Cardiorespiratory arrest in aneurysmal subarachnoid hemorrhage.
Aneurysmal subarachnoid hemorrhage (ASAH) can cause sudden death from cardiorespiratory arrest (CRA). Successful resuscitation (SR) allows diagnosis and treatment of survivors. We studied incidences of CRA and the influence of SR in ASAH prognosis. Hospital records of patients with ASAH diagnosed by computed tomography, lumbar puncture, surgery, or autopsy and treated from 1980 to 1988 were reviewed. Symptoms, aneurysm location, treatment, course, and outcome were tabulated. The literature was reviewed. Of 95 consecutive ASAH patients, 15 (16%, 2 males, 13 females) had CRA, seven primary cardiac, six primary respiratory, and two combined CRA. Four of 11(36.4%) had posterior circulation aneurysm (PCA);13 (86.6%) had intracerebral-ventricular clot (ICC). All were clinically Stage V, six improved and had angiography, two had surgery, and one (7%) survived hospitalization. Of other ASAH patients (37 males and 43 females), 4.4% of 68 had PCA, 37.5% had ICC, and 56% survived hospitalization. Of 287 patients hospitalized after out-of-hospital SR in the same period, 18% survived; 14 (4.9%) had ASAH and 1 (7%) survived hospitalization. CRA is not infrequent after onset of ASAH and occurs more commonly in women with PCA. Most likely, it is due to a very large initial hemorrhage disrupting diencephalic circulatory and respiratory centers. Prognosis of patients suffering CRA from ASAH is dismal and not influenced by SR.
From the Department of Neurology and Stroke Service, St. Paul-Ramsey Medical Center, St. Paul, and the Department of Neurology, University of Minnesota, Minneapolis, MN, U.S.A.
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Ramirez-Lassepas
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Ahmed