重症クモ膜下出血超早期の病態と管理

概要

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In this study we discussed clinical analysis and management of 31 cases with severe subarachnoid hemorrhages (SAH) in the acute stage and also emphasized the value of CT scan, serial monitoring of intracranial pressure (ICP) and auditory brain stem response (ABR).<BR>They were admitted to our hospital within 3 hours after the attack. Most cases were grade IV or V according to Hunt & Hess. They were divided into three groups on the basis of clinical findings.<BR>In the first group of 20 cases, they were admitted in DOA (dead on arrival) or near DOA. In the second group of 7 cases, they showed signs of acute pulmonary edema at the time of admission. In both groups CT scan showed severe SAH located in the basal cisterns surrounded the brain stem and increased ICP. The major mechanisms leading to acute death or very severe state soon after SAH might be caused by acute brain stem dysfunction and acute increase in ICP by cerebral edema following SAH and secondary cerebral ischemia due to cardiac and respiratory arrest.<BR>In the third group of 4 cases, the level of consciousness improved soon after coma or semicoma by severe SAH with the normalization of ABR. This clinical course also seemed to be associated with acute brain stem dysfunction. In neurosurgical intensive care, serial monitoring of ICP and ABR is important in evaluation of the patients with acute severe SAH.
The Japanese Society on Surgery for Cerebral Strokeの論文