Subarachnoid aneurysm

International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms a randomised trial. The Lancet, 360, 1267-1274. 

Molyneux A J. Kerr R S, Yu L M et al. (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneurysms a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 3-9 366 809-917 Richter G, Engelhorn T, Struffert T et al. (2007) Flat panel detector angiographic CT for stent-assisted coil embolization of broad-based cerebral aneurysms. Am J Neurora-diol 28 1902-1908... 

Parra A, Kreiter KT, Williams S, Sciacca R, Mack WJ, Naidech AM, Commichau CS, Fitzsimmons BF, Janjua N, Mayer SA, Connolly Jr. ES, Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage a matched controlled cohort study. Neurosurgery 2005 56 476 84 [discussion 476 84]. 

Tseng MY, Czosnyka M, Richards H, Pickard JD, Kirkpatrick PJ. Effects of acute treatment with pravastatin on cerebral vasospasm, autoregulation, and delayed ischemic deficits after aneurysmal subarachnoid hemorrhage a phase II randomized placebo-controlled trial. Stroke 2005 36 1627-1632. 

Endo S, Nishijima M, Nomura H, Takaku A, Okada E. A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage report of three autopsied cases and review of the literature. Neurosurgery 1993 33 732-738. 

Kassell, N.F., Haley, E.C., Halves, W.M., Hunsen, C.A. and Weir, B. (1993). Phase two trial of tirilazad in aneurysmal subarachnoid hemorrhage. Vth International Symposium on Cerebral Vasospasm, Edmonton and Jasper, Alberta, Canada, May 18-21. Can. J. Neurol. Sci. 20, S29. 

Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. Delayed cerebral ischemia occurs 4 to 14 days after the initial aneurysm rupture and is a common cause of neurologic deficits and death. A meta-analysis of 12 studies was conducted and concluded that oral nimodipine 60 mg every 4 hours for 21 days following aneurysmal SAH reduced the risk of a poor outcome and delayed cerebral ischemia.40... 

Mase, M., et al. (1999). Acute and transient increase of lipocalin-type prostaglandin D synthase (beta-trace) level in cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage. Neurosci. Lett. 270, 188-90. 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

Hemorrhagic strokes account for 12% of strokes and include subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. Subarachnoid hemorrhage may result from trauma or rupture of an intracranial aneurysm or arteriovenous malformation. Intracerebral hemorrhage occurs when a ruptured blood vessel within the brain parenchyma causes formation of a hematoma. Subdural hematomas are most often caused by trauma. 

In subarachnoid hemorrhage due to a ruptured intracranial aneurysm or arteriovenous malformation, surgical intervention to clip or ablate the vascular abnormality substantially reduces mortality from rebleeding. The benefits of surgery are less well documented in cases of primary intracerebral hemorrhage. In patients with intracerebral hematomas, insertion of an intraventricular drain with monitoring of intracranial pressure is... 

Ghck H, Wihke R, Polsky D, Liana T, Alves WM, Kasseh N, Schulman KA. Economic analysis of tirilazad mesylate for aneurysmal subarachnoid hemorrhage economic evaluation of a phase IB clinical trial in Eu-... 

Improvement of neurologic deficits after subarachnoid hemorrhage from ruptured congenital aneurysms PO 60 mg q4h for 21 days. Begin within 96 hr of subarachnoid hemorrhage. 

Cerebral vasospasm following aneurysmal subarachnoid haemorrhage is one... 

Adams HP Jr, Kassell NF, Turner JC et al (1983) CT and clinical correlation in recent aneurysmal subarachnoid hemorrhage a report of the cooperative aneurysm study. Neurology 33 981-988... 

Conway JE, Tamargo RJ. Cocaine use is an independent risk factor for cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2001 32(10) 2338-43. 

Two cases of non-aneurysmal subarachnoid hemorrhage associated with ecstasy have been reported (46). 

Intracranial dissection is much rarer. It may present with subarachnoid hemorrhage owing to rupture of a pseudo-aneurysm, as well as with ischemic stroke, and is less often diagnosed during life (Farrell et al. 1985 de Bray et al. 1997 Chaves et al. 2002). 

Moyamoya seems to be mainly confined to the Japanese and other Asians, and in most cases the cause is unknown (Bruno et al. 1988 Chiu et al. 1998). Some cases are familial (Kitahara et al. 1979) others appear to be caused by a generalized fibrous disorder of arteries (Aoyagi et al. 1996), and a few may result from a congenital hypoplastic anomaly affecting arteries at the base of the brain, or associated with Down s syndrome (Cramer et al. 1996). The syndrome may present in infancy with recurrent episodes of cerebral ischemia and infarction, mental retardation, headache, epileptic seizures and, occasionally, involuntary movements. In adults, subarachnoid or primary intracerebral hemorrhage are also common owing to rupture of collateral vessels. There have also been a few reports of associated intracranial aneurysms (Iwama et al. 1997) and also of cerebral arteriovenous malformations. 

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