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Vol. 3. Issue 3.
Pages 186-196 (January 1992)
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Vol. 3. Issue 3.
Pages 186-196 (January 1992)
Hemorragia subaracnoidea aneurismática. Estudio de una serie clínica de 412 casos
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P.A. Gómez, R.D. Lobato, J.J. Rivas, A. Cabrera, R. Alday, J. Domínguez, J. Ayerbe, E. Lamas
Servicio de Neurocirugía, Hospital «12 de Octubre», Madrid
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Resumen

Se analizan retrospectivamente 412 casos consecutivos de hemorragia subaracnoidea aneurismática, tratados durante los años 1974–1991. El 79% de los pacientes ingresaron en los tres primeros días del sangrado. El 63% de los pacientes ingresaron en buen grado clínico (Botterell I y II). Se apreció vasoespasmo angiográfico en el 38% de los casos. Se intervinieron 336 pacientes (81,6%), la mayoría pasados siete días. Del total de la serie fallecieron 132 pacientes (32%), 69 de éstos (16,7%) después de haber sido intervenidos. Las complicaciones que más influyeron en la mortalidad fueron la isquemia cerebral y el resangrado. Apreciamos una estrecha correlación entre el depósito de sangre cisternal, la aparición de vasoespasmo angiográfico y el desarrollo de isquemia cerebral, lo que apoya la teoría que imputa a la sangre, o a alguno de sus componentes o productos de degradación un papel fundamental en la producción de vasoespasmo. Es muy importante reconocer precozmente esta enfermedad con el fin de instaurar lo antes posible el tratamiento adecuado.

Palabras clave:
Hemorragia subaracnoidea
aneurisma
hallazgos TC
vasoespasmo
evolución final
Summary

A series of 412 consecutive cases of aneurysmal subarachnoid hemorrhage are analyzed. Nearly 80% of the patients were admitted within three days after bleeding. At admission, 63% of the patients were in good neurological condition (Botterell I-II). Cerebral vasospasm was appreciated in 38% of the preoperative angiographies. A total of 336 (81,6%) patients were operated on, most after seven days of initial hemorrhage. The overall mortality was 32% (132 patients); of these, 69 died after surgery (16,7%). Vasospasm and rebleeding were the leading causes of morbidity and mortality. A close correlation was found between the amount of subarachnoid bleeding and the development of vasospasm and brain ischemia, supporting the concept that the extravasated blood plays an essential role in the pathogenesis of vasospasmo The early diagnosis of this clinical entity is an important step in order to apply adecuate treatment as soon as possible.

Key words:
Subarachnoid hemorrhage
aneurysm
CT findings
vasospasm
outcome

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