[Evaluation of the treatment of aneurysmal meningeal hemorrhage with antifibrinolytic agents, calcium inhibitors and maintenance of effective blood volume]. / Bilan du traitement des hémorragies méningées anévrysmales par antifibrinolytique, inhibiteur calcique et maintien d'une volémie efficace.

ABSTRACT

To prevent and treat the ischemic complications due to the vasospasm, this report suggest the management of aneurysmal subarachnoid haemorrhage by the association of antifibrinolytics (tranexamic acid) to lower the risk of rebleeding, calcium channel blockers (nimodipine), and the keeping of an effective total blood volume (thanks to volume expansion and dopamine). From 88 patients aged from 4 to 73, two thirds were admitted at latest 48 h after the aneurysmal rupture Emergency surgery was carried out in the case of a compressive hematoma, early surgery (between the first and the third day) on the grades I, II and III of Hunt and Hess without any signs of angiographic vasospasms (40% of this series), delayed surgery for the others (27.5%), 10% didn't undergo any surgery. Only three patients (3.4%) presented rebleeding leading to death. The features of the whole series are 51% recovered without any after effects, 22% had mild neurological deficiency, 10% had severe neurological deficiency and 17% died after their release from hospital. This protocol allowed a decrease in the ischemic complications due to the vasospasm and in the rate of rebleeding during the waiting interval when an angiographic or a clinical vasospasm allowed no surgery.