Aneurysmal subarachnoid hemorrhages — a current view on the diagnosis, clinical picture, treatment

I.S. Zozulia, A.I. Zozulia, A.O. Volosovets, A.O. Kaminskyi

Abstract


The article presents observations of 35 patients with aneurysmal subarachnoid haemorrhages (АSAH) who were on treatment at the Oleksandrivska City Clinical Hospital of Kyiv and Kyiv Municipal Emergency Clinical Hospital. The age of the patients ranged from 35 to 65 years, the mean age was 42.0 ± 3.5 years. Men were 20, women — 15. In the work, classification on Hunt and Hess scale and World Federation of Neurological Surgeons was used. Neuroimaging techniques were applied (computed tomography (CT), magnetic resonance imaging (MRI), CT and MRI angiography, selective angio­graphy (catheter angiography — digital subtraction angiography — а gold standard)). In the treatment, open neurosurgical interventions and endovascular neurosurgery were used. АSAH is an urgent condition. The high level of suspected АSAH in patients is a sudden onset of severe headache. Urgent diagnostic measures should include non-contrast CT, MRI (CT and MRI angio­graphy), lumbar puncture. Digital subtraction angiography with 3-dimensional rotational reconstruction is indicated for the detection of aneurysm in patients with АSAH and for the planning of the type of surgical treatment. In the period between the manifestations of АSAH symptoms and the aneurysm obli­teration, blood pressure control with titrating drugs and maintaining systolic arterial pressure < 160 mmHg are required. In the vast majority of cases, in order to reduce the incidence of re-hemorrhage, surgical clumping or endovascular embolization of the aneurysm should be performed as soon as possible (up to 72 hours) after АSAH. In all possible cases, a complete obliteration of aneurysms with the advantage of an endovascular surgery is recommended. Symptomatic hydrocephalus in the acute period of АSAH can be correlated by eliminating liquor (external drainage of the ventricular system or lumbar drainage depending on the nature of the liquorodynamic disorders).

Keywords


aneurysmal subarachnoid haemorrhages; diagnosis; clinical picture; treatment; prognosis

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DOI: https://doi.org/10.22141/2224-0586.8.87.2017.121331

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