Strict Bed Rest Research Articles

The ability of low-magnitude mechanical signals to normalize bone turnover in adolescents hospitalized for anorexia nervosa.

Malnourished adolescents with AN requiring medical hospitalization are at high risk for rapid reduction in skeletal quality. Even short-term bed rest can suppress normal patterns of bone turnover. We sought to determine whether LMMS normalizes bone turnover among adolescents hospitalized for complications of AN. In this randomized, double-blind trial, we prospectively enrolled adolescent females (n=41) with AN, age 16.3±1.9years (mean±SD) and BMI 15.6±1.7kg/m2. Participants were randomized to stand on a platform delivering LMMS (0.3g at 32-37Hz) or placebo platform for 10min/day for 5days. Serum markers of bone formation [bone-specific alkaline phosphatase (BSAP)], turnover [osteocalcin (OC)], and bone resorption [serum C-telopeptides (CTx)] were measured. From a random coefficients model, we constructed estimates and confidence intervals for all outcomes. BSAP decreased by 2.8% per day in the placebo arm (p=0.03) but remained stable in the LMMS group (p=0.51, pdiff=0.04). CTx did not change with placebo (p=0.56) but increased in the LMMS arm (+6.2% per day, p=0.04; pdiff=0.01). Serum OC did not change in either group (p>0.70). Bed rest during hospitalization for patients with AN is associated with a suppression of bone turnover, which may contribute to diminished bone quality. Brief, daily LMMS prevents a decline in bone turnover during bed rest in AN. Protocols prescribing strict bed rest may not be appropriate for protecting bone health for these patients. LMMS may have application for these patients in the inpatient setting.

Nonspecific purulent osteomyelitis of the spine.

Recently , in Ukraine a trend to increased incidence of suppurative osteomyelitis of the spine is defined . The main factors contributing to incidence increase is the growth of proportion of population with immunodeficiency and implementation of computer and magnetic resonance tomography in clinical practice. Treatment of suppurative osteomyelitis of the spine should include antibiotic therapy, adequate sanitation of the infectious focus, strict bed rest with exercise therapy . T actics of surgical treatment combin ed with antibiotic deescalation therapy with glycopeptide antibiotic – teicoplanin and rehabilitation program which helped to achieve recovery in 23 (37.8%) of patients treated conservatively and in 55 (91%) of the operated patients was proposed .

Endoscopic Transnasal Removal of Cavernous Hemangiomas of the Optic Canal

To assess the feasibility and efficacy of endoscopic transnasal removal of cavernous hemangiomas of the optic canal. Retrospective, noncomparative case series. Eleven consecutive patients (11 eyes) with cavernous hemangioma of the optic canal underwent endoscopic trans-ethmoidal-sphenoidal removal of the tumor at the Eye Hospital of Wenzhou Medical University from January 2009 to March 2016. In each case, the indication for surgery was decreased visual acuity due to the tumor. The removal was believed to be complete if the tumor was removed en bloc during the surgery. A mucoperiosteal flap was used to cover the defect in the optic nerve sheath after tumor removal. The tumor was pathologically confirmed to be cavernous hemangioma after surgery. The mean follow-up time was 9.9 ± 5.5months. Visual acuity before and after surgery was compared. All tumors were completely removed by the endoscopic approach. The best-corrected visual acuity (BCVA) improved after surgery in all patients. The mean preoperative BCVA was 6/30 (95% confidence interval [CI] 6/60-6/20) and the mean postoperative BCVA was 6/10 (95% CI 6/12-6/7.5). All patients showed cerebrospinal fluid rhinorrhea, which resolved with strict bed rest. Other complications included hyposmia in 2 patients; nasal bleeding in 3 patients, which resolved spontaneously; and temporary headache. Endoscopic trans-ethmoidal-sphenoidal approach is a feasible option for cavernous hemangiomas of the optic canal.

Effect of alterations in blood volume with bed rest on glucose tolerance.

Bed rest leads to rapid impairments in glucose tolerance. Plasma volume and thus dilution space for glucose are also reduced with bed rest, but the potential influence on glucose tolerance has not been investigated. Accordingly, the aim was to investigate whether bed rest-induced impairments in glucose tolerance are related to a concomitant reduction in plasma volume. This hypothesis was tested mechanistically by restoring plasma volume with albumin infusion after bed rest and parallel determination of glucose tolerance. Fifteen healthy volunteers (age 24 ± 3 yr, body mass index 23 ± 2 kg/m2, maximal oxygen uptake 44 ± 8 ml·min-1·kg-1; means ± SD) completed 4 days of strict bed rest. Glucose tolerance [oral glucose tolerance test (OGTT)] and plasma and blood volumes (carbon monoxide rebreathing) were assessed before and after 3 days of bed rest. On the fourth day of bed rest, plasma volume was restored by means of an albumin infusion prior to an OGTT. Plasma volume was reduced by 9.9 ± 3.0% on bed rest day 3 and area under the curve for OGTT was augmented by 55 ± 67%. However, no association (R2 = 0.09, P = 0.33) between these simultaneously occurring responses was found. While normalization of plasma volume by matched albumin administration (408 ± 104 ml) transiently decreased (P < 0.05) resting plasma glucose concentration (5.0 ± 0.4 to 4.8 ± 0.3 mmol/l), this did not restore glucose tolerance. Bed rest-induced alterations in dilution space may influence resting glucose values but do not affect area under the curve for OGTT.

Effects of mobility training on severe burn patients in the BICU: A retrospective cohort study

PurposeTo assess the effects of mobility training on severe burn patients in the Burn Intensive Care Unit (BICU). MethodsThis was a retrospective cohort study. Severe burn patients with equal to or more than 50% Total Body Surface Area (TBSA) burns who received early rehabilitation in the BICU were included in this study. Based on the different early rehabilitation strategies during the two periods, patients admitted to the BICU from January 2011 to April 2013 were identified as the passive training cohort (n=49) while patients admitted to the BICU from May 2013 to December 2013 were identified as the mobility training cohort (n=24). Data on length of BICU stay, length of hospital stay, length of rehabilitation in the BICU, ventilator dependent days, strict bed rest time, range of motion (ROM), the Barthel Index (BI) and the Functional Independence Measure (FIM) were collected. ResultsCompared with the passive training cohort, patients in the mobility training cohort had significantly shorter length of BICU stay (p=0.002), length of hospital stay (p=0.010), strict bed rest time (p<0.001) and length of rehabilitation in the BICU (p=0.026) with improved ROM of shoulder, wrist, hip, knee and ankle joints. ConclusionsMobility training in the BICU was shown to be feasible and effective in achieving better outcomes than passive training for severe burn patients.

One Week of Bed Rest Leads to Substantial Muscle Atrophy and Induces Whole-Body Insulin Resistance in the Absence of Skeletal Muscle Lipid Accumulation.

Short (<10 days) periods of muscle disuse, often necessary for recovery from illness or injury, lead to various negative health consequences. The current study investigated mechanisms underlying disuse-induced insulin resistance, taking into account muscle atrophy. Ten healthy, young males (age: 23 ± 1 years; BMI: 23.0 ± 0.9 kg · m(-2)) were subjected to 1 week of strict bed rest. Prior to and after bed rest, lean body mass (dual-energy X-ray absorptiometry) and quadriceps cross-sectional area (CSA; computed tomography) were assessed, and peak oxygen uptake (VO2peak) and leg strength were determined. Whole-body insulin sensitivity was measured using a hyperinsulinemic-euglycemic clamp. Additionally, muscle biopsies were collected to assess muscle lipid (fraction) content and various markers of mitochondrial and vascular content. Bed rest resulted in 1.4 ± 0.2 kg lean tissue loss and a 3.2 ± 0.9% decline in quadriceps CSA (both P < 0.01). VO2peak and one-repetition maximum declined by 6.4 ± 2.3 (P < 0.05) and 6.9 ± 1.4% (P < 0.01), respectively. Bed rest induced a 29 ± 5% decrease in whole-body insulin sensitivity (P < 0.01). This was accompanied by a decline in muscle oxidative capacity, without alterations in skeletal muscle lipid content or saturation level, markers of oxidative stress, or capillary density. In conclusion, 1 week of bed rest substantially reduces skeletal muscle mass and lowers whole-body insulin sensitivity, without affecting mechanisms implicated in high-fat diet-induced insulin resistance.

Symptomatic Infratentorial and Supratentorial Subdural Fluid Collection Complicating Foramen Magnum Decompression for Chiari Malformation Type I

Subdural cerebrospinal fluid collection and ventricular dilatation occur rarely after foramen magnum decompression. We report 2 cases of symptomatic subdural fluid collection after uncomplicated foramen magnum decompression for Chiari I malformation with syringomyelia. In these cases, postoperative magnetic resonance imaging showed significant shrinkage of the syrinx. The patients subsequently experienced clinical deterioration on days 9 and 13 after discharge, respectively. Repeat magnetic resonance imaging showed bilateral infratentorial subdural fluid collection extending supratentorially, passing through the tentorial notch, and with prominent midline shift. Inferior decent of the cerebellum into the decompression field was also demonstrated. Following evacuation of the subdural fluid by burr-hole and drainage for 3 days, clinical signs did not improve until symptomatic treatment with strict bed rest in the Trendelenburg position was prescribed. In such cases the arachnoid either should not be opened, or should be widely opened and expansile duraplasty performed. It is the authors’ opinion that the latter is the appropriate treatment, followed by conservative therapy including the Trendelenburg position, and restriction of ambulation and effort.

A study of blunt and penetrating abdominal trauma, its various patterns of injuries, and its management

Background: Abdominal trauma is one of the most common injuries among injuries caused mainly due to road traffic accidents. The rapid increase in motor vehicles and its aftermath has caused rapid increase in the number of victims to blunt abdominal trauma (BAT). Motor vehicle accidents account for 75%–80% of BAT. The knowledge in the management of BAT is progressively increasing due to the inpatient data gathered from different parts of the world. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remains at large. The reason of this could be due to the interval between trauma and hospitalization, delay in diagnosis, inadequate or lack of appropriate surgical treatment, postoperative complications, and associated trauma especially to spine, head, thorax, and extremities. Objective: To study the blunt and penetrating abdominal trauma, its various patterns of injuries, and its management. Materials and Methods: After initial resuscitation of the trauma victims, a careful history was taken to document any associated medical problem. Documentation of patients, which included identification, history, clinical findings, diagnostic test, operative findings, operative procedures, and complications during the stay in the hospital and during subsequent follow-up period, was recorded on a Performa specially prepared. The decision for operative or nonoperative management depended on the outcome of the clinical examination and results of diagnostic tests. Patients selected for nonoperative or conservative management were placed on strict bed rest and subjected to serial clinical examinations that included hourly pulse rate, blood pressure, respiratory rate, and repeated examination of abdomen and other systems. Result: The most common age group involved in BAT was between 13 and 20 years, whereas in penetrating abdominal trauma was between 21 and 30 years. This study showed that of 100 cases of abdominal trauma, 19 were presented with shock (blood pressure

The effect of 8 days of strict bed rest on the incretin effect in healthy volunteers.

Bed rest and physical inactivity are the consequences of hospital admission for many patients. Physical inactivity induces changes in glucose metabolism, but its effect on the incretin effect, which is reduced in, e.g., Type 2 diabetes, is unknown. To investigate how 8 days of strict bed rest affects the incretin effect, 10 healthy nonobese male volunteers underwent 8 days of strict bed rest. Before and after the intervention, all volunteers underwent an oral glucose tolerance test (OGTT) followed by an intravenous glucose infusion (IVGI) on the following day to mimic the blood glucose profile from the OGTT. Blood glucose, serum insulin, serum C-peptide, plasma incretin hormones [glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic peptide (GIP)], and serum glucagon were measured serially during both the OGTT and the IVGI. The incretin effect is calculated as the relative difference between the area under the curve for the insulin response during the OGTT and that of the corresponding IVGI, respectively. Concentrations of glucose, insulin, C-peptide, and GIP measured during the OGTT were higher after the bed rest intervention (all P < 0.05), whereas there was no difference in the levels of GLP-1 and Glucagon. Bed rest led to a mean loss of 2.4 kg of fat-free mass, and induced insulin resistance evaluated by the Matsuda index, but did not affect the incretin effect (P = 0.6). In conclusion, 8 days of bed rest induces insulin resistance, but we did not see evidence of an associated change in the incretin effect.

Collagen Type III and VI Turnover in Response to Long-Term Immobilization

BackgroundMuscle mass and function are perturbed by immobilization and remobilization. When muscle mass changes, the quality and quantity of the extracellular matrix protein, particularly the collagens, change with it. In this study, we investigated the temporal profile of three peptide biomarkers derived from turnover of collagen type III and type VI in a long-term immobilization and remobilization study. We also compared individual biomarker levels with Lean body Mass (LBM) and changes therein, hypothesizing that these biomarkers would be biomarkers of the remodeling processes associated with immobilization and/or remobilization.MethodsIn the Berlin bed rest study, 20 young men were recruited and randomly assigned to 8-week’s strict bed rest with or without resistive vibration exercise countermeasure. We measured three neo-epitope ELISA kits in the serum samples of this study: Pro-C3, measured the synthesis of collagen type III; Pro-C6, measured the synthesis of collagen type VI; and C6M measured the degradation of collagen type VI induced by MMP-2 and MMP-9 cleavage.ResultsPro-C3 and Pro-C6 biomarkers are up-regulated with both immobilization and remobilization, whereas C6M is hardly affected at all. We found that Pro-C3 and C6M levels are related to LBM at baseline and that high levels of Pro-C6 are associated with smaller changes in muscle mass during both immobilization and remobilization.ConclusionThe Pro-C3 and–C6 biomarkers change likely reflect remodeling changes in response to unloading or reloading, whereas C6M does not appear to respond to unloading. Pro-C3 and C6M levels correlate with LBM at baseline, while Pro-C6 is related to the anabolic and catabolic responses to unloading and reloading.

The Effect of Head of Bed Elevation on Patient Comfort After Angiography.

Maintaining patient comfort and avoiding complications after coronary angiography are important both to the patient and the nurse. Strict bed rest with the head of bed (HOB) completely flat is standard care for postprocedure positioning to decrease pressure on the femoral artery. This position is not thought to be the most comfortable position for patients. The purpose of this study was to determine if raising the HOB to 15° would impact patient comfort after cardiac angiography. This study used a randomized, controlled crossover design to compare 3 groups with different HOB positions during the first hour after procedure. Data from 71 patients demonstrated that HOB position did not significantly impact difference in pain/discomfort rating. Of all the nursing interventions designed to improve patient comfort after angiography, slightly raising the HOB was not a factor in reducing pain/discomfort.

Complicated spontaneous intracranial hypotension treated with intrathecal saline infusion

Spontaneous intracranial hypotension typically results from a spontaneous cerebrospinal fluid (CSF) leak.1 ,2 Symptoms include orthostatic headache and meningism without a recent dural puncture,2 and may be associated with distant...

Bone graft of a femoral head by fragments of neurogenic heterotopic ossification

Neurogenic heterotopic ossification (NHO) are a common complication after lesions of the central nervous system (10–23% after head injury). The late removal of hip NHOs sometimes causes the risk of femoral head and femoral neck fracture per or postoperatively. Indeed ankylosis of a joint eventually induces bone loss and joint destruction. A 23-year-old patient who suffered a severe TBI in 2012 in a military context presents multiple NHOs, which especially affects both hips. On the right side, CT of the pelvis shows a circumferential NHO that ankyloses the joint. The NHO therefore absorbs the stresses on the femoral head which is thus off-loaded. This causes bone loss quantified by CT. A surgical indication for excision is established for functional reasons and because of the risks of the sciatic nerve compression. A soft femoral neck is found during the procedure. A bone graft using the fragments of the NHO is attempted by internal drilling. The procedure ends with a sciatic nerve release. The rehabilitation program started after two weeks of strict bed rest in order to consolidate the bone graft. A passive mobilization program in flexion-extension is started afterward, with a gain of 10° every two weeks. Rotations and abductions-adductions are strictly prohibited during the first 6 weeks. Progressive verticalization is started after 2 months. A radiography of the pelvis shows the integrity of the femoral head 6 weeks after surgery. The patient is then placed in a wheelchair. The NHOs must be removed as soon as they are troublesome. Late surgery is exposing the patient to a joint ankylosis which complicates the surgical procedure and its aftermath. In this case, bone grafting the femoral head with fragments of NHOs seems to be an alternative to explore in order to avoid head-neck resection or the implantation of a hip replacement. However, an extremely cautious rehabilitation seems to be necessary.

One Week of Bed‐rest Substantially Reduces Muscle Mass and Induces Insulin Resistance in Healthy, Young Males

Background The recovery from illness or injury is generally accompanied by short periods (<1 week) of bed-rest, which can contribute substantially to the development of sarcopenia. Whereas the functional and metabolic consequences of prolonged (> 1 month) bed-rest have been well-established, the impact of short-term bed-rest remains largely unexplored. The present study assessed the effects of one week of bed-rest on skeletal muscle mass, leg strength, and whole-body insulin sensitivity. Methods: Ten healthy males (23±1 y) were subjected to 7 days of strict bed-rest. Prior to and following bed-rest, a DEXA scan, CT scan of the upper leg, and a one-step hyperinsulinemic-euglycemic clamp were performed to assess lean body mass, quadriceps cross sectional area (CSA) and peripheral insulin sensitivity, respectively. Additionally, prior to and after bed-rest, an incremental cycle ergometer test and a 1-Repetition Maximum (1RM) test were performed to determine VO2peak and maximal leg strength. Results: One week of bed-rest resulted in 1.4±0.2 kg loss of lean tissue mass (P<0.01) and a 3.2±1.0% loss of quadriceps CSA (P<0.01). Glucose infusion rates decreased from 62±6 to 42±3 μmol·kg FFM-1·min-1, representing a 29±5% decline in peripheral insulin sensitivity (P<0.01). Following bed-rest, VO2peak and 1RM had declined by 6.4±2.3% (P<0.05) and 6.9±1.4% (P<0.01), respectively. Conclusion One week of bed-rest substantially reduces muscle mass, muscle strength, oxidative capacity, and peripheral insulin sensitivity. Effective strategies need to be designed to prevent the loss of muscle mass and decline in metabolic health during short periods of muscle disuse.

Single-port retroperitoneal renal biopsy using standard urological instruments.

Objective To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB).Materials and Methods Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample.Results SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31.Conclusion SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy.

Nonpigment producing Serratia marcescens causing discitis following lumbar endoscopic discectomy

In contrary to the belief that less invasive modalities offer reasonable success rates with minimal infection complications, discitis after lumbar endoscopic discectomies occurs in 2-3% of patients. We present a rare case of post-operative discitis, due to non-pigment producing Serratia marcescens in a female patient who had undergone single level lumbar endoscopic discectomy 6 weeks back. The patient was able to completely resume her activities 12 weeks after surgical irrigation and debridement, appropriate antibiotics and strict bed rest. Our case sheds light on a serious complication after a minimally invasive surgery by a relatively rare pathogen and highlights its clinical significance.

Salvageability of kidney in Grade IV renal trauma by minimally invasive treatment methods.

Context:Renal trauma is increasingly being managed conservatively. Grade I-III injuries are managed conservatively whereas Grade V injuries may end in surgery. Managing Grade IV renal trauma is individualized and managed accordingly.Aims:To evaluate retrospectively all Grade IV renal injuries managed in our institute over five years and to review the available literature.Settings and Design:Reviewing the records of patients who sustained renal trauma and study all Grade IV renal injuries.Materials and Methods:We retrospectively analyzed all Grade IV renal injuries (16) managed at our institute between July 2008-August 2013. All patients were treated conservatively initially by hemodynamic stabilization, strict bed rest, if required endoscopic procedures. These patients were followed up with CECT.Statistical analysis:Descriptive statistics was performed using Microsoft excel spreadsheet 2007. Continuous data were described as mean and range. Categorical data was described as percentages.Results:Sixteen patients with Grade IV renal injury were included in the study. All patients had gross hematuria and 15 had urinary extravasation. D-J Stenting was done in 7 patients; perinephric tube drainage with D-J stentingwas done in 2 patients. One required selective upper pole arterial embolisation. Nephrectomy was not required in any of the patients. In the follow-up period, no patient had delayed complications.Conclusions:Successful conservative management of Grade IV renal trauma requires constant monitoring both clinically and radiologically, and if properly managed, kidneys can be salvaged in all stable patients as reinforced by our study.

77.: Uncovering the therapeutic mechanism of blood patching for treatment of spontaneous cerebrospinal fluid leaks

The mechanism of action for lumbar blood patches affecting a therapeutic response in a proximal cerebrospinal fluid (CSF) leak is thought to be via a tamponade effect. However, our case study reveals that blood products reach and pool at the site of a proximal CSF leak in the cervical spine – therefore we hypothesise that the therapeutic response results from a combination of a tamponade effect and blood products forming a localised clot in the proximal cervical region. We present a 41-year-old woman with a 12 month history of headache from postural hypotension. The patient’s general practitioner ordered a CT scan of the brain and lumbar spine as part of a workup which revealed that the patient had a cervical spine CSF leak. Subsequent MRI confirmed the CSF leak and intracranial hypotension. A 25 ml epidural blood patch was performed in the lumbar region together with conservative measures including a period of strict bed rest for days with increased hydration and caffeine intake. The patient reported an immediate symptomatic improvement following blood patching with a reduction in headaches. Subsequent imaging revealed resolution of the intracranial hypotension. We followed up the patient with serial MRI scans. These revealed blood reaching and pooling around the site of the CSF leak in the cervical spine. The current case report demonstrates that a lumbar epidural injection of blood reaches and pools around a CSF leak as far proximally as the cervical region. This supports the “plug” theory as the mechanism for persistent symptom resolution. However, the mechanism of immediate symptomatic improvement may still involve a tamponade effect. This two stage process appears to be the best explanation for the therapeutic response obtained from epidural blood patching on the basis of the available clinical, imaging and experimental data.

Intravenous misplacement of nephrostomy tube following percutaneous nephrolithotomy: Three new cases and review of seven cases in the literature

We investigated the characteristics and management of patients with intravenous misplacement of a nephrostomy tube. Between July 2007 and July 2013, 4148 patients with urolithiasis underwent percutaneous nephrolithotomy (PCNL) in our hospital. Intravenous misplacement of a nephrostomy tube occurred in two of these patients. Another patient with intravenous misplacement of a nephrostomy tube, who underwent PCNL in another hospital, was transferred to our hospital. The data of the three patients were retrospectively analyzed. The incidence of intravenous misplacement of a nephrostomy tube following PCNL was 0.5% (2/4148) at our hospital. A solitary kidney was present in one of the three patients. The tip of tube was located into the inferior vena cava (IVC) in two patients and into the renal vein in one patient. All three patients were successfully managed with strict bed rest, intravenous antibiotics and one-step (one patient) or two-step (two patients) tube withdrawal under close monitoring. None of the patients underwent antithrombotic therapy. The original operations were performed successfully under close observation in two patients and changed to another operation in one patient. All patients were discharged uneventfully. The incidence of intravenous misplacement of a nephrostomy tube following PCNL is 0.5% at our hospital. Intravenous nephrostomy tube misplacement is an uncommon complication of PCNL. A solitary kidney may render patients susceptible to this complication. Most patients may be managed conservatively with strict bed rest, intravenous antibiotics and one-step or two-step tube withdrawal under close monitoring.

Medical and neurologic complications of the current management strategy of angiographically negative nontraumatic subarachnoid hemorrhage patients

PurposeCommon management of angionegative subarachnoid hemorrhage includes mandatory intensive care unit stay for up to 14 days with strict bedrest, constant neurologic serial examination, invasive arterial and central line monitoring, and aneurysm rupture precautions. We evaluated the frequency of neurologic and nonneurologic complications in this patient population. MethodsThis was a retrospective chart review from July 2008 to 2011. Adult patients with International Classification of Diseases, Ninth Revision code for nontraumatic subarachnoid hemorrhage who had angiograms and cranial cat scans (CTs) were evaluated as the first screening measure. Negative screening angiograms constituted our study population and were divided into 2 groups (aneurysmal or perimesencephalic) based on the CT blood pattern. ResultsFifty-one patients met the study criteria (aneurysmal CT, n = 26; perimesencephalic CT pattern, n = 25). There were no incidences of rebleeding or mortality, and patients were discharged after a mean of 15.24 hospital days and a mean of 11 bedrest days. Seventeen patients (65%) in the aneurysmal group developed at least 1 nonneurologic complication compared with 2 patients (8%) in the perimesencephalic group (P = .001). Eleven patients in the aneurysmal group (42.3%) developed at least 1 neurologic complication compared with 1 patient (4%) in the perimesecephalic group (P = .001). ConclusionBased on our results, we propose admission to the medical floor for patients with World Federation of Neurosurgical Societies score 1 to 3, perimesencephalic CT pattern, and no hydrocephalus.