Hemorrhagic Stroke

  • Jamary Oliveira-Filho
  • Walter J. Koroshetz


Hemorrhagic stroke comprises 10% to 20% of all strokes. Intracerebral hemorrhage (ICH) occurs twice as often as subarachnoid hemorrhage (SAH) (1). Both ICH and SAH are associated with high initial mortality and long-term morbidity. Various treatment strategies are available to minimize and to prevent ongoing neurologic injury. For these treatments to be effective, they must be instituted while the injury is still reversible. Thus, early recognition is essential. This chapter discusses the etiology, clinical manifestations, and critical management of ICH and SAH.


Subarachnoid Hemorrhage Brain Natriuretic Peptide Intracerebral Hemorrhage Intracranial Aneurysm Hemorrhagic Stroke 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage is more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993; 78: 188–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Broderick JP, Adams HP, Jr., Barsan W, Feinberg W, Feldman E, Grotta J, Kase C, Krieger D, Mayberg M, Tilley B, Zabramski JM, Zuccarello M. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999; 30: 905–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Ruiz-Sandoval IL, Cantû C, Barinagarrementeria F. Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke 1999; 30: 537–41.PubMedCrossRefGoogle Scholar
  4. 4.
    O’Donnell HC, Rosand J, Knudsen KA, Furie KL, Segal AZ, Chiu RI, Ikeda D, Greenberg SM. Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med 2000; 342: 240–5.CrossRefGoogle Scholar
  5. 5.
    Marti-Fàbregas J, Piles S, Guardia E, Marti-Vilalta JL. Spontaneous primary intraventricular hemorrhage: clinical data, etiology and outcome. J Neurol 1999; 246: 287–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim JS, Lee JH, Lee MC. Small primary intracerebral hemorrhage. Clinical presentation of 28 cases. Stroke 1994; 25: 1500–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Barzô P, Vörös E, Bodosi M. Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report Surg Neurol 1999; 51: 430–4.Google Scholar
  8. 8.
    Sloan MA, Sila CA, Mahaffey KW, Granger CB, Longstreth WTJr, Koudstaal P, White MD, Gore IM, Simoons ML, Weaver WD, Green CL, Topol EJ, Califf RM. Prediction of 30-day mortality among patients with thrombolysis-related intracranial hemorrhage. Circulation 1998; 98: 1376–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Gebel JM, Sila CA, Sloan MA, Granger CB, Mahaffey KW, Weisenberger J, Green CL, White HD, Gore JM, Weaver WD, Calif RM, Topol EJ. Thrombolysis-related intracranial hemorrhage: a radiographic analysis of 244 cases from the GUSTO-1 trial with clinical correlation. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. Stroke 1998; 29: 563–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Gorelick PB, Hier DB, Caplan LR, Langenberg P. Headache in acute cerebrovascular disease. Neurology 1986; 36: 1445–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Barraquer-Bordas L, la I, Escartin A, Ruscalleda J, Marti-Vilalta JL. Thalamic hemorrhage. A study of 23 patients with diagnosis by computed tomography. Stroke 1981; 12: 524–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Ott KH, Kase CS, Ojemann RG, Mohr JP. Cerebellar hemorrhage: diagnosis and treatmentA review of 56 cases. Arch Neurol 1974; 31: 160–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Fisher CM. Ocular bobbing. Arch Neurol 1964; 11: 543–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Zhu XL, Chan MS, Poon WS. Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 1997; 28: 1406–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Patel MR, Edelman RR, Warach S. Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 1996; 27: 2321–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Shellinger P, Jansen O, Fiebach JB, Hacke W, Sartor K. A standardized MR1 stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. Stroke 1999; 30: 765–8.CrossRefGoogle Scholar
  17. 17.
    Linfante I, Llinas RH, Caplan LR, Warach S. MRI features of intracerebral hemorrhage within 2 hours from symptom onset Stroke 1999; 30: 2263–7.Google Scholar
  18. 18.
    Meyer JS, Bauer RB. Medical treatment of spontaneous intracranial hemorrhage by the use of hypotensive drugs. Neurology 1962; 12: 36–47.PubMedCrossRefGoogle Scholar
  19. 19.
    Dandapani BK, Suzuki S, Kelley RE, Reyes-Iglesias Y, Duncan RC. Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke 1995; 26: 21–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Qureshi AI, Wilson DA, Hanley DF, Traystman RJ. No evidence for an ischemic penumbra in massive experimental intracerebral hemorrhage. Neurology 1999; 52: 266–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Powers WJ, Adams RE, Yundt KD, Manno EM, Diebert E, Zazulia A, Videen TO, Diringer MN. Acute pharmacological hypotension after intracerebral hemorrhage does not change cerebral blood flow. Stroke 1999;30:242. Abstract.Google Scholar
  22. 22.
    Qureshi AI, Bliwise DL, Bliwise NG, Akbar MS, Uzen G, Frankel MR. Rate of 24-hour blood pressure decline and mortality after spontaneous intracerebral hemorrhage: a retrospective analysis with a random effects regression model. Crit Care Med 1999; 27: 480–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, Spilker J, Duldner J, Khoury J. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28: 1–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Zazulia AR, Diringer MN, Derdeyn CP, Powers WJ. Progression of mass effect after intracerebral hemorrhage. Stroke 1999; 30: 1167–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Poungvarin N, Bhoopat W, Viriyavejakul A, Rodprasert P, Buranasiri P, Sukondhabhant S, Hensley MJ, Strom BL. Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 1987; 316: 1229–1233.PubMedCrossRefGoogle Scholar
  26. 26.
    Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 1998; 29: 1352–7.PubMedCrossRefGoogle Scholar
  27. 27.
    McKissock W, Richardson A, Taylor J. Primary intracerebral hemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 1961; 2: 221–6.CrossRefGoogle Scholar
  28. 28.
    Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, Troupp H. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment J Neurosurg 1989; 70: 755–8.Google Scholar
  29. 29.
    Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 1990; 47: 1103–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Auer LM, Deinsberger W, Niederkom K, Gell G, Kleinert R, Schneider G, Holzer P, Bone G, Mokry M, Korner E, Kleinert G, Hanusch S. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 1989; 70: 530–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Taneda M, Hayakawa T, Mogami H. Primary cerebellar hemorrhage. Quadrigeminal cistern obliteration on CT scans as a predictor of outcome. J Neurosurg 1987; 67: 545–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Kobayashi S, Sato A, Kageyama Y, Nakamura H, Watanabe Y, Yamaura A. Treatment of hypertensive cerebellar hemorrhage–surgical or conservative management? Neurosurgery 1994; 34: 246–51.PubMedCrossRefGoogle Scholar
  33. 33.
    Broderick JP, Bmtt TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 1993; 24: 987–93.PubMedCrossRefGoogle Scholar
  34. 34.
    McCormick WF, Acosta-Rua GJ. The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 1970; 33: 422–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Neil-Dwyer G, Bartlett JR, Nicholls AC, Narcisi P, Pope FM. Collagen deficiency and ruptured cerebral aneurysms. A clinical and biochemical study. J Neurosurg 1983; 59: 16–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Lanzino G, Kassell NF, Germanson T, Truskowski L, Alves W. Plasma glucose levels and outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 1993; 79: 885–91.PubMedCrossRefGoogle Scholar
  37. 37.
    Taylor CL, Yuan Z, Selman WR, Ratcheson RA, Rimm AA. Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors. J Neurosurg 1995; 83: 812–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Stober T, Sen S, Anstätt T, Freier G, Schimrigk K. Direct evidence of hypertension and the possible role of post-menopause oestrogen deficiency in the pathogenesis of berry aneurysms. J Neurol 1985; 232: 67–72.PubMedCrossRefGoogle Scholar
  39. 39.
    Longstreth WTJ, Nelson LM, Koepsell TD, van Belle G. Subarachnoid hemorrhage and hormonal factors in women. A population-based case-control study. Ann Intern Med 1994; 121: 168–73.PubMedGoogle Scholar
  40. 40.
    Kassell NF, Tomer JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysm Surgery. Part I: Overall management results. J Neurosurg 1990; 73: 18–36.PubMedCrossRefGoogle Scholar
  41. 41.
    Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Kistler JP, Crowell RM, Davis KR, Heros R, Ojemann RG, Zervas T, Fisher CM. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology 1983; 33: 424–36.PubMedCrossRefGoogle Scholar
  43. 43.
    Schwartz RB, Tice HM, Hooten SM, Hsu L, Stieg PE. Evaluation of cerebral aneurysms with helical CT: correlation with conventional angiography and MR angiography. Radiology 1994; 192: 717–22.PubMedGoogle Scholar
  44. 44.
    Rinkel GJ, Wijdicks EF, Hasan D, Kiensra GE, Franke CL, Hageman LM, Vermeulen M, van Gijn J. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet 1991; 338: 964–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Brismar J, Sundbärg G. Subarachnoid hemorrhage of unknown origin: prognosis and prognostic factors. J Neurosurg 1985; 63: 349–54.PubMedCrossRefGoogle Scholar
  46. 46.
    Tatter SB, Crowell RM, Ogilvy CS. Aneurysmal and microaneurysmal “angiogram-negative” subarachnoid hemorrhage. Neurosurgery 1995; 37: 48–55.PubMedCrossRefGoogle Scholar
  47. 47.
    Wijdicks EF, Vermeulen M, Murray GD, Hijdra A, van Gijn J. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 1990; 92: 111–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Kassell NF, Tomer JC, Jane JA, Haley EC Jr, Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 1990; 73: c37–47.CrossRefGoogle Scholar
  49. 49.
    Le Roux PD, Elliott JP, Downey L, Newell DW, Grady MS, Mayberg MR, Eskridge JM, Winn HR. Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg 1995; 83: 394–402.PubMedCrossRefGoogle Scholar
  50. 50.
    Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ. Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 1990; 72: 559–66.PubMedCrossRefGoogle Scholar
  51. 51.
    Rordorf G, Ogilvy CS, Gress DR, Crowell RM, Choi IS. Patients in poor neurological condition after subarachnoid hemorrhage: early management and long-term outcome. Acta Neurochir (Wien) 1997; 139: 1143–51.CrossRefGoogle Scholar
  52. 52.
    Le Roux PD, Elliott JP, Newell DW, Grady MS, Winn HR. Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 1996; 85: 39–49.PubMedCrossRefGoogle Scholar
  53. 53.
    Vanninen R, Koivisto T, Saari T, Hemesniemi J, Vapalahti M. Ruptured intracranial aneurysms: Acute endovascular treatment with electrolytically detachable coils–a prospective randomized study. Radiology 1999; 211: 325–36.PubMedGoogle Scholar
  54. 54.
    Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results AJNR Am J Neuroradiol 1994; 15: 815–20.Google Scholar
  55. 55.
    Byrne JV, Sohn MJ, Molyneux AJ, Chir B. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg 1999; 90: 656–63.PubMedCrossRefGoogle Scholar
  56. 56.
    Nashioka H, Tomer JC, Graf CJ, Kassell NF, Sahs AL, Goettler LC. Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively. Arch Neurol 1984; 41: 1142–6.CrossRefGoogle Scholar
  57. 57.
    Winn HR, Richardson AE, Jane JA. The long-term prognosis in untreated cerebral aneurysms: I. The incidence of late hemorrhage in cerebral aneurysm: a 10-year evaluation of 364 patients. Ann Neurol 1977; 1: 358–70.PubMedCrossRefGoogle Scholar
  58. 58.
    Inagawa T, Kamiya K, Ogasawara H, Yano T. Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 1987; 28: 93–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16: 562–72.PubMedCrossRefGoogle Scholar
  60. 60.
    Miller J, Diringer M. Management of aneurysmal subarachnoid hemorrhage. Neurol Clin 1995; 13: 451–78.PubMedGoogle Scholar
  61. 61.
    Allen GS, Ahn HS, Preziosi TJ, Battye R, Boone SC, Chou SN, Kelly DL, Weir BK, Crabbe RA, Lavik Pi, Rosenbloom SB, Dorsey FC, Ingram CR, Mellits DE, Bertsch LA, Boisvert DP, Hundley MB, Johnson RK, Strom JA, Transou CR. Cerebral arterial spasm–a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 1983; 308: 619–24.PubMedCrossRefGoogle Scholar
  62. 62.
    Pickard JD, Murray GD, Illingworth R, Shaw MD, Teasdale GM, Foy PM, Humphrey PR, Lang DA, Nelson R, Richards P, Sinar J, Bailey S, Skene A. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989; 298: 636–42.PubMedCrossRefGoogle Scholar
  63. 63.
    Sloan MA, Wozniak MA, Macko RF. Monitoring of vasospasm after subarachnoid hemorrhage. In: Babikian VL, Wechsler LR, eds. Transcranial Doppler Ultrasonography. Boston: Butterworth-Heinemann, 1999: 109–28.Google Scholar
  64. 64.
    Awad IA, Carter LP, Spetzler RF, Medina M, Williams FC Jr. Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 1987; 18: 365–72.PubMedCrossRefGoogle Scholar
  65. 65.
    Kassell NF, Peerless SJ, Durward QJ, Beck DW, Drake CG, Adams HP. Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 1982; 11: 337–43.PubMedCrossRefGoogle Scholar
  66. 66.
    Solomon RA, Fink ME, Lennihan L. Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage. Neurosurgery 1988; 23: 699–704.PubMedCrossRefGoogle Scholar
  67. 67.
    Miller JA, Dacey RG Jr, Diringer MN. Safety of hypertensive hypervolemic therapy with phenylephrine in the treatment of delayed ischemic deficits after subarachnoid hemorrhage. Stroke 1995; 26: 2260–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Mayer SA, Lin J, Homma S, Solomon RA, Lennihan L, Sherman D, Fink ME, Beckford A, Klebanoff LM. Myocardial injury and left ventricular performance after subarachnoid hemorrhage. Stroke 1999; 30: 780–6.PubMedCrossRefGoogle Scholar
  69. 69.
    Elliott JP, Newell DW, Lam DJ, Eskridge JM, Douville CM, LeRoux PD, Lewis DH, Mayberg MR, Grady MS, Winn HR. Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 1998; 88: 277–84.PubMedCrossRefGoogle Scholar
  70. 70.
    Eskridge JM, McAuliffe W, Song JK, Deliganis AV, Newell DW, Lewis DI-I, Mayberg MR, Winn HR. Balloon angioplasty for the treatment of vasospasm: Results of first 50 cases. Neurosurgery 1998; 42: 510–17.PubMedCrossRefGoogle Scholar
  71. 71.
    Bejjani GK, Bank WO, Olan WJ, Sekhar LN. The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 1998; 42: 979–87.PubMedCrossRefGoogle Scholar
  72. 72.
    Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS. Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 1992; 77: 848–52.PubMedCrossRefGoogle Scholar
  73. 73.
    Firlik KS, Kaufmann AM, Firlik AD, Jungreis CA, Yonas H. Intra-arterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid hemonfiage. Sing Neurol 1999; 51: 66–74.Google Scholar
  74. 74.
    Cross DT 3d, Moran CJ, Angtuaco EE, Milburn JM, Diringer MN, Dacey RG Jr. Intracranial pressure monitoring during intraarterial papaverine infusion for cerebral vasospasm. AJNR Am J Neuroradiol 1998; 19: 1319–23.PubMedGoogle Scholar
  75. 75.
    Tomida M, Muraki M, Uemura K, Yamasaki K. Plasma concentrations of brain natriuretic peptide in patients with subarachnoid hemorrhage. Stroke 1998; 29: 1584–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Berendes E, Walter M, Cullen P, Prien T, Van Aken H, Horsthemke J, Schulte M, von Wild K, Scherer R. Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage. Lancet 1997; 349: 245–9.PubMedCrossRefGoogle Scholar
  77. 77.
    Lusic I, Ljutic D, Maskovic J, Jankovic S. Plasma and cerebrospinal fluid endogenous digoxin- like immunoreactivity in patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1999; 141: 691–7.CrossRefGoogle Scholar
  78. 78.
    Sviri GE, Feinsod M, Soustiel JF. Brain natriuretic peptide and cerebral vasospasm in subarachnoid hemorrhage. Clinical and TCD correlations. Stroke 2000; 31: 118–22.CrossRefGoogle Scholar
  79. 79.
    Oliveira-Filho J, Ezzeddine M, Segal AZ, Buonanno FS, Koroshetz WJ, Rordorf G, Schwamm L, McDonald CT. Causes of fever in subarachnoid hemorrhage. Stroke 2000;31:296. Abstract.Google Scholar
  80. 80.
    Frosini M, Sesti C, Valoti M, Palmi M, Fusi F, Parente L, Sgaragli G. Rectal temperature and prostaglandin E2 increase in cerebrospinal fluid of conscious rabbits after intracerebroventricular injection of hemoglobin. Exp Brain Res 1999; 126: 252–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Weir B, Disney L, Grace M, Roberts R Daily trends in white blood cell count and temperature after subarachnoid hemorrhage from aneurysm. Neurosurgery 1989; 25: 161–5.PubMedCrossRefGoogle Scholar
  82. 82.
    Zaroff JG, Rordorf GA, Newell JB, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery 1999; 44: 34–9.PubMedCrossRefGoogle Scholar
  83. 83.
    Horowitz MB, Willet D, Keffer J. The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1998; 140: 87–93.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Jamary Oliveira-Filho
    • 1
  • Walter J. Koroshetz
    • 1
  1. 1.Harvard Medical SchoolMassachusetts General HospitalBostonUSA

Personalised recommendations