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Decompressive craniectomy is sometimes used in TBI patients with raised intracranial pressure (ICP) not responding to first-tier intensive care and neurosurgical therapies.A randomized controlled trial, however, found that those randomized to decompressive craniectomy had decreased ICP and length of ICU stay but more unfavorable outcomes as determined by the Extended Glasgow Outcome Scale at 6 months after injury .
In one retrospective analysis of 205 consecutive patients with aneurysmal SAH, there was a higher risk of thrombosis, pulmonary embolism and poor outcome in patients receiving blood transfusion .
More recent data indicated that intravenous alteplase was beneficial when given within 4.5 hours of onset in nondiabetic patients 4.5 hours or those for whom systemic intravenous thrombolysis is contraindicated [11,14].
Recent data on intra-arterial strategies as an alternative or supplement to intravenous thrombolysis in tissue plasminogen activator-eligible patients have been mixed [13,15-17], but they indicate potential benefit in stroke with proximal large vessel occlusions.
Following the primary cerebral insult, a cascade of events amplifies the initial damage regardless of the etiology of the precipitating event.
Secondary biochemical changes contribute to subsequent tissue damage with associated neuronal cell death.