Abstract
Acute referral and early treatment of ruptured intracranial aneurysms have led to a discussion of the treatment consensus among patients in Hunt Hess grades 4 and 5. The resent possible benefit of Tirilazad among males have been disputed and could not be proven among women in a randomized controlled series.
In a small consecutive series of 14 male patients in H & H grades 4-5, 12 received Tirilazad. 3/12=33% died from MOF and other causes but not from delayed clinical vasospasm, 7/12=58% had a GOS of 3, 2/2=100% not receiving Tirilazad died from vasospasm. Usually 60% of our patients are dying upon admittance with significant infarction and brain shifts due to early referral in our area.The H & H 4-5 group should thus be considered heterogenous and different selective treatment modalities may be advocated including“no treatment.” Early surgery and a strict protocol of 2-H and 3-H treatment consisting of immediate control of ICP and CPP combined with the free radical scavenger Tirilazad resulted in a survival rate of 67% with a good outcome GOS-3 in 58%. It is speculated why early free radical scavengers could be of benefit using the 3-H therapy.
