Subarachnoid hemorrhage in the African-American population: a cooperative study.
The clinical outcome of patients following subarachnoid hemorrhage is complicated by delayed cerebral ischemia and contributing factors such as hypertension. To observe the impact of hypertension and delayed cerebral ischemia on the outcome of a predominantly African-American cohort following subarachnoid hemorrhage, both retrospective (n = 42) and prospective (n = 21) studies were conducted. In the total pool (n = 63), the mean age was 49.7 years (range: 17 to 80) with a preponderance of female patients (70%). Aneurysm formation was significant in the region of the posterior communicating artery. Of the patients reviewed, 73.8% had preexisting hypertension and 45.9% developed delayed cerebral ischemia. Approximately 89% of the patients who suffered from delayed cerebral ischemia had hypertension. Results failed to display any significant beneficial association between the use of the calcium channel blocker nimodipine and delayed cerebral ischemia. Use of the antifibrinolytic drug aminocaproic acid demonstrated a worse patient outcome. It is not recommended that aminocaproic acid be used in this population. Subsequently, due to the proportional occurrence of delayed cerebral ischemia in hypertensive patients following subarachnoid hemorrhage, it is suggested that prophylactic surgical management of unruptured intracranial aneurysms be considered in hypertensive patients. Further study is needed to discern the association between hypertension, delayed cerebral ischemia, and stroke in patients following subarachnoid hemorrhage.
Dennis
G C
GC
Division of Neurosurgery, Howard University Hospital, Washington, DC 20060, USA.
Welch
B
B
Cole
A N
AN
Mendoza
R
R
Morgan
J
J
Epps
J
J
Bernard
E
E
St Louis
P
P
D000614:Aminocaproates / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D044383:Black People; D002545:Brain Ischemia / Q000208:ethnology / Q000517:prevention & control; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy / Q000208:ethnology*; D016896:Treatment Outcome; D001741:Black or African American
D000614:Aminocaproates; D000933:Antifibrinolytic Agents; D002121:Calcium Channel Blockers; D009553:Nimodipine