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Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Neuroscience.
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2001 In: Stroke, Vol. 32, no 12, 2845-2849 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2001. Vol. 32, no 12, 2845-2849 p.
URN: urn:nbn:se:uu:diva-97921OAI: oai:DiVA.org:uu-97921DiVA: diva2:173041
Available from: 2008-12-19 Created: 2008-12-19Bibliographically approved
In thesis
1. Subarachnoid Hemorrhage in the Elderly
Open this publication in new window or tab >>Subarachnoid Hemorrhage in the Elderly
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Subarachnoid hemorrhage (SAH) is a disease with high risk of mortality and morbidity. Elderly patients have an even higher risk of poor outcome. The incidence of SAH increases with age and the elderly constitute a substantial and increasing proportion of the population. Thus, the management of elderly SAH patients is an imminent clinical challenge. Time trends in clinical management and outcome were investigated in 281 SAH patients aged ≥65 years admitted over an 18-year period. The volume of elderly patients, especially patients ≥70 years and patients in worse clinical condition increased over time. The proportion of patients with favorable outcome increased over time, without an increase in severely disabled patients. Technical results and clinical outcome of endovascular aneurysm treatment (EVT) was investigated in 62 elderly SAH patients. EVT can be performed in elderly SAH patients with high technical success, acceptable aneurysm occlusion degree, acceptable procedural complication rate, and fair outcome results. EVT was compared to neurosurgical clipping (NST) in 278 elderly SAH patients in the International Subarachnoid Aneurysm Trial. In good grade elderly SAH patients, EVT should probably be the favored treatment for internal carotid and posterior communicating artery aneurysms, while elderly patients with middle cerebral artery aneurysms appear to benefit from NST. Occurrence of secondary insults and their impact on clinical deterioration were studied in 99 patients with severe SAH. High intracranial pressure increased and high cerebral perfusion pressure decreased the risk of clinical deterioration. Elderly patients had less intracranial hypertension insults and more hypertensive, hypotensive and hypoxemic insults. Good outcome was achieved in 24% of elderly patients with severe SAH, and the proportion of severe disability was similar to that of younger patients. Patient age was not a significant predictor for vasospasm in 413 SAH patients when admission and treatment variables were adjusted for with multiple logistic regression.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 106 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 407
subarachnoid hemorrhage, intracranial aneurysm, elderly, outcome, endovascular coiling, neurosurgical clipping, secondary insult, cerebral vasospasm
National Category
urn:nbn:se:uu:diva-9504 (URN)978-91-554-7375-4 (ISBN)
Public defence
2009-01-09, Enghoffsalen, Akademiska sjukhuset, ing 50, Uppsala, 09:15
Available from: 2008-12-19 Created: 2008-12-19 Last updated: 2011-01-12Bibliographically approved

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