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      Tratamiento de la hemorragia subaracnoidea aneurismática en el Hospital Clínico de la Universidad de Chile Translated title: Subarachnoid hemorrhage caused by intracranial aneurysms, experience in 82 patients

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          Translated abstract

          Background: One third of patients with subarachnoid hemorrhage caused by intracranial aneurysms, die. Aim: Review of medical records of patients with subarachnoid hemorrhage treated at a clinical hospital. Material and Methods: Review of medical records of patients discharged from the hospital between 2006 and 2011 with the diagnosis of subarachnoid hemorrhage. Patients initially or subsequently treated elsewhere were not analyzed. Results: The medical records of 82 patients aged 24 to 100 years (77% females), were analyzed. The clinical diagnosis at the onset of the condition was correct in 82% of cases. In 95% of patients, an angiographic study and subsequent surgical intervention of the aneurysm were carried out within 24 hours of diagnosis. Global mortality was 23%. Twelve patients died prior to any possible treatment, due to the severity of the disease. Seventy six aneurysms in 70 patients were treated with clips or coils in 37 and 39 cases, respectively. Seven patients died. Forty seven patients had a Rankin disability score of two or less. Conclusions: The presence of an intracranial hematoma or acute hydrocephaly on admission and clinical vasospasm during evolution were associated with a bad prognosis.

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          Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale.

          We developed a modification of the Fisher computed tomographic rating scale and compared it with the original Fisher scale to determine which scale best predicts symptomatic vasospasm after subarachnoid hemorrhage. We analyzed data from 1355 subarachnoid hemorrhage patients in the placebo arm of four randomized, double-blind, placebo-controlled studies of tirilazad. Modified Fisher computed tomographic grades were calculated on the basis of the presence of cisternal blood and intraventricular hemorrhage. Crude odds ratios (OR) reflecting the risk of developing symptomatic vasospasm were calculated for each scale level, and adjusted ORs expressing the incremental risk were calculated after controlling for known predictors of vasospasm. Of 1355 patients, 451 (33%) developed symptomatic vasospasm. For the modified Fisher scale, compared with Grade 0 to 1 patients, the crude OR for vasospasm was 1.6 (95% confidence interval [CI], 1.0-2.5) for Grade 2, 1.6 (95% CI, 1.1-2.2) for Grade 3, and 2.2 (95% CI, 1.6-3.1) for Grade 4. For the original Fisher scale, referenced to Grade 1, the OR for vasospasm was 1.3 (95% CI, 0.7-2.2) for Grade 2, 2.2 (95% CI, 1.4-3.5) for Grade 3, and 1.7 (95% CI, 1.0-3.0) for Grade 4. Early angiographic vasospasm, history of hypertension, neurological grade, and elevated admission mean arterial pressure were identified as risk factors for symptomatic vasospasm. After adjusting for these variables, the modified Fisher scale remained a significant predictor of vasospasm (adjusted OR, 1.28; 95% CI, 1.06-1.54), whereas the original Fisher scale was not. The modified Fisher scale, which accounts for thick cisternal and ventricular blood, predicts symptomatic vasospasm after subarachnoid hemorrhage more accurately than original Fisher scale.
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            Reliability of the modified Rankin Scale: a systematic review.

            A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies. Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus. From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted kappa=0.95 to kappa=0.25. Overall reliability of mRS was kappa=0.46; weighted kappa=0.90 (traditional modified Rankin Scale) and kappa=0.62; weighted kappa=0.87 (structured interview). There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-scale clinical trials demonstrate potentially significant interobserver variability.
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              The epidemiology of admissions of nontraumatic subarachnoid hemorrhage in the United States.

              Subarachnoid hemorrhage (SAH) is the cause of 5% to 10% of strokes annually in the United States.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                rmc
                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago )
                0034-9887
                August 2014
                : 142
                : 8
                : 982-988
                Affiliations
                [1 ] Hospital Clínico de la Universidad de Chile Chile
                [2 ] Universidad de Chile Chile
                [3 ] Clínica Alemana de Santiago Chile
                Article
                S0034-98872014000800005
                10.4067/S0034-98872014000800005
                8cdbc079-cb6d-4182-9028-8996940546e3

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Chile

                Self URI (journal page): http://www.scielo.cl/scielo.php?script=sci_serial&pid=0034-9887&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Intracranial aneurysms,Subarachnoid haemorrhage,Treatment
                Internal medicine
                Intracranial aneurysms, Subarachnoid haemorrhage, Treatment

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