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- Perspective and Pathogenesis
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1. Expanding frontiers of cerebrovascular disease
- Prof. Vladimir Hachinski
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2. Basic anatomy, physiology and pathophysiology of the cerebral circulation for the physician
- Prof. Jean-Claude Baron
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3. Pathophysiology of cerebral ischemia
- Prof. Wolf-Dieter Heiss
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4. Intracerebral hemorrhages: causes and clinical findings
- Prof. Louis Caplan
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5. Subarachnoid hemorrhage (SAH)
- Prof. R. Loch Macdonald
- Diagnosis
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6. Clinical diagnosis of stroke and subtypes
- Prof. Louis Caplan
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7. The investigation of stroke
- Dr. Bart Demaerschalk
- Treatment
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8. Acute therapy of stroke and reperfusion treatments
- Prof. Brian Silver
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9. Subarachnoid hemorrhage diagnosis and management
- Prof. Gary K. Steinberg
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10. Stroke-induced heart injury
- Dr. Luciano A. Sposato
- Rehabilitation
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11. Stroke rehabilitation: principles of stroke
- Prof. Robert Teasell
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12. Stroke rehabilitation: therapies and treatments
- Prof. Robert Teasell
- Prevention
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13. Lifestyle and nutrition in stroke prevention
- Prof. J. David Spence
- Special Topics
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15. Pediatric stroke: cerebrovascular injury in the developing brain
- Prof. Adam Kirton
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16. Stroke in women: epidemiology, risk and prevention
- Prof. Cheryl Bushnell
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17. Transient ischemic attack and cognition
- Dr. Jennifer Mandzia
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18. Vascular cognitive impairment
- Prof. Eric E. Smith
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19. Atrial fibrillation, anticoagulation and vitamins for homocysteine
- Prof. J. David Spence
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20. Stroke in the young adult
- Prof. Jeffrey Saver
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21. Stroke in the young
- Dr. Gyan Kumar
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22. Convergence and joint prevention of stroke and dementia
- Prof. Vladimir Hachinski
- Archived Lectures *These may not cover the latest advances in the field
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23. Vascular cognitive impairment
- Dr. John Bowler
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24. Pediatric stroke
- Dr. Gabrielle deVeber
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25. The deteriorating stroke
- Prof. Werner Hacke
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26. General management
- Prof. Bo Norrving
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27. The treatment of stroke: specific management - thrombolysis plus
- Prof. Nils Wahlgren
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28. Rehabilitation: the chronic phase
- Prof. Lalit Kalra
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29. Prevention: management of risk and protective factors
- Prof. Graeme Hankey
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30. Medical therapy for secondary prevention of ischemic stroke
- Prof. Larry Goldstein
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31. Subarachnoid haemorrhage
- Prof. Jan van Gijn
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32. Controversies in stroke
- Prof. Stephen Davies
- Prof. Geoffrey Donnan
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33. Medical and surgical stroke
- Prof. Carlos Kase
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34. The urgency of stroke prevention after TIA
- Prof. S. Claiborne Johnston
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35. Carotid endarterectomy, angioplasty and stenting
- Prof. Martin Brown
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36. The clinical diagnosis of stroke and stroke subtypes
- Prof. Louis Caplan
Printable Handouts
Navigable Slide Index
- Introduction
- Annual incidence rate of categories of stroke
- Causes of subarachnoid hemorrhage
- Intracranial aneurysms (1)
- Incidence of aSAH
- Intracranial aneurysms (2)
- Distribution of congenital cerebral aneurysms
- Symptoms of SAH
- Circumstances of SAH
- Potential risk factors for SAH
- Diagnostic guidelines
- Case 1: Patient with sudden onset "worst headache of life"
- Diagnostic options
- Hunt and hess scale
- World federation of neurosurgical societies scale
- The international cooperative study on the timing of aneurysm surgery
- Case 2: 35 yo female H/H Grade II
- Cumulative risk of rebleeding after aneurysm rupture
- Aneurysm rebleeding
- Natural history of untreated ruptured aneurysms
- Medical measures to prevent rebleeding after aSAH: recommendations
- 28,000 ruptured aneurysms/year (north america)
- Intracranial aneurysms: microsurgical clipping
- Case 3: 69 yo female with 12 mm L MCA aneurysm (1)
- Case 3: Surgery
- Case 3: Surgery video
- Stanford neurosurgical simulation and virtual reality center (1)
- Case 4: Stanford neurosurgical simulation and virtual reality center (2)
- Case 4: Video of procedure
- Two days post-op
- Intracranial aneurysms (3)
- Case 5: 83 yo female, SAH
- 2002 - landmark paper
- ISAT (Lancet 2002, 2005) (1)
- ISAT (Lancet, 2002)
- ISAT (Lancet, 2002, 2005) (2)
- Treatment of aneurysms, 2002-2006
- Treatment of aneurysms, 2007-2012
- Medicare Beneficiaries 2007-2012
- ISAT (Lancet, 2015)
- Intracranial aneurysms (4)
- Case 6: 75 yo female, onset left sided numbness transient facial weakness & dysarthria
- Pipeline flow diverter
- Flow diverter for unruptured aneurysms (for ruptured aneurysms?)
- Surgical and endovascular methods of treatment of ruptured cerebral aneurysms: recommendations
- Stanford Study 2007
- Coiling vs. clipping: a patient comparison (1)
- Coiling vs. clipping: a patient comparison (2)
- Coiling vs. clipping for intracranial aneurysms (1)
- Coiling vs. clipping for intracranial aneurysms (2)
- Stanford aneurysms 1989-2018
- Complications of SAH
- Case 7: 51 yo female, hx migraine HAs, sudden severe HA 1 wk prior to admission, persistent
- Case 7: Patient deteriorated intubated
- Delayed ischemic deficit (DID) due to vasospasm after SAH
- Fisher grade
- Cerebral vasospasm: CT appearance and incidence of DID
- Diagnosis of vasospasm
- Transcranial doppler (1)
- Transcranial doppler (2)
- Patient's status dynamics
- Results of randomized clinical trials of oral Nimodipine in patients with ruptured cerebral aneurysms
- Management of cerebral vasospasm and DCI after aSAH: recommendations
- Vasopasm nicardipine
- Balloon angioplasty
- Case 8: 55 yo female, H/H grade IV (1)
- Case 8: 55 yo female, H/H grade IV (2)
- Management of hydrocephalus associated with aSAH: recommendations
- Management of medical complications associated with aSAH: recommendations
- Pros and cons of early versus delayed surgery
- Timing of aneurysm obliteration
- Giant aneurysms
- Case 9: 37 yo male, 3 mos, increased headaches & partial complex seizures
- Case 9: Surgery
- Case 9: Surgery video (33 oC intraoperative mild hypothermia 1 hr, 51 min temporary Rt M2 (MCA) occlusion)
- Postop angiogram
- Clipping after stent/coiling (1)
- Clipping after stent/coiling surgery
- Clipping after stent/coiling surgery video (Lt A1 occlusion: 53 min bilat A2 occlusion: 10 min; 33oC)
- Clipped 77 aneurysms after coiling or stent/coiling
- Case 10: 52 yo male, SAH, Hunt/Hess II, Fisher III
- Arterial bypass for complex aneurysms: mild hypothermia 33oC, PICA CBF: pre-bypass 9 ml/min; post-bypass 13 ml/min
- Inta Op & Post Op
- Two days post-op
- Case 11: 38 yo female, SAH H/H grade II jehovah’s witness
- Deliberate basilar or vertebral artery occlusion in the treatment of intracranial anuerysms
- Posterior communicating artery size as a predictor of ischemic deficit after treatment
- Wide-necked aneurysms
- New materials for endovascular filling of aneurysms
- 2005: new stanford 3D-DSA biplane angiography suite
- Stanford cerebrovascular team 2018
- Stanford University
Topics Covered
- Epidemiology of subarachnoid hemorrhage (SAH)
- Symptoms of aneurysmal SAH
- Diagnostic guidelines
- Clinical grading scale
- Intracranial aneurisms: microsurgical clipping, 3D virtual reality simulation
- Intracranial aneurisms: endovascular coiling/stent coiling/flow diverters
- Complications of SAH
- Treatment of vasospasm
- American Heart & Stroke Association Guidelines for the management of aneurysmal SAH
- Timing of treatment and options
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Steinberg, G.K. (2019, November 28). Subarachnoid hemorrhage diagnosis and management [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 15, 2024, from https://doi.org/10.69645/KZDD5683.Export Citation (RIS)
Publication History
Financial Disclosures
- There are no commercial/financial matters to disclose.
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Gary Steinberg.
I'm the Lacroute-Hearst Professor and Chair of the Department of Neurosurgery at
Stanford University School of Medicine and
the founder and co-director of the Stanford stroke center.
I'm going to talk to you today about subarachnoid hemorrhage diagnosis and management.
0:18
As you can see, subarachnoid hemorrhage represents only about 10 percent of all strokes,
but it has a significant morbidity and mortality associated with it,
particularly in young and middle aged patients.
0:32
Traumatic brain injury is a common cause of subarachnoid hemorrhage,
but does not usually cause a stroke.
I want to focus on spontaneous subarachnoid hemorrhage,
the most common cause of which is a ruptured intracranial aneurysm.
As you can see on this slide,
there are many other causes much less frequent of spontaneous subarachnoid hemorrhage.
0:53
Intracranial aneurysms occur in patients between approximately 35 to 65 years old.
Prevalence of about two to five percent in
the population and there's a significant morbidity and
mortality of about 60 percent overall associated with ruptured intracranial aneurysm.
You can see that the median mortality varies according to country.
1:17
The incidence of aneurysmal subarachnoid hemorrhage varies from two to
100,000 in China to ten times that in Finland.
In the US, it's about 12 to 15 for a 100,000 patients.
It's more common in women and interestingly,
significant percentage of patients with aneurysmal subarachnoid hemorrhage have
another family member who also have a confirm intracranial aneurysm.