Table 1. Common secondary complications of subarachnoid hemorrhage* Medical complications Pulmonary complications 2. 호흡기계합병증 (Pulmonary complications)

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1 KISEP KOR J CEREBROVASCULAR DISEASE March 2001 Vo. 3, No 1, page 뇌동맥류성지주막하출혈의합병증 이제혁 김태선 General Complications of Aneurysmal Subarachnoid Hemorrhage Je-Hyuk Lee, MD and Tae-Sun Kim, MD Department of Neurosurgery, Chonnam National University Hospital & Medical Scool, Gwangju, Korea ABSTRACT The ruptured aneurysms are frequently complicated with cerebral infarction, rebleeding, hydrocephalus and severe medical complications which add secondary injury to the brain surviving initial hemorrhage. Early diagnosis and judicious medical management for the complications as they occur will improve patient outcome. This paper will review current opinion about prevention and management of secondary complications associated with aneurysmal subarachnoid hemorrhage. Kor J Cerebrovascular Disease 3:19-24, 2001 KEY WORDSAneurysm Subarachnoid hemorrhage Complication. 내과적합병증 (Medical Complications) 1. 심혈관계합병증 (Cardiovascular complications) 19

2 Table 1. Common secondary complications of subarachnoid hemorrhage* Medical complications Pulmonary complications 2. 호흡기계합병증 (Pulmonary complications) Neurological complications Rebleeding Cardiovascular complications Cerebral vasospasm Electrolyte abnormalities Hydrocephalus Gastrointestinal complications Seizures Infections Venous thromboembolism Genitourinary complications From Ho HW, Batjer HHAneurysmal subarachnoid hemorrhagepathophysiology and sequelae. Cerebrovascular Disease, in Batjer HHCerebrovascular Disease., Philadelphia, Lippincott-Raven Publishers., 1997, pp 수액및전해질장애 (Fluid and electrolyte disturbance) 신경학적합병증 (Neurological Complications) 20 Kor J Cerebrovascular Disease 3:19-24, 2001

3 1. 재출혈 (Rebleeding) 2. 뇌혈관연축 (Vasospasm) Kor J Cerebrovascular Disease 3:19-24,

4 Table 2. Potential treatment for cerebral vasospasm* Adverse factors to avoid Hypovolemia Hypotension Antifibrinolytic drugs Antihypertensive drugs Excessive intracranial pressure Prevention of arterial narrowing Clot removal Surgical removal Cisternal drainage Clot lysis urokinase. tpa Pharmacological Nonsteroidal anti-inflammatory drugs Glucocorticosteroids methylprednisolone Cyclosporine A 21-Aminosteroids U74006F Calcium-channel blockers nicardipine Intracellular calcium antagonists AT877 Reversal of arterial narrowing Mechanical percutaneous transluminal balloon angioplasty Pharmacological Calcitonin gene-related peptide Papaverine Nitroglycerine Adenosine Prevention of cerebral ischemia Calcium channel blockers nimodipine Reversal of cerebral ischemia Hemodilutional. hypervolemic, hypertensivetriple-h therapy From Macdonald RL, Weir BCerebral vasospasm and delayed cerebral ischemia in Tindall GTThe Practice of Neurosurgery., 1996, pp Kor J Cerebrovascular Disease 3:19-24, 2001

5 3. 뇌수두증 (Hydrocephalus) 4. 경련 (Seizure) REFERENCES 1) Adams HP Jr, Kassell NF, Torner JC, et al. Predicting cerebral ischemia after aneurysmal subarachrnoid hemorrhage influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the cooperative aneurysmal study. Neurology , ) Andreoli A, Dipasquale G, Pinelli G, et al. A subarachnoid hemorrhage frequency and severity of cardiac arrhythmias. Stroke , ) Aoyai N, Hayakawa I. Study on early rerupture of intracranial aneurysm. Acta Neurochir , ) Auer LM, Mokry M. Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage and acute aneurysm surgery. Neurosurgery , ) Doczi T, Bende J, Huszka E, et al. Syndrome of inappropriate secretion of antidiuretic hormone after subarachnoid hemorrhage. Neurosurgery , ) Fisher CM, Kistler JP, Davs JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 61-9, ) Fox JL, Falik KL, Shalhoub RJ. Neurosurgical hyponatremia the role of inappropriate antidiuresis. J Neurosurg , ) Francesco Tomasello, Domenico d Avella, Oreste de Divitiis. Dose lamina terminalis fenestration reduce the incidence of chronic hydrocephalus after subarachnoid hemorrhage. Neurosurgery , ) Fujii Y, Takeuchi S, Sasaki O, et al. Ultraearly rebleeding in spontaneous subarachnoid hemorrhage. J Neurosurg , ) Fujimura M, Nishijima M, Umezawa K, et al. Severe subarachnoid hemorrhage with pulmonary edema successfully treated by intra-aneurysmal embolization using Guglielmi detachable coilstwo case reports. Neurol Med ChirTokyo , ) Grosset DG, Stration J, McDonald I, et al. Use of transcranial doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage. J Neurosurg , ) Gruber A, Reinprecht A, Bavinzski G, et al. Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms. Neurosurgery , ) Gruber A, Reinprecht A, Gorzer H, et al. Pulmonary function and radiographic abnormalities related to neurological outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg , ) Hasan D, Lindsay KW, Wijdicks EF, et al. Effect of fludrocotisone acetate in patients with subarachnoid hemorrhage. Stroke , ) Harrigan MR. Cerebral salt wasting syndrome. Neurosurgery , ) Hart RG, Byer JA, Staughter JR, et al. Occurrence and implications of seizure in subarachnoid hemorrhage due to ruptured intracranial aneurysms. Neurosurgery , ) Heiserman JE. MR Angiography for the diagnosis of vasospasm after subarachnoid hemorrhage. Is it accurate? Is it safe? AJNR , ) Heros RC, Zervas NT, Varsos V. Cerebral vasospasm after subarachnoid hemorrhage; an update. Ann Neurol , ) Higashida RT, Halbach VV, Cahan LD, et al. Transluminal angioplasty for treatment of intracranial arterial vasospam. J Neurosurg , ) Hutchison K, Weir B. Transcranial doppler studies in aneurysm patients. Can J Neurol Sci , ) Inagawa T. Ultra-early rebleeding within six Hours after aneury- Kor J Cerebrovascular Disease 3:19-24,

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동맥류성 지주막하출혈 후 발생한 뇌혈관연축의 동맥 내 니모디핀 주입술의 효과 니모디핀은 칼슘 길항제로서 혈관 평활근의 수축을 줄이는 역할을 한다(9). 근래에 몇몇 저자들에 의해 뇌동맥 내 니모디 핀(intra-arterial nimodipine; 이하 IAN) 주입술

동맥류성 지주막하출혈 후 발생한 뇌혈관연축의 동맥 내 니모디핀 주입술의 효과 니모디핀은 칼슘 길항제로서 혈관 평활근의 수축을 줄이는 역할을 한다(9). 근래에 몇몇 저자들에 의해 뇌동맥 내 니모디 핀(intra-arterial nimodipine; 이하 IAN) 주입술 Original Article pissn 1738-2637 J Korean Soc Radiol 2012;66(6):501-506 Effect of Intra-Arterial Nimodipine Infusion for the Treatment of Symptomatic Cerebral Vasospasm Following an Aneurysmal Subarachnoid