Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage

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  • 1 Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurosurgery, Rocky Mountain Neurosurgical Alliance, Englewood, Colorado; Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
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Object. Increased intracranial pressure (ICP) is well known to affect adversely patients with head injury. In contrast, the variables associated with ICP following aneurysmal subarachnoid hemorrhage (SAH) and their impact on outcome have been less intensely studied.

Methods. In this retrospective study the authors reviewed a prospective observational database cataloging the treatment details in 433 patients with SAH who had undergone surgical occlusion of an aneurysm as well as ICP monitoring. All 433 patients underwent postoperative ICP monitoring, whereas only 146 (33.7%) underwent both pre- and postoperative ICP monitoring.

The mean maximal ICP was 24.9 ± 17.3 mm Hg (mean ± standard deviation). During their hospital stay, 234 patients (54%) had elevated ICP (> 20 mm Hg), including 136 of those (48.7%) with a good clinical grade (Hunt and Hess Grades I–III) and 98 (63.6%) of the 154 patients with a poor grade (Hunt and Hess Grades IV and V) on admission. An increased mean maximal ICP was associated with several admission variables: worse Hunt and Hess clinical grade (p < 0.0001), a lower Glasgow Coma Scale (GSC) motor score (p < 0.0001); worse SAH grade based on results of computerized tomography studies (p < 0.0001); intracerebral hemorrhage (p = 0.024); severity of intraventricular hemorrhage (p < 0.0001); and rebleeding (p = 0.0048). Both intraoperative cerebral swelling (p = 0.0017) and postoperative GCS score (p < 0.0001) were significantly associated with a raised ICP. Variables such as patient age, aneurysm size, symptomatic vasospasm, intraoperative aneurysm rupture, and secondary cerebral insults such as hypoxia were not associated with raised ICP. Increased ICP adversely affected outcome: 71.9% of patients with normal ICP demonstrated favorable 6-month outcomes postoperatively, whereas 63.5% of patients with ICP between 20 and 50 mm Hg and 33.3% with ICP greater than 50 mm Hg demonstrated favorable outcomes. Among 21 patients whose raised ICP did not respond to mannitol therapy, all experienced a poor outcome and 95.2% died. Among 145 patients whose elevated ICP responded to mannitol, 66.9% had a favorable outcome and only 20.7% were dead 6 months after surgery (p < 0.0001). According to results of multivariate analysis, however, ICP was not an independent outcome predictor (odds ratio 1.26, 95% confidence interval 0.28–5.68).

Conclusions. Increased ICP is common after SAH, even in patients with a good clinical grade. Elevated ICP post-SAH is associated with a worse patient outcome, particularly if ICP does not respond to treatment. This association, however, may depend more on the overall severity of the SAH than on ICP alone.

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  • 1.

    Bailes JE, , Spetzler RF, & Hadley MN, et al: Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72:559566, 1990 Bailes JE, Spetzler RF, Hadley MN, et al: Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72:559–566, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Bederson JB, , Levy AL, & Ding WH, et al: Acute vasoconstriction after subarachnoid hemorrhage. Neurosurgery 42:352362, 1998 Bederson JB, Levy AL, Ding WH, et al: Acute vasoconstriction after subarachnoid hemorrhage. Neurosurgery 42:352–362, 1998

    • Search Google Scholar
    • Export Citation
  • 3.

    Black PM: Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysms. Neurosurgery 18:1216, 1986 Black PM: Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysms. Neurosurgery 18:12–16, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Brinker T, , Seifert V, & Stolke D: Acute changes in the dynamics of the cerebrospinal fluid system during experimental subarachnoid hemorrhage. Neurosurgery 27:369372, 1990 Brinker T, Seifert V, Stolke D: Acute changes in the dynamics of the cerebrospinal fluid system during experimental subarachnoid hemorrhage. Neurosurgery 27:369–372, 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Chestnut RM: Medical management of intracranial pressure, in Cooper PR, & Golfinos JG (eds): Head Injury, ed 4. New York: McGraw-Hill, 2000, pp 225246 Chestnut RM: Medical management of intracranial pressure, in Cooper PR, Golfinos JG (eds): Head Injury, ed 4. New York: McGraw-Hill, 2000, pp 225–246

    • Search Google Scholar
    • Export Citation
  • 6.

    Citerio G, , Cormio M, & Portella G, et al: Jugular saturation (SjvO2) monitoring in subarachnoid hemorrhage (SAH). Acta Neurochir Suppl 71:316319, 1998 Citerio G, Cormio M, Portella G, et al: Jugular saturation (SjvO2) monitoring in subarachnoid hemorrhage (SAH). Acta Neurochir Suppl 71:316–319, 1998

    • Search Google Scholar
    • Export Citation
  • 7.

    Claassen J, , Bernardini GL, & Kreiter K, et al: Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 32:20122020, 2001 Claassen J, Bernardini GL, Kreiter K, et al: Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 32:2012–2020, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Cross DT III, , Moran CJ, & Angtuaco EE, et al: Intracranial pressure monitoring during intraarterial papaverine infusion for cerebral vasospasm. AJNR 19:13191323, 1998 Cross DT III, Moran CJ, Angtuaco EE, et al: Intracranial pressure monitoring during intraarterial papaverine infusion for cerebral vasospasm. AJNR 19:1319–1323, 1998

    • Search Google Scholar
    • Export Citation
  • 9.

    Fearnside MR, , Cook RJ, & McDougall P, et al: The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg 7:267279, 1993 Fearnside MR, Cook RJ, McDougall P, et al: The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg 7:267–279, 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Fukuhara T, , Douville CM, & Eliott JP, et al: Relationship between intracranial pressure and the development of vasospasm after aneurysmal subarachnoid hemorrhage. Neurol Med Chir 38:710717, 1998 Fukuhara T, Douville CM, Eliott JP, et al: Relationship between intracranial pressure and the development of vasospasm after aneurysmal subarachnoid hemorrhage. Neurol Med Chir 38:710–717, 1998

    • Search Google Scholar
    • Export Citation
  • 11.

    Furuichi S, , Endo S, & Haji A, et al: Related changes in sympathetic activity, cerebral blood flow and intracranial pressure, and effect of an alpha-blocker in experimental subarachnoid haemorrhage. Acta Neurochir 141:415424, 1999 Furuichi S, Endo S, Haji A, et al: Related changes in sympathetic activity, cerebral blood flow and intracranial pressure, and effect of an alpha-blocker in experimental subarachnoid haemorrhage. Acta Neurochir 141:415–424, 1999

    • Search Google Scholar
    • Export Citation
  • 12.

    Gambardella G, , De Blasi F, & Caruso G, et al: Intracranial pressure, cerebral perfusion pressure, and SPECT in the management of patients with SAH Hunt and Hess grades I–II. Acta Neurochir Suppl 71:215218, 1998 Gambardella G, De Blasi F, Caruso G, et al: Intracranial pressure, cerebral perfusion pressure, and SPECT in the management of patients with SAH Hunt and Hess grades I–II. Acta Neurochir Suppl 71:215–218, 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    Groden C, , Kremer C, & Regelsberger J, et al: Comparison of operative and endovascular treatment of anterior circulation aneurysms in patients in poor grades. Neuroradiology 43:778783, 2001 Groden C, Kremer C, Regelsberger J, et al: Comparison of operative and endovascular treatment of anterior circulation aneurysms in patients in poor grades. Neuroradiology 43:778–783, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    Grote E, & Hassler W: The critical first minutes after subarachnoid hemorrhage. Neurosurgery 22:654661, 1988 Grote E, Hassler W: The critical first minutes after subarachnoid hemorrhage. Neurosurgery 22:654–661, 1988

    • Search Google Scholar
    • Export Citation
  • 15.

    Hasan D, , Vermeulen M, & Wijdicks EF, et al: Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20:747753, 1989 Hasan D, Vermeulen M, Wijdicks EF, et al: Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20:747–753, 1989

    • Search Google Scholar
    • Export Citation
  • 16.

    Hayashi M, , Kobayashi H, & Kawano H, et al: Cerebral blood flow and ICP patterns in patients with communicating hydrocephalus after aneurysm rupture. J Neurosurg 61:3036, 1984 Hayashi M, Kobayashi H, Kawano H, et al: Cerebral blood flow and ICP patterns in patients with communicating hydrocephalus after aneurysm rupture. J Neurosurg 61:30–36, 1984

    • Search Google Scholar
    • Export Citation
  • 17.

    Hayashi M, , Marukawa S, & Fujii H, et al: Intracranial pressure in patients with diffuse cerebral arterial spasm following ruptured intracranial aneurysms. Acta Neurochir 44:8195, 1978 Hayashi M, Marukawa S, Fujii H, et al: Intracranial pressure in patients with diffuse cerebral arterial spasm following ruptured intracranial aneurysms. Acta Neurochir 44:81–95, 1978

    • Search Google Scholar
    • Export Citation
  • 18.

    Hebert PC, , Wells G, & Blajchman MA, et al: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409417, 1999 Hebert PC, Wells G, Blajchman MA, et al: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409–417, 1999

    • Search Google Scholar
    • Export Citation
  • 19.

    Hebert PC, , Yetisir E, & Martin C, et al: Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 29:227234, 2001 Hebert PC, Yetisir E, Martin C, et al: Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 29:227–234, 2001

    • Search Google Scholar
    • Export Citation
  • 20.

    Heinsoo M, , Eelmae J, & Kuklane M, et al: The possible role of CSF hydrodynamic parameters following in management of SAH patients. Acta Neurochir Suppl 71:1315, 1998 Heinsoo M, Eelmae J, Kuklane M, et al: The possible role of CSF hydrodynamic parameters following in management of SAH patients. Acta Neurochir Suppl 71:13–15, 1998

    • Search Google Scholar
    • Export Citation
  • 21.

    Hunt WE, & Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:1420, 1968 Hunt WE, Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968

    • Search Google Scholar
    • Export Citation
  • 22.

    Inamasu J, , Nakamura Y, & Saito R et al: Endovascular treatment for poorest-grade subarachnoid hemorrhage in the acute stage: has the outcome been improved? Neurosurgery 50:11991206, 2002 Inamasu J, Nakamura Y, Saito R et al: Endovascular treatment for poorest-grade subarachnoid hemorrhage in the acute stage: has the outcome been improved? Neurosurgery 50:1199–1206, 2002

    • Search Google Scholar
    • Export Citation
  • 23.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 24.

    Kaye AH, & Brownbill D: Postoperative intracranial pressure in patients operated on for cerebral aneurysms following subarachnoid hemorrhage. J Neurosurg 54:726732, 1981 Kaye AH, Brownbill D: Postoperative intracranial pressure in patients operated on for cerebral aneurysms following subarachnoid hemorrhage. J Neurosurg 54:726–732, 1981

    • Search Google Scholar
    • Export Citation
  • 25.

    Kosteljanetz M: CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage. J Neurosurg 60:940946, 1984 Kosteljanetz M: CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage. J Neurosurg 60:940–946, 1984

    • Search Google Scholar
    • Export Citation
  • 26.

    Kuyama H, , Ladds A, & Branston NM, et al: An experimental study of acute subarachnoid haemorrhage in baboons: changes in cerebral blood volume, blood flow, electrical activity and water content. J Neurol Neurosurg Psychiatry 47:354364, 1984 Kuyama H, Ladds A, Branston NM, et al: An experimental study of acute subarachnoid haemorrhage in baboons: changes in cerebral blood volume, blood flow, electrical activity and water content. J Neurol Neurosurg Psychiatry 47:354–364, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    Lannoo E, , Van Rietvelde F, & Colardyn F, et al: Early predictors of mortality and morbidity after severe closed head injury. J Neurotrauma 17:403414, 2000 Lannoo E, Van Rietvelde F, Colardyn F, et al: Early predictors of mortality and morbidity after severe closed head injury. J Neurotrauma 17:403–414, 2000

    • Search Google Scholar
    • Export Citation
  • 28.

    Le Roux PD, , Dailey AT, & Newell DW, et al: Emergent aneurysm clipping without angiography in the moribund patient with intracerebral hemorrhage: The use of infusion computed tomography scans. Neurosurgery 33:189197, 1993 Le Roux PD, Dailey AT, Newell DW, et al: Emergent aneurysm clipping without angiography in the moribund patient with intracerebral hemorrhage: The use of infusion computed tomography scans. Neurosurgery 33:189–197, 1993

    • Search Google Scholar
    • Export Citation
  • 29.

    Le Roux PD, , Elliott JP, & Downey L, et al: Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg 83:394402, 1995 Le Roux PD, Elliott JP, Downey L, et al: Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg 83:394–402, 1995

    • Search Google Scholar
    • Export Citation
  • 30.

    Le Roux PD, , Elliott JP, & Newell DW, et al: Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 85:3949, 1996 Le Roux PD, Elliott JP, Newell DW, et al: Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 85:39–49, 1996

    • Search Google Scholar
    • Export Citation
  • 31.

    Le Roux PD, & Winn HR: Intracranial aneurysms and subarachnoid hemorrhage management of the poor grade patient. Acta Neurochir Suppl 72:726, 1999 Le Roux PD, Winn HR: Intracranial aneurysms and subarachnoid hemorrhage management of the poor grade patient. Acta Neurochir Suppl 72:7–26, 1999

    • Search Google Scholar
    • Export Citation
  • 32.

    Le Roux PD, & Winn HR: Management of the ruptured aneurysm, in Le Roux PD, , Winn HR, & Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 303333 Le Roux PD, Winn HR: Management of the ruptured aneurysm, in Le Roux PD, Winn HR, Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 303–333

    • Search Google Scholar
    • Export Citation
  • 33.

    Le Roux PD, & Winn HR: The poor grade aneurysm patient, in Salcman M (ed): Current Techniques in Neurosurgery. Philadelphia: Current Medicine, 1993, pp 10.110.28 Le Roux PD, Winn HR: The poor grade aneurysm patient, in Salcman M (ed): Current Techniques in Neurosurgery. Philadelphia: Current Medicine, 1993, pp 10.1–10.28

    • Search Google Scholar
    • Export Citation
  • 34.

    Lindegaard KF: The role of transcranial Doppler in the management of patients with subarachnoid haemorrhage—a review. Acta Neurochir Suppl 72:5971, 1999 Lindegaard KF: The role of transcranial Doppler in the management of patients with subarachnoid haemorrhage—a review. Acta Neurochir Suppl 72:59–71, 1999

    • Search Google Scholar
    • Export Citation
  • 35.

    Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (Suppl 149):1193, 1960 Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (Suppl 149):1–193, 1960

    • Search Google Scholar
    • Export Citation
  • 36.

    Marik PE, & Sibbald WJ: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269:30243029, 1993 Marik PE, Sibbald WJ: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269:3024–3029, 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Marmarou A, , Anderson RL, & Ward JD, et al: Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:S59S66, 1991 Marmarou A, Anderson RL, Ward JD, et al: Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:S59–S66, 1991

    • Search Google Scholar
    • Export Citation
  • 38.

    McKhann GM II, , Mayer SA, & Le Roux PD: Perioperative and ICU care of patients with aneurysmal subarachnoid hemorrhage, in Le Roux P, , Winn HR, & Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 431454 McKhann GM II, Mayer SA, Le Roux PD: Perioperative and ICU care of patients with aneurysmal subarachnoid hemorrhage, in Le Roux P, Winn HR, Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 431–454

    • Search Google Scholar
    • Export Citation
  • 39.

    Mendelow AD: Pathophysiology of delayed ischaemic dysfunction after subarachnoid haemorrhage: experimental and clinical data. Acta Neurochir Suppl 45:710, 1988 Mendelow AD: Pathophysiology of delayed ischaemic dysfunction after subarachnoid haemorrhage: experimental and clinical data. Acta Neurochir Suppl 45:7–10, 1988

    • Search Google Scholar
    • Export Citation
  • 40.

    Miller JD, , Becker DP, & Ward JD, et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503516, 1977 Miller JD, Becker DP, Ward JD, et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503–516, 1977

    • Search Google Scholar
    • Export Citation
  • 41.

    Narayan RK, , Kishore PR, & Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650659, 1982 Narayan RK, Kishore PR, Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650–659, 1982

    • Search Google Scholar
    • Export Citation
  • 42.

    Newell DW, , LeRoux PD, & Dacey RG Jr, et al: CT infusion scanning for the detection of cerebral aneurysms. J Neurosurg 71:175179, 1989 Newell DW, LeRoux PD, Dacey RG Jr, et al: CT infusion scanning for the detection of cerebral aneurysms. J Neurosurg 71:175–179, 1989

    • Search Google Scholar
    • Export Citation
  • 43.

    Nornes H: The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39:226234, 1973 Nornes H: The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39:226–234, 1973

    • Search Google Scholar
    • Export Citation
  • 44.

    Nornes H, & Magnaes B: Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg 36:537547, 1972 Nornes H, Magnaes B: Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg 36:537–547, 1972

    • Search Google Scholar
    • Export Citation
  • 45.

    Pare L, , Delfino R, & Leblanc R: The relationship of ventricular drainage to aneurysmal rebleeding. J Neurosurg 76:422427, 1992 Pare L, Delfino R, Leblanc R: The relationship of ventricular drainage to aneurysmal rebleeding. J Neurosurg 76:422–427, 1992

    • Search Google Scholar
    • Export Citation
  • 46.

    Raimondi AJ, & Torres H: Acute hydrocephalus as a complication of subarachnoid hemorrhage. Surg Neurol 1:2326, 1973 Raimondi AJ, Torres H: Acute hydrocephalus as a complication of subarachnoid hemorrhage. Surg Neurol 1:23–26, 1973

    • Search Google Scholar
    • Export Citation
  • 47.

    Robertson C: Critical care management of traumatic brain injury, in Winn HR (ed): Youmans Neurological Surgery, ed 5. Philadelphia: Saunders, 2004, pp 51035144 Robertson C: Critical care management of traumatic brain injury, in Winn HR (ed): Youmans Neurological Surgery, ed 5. Philadelphia: Saunders, 2004, pp 5103–5144

    • Search Google Scholar
    • Export Citation
  • 48.

    Rordorf G, , Ogilvy CS, & Gress DR, et al: Patients in poor neurological condition after subarachnoid hemorrhage: early management and long-term outcome. Acta Neurochir 139:11431151, 1997 Rordorf G, Ogilvy CS, Gress DR, et al: Patients in poor neurological condition after subarachnoid hemorrhage: early management and long-term outcome. Acta Neurochir 139:1143–1151, 1997

    • Search Google Scholar
    • Export Citation
  • 49.

    Schmoker JD, , Shackford SR, & Wald SL, et al: An analysis of the relationship between fluid and sodium administration and intracranial pressure after head injury. J Trauma 33:476481, 1992 Schmoker JD, Shackford SR, Wald SL, et al: An analysis of the relationship between fluid and sodium administration and intracranial pressure after head injury. J Trauma 33:476–481, 1992

    • Search Google Scholar
    • Export Citation
  • 50.

    Smith ER, , Carter BS, & Ogilvy CS: Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas. Neurosurgery 51:117124, 2002 Smith ER, Carter BS, Ogilvy CS: Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas. Neurosurgery 51:117–124, 2002

    • Search Google Scholar
    • Export Citation
  • 51.

    Steiner L, , Lofgren J, & Zwetnow NN: Characteristics and limits of tolerance in repeated subarachnoid hemorrhage in dogs. Acta Neurol Scand 52:241267, 1975 Steiner L, Lofgren J, Zwetnow NN: Characteristics and limits of tolerance in repeated subarachnoid hemorrhage in dogs. Acta Neurol Scand 52:241–267, 1975

    • Search Google Scholar
    • Export Citation
  • 52.

    Takeuchi S, , Koike T, & Sasaki O, et al: Intracranial extradural pressure monitoring after direct operation on ruptured cerebral aneurysms. Neurosurgery 24:878883, 1989 Takeuchi S, Koike T, Sasaki O, et al: Intracranial extradural pressure monitoring after direct operation on ruptured cerebral aneurysms. Neurosurgery 24:878–883, 1989

    • Search Google Scholar
    • Export Citation
  • 53.

    Teasdale GM, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale GM, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • Search Google Scholar
    • Export Citation
  • 54.

    Tomei G, , Gaini SM, & Giovanelli M, et al: Intracranial pressure in subarachnoid hemorrhage. Preliminary report in 36 cases. J Neurosurg Sci 25:5766, 1981 Tomei G, Gaini SM, Giovanelli M, et al: Intracranial pressure in subarachnoid hemorrhage. Preliminary report in 36 cases. J Neurosurg Sci 25:57–66, 1981

    • Search Google Scholar
    • Export Citation
  • 55.

    Trojanowski T: Early effects of experimental arterial subarachnoid haemorrhage on the cerebral circulation. Part I: Experimental subarachnoid haemorrhage in cat and its pathophysiological effects. Methods of regional cerebral blood flow measurement and evaluation of microcirculation. Acta Neurochir 72:7994, 1984 Trojanowski T: Early effects of experimental arterial subarachnoid haemorrhage on the cerebral circulation. Part I: Experimental subarachnoid haemorrhage in cat and its pathophysiological effects. Methods of regional cerebral blood flow measurement and evaluation of microcirculation. Acta Neurochir 72:79–94, 1984

    • Search Google Scholar
    • Export Citation
  • 56.

    van Gijn J, , Hijdra A, & Wijdicks EF, et al: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:355362, 1985 van Gijn J, Hijdra A, Wijdicks EF, et al: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:355–362, 1985

    • Search Google Scholar
    • Export Citation
  • 57.

    Vincent JL, , Baron JF, & Reinhart K, et al: Anemia and blood transfusion in critically ill patients. JAMA 288:14991507, 2002 Vincent JL, Baron JF, Reinhart K, et al: Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507, 2002

    • Search Google Scholar
    • Export Citation
  • 58.

    Voldby B, & Enevoldsen EM: Intracranial pressure changes following aneurysm rupture. Part 1: clinical and angiographic correlations. J Neurosurg 56:186196, 1982 Voldby B, Enevoldsen EM: Intracranial pressure changes following aneurysm rupture. Part 1: clinical and angiographic correlations. J Neurosurg 56:186–196, 1982

    • Search Google Scholar
    • Export Citation
  • 59.

    Zhao W, , Ujiie H, & Tamano Y, et al: Sudden death in a rat subarachnoid hemorrhage model. Neurol Med Chir 39:735743, 1999 Zhao W, Ujiie H, Tamano Y, et al: Sudden death in a rat subarachnoid hemorrhage model. Neurol Med Chir 39:735–743, 1999

    • Search Google Scholar
    • Export Citation

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