Subarachnoid Hemorrhage in Clinical Practice

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Although, as the authors mentioned, 1 the primary initial problem was the absence of the documented clinical presentation at admission, an almost essential issue, especially in patients with SAH, because it is critical to know where the patient's clinical condition started before trying to evaluate where it may end.

This may provide significant bias, especially in d mortality, because you cannot exclude a patient's previous condition when comparing treatment methods, and only with a random allocation of patients, it may provide higher evidence; however, this cannot be done in retrospective studies. A general suggestion would be the stratification of patients HH 1—3, mFS 1—3 and WFNS 1—3 , as a measure to reduce the impact of neurological complications of SAH over mortality, as well long-term follow-ups for both treatment groups, to evaluate complementary treatments, and the comparison of anterior circulation aneurysms against posterior circulation aneurysms.

It is clear that in emerging countries, the overall mortality rates are a bit higher than those presented and the actual learning-curve and range of coiling techniques are a more initial.

Thus, studies with a more practical approach like this one are ideal to point our in-development Public Healthcare System in the right direction. In Anderson et al, 4 there is a statistically positive association for microsurgical treatment, and they postulate that the number of microsurgical cases performed may be a surrogate indicator of closer neurosurgical involvement in the overall management of neurovascular patients and optimal case selection.

The idea of coiling replacing clipping may be unachivable into the long run, as we can see in the higher mortality for the first 14 d after coiling.


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Centers management protocols for aneurysmal SAH are not universal, and surgery continues to be the readiest and widespread treatment modality in the world. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

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Advanced Search. Rinkel, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis, 35 , pp.

Connecting the early brain injury of aneurysmal subarachnoid hemorrhage to clinical practice.

Lagares, P. Arikan, R. Sarabia, A. Horcajadas, et al. Neurocirugia, 22 , pp. Connolly Jr. Rabinstein, J. Carhuapoma, C. Derdeyn, J. Dion, R.

Subarachnoid Haemorrhage

Higashida, et al. Stroke, 43 , pp. Alberts, R. Latchaw, W. Selman, T. Shephard, M. Hadley, L.

Risk Factors

Brass, et al. Recommendations for comprehensive stroke centers: A consensus statement from the Brain Attack Coalition. Stroke, 36 , pp. Rev Neurol, 55 , pp. Nilsson, H.


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  4. Ramgren, M. Cronqvist, L. Impact of coil embolization on overall management and outcome of patients with aneurysmal subarachnoid hemorrhage. Neurosurgery, 57 , pp. Subscribe to our newsletter. Clinical practice guidelines for subarachnoid haemorrhage External lumbar cerebrospinal fluid drainage in patients Subarachnoid haemorrhage from a ruptured intracranial Intracranial Vasospasm.

    Subarachnoid Hemorrhage in Clinical Practice | Gabriel J.E. Rinkel | Springer

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