Full Description
Ever since I began my training in internaI medicine and subsequently in neurology, I have been interested in subarachnoid haemorrhage and indeed chose this topic as a subject of study for my Doctorate in Medicine. It was because the information derived from a retrospective study of 312 patients proved to be so interesting that I published a monograph on the subject 30 years ago. My first reaction on reading this splendid book by my former coHeagues in Newcastle, Mr. Sengupta and Dr. McAllister, was one of realisation of the extent to whjch knowledge about the condition' and principles of management have been transformed. This splendidly comprehensive volume carefully reviews the earlier literature, analyses the anato- micaI, pathophysiologicaI and clinical features of the condition in consummate detail and goes on to consider in depth all of those issues relating to investigation and medical and surgical management which continue to present chaHenges to neurologists and neuro-surgeons alike. When I began my personal study, angiography had still to be introduced as a routine method of radiologicaI diagnosis in many centres in the U .K. and we were Iargely dependent upon dinicaI methods of diagnosis and assessment.
How interesting it is to see that now, very properly, computerised tomography (CT scanning) takes precedence as an initiaI diagnostic instrument over angiography, and that lumbar puncture, once thought to be obligatory for diagnosis, is being used Iess and less since its dangers were fully appreciated.
Contents
1 Historical Review.- 2 Anatomy of the Cerebral Vessels.- Circle of Willis.- Internal Carotid Artery.- Ophthalmic Artery.- Posterior Communicating Artery.- Anterior Choroidal Artery.- Anterior Cerebral Artery.- Middle Cerebral Artery.- Lenticulostriate Arteries (Thalamostriate Arteries).- Posterior Cerebral Artery.- Vertebrobasilar System.- Venous Anatomy.- 3 Pathophysiology.- Massive or Catastrophic Haemorrhage.- Major Subarachnoid Haemorrhage.- Pathological Changes Associated with Minor Haemorrhage.- Histopathological Features.- Aetiology of Subarachnoid Haemorrhage.- Intracranial Aneurysms.- 4 Clinical Features.- Symptomatology.- Physical Examination.- Warning Signs of Impending Subarachnoid Haemorrhage.- Grading of Severity of Subarachnoid Haemorrhage.- 5 Differential Diagnosis.- Modes of Presentation.- Confirmation of Subarachnoid Haemorrhage.- Aetiology of Subarachnoid Haemorrhage.- Subarachnoid Haemorrhage of Unknown Aetiology.- 6 Computerised Tomography.- Material.- CT Scan Appearances.- Blood in the Subarachnoid Cisterns.- Intracerebral Haematoma.- Intraventricular Haematoma.- Subdural Haematoma.- Low Attenuation Areas.- Hydrocephalus.- Contrast Enhancement.- CT in Multiple Aneurysms.- CT Scan Findings and Patient Grade.- CT Scan Findings and Prognosis.- Accuracy of CT.- CT Scan Findings and Subarachnoid Haemorrhage of Unknown Cause.- CT Scan Findings and Vasospasm.- CT and Brain Haemorrhage Due to Intracranial Tumours.- CT and Giant Aneurysms.- CT and Patient Deterioration.- 7 Cerebral Angiography.- Indications.- Contraindications.- Timing.- Technique.- Anterior Cerebral Artery Aneurysms.- Middle Cerebral Artery Aneurysms.- Posterior Communicating Artery Aneurysms.- Internal Carotid Artery (Bifurcation) Aneurysms.- Anterior Choroidal Aneurysms.- Carotid Ophthalmic Aneurysms.- Intracavernous Aneurysms.- Vertebrobasilar Aneurysms.- Angiotomography and Magnification Angiography.- Angiographic Findings in Ruptured Aneurysms.- Accuracy of Angiography.- Peroperative Angiography.- Postoperative Check Angiography.- Complications.- Arteriovenous Malformations.- Mycotic Aneurysms.- Traumatic Aneurysms.- Neoplastic Aneurysms.- Arterial Anomalies.- Fibromuscular Hyperplasia.- Moya Moya Syndrome.- Cerebral Arteritis.- Digital Subtraction Angiography.- 8 Management of Subarachnoid Haemorrhage.- Management at the Receiving Hospital.- General Measures.- Management of the Comatose Patient.- Prevention of Recurrent Haemorrhage.- Treatment of Complications.- Metabolic, Electrolyte and Haematological Changes.- 9 Anaesthesia.- Historical Background.- Pre-operative Management.- Anaesthesia for Angiography.- Anaesthesia for Craniotomy.- Techniques for Special Aneurysms.- Postoperative Management.- Arteriovenous Malformations.- 10 Basic Principles of Surgical Treatment of Intracranial Aneurysms.- Selection of Patients.- Timing of Surgery.- Methods of Surgical Treatment.- Technical Aids for Intracranial Surgery.- Aneurysms in Various Sites.- 11 Results of Surgical Treatment of Intracranial Aneurysms.- Natural History of Intracranial Aneurysms.- Clinical Profile of Surgical Patients.- Outcome.- Analysis of Patients with Fatal Outcome.- Outcome in Relation to the Site of the Aneurysm.- Quality of Survival.- Factors WhichInfluence Outcome.- Conclusions.- 12 Vasospasm.- Cerebral Blood Flow.- Cerebral Autoregulation.- Cerebral Blood Flow in Subarachnoid Haemorrhage.- Aetiology and Pathophysiology.- Pathological Changes in Vasospasm.- Incidence.- Vasospasm and Neurological Condition of the Patient.- Management of Cerebral Vasospasm.- 13 Arteriovenous Malformations.- Incidence.- Natural History.- Pathology.- Surgical Pathology.- Site of the Lesion.- Clinical Presentation.- Management.- Principles of Direct Surgical Treatment.- Operative Procedures.- Postoperative Care.- Alternative Methods of Treatment.- Aneurysms of the Vein of Galen.- 14 Subarachnoid Haemorrhage in Pregnancy.- Incidence.- Cause.- Time of Occurrence.- Course of Haemorrhage.- Physiological Changes During Pregnancy Relevant to Subarachnoid Haemorrhage.- Diagnosis.- Treatment.- 15 Subarachnoid Haemorrhage in Infancy, Childhood and Adolescence.- Material.- Cause.- Aneurysms.- Arteriovenous Malformations.- Idiopathic (No Cause) Group.- Rare Causes.- Neonatal Intracranial Haemorrhage.- 16 Spinal Subarachnoid Haemorrhage.- Aetiology.- Clinical Features.- Differential Diagnosis.- Investigations.- Natural History and Outcome.- Management of Spinal Arteriovenous Malformations.- 17 Future Developments.- Prevention of Subarachnoid Haemorrhage.- Improved Diagnosis.- Treatment of the Complications of Subarachnoid Haemorrhage.- Improved Surgical Techniques.- New Imaging Techniques.
