial clinical and laboratory findings in predicting complications and outcome after SAH. Current conservative management of SAH is briefly discussed.
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References
1.
Pakarinen S.Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage. Acta Neurol Scand1967; 43(suppl): 1-128
2.
Ljunggren B. , Saeveland H., Brandt L., Uski T.Aneurysmal subarachnoid hemorrage. Total annual outcome in a 1.46 million population. Surg Neurol1984;22:435-438
3.
Heros RC, Zervas NT, Varsos V.Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann Neurol1983; 4: 599-608
4.
Kassell NF, Torner JCThe International Cooperative Study on the Timing of Aneurysm Surgery—an update. Stroke1984; 15: 566-570
5.
Locksley HBReport on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg1966;25:321-368
Drake CGManagement of cerebral aneurysm. Stroke1981 ; 12: 273-283
8.
Torner JC, Nibbelink DW, Burmeister LFStatistical comparison of end results of a randomized treatment study . In: Sahs AL, Nibbelink DW, Torner JC, eds. Aneurysmal subarachnoid hemorrhage. Report of the Cooperative Study . Baltimore: Urban & Schwarzenberg , 1981:249-273
9.
Locksley HBReport on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, part I. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations . J Neurosurg1966; 25: 219-239
10.
Alvord EC Jr, Loeser JD, Bailey WL, Copass MKSubarachnoid hemorrhage due to ruptured aneurysms. Arch Neurol1972; 27: 273-284
11.
Alvord EC Jr, Thorn RBNatural history of subarachnoid hemorrhage: early prognosis. Clin Neurosurg1977;24:167-175
12.
Phillips LH , Whisnant JP, O'Fallon WM, Sundt TMThe unchanging pattern of subarachnoid hemorrhage in a community. Neurology1980;30:1034-1040
13.
Richardson AE, Jane JA, Payne PMAssessment of the natural history of anterior communicating aneurysms. J Neurosurg1964; 21: 266-274
14.
Richardson AE, Jane JA, Yashon D.Prognostic factors in the untreated course of posterior communicating aneurysms. Arch Neurol1966; 14: 172-176
15.
Richardson AE, Jane JA, Payne PMThe prediction of morbidity and mortality in anterior communicating aneurysms treated by proximal anterior cerebral ligation. J Neurosurg1966; 25: 280-283
Davis JM, Davis KR, Crowell RMSubarachnoid hemorrhage secondary to ruptured intracranial aneurysm: prognostic significance of cranial CT. AJR1980; 134: 711-715
18.
Fisher CM, Kistler JP, Davis JMRelation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery1980;6:1-9
19.
Gurusinghe NT, Richardson AEThe value of computerized tomography in aneurysmal subarachnoid hemorrhage. J Neurosurg1984;60:763-770
20.
Kistler JP, Crowell RM, Davis KR, et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology1983;33:424-436
21.
Mizukami M. , Takemae T., Tazawa T., et al. Value of computed tomography in the prediction of cerebral vasospasm after aneurysm rupture . Neurosurgery1980;7:583-586
22.
Mohsen F., Pomonis S., Illingworth R Prediction of delayed cerebral ischemia after subarachnoid hemorrhage by computed tomography. J Neurol Neurosurg Psychiatry1984; 47: 1197-1202
23.
Sano H., Kanno T., Shinomiya Y., et al. Prospection of chronic vasospasm by CT findings. Acta Neurochir (Wien)1982; 63: 23-30
24.
Tazawa T., Mizukami M., Kawase T., et al. Relationship between contrast enhancement on computed tomography and cerebral vasospasm in patients with subarachnoid hemorrhage. Neurosurgery1983;12:643-648
25.
Sahs AL, Nishioka H., Torner JC, et al. Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: a long-term prognostic study. I. Introduction. Arch Neurol1984; 41: 1140-1141
26.
Riegelman RKStudying a study and testing a test. Boston: Little, Brown, 1981: 203-208
27.
Maurice-Williams RSRuptured intracranial aneurysms: has the incidence of early rebleeding been overestimated?J Neurol Neurosurg Psychiatry1982; 45: 774-779
28.
Vermeulen M. , van Gijn J., Hijdra A., van Crewel H.Causes of acute deterioration in patients with a ruptured intracranial aneurysm. J Neurosurg1984;60:935-939
29.
Richardson AEThe natural history of patients with intracranial aneurysm after rupture. Progr Brain Res1968 ; 30: 269-273
30.
Ropper AH, Zervas NTOutcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients. J Neurosurg1984;60:909-915
31.
Kaste M., Troupp H.Subarachnoid hemorrhage: long-term follow-up results of late surgical versus conservative treatment. Br Med J1978 ; 1: 1310-1311
32.
Nishioka H. , Torner JC, Graf CJ, et al. Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively. Arch Neurol1984;41:1142-1146
33.
Winn HR, Richardson AE, Jane JALate morbidity and mortality in cerebral aneurysms: a ten-year follow-up of 364 conservatively treated patients with a single cerebral aneurysm. Trans Am Neurol Assoc1973;98:148-150
34.
Winn HR, Richardson AE, Jane JAThe long-term prognosis in untreated cerebral aneurysms: I. The incidence of late hemorrhage in cerebral aneurysm: a ten-year evaluation of 364 patients . Ann Neurol1977; 1: 358-370
35.
Graf CJ, Nibbelink DWCooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Report on a randomized treatment study. III. Intracranial surgery. Stroke1974; 5: 557-601
36.
Torner JC, Kassell NF, Wallace RB, Adams HP Jr.Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study. Neurosurgery1981; 9: 506-513
Perret G., Nishioka H.Report on the Cooperative Study on Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VII. Arteriovenous malformations. J Neurosurg1966; 25: 467-490
VanGijn J, van Dongen Kj, Vermeulen M, Hijdra A. Perimesencephalic hemorrhage: a non-aneurysmal and benign form of subarachnoid hemorrhage. Neurology1985; 35: 493-497
41.
Graf CJ, Perret GE, Torner JCBleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg1983; 58: 331-337
42.
Hart RG, Byer JA, Slaughter JR, et al. The occurrence and implications of seizures in subarachnoid hemorrhage due to ruptured intracranial aneurysms. Neurosurgery1981;8:417-421
Höök O.Subarachnoid haemorrhage. Prognosis when angiography reveals no aneurysm. A report of 138 cases. Acta Med Scand1958 ;162:493-503
45.
Adams HP Jr, Kassell NF, Torner JC, Sahs ALCT and clinical correlations in recent aneurysmal subarachnoid hemorrhage: a preliminary report of the Cooperative Aneurysm Study. Neurology1983;33:981-988
46.
Mohr G., Ferguson G., Khan M., et al. Intraventricular hemorrhage from ruptured aneurysm. J Neurosurg1983; 58: 482-487
47.
Drake CGCerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg1979; 26: 145-208
48.
VanGijn J, van Dongen KJ. Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography. Neurology1980; 30: 538-539
49.
Forster Dmc , Steiner L., Hakanson S., Bergvall U.The value of repeat pan-angiography in cases of unexplained subarachnoid hemorrhage . J Neurosurg1978; 48: 712-716
50.
Locksley HB , Sahs AL, Knowler L.Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg1966;24:922-932
51.
Pelletieri L.Surgical versus conservative management of intracranial arteriovenous malformations: a study in surgical decision-making . Acta Neurochir (Wien)1980;29 (suppl):1-86
52.
Eskesen V., Sörensen EB, Rosenörn J., Schmidt K.The prognosis in subarachnoid hemorrhage of unknown etiology. J Neurosurg1984; 61: 1029-1031
53.
Shephard RHPrognosis of spontaneous (non-traumatic) subarachnoid haemorrhage of unknown cause. Lancet1984; 1: 777-778
54.
Tappura M.Prognosis of subarachnoid haemorrhage. Acta Med Scand1962;392(suppl):1-75
55.
Fox JLIntracranial aneurysms. Vol 3. Appendix I. New York: Springer-Verlag, 1983:1103-1112
56.
Lindsay KW, Teasdale GM, Knill-Jones RP, Murray L.Assessment of the consequences of subarachnoid haemorrhage. Acta Neurochir (Wien)1982;63:59-64
57.
Adams HP Jr, Kassell NF, Torner JCUsefulness of computed tomography in predicting outcome after aneurysmal subarachnoid hemorrhage: a preliminary report of the Cooperative Aneurysm Study. Neurology1985;35:1263-1267
58.
Nishioka H.Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VII, part I. Evaluation of the conservative management of ruptured intracranial aneurysms. J Neurosurg1966;25:574-592
59.
Pollack SL, Paddison RMPrognosis in subarachnoid hemorrhage. Ann Intern Med1960;52:1088-1098
60.
Nibbelink DW , Torner JC, Henderson WGCooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage—report on a randomized treatment study. IV—A. Regulated bed rest. Stroke1977 ; 8: 202-218
61.
Troupp H., af Björkesten G.Results of a controlled trial of late surgical versus conservative treatment of intracranial arterial aneurysms. J Neurosurg1971; 35: 20-24
62.
McKissock W. , Paine Kwe, Walsh LSAn analysis of the results of treatment of ruptured intracranial aneurysms. Report of 722 cases . J Neurosurg1960;17:762-776
63.
Henderson WG , Torner JC, Nibbelink DWIntracranial aneurysms and subarachnoid hemorrhage—report on a randomized treatment study. IV—B. Regulated bed rest— statistical evaluation. Stroke1977;8:579-589
Fisher CM, Roberson GH, Ojemann RGCerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations . Neurosurgery1977;1:245-248
66.
Griffith HB , Cummins BH, Thomson Jlg.Cerebral arterial spasm and hydrocephalus in leaking arterial aneurysms. Neuroradiology1972; 4: 212-214
67.
Yasargil MG , Yonekawa Y., Zumstein B., Stahl H-J.Hydrocephalus following spontaneous subarachnoid hemorrhage. Clinical features and treatment . J Neurosurg1973;39:474-479
68.
Keller AZHypertension, age and residence in the survival with subarachnoid hemorrhage . Am J Epidemiol1970; 91:139-147
69.
McCormick WF , Schmalstieg EJThe relationship of arterial hypertension to intracranial aneurysms. Arch Neurol1977 ; 34:285-287
70.
Ostergaard JR, Höög E.Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg1985;63:49-55
71.
Kassell NF, Adams HP Jr, Torner JC, Sahs ALInfluence of timing of admission after aneurysmal subarachnoid hemorrhage on overall outcome. Report of the Cooperative Aneurysm Study. Stroke1981;12:620-623
72.
Davis KR, New Pfj, Ojemann RG, et al. Computed tomographic evaluation of hemorrhage secondary to intracranial aneurysm. AJR1976;27:143-153
73.
Van Gijn J. , van Dongen KJThe time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology1982 ;23:153-156
74.
Inoue Y., Saiwai S., Miyamoto T., et al. Postcontrast computed tomography in subarachnoid hemorrhage from ruptured aneurysms. J Comput Assist Tomogr1981;5:341-344
75.
Weisberg LARuptured aneurysms of anterior cerebral or anterior communicating arteries: CT patterns. Neurology1985;35:1562-1566
76.
Yeh HS, Tomsick TA, Tew JMIntraventricular hemorrhage due to aneurysms of the distal posterior inferior cerebellar artery. J Neurosurg1985;62:772-775
77.
Van Gilder JC , Torner JCSubarachnoid hemorrhage: patients with severe neurologic deficit. In: Sahs AL , Nibbelink DW, Torner JC, eds. Aneurysmal subarachnoid hemorrhage. Report of the Cooperative Study. Baltimore: Urban & Schwarzenberg , 1981:349-362
78.
Botterell EH , Lougheed WM, Scott JW, Vandewater SLHypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg1956;13:1-42
79.
Doczi T., Ambrose J., O'Laoire S.Significance of contrast enhancement in cranial computed tomography after subarachnoid hemorrhage. J Neurosurg1984;60:335-342
80.
Menon D., Weir B., Overton T.Ventricular size and cerebral blood flow following subarachnoid hemorrhage . J Comput Assist Tomogr1981;5:328-333
81.
Saito I., Ueda Y., Sano K.Significance of vasospasm in the treatment of ruptured intracranial aneurysms . J Neurosurg1977;47:412-429
82.
Weir B., Grace M., Hansen J., Rothberg C.Time course of vasospasm in man. J Neurosurg1978;48:173-178
83.
Winn HR, Almaani WS, Berga SL, et al. The long-term outcome in patients with multiple aneurysms. J Neurosurg1983;59:642-651
84.
Byer E., Ashman R., Toth LAElectrocardiograms with large upright T waves and long Q-T. Am Heart J1947;33:796-806
85.
Cruickshank JM, Neil-Dwyer G., Bryce J.Electrocardiographic changes and their prognostic significance in subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry1974;37:755-759
86.
Melin J., Fogelholm R.Electrocardiographic findings in subarachnoid hemorrhage. Acta Med Scand1983;213:5-8
87.
Page A., Boulard G., Guerin J.Anomalies electrocardiographiques au coeurs des hémorragies sous-arachnoidiennes . Arch Mal Coeur1983;9:1031-1038
88.
Stober T., Kunze K.Electrocardiographic alterations in subarachnoid haemorrhage. J Neurol1982;227:99-113
89.
Estanol BV, Marin Osm.Cardiac arrhythmias and sudden death in subarachnoid hemorrhage. Stroke1975;6:382-386
90.
Sen S., Stober T., Burger L., et al. Häufigkeit von Kammerarrhythmien in Abhängigkeit vom QT-Intervall bei spontanen intrakraniellen Blutungen. Dtsch Med Wschr1984; 109:817-820
91.
Vidal BE, Dergal EB, Cesarman E., et al. Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery1979;5:675-680
92.
Benedict CR , Loach ABClinical significance of plasma adrenaline and noradrenaline concentrations in patients with subarachnoid haemorrhage. J. Neurol Neurosurg Psychiatry1978;41:113-117
93.
Neil-Dwyer G., Cruickshank J., Stott A., Brice J.The urinary catecholamine and plasma cortisol levels in patients with subarachnoid haemorrhage. J Neurol Sci1974;22:375-382
94.
Doshi R., Neil-Dwyer G.A clinicopathological study of patients following a subarachnoid hemorrhage . J Neurosurg1980;52:295-301
Weintraub BM , McHenry LCJr. Cardiac abnormalities in subarachnoid hemorrhage: a resume. Stroke1974;5:384-392
97.
Wilkins RHHypothalamic dysfunction and intracranial arterial spasms. Surg Neurol1975;4:472-480
98.
Neil-Dwyer G., Cruickshank J.The blood leucocyte count and its prognostic significance in subarachnoid haemorrhage. Brain1974;97:79-86
99.
Parkinson D. , Stephensen S.Leukocytosis and subarachnoid hemorrhage . Surg Neurol1984;21:132-134
100.
Wijdicks Efm , Vermeulen M., ten Haaf JA, et al. Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol1985;18:211-216
101.
Doczi T., Bende J., Huszka E., Kiss J.Syndrome of inappropriate secretion of antidiuretic hormone after subarachnoid hemorrhage. Neurosurgery1981 ;9:394-397
102.
Wijdicks Efm , Vermeulen M., Hijdra A., van Gijn J.Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful? Ann Neurol1985;137-140
103.
Takaku A., Shindo K., Tanaka S., et al. Fluid and electrolyte disturbances in patients with intracranial aneurysms. Surg Neurol1979;11:349-356
104.
Voldby B., Enevoldsen EMIntracranial pressure changes following aneurysm rupture. Part I: clinical and angiographic correlations. J Neurosurg1982;56:186-196
105.
Aaslid R., Nornes H.Musical murmurs in human cerebral arteries after subarachnoid hemorrhage . J Neurosurg1984;60:32-36
106.
Aaslid R., Huber P., Nornes H.Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound . J Neurosurg1984;60:37-41
107.
Fox JE, Williams B.Central conduction time following surgery for cerebral aneurysm. J Neurol Neurosurg Psychiatry1984;47:873-875
108.
Wang AD, Cone J., Symon L., Costa e Silva IE. Somatosensory evoked potential monitoring during the management of aneurysmal SAH. J Neurosurg1984;60:264-268
109.
Geraud G., Tremoulet M., Guell A., Bes A.The prognostic value of noninvasive CBF measurement in subarachnoid hemorrhage . Stroke1984;15:301-305
110.
Mickey B., Vorstrup S., Voldby B., et al. Serial measurement of regional cerebral blood flow in patients with SAH using 133 Xe inhalation and emission computerized tomography. J Neurosurg1984;60:916-922
111.
Hayashi M. , Kobayashi H., Kawano H., et al. ICP patterns and isotope cisternography in patients with communicating hydrocephalus following rupture of intracranial aneurysm. J Neurosurg1985;62:220-226
112.
Hijdra A., Vermeulen M., van Gijn J., van Crewel H.Respiratory arrest in subarachnoid hemorrhage. Neurology1984;34:1501-1503
113.
Weir BKPulmonary edema following fatal aneurysm rupture. J Neurosurg1978;49:502-507
114.
Kassell NF , Peerless SJ, Durward QJ, et al. Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension . Neurosurgery1982;11:337-343
115.
Pritz, MB, Giannotta SL, Kindt GW, et al. Treatment of patients with neurological deficits associated with cerebral vasospasm by intravascular volume expansion. Neurosurgery1978;3:364-368
116.
Kistler JPManagement of subarachnoid hemorrhage from ruptured saccular aneurysm . In: Ropper AH, Kennedy SK, Zervas NT, eds. Neurological and neurosurgical intensive care. Baltimore : University Park Press, 1983:175-187
117.
Koos WT, Perneczky A., Auer LM, et al. Nimodipine treatment of ischemic neurological deficits due to cerebral vasospasm after subarachnoid hemorrhage. Neurochirurgia (Stuttg)1985;28:114-117
118.
Rockoff MA, Ropper AHTreatment of intracranial hypertension. In: Ropper AH, Kennedy SK, Zervas NT, eds. Neurological and neurosurgical intensive care. Baltimore: University Park Press, 1983:21-37
119.
Kassell NF, Peerless SJ, Drake CJ, Adams HP Jr. High dose barbiturate therapy for cerebral vasospasm: preliminary results. In: Wilkins RH, ed. Cerebral arterial spasm. Proceedings of the second international workshop . Baltimore: Williams and Wilkins , 1980:628-633
120.
Kusske JA, Turner PT, Ojemann GA, Harris ABVentriculostomy for the treatment of acute hydrocephalus following subarachnoid hemorrhage. J Neurosurg1973;38: 591-594
121.
Vassilouthis J., Richardson AEVentricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg1979;51:341-351
122.
Kase CS, Williams JP, Wyatt DA, Mohr JPLobar intracerebral hematomas: clinical and CT analysis of 22 cases . Neurology1982;32:1146-1150
Wheelock B. , Weir B., Watts R., et al. Timing of surgery for intracerebral hematomas due to aneurysm rupture. J Neurosurg1983;58:476-481
125.
Ropper AH, King RBIntracranial pressure monitoring in comatose patients with cerebral hemorrhage . Arch Neurol1984;41:725-728
126.
Allen GS, Ahn HS, Preziosi TJ, et al. Cerebral arterial spasm—a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N. Engl J Med1983;308:619-624
127.
Auer LMAcute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery1984;15:57-66
128.
Ljunggren B., Brandt L., Saeveland H., et al. Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg1984;61:864-873
129.
Neil-Dwyer G., Walter P., Cruickshank JM, et al. Effect of propanolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J1978;2:990-992
130.
Walter P., Neil-Dwyer G. Cruickshank JMBeneficial effects of adrenergic blockade in patients with subarachnoid haemorrhage . Br Med J1982;284:1661-1664
131.
Kassell NF, Torner JC, Adams HP Jr.Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage. Preliminary observations from the Cooperative Aneurysm Study. J Neurosurg1984;61:225-230
132.
Vermeulen M. , Lindsay KW, Murray GD, et al. Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med1984;311:432-437
133.
Thie A., Spitzer K., Kunze K.Spontaneous subarachnoid hemorrhage: a microcomputer-based expert system for decision support of best therapy. Neurology1985;35 (suppl)1:187
134.
Sahs AL, Perret GE, Locksley HB, Nishioka H, eds. Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Philadelphia : JB Lippincott, 1969
135.
Svien HJ, McRae JAArteriovenous anomalies of the brain. Fate of patients not having definitive surgery. J Neurosurg1965;23:23-28
136.
Turnbull IWComputed tomographic pointers to the prognosis of subarachnoid haemorrhage. Br J Radiol1980 ; 53:416-420
137.
Hunt WE, Hess RMSurgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg1968:28:14-20