3 research outputs found
Stroke in three patients due to spontaneous intra tumoral hemorrhage in meningiomas: Lessons learnt
Poor-grade subarachnoid hemorrhage: Is surgical clipping worthwhile?
Background : Management of patients with poor-grade aneurysmal
subarachnoid hemorrhage (SAH) is difficult and the protocols followed
differ from center to center. Material and Methods : In this report,
we present our experience with aneurysmal clipping in patients with
poor-grade SAH. Patients with poor Hunt and Hess (H and H) grade (Grade
IV and Grade V) were offered surgery after stabilization of their
hemodynamic and metabolic parameters. The status was recorded as
favorable (good recovery, mild to moderate disability but independent),
unfavorable (severe disability, vegetative) and dead. Results : Out of
a total of 1196 patients who underwent aneurysmal clipping, 165(13.8%)
were in poor grade. Of the 165 patients, 99 (60%) were in H and H Grade
IV and 66 (40%) were in Grade V. More than half of the patients (58%)
were operated within 24 h of admission. There was an overall mortality
of 50.9%. In the long term, of the survivors who were followed up,
about 72% achieved a favorable outcome. Conclusions : With an
aggressive approach aimed at early clipping, the chances of rebleed are
reduced and vasospasm can be managed more aggressively. This protocol
resulted in survival in a significant proportion of patients who would
have otherwise died. In the long-term follow-up, the surviving patients
showed significant improvement from the status at discharge