Cerebral Aneurysms

NATURAL HISTORY OF RUPTURED ANEURYSM

Of 100 patients with aneurysmal SAH

I treated conservatively

T 15 die before reaching hospital SAH from ruptured aneurysm

85 carries a high initial mortality

I \ risk which gradually declines

I 15 die in first 24 hours in hospital with time. Of those who survive

24 hours -70----------------------------------------the initial bleed, rebleeding and

I \ cerebral infarction (see below)

t 15 die between 24 hours and 2 weeks are the major causes of death.

2 weeks - 55--------------------------------------These figures are based on

I \ studies of conservative treatment

T 15 die between 2 weeks and 2 months carried out in the 1960s, at a time

2 months-40--------------------------------------when the risks of operation were

I \ greater and benefits uncertain. \ 15 die between 2 months and 2 years

COMPLICATIONS OF ANEURYSMAL SAH

intracranial

- Rebleeding

- Cerebral ischaemia/infarction

- Hydrocephalus

- 'Expanding' haematoma

- Epilepsy.

extracranial

- Myocardial infarction

- Cardiac arrhythmias

- Pulmonary oedema

- Gastric haemorrhage (stress ulcer).

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