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From the Division of Cerebrovascular Diseases, Department of Neurology (Dr. Adams), University of Iowa, Iowa City, IA; and the Departments of Neurosurgery (Drs. Kassell and Torner) and Neurology (Dr. Haley), University of Virginia, Charlottesville, VA.
Cerebral ischemia from vasospasm is a major cause of death and disability following aneurysmal subarach-noid hemorrhage (SAH). This study examines and compares the relative utility of the initial neurologic examination and early CT in predicting cerebral ischemia after SAH. The influence of antifibrinolytic drugs (AFD) in the development of cerebral ischemia was also studied. AFD increased the risk of cerebral ischemia regardless of the admitting neurologic condition or the findings of CT. Among patients given AF'D, impaired orientation or alertness was associated with a higher risk of ischemia. Other neurologic signs were not predictive of ischemia. Clinical features were not predictive of ischemia among patients not given AFD. Focal, thick collections of blood on CT were highly predictive of ischemia, whether or not patients received AFD. Admitting CT is the best prognostic indicator for the development of cerebral ischemia after SAH. It should be used to supplement the clinical examination in selecting patients best suited for therapy to prevent vasospasm.
Address correspondence and reprint requests to Dr. Adams, Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa Hospitals & Clinics, Iowa City, IA 52242.
The Cooperative Aneurysm Study is funded by NINCDS grant No. 5-R01-NS15940-02.
Presented in part at the thirty-eighth annual meeting of the American Academy of Neurology, New Orleans, LA, April 1986.
Received November 3, 1986. Accepted for publication in final form January 15, 1987.
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