exudates and Subarachnoid-Hemorrhage

This is a prospective study conducted from February 2000 to July 2002 in a single neurosurgeon neurosurgical service in the state of Sarawak, Malaysia. There were 66 cases of subarachnoid hemorrhage or intracranial aneurysm presenting to this hospital over the study period. Fifty cases had their aneurysms clipped. Eighty percent of our patients were operated within 48 h of presentation. Forty-four percent presented with poor WFNS grades of 4 and 5. We had a 20% operative mortality and 29% total management mortality. Twenty-nine (58%) of the operated cases had a favorable outcome with a mean follow-up of 32 weeks. Multiple aneurysms were less common. The diagnosis of aneuysmal subarachnoid hemorrhage and clipping of aneurysms have increased dramatically over the previous two and half years indicating an increased awareness of the diagnosis and treatment. This series supports the previously reported beliefs that the lower rate of aneurymal subarachnoid hemorrhage in developing countries is likely due to both underdiagnosis and undertreatment. Good results can be achieved in developing countries with early diagnosis and intensive management.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Cohort Studies; Developing Countries; Female; Glasgow Coma Scale; Glasgow Outcome Scale; Hospital Mortality; Humans; Intracranial Aneurysm; Malaysia; Male; Middle Aged; Neurosurgical Procedures; Prospective Studies; Subarachnoid Hemorrhage; Treatment Outcome

The outcome of 151 children less than 15 years of age and admitted within 24 h of head injury was studied in relation to clinical and computed tomography (CT) scan features. Thirty one (20.5%) had a poor outcome (24 died, 6 were severely disabled at 6 months after injury and 1 was in a persistent vegetative state) while 120 (79.5%) had a good outcome (89 recovered well and 31 were moderately disabled). Factors associated with a poor outcome were Glasgow Coma Scale (GCS) score 24 h following injury, presence of hypoxia on admission and CT scan features of subarachnoid haemorrhage, diffuse axonal injury and brain swelling. GCS scores alone, in the absence of other factors, had limited predictive value. The prognostic value of GCS scores < 8 was enhanced two-to fourfold by the presence of hypoxia. The additional presence of the CT scan features mentioned above markedly increased the probability of a poor outcome to > 0.8, modified only by the presence of GCS scores > 12. Correct predictions were made in 90.1% of patients, indicating that it is possible to estimate the severity of a patient's injury based on a small subset of clinical and radiological criteria that are readily available.

Topics: Adolescent; Brain Damage, Chronic; Brain Edema; Brain Injuries; Child; Child, Preschool; Disability Evaluation; Female; Glasgow Coma Scale; Humans; Hypoxia; Hypoxia, Brain; Infant; Malaysia; Male; Neurologic Examination; Prognosis; Subarachnoid Hemorrhage; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome

The outcome of 109 patients with severe head injury was studied in relation to clinical and computed tomographic (CT) criteria on admission, after resuscitation. Age, Glasgow Coma Score (GCS) and state of pupils strongly correlated with outcome. The presence of hypothalamic disturbances, hypoxia and hypotension were associated with an adverse outcome. The CT indicators associated with poor outcome were perimesencephalic cistern (PMC) obliteration, subarachnoid haemorrhage, diffuse axonal injury and acute subdural haematoma. The prognostic value of midline shift and mass effect were influenced by concomitant presence of diffuse brain injury. For the subset of patients aged < 20 years, with GCS 6-8 and patent PMC (n = 21), 71.4% correct predictions were made for a good outcome. For the subset of patients aged > 20 years, with GCS 3-5 and partial or complete obliteration of PMC (n = 28), 89.3% correct predictions were made for a poor outcome.

Topics: Adolescent; Adult; Age Factors; Aged; Brain Edema; Cerebral Hemorrhage; Child; Child, Preschool; Craniocerebral Trauma; Glasgow Coma Scale; Humans; Infant; Malaysia; Middle Aged; Predictive Value of Tests; Prognosis; Subarachnoid Hemorrhage; Tomography, X-Ray Computed

Topics: Adult; Cerebral Angiography; Female; Humans; Intracranial Aneurysm; Intracranial Arteriovenous Malformations; Malaysia; Male; Prospective Studies; Retrospective Studies; Subarachnoid Hemorrhage

Topics: Adolescent; Adult; Cerebral Angiography; Child; Female; Humans; Malaysia; Male; Middle Aged; Subarachnoid Hemorrhage; Tomography, X-Ray Computed

Topics: Adult; China; Female; Humans; India; Intracranial Arteriovenous Malformations; Malaysia; Male; Subarachnoid Hemorrhage