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A 70-year-old woman with poor grade subarachnoid hemorrhage complicated by carotid stenosis, cerebral vasospasm, and cerebral rebleed

  • Cases With Tough Decisions
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An Erratum to this article was published on 01 December 2005

Abstract

Introduction: Subarachnoid hemorrhage is one of the most common entities encountered in neurocritical care units. Knowledge of disease sequelae and their management is paramount for all neurointensivists.

Materials and Methods: This study relates the case of a 70-year-old woman with poor grade subarachnoid hemorrhage who underwent endovascular detachable coil embolization of a right internal carotid artery aneurysm. Her hospital course was subsequently complicated by symptomatic carotid stenosis and cerebral vasospasm requiring intervention.

Discussion: The discussants present their views regarding five main questions pertaining to management of the patient regarding the choice of endovascular versus surgical aneurysm occlusion, stent-supported angioplasty in a patient with a recent subarachnoid hemorrhage, and treatment options for vasospasm.

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References

  1. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6:1–9.

    Article  PubMed  CAS  Google Scholar 

  2. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968;28:14–20.

    PubMed  CAS  Google Scholar 

  3. van Gijn J, van Dongen KJ. Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography. Neurology 1980;30:538–539.

    PubMed  Google Scholar 

  4. van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 1985;35:493–497.

    PubMed  Google Scholar 

  5. van der Jagt M, Hasan D, Bijvoet HW, et al. Validity of prediction of the site of ruptured intracranial aneurysms with CT. Neurology 1999;52:34–39.

    PubMed  Google Scholar 

  6. Russell SM, Lin K, Hahn SA, Jafar JJ. Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants. J Neurosurg 2003;99:248–253.

    PubMed  Google Scholar 

  7. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267–1274.

    Article  PubMed  Google Scholar 

  8. Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 1994;15:815–820.

    PubMed  CAS  Google Scholar 

  9. Brisman JL, Roonprapunt C, Song JK, Niimi Y, Setton A, Berenstein A, Flamm ES. Intentional partial coil occlusion followed by delayed clip application to wide-necked middle cerebral artery aneurysms in patients presenting with severe vasospasm. Report of two cases. J Neurosurg 2004;101:154–158.

    Article  PubMed  Google Scholar 

  10. Qureshi AI, Luft AR, Sharma M, Guterman LR, Hopkins LN. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part I. Pathophysiological and pharmacological features. Neurosurgery 2002;46:1344–1359.

    Article  Google Scholar 

  11. Qureshi AI, Luft AR, Sharma M, Guterman LR, Hopkins LN. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II. Clinical aspects and recommendations. Neurosurgery 2000;46:1360–1375; discussion 1375, 1376.

    Article  PubMed  CAS  Google Scholar 

  12. Denny-Brown D. The treatment of recurrent cerbrovascular symptoms and the question of ‘vasospasm’. Med Clin North Am 1951;35:1457–1474.

    PubMed  CAS  Google Scholar 

  13. Farhat SM, Schneider RC. Observations on the effect of systemic blood pressure on intracranial circulation in patients with cerebrovascular insufficiency. J Neurosurg 1967;27:441–445.

    PubMed  CAS  Google Scholar 

  14. Sen J, Belli A, Albon H, Morgan L, Petzold A, Kitchen N. Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage. Lancet Neurol 2003;2:614–621.

    Article  PubMed  Google Scholar 

  15. Awad IA, Carter LP, Spetzler RF, Medina M, Williams FC Jr. Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic, hemodilution and arterial hypertension. Stroke 1987;18:365–372.

    PubMed  CAS  Google Scholar 

  16. Hanel RA, Xavier AR, Mohammad Y, Kirmani JF, Yahia AM, Qureshi AI. Outcome following intracerebral hemorrhage and subarachnoid hemorrhage. Neurol Res 2002;24:S58-S62.

    Article  PubMed  Google Scholar 

  17. Hartmann M, Weber R, Zoubaa S, Schranz C, Knauth M. Fatal subarachnoid hemorrhage after carotid stenting. J Neuroradiol 2004;31:63–66.

    Article  PubMed  CAS  Google Scholar 

  18. Kaku Y, Yonekawa Y, Tsukahara T, Kazekawa K. Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 1992;77:842–847.

    PubMed  CAS  Google Scholar 

  19. Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS. Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 1992;77:848–852.

    PubMed  CAS  Google Scholar 

  20. Badjatia N, Topcuoglu MA, Pryor JC. et al. Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. AJNR Am J Neuroradiol 2004;25:819–826.

    PubMed  Google Scholar 

  21. McAuliffe W, Townsend M, Eskridge JM, Newell DW, Grady MS, Winn HR. Intracranial pressure changes induced during papaverine infusion for treatment of vasospasm J Neurosurg 1995;83:430–434.

    PubMed  CAS  Google Scholar 

  22. DT Cross, 3rd, Moran CJ, Angtuaco EE, Milburn JM, Diringer MN, Dacey RG, Jr. Intracranial pressure monitoring during intraarterial papverine infusion for cerebral vasospasm. AJNR Am J Neuroradiol 1998;19:1319–1323.

    PubMed  Google Scholar 

  23. Carhuapoma JR, Qureshi AI, Tamargo RJ, Mathis JM, Hanley DF. Intra-arterial papaverine-induced seizures: case report and review of the literature. Surg Neurol. 2001;56:159–163.

    Article  PubMed  CAS  Google Scholar 

  24. Diringer MN, Edwards DF, Aiyagari V, Hollingsworth H. Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit. Crit Care Med 2001;29:1792–1797.

    Article  PubMed  CAS  Google Scholar 

  25. Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology 2001;56:766–772.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Peoria, IL

    Giuseppe Lanzino

  2. Neurocritical Care and Stroke Program, University of Southern California, Los Angeles, CA

    Gene Sung

  3. Division of Neurocritical Care, Departments of Neurology and Neurosurgery, University Hospitals of Cleveland, Case Western Reserve, Cleveland, OH

    Jose I. Suarez

  4. Department of Neurology and Neurosciences, Zeenat Qureshi Stroke Research Center, University of Medicine and Dentistry, New Jersey 90 Bergen Street, DOC 8100, 07103, Newark, NJ

    Nazli Janjua, Adnan Qureshi, Jawad F. Kirmani, Ali Ebrahimi & Afshin Divani

Authors
  1. Nazli Janjua
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  2. Adnan Qureshi
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  3. Jawad F. Kirmani
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  4. Giuseppe Lanzino
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  5. Gene Sung
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  6. Jose I. Suarez
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  7. Ali Ebrahimi
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  8. Afshin Divani
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Corresponding author

Correspondence to Nazli Janjua.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s12028-005-0025-6.

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Janjua, N., Qureshi, A., Kirmani, J.F. et al. A 70-year-old woman with poor grade subarachnoid hemorrhage complicated by carotid stenosis, cerebral vasospasm, and cerebral rebleed. Neurocrit Care 3, 183–188 (2005). https://doi.org/10.1385/NCC:3:2:183

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  • DOI: https://doi.org/10.1385/NCC:3:2:183

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