Table of Contents
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Abstract
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Case Presentations
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Introduction
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Critical Appraisal Of The Literature
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Etiology And Pathophysiology
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Incidence
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Etiology
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Pathophysiology Of Aneurysms
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Subarachnoid Hemorrhage Clinical Severity Scales
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Differential Diagnosis
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Prehospital Care
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Emergency Department Evaluation
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Whom To Evaluate?
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History
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Physical Examination
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Clinical Decision Rules
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Diagnostic Studies
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Noncontrast Computed Tomography
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Lumbar Puncture
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Interpreting The Lumbar Puncture
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Opening Pressure
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Red Blood Cell Analysis
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Xanthochromia
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Assessing Xanthochromia: Visual Analysis Versus Spectrophotometry
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Cardiopulmonary Testing
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Clinical Decision Making
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Role Of Primary Computed Tomography Angiography In Subarachnoid Hemorrhage
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Role Of Primary Magnetic Resonance Imaging In Diagnosis Of Subarachnoid Hemorrhage
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Management
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Initial Management
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General Care Measures
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Cerebrovascular Imaging
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Monitoring And Preventing Complications
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Rebleeding
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Blood Pressure Management
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Preventing Vasospasm
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Seizure Prophylaxis
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Acute Clinical Deterioration
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Definitive Aneurysm Repair
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Prognosis
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Special Circumstances
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Pregnant And Postpartum Women
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Anticoagulated Patients
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Controversies And Cutting Edge
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Computed Tomography Angiography
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Lumbar Puncture–First Strategy
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Role Of Warning Headache
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Disposition
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Summary
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Cost-Effective Strategies
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Risk Management Pitfalls For Subarachnoid Hemorrhage
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Case Conclusion
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Clinical Pathway For Emergency Evaluation Of Suspected Subarachnoid Hemorrhage
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Tables and Figures
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Table 1. 2008 ACEP Clinical Policy On Acute Headache (Subarachnoid Hemorrhage)
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Table 2. 2012 AHA Guidelines For Management Of Aneurysmal Subarachnoid Hemorrhage
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Table 3. Subarachnoid Hemorrhage Grading Scales
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Table 4. Differential Diagnosis Of Sudden-Onset Nontraumatic Headache
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Table 5. Key Questions For Patients With Acute Headache
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Table 6. Associated Findings That May Distract From Diagnosis Of Subarachnoid Hemorrhage
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Table 7. Physical Examination Findings Associated With Aneurysmal Subarachnoid Hemorrhage
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Table 8. Ottawa Subarachnoid Hemorrhage Rules
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Table 9. Limitations Of Computed Tomography
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Table 10. Limitations Of Lumbar Puncture
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Table 11. Non-SAH Causes Of Xanthochromia
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Table 12. Emergency Department Management Of Subarachnoid Hemorrhage
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Figure 1. Subarachnoid Hemorrhage On Noncontrast Head Computed Tomography
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Figure 2. Perimesencephalic Hemorrhage On Noncontrast Head Computed Tomography
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Figure 3. Causes Of Spontaneous Subarachnoid Hemorrhage
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Figure 4. Traumatic Subarachnoid Hemorrhage On Noncontrast Head Computed Tomography
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Figure 5. Detection Of Aneurysm By Computed Tomography Angiography OF The Head
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References
Abstract
Aneurysmal subarachnoid hemorrhage accounts for a small percentage of strokes, but it is a significant contributor to the morbidity rate. The diagnosis is challenging and has devastating consequences if it is missed. Accurate initial diagnosis and management are critical to the outcome of the disease. The emergency clinician must have a high index of suspicion and a judicious approach to evaluating the chief complaint of patients with spontaneous subarachnoid hemorrhage (ie, headache). This review evaluates the literature and current evidence, including controversies and recent American Heart Association guidelines, to support a best-practice approach to the diagnosis and treatment of patients with spontaneous subarachnoid hemorrhage.
Case Presentations
You walk into a crowded evening shift in the ED, and your first patient is a middle-aged woman clutching her head in her hands, complaining of the "worst headache of her life." You are worried about a subarachnoid hemorrhage. After treating her pain, you order a noncontrast head CT, which is negative. She now says that her headache is better and that she needs to go home to pick up her kids. Does she really need a lumbar puncture? She eventually agrees to stay for a lumbar puncture, which is also negative. Can she go home now? Does she need any additional workup?
While you are thinking about this, another patient with a history of migraine arrives complaining of suddenonset, severe headache that has lasted 12 hours. Is this headache her usual migraine or could this be a spontaneous subarachnoid hemorrhage? After further history is obtained, you are concerned about a subarachnoid hemorrhage and you obtain a CT, which is normal. You perform a lumbar puncture, which shows some clearing of red blood cells from tube 1 to tube 4. You think it may have been a traumatic tap, but how can you be sure? Just as you are pondering this, the lab calls to say there is xanthochromia. You make the diagnosis of spontaneous subarachnoid hemorrhage. After calling for neurosurgical consultation, what else should you do in the ED to treat this patient?
Introduction
Subarachnoid hemorrhage (SAH) is the extravasation of blood into the cerebrospinal fluid (CSF). It is usually a diffuse process that results from rupture of corticomeningeal vessels and from hemorrhagic contusions of the brain.1 Trauma is the most common cause of all SAH; however, the majority (85%) of nontraumatic, or spontaneous SAH (sSAH), the focus of this article, are related to aneurysm rupture.2-4 Aneurysmal SAH (aSAH) and other forms of sSAH can pose diagnostic challenges in the emergency department (ED).
Distinguishing traumatic SAH from sSAH may be difficult in some cases because the trauma may have been unwitnessed; however, this distinction is important. See Figure 1 for the typical appearance of a sSAH on noncontrast head computed tomography (CT). The emergency clinician must be able to quickly and accurately identify and categorize SAH, and should be aware of the secondary complications that affect both the central nervous system and other major organs. Initial management and treatment decisions should be made to minimize effects of the initial neurologic injury. This issue of Emergency Medicine Practice focuses on the diagnostic challenges, the initial management and treatment options, and some of the more severe complications of sSAH, using the best available evidence from the literature.
Critical Appraisal Of The Literature
The overall incidence of sSAH is relatively low and, therefore, the availability of high-quality evidence is limited. A literature search was performed using Ovid MEDLINE® and PubMed from 1950 to May 2014. Search terms included subarachnoid hemorrhage, aneurysm, thunderclap headache, sentinel headache, lumbar puncture, xanthochromia, emergency department, head CT, CTA, angiography, MRI, nimodipine, risk factors, prehospital care, diagnosis, management, analgesia, treatment, rebleeding, vasospasm, hypertension, antiepileptic, and combinations of these keywords. The search was limited to the English language and human studies. More than 500 articles were reviewed, which provided background for further literature review. During the literature review process, the highest value was placed on clinical trials, larger prospective cohort studies, and meta-analyses of clinical trials. Secondary evidence was collected from retrospective studies, case-control studies, and other metaanalyses. Finally, expert consensus statements and case reports were reviewed. The Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse (www.guideline.gov) were also consulted.
The most relevant guidelines for emergency clinicians are the 2008 American College of Emergency Physicians (ACEP) Clinical Policy on acute headache (see Table 1),5 the 2012 American Heart Association (AHA) Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage,6 (see Table 2) and the 2011 Neurocritical Care Society (NCS) Guidelines on the critical care management of patients with aSAH.7
Risk Management Pitfalls For Subarachnoid Hemorrhage
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“I thought it was a migraine, so I did not order a head CT.” A head CT should be considered even in patients with a primary headache disorder, like migraine, if the characteristics of the headache are substantially different from their usual symptoms.
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“Her symptoms were suggestive of the flu.” Emergency clinicians should be aware of the wide spectrum of clinical symptoms that may present as SAH. Patients may have nonspecific symptoms, including neck pain, myalgia, and mild headache, which may be misdiagnosed as a viral syndrome. Consider CT and, if negative, LP.
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“His symptoms improved with antiemetics and analgesics.” Patients with SAH may have symptoms that completely resolve with pain medications and sometimes even without treatment. The decision to work up a patient for SAH should not be solely influenced by response to pain medications.
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“He was from a nursing home, delirious, and had a urinary tract infection, so I thought it was urosepsis.” Patients with delirium or a change in mental status should be carefully evaluated, as SAH may be in the differential. Studies have shown that psychiatric diagnoses and delirium are common misdiagnoses for SAH.
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“Her pain was atypical and she had chest pain with an abnormal ECG.” Patients with SAH may have an abnormal ECG and/or positive cardiac markers due to effects of a catecholamine surge from brain injury. Focusing on these cardiac findings may distract the emergency clinician from diagnosing the underlying etiology, which may be SAH.
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“The head CT was negative and the patient clinically improved and wanted to go home.” CT may be negative in 2% to 7% of patients with SAH, and sensitivity is highly time-dependent. In a patient with suspected SAH, LP is required to rule out the diagnosis, regardless of other circumstances. However, patients’ autonomy is important and should be respected as long as they are informed.
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“The patient did not mention taking anticoagulants, so I did not check anticoagulation tests.” Basic laboratory tests (including prothrombin time and partial thromboplastin time) should be checked in all patients with intracranial hemorrhage. Some patients may not be able to provide an accurate history. When patients on therapeutic anticoagulants are diagnosed with SAH, the clotting deficiency should be reversed quickly with intravenous vitamin K and clotting factor.
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“The number of RBCs decreased from the first tube to the fourth tube so I presumed it was a traumatic tap.” There is no cutoff for the minimum number of RBCs required to diagnose SAH, and it has been reported with even a few hundred cells. Despite serial clearing of red cells, if there is ambiguity between a traumatic tap and possible SAH, further neuroimaging and neurosurgical consultation should be obtained to rule out the diagnosis. Also, remember that the number of RBCs diminishes with time after onset of headache.
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“I did not transfer the patient because…” Any patient whose condition is diagnosed as SAH should be transferred to a facility with neurosurgical, endovascular, and advanced neuroimaging capabilities. Data show better outcomes for patients treated quickly at these specialized centers.
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“I diagnosed the SAH and the patient was waiting to transfer when she became disoriented.” Patients with SAH should have careful cardiorespiratory monitoring and serial neurological examinations. They are at risk for developing complications such as rebleeding, vasospasm, and hydrocephalus. Intubation may need to be performed if the patient is unable to protect the airway. Repeated head CT should be considered, because clinical deterioration from acute hydrocephalus can be reversed with treatment.
Tables and Figures
References
Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.
To help the reader judge the strength of each reference, pertinent information about the study will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.
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Edlow JA, Malek AM, Ogilvy CS. Aneurysmal subarachnoid hemorrhage: update for emergency physicians. J Emerg Med. 2008;34(3):237-251. (Review)
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Fukuda T, Hasue M, Ito H. Does traumatic subarachnoid hemorrhage caused by diffuse brain injury cause delayed ischemic brain damage? Comparison with subarachnoid hemorrhage caused by ruptured intracranial aneurysms. Neurosurgery. 1998;43(5):1040-1049. (Retrospective; 99 patients, 114 patients)
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*Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354(4):387-396. (Review)
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Carvi y Nievas MN, Archavlis E. Atypical causes of nontraumatic intracranial subarachnoid hemorrhage. Clin Neurol Neurosurg. 2009;111(4):354-358. (Retrospective; 820 patients)
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* Edlow JA, Panagos PD, Godwin SA, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52(4):407- 436. (Practice guidelines, systematic review)
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* Connolly ES, Jr., Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43(6):1711-1737. (Practice guidelines)
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* Bederson JB, Connolly ES, Jr., Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40(3):994-1025. (Practice guidelines, systematic review)
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Findlay JM. Current management of aneurysmal subarachnoid hemorrhage guidelines from the Canadian Neurosurgical Society. Can J Neurol Sci. 1997;24(2):161-170. (Practice guidelines, systemic review)
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Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38(6):2001-2023. (Practice guidelines, systemic review)
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Masdeu JC, Irimia P, Asenbaum S, et al. EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force. Eur J Neurol. 2006;13(12):1271-1283. (Practice guidelines, systematic review, and expert consensus)
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Martin V, Elkind A. Diagnosis and classification of primary headache disorders. In: Standards of Care for Headache Diagnosis and Treatment. Chicago, IL: National Headache Foundation. 2004. (Practice guidelines, systematic review, and expert consensus)
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Diringer MN, Bleck TP, Claude Hemphill J, 3rd, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15(2):211-240. (Practice guidelines)
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Ingall T, Asplund K, Mahonen M, et al. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke. 2000;31(5):1054- 1061. (Prospective international multicenter; 3368 patients)
-
Kozak N, Hayashi M. Trends in the incidence of subarachnoid hemorrhage in Akita Prefecture, Japan. J Neurosurg. 2007;106(2):234-238. (Retrospective; 3257 patients)
-
King JT, Jr. Epidemiology of aneurysmal subarachnoid hemorrhage. Neuroimaging Clin N Am. 1997;7(4):659-668. (Review)
-
Broderick JP, Viscoli CM, Brott T, et al. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke. 2003;34(6):1375-1381. (Retrospective; 425 patients)
-
Juvela S, Hillbom M, Numminen H, et al. Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage. Stroke. 1993;24(5):639-646. (Retrospective; 592 patients)
-
Stampfer MJ, Colditz GA, Willett WC, et al. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988;319(5):267-273. (Prospective; 87,526 subjects, 334,382 person-years)
-
Donahue RP, Abbott RD, Reed DM, et al. Alcohol and hemorrhagic stroke. The Honolulu Heart Program. JAMA. 1986;255(17):2311-2314. (Prospective; 8006 patients)
-
van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124(Pt 2):249-278. (Review)
-
Okamoto K, Horisawa R, Kawamura T, et al. Family history and risk of subarachnoid hemorrhage: a case-control study in Nagoya, Japan. Stroke. 2003;34(2):422-426. (Prospective; 195 patients)
-
Wang PS, Longstreth WT Jr, Koepsell TD. Subarachnoid hemorrhage and family history. A population-based casecontrol study. Arch Neurol. 1995;52(2):202-204. (Prospective; 149 patients)
-
Mhurchu CN, Anderson C, Jamrozik K, et al. Hormonal factors and risk of aneurysmal subarachnoid hemorrhage: an international population-based, case-control study. Stroke. 2001;32(3):606-612. (Prospective; 268 patients)
-
Gaist D, Pedersen L, Cnattingius S, et al. Parity and risk of subarachnoid hemorrhage in women: a nested casecontrol study based on national Swedish registries. Stroke. 2004;35(1):28-32. (Retrospective; 887 cases)
-
Yang CY, Chang CC, Kuo HW, et al. Parity and risk of death from subarachnoid hemorrhage in women: evidence from a cohort in Taiwan. Neurology. 2006;67(3):514-515. (Vital statistics database review; 1,292,462 patients)
-
Qureshi AI, Suri MF, Yahia AM, et al. Risk factors for subarachnoid hemorrhage. Neurosurgery. 2001;49(3):607-612. (Retrospective; 323 patients).
-
Watanabe A, Hirano K, Kamada M, et al. Perimesencephalic nonaneurysmal subarachnoid haemorrhage and variations in the veins. Neuroradiology. 2002;44(4):319-325. (Retrospective; 6 patients)
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Yamakawa H, Ohe N, Yano H, et al. Venous drainage patterns in perimesencephalic nonaneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2008;110(6):587-591. (Retrospective; 18 patients)
-
Greebe P, Rinkel GJ. Life expectancy after perimesencephalic subarachnoid hemorrhage. Stroke. 2007;38(4):1222-1224. (Prospective; 160 patients)
-
Hui FK, Tumialan LM, Tanaka T, et al. Clinical differences between angiographically negative, diffuse subarachnoid hemorrhage and perimesencephalic subarachnoid hemorrhage. Neurocrit Care. 2009;11(1):64-70. (Retrospective; 94 patients)
-
Lin N, Zenonos G, Kim AH, et al. Angiogram-negative subarachnoid hemorrhage: relationship between bleeding pattern and clinical outcome. Neurocrit Care. 2012;16(3):389- 398. (Retrospective; 352 patients)
-
Rinkel GJ, Wijdicks EF, Vermeulen M, et al. The clinical course of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Ann Neurol. 1991;29(5):463-468. (Prospective; 65 patients)
-
Rinkel GJ, van Gijn J, Wijdicks EF. Subarachnoid hemorrhage without detectable aneurysm. A review of the causes. Stroke. 1993;24(9):1403-1409. (Review)
-
van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;369(9558):306-318. (Review)
-
Heiskanen O. Ruptured intracranial arterial aneurysms of children and adolescents. Surgical and total management results. Childs Nerv Syst. 1989;5(2):66-70. (Retrospective; 16 patients)
-
Stehbens WE. Etiology of intracranial berry aneurysms. J Neurosurg. 1989;70(6):823-831. (Review)
-
Rinkel GJ, Djibuti M, Algra A, et al. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998;29(1):251-256. (Systematic review and metaanalysis; 23 studies, 56,304 patients)
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Wiebers DO, Whisnant JP, Huston J 3rd, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103-110. (Prospective; 4060 patients)
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Kataoka K, Taneda M, Asai T, et al. Structural fragility and inflammatory response of ruptured cerebral aneurysms. A comparative study between ruptured and unruptured cerebral aneurysms. Stroke. 1999;30(7):1396-1401. (Comparative study; 71 patients)
-
Khurana VG, Meissner I, Meyer FB. Update on genetic evidence for rupture-prone compared with ruptureresistant intracranial saccular aneurysms. Neurosurg Focus. 2004;17(5):E7. (Prospective; 197 patients)
-
Mackey J, Brown RD Jr, Moomaw CJ, et al. Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location. J Neurosurg. 2012;117(1):60-64. (Prospective; 983 patients)
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Morita A, Fujiwara S, Hashi K, et al. Risk of rupture associated with intact cerebral aneurysms in the Japanese population: a systematic review of the literature from Japan. J Neurosurg. 2005;102(4):601-606. (Systematic review, 13 Japenese studies; 3801 patient-years)
-
Lindner SH, Bor AS, Rinkel GJ. Differences in risk factors according to the site of intracranial aneurysms. J Neurol Neurosurg Psychiatry. 2010;81(1):116-118. (Prospective; 304 patients)
-
Schievink WI, Karemaker JM, Hageman LM, et al. Circumstances surrounding aneurysmal subarachnoid hemorrhage. Surg Neurol. 1989;32(4):266-272. (Retrospective; 500 patients)
-
Fann JR, Kukull WA, Katon WJ, et al. Physical activity and subarachnoid haemorrhage: a population based case-control study. J Neurol Neurosurg Psychiatry. 2000;69(6):768-772. (Retrospective; 149 patients)
-
Anderson C, Ni Mhurchu C, Scott D, et al. Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke. 2003;34(7):1771-1776. (Retrospective; 432 patients)
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Matsuda M, Watanabe K, Saito A, et al. Circumstances, activities, and events precipitating aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2007;16(1):25-29. (Retrospective; 513 patients)
-
Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology. 2008;50(8):653-664. (Systematic review of 46 systematic reviews)
-
Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14-20. (Retrospective; 275 patients)
-
Teasdale GM, Drake CG, Hunt W, et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry. 1988;51(11):1457. (Prospective evaluation; 3521 patients)
-
Degen LA, Dorhout Mees SM, Algra A, et al. Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage. Stroke. 2011;42(6):1546-1549. (Prospective evaluation; 50 patients)
-
Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1-9. (Retrospective; 47 patients)
-
Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006;59(1):21-27. (Metaanalysis; 1355 patients)
-
Wilson DA, Nakaji P, Abla AA, et al. A simple and quan titative method to predict symptomatic vasospasm after subarachnoid hemorrhage based on computed tomography: beyond the Fisher scale. Neurosurgery. 2012;71(4):869- 875. (Prospective evaluation; 250 patients)
-
Sato T, Sasaki T, Sakuma J, et al. Quantification of subarachnoid hemorrhage by three-dimensional computed tomography: correlation between hematoma volume and symptomatic vasospasm. Neurol Med Chir (Tokyo). 2011;51 (3):187-194. (Prospective evaluation; 50 patients)
-
Ko SB, Choi HA, Carpenter AM, et al. Quantitative analysis of hemorrhage volume for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Stroke. 2011;42(3):669- 674. (Prospective evaluation; 160 patients)
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* Goldstein JN, Camargo CA, Jr., Pelletier AJ, et al. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia. 2006;26(6):684-690. (Retrospective; 21 million ED visits)
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Ramirez-Lassepas M, Espinosa CE, Cicero JJ, et al. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol. 1997;54(12):1506-1509. (Retrospective case- control; 468 patients)
-
Dhopesh V, Anwar R, Herring C. A retrospective assessment of emergency department patients with complaint of headache. Headache. 1979;19(1):37-42.
-
Leicht MJ. Non-traumatic headache in the emergency department. Ann Emerg Med. 1980;9(8):404-409. (Retrospective; 872 patients)
-
Linn FH, Wijdicks EF, van der Graaf Y, et al. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344(8922):590-593. (Prospective; 148 patients)
-
Wijdicks EF, Kerkhoff H, van Gijn J. Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage. Lancet. 1988;2(8602):68-70. (Prospective; 71 patients)
-
Landtblom AM, Fridriksson S, Boivie J, et al. Sudden-onset headache: a prospective study of features, incidence and causes. Cephalalgia. 2002;22(5):354-360. (Prospective; 137 patients)
-
Morgenstern LB, Luna-Gonzales H, Huber JC Jr, et al. Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis. Ann Emerg Med. 1998;32(3 Pt 1):297-304. (Prospective; 107 patients)
-
Bo SH, Davidsen EM, Gulbrandsen P, et al. Acute headache: a prospective diagnostic work-up of patients admitted to a general hospital. Eur J Neurol. 2008;15(12):1293-1299. (Prospective; 433 patients)
-
Perry JJ, Spacek A, Forbes M, et al. Is the combination of negative computed tomography result and negative lumbar puncture result sufficient to rule out subarachnoid hemorrhage? Ann Emerg Med. 2008;51(6):707-713. (Prospective; 592 patients)
-
Vermeulen MJ, Schull MJ. Missed diagnosis of subarachnoid hemorrhage in the emergency department. Stroke. 2007;38(4):1216-1221. (Retrospective; 1507 patients)
-
* Kowalski RG, Claassen J, Kreiter KT, et al. Initial misdiagnosis and outcome after subarachnoid hemorrhage. JAMA. 2004;291(7):866-869. (Retrospective; 482 patients)
-
Mayer PL, Awad IA, Todor R, et al. Misdiagnosis of symptomatic cerebral aneurysm. Prevalence and correlation with outcome at four institutions. Stroke. 1996;27(9):1558-1563. (Retrospective; 217 patients)
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Vannemreddy P, Nanda A, Kelley R, et al. Delayed diagnosis of intracranial aneurysms: confounding factors in clinical presentation and the influence of misdiagnosis on outcome. South Med J. 2001;94(11):1108-1111. (Retrospective; 270 patients)
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* Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. 2000;342(1):29-36. (Review)
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Hop JW, Rinkel GJ, Algra A, et al. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28(3):660-664. (Review)
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Neil-Dwyer G, Lang D. ‘Brain attack’--aneurysmal subarachnoid haemorrhage: death due to delayed diagnosis. J R Coll Physicians Lond. 1997;31(1):49-52. (Retrospective; 136 patients)
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Broderick JP, Brott TG, Duldner JE, et al. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke. 1994;25(7):1342-1347. (Review)
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Feigin VL, Lawes CM, Bennett DA, et al. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43-53. (Review)
-
Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355(9):928-939. (Review)
-
Acker JE 3rd, Pancioli AM, Crocco TJ, et al. Implementation strategies for emergency medical services within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council. Stroke. 2007;38(11):3097-3115. (Policy statement)
-
Dodick DW. Thunderclap headache. J Neurol Neurosurg Psychiatry. 2002;72(1):6-11. (Review)
-
Linn FH, Rinkel GJ, Algra A, et al. Follow-up of idiopathic thunderclap headache in general practice. J Neurol. 1999;246(10):946-948. (Prospective; 93 patients)
-
Harling DW, Peatfield RC, Van Hille PT, et al. Thunderclap headache: is it migraine? Cephalalgia. 1989;9(2):87-90. (Prospective; 16 patients)
-
Lledo A, Calandre L, Martinez-Menendez B, et al. Acute headache of recent onset and subarachnoid hemorrhage: a prospective study. Headache. 1994;34(3):172-174. (Prospective; 27 patients)
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Linn FH, Rinkel GJ, Algra A, et al. Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. J Neurol Neurosurg Psychiatry. 1998;65(5):791-793. (Prospective; 102 patients)
-
Day JW, Raskin NH. Thunderclap headache: symptom of unruptured cerebral aneurysm. Lancet. 1986;2(8518):1247- 1248. (Case report)
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Kassell NF, Torner JC, Haley EC, Jr., et al. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg. 1990;73(1):18-36. (Prospective observational multicenter; 3521 patients)
-
Naganuma M, Fujioka S, Inatomi Y, et al. Clinical characteristics of subarachnoid hemorrhage with or without headache. J Stroke Cerebrovasc Dis. 2008;17(6):334-339. (Retrospective; 224 patients)
-
Fountas KN, Kapsalaki EZ, Lee GP, et al. Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: predisposing factors and prognostic significance. J Neurosurg. 2008;109(3):439-444. (Prospective; 174 patients)
-
Pope JV, Edlow JA. Favorable response to analgesics does not predict a benign etiology of headache. Headache. 2008;48(6):944-950. (Systematic review; 5 case reports)
-
Rothrock J. The perils of misinterpreting a treatment response. Headache. 2005;45(5):599-600. (Case report; 1 included)
-
Barclay CL, Shuaib A, Montoya D, et al. Response of non-migrainous headaches to chlorpromazine. Headache. 1990;30(2):85-87. (Case report: 1 patient)
-
Rosenberg JH, Silberstein SD. The headache of SAH responds to sumatriptan. Headache. 2005;45(5):597-598. (Case report; 1 patient)
-
Seymour JJ, Moscati RM, Jehle DV. Response of headaches to nonnarcotic analgesics resulting in missed intracranial hemorrhage. Am J Emerg Med. 1995;13(1):43-45. (Case report; 2 patients)
-
Pfadenhauer K, Schonsteiner T, Keller H. The risks of sumatriptan administration in patients with unrecognized subarachnoid haemorrhage (SAH). Cephalalgia. 2006;26(3):320- 323. (Case report; 3 patients)
-
Kassell NF, Kongable GL, Torner JC, et al. Delay in referral of patients with ruptured aneurysms to neurosurgical attention. Stroke. 1985;16(4):587-590. (Retrospective; 150 patients)
-
Adams HP Jr, Jergenson DD, Kassell NF, et al. Pitfalls in the recognition of subarachnoid hemorrhage. JAMA. 1980;244(8):794-796. (Retrospective; 182 SAH patients)
-
Reijneveld JC, Wermer M, Boonman Z, et al. Acute confusional state as presenting feature in aneurysmal subarachnoid hemorrhage: frequency and characteristics. J Neurol. 2000;247(2):112-116. (Retrospective; 646 patients)
-
Caeiro L, Menger C, Ferro JM, et al. Delirium in acute subarachnoid haemorrhage. Cerebrovasc Dis. 2005;19(1):31-38. (Retrospective; 68 patients)
-
Sakas DE, Dias LS, Beale D. Subarachnoid haemorrhage presenting as head injury. BMJ. 1995;310(6988):1186-1187. (Case report; 4 patients)
-
Frontera JA, Parra A, Shimbo D, et al. Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Cerebrovasc Dis. 2008;26(1):71-78. (Prospective; 580 patients)
-
Naidech AM, Kreiter KT, Janjua N, et al. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005;112(18):2851-2856. (Prospective; 253 patients)
-
Toussaint LG 3rd, Friedman JA, Wijdicks EF, et al. Survival of cardiac arrest after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2005;57(1):25-31. (Retrospective; 305 patients, 11 with cardiac arrest)
-
* Perry JJ, Stiell IG, Sivilotti ML, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013;310(12):1248-1255. (Prospective; 2131 patients)
-
Specogna AV. Subarachnoid hemorrhage diagnosis. JAMA. 2014;311(2):201. (Response)
-
Matloob SA, Roach J, Marcus HJ, et al. Evaluation of the impact of the Canadian subarachnoid haemorrhage clinical decision rules on British practice. Br J Neurosurg. 2013;27(5):603- 606. (Retrospective; 112 patients)
-
Brilstra EH, Rinkel GJ, Algra A, et al. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage. Neurology. 2000;55(11):1656-1660. (Prospective; 346 patients)
-
Vermeulen M, van Gijn J. The diagnosis of subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1990;53(5):365- 372. (Review)
-
Woodruff MM, Edlow JA. Evaluation of third nerve palsy in the emergency department. J Emerg Med. 2008;35(3):239-246. (Review)
-
Akagi T, Miyamoto K, Kashii S, et al. Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy. Jpn J Ophthalmol. 2008;52(1):32-35. (Retrospective; 221 patients)
-
Munakata A, Ohkuma H, Nakano T, et al. Abducens nerve pareses associated with aneurysmal subarachnoid hemorrhage. Incidence and clinical features. Cerebrovasc Dis. 2007;24(6):516-519. (Retrospective; 101 patients)
-
van Gijn J, van Dongen KJ. The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology. 1982;23(3):153-156. (Prospective; 100 patients)
-
Sames TA, Storrow AB, Finkelstein JA, et al. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Acad Emerg Med. 1996;3(1):16-20. (Retrospective; 181 patients)
-
Sidman R, Connolly E, Lemke T. Subarachnoid hemorrhage diagnosis: lumbar puncture is still needed when the computed tomography scan is normal. Acad Emerg Med. 1996;3(9):827-831. (Retrospective; 140 patients)
-
van der Wee N, Rinkel GJ, Hasan D, et al. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry. 1995;58(3):357-359. (Retrospective; 175 patients)
-
Perry JJ, Stiell IG, Sivilotti ML, et al. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ. 2011;343:d4277. (Prospective; 3132 patients)
-
Boesiger BM, Shiber JR. Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: are fifth generation CT scanners better at identifying subarachnoid hemorrhage? J Emerg Med. 2005;29(1):23-27. (Retrospective; 177 patients)
-
Byyny RL, Mower WR, Shum N, et al. Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage. Ann Emerg Med. 2008;51(6):697-703. (Retrospective; 177 patients)
-
Lourenco AP, Mayo-Smith WW, Tubbs RJ, et al. Does 16-detector computed tomography improve detection of non-traumatic subarachnoid hemorrhage in the emergency department? J Emerg Med. 2009;36(2):171-175. (Retrospective; 61 patients)
-
* Backes D, Rinkel GJ, Kemperman H, et al. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage. Stroke. 2012;43(8):2115-2119. (Prospective; 250 patients)
-
Mark DG, Hung YY, Offerman SR, et al. Nontraumatic subarachnoid hemorrhage in the setting of negative cranial computed tomography results: external validation of a clinical and imaging prediction rule. Ann Emerg Med. 2013;62(1):1-10. (Prospective; 55 patients)
-
Mark DG, Vinson DR, Ballard DW. In reply. Ann Emerg Med. 2013;62(4):436-437. (Author reply)
-
Leblanc R. The minor leak preceding subarachnoid hemorrhage. J Neurosurg. 1987;66(1):35-39. (Retrospective; 87 patients)
-
Refai D, Botros JA, Strom RG, et al. Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course. J Neurosurg. 2008;109(6):1034-1041. (Retrospective case series; 12 patients)
-
Schriger DL, Kalafut M, Starkman S, et al. Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy. JAMA. 1998;279(16):1293-1297. (Prospective; 103 physicians)
-
Patel KC, Finelli PF. Nonaneurysmal convexity subarachnoid hemorrhage. Neurocrit Care. 2006;4(3):229-233. (Retrospective case series; 12 patients)
-
Beitzke M, Gattringer T, Enzinger C, et al. Clinical presentation, etiology, and long-term prognosis in patients with nontraumatic convexal subarachnoid hemorrhage. Stroke. 2011;42(11):3055-3060. (Retrospective; 131 patients)
-
Kumar S, Goddeau RP Jr, Selim MH, et al. Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies. Neurology. 2010;74(11):893- 899. (Retrospective; 460 patients)
-
Mas J, Bouly S, Mourand I, et al. [Focal convexal subarachnoid hemorrhage: clinical presentation, imaging patterns and etiologic findings in 23 patients]. Rev Neurol (Paris). 2013;169(1):59-66. (Retrospective; 23 patients)
-
O’Neill J, McLaggan S, Gibson R. Acute headache and subarachnoid haemorrhage: a retrospective review of CT and lumbar puncture findings. Scott Med J. 2005;50(4):151-153. (Retrospective; 116 patients)
-
Perry JJ, Stiell I, Wells G, et al. Diagnostic test utilization in the emergency department for alert headache patients with possible subarachnoid hemorrhage. CJEM. 2002;4(5):333-337. (Retrospective; 891 patients)
-
Edlow JA, Wyer PC. Evidence-based emergency medicine/ clinical question. How good is a negative cranial computed tomographic scan result in excluding subarachnoid hemorrhage? Ann Emerg Med. 2000;36(5):507-516. (Systematic review)
-
Pines JM, Szyld D. Risk tolerance for the exclusion of potentially life-threatening diseases in the ED. Am J Emerg Med. 2007;25(5):540-544. (Prospective; risk assessment modeling)
-
Shah KH, Richard KM, Nicholas S, et al. Incidence of traumatic lumbar puncture. Acad Emerg Med. 2003;10(2):151-154. (Retrospective; 786 samples)
-
Eskey CJ, Ogilvy CS. Fluoroscopy-guided lumbar puncture: decreased frequency of traumatic tap and implications for the assessment of CT-negative acute subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2001;22(3):571-576. (Retrospective; 1489 bedside procedures, 723 fluoroscopic procedures)
-
Schievink WI, Wijdicks EF, Meyer FB, et al. Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage. Neurosurgery. 2001;48(3):513-516. (Prospective; 28 patients)
-
Schievink WI. Misdiagnosis of spontaneous intracranial hypotension. Arch Neurol. 2003;60(12):1713-1718. (Retrospective; 18 patients)
-
Quattrone A, Bono F, Oliveri RL, et al. Cerebral venous thrombosis and isolated intracranial hypertension without papilledema in CDH. Neurology. 2001;57(1):31-36. (Prospective; 114 patients)
-
Dupont SA, Wijdicks EF, Manno EM, et al. Thunderclap headache and normal computed tomographic results: value of cerebrospinal fluid analysis. Mayo Clin Proc. 2008;83(12):1326-1331. (Retrospective; 152 patients)
-
Buruma OJ, Janson HL, Den Bergh FA, et al. Blood-stained cerebrospinal fluid: traumatic puncture or haemorrhage? J Neurol Neurosurg Psychiatry. 1981;44(2):144-147. (Prospective; 25 patients)
-
Heasley DC, Mohamed MA, Yousem DM. Clearing of red blood cells in lumbar puncture does not rule out ruptured aneurysm in patients with suspected subarachnoid hemorrhage but negative head CT findings. AJNR Am J Neuroradiol. 2005;26(4):820-824. (Retrospective; 123 patients)
-
Shah KH, Edlow JA. Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23(1):67-74. (Review)
-
Czuczman AD, Thomas LE, Boulanger AB, et al. Interpreting red blood cells in lumbar puncture: distinguishing true subarachnoid hemorrhage from traumatic tap. Acad Emerg Med. 2013;20(3):247-256. (Retrospective; 4496 patients)
-
Thomas LE, Czuczman AD, Boulanger AB, et al. Low risk for subsequent subarachnoid hemorrhage for emergency department patients with headache, bloody cerebrospinal fluid, and negative findings on cerebrovascular imaging. J Neurosurg. 2014. (Prospective; 4641 patients)
-
Carstairs SD, Tanen DA, Duncan TD, et al. Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage. Acad Emerg Med. 2006;13(5):486- 492. (Prospective; 116 patients)
-
Nijjar S, Patel B, McGinn G, et al. Computed tomographic angiography as the primary diagnostic study in spontaneous subarachnoid hemorrhage. J Neuroimaging. 2007;17(4):295- 299. (Retrospective; 243 patients)
-
Mitchell P, Wilkinson ID, Hoggard N, et al. Detection of subarachnoid haemorrhage with magnetic resonance imaging. J Neurol Neurosurg Psychiatry. 2001;70(2):205-211. (Prospective; 41 patients)
-
Wiesmann M, Mayer TE, Yousry I, et al. Detection of hyperacute subarachnoid hemorrhage of the brain by using magnetic resonance imaging. J Neurosurg. 2002;96(4):684-689. (Retrospective; 13 patients)
-
Walton J. Subarachnoid Hemorrhage. Edinburgh, Scotland: E & S Livingstone Ltd; 1956. (Textbook)
-
Barrows LJ, Hunter FT, Banker BQ. The nature and clinical significance of pigments in the cerebrospinal fluid. Brain. 1955;78(1):59-80. (Prospective experimental; 7 samples)
-
Edlow JA, Bruner KS, Horowitz GL. Xanthochromia. Arch Pathol Lab Med. 2002;126(4):413-415. (Survey; 3500 laboratories)
-
Tourtellotte WW, Somers JF, Parker JA, et al. A study on traumatic lumbar punctures. Neurology. 1958;8(2):129-134. (Prospective experimental study)
-
Fishman R. Composition of the Cerebrospinal Fluid. 2nd ed. Philadelphia, PA: WB Saunders; 1992. (Textbook)
-
Vermeulen M, Hasan D, Blijenberg BG, et al. Xanthochromia after subarachnoid haemorrhage needs no revisitation. J Neurol Neurosurg Psychiatry. 1989;52(7):826-828. (Retrospective; 11 patients)
-
MacDonald A, Mendelow AD. Xanthochromia revisited: a re-evaluation of lumbar puncture and CT scanning in the diagnosis of subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1988;51(3):342-344. (Retrospective; 100 patients)
-
Soderstrom CE. Diagnostic significance of CSF spectrophotometry and computer tomography in cerebrovascular disease. A comparative study in 231 cases. Stroke. 1977;8(5):606- 612. (Retrospective; 231 patients)
-
Cruickshank A, Auld P, Beetham R, et al. Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Ann Clin Biochem. 2008;45(Pt 3):238-244. (Practice guidelines)
-
Linn FH, Voorbij HA, Rinkel GJ, et al. Visual inspection versus spectrophotometry in detecting bilirubin in cerebrospinal fluid. J Neurol Neurosurg Psychiatry. 2005;76(10):1452- 1454. (Prospective; 102 patients)
-
Smith A, Wu AH, Lynch KL, et al. Multi-wavelength spectrophotometric analysis for detection of xanthochromia in cerebrospinal fluid and accuracy for the diagnosis of subarachnoid hemorrhage. Clin Chim Acta. 2013;424:231 -236. (Prospective; 70 patients)
-
Wood MJ, Dimeski G, Nowitzke AM. CSF spectrophotometry in the diagnosis and exclusion of spontaneous subarachnoid haemorrhage. J Clin Neurosci. 2005;12(2):142-146. (Retrospective; 253 patients)
-
Perry JJ, Sivilotti ML, Stiell IG, et al. Should spectrophotometry be used to identify xanthochromia in the cerebrospinal fluid of alert patients suspected of having subarachnoid hemorrhage? Stroke. 2006;37(10):2467- 2472. (Prospective; 220 patients)
-
Hoh BL, Cheung AC, Rabinov JD, et al. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery. 2004;54(6):1329-1340. (Prospective; 223 patients)
-
Andreoli A, di Pasquale G, Pinelli G, et al. Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase. Stroke. 1987;18(3):558-564. (Prospective; 70 patients)
-
Brouwers PJ, Wijdicks EF, Hasan D, et al. Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke. 1989;20(9):1162-1167. (Prospective; 61 patients)
-
Mayer SA, LiMandri G, Sherman D, et al. Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. J Neurosurg. 1995;83(5):889- 896. (Prospective; 57 patients)
-
Tung P, Kopelnik A, Banki N, et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004;35(2):548-551. (Prospective; 223 patients)
-
Deibert E, Barzilai B, Braverman AC, et al. Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg. 2003;98(4):741- 746. (Prospective; 43 patients)
-
Menon V, Harrington RA, Hochman JS, et al. Thrombolysis and adjunctive therapy in acute myocardial infarction: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):549S-575S. (Practice guidelines)
-
Lee VH, Abdelmoneim SS, Daugherty WP, et al. Myocardial contrast echocardiography in subarachnoid hemorrhageinduced cardiac dysfunction: case report. Neurosurgery. 2008;62(1):E261-E262. (Case report)
-
Chang PC, Lee SH, Hung HF, et al. Transient ST elevation and left ventricular asynergy associated with normal coronary artery and Tc-99m PYP myocardial infarct scan in subarachnoid hemorrhage. Int J Cardiol. 1998;63 (2):189-192. (Case report)
-
de Chazal I, Parham WM 3rd, Liopyris P, et al. Delayed cardiogenic shock and acute lung injury after aneurysmal subarachnoid hemorrhage. Anesth Analg. 2005;100(4):1147- 1149. (Case report)
-
Yasu T, Owa M, Omura N, et al. Transient ST elevation and left ventricular asynergy associated with normal coronary artery in aneurysmal subarachnoid hemorrhage. Chest. 1993;103(4):1274-1275. (Case report)
-
Mayer SA, Fink ME, Homma S, et al. Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage. Neurology. 1994;44(5):815-820. (Prospective; 5 patients)
-
Zaroff JG, Rordorf GA, Newell JB, et al. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery. 1999;44(1):34-39. (Retrospective; 439 patients)
-
Kilbourn KJ, Levy S, Staff I, et al. Clinical characteristics and outcomes of neurogenic stress cadiomyopathy in aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2013;115(7):909-914. (Retrospective; 299 patients)
-
Kono T, Morita H, Kuroiwa T, et al. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol. 1994;24(3):636-640. (Prospective; 12 patients)
-
Hamann G, Haass A, Schimrigk K. Beta-blockade in acute aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien). 1993;121(3-4):119-122.
-
McLaughlin N, Bojanowski MW, Girard F, et al. Pulmonary edema and cardiac dysfunction following subarachnoid hemorrhage. Can J Neurol Sci. 2005;32(2):178-185. (Retrospective; 178 patients)
-
Tung PP, Olmsted E, Kopelnik A, et al. Plasma B-type natriuretic peptide levels are associated with early cardiac dysfunction after subarachnoid hemorrhage. Stroke. 2005;36(7):1567-1569. (Prospective; 57 patients)
-
Markus HS. A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1991;54(12):1117-1118. (Prospective; 16 patients)
-
Savitz SI, Levitan EB, Wears R, et al. Pooled analysis of patients with thunderclap headache evaluated by CT and LP: is angiography necessary in patients with negative evaluations? J Neurol Sci. 2009;276(1-2):123-125. (Systematic review; 7 studies, 813 patients)
-
Agid R, Lee SK, Willinsky RA, et al. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology. 2006;48(11):787- 794. (Prospective; 73 patients)
-
Bederson JB, Awad IA, Wiebers DO, et al. Recommendations for the management of patients with unruptured intracranial aneurysms: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 2000;31(11):2742-2750. (Guidelines)
-
Dammert S, Krings T, Moller-Hartmann W, et al. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology. 2004;46(6):427-434. (Prospective; 50 patients)
-
Harrison MJ, Johnson BA, Gardner GM, et al. Preliminary results on the management of unruptured intracranial aneurysms with magnetic resonance angiography and computed tomographic angiography. Neurosurgery. 1997;40 (5):947-955. (Prospective; 10 patients)
-
Uysal E, Yanbuloglu B, Erturk M, et al. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage. Diagn Interv Radiol. 2005;11(2):77- 82. (Prospective; 32 patients)
-
White PM, Teasdale EM, Wardlaw JM, et al. Intracranial aneurysms: CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort. Radiology. 2001;219(3):739-749. (Prospective; 142 patients)
-
White PM, Wardlaw JM, Easton V. Can noninvasive imaging accurately depict intracranial aneurysms? A systematic review. Radiology. 2000;217(2):361-370. (Systematic review; 38 studies)
-
McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med. 2010;17(4):444-451. (Review)
-
Anderson GB, Findlay JM, Steinke DE, et al. Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage. Neurosurgery. 1997;41(3):522-527. (Prospective; 40 patients)
-
Delgado Almandoz JE, Crandall BM, Fease JL, et al. Diagnostic yield of catheter angiography in patients with subarachnoid hemorrhage and negative initial noninvasive neurovascular examinations. AJNR Am J Neuroradiol. 2013;34(4):833-839. (Prospective; 55 patients)
-
Jethwa PR, Punia V, Patel TD, et al. Cost-effectiveness of digital subtraction angiography in the setting of computed tomographic angiography negative subarachnoid hemorrhage. Neurosurgery. 2013;72(4):511-519. (Retrospective)
-
MacKinnon AD, Clifton AG, Rich PM. Acute subarachnoid haemorrhage: is a negative CT angiogram enough? Clin Radiol. 2013;68(3):232-238. (Prospective; 200 patients)
-
Wang H, Li W, He H, et al. 320-detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol. 2013;68(1):e15-e20. (Retrospective; 52 patients)
-
Mohamed M, Heasly DC, Yagmurlu B, et al. Fluidattenuated inversion recovery MR imaging and subarachnoid hemorrhage: not a panacea. AJNR Am J Neuroradiol. 2004;25(4):545-550. (Retrospective; 12 patients)
-
Pierot L, Portefaix C, Rodriguez-Regent C, et al. Role of MRA in the detection of intracranial aneurysm in the acute phase of subarachnoid hemorrhage. J Neuroradiol. 2013;40(3):204-210. (Prospective; 84 patients)
-
Verma RK, Kottke R, Andereggen L, et al. Detecting subarachnoid hemorrhage: comparison of combined FLAIR/ SWI versus CT. Eur J Radiol. 2013;82(9):1539-1545. (Prospective; 25 patients)
-
Woodfield J, Rane N, Cudlip S, et al. Value of delayed MRI in angiogram-negative subarachnoid haemorrhage. Clin Radiol. 2014;69(4):350-356. (Prospective; 1023 angiograms)
-
Boogaarts HD, van Amerongen MJ, de Vries J, et al. Caseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2014;120(3):605-611. (Systematic review; meta-analysis; 4 articles; 36,600 patients)
-
Anxionnat R, Bracard S, Ducrocq X, et al. Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment. Radiology. 2001;218(3):799-808. (Prospective; 22 ruptured aneurysms)
-
Topcuoglu MA, Ogilvy CS, Carter BS, et al. Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg. 2003;98 (6):1235-1240. (Retrospective; 806 patients)
-
Jung JY, Kim YB, Lee JW, et al. Spontaneous subarachnoid haemorrhage with negative initial angiography: a review of 143 cases. J Clin Neurosci. 2006;13(10):1011-1017. (Prospective; 143 SAH patients with negative angiograms)
-
Andaluz N, Zuccarello M. Yield of further diagnostic workup of cryptogenic subarachnoid hemorrhage based on bleeding patterns on computed tomographic scans. Neurosurgery. 2008;62(5):1040-1046. (Retrospective; 719 patients)
-
Willinsky RA, Taylor SM, TerBrugge K, et al. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology. 2003;227(2):522-528. (Prospective; 2899 procedures)
-
Dawkins AA, Evans AL, Wattam J, et al. Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures. Neuroradiology. 2007;49(9):753-759. (Prospective; 2924 procedures)
-
Kaufmann TJ, Huston J 3rd, Mandrekar JN, et al. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology. 2007;243(3):812-819. (Retrospective; 19,826 patients)
-
Chen W, Wang J, Xing W, et al. Accuracy of 16-row multislice computerized tomography angiography for assessment of intracranial aneurysms. Surg Neurol. 2009;71(1):32- 42. (Prospective; 152 patients)
-
Chen W, Wang J, Xin W, et al. Accuracy of 16-row multislice computed tomographic angiography for assessment of small cerebral aneurysms. Neurosurgery. 2008;62(1):113-121. (Prospective; 192 patients)
-
El Khaldi M, Pernter P, Ferro F, et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. Radiol Med. 2007;112(1):123-137. (Prospective; 130 patients)
-
Chappell ET, Moure FC, Good MC. Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a metaanalysis. Neurosurgery. 2003;52(3):624-631. (Meta-analysis; 21 studies, 1251 patients)
-
Kokkinis C, Vlychou M, Zavras GM, et al. The role of 3Dcomputed tomography angiography (3D-CTA) in investigation of spontaneous subarachnoid haemorrhage: comparison with digital subtraction angiography (DSA) and surgical findings. Br J Neurosurg. 2008;22(1):71-78. (Prospective; 198 patients)
-
Westerlaan HE, Gravendeel J, Fiore D, et al. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling. Neuroradiology. 2007;49(12):997-1007. (Prospective; 224 patients)
-
Pechlivanis I, Schmieder K, Scholz M, et al. 3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms. Acta Neurochir (Wien). 2005;147(10):1045-1053. (Prospective; 100 patients)
-
Caruso R, Colonnese C, Elefante A, et al. Use of spiral computerized tomography angiography in patients with cerebral aneurysm. Our experience. J Neurosurg Sci. 2002;46(1):4-9. (Prospective; 31 patients)
-
Boet R, Poon WS, Lam JM, et al. The surgical treatment of intracranial aneurysms based on computer tomographic angiography alone--streamlining the acute mananagement of symptomatic aneurysms. Acta Neurochir (Wien). 2003;145(2):101-105. (Prospective; 90 patients)
-
Westerlaan HE, van der Vliet AM, Hew JM, et al. Magnetic resonance angiography in the selection of patients suitable for neurosurgical intervention of ruptured intracranial aneurysms. Neuroradiology. 2004;46(11):867-875. (Prospective; 205 patients)
-
Sato M, Nakano M, Sasanuma J, et al. Preoperative cerebral aneurysm assessment by three-dimensional magnetic resonance angiography: feasibility of surgery without conventional catheter angiography. Neurosurgery. 2005;56 (5):903- 912. (Retrospective; 108 total patients, 59 SAH patients)
-
Larsen CC, Astrup J. Rebleeding after aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg. 2013;79(2):307-312. (Review)
-
Roos YB, Rinkel GJ, Vermeulen M, et al. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2003(2):CD001245. (Systematic review, 9 randomized controlled trials; 1399 patients)
-
Leipzig TJ, Redelman K, Horner TG. Reducing the risk of rebleeding before early aneurysm surgery: a possible role for antifibrinolytic therapy. J Neurosurg. 1997;86(2):220-225. (Prospective; 307 patients)
-
Hillman J, Fridriksson S, Nilsson O, et al. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg. 2002;97(4):771- 778. (Prospective multicenter randomized controlled trial; 505 patients)
-
Starke RM, Kim GH, Fernandez A, et al. Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage. Stroke. 2008;39(9):2617-2621. (Prospective nonrandomized trial; 248 patients)
-
Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke. 2001;32(5):1176-1180. (Prospective; 273 patients)
-
Naidech AM, Janjua N, Kreiter KT, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Arch Neurol. 2005;62(3):410-416. (Prospective; 574 patients)
-
De Marchis GM, Lantigua H, Schmidt JM, et al. Impact of premorbid hypertension on haemorrhage severity and aneurysm rebleeding risk after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2014;85(1):56-59. (Retrospective; 1312 patients)
-
Bekker A, Didehvar S, Kim S, et al. Efficacy of clevidipine in controlling perioperative hypertension in neurosurgical patients: initial single-center experience. J Neurosurg Anesthesiol. 2010;22(4):330-335. (Prospective; 22 patients)
-
Smith WB, Marbury TC, Komjathy SF, et al. Pharmacokinetics, pharmacodynamics, and safety of clevidipine after prolonged continuous infusion in subjects with mild to moderate essential hypertension. Eur J Clin Pharmacol. 2012;68(10):1385-1394. (Prospective; 61 patients)
-
Rabinstein AA, Friedman JA, Weigand SD, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004;35(8):1862-1866. (Retrospective; 143 patients)
-
Dorhout Mees SM, Rinkel GJ, Feigin VL, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007(3):CD000277. (Systematic review, 16 randomized controlled trials; 3361 patients)
-
Pickard JD, Murray GD, Illingworth R, et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ. 1989;298(6674):636-642. (Prospective multicenter double-blind randomized controlled trial; 554 patients)
-
Haley EC Jr, Kassell NF, Torner JC. A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. J Neurosurg. 1993;78(4):537-547. (Prospective multicenter randomized double-blind placebo-controlled trial; 283 patients)
-
van den Bergh WM, Algra A, van Kooten F, et al. Magnesium sulfate in aneurysmal subarachnoid hemorrhage: a randomized controlled trial. Stroke. 2005;36(5):1011-1015. (Prospective randomized placebo-controlled trial; 283 patients)
-
Lynch JR, Wang H, McGirt MJ, et al. Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke. 2005;36(9):2024- 2026. (Prospective randomized placebo-controlled trial; 39 patients)
-
Tseng MY, Hutchinson PJ, Czosnyka M, et al. Effects of acute pravastatin treatment on intensity of rescue therapy, length of inpatient stay, and 6-month outcome in patients after aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(5):1545- 1550. (Prospective randomized placebo-controlled trial; 80 patients)
-
Chou SH, Smith EE, Badjatia N, et al. A randomized, doubleblind, placebo-controlled pilot study of simvastatin in aneurysmal subarachnoid hemorrhage. Stroke. 2008;39(10):2891- 2893. (Prospective double blind randomized placebo-controlled trial; 39 patients)
-
Sanchez-Pena P, Nouet A, Clarencon F, et al. Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: a comparative study. Crit Care Med. 2012;40(2):594-602. (Retrospective; 278 patients)
-
Tseng MY. Summary of evidence on immediate statins therapy following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;15(2):298-301. (Review)
-
Vergouwen MD, de Haan RJ, Vermeulen M, et al. Effect of statin treatment on vasospasm, delayed cerebral ischemia, and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis update. Stroke. 2010;41(1):e47-e52. (Systematic review; meta-analysis; 190 patients)
-
Wong GK, Liang M, Tan H, et al. High-dose simvastatin for aneurysmal subarachnoid hemorrhage: a multicenter, randomized, controlled, double-blind clinical trial protocol. Neurosurgery. 2013;72(5):840-844. (Prospective; 240 patients)
-
Garg K, Sinha S, Kale SS, et al. Role of simvastatin in prevention of vasospasm and improving functional outcome after aneurysmal sub-arachnoid hemorrhage: a prospective, randomized, double-blind, placebo-controlled pilot trial. Br J Neurosurg. 2013;27(2):181-186. (Prospective; 38 patients)
-
Dorhout Mees SM. Magnesium in Aneurysmal Subarachnoid Hemorrhage (MASH II) phase III clinical trial MASH-II study group. Int J Stroke. 2008;3(1):63-65. (Prospective randomized controlled trial, ongoing; 1200 patients expected)
-
Lin CL, Dumont AS, Lieu AS, et al. Characterization of perioperative seizures and epilepsy following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;99(6):978-985. (Retrospective; 217 patients)
-
Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1994;25(11):2315-2328. (Practice guidelines, systematic review)
-
Rinkel GJ. Medical management of patients with aneurysmal subarachnoid haemorrhage. Int J Stroke. 2008;3(3):193-204. (Review)
-
Baker CJ, Prestigiacomo CJ, Solomon RA. Short-term perioperative anticonvulsant prophylaxis for the surgical treatment of low-risk patients with intracranial aneurysms. Neurosurgery. 1995;37(5):863-870. (Retrospective; 387 patients)
-
Butzkueven H, Evans AH, Pitman A, et al. Onset seizures independently predict poor outcome after subarachnoid hemorrhage. Neurology. 2000;55(9):1315-1320. (Retrospective; 412 patients)
-
Rosengart AJ, Huo JD, Tolentino J, et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. J Neurosurg. 2007;107(2):253-260. (Retrospective pooled analysis of 4 multicenter prospective randomized doubleblind placebo-controlled trials; 3552 patients)
-
Naidech AM, Kreiter KT, Janjua N, et al. Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke. 2005;36(3):583-587. (Prospective; 527 patients)
-
Raper DM, Starke RM, Komotar RJ, et al. Seizures after aneurysmal subarachnoid hemorrhage: a systematic review of outcomes. World Neurosurg. 2013;79(5-6):682-690. (Systematic review; meta-analysis; 25 studies and 7002 patients)
-
Chumnanvej S, Dunn IF, Kim DH. Three-day phenytoin prophylaxis is adequate after subarachnoid hemorrhage. Neurosurgery. 2007;60(1):99-102. (Retrospective; 79 patients)
-
Whitfield PC, Kirkpatrick PJ. Timing of surgery for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2001(2):CD001697. (Systematic review; 1 randomized controlled trial)
-
Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267-1274. (Prospective multicenter randomized trial; 2143 patients)
-
van der Schaaf I, Algra A, Wermer M, et al. Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2005(4):CD003085. (Systematic review; 3 randomized trials, 2272 patients)
-
Johnston SC, Higashida RT, Barrow DL, et al. Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke. 2002;33(10):2536-2544. (Practice guidelines)
-
Qureshi AI, Janardhan V, Hanel RA, et al. Comparison of endovascular and surgical treatments for intracranial aneurysms: an evidence-based review. Lancet Neurol. 2007;6(9):816-825. (Systematic review)
-
Britz GW. ISAT trial: coiling or clipping for intracranial aneurysms? Lancet. 2005;366(9488):783-785. (Editorial)
-
Bardach NS, Zhao S, Gress DR, et al. Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke. 2002;33(7):1851-1856. (Retrospective; 12,804 patients)
-
Cross DT 3rd, Tirschwell DL, Clark MA, et al. Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states. J Neurosurg. 2003;99(5):810- 817. (Retrospective; 16,399 patients)
-
Hijdra A, van Gijn J, Nagelkerke NJ, et al. Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage. Stroke. 1988;19(10):1250- 1256. (Prospective; 176 patients)
-
Weir RU, Marcellus ML, Do HM, et al. Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system. AJNR Am J Neuroradiol. 2003;24(4):585-590. (Retrospective; 27 patients)
-
Rosengart AJ, Schultheiss KE, Tolentino J, et al. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315-2321. (Retrospective pooled analysis of 4 multicenter prospective randomized controlled trials; 3567 patients)
-
Roos YB, de Haan RJ, Beenen LF, et al. Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in the Netherlands. J Neurol Neurosurg Psychiatry. 2000;68 (3):337- 341. (Prospective; 110 patients)
-
Wijdicks EF, Schievink WI, Brown RD, et al. The dilemma of discontinuation of anticoagulation therapy for patients with intracranial hemorrhage and mechanical heart valves. Neurosurgery. 1998;42(4):769-773. (Retrospective; 39 patients with intracranial hemorrhage, 4 with SAH)
-
Bernardini GL, DeShaies EM. Critical care of intracerebral