What is the Fisher scale?

The Fisher scale is the initial and best known system of classifying the amount of subarachnoid hemorrhage on CT scans, and is useful in predicting the occurrence and severity of cerebral vasospasm, highest in grade 3 ².

What is the modified Fisher scale?

The modified Fisher scale is a method for radiological grading subarachnoid haemorrhage (SAH) secondary to intracranial aneurysm rupture, assessed on the first non-contrast CT. It was modified from the original Fisher scale to account for patients with thick cisternal blood and concomitant intraventricular haemorrhage.

What is a Grade 4 subarachnoid hemorrhage?

Poor grade aneurysmal subarachnoid hemorrhage (PGASAH) , is classified as Grade IV and V and accounts for approximately 20-40% of patients with SAH [4]. The prognosis of PGASAH is extraordinarily poor. More than 60% patients will become dependent or will die [5, 6].

What is delayed cerebral ischemia?

Delayed cerebral ischemia (DCI) is a feared and significant medical complication following aneurysmal subarachnoid hemorrhage (aSAH). It occurs in about 30% of patients surviving the initial hemorrhage, mostly between days 4 and 10 after aSAH.

What is Triple H therapy?

The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH).

What is Fisher Information?

What is Hyperdynamic therapy?

The cornerstone of medical therapy for cerebral vasospasm is so-called hyperdynamic therapy. Also referred to as triple-H therapy, this strategy includes the use of hypertension, hypervolemia, and hemodilution to optimize cerebral perfusion.

What type of drug is nimodipine?

Nimodipine is in a class of medications called calcium channel blockers. It works by relaxing blood vessels in the brain to allow more blood to flow to damaged areas.

Is a cerebral infarction the same as a stroke?

A cerebral infarction (also known as a stroke) refers to damage to tissues in the brain due to a loss of oxygen to the area. The mention of "arteriosclerotic cerebrovascular disease" refers to arteriosclerosis, or "hardening of the arteries" that supply oxygen-containing blood to the brain.

What is brain ischemia?

Cerebral ischemia is a common mechanism of acute brain injury that results from impaired blood flow to the brain. Cerebral ischemia represents a medical emergency; if untreated, it can result in cerebral infarctions or global hypoxic-ischemic encephalopathy, which can result in death or permanent disability.

What is a cerebral vasospasm?

Cerebral vasospasm is a delayed event after an aneurysmal subarachnoid hemorrhage, with a usual peak from days 7 to 9 after a bleed. It usually affects the large arteries near the ruptured aneurysm.

What is the severity score for a subarachnoid hemorrhage called?

The most common clinical scoring systems for grading aneurysmal subarachnoid hemorrhage are the Hunt and Hess grading scheme and the World Federation of Neurosurgeons (WFNS) grading scheme, which incorporates the Glasgow Coma Scale.

What is a Grade 5 SAH?

Abstract. Background: Aneurysmal subarachnoid haemorrhage (SAH) WFNS grade V is commonly known to be associated with high mortality and a very poor prognosis for survivors. Therefore, maximal invasive therapy is frequently delayed until any spontaneous improvement with or without an external ventricular drainage occurs ...

What is a Level 5 brain aneurysm?

The higher the Hunt and Hess grade on admission to hospital, the lower the likelihood of survival. The Hunt and Hess scale ranges from grade 1 where a patient may be asymptomatic through to grade 5, where a patient may be in a coma or have a rigid posture with their limbs extended, pointed and tense.

What is Ogilvy and Carter scale?

Ogilvy and Carter proposed a comprehensive grading system for patients with SAH that includes age, aneurysm size, Fisher grade, and Hunt and Hess score. ¹¹. They indeed found that their scale was useful in stratifying outcomes with significant accuracy.

How long can you live with brain ischemia?

Another study found that 36% of patients did not survive beyond the first month. Of the remaining, 60% of patients suffering from an ischemic stroke survived one year, but only 31% made it past the five-year mark.

What does lack of blood flow to brain feel like?

Symptoms of restricted blood flow to the back of the brain, also called vertebrobasilar insufficiency, include dizziness and slurred speech. If something stops or disrupts blood flow to an area of the body, it is known as ischemia. When this happens to the brain, it can damage brain cells and result in health problems.

What are the symptoms of not having enough blood flow to the brain?

Which side of the brain is worse to have a stroke?

Left-hemispheric ischemic strokes appear to be more frequent and often have a worse outcome than their right-hemispheric counterparts.

What time of day do strokes usually occur?

Ischaemic stroke, similar to myocardial infarction and sudden death, occurs most often after awakening in the morning hours. A meta-analysis of 31 publications reporting the circadian timing of 11 816 strokes found a 49% increase in stroke of all types between 06 00 and 12 00.

Are there warning signs days before a stroke?

- Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.

What is another name for nimodipine?

Nimodipine, sold under the brand name Nimotop among others, is calcium channel blocker used in preventing vasospasm secondary to subarachnoid hemorrhage (a form of cerebral hemorrhage).

Why do you give nimodipine for SAH?

Nimodipine is used to decrease problems due to a certain type of bleeding in the brain (subarachnoid hemorrhage-SAH). Nimodipine is called a calcium channel blocker. The body naturally responds to bleeding by narrowing the blood vessel to slow blood flow.

Is nimodipine and amlodipine the same?

Nymalize (nimodipine) Lowers blood pressure. Norvasc (Amlodipine) works well to lower blood pressure and prevent chest pain. You can't miss doses, and you might get persistent swelling.

Why does hypertension cause vasospasm?

Vasoconstriction reduces the volume or space inside affected blood vessels. When blood vessel volume is lowered, blood flow is also reduced. At the same time, the resistance or force of blood flow is raised. This causes higher blood pressure.

How does hypertension prevent vasospasm?

Induced hypertension may reduce the incidence of vasospasm or the incidence of vasospasm‐related complications by providing an increased perfusion pressure which may overcome the reduction in blood flow.