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J Korean Neurol Assoc. 1984;2(2):103-119.
- A Clinical Study on Spontaneous Subarachnoid Hemorrhage
-with a special reference to intracranial complications-
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Sung-Ho Park, M.D., Jae-Kyu Rho M.D., Ho-Jin Myong, M.D.
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Department of Neurology, Seoul National University
- 자발성 지주막하출혈에 대한 임상적 고찰
-두개강내 합병증을 중심으로-
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박성호, 노재규, 명호진
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서울대학교 신경과.
- Abstract
- The authors reviewed the medical records of 94 patients who met the strict diagnostic criteria of spontaneous subarachnoid hemorrhage (SAH). They were diagnosed and treated at Seoul National University Hospital from January 1983 to June 1984. The interrelationships among the age, clinical status on admission, findings on brain computerized tomography (CT), site of the ruptured aneurysm and the intracranial complicaions (ventricular dilatation, vasospasm, rebleeding) and their outcome were studied. Conclusions obtained are as follows:
1) The local clot on CT (especially associated with ICH and /or IVH) was more frequently found in clinically poor patients than in good ones.
2) Cerebral angiography (TFCAs, 53 cases) revealed the anterior communicating artery
(A-COM) to be the most common site of aneurysm in 21 cases (39.6%) and multiple
aneurysms in 5 cases (9.4% : two in 4 cases, three in 1 case) and no aneurysm in 9 cases
(17%). Vasospasm on angiography was found in 27 cases (50.9%).
3) Ventricular dilatation, which was measured on the first CT after SAH, was detected in 43
cases (45.7%). High incidence was found in the cases showing a local clot on CT (53.4%),
especially associated with intraventricular hemorrhage (IVH; 83.3%), and in the cases of
A-COM aneurysm rupture (52.4%; probably due to IVH).
4) The clinical vasospasm was edtected in 41 cases (43.6%). The interval between SAH and
the development of clinical vasospasm ranged from from 3 to 35 days (mean 9.8 days).
Thirty-five cases (85.4%) of them suffered from clinical vasospasm within 14 days. The
incidence of clinical vasospasm steeply increased in the elderly patients (Fifties: 60%, Sixties:
66.7%) but that of findings of vasospasm on angiography (angiographic vasospasm) slowly
increased with age. The local clot on CT seemed to be the most important factor of
vasospasm, both clinically (51.7%) and angiographically (75%). The site of vasospasm on
angiography was closely related with that of the ruptured aneurysm.
5) Rebleeding occurred in 21 cases (22.3%) with the interval ranging from 2 hours to 38 days
(mean 10.1 days) after SAH and 14 cases (66.7%) of them rebled within 10 days. The shorter
the interval after SAH, the higher the incidence. There were no definitely related factors
affecting the rebleeding but it seemed to be affected to some extent by ICH and/or IVH on
CT (31.3%).
6) Thirty-five cases (37.2%) diedof various causes. Mortality seemed to be most closely
related with the clinical status on admission. Other related iactros were the aging, the local
clot on CT (53.4%), especially associated with ICH and/or IVH (69.7%), and the development
of various systemic or intracranial complications. Mortality seemed to be more closely related
with ventricuar dilstation and rebleeding than with vasospasm. But it was suggested that
vasospasm should be regrarded as a major cause of disabilities and an indirect cause of
death.
Keywords :
- 초록
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