By R Loch Macdonald; Bryce Weir

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The Incidence of Vasospasm over Time There was no clear reduction in reported incidence of VSP or D I D in the decades from the 1970s to the early 1990s. Dorsch and King's review found an incidence of D I D of approximately 40% with a range of approximately 20-60% (34). On the contrary, it was suggested that the overall mortality in patients with ruptured aneurysms who reached the hospital has declined from approximately 40% in the 1960s to 25% in the 1970s, to 20% in the 1980s, and to approximately 15% currently .

An apparently definitive randomized, double-blind, placebo-controlled trial of antifibrinolytic therapy in SAH found that, compared with placebo-treated patients, tranexamic acid-treated patients had an increased incidence of DID (24 vs 15%, respectively). Bleeding occurred in 24% of control and 9% of treated patients. There was no significant difference in outcome between the groups at 3 months (53). F. Age and Sex Between 1982 and 1986, in a study of 25 patients aged 65 years or older and 118 younger patients, all had early surgery performed The clinical manifestations of VSP were evaluated at 3 months post-SAH and classified as transient or permanent.

This is certainly consistent with the possibility that the surgical insult is a contributing factor to "VSP"induced DID. Torner and colleagues concluded that the relationship of time of surgery and VSP is influenced by 34 2, E P I D E M I O L O G Y time course of VSP, the effectiveness of surgical clot removal, and the choice of medical management to prevent rebleeding and treat VSP (91). In 295 patients managed between 1986 and 1988 in Glasgow, surgical mortality rate was only 4%. Seven percent of the patients had unruptured aneurysms and only 9% were in neurological grades IV or V.

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