Abstract
In this paper, authors reported and discussed the acute management of severe subarachnoid hemorrhage due to cerebral aneurysm rupture. There were 45 cases in Hunt & Hess Grade IV or V with no assessment as to any systemic complications, among 137 cases with ruptured cerebral aneurysms during the period from April, 1984 to September, 1987 in Showa General Hospital.
Out of 18 cases in Grade IV, 12 were graded IV on arrival and six were regarded as Grade IV following aneurysm re-rupture after emergent procedures. Seventeen cases were operated on, mostly within 48 hours and barbiturate therapy was performed in 12 cases before and/or after the operation (aneurysm neck clipping) during 10 days on average. One conservatively treated patient died and among 17 surgically treated cases the outcome was as follows; good, six; poor, four; death, seven.
Out of 27 cases in Grade V, 15 were in Grade V at admission and 12 fell into Grade V following a second or third rupture after admission. Aneurysm neck clipping was performed in 14 cases within 24 hours, among whom 12 cases were under barbiturate therapy for seven days on an average and the outcome consisted of: good, four cases; poor, six cases; and death four cases. All of the 13 cases with no radical operations died.
Barditurate therapy for the patients with severe subarachnoid hemorrhage is expected to protect the brain from ischemic damage due to vasospasm and to lower the increased intracranial pressure. These beneficial effects might be connected to or explain the relatively good results in this report.
The palliative therapy without acute aneurysm neck clipping may sometimes be profitable while awaiting neurological improvements but often runs the risk of preoperative aneurysm re-rupture. The acute management of early operation and intensive care, including barbiturate therapy for Grade IV or V patients, did not necessarily result in poor outcomes and therefore can be more significant than the strategy of so-called conservative management or intentionally delayed operation.
