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      Subarachnoid haemorrhage.

      1 , ,
      Lancet (London, England)
      Elsevier BV

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          Abstract

          Subarachnoid haemorrhage accounts for only 5% of strokes, but occurs at a fairly young age. Sudden headache is the cardinal feature, but patients might not report the mode of onset. CT brain scanning is normal in most patients with sudden headache, but to exclude subarachnoid haemorrhage or other serious disorders, a carefully planned lumbar puncture is also needed. Aneurysms are the cause of subarachnoid haemorrhage in 85% of cases. The case fatality after aneurysmal haemorrhage is 50%; one in eight patients with subarachnoid haemorrhage dies outside hospital. Rebleeding is the most imminent danger; a first aim is therefore occlusion of the aneurysm. Endovascular obliteration by means of platinum spirals (coiling) is the preferred mode of treatment, but some patients require a direct neurosurgical approach (clipping). Another complication is delayed cerebral ischaemia; the risk is reduced with oral nimodipine and probably by maintaining circulatory volume. Hydrocephalus might cause gradual obtundation in the first few hours or days; it can be treated by lumbar puncture or ventricular drainage, dependent on the site of obstruction.

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          Author and article information

          Journal
          Lancet
          Lancet (London, England)
          Elsevier BV
          1474-547X
          0140-6736
          Jan 27 2007
          : 369
          : 9558
          Affiliations
          [1 ] Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, 3584CX Utrecht, Netherlands. J.vanGijn@umcutrecht.nl
          Article
          S0140-6736(07)60153-6
          10.1016/S0140-6736(07)60153-6
          17258671
          e54d0b9e-8ff5-4191-a5e1-6b16a91f5701
          History

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