Evidence-Based Treatment of Cerebrovascular Disease

Evidence-Based Management of Subarachnoid Hemorrhage

Michael Diringer, M.D. -- Professor of Neurology, Neurological Surgery, and Occupational Therapy
Washington University School of Medicine -- Presented September 12, 2006

Introduction

The following lecture is part of an ongoing series of lectures that discuss the current state of evidence supporting different treatments for the most common types of cerebrovascular disease.

Table of Contents

All References

1. Subarachnoid hemorrhage
2. Disclosure
3. Common aneurysm locations
4. Rebleeding rates
5. Antifibrinolytic therapy for subarachnoid hemorrhage
6. Rebleeding followup
7. Cerebral ischemia followup
8. Poor outcome followup
9. Followup conclusions
10. Immediate administration of tranexamic acid
11. Number of verified rebleeds and outcomes
12. Occurrence of DINDs and vasospasm
13. Steroids - Cochrane review
14.Prevention of rebleeding
15. Surgical repair of aneurysm
16. Surgical repair of aneurysm (illustration)
17. Endovascular repair of aneurysms
18. Coils in aneurysms
19. ISAT - clipping vs. coiling
20. ISAT controversies
21.ISAT 1-year followup
22.ISAT: 2-month and 1-year outcomes
23.Mortality
24. Rebleeding of treated aneurysm
25. Cumulative rebleeding of treated aneurysm
26. Coiling (illustrations)
27. Vasospasm - delayed ischemic deficit (DID)
28. Factors in cerebral ischemia
29. Early ID of patients at risk for vasospasm
30. Variables
31. Clinical signs
32. Hemodynamic changes with vasospasm
33. Monitoring for vasospasm
34. Angiographic vasospasm
35. Angiographic vasospasm (illustration)
36. Incidence of angiographic vasospasm
37. TCD vasospasm
38. MCA diameter (graph)
39. Retrospective review of utility of TCD
40. Retrospective review of utility of TCD (graphs)
41. Mean time for TCD signs
42. Effects of induced hypertension on transcranial Doppler ultrasound
43. Clinical utility of monitoring with TCD
44. Early detection of vasospasm after acute SAH
45."Prophylactic" measures
46. Aggressive treatment of vasospasm
47. Hemodynamic augmentation
48. Literature
49. Published series on hemodynamic augmentation
50. Review of prevention of delayed ischemic deficits
51. Trials of hemodynamic augmentation
52. Review of prevention of delayed ischemic deficits II
53. Effects of hypervolemic therapy
54. Effects of hypervolemic therapy (table)
55. Effects of albumin administration
56. Safety of hypertensive hypervolemic therapy with phenylephrine
57. Safety of hemodynamic augmentation with Guglielmi cells
58. Efficacy of prophylactic nimodipine
59. Efficacy and safety of nicardipine implants
60. Application of nicardipine implants
61. Favorable vs. unfavorable outcome
62. Efficacy of controlled-release papaverine pellets
63. Lumbar drainage of CS fluid
64. Simvastatin after SAH
65. Markers of endothelial dysfunction and neuronal injury
66. Simvastatin for vasospasm (table)
67. Head-shaking method with urokinase irrigation
68. Enoxaparin vs. placebo
69. Transluminal balloon angioplasty
70. Magnesium therapy I
72.Magnesium therapy II
73. Magnsium results and conclusion

References