11/14. The risks of sumatriptan administration in patients with unrecognized subarachnoid haemorrhage (SAH).Administration of sumatriptan in subarachnoid haemorrhage (SAH) patients, misdiagnosed as migraine patients, may induce symptomatic cerebral vasospasm with potentially dangerous consequences. Over a 5-year period, we observed three patients with a 3-15-year history of migraine, who received sumatriptan for acute headache. Two patients received 6 mg sumatriptan subcutaneously on days 4 and 6, and one patient 3 x 100 mg sumatriptan orally on day 1 after an acute headache episode. In all three cases, an alleviation of headache intensity from severe to moderate was observed. When headache recurred and meningeal signs appeared, SAH was diagnosed by computed tomography in all three cases. No neurological deficits occurred during the further course of the disease. In both patients with a SAH caused by an aneurysm, transcranial Doppler sonography demonstrated vasospasm of the basal cerebral arteries. An antinociceptive effect of sumatriptan can be observed in SAH patients in good clinical condition, which suggests a specific craniovascular antinociceptive action. This may lead to misdiagnosis as migraine and delayed appropriate diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
12/14. An unusual cause of hypocalcaemia: magnesium induced inhibition of parathyroid hormone secretion in a patient with subarachnoid haemorrhage.We describe a case of a woman with subarachnoid haemorrhage who developed hypocalcaemia and decreased serum parathyroid hormone levels due to hypermagnesemia. The patient had been receiving bisphosphonate therapy prior to admission and this may have contributed to the severity of the problem.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
13/14. Aneurysmal subarachnoid haemorrhage in a patient with thyrotoxicosis.A case of subarachnoid haemorrhage secondary to rupture of an intracranial aneurysm occurring in a patient with new-onset, frank thyrotoxicosis is described. This unusual case highlights the dilemma of whether to continue beta-blockers such as propanolol for frank thyrotoxicosis, or whether to assign higher priority to maintaining adequate cerebral perfusion pressure in established ischaemic deficit due to vasospasm. In a complicated case such as this, the Maudsley Mentation Test score and perfusion CT scanning are two useful adjuncts for the early detection and evaluation of the course of ischaemic deficit.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
14/14. Haemodynamic changes after intracisternal papaverine instillation during intracranial aneurysmal surgery.Cerebral vasospasm remains a significant cause of mortality and morbidity after aneurysmal subarachnoid haemorrhage. Use of either intra-arterial or intracisternal papaverine as an alternative treatment of refractory cerebral vasospasm has been associated with various complications including haemodynamic instabilities. However, our search in literature did not reveal association of bradycardia and hypotension with the use of papaverine by either of these routes. Here, we describe a case of anterior communicating artery aneurysm with hydrocephalus. The patient underwent craniotomy and clipping of the aneurysm followed by third ventriculostomy. Instillation of papaverine at the surgical site caused significant haemodynamic changes possibly because of stimulation of hypothalamus in the third ventricle or vagal nuclei in the fourth ventricle, or even both. We recommend cautious use of intracisternal papaverine in such scenario especially when third ventriculostomy has been performed as an adjunct surgical procedure.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
| <- Previous | |