[Prognostic factors in ruptured intracranial aneurysm. Significance of the temperature curve].
This report concerns 130 consecutive patients admitted as emergencies for ruptured intracranial aneurysms. The poorer the patient's clinical condition, the longer the time elapsed before surgery (14 days on average). While awaiting surgery, 4.6 per cent of the patients rebled and 5.4 per cent deteriorated due to vasospasm. The 14 patients who had shown no symptom since the rupture remained asymptomatic until surgery, while the clinical status of the other 116 patients improved in 36.3 per cent, remained unchanged in 53.4 per cent and deteriorated in 10.3 per cent (3 per cent of whom died). After a one year follow-up, 58 per cent of the 126 patients operated upon had resumed all their previous activities; 10.3 per cent were autonomous but had been unable to resume their professional activities normally; 8.7 per cent were dependent and 20.5 per cent had died of neurological complications and/or sequelae (2.4 per cent had died of intercurrent diseases). An analysis of prognostic factors showed that the outcome was not significantly influenced by the site of the aneurysms, the patient's sex or age, or a past history of systemic arterial hypertension, but it was narrowly dependent (P less than 0.001) upon the clinical status at the time of surgery, the amount of extravasated blood at CT or the degree of vasospasm at angiography. The greater the size of the haematoma and the degree of vasosplasm, the more the clinical status was affected (P less than 0.01). In addition, the clinical status was found to be particularly poor when hyperthermia was present (P less than 0.01), and the outcome was worse in patients who were operated upon during the ascending phase of fever (P less than 0.05). Thus, a careful examination of the temperature curve might be of help in the choice of the optimal time for surgery.
Sindou
M
M
Service Neuro-chirurgie A., Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon.
Debourdeau
P
P
Benhamouda
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001831:Body Temperature; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000503:physiopathology; D002648:Child; D004630:Emergencies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012422:Rupture, Spontaneous; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Facteurs pronostiques dans les anévrysmes intra-crâniens rompus. Signification de la courbe thermique.