KISEP KOR J CEREBROVASCULAR DISEASE March 2001 Vo. 3, No 1, page 19-24 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
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 889-899 3. 수액및전해질장애 (Fluid and electrolyte disturbance) 신경학적합병증 (Neurological Complications) 20 Kor J Cerebrovascular Disease 3:19-24, 2001
1. 재출혈 (Rebleeding) 2. 뇌혈관연축 (Vasospasm) Kor J Cerebrovascular Disease 3:19-24, 2001 21
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 1969-1988 22 Kor J Cerebrovascular Disease 3:19-24, 2001
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