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      An Excellent Functional Recovery Following Grade IV Subarachnoid Hemorrhage From a Cerebral Aneurysm Rebleed With Ultra-Early Surgical Intervention: A Case Report

      case-report
      Author(s): 1 , 2 , , 3 , 4 , 1
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: endovascular coiling, hemorrhagic stroke, ultra-early surgical clipping, aneurysmal rupture, aneurysm

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          Abstract

          Aneurysms are focal abnormal dilations of the arterial wall occurring frequently at branching points along the arteries of the base of the brain. Aneurysmal rupture is one of the possible aneurysm complications and can cause aneurysmal subarachnoid hemorrhages (aSAH). Treatment of aSAH consists of pharmacologic, surgical, or endovascular approaches. The ultra-early intervention of ruptured aSAH occurs within the first 24 hours after ruptured aSAH. This case is about a 49-year-old obese male with multiple comorbidities who suffered from a grade IV subarachnoid hemorrhage and underwent an ultra-early surgical clipping approximately four hours after admission to the emergency center. The patient had excellent functional recovery at a six-month follow-up. Ultra-early surgical intervention for high-grade aSAH with rebleeding could improve outcomes.

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          Most cited references17

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          Cerebral aneurysms.

          J Brisman, Evan Newell, J. Song (2006)
          Article 0 comments Cited 186 times – based on 0 reviews     Review now
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            Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage.

            Axel Rosengart, Kim Schultheiss, Jocelyn Tolentino … (2007)
            The purpose of this study was to describe prognostic factors for outcome in a large series of patients undergoing neurosurgical clipping of aneurysms after subarachnoid hemorrhage (SAH). Data were analyzed from 3567 patients with aneurysmal SAH enrolled in 4 randomized clinical trials between 1991 and 1997. The primary outcome measure was the Glasgow outcome scale 3 months after SAH. Multivariable logistic regression with backwards selection and Cox proportional hazards regression models were derived to define independent predictors of unfavorable outcome. In multivariable analysis, unfavorable outcome was associated with increasing age, worsening neurological grade, ruptured posterior circulation aneurysm, larger aneurysm size, more SAH on admission computed tomography, intracerebral hematoma or intraventricular hemorrhage, elevated systolic blood pressure on admission, and previous diagnosis of hypertension, myocardial infarction, liver disease, or SAH. Variables present during hospitalization associated with poor outcome were temperature >38 degrees C 8 days after SAH, use of anticonvulsants, symptomatic vasospasm, and cerebral infarction. Use of prophylactic or therapeutic hypervolemia or prophylactic-induced hypertension were associated with a lower risk of unfavorable outcome. Time from admission to surgery was significant in some models. Factors that contributed most to variation in outcome, in descending order of importance, were cerebral infarction, neurological grade, age, temperature on day 8, intraventricular hemorrhage, vasospasm, SAH, intracerebral hematoma, and history of hypertension. Although most prognostic factors for outcome after SAH are present on admission and are not modifiable, a substantial contribution to outcome is made by factors developing after admission and which may be more easily influenced by treatment.
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              The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results.

              J Torner, N Kassell, David Adams … (1990)
              A prospective, observational clinical trial was conducted by the International Cooperative Study on the Timing of Aneurysm Surgery to determine the best time in relation to the hemorrhage for surgical treatment of ruptured intracranial aneurysms. Sixty-eight centers contributed 3521 patients in a 2 1/2-year period beginning in December, 1980. Analysis by a prespecified "planned" surgery interval demonstrated that there was no difference in early (0 to 3 days after the bleed) or late surgery (11 to 14 days). Outcome was worse if surgery was performed in the 7 to 10-day post-bleed interval. Surgical results were better for patients operated on after 10 days. Patients alert on admission fared best; however, alert patients had a mortality rate of 10% to 12% when undergoing surgery prior to Day 11 compared with 3% to 5% when surgery was performed after Day 10. Patients drowsy on admission had a 21% to 25% mortality rate when operated on up to Day 11 and 7% to 10% with surgery thereafter. Overall, early surgery was neither more hazardous nor beneficial than delayed surgery. The postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery.
              Article 0 comments Cited 87 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 17 October 2023
                Publication date (Electronic, collection): October 2023
                Volume: 15
                Issue: 10
                Electronic Location Identifier: e47197
                Affiliations
                [1 ] Department of Neurological Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
                [2 ] Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, USA
                [3 ] School of Osteopathic Medicine, William Carey College of Osteopathic Medicine, Hattiesburg, USA
                [4 ] Department of Emergency Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
                Author notes
                Article
                DOI: 10.7759/cureus.47197
                PMC ID: 10652662
                SO-VID: bae8b2ac-f076-46eb-b919-41cb6fb1882f
                Copyright © Copyright © 2023, Pendse et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 16 October 2023
                Categories
                Subject: Neurology
                Subject: Neurosurgery
                Subject: Trauma

                Keywords: endovascular coiling,hemorrhagic stroke,ultra-early surgical clipping,aneurysmal rupture,aneurysm
                Data availability:
                Keywords: endovascular coiling, hemorrhagic stroke, ultra-early surgical clipping, aneurysmal rupture, aneurysm

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