Traumatic Subarachnoid Haemorrhage

ISBN-13: 9783540607717 / Angielski / Miękka / 1996 / 109 str.

A. Kakarieka;Kakarieka; Algirdas Kakarieka

Opis

In the last few decades an abundance of publications have accumu lated on the clinical implications of subarachnoid haemorrhage (SAH) due to aneurysmal rupture. In contrast, until about 6 years ago, SAH due to traumatic head injury mainly, if not only, drew the attention of the forensic pathologist. In their analysis of the data from the American Traumatic Coma Data Bank, Eisenberg et al. concluded in 1990 that the presence of SAH on the initial computed tomographic scan (tSAH) had an un favourable effect on outcome. This conclusion has since been con firmed in other series. Dr. Kakarieka, the author of the present monograph, has been fascinated by tSAH since his participation in 1989 as International Trial Coordinator of the large European Trial on the effect of nimodipine on outcome after severe injury (HIT 2). This study re vealed a statistically significant, favourable effect in the subgroup of patients with tSAH, a result which warranted a further trial on the efficacy of nimodipine administration in patients with tSAH. This trial, the so-called German trial which was completed in 1995, not only revealed that tSAH is an important and independent factor predicting unfavourable outcome in head injury, but also showed convincingly the statistically significant, favourable effect of nimodipine adminis tration in patients with tSAH."

Spis treści

Survey of the Literature.- Pathology.- Incidence.- Relation to Age.- Relation to Alcohol Intoxication.- Prognosis.- Vasospasm and Ischaemic Neurological Deficits After tSAH.- Summary.- Patient Characteristics and Methodology.- Patient Population.- Variables Recorded.- Laboratory Evaluation.- Treatment of Patients.- CT Evaluation.- Criteria for Assessment of Amount of Blood on CT.- Criteria for Classification of the Mechanism of Injury.- Criteria for Defining Severity of Head Injury on Entry to the Trial.- Criteria for Assessment of Outcome.- Biometric Methods.- Summary.- Analysis of CT Findings in tSAH.- Frequency.- Time of CT.- Amount of Blood.- Clearance of tSAH.- Topographic Location of Blood.- Associated CT Findings.- Contusions.- Subdural Haematoma.- Epidural Haematoma.- Intracerebral Haematoma.- Intraventricular Blood.- Signs of Raised ICP on CT.- Hypodensity Compatible with Ischaemia.- Summary.- Demographic and Clinical Aspects of tSAH.- Age.- Sex.- Cause of Injury.- Alcohol Intake Before Injury.- Multiple Injuries.- Interval Between Injury and Admission.- Severity of Head Injury on Entry to the Trial.- Plain Skull X-Rays.- Craniotomy for Removal of Mass Lesions.- Intracranial Pressure Monitoring.- Haemodynamics.- Neurological Status.- Body Temperature.- Mortality.- Summary.- Outcome in tSAH.- Outcome in tSAH.- Amount of Blood and Outcome.- Fisher’s Categories and Outcome.- Location of Blood and Outcome.- Associated CT Lesions and Outcome.- Relationship of Various Demographic and Clinical Aspects to Outcome.- Functional Assessment.- Post-traumatic Epilepsy.- Summary.- tSAH as a Prognostic Factor.- Risk of Unfavourable Outcome in tSAH Patients.- Determination of Prognostic Factors.- Summary.- Clinical Laboratory Evaluation in tSAH.- Haematocrit.- Leucocytes.- Platelets.- Serum Aminotransferases.- Serum Lipase.- Serum Amylase.- Summary.- Therapeutic Prospects of tSAH with the Calcium Antagonist Nimodipine.- Pharmacological and Clinical Rational for the Use of the Calcium Antagonist Nimodipine in Head Injury.- The Effect of Nimodipine in the Overall Head-Injury Study Population.- The Effect of Nimodipine on tSAH.- Adverse Events.- Summary.- Confirmation of the Hypothesis: The German tSAH Study.- Patient Population.- Treatment with the Test Drug.- Statistical Analysis.- Demographic Results.- CT Findings.- Transcranial Doppler Blood Flow Velocities.- Blood Pressure and ICP.- Follow-Up Investigation.- Post-traumatic Epilepsy.- Pool Analysis of 460 tSAH Patients.- Summary.- Discussion and Conclusions.- tSAH, a Frequent Finding in Head Injury.- tSAH: CT Aspects.- tSAH: Clinical Aspects.- tSAH and Outcome.- tSAH and Vasospasm.- tSAH and Post-traumatic Epilepsy.- tSAH as a Prognostic Factor.- tSAH and Its Treatment with Nimodipine.- References.

Blurb

This monograph highlights the clinical significance of traumatic subarachnoid haemorrhage on CT scan after head injury, a subject which has received little attention until recently. The diagnosis, clinical aspects, prognosis, and therapy are discussed for patients with traumatic subarachnoid haemorrhage.