J Hillman

Linköping University, Linköping, Östergötland, Sweden

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Publications (30)64.25 Total impact

  • Zhengquan Yu · Wei Li · Jan Hillman · Ulf T Brunk
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    ABSTRACT: 3-Aminopropanal (3-AP), a degradation product of polyamines such as spermine, spermidine and putrescine, is a lysosomotropic small aldehyde that causes apoptosis or necrosis of most cells in culture, apparently by inducing moderate or extensive lysosomal rupture, respectively, and secondary mitochondrial changes. Here, using the human neuroblastoma SH-SY5Y cell line, we found simultaneous occurrence of apoptotic and necrotic cell death when cultures were exposed to 3-AP in concentrations that usually are either nontoxic, or only cause apoptosis. At 30 mM, but not at 10 mM, the lysosomotropic base and proton acceptor NH3 completely blocked the toxic effect of 3-AP, proving that 3-AP is lysosomotropic and suggesting that the lysosomal membrane proton pump of neuroblastoma cells is highly effective, creating a lower than normal lysosomal pH and, thus, extensive intralysosomal accumulation of lysosomotropic drugs. A wave of internal oxidative stress, secondary to changes in mitochondrial membrane potential, followed and gave rise to further lysosomal rupture. The preincubation of cells for 24 h with a chain-breaking free radical-scavenger, alpha-tocopherol, before exposure to 3-AP, significantly delayed both the wave of oxidative stress and the secondary lysosomal rupture, while it did not interfere with the early 3-AP-mediated phase of lysosomal break. Obviously, the reported oxidative stress and apoptosis/necrosis are consequences of lysosomal rupture with ensuing release of lysosomal enzymes resulting in direct/indirect effects on mitochondrial permeability, membrane potential, and electron transport. The induced oxidative stress seems to act as an amplifying loop causing further lysosomal break that can be partially prevented by alpha-tocopherol. Perhaps secondary brain damage during a critical post injury period can be prevented by the use of drugs that temporarily raise lysosomal pH, inactivate intralysosomal 3-AP, or stabilize lysosomal membranes against oxidative stress.
    Brain Research 09/2004; 1016(2):163-9. DOI:10.1016/j.brainres.2004.04.075 · 2.83 Impact Factor
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    ABSTRACT: By pursuing a policy of very early aneurysm treatment in neurosurgical centers, in-hospital rebleeds can be virtually eliminated. Nonetheless, as many as 15% of patients with aneurysm rupture suffer ultraearly rebleeding with high mortality rates, and these individuals are beyond the reach of even the most ambitious protocol for diagnosis and referral. Only drugs given immediately after the diagnosis of subarachnoid hemorrhage (SAH) has been established at the local hospital level can, in theory, contribute to the minimization of such ultraearly rebleeding. The object of this randomized, prospective, multicenter study was to assess the efficacy of short-term antifibrinolytic treatment with tranexamic acid in preventing rebleeding. Only patients suffering SAH verified on computerized tomography (CT) scans within 48 hours prior to the first hospital admission were included. A 1-g dose of tranexamic acid was given intravenously as soon as diagnosis of SAH had been verified in the local hospitals (before the patients were transported), followed by doses of 1 g every 6 hours until the aneurysm was occluded; this treatment did not exceed 72 hours. In this study, 254 patients received tranexamic acid and 251 patients were randomized as controls. Age, sex, Hunt and Hess and Fisher grade distributions, as well as aneurysm locations, were congruent between the groups. Outcome was assessed at 6 months post-SAH by using the Glasgow Outcome Scale (GOS). Vasospasm and delayed ischemic neurological deficits were classified according to clinical findings as well as by transcranial Doppler (TCD) studies. All events classified as rebleeding were verified on CT scans or during surgery. More than 90% of patients reached the neurosurgical center within 12 hours of their first hospital admission after SAH; 70% of all aneurysms were clipped or coils were inserted within 24 hours of the first hospital admission. Given the protocol, only one rebleed occurred later than 24 hours after the first hospital admission. Despite this strong emphasis on early intervention, however, a cluster of 27 very early rebleeds still occurred in the control group within hours of randomization into the study, and 13 of these patients died. In the tranexamic acid group, six patients rebled and two died. A reduction in the rebleeding rate from 10.8 to 2.4% and an 80% reduction in the mortality rate from early rebleeding with tranexamic acid treatment can therefore be inferred. Favorable outcome according to the GOS increased from 70.5 to 74.8%. According to TCD measurements and clinical findings, there were no indications of increased risk of either ischemic clinical manifestations or vasospasm that could be linked to tranexamic acid treatment. Neurosurgical guidelines for aneurysm rupture should extend also into the preneurosurgical phase to guarantee protection from ultraearly rebleeds. Currently available antifibrinolytic drugs can provide such protection, and at low cost. The number of potentially saved lives exceeds those lost to vasospasm.
    Journal of Neurosurgery 11/2002; 97(4):771-8. DOI:10.3171/jns.2002.97.4.0771 · 3.23 Impact Factor
  • Journal of Neurosurgery 10/2002; 97(4):751-752. · 3.23 Impact Factor
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    ABSTRACT: Sudden onset headache is a common condition that sometimes indicates a life-threatening subarachnoid haemorrhage (SAH) but is mostly harmless. We have performed a prospective study of 137 consecutive patients with this kind of headache (thunderclap headache=TCH). The examination included a CT scan, CSF examination and follow-up of patients with no SAH during the period between 2 days and 12 months after the headache attack. The incidence was 43 per 100 000 inhabitants >18 years of age per year; 11.3% of the patients with TCH had SAH. Findings in other patients indicated cerebral infarction (five), intracerebral haematoma (three), aseptic meningitis (four), cerebral oedema (one) and sinus thrombosis (one). Thus no specific finding indicating the underlying cause of the TCH attack was found in the majority of the patients. A slightly increased prevalence of migraine was found in the non-SAH patients (28%). The attacks occurred in 11 cases (8%) during sexual activity and two of these had an SAH. Nausea, neck stiffness, occipital location and impaired consciousness were significantly more frequent with SAH but did not occur in all cases. Location in the temporal region and pressing headache quality were the only features that were more common in non-SAH patients. Recurrent attacks of TCH occurred in 24% of the non-SAH patients. No SAH occurred later in this group, nor in any of the other patients. It was concluded that attacks caused by a SAH cannot be distinguished from non-SAH attacks on clinical grounds. It is important that patients with their first TCH attack are investigated with CT and CSF examination to exclude SAH, meningitis or cerebral infarction. The results from this and previous studies indicate that it is not necessary to perform angiography in patients with a TCH attack, provided that no symptoms or signs indicate a possible brain lesion and a CT scan and CSF examination have not indicated SAH.
    Cephalalgia 06/2002; 22(5):354-60. DOI:10.1046/j.1468-2982.2002.00368.x · 4.12 Impact Factor
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    ABSTRACT: With increasing use of endovascular procedures, the number of aneurysms treated surgically will decline. In this study the authors review complications related to the surgical treatment of aneurysms and address the issue of maintaining quality standards on a national level. A prospective, nonselected amalgamation of every aneurysm case treated in five of six neurosurgical centers in Sweden during 1 calendar year was undertaken (422 patients; 7.4 persons/100,000 population/year). The treatment protocols at these institutions were very similar. Outcome was assessed using clinical end points. In this series, 84.1% of the patients underwent surgery, and intraoperative complications occurred in 30% of these procedures. Poor outcome from technical complications was seen in 7.9% of the surgically treated patients. Intraoperative aneurysm rupture accounted for 60% and branch sacrifice for 12% of all technical difficulties. Although these complications were significantly related to aneurysm base geometry and the competence of the surgeon, problems still occurred apparently at random and also in the best of hands (17%). The temporary mean occlusion time in the patients who suffered intraoperative aneurysm rupture was twice as long as the temporary arrest of blood flow performed to aid dissection. The results obtained in this series closely reflect the overall management results of this disease and support the conclusion that surgical complications causing a poor outcome can be estimated on a large population-based scale. Intraoperative aneurysm rupture was the most common and most devastating technical complication that occurred. Support was found for a more liberal use of temporary clips early during dissection, regardless of the experience of the surgeon. Temporary regional interruption of arterial blood flow should be a routine method for aneurysm surgery on an everyday basis. A random occurrence of difficult intraoperative problems was clearly shown, and this factor of unpredictability, which is present in any preoperative assessment of risk, strengthens the case for recommending neuroprotection as a routine adjunct to virtually every aneurysm operation, regardless of the surgeon's experience.
    Journal of Neurosurgery 04/2002; 96(3):515-22. DOI:10.3171/jns.2002.96.3.0515 · 3.23 Impact Factor
  • Jan Hillman
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    ABSTRACT: The author sought to describe overall management data on cerebral arteriovenous malformations (AVMs) and to focus the actuarial need for different treatment modalities on a population-based scale. Such data would seem important in the planning of regional or national multimodality strategies for the treatment of AVMs. This analysis of a nonselected, consecutive series of patients representing every diagnosed case of cerebral AVM in a population of 1,000,000 over one decade may serve to shed some light on these treatment aspects. During the 11-year period from 1989 to 1999, data from every patient harboring a cerebral AVM that was presented clinically or discovered incidentally in a strictly defined population of 986,000 people were collected prospectively. No patient was lost to follow up. There were 12.4 de novo diagnosed AVMs per 1,000,000 population per year (135 AVMs). Large high-grade AVMs (Spetzler-Martin classification) were rare, and Grade 1 to 3 lesions represented 85% of the caseload. Hemorrhage was the initial manifestation of AVM in 69.6% of the cases. lntracerebral hematoma was the most common hemorrhagic manifestation occurring in 78 patients. There were 4.4 cases per 1,000,000 population per year of hematomas needing expedient surgical evacuation. In the remaining patients who did not require hematoma surgery, small, critically located Grade 3 and Grade 4 lesions amounted to 1.6 cases per 1,000,000 population per year. There were 5.8 cases per 1,000,000 population per year of Grade 1 to 2 and larger noncritically located Grade 3 malformations. There were 0.5 cases per 1,000,000 population per year of Grade 5 AVMs. The overall outcome in 135 patients was classified as good according to the Glasgow Outcome Scale (Score 5) in 61% of the cases, and the overall mortality rate was 9%. In centers with population-based referral, AVM of the brain is predominantly a disease related to intracranial bleeding. and parenchymal clots have a profound impact on overall management outcome. The rupture of an AVM is as devastating as that of an aneurysm. Aneurysm ruptures are more lethal, whereas AVM rupture tends to result in more neurological disability due to the high occurrence of lobar intracerebral hematoma. In an attempt to quantify the need for different modalities of AVM treatment based on a population of 1,000,000 people, figures for surgeries performed range from six to 10 operations per year and embolization as well as gamma knife surgery procedures range from two to seven per year, depending on the strategy at hand. When using nonsurgical approaches to Grade 1 to 3 lesions, the number of patients requiring treatment with more than one method for obliteration increases drastically as does the potential risk for procedure-related complications.
    Journal of Neurosurgery 11/2001; 95(4):633-7. DOI:10.3171/jns.2001.95.4.0633 · 3.23 Impact Factor
  • S Fridriksson · J Hillman · A M Landtblom · J Boive
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    ABSTRACT: Forty percent of patients with aneurysmal subarachnoid hemorrhage have prodromal warning episodes and difficulties in identifying these events are repeatedly documented. Modifications of diagnostic and referral patterns through educational programs of local doctors may help to identify such patients before a major devastating rupture occurs. A teaching program about sudden onset headache, targeting referring doctors, was systematically applied and its impact on early misdiagnosis of ruptured aneurysms was prospectively studied. Forty percent of all studied patients experienced a warning episode, manifested as apoplectic headache, prior to hospitalization. An initial diagnostic error was evident in 12% of the patients. Diagnostic errors were reduced by 77% as a result of continuous interaction between neurosurgeons and local physicians. Misdiagnosed warning episodes cause greater loss of lives and higher morbidity on a population basis than does delayed ischemic complications from vasospasm in aneurysmal SAH. Teaching programs focused on local physicians have a profound impact on outcome at low cost.
    Acta Neurologica Scandinavica 05/2001; 103(4):238-42. DOI:10.1034/j.1600-0404.2001.103004238.x · 2.44 Impact Factor
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    ABSTRACT: Transportation of unstable neurosurgical patients involves risks that may lead to further deterioration and secondary brain injury from perturbations in physiological parameters. Mobile computerized tomography (CT) head scanning in the neurosurgery intensive care (NICU) is a new technique that minimizes the need to transport unstable patients. The authors have been using this device since June 1997 and have developed their own method of scanning such patients. The scanning procedure and radiation safety measures are described. The complications that occurred in 89 patients during transportation and conventional head CT scanning at the Department of Radiology were studied prospectively. These complications were compared with the ones that occurred during mobile CT scanning in 50 patients in the NICU. The duration of the procedures was recorded, and an estimation of the staff workload was made. Two patient groups, defined as high- and medium-risk cases, were studied. Medical and/or technical complications occurred during conventional CT scanning in 25% and 20% of the patients in the high- and medium-risk groups, respectively. During mobile CT scanning complications occurred in 4.3% of the high-risk group and 0% of the medium-risk group. Mobile CT scanning also took significantly less time, and the estimated personnel cost was reduced. Mobile CT scanning in the NICU is safe. It minimizes the risk of physiological deterioration and technical mishaps linked to intrahospital transport, which may aggravate secondary brain injury. The time that patients have to remain outside the controlled environment of the NICU is minimized, and the staff's workload is decreased.
    Journal of Neurosurgery 10/2000; 93(3):432-6. DOI:10.3171/jns.2000.93.3.0432 · 3.23 Impact Factor
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    Thorsteinn Gunnarsson · Jan Hillman
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    ABSTRACT: The practice of modern neurointensive care is based on the use of multimodality monitoring to respond rapidly to physiological, biochemical, or morphological changes and avoid secondary brain injury. Until recently, one important monitoring method, computerized tomography (CT), has not been available for bedside use. The authors have over 3 years of experience with the routine use of bedside CT scanning and have developed their own method of scanning the patients in their beds. In this report, they describe three illustrative cases in which the mobile CT scanner was of great value in the management of difficult neurosurgical intensive care problems. It is concluded that the availability of bedside morphological monitoring in the neurosurgery intensive care unit is of great help in management and clinical decision making.
    Neurosurgical FOCUS 02/2000; 9(5):e5. DOI:10.3171/foc.2000.9.5.5 · 2.14 Impact Factor
  • Lakartidningen 05/1998; 95(16):1796-8.
  • Journal of the Neurological Sciences 09/1997; 150. DOI:10.1016/S0022-510X(97)84995-7 · 2.26 Impact Factor
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    ABSTRACT: The impact of warning leaks on management results in patients with aneurysmal subarachnoid hemorrhage (SAH) was evaluated in this prospective study. In a consecutive series of 422 patients with aneurysmal SAH, 84 patients (19.9%) had an episode suggesting a warning leak; 34 (40.5%) of these patients were seen by a physician without the condition being recognized. The warning leak occurred less than 2 weeks before a major SAH in 75% of the patients. A good outcome was experienced by 53.6% of patients who had a warning leak versus 63.3% of those who had no warning leak. In a subgroup of patients who had an interval of 3 days or less from warning leak to SAH, only 36.4% had a good outcome. The proportion of patients in good neurological condition (Hunt and Hess Grades I and II) who had a good outcome was 88.1% in the group with no warning leak versus 53.6% in the group whose SAH was preceded by a warning leak. A difference of 35% between these two groups reflects the impact of an undiagnosed warning leak on patient outcome, based on the assumption that patients with a warning leak had clinical conditions no worse than Hunt and Hess Grade II at the time of the episode. In the subgroup of patients with the short interval between warning leak and SAH, the difference was almost 52%. The difference in outcome also reflects the potential improvement in outcome that can be achieved by a correct diagnosis of the warning leak. If the correct diagnosis is made in patients seeking medical attention due to a warning leak, favorable outcomes in the overall management of aneurysmal SAH are estimated to increase by 2.8%. An active diagnostic attitude toward patients experiencing a sudden and severe headache is warranted as it offers a means of improving overall outcome in patients with SAH.
    Journal of Neurosurgery 01/1997; 85(6):995-9. DOI:10.3171/jns.1996.85.6.0995 · 3.23 Impact Factor
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    ABSTRACT: A study of the overall management of ruptured posterior fossa aneurysms was conducted over a 1-year period (1993) in five neurosurgical centers in Sweden, serving a population of 6.93 million people. Forty-nine cases were identified and treated. One-third of the patients were in the seventh or eighth decade of life. Good overall management outcomes at 6 months were achieved in 30 cases (61%). The overall mortality rate was 27%. Patients with Hunt and Hess Grades I and II had a good overall recovery rate of 87%. On admission, 69% of the patients were assigned Hunt and Hess Grades III to V. The impact on patient outcomes of the intraoperative difficulties encountered, especially in the basilar tip area, is stressed. The authors found that delayed operation is not warranted in most cases. Frequent devastating rebleeding was observed among patients not offered early aneurysm clipping and the operative results were not at significant variance between the early and late surgical groups. Only 50% of the patients scheduled for delayed surgery ultimately made a good recovery, whereas 72% of patients scheduled for early operation did so. The data demonstrate that overall management results with posterior fossa aneurysms, comparable to achievements with supratentorial lesions, are within the reach of modern strategies, even in centers not specializing in these problems.
    Journal of Neurosurgery 08/1996; 85(1):33-8. DOI:10.3171/jns.1996.85.1.0033 · 3.23 Impact Factor
  • S M Fridriksson · J Hillman · H Säveland · L Brandt
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    ABSTRACT: Thirteen percent of Sweden's population (8.6 million) is aged 70 years or older, and this percentage is expected to increase over the coming decades. We have traced every diagnosed case of subarachnoid hemorrhage in patients older than 70 years in a well-defined catchment population of 953,000 individuals. The age-specific incidence for this group was 16 per 100,000 individuals per year, corresponding to 2.3 per 100,000 inhabitants per year. In most recent population-based surgical series on ruptured aneurysms, few patients in this age group are included, corresponding to only 20 to 25% of the actual number of patients, as shown in this study. Surgery is, in many cases, refused to the "elderly" because of age. However, patients who are neurologically intact after the bleed and who are without severe intercurrent diseases are potential candidates for surgical treatment. In our series, surgery yielded good results in two-thirds of 76 patients aged 70 to 74 years who returned to independent living in good mental condition. Among matched patients being refused surgery because of age, 75% suffered morbidity and mortality, with more than half of the patients having died within the 1st 3 months. When calculated for the entire population of Sweden, our data show that a 14% increase in the number of individuals achieving complete remedy from aneurysm rupture each year can be expected with more active therapy among the elderly. Most of these patients are between 70 and 74 years old. In the 9th decade of life, aneurysm surgery probably best remains an exception.
    Neurosurgery 11/1995; 37(4):627-31; discussion 631-2. DOI:10.1227/00006123-199510000-00004 · 3.03 Impact Factor
  • V Zbornikova · C Lassvik · J Hillman
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    ABSTRACT: Seventeen patients, 14 males and 3 females, mean age 64 years (range 45-77 years) with longstanding unilateral occlusion of the internal carotid artery and minimal neurological deficit, were evaluated in order to find criteria for potential benefit of extracranial-intracranial by-pass surgery. 3-D transcranial Doppler was used for estimation of mean velocities and pulsatility index in the middle cerebral artery, anterior cerebral artery and posterior cerebral artery before and after iv injection of 1 g acetazolamide. The anterior cerebral artery was the supplying vessel to the occluded side in 16 patients and mean velocities were significantly (p < 0.001) faster on the occluded (59.3 +/- 14.5 cm sec-1) and nonoccluded (91.6 +/- 29.6 cm sec-1, p < 0.05)) side than those found in the middle cerebral artery (39.2 +/- 13.7 and 50.9 +/- 8.5 cm sec-1). In two patients a decrease of mean velocity after acetazolamide was noted in middle cerebral artery indicating 'steal' effect. In another 4 patients, poor vasomotor response was seen with less than 11% of mean velocity increase in the middle cerebral artery. Differences between posterior cerebral artery on the occluded and nonoccluded side were insignificant as well as those between middle and posterior on the occluded side. Resting values of pulsatility index differed significantly (p < 0.01) only between anterior and posterior cerebral artery on the nonoccluded side.(ABSTRACT TRUNCATED AT 250 WORDS)
    Neurological Research 05/1995; 17(2):137-43. · 1.45 Impact Factor
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    ABSTRACT: In the present prospective study, 6.93 of Sweden's 8.59 million inhabitants (81%) were covered by the five participating centres. All patients with verified aneurysmal SAH admitted between June 1, 1989 and May 31, 1990, were enrolled. Basically, all participating centres have the same management protocol for SAH victims, including ultra-early referral to a neurosurgical unit, followed by pan-angiography and surgery as early as logistically possible. In this presentation, 145 patients who preoperatively were in Hunt & Hess Grades I-III and who underwent surgery for a supratentorial aneurysm within 72 h after the bleed, are evaluated. Eighty-one % (117 patients) made a good recovery. The morbidity was 12% (17 patients) and the mortality 7% (11 patients). The most common cause of unfavorable outcome was surgical complications, which accounted for 8% of the total series (12 patients). A subanalysis of these cases did reveal a positive correlation to higher age and more severe SAH on CAT scan.
    Acta Neurologica Scandinavica 10/1993; 88(4):254-8. DOI:10.1111/j.1600-0404.1993.tb04231.x · 2.44 Impact Factor
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    J Hillman
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    ABSTRACT: In a consecutive series of 312 surgical aneurysm cases more than 90% of the patients reached neurosurgical expertise within 48 hours from bleeding. Computed tomography permitted prediction of the assumed rupture site based on blood clot location in the majority (86%) of cases. This target vascular territory was usually investigated by selective angiography and in 9 out of 10 patients an aneurysm, ultimately shown to be the correct source of bleeding, was demonstrated. In 14% of the cases the source of bleeding could not be established thus calling for complete four vessel studies. It is concluded that limited angiographic studies are compatible with preserving a high surgical standard in cases unequivocally exhibiting a localizing clot pattern on the CT scan. Though suboptimal in a general sense, incomplete vascular studies, if four vessel angiography is not obtainable without delay or risk, should not delay earliest possible clipping of ruptured aneurysms to avoid the devastating effects of recurrent bleeds.
    Acta Neurochirurgica 02/1993; 121(1-2):20-5. DOI:10.1007/BF01405178 · 1.79 Impact Factor
  • Jan Hillman · Olof Bynke
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    ABSTRACT: Two cases of spinal occult dysraphism are described. The association of a dermoid cyst and ectopic tissue foci of both ecto- and mesodermal origin at the junction zone between lipoma and nervous tissue is argued to support the disjunction theory on lipomeningomyelocele formation.
    Child s Nervous System 07/1992; 8(4):211-4. DOI:10.1007/BF00262848 · 1.16 Impact Factor
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    ABSTRACT: The present prospective study, with participation of five of the six neurosurgical centers in Sweden, was conducted to evaluate the overall management results in patients with aneurysmal subarachnoid hemorrhage (SAH). The participating centers covered 6.93 million (81%) of Sweden's 8.59 million inhabitants. All patients with verified aneurysmal SAH admitted between June 1, 1989, and May 31, 1990, were included in this prospective study. A uniform management protocol was adopted involving ultra-early referral, earliest possible surgery, and aggressive anti-ischemic treatment. A total of 325 patients were admitted during the study period, 69% within 24 hours after hemorrhage. On admission, the patients were graded according to the scale of Hunt and Hess: 43 patients (13%) were classified in Grade I, 119 (37%) in Grade II, 53 (16%) in Grade III, 76 (23%) in Grade IV, and 34 (11%) in Grade V. Nimodipine was administered to 269 of the 325 patients: intravenously in 218, orally in 15, and intravenously followed by orally in 36. At follow-up examination 3 to 6 months after SAH, 183 patients (56%) were classified as having made a good neurological recovery, 73 patients (23%) suffered some morbidity, and 69 (21%) were dead. Surgery was performed in 276 (85%) of the patients; emergency surgery with evacuation of an associated intracerebral hematoma was carried out in 30 patients. Early surgery (within 72 hours after SAH) was performed in 170 individuals, intermediate surgery (between Days 4 and 6 post-SAH) in 29 patients, and late surgery (Day 7 or later after SAH) in 47 individuals. Of 145 patients with supratentorial aneurysms who were preoperatively in Hunt and Hess Grades I to III and who were treated within 72 hours, 81% made a good recovery; in 5.5% of patients, the unfavorable outcome was ascribed to delayed ischemia. It is concluded that, among patients with all clinical grades and aneurysmal locations, almost six of 10 SAH victims referred to a neurosurgical unit can be saved and can recover to a normal life.
    Journal of Neurosurgery 06/1992; 76(5):729-34. DOI:10.3171/jns.1992.76.5.0729 · 3.23 Impact Factor
  • J Hillman · O Bynke · H Westergren
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    ABSTRACT: In subarachnoid hemorrhage (SAH) late cerebral ischemia may develop without significant visible narrowing of arteries at angiography, but in severe ischemic conditions "vasospasm" invariably seems to be present. The majority of patients with aneurysm rupture develop some degree of vasospasm, whereas relatively few suffer from ultimate brain infarction. The prophylactic use of the calcium antagonist Nimodipine is linked to a beneficial anti-ischemic effect in SAH, although narrowing of large bore arteries still seems to develop despite administration of this drug. Attenuation of vascular spasm, mainly in the arterioles has been implicated as the major mechanism of action, although a neuronprotective effect of Nimodipine has been suggested as well. The present paper presents fragmentary evidence that Nimodipine does elicit a vasoactive response in the cerebral vasculature early during the development of late cerebral vasospasm, and that this response seems closely linked to reversal of attendant ischemic symptoms.
    Neurochirurgia 10/1991; 34(5):157-9. DOI:10.1055/s-2008-1052079

Publication Stats

888 Citations
64.25 Total Impact Points


  • 2004
    • Linköping University
      • Faculty of Health Sciences
      Linköping, Östergötland, Sweden
  • 1992–2002
    • Lund University
      • Department of Neurosurgery
      Lund, Skåne, Sweden
  • 1987–2002
    • University Hospital Linköping
      • • Department of Neurosurgery
      • • Department of Neurology
      • • Department of Surgery
      Linköping, Östergötland, Sweden
  • 2001
    • Akademiska Sjukhuset
      Uppsala, Uppsala, Sweden
  • 1997
    • Sahlgrenska University Hospital
      Goeteborg, Västra Götaland, Sweden