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Sample records for aneurysmal subarachnoid hemorrhage

  1. [Subarachnoid hemorrhage without aneurysm].

    Science.gov (United States)

    Müller-Forell, W; Welschehold, S; Köhler, J; Schicketanz, K H

    2002-11-01

    The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependent from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls. PMID:12458439

  2. Rebleeding After Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Larsen, Carl Christian; Astrup, Jens

    2013-01-01

    OBJECTIVE: To summarize the current knowledge of the mechanisms leading to rebleeding and the prevention of rebleeding after subarachnoid hemorrhage (SAH). METHODS: A literature search was performed to investigate factors associated with rebleeding after SAH. RESULTS: The review of the literature...

  3. Continuous EEG Monitoring in Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Friberg, Christian Kærsmose; Wellwood, Ian;

    2015-01-01

    BACKGROUND: Continuous EEG (cEEG) may allow monitoring of patients with aneurysmal subarachnoid hemorrhage (SAH) for delayed cerebral ischemia (DCI) and seizures, including non-convulsive seizures (NCSz), and non-convulsive status epilepticus (NCSE). We aimed to evaluate: (a) the diagnostic...

  4. Life Satisfaction and Return to Work After Aneurysmal Subarachnoid Hemorrhage

    NARCIS (Netherlands)

    Passier, Patricia E. C. A.; Visser-Meily, Johanna M. A. Anne; Rinkel, Gabriel J. E.; Lindeman, Eline; Post, Marcel W. M.

    2011-01-01

    This study was conducted to investigate life satisfaction and employment status after aneurysmal subarachnoid hemorrhage (SAH) and to explain the associations between life satisfaction and demographic, disease-related, psychological, and personality characteristics. Subjects with SAH (n = 141) livin

  5. Hyperglycemia and Clinical Outcome in Aneurysmal Subarachnoid Hemorrhage A Meta-Analysis

    NARCIS (Netherlands)

    N.D. Kruyt; G.J. Biessels; R.J. de Haan; M. Vermeulen; G.J.E. Rinkel; B. Coert; Y.B.W.E.M. Roos

    2009-01-01

    Background and Purpose-Hyperglycemia may worsen outcome after aneurysmal subarachnoid hemorrhage. We performed a systematic review to investigate the relation between admission hyperglycemia and outcome after aneurysmal subarachnoid hemorrhage. Methods-We included cohort studies or clinical trials o

  6. Hyponatremia, volume status and blood pressure following aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    E.F.M. Wijdicks (Eelco)

    1987-01-01

    textabstractPatients who survive an aneurysmal subarachnoid hemorrhage (SAH) are endangered by complications, which especially occur during the first weeks after the hemorrhage. These complications have a high mortality and morbidity, and the outcome of patients with SAH will improve if these compli

  7. Aneurysmal Subarachnoid Hemorrhage and Neuroinflammation: A Comprehensive Review

    Science.gov (United States)

    Lucke-Wold, Brandon P.; Logsdon, Aric F.; Manoranjan, Branavan; Turner, Ryan C.; McConnell, Evan; Vates, George Edward; Huber, Jason D.; Rosen, Charles L.; Simard, J. Marc

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) can lead to devastating outcomes including vasospasm, cognitive decline, and even death. Currently, treatment options are limited for this potentially life threatening injury. Recent evidence suggests that neuroinflammation plays a critical role in injury expansion and brain damage. Red blood cell breakdown products can lead to the release of inflammatory cytokines that trigger vasospasm and tissue injury. Preclinical models have been used successfully to improve understanding about neuroinflammation following aneurysmal rupture. The focus of this review is to provide an overview of how neuroinflammation relates to secondary outcomes such as vasospasm after aneurysmal rupture and to critically discuss pharmaceutical agents that warrant further investigation for the treatment of subarachnoid hemorrhage. We provide a concise overview of the neuroinflammatory pathways that are upregulated following aneurysmal rupture and how these pathways correlate to long-term outcomes. Treatment of aneurysm rupture is limited and few pharmaceutical drugs are available. Through improved understanding of biochemical mechanisms of injury, novel treatment solutions are being developed that target neuroinflammation. In the final sections of this review, we highlight a few of these novel treatment approaches and emphasize why targeting neuroinflammation following aneurysmal subarachnoid hemorrhage may improve patient care. We encourage ongoing research into the pathophysiology of aneurysmal subarachnoid hemorrhage, especially in regards to neuroinflammatory cascades and the translation to randomized clinical trials. PMID:27049383

  8. Cardiac arrhythmia as initial presentation of aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    van der Kleij, FGH; Henselmans, JML; van de Loosdrecht, AA

    1999-01-01

    Cardiac arrhythmia and sudden death are most frequently caused by preexisting heart disease. Rarely, cardiac arrhythmia is a first symptom of an acute neurological event. We describe a patient with asystole and other cardiac arrhythmias, as initial symptoms of acute aneurysmal subarachnoid hemorrhag

  9. Cardiac dysfunction after aneurysmal subarachnoid hemorrhage : Relationship with outcome

    NARCIS (Netherlands)

    van der Bilt, Ivo; Hasan, Djo; van den Brink, Renee; Cramer, Maarten-Jan; van der Jagt, Mathieu; van Kooten, Fop; Meertens, John; van den Berg, Maarten; Groen, Rob; ten Cate, Folkert; Kamp, Otto; Goette, Marco; Horn, Janneke; Groeneveld, Johan; Vandertop, Peter; Algra, Ale; Visser, Frans; Wilde, Arthur; Rinkel, Gabriel

    2014-01-01

    OBJECTIVE: To assess whether cardiac abnormalities after aneurysmal subarachnoid hemorrhage (aSAH) are associated with delayed cerebral ischemia (DCI) and clinical outcome, independent from known clinical risk factors for these outcomes. METHODS: In a prospective, multicenter cohort study, we perfor

  10. Fahr′s disease Presenting with Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Hosam Al-Jehani

    2012-01-01

    Full Text Available Fahr′s disease is a rare disorder of slowly progressive cognitive, psychiatric, and motor decline associated with idiopathic basal ganglia calcification (IBGC and widespread calcification in the brain and cerebellum. Acute presentation of IBGC is most often as a seizure disorder; however, we present a case of an acute IBCG presentation in which the cause of the deterioration was an aneurysmal subarachnoid hemorrhage.

  11. Prediction of outcomes in young adults with aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Chotai, Silky; Ahn, Sung-Yong; Moon, Hong-Joo; Kim, Jong-Hyun; Chung, Heung-Seob; Chung, Yong-Gu; Kwon, Taek-Hyun

    2013-01-01

    Subarachnoid hemorrhage (SAH) is rare in young adults and little is known about aneurysms in this subgroup. The effect of clinical and prognostic factors on the outcome based on the Glasgow Outcome Scale (GOS) scores and the predictors of unfavorable outcomes were analyzed in young adults with aneurysmal SAH. A retrospective review of the clinical parameters, including age, sex, hypertension, smoking status, hyperlipidemia, location of the cerebral aneurysm, size of the aneurysm, multiplicity, perioperative complication such as hydrocephalus, vasospasm, and hematoma, and Hunt and Hess and Fisher grading on presentation, was conducted in 108 young adults (mean age 34.8 years) managed at our institute. The outcome was classified based on GOS grading into unfavorable (GOS scores 1-3) or favorable (GOS scores 4 or 5). The overall mortality rate was 3.7% (4/108 patients). Univariate regression analysis for the outcomes at discharge found that age at the time of presentation, male sex, size of aneurysm, multiple aneurysms, hyperlipidemia, and poor Hunt and Hess and Fischer grades were associated with unfavorable outcome. Multivariate regression analysis found independent effects of sex, multiple aneurysms, size of aneurysm, and Hunt and Hess grade on the outcome at discharge. Size of aneurysm, presence of multiple aneurysms, Hunt and Hess grade, and hypertension were the predictors of outcome at mean 2-year follow up based on multivariate exact regression analysis. The multimodal approach with aggressive medical management, early intervention, and surgical treatment might contribute to favorable long-term outcomes in patients with poor expected outcomes.

  12. Drug treatment of cerebral vasospasm after subarachnoid hemorrhage following aneurysms

    Institute of Scientific and Technical Information of China (English)

    Yongfei Liu; HanCheng Qiu; Juan Su; WeiJian Jiang

    2016-01-01

    Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th–7th postictal days. Several therapeutic modalities have been employed to prevent or reverse CVS. The aim of this review is to summate all the available drug treatment modalities for vasospasm.

  13. Matrix Metalloproteinases in Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Vivek Mehta

    2013-01-01

    Full Text Available Delayed cerebral vasospasm is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH. While the cellular mechanisms underlying vasospasm remain unclear, it is believed that inflammation may play a critical role in vasospasm. Matrix metalloproteinasees (MMPs are a family of extracellular and membrane-bound proteases capable of degrading the blood-rain barrier (BBB. As such, MMP upregulation following SAH may result in a proinflammatory extravascular environment capable of inciting delayed cerebral vasospasm. This paper presents an overview of MMPs and describes existing data pertinent to delayed cerebral vasospasm.

  14. [A case of peduncular hallucination after aneurysmal subarachnoid hemorrhage].

    Science.gov (United States)

    Nakagawa, N; Akai, F; Niiyama, K; Asai, T; Tanada, M

    1999-01-01

    We reported a case of peduncular hallucination after aneurysmal subarachnoid hemorrhage (SAH). The patient underwent endovascular embolization of an intracranial aneurysm using the Guglielmi detachable coils (GDCs) 9 days after SAH. On the 11th day, she reported visual hallucination: a maggot was on the ceiling, or a soldier who wore green clothes was standing by a locker. The hallucination was vivid, well-formed and associated with insomnia, suggesting peduncular hallucination. A computed tomographic (CT) scan revealed small infarctions of right frontal lobe, which were not responsible for the visual hallucination. Hyperdynamic therapy relieved the visual hallucination 23 days after SAH. It was conceivable that vasospasm was the cause of the infarction and visual hallucination. Only 4 cases with peduncular hallucination after SAH were reported in conjunction with vasospasm. The symptom may be concealed by disturbance of consciousness. Visual hallucination should be considered as a sign of cerebral vasospasm, and an appropriate treatment should be done at right time. PMID:10065463

  15. Effect of Aneurysmal Subarachnoid Hemorrhage on Word Generation

    Directory of Open Access Journals (Sweden)

    Daniella Ladowski

    2014-01-01

    Full Text Available Background. Aneurysmal subarachnoid hemorrhage (aSAH survivors commonly exhibit impairment on phonemic and semantic fluency tests; however, it is unclear which of the contributing cognitive processes are compromised in aSAH patients. One method of disentangling these processes is to compare initial word production, which is a rapid, semiautomatic, frontal-executive process, and late phase word production, which is dependent on more effortful retrieval and lexical size and requires a more distributed neural network. Methods. Seventy-two individuals with aSAH and twenty-five control subjects were tested on a cognitive battery including the phonemic and semantic fluency task. Demographic and clinical information was also collected. Results. Compared to control subjects, patients with aSAH were treated by clipping and those with multiple aneurysms were impaired across the duration of the phonemic test. Among patients treated by coiling, those with anterior communicating artery aneurysms or a neurological complication (intraventricular hemorrhage, vasospasm, and edema showed worse output only in the last 45 seconds of the phonemic test. Patients performed comparably to control subjects on the semantic test. Conclusions. These results support a “diffuse damage” hypothesis of aSAH, indicated by late phase phonemic fluency impairment. Overall, the phonemic and semantic tests represent a viable, rapid clinical screening tool in the postoperative assessment of patients with aSAH.

  16. Direct costs of modern treatment of aneurysmal subarachnoid hemorrhage in the first year after diagnosis

    NARCIS (Netherlands)

    Roos, Y B W E M; Dijkgraaf, M G W; Albrecht, K W; Beenen, L F M; Groen, R J M; de Haan, R J; Vermeulen, M

    2002-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to investigate the current direct costs of modern management of patients with aneurysmal subarachnoid hemorrhage in the first year after diagnosis. METHODS: During a 1-year period, we studied all admitted patients with subarachnoid hemorrhage fro

  17. Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Hellingman, Catharine A; van den Bergh, Walter M; Beijer, Inge S; van Dijk, Gert W; Algra, Ale; van Gijn, Jan; Rinkel, Gabriël J E

    2007-01-01

    BACKGROUND AND PURPOSE: Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for ac

  18. Subarachnoid hemorrhage without aneurysm; Die Subarachnoidalblutung ohne Aneurysmanachweis

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Forell, W. [Institut fuer Neuroradiologie des Universitaetsklinikums Mainz (Germany); Welschehold, S. [Klinik und Poliklinik fuer Neurochirurgie des Universitaetsklinikums Mainz (Germany); Koehler, J. [Klinik und Poliklinik fuer Neurologie des Universitaetsklinikums Mainz (Germany); Schicketanz, K.H. [Institut fuer Medizinische Biometrie, Epidemiologie und Informatik des Universitaetsklinikums Mainz (Germany)

    2002-11-01

    The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependant from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls. (orig.) [German] Die Aneurysmablutung stellt die haeufigste Ursache einer spontanen, nichttraumatischen Subarachnoidalblutung (SAB) dar, bei einem Teil dieser Patienten kann jedoch kein Aneurysma nachgewiesen werden. Die Prognose dieser Patienten ist, im Vergleich zu denen mit positivem Aneurysmabefund, deutlich guenstiger. Die retrospektive Evaluation der initialen CT- und Angiographiebefunde sowie des klinischen Verlaufs von 773 Patienten, die innerhalb der letzten 11 Jahre nach einer spontanen SAB einer 4-Gefaessangiographie (DSA) unterzogen worden waren, ergab in unserem Krankengut einen Prozentsatz von 12,4% mit endgueltig fehlendem Aneurysmanachweis, wobei bis zu 3 Kontrollangiographien durchgefuehrt worden waren. Der positive Verlauf des

  19. Hemostasis and fibrinolysis in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : a systematic review

    NARCIS (Netherlands)

    Boluijt, Jacoline; Meijers, Joost C. M.; Rinkel, Gabriel J. E.; Vergouwen, Mervyn D. I.

    2015-01-01

    Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with microthrombosis, which can result from activated hemostasis, inhibited fibrinolysis, or both. We systematically searched the PUBMED and EMBASE databases to identify hemostatic or fibrinolytic par

  20. Subarachnoid hemorrhage from intracranial aneurysms during pregnancy and the puerperium.

    Science.gov (United States)

    Kataoka, Hiroharu; Miyoshi, Takekazu; Neki, Reiko; Yoshimatsu, Jun; Ishibashi-Ueda, Hatsue; Iihara, Koji

    2013-01-01

    Subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm (IA) is a rare but serious complication of pregnancy and is responsible for important morbidity and mortality during pregnancy. This study reviewed reports of ruptured IA during pregnancy and the puerperium, and our own cases of ruptured IA in pregnant women. Hemorrhage occurred predominantly during the third trimester of pregnancy, when maternal cardiac output and blood volume increase and reach maximum. Physiological and hormonal changes in pregnancy are likely to affect the risk of IA rupture. Ruptured IAs during pregnancy should be managed based on neurosurgical considerations, and the obstetrical management of women with ruptured IAs should be decided according to the severity of SAH and the gestational age. Emergent cesarean section followed by clipping or coiling of aneurysms is indicated if the maternal condition and the gestational age allow such interventions. Although SAH during pregnancy can result in disastrous outcomes, the necessity of intracranial screening for high-risk pregnant women is still controversial. PMID:23979051

  1. Prevalence of superficial siderosis following singular, acute aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Lummel, N.; Bochmann, K. [Ludwig-Maximilian-University, Department of Neuroradiology, Klinikum Grosshadern, Munich (Germany); Bernau, C. [Leibniz-Rechenzentrum, Munich (Germany); Thon, N. [Ludwig-Maximilian-University, Department of Neurosurgery, Klinikum Grosshadern, Munich (Germany); Linn, J. [Technical University, Department of Neuroradiology, Klinikum Dresden, Dresden (Germany)

    2015-04-01

    Superficial siderosis is presumably a consequence of recurrent bleeding into the subarachnoid space. The objective of this study was to assess the prevalence of superficial siderosis after singular, aneurysmal subarachnoid hemorrhage (SAH) in the long term. We retrospectively identified all patients who presented with a singular, acute, aneurysmal SAH at our institution between 2010 and 2013 and in whom a magnetic resonance imaging (MRI) including T2*-weighted imaging was available at least 4 months after the acute bleeding event. MRI scans were judged concerning the presence and distribution of superficial siderosis. Influence of clinical data, Fisher grade, localization, and cause of SAH as well as the impact of neurosurgical interventions on the occurrence of superficial siderosis was tested. Seventy-two patients with a total of 117 MRIs were included. Mean delay between SAH and the last available MRI was 47.4 months (range 4-129). SAH was Fisher grade 1 in 2 cases, 2 in 4 cases, 3 in 10 cases, and 4 in 56 cases. Superficial siderosis was detected in 39 patients (54.2 %). In all patients with more than one MRI scan, localization and distribution of superficial siderosis did not change over time. Older age (p = 0.02) and higher degree of SAH (p = 0.03) were significantly associated with the development of superficial siderosis. Superficial siderosis develops in approximately half of patients after singular, aneurysmal SAH and might be more common in patients with an older age and a greater amount of blood. However, additional factors must play a role in whether a patient is prone to develop superficial siderosis or not. (orig.)

  2. Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Choo, Juk-Dong; Suh, Bumn-Suk; Lee, Hyun-Sung; Lee, Jong-Soo; Song, Chang-June; Shin, Dae-Whan; Lee, Young-Ha

    2003-11-01

    A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. Magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim enhancement. She underwent craniotomies to clip the aneurysm and remove the calcified masses. Paragonimus westermani eggs were identified in the calcified necrotic lesions. Results of parasitic examinations on the sputum and an enzyme-linked immunosorbent assay for P. westermani were all negative. The patient presented with headache and dizziness that had occurred for more than 30 years. She had not eaten freshwater crayfish or crabs. However, she had sometimes prepared raw crabs for several decades. Overall, this case was diagnosed as chronic cerebral paragonimiasis, in which she may have been infected through the contamination of utensils during the preparation of the second intermediate hosts, combined with a cerebral hemorrhage.

  3. Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2013-01-01

    Full Text Available Background : Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+ level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods : This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1 st January to 31 st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS grading system. Discharge status was calculated using the Glasgow outcome score scale. Results : Fifty nine patients were included in the study and 53 (89.8% of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%. The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion : Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.

  4. Effect of antiplatelet therapy for endovascular coiling in aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    van den Bergh, Walter M; Kerr, Richard S C; Algra, Ale; Rinkel, Gabriel J E; Molyneux, Andrew J

    2009-01-01

    BACKGROUND AND PURPOSE: Antiplatelets are frequently used during or after endovascular coiling of aneurysm in patients with subarachnoid hemorrhage (SAH). This strategy is based on uncontrolled case series including also patients with unruptured aneurysms or other lesions. We collected data on effec

  5. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage : the role of coagulation and fibrinolysis

    NARCIS (Netherlands)

    M.D.I. Vergouwen

    2009-01-01

    Patients with aneurysmal subarachnoid hemorrhage (SAH) are at risk to develop complications, especially within the first two weeks after the hemorrhage. Delayed cerebral ischemia (DCI) is a complication which occurs in about 30% of SAH patients, leading to symptoms such as aphasia, hemiparesis, or i

  6. Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

    OpenAIRE

    Schebesch, Karl-Michael; Schödel, Petra; Rennert, Janine; Mark, Karl-Heinz; Brawanski, Alexander

    2012-01-01

    Subarachnoid hemorrhages (SAH) due to true aneurysms of the Posterior Cerebral Artery (PCA) during puerperium in young and healthy females are extremely rare. We present the case of a 31-year old, healthy woman that experienced a spontaneous SAH due to a PCA aneurysm, arising from the P3 segment, 9 days post-delivery. The aneurysm was successfully treated via an endovascular approach and the patient recovered well. After 21 days she was discharged from hospital without neurological defici...

  7. Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment

    OpenAIRE

    van der Jagt, Mathieu

    2006-01-01

    textabstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA is still regarded as the gold standard in the diagnosis of intracranial ruptured aneurysms. No studies have specifically addressed the value of CTA in planning of endovascular treatment of ruptured aneurysms. Mathieu van der Jagt investigates the diagnostic value of CTA for endovasc...

  8. Calcium homeostasis during magnesium treatment in aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    van den Bergh, Walter M.; van de Water, Jolanda M. W.; Hoff, Reinier G.; Algra, Ale; Rinkel, Gabriel J. E.

    2008-01-01

    Objective Magnesium treatment in patients with subarachnoid hemorrhage (SAH) can result in hypocalcemia; this hypocalcemia increases the risk of delayed cerebral ischemia (DCI) and poor outcome. We assessed whether low serum levels of total calcium in patients with SAH treated with magnesium is medi

  9. Cognitive Deficits After Aneurysmal and Angiographically Negative Subarachnoid Hemorrhage : Memory, Attention, Executive Functioning, and Emotion Recognition

    NARCIS (Netherlands)

    Buunk, Anne M; Groen, Rob J M; Veenstra, Wencke S; Metzemaekers, Jan D M; van der Hoeven, Johannes H; van Dijk, J Marc C; Spikman, Jacoba M

    2016-01-01

    OBJECTIVE: The authors' aim was to investigate cognitive outcome in patients with aneurysmal and angiographically negative subarachnoid hemorrhage (aSAH and anSAH), by comparing them to healthy controls and to each other. Besides investigating cognitive functions as memory and attention, they focuse

  10. Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Dankbaar, Jan W.; Rijsdijk, Mienke; van der Schaaf, Irene C.; Velthuis, Birgitta K.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    2009-01-01

    Vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is thought to cause ischemia. To evaluate the contribution of vasospasm to delayed cerebral ischemia (DCI), we investigated the effect of vasospasm on cerebral perfusion and the relationship of vasospasm with DCI. We studied 37 consecutive SAH

  11. Nosocomial infections after aneurysmal subarachnoid hemorrhage : time course and causative pathogens

    NARCIS (Netherlands)

    Laban, Kamil G.; Rinkel, Gabriel J. E.; Vergouwen, Mervyn D. I.

    2015-01-01

    BackgroundNosocomial infections after aneurysmal subarachnoid hemorrhage (aSAH) are associated with prolonged length of stay and poor functional outcome. It remains unclear if infections result in prolonged length of stay or, vice versa, if prolonged length of stay results in more infections. Before

  12. Hyperglycemia in aneurysmal subarachnoid hemorrhage : a potentially modifiable risk factor for poor outcome

    NARCIS (Netherlands)

    Kruyt, Nyika D.; Biessels, Geert Jan; DeVries, J. Hans; Luitse, Merel J. A.; Vermeulen, Marinus; Rinkel, Gabriel J. E.; Vandertop, W. Peter; Roos, Yvo B.

    2010-01-01

    Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor c

  13. Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment

    NARCIS (Netherlands)

    M. van der Jagt (Mathieu)

    2006-01-01

    textabstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA is still regarded as the gold standard in the diagnosis of intracranial ruptured aneur

  14. Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms

    NARCIS (Netherlands)

    J.D. Schaafsma; M.E. Sprengers; W.J. van Rooij; M. Sluzewski; C.B.L.M. Majoie; M.J.H. Wermer; G.J.E. Rinkel

    2009-01-01

    BACKGROUND AND PURPOSE: Coiling is increasingly used as treatment for intracranial aneurysms. Despite its favorable short-term outcome, concerns exist about long-term reopening and inherent risk of recurrent subarachnoid hemorrhage (SAH). We hypothesized a higher risk for recurrent SAH after adequat

  15. Long-Term Recurrent Subarachnoid Hemorrhage After Adequate Coiling Versus Clipping of Ruptured Intracranial Aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Sprengers, Marieke E.; van Rooij, Willem Jan; Sluzewski, Menno; Majoie, Charles B. L. M.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    2009-01-01

    Background and Purpose-Coiling is increasingly used as treatment for intracranial aneurysms. Despite its favorable short-term outcome, concerns exist about long-term reopening and inherent risk of recurrent subarachnoid hemorrhage (SAH). We hypothesized a higher risk for recurrent SAH after adequate

  16. Postoperative subarachnoid hemorrhage from an intracranial aneurysm after craniotomy for astrocytoma--case report.

    Science.gov (United States)

    Yamada, H; Taomoto, K

    1989-09-01

    The authors present the first reported case of a glioma associated with a right posterior cerebral artery (PCA) aneurysm. A 37-year-old male underwent craniotomy and total removal of the glioma, which appeared, according to encephalographic findings, to be responsible for the initial symptom of loss of consciousness. The risk of craniotomy-induced bleeding from the aneurysm was thought to be low, since it was unruptured and was packed with coagulum. However, subarachnoid hemorrhage due to rupture of the PCA aneurysm occurred just after craniotomy, and clipping was performed 15 days after the first operation. PMID:2480546

  17. Clinical Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage Using Bayesian Neural Networks with Fuzzy Logic Inferences

    Directory of Open Access Journals (Sweden)

    Benjamin W. Y. Lo

    2013-01-01

    Full Text Available Objective. The novel clinical prediction approach of Bayesian neural networks with fuzzy logic inferences is created and applied to derive prognostic decision rules in cerebral aneurysmal subarachnoid hemorrhage (aSAH. Methods. The approach of Bayesian neural networks with fuzzy logic inferences was applied to data from five trials of Tirilazad for aneurysmal subarachnoid hemorrhage (3551 patients. Results. Bayesian meta-analyses of observational studies on aSAH prognostic factors gave generalizable posterior distributions of population mean log odd ratios (ORs. Similar trends were noted in Bayesian and linear regression ORs. Significant outcome predictors include normal motor response, cerebral infarction, history of myocardial infarction, cerebral edema, history of diabetes mellitus, fever on day 8, prior subarachnoid hemorrhage, admission angiographic vasospasm, neurological grade, intraventricular hemorrhage, ruptured aneurysm size, history of hypertension, vasospasm day, age and mean arterial pressure. Heteroscedasticity was present in the nontransformed dataset. Artificial neural networks found nonlinear relationships with 11 hidden variables in 1 layer, using the multilayer perceptron model. Fuzzy logic decision rules (centroid defuzzification technique denoted cut-off points for poor prognosis at greater than 2.5 clusters. Discussion. This aSAH prognostic system makes use of existing knowledge, recognizes unknown areas, incorporates one's clinical reasoning, and compensates for uncertainty in prognostication.

  18. Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage

    Science.gov (United States)

    Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Rotta, Marcus Alexandre Cavalcanti; Dias, Guilherme Marcos Soares; Rezende, André Luiz; Rotta, José Marcus

    2014-01-01

    Background: Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. Case Description: We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram. Due to the location of the aneurysm and clinical status of the patient, conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection. Conclusion: We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive. PMID:25317354

  19. Management of Agitation Following Aneurysmal Subarachnoid Hemorrhage: Is There a Role for Beta-Blockers?

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    Fayaz Ibrahim

    2012-01-01

    Full Text Available Introduction. Stroke is a leading cause of mortality and morbidity in the United States. About 20% of the stroke is hemorrhagic and about 50% of these is due to aneurysmal subarachnoid hemorrhage. A troublesome neuropsychiatric complication of subarachnoid hemorrhage is agitation/aggression. Case Presentation. A 45-year-old man with no prior psychiatric history, sustained subarachnoid hemorrhage. After initial stabilization for 2 days, he underwent craniotomy and clipping of anterior cerebral communicating artery aneurysm. Treatment was continued with labetalol, nimodipine, and levetiracetam. Beginning postoperative day 4, patient developed episodes of confusion and agitation/aggression. Switching of Levetiracetam to valproate did not show any improvement. Psychiatry team tried to manage him with intense nursing intervention and different medications like olanzapine, valproate, lorazepam, and haloperidol. However, patient continued to be agitated and aggressive. Switching from labetalol to metoprolol resulted in dramatic improvement within 3 days. Discussion. Antipsychotics and benzodiazepines are often not sufficiently effective in the control of agitation/aggression in patients with traumatic brain injury and similar conditions. Our case report and the literature review including a cochrane review suggests that beta-blockers may be helpful in this situation.

  20. Risk factors responsible for the volume of hemorrhage in aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Jianfeng Liu

    2016-01-01

    Conclusion: Preadmission DBP, multiple aneurysms, and aneurysms of the ACOA are associated with markedly increased volume of hemorrhage as evaluated by the revised Fisher grades. Thus, patients harboring an intracranial aneurysm having the above mentioned features should seek an early intervention in order to prevent the occurrence of aSAH.

  1. Subarachnoid Hemorrhage: An Update.

    Science.gov (United States)

    Dority, Jeremy S; Oldham, Jeffrey S

    2016-09-01

    Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema. Hyponatremia is common in subarachnoid hemorrhage and is associated with longer length of stay, but not increased mortality. PMID:27521199

  2. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage: A Case Study for Medical Decision-Making Heuristics.

    Science.gov (United States)

    Dredla, Brynn; Freeman, William D

    2016-04-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient's medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis. PMID:27053985

  3. Frequency and appearance of hemosiderin depositions after aneurysmal subarachnoid hemorrhage treated by endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    Falter, Bernhard; Wiesmann, Martin; Freiherr, Jessica; Nikoubashman, Omid; Mull, Michael [University Hospital Aachen RWTH, Department of Neuroradiology, Aachen (Germany)

    2015-10-15

    It is still unclear how often subarachnoid hemorrhage (SAH) leads to chronic hemosiderin depositions. In this study, we aimed to determine the frequency of chronic hemosiderin depositions after aneurysmal SAH in patients who did not undergo surgery. Furthermore, we analyzed typical MRI patterns of chronic SAH and sought to obtain information on the temporal course of MRI signal changes. We retrospectively analyzed 90 patients who had undergone endovascular treatment for acute aneurysmal SAH. In all patients, initial CT studies and at least one T2*-weighted MRI obtained 6 months or later after SAH were analyzed for the presence and anatomical distribution of SAH or chronic hemosiderin depositions. In total, 185 T2*-weighted MRI studies obtained between 2 days and 148 months after SAH were evaluated (mean follow-up 30.2 months). On MRI studies obtained later than 6 months after SAH, subpial hemosiderin depositions were found in 50 patients (55.5 %). Most frequent localizations were the parenchyma adjacent to the frontal and parietal sulci and the insular cisterns. While the appearance of hemosiderin depositions was dynamic within the first 3 months, no changes were found during subsequent follow-up. MR signal changes were not only conclusive with subarachnoid hemosiderin depositions but in many cases also resembled those that have been associated with cortical hemosiderosis. T2*-weighted MRI is an effective means of diagnosing prior SAH. Our study suggests that chronic hemosiderin depositions can be found in a considerable number of patients after a single event of subarachnoid hemorrhage. (orig.)

  4. Rare anatomical variations of persistent trigeminal artery in two patients with non-aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Samaniego, Edgar A; Dabus, Guilherme; Andreone, Vincenzo; Linfante, Italo

    2011-09-01

    Carotid-basilar anastomoses are remnants of the fetal circulation and although rare, they may become symptomatic and should be recognized during cerebral angiography. Two patients are described with non-aneurysmal subarachnoid hemorrhage and persistent trigeminal arteries (PTA) found on cerebral angiography. In the first patient, the PTA ended in the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery. The second patient had a PTA terminating in the AICA and superior cerebellar artery. These rare anatomical PTA variants should be recognized on cerebral angiography. PMID:21990842

  5. Association of the NOS3 intron-4 VNTR polymorphism with aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Edsen, Troels; Kotinis, Alexandros;

    2014-01-01

    OBJECT: The nitric oxide system has been linked to the pathogenesis of aneurysmal subarachnoid hemorrhage (SAH). The authors performed a case-control study to investigate the association between SAH and common genetic variants within the endothelial nitric oxide synthase gene (NOS3). METHODS: Three......-VNTR. Haplotype analysis revealed that no single haplotype containing the b-allele was responsible for the observed genotype effect. CONCLUSIONS: The authors' results suggest that the NOS3 27-bp-VNTR b/b genotype independent of other risk factors act in concert with male sex to substantially increase risk of SAH....... This effect is not mediated by any single NOS3 haplotype....

  6. Restrictions and satisfaction with participation in patients who are ADL-independent after an aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Huenges Wajer, Irene M C; Visser-Meily, Johanna M A; Greebe, Paut; Post, Marcel W M; Rinkel, Gabriel J E; van Zandvoort, Martine J E

    2016-01-01

    BACKGROUND: Most survivors of an aneurysmal subarachnoid hemorrhage (aSAH) are ADL-independent, but they often experience restrictions in (social) activities and, therefore, cannot regain their pre-morbid level of participation. OBJECTIVE: In this study, participation restrictions and participation

  7. Copeptin as a marker for severity and prognosis of aneurysmal subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christian Fung

    Full Text Available BACKGROUND: Grading of patients with aneurysmal subarachnoid hemorrhage (aSAH is often confounded by seizure, hydrocephalus or sedation and the prediction of prognosis remains difficult. Recently, copeptin has been identified as a serum marker for outcomes in acute ischemic stroke and intracerebral hemorrhage (ICH. We investigated whether copeptin might serve as a marker for severity and prognosis in aSAH. METHODS: Eighteen consecutive patients with aSAH had plasma copeptin levels measured with a validated chemiluminescence sandwich immunoassay. The primary endpoint was the association of copeptin levels at admission with the World Federation of Neurological Surgeons (WFNS grade score after resuscitation. Levels of copeptin were compared across clinical and radiological scores as well as between patients with ICH, intraventricular hemorrhage, hydrocephalus, vasospasm and ischemia. RESULTS: Copeptin levels were significantly associated with the severity of aSAH measured by WFNS grade (P = 0.006, the amount of subarachnoid blood (P = 0.03 and the occurrence of ICH (P = 0.02. There was also a trend between copeptin levels and functional clinical outcome at 6-months (P = 0.054. No other clinical outcomes showed any statistically significant association. CONCLUSIONS: Copeptin may indicate clinical severity of the initial bleeding and may therefore help in guiding treatment decisions in the setting of aSAH. These initial results show that copeptin might also have prognostic value for clinical outcome in aSAH.

  8. Aneurysmal subarachnoid hemorrhage prognostic decision-making algorithm using classification and regression tree analysis

    Science.gov (United States)

    Lo, Benjamin W. Y.; Fukuda, Hitoshi; Angle, Mark; Teitelbaum, Jeanne; Macdonald, R. Loch; Farrokhyar, Forough; Thabane, Lehana; Levine, Mitchell A. H.

    2016-01-01

    Background: Classification and regression tree analysis involves the creation of a decision tree by recursive partitioning of a dataset into more homogeneous subgroups. Thus far, there is scarce literature on using this technique to create clinical prediction tools for aneurysmal subarachnoid hemorrhage (SAH). Methods: The classification and regression tree analysis technique was applied to the multicenter Tirilazad database (3551 patients) in order to create the decision-making algorithm. In order to elucidate prognostic subgroups in aneurysmal SAH, neurologic, systemic, and demographic factors were taken into account. The dependent variable used for analysis was the dichotomized Glasgow Outcome Score at 3 months. Results: Classification and regression tree analysis revealed seven prognostic subgroups. Neurological grade, occurrence of post-admission stroke, occurrence of post-admission fever, and age represented the explanatory nodes of this decision tree. Split sample validation revealed classification accuracy of 79% for the training dataset and 77% for the testing dataset. In addition, the occurrence of fever at 1-week post-aneurysmal SAH is associated with increased odds of post-admission stroke (odds ratio: 1.83, 95% confidence interval: 1.56–2.45, P decision making. This prognostic decision-making algorithm also shed light on the complex interactions between a number of risk factors in determining outcome after aneurysmal SAH. PMID:27512607

  9. Posterior reversible encephalopathy syndrome following hemodynamic treatment of aneurysmal subarachnoid hemorrhage-induced vasospasm.

    Science.gov (United States)

    Awori, Jonathan; Rajajee, Venkatakrishna; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, B Gregory; Pandey, Aditya S

    2016-04-01

    Posterior reversible encephalopathy syndrome (PRES) is an uncommon but significant complication of hemodynamic therapy after aneurysmal subarachnoid hemorrhage (aSAH)-induced vasospasm. We performed a PubMed literature search for the period January 1999 to January 2015 using the search terms "posterior reversible encephalopathy syndrome", "subarachnoid hemorrhage", "vasospasm", and "hypertensive encephalopathy", and identified nine cases of PRES after aSAH-induced vasospasm in the literature. We also present a 63-year-old man with aSAH complicated by vasospasm treated with hemodynamic augmentation who subsequently developed PRES. Imaging following development of PRES symptoms shows vasogenic edema in the white matter of the parietal and occipital lobes. Age, sex, history of hypertension, and baseline blood pressure were variable among patients in the literature review. In all cases, patients improved both from a radiological and clinical perspective following blood pressure reduction. To summarize, PRES is a rare complication of hemodynamic therapy for vasospasm following aSAH. The literature at the time of writing demonstrates no common pattern with regard to patient demographics, medical history, or mode of treatment for symptomatic vasospasm. Given its sporadic and unpredictable nature, considering PRES in the differential diagnosis is important when addressing neurological decline following hemodynamic treatment of vasospasm related to aSAH. PMID:26755456

  10. A case of cerebral aneurysm rupture and subarachnoid hemorrhage associated with air travel

    Directory of Open Access Journals (Sweden)

    Cui V

    2014-04-01

    Full Text Available Victoria Cui,1,2 Timur Kouliev,1 Jason Wood1 1Beijing United Family Hospital, Beijing, People's Republic of China; 2Department of Biological Sciences, Columbia University, New York, NY, USA Abstract: During air travel, passengers are exposed to unique conditions such as rapid ascent and descent that can trigger significant physiological changes. In addition, the cabins of commercial aircraft are only partially pressured to 552–632 mmHg or the equivalent terrestrial altitudes of 1,500–2,500 m (5,000–8,000 feet above sea level. While studies in high-altitude medicine have shown that all individuals experience some degree of hypoxia, cerebral edema, and increased cerebral blood flow, the neurological effects that accompany these changes are otherwise poorly understood. In this study, we report a case of acute subarachnoid hemorrhage from a ruptured cerebral aneurysm associated with travel on commercial aircraft. We then review relevant cases of neurological incidents with possible air travel-related etiology and discuss the physiological factors that may have contributed to the patient's acute subarachnoid hemorrhage. In the future, this report may serve as reference for more detailed and conservative medical guidelines and recommendations regarding air travel. Keywords: high-altitude, cabin pressure, emergency, cerebral edema, triage, neurological

  11. Common Variants of the ACE Gene and Aneurysmal Subarachnoid Hemorrhage in a Danish Population: A Case-control Study

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Nielsen, Morten; Edsen, Troels BS;

    2011-01-01

    C/G, rs4305 C/T, rs4311 C/T, rs4331 T/C, rs4343 C/T) in the ACE gene were genotyped along with the I/D polymorphism. Haplotypes were estimated using the PHASE software. RESULTS: Fifty-five haplotypes were identified with 3 of these having a frequency above 5%: ACCCCIT (41.6±0.4%), TGTTTDC (32......OBJECTIVE: The intron 16 insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene has been associated with rupture of intracranial aneurysms, but the effect of haplotypes within ACE has not been studied. This study investigated whether ACE haplotypes including the I....../D polymorphism are associated with aneurysmal subarachnoid hemorrhage. METHODS: The hypothesis was tested with a case-control design in 176 patients with aneurysmal subarachnoid hemorrhage and with 498 hospital controls. Through the pairwise tagging principle, single nucleotide polymorphisms (rs4291 A/T, rs4295...

  12. Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

    International Nuclear Information System (INIS)

    To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

  13. Usefulness of {sup 99m}Tc-HMPAO SPECT in Patients with Subarachnoid Hemorrhage due to Ruptured Intracranial Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, C. W.; Lee, K. H.; Kim, J. H.; Kwark, C. E.; Lee, D. S.; Chung, J. K.; Lee, M. C.; Han, D. H.; Koh, C. S. [Seoul National University Hospital, Seoul (Korea, Republic of)

    1993-07-15

    We evaluated the usefulness of {sup 99m}Tc-HMPAO SPECT in 21 Patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm and in 3 patients with unruptured intracranial aneurysm. SPECT study could detect the bilaterally hypoperfused cases in 10 patients(48%), but CT/MRI showed the bilateral abnormalities in only 3 patients(14%). The number of abnormal lesions were 56 in SPECT and 25 in CT/MRI. The lesions found in SPECT were well correlated with the neurological signs of the patients such as aphasia or hemiplegia. SPECT study during Matas test was helpful in evaluating the risk for carotid artery occlusion therapy. We thought that {sup 99m}Tc-HMPAO brain SPECT is helpful in evaluating the functional changes in patients with subarachnoid hemorrhage.

  14. Cardiac abnormalities after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Bilt, I.A.C. van der

    2016-01-01

    Aneurysmal subarachnoid hemorrhage(aSAH) is a devastating neurological disease. During the course of the aSAH several neurological and medical complications may occur. Cardiac abnormalities after aSAH are observed often and resemble stress cardiomyopathy or Tako-tsubo cardiomyopathy(Broken Heart Syn

  15. Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage

    OpenAIRE

    Hanafy, Khalid A.; Stuart, R Morgan; Khandji, Alexander G.; Connolly, E. Sander; Badjatia, Neeraj; Mayer, Stephan A; Schindler, Christian

    2010-01-01

    Tumor necrosis factor-α (TNF-α) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-α measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). Methods and results: From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA)...

  16. Early CT perfusion changes and blood-brain barrier permeability after aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Amanda; Bharatha, Aditya [University of Toronto, Department of Medical Imaging, Toronto, ON (Canada); De Oliveira Manoel, Airton Leonardo; Kouzmina, Ekaterina [St. Michael' s Hospital, Toronto (Canada); Burgers, Kyle; Lee, Ting [Robarts Research Institute, London (Canada); Macdonald, R.L. [St. Michael' s Hospital, Department of Neurosurgery, Toronto (Canada)

    2015-08-15

    Early brain injury (EBI) can occur within 72 h of aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to determine if there are differences in early CTP parameters (<72 h) with respect to delayed cerebral ischemia (DCI), cerebral infarction, and functional outcome. We performed a prospective cohort study of aSAH patients admitted to a single tertiary care center. MTT, CBF and blood-brain barrier permeability (PS) were quantified with CTP within 72 h of aneurysm rupture. Primary outcomes were functional outcome by the Modified Rankin Scale (mRS) at 3 months and cerebral infarction. Secondary outcome was the development of DCI. Differences between early CTP parameters were determined with respect to primary and secondary outcomes. Fifty aSAH patients were included in the final analysis. MTT was significantly higher in patients who developed DCI (6.7 ± 1.2 vs 5.9 ± 1.0; p = 0.03) and cerebral infarction (7.0 ± 1.2 vs 5.9 ± 0.9; p = 0.007); however, no difference in MTT was found between patients with and without a poor outcome (mRS > 2). Early CBF and PS did not differ with respect to functional outcome, DCI, and cerebral infarction. Elevated MTT within 72 h of aneurysm rupture is associated with DCI and cerebral infarction but not with long-term functional outcome. Blood-brain barrier permeability, as assessed by CT perfusion, was not associated with DCI or worse outcome in this cohort. (orig.)

  17. Serum magnesium levels and clinical outcome of aneurysmal subarachnoid hemorrhage: a study in 60 patients

    Directory of Open Access Journals (Sweden)

    Habibi Z

    2008-06-01

    Full Text Available Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH, cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI as well as the neurological outcome after a period of three months.Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS. Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS and the patients were allocated to "Good" (GOS = 4, 5 and "Poor" (GOS= 1-3 outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05, whereas low serum magnesium levels during days 4-7 17% of patients and the second week (22% of patients after SAH were correlated with poor clinical outcome (p<0.05. No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

  18. Serum and cerebrospinal fluid concentrations of E-selectin in patients with aneurysmal subarachnoid hemorrhage

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    T. Tanriverdi

    2005-11-01

    Full Text Available The goal of the present study was to determine concentrations of E-selectin in both cerebrospinal fluid (CSF and serum of patients with aneurysmal subarachnoid hemorrhage (SAH and to evaluate the correlation between the clinical parameters and E-selectin levels. Both CSF and serum samples obtained from 12 patients with aneurysmal SAH and 8 patients with hydrocephalus (control group without any other known central nervous system disease were assayed for E-selectin by quantitative enzyme-linked immunosorbent assay and the results were compared between the two groups. Mean levels of soluble forms of E-selectin within the first 3 days and on the 5th and 7th days of SAH were 4.0 ± 7.9, 2.8 ± 5.2, and 3.1 ± 4.9 ng/ml in the patient's CSF, and 33.7 ± 9.2, 35.1 ± 7.0, and 35.2 ± 8.7 ng/ml in serum, respectively. In contrast, mean E-selectin levels were 0.1 ± 0.2 ng/ml in CSF and 8.7 ± 5.0 ng/ml in serum of control patients. The difference between groups was statistically significant regarding both CSF and serum E-selectin levels (P < 0.05. Thus, we have demonstrated a marked increase of E-selectin concentration in both CSF and serum of patients with aneurysmal SAH compared with control and suggest that blocking the interaction between E-selectin and vascular endothelium may have a beneficial effect on vasospasms.

  19. Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach

    Science.gov (United States)

    Nichols, Linda Jayne; Gall, Seana; Stirling, Christine

    2016-01-01

    An aneurysmal subarachnoid hemorrhage (aSAH) carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. This a priori knowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another. PMID:27695237

  20. Evidence that a panel of neurodegeneration biomarkers predicts vasospasm, infarction, and outcome in aneurysmal subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Robert Siman

    Full Text Available Biomarkers for neurodegeneration could be early prognostic measures of brain damage and dysfunction in aneurysmal subarachnoid hemorrhage (aSAH with clinical and medical applications. Recently, we developed a new panel of neurodegeneration biomarkers, and report here on their relationships with pathophysiological complications and outcomes following severe aSAH. Fourteen patients provided serial cerebrospinal fluid samples for up to 10 days and were evaluated by ultrasonography, angiography, magnetic resonance imaging, and clinical examination. Functional outcomes were assessed at hospital discharge and 6-9 months thereafter. Eight biomarkers for acute brain damage were quantified: calpain-derived α-spectrin N- and C-terminal fragments (CCSntf and CCSctf, hypophosphorylated neurofilament H,14-3-3 β and ζ, ubiquitin C-terminal hydrolase L1, neuron-specific enolase, and S100β. All 8 biomarkers rose up to 100-fold in a subset of patients. Better than any single biomarker, a set of 6 correlated significantly with cerebral vasospasm, brain infarction, and poor outcome. Furthermore, CSF levels of 14-3-3β, CCSntf, and NSE were early predictors of subsequent moderate-to-severe vasospasm. These data provide evidence that a panel of neurodegeneration biomarkers may predict lasting brain dysfunction and the pathophysiological processes that lead to it following aSAH. The panel may be valuable as surrogate endpoints for controlled clinical evaluation of treatment interventions and for guiding aSAH patient care.

  1. Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach

    Directory of Open Access Journals (Sweden)

    Linda Jayne Nichols

    2016-01-01

    Full Text Available An aneurysmal subarachnoid hemorrhage (aSAH carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. This a priori knowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another.

  2. Impact of Hunt-Hess grade on the glycemic status of aneurysmal subarachnoid hemorrhage patients

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    Sayantani Ghosh

    2012-01-01

    Full Text Available Objective: This study has explored the impact of Hunt-Hess (H-H grade of aneurysmal subarachnoid hemorrhage (aSAH on the glycemic status of such patients during their intensive care unit (ICU stay and has also analyzed whether H-H grade predicts their outcome independent of their glycemic status. Materials and Methods: This was a retrospective case record review of prospectively maintained database of 1090 previously non-diabetic aSAH patients admitted to Thomas Jefferson University Hospital, Philadelphia. H-H grade of SAH, serum and CSF glucose on admission, serum glucose on the day of surgery and 14 days post-surgery, as well as the extended Glasgow Outcome Score (GOS-E score at discharge were noted. After univariate analysis, significant variables (P 200 mg/dl (P < 0.001 during the 14-day period of ICU stay. Also, the relationship between serum and CSF glucose levels at admission increased with HH grades 1 through 4, but became negative and more tightly bound at H-H grade 5. Admission H-H grades 4-5 contributed to poor outcome compared to lower H-H grades (P < 0.0001. Conclusion: Poor admission H-H grades lead to poor immediate glycemic status as well as poor short-term outcome, and it is dependent on serum glucose but independent of CSF glucose in predicting the outcome.

  3. Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach

    Science.gov (United States)

    Nichols, Linda Jayne; Gall, Seana; Stirling, Christine

    2016-01-01

    An aneurysmal subarachnoid hemorrhage (aSAH) carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. This a priori knowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another.

  4. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

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    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  5. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

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    Cremers, Charlotte H.P. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Dankbaar, Jan Willem; Bennink, Edwin; Velthuis, Birgitta K.; Schaaf, Irene C. van der [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Room G03.232, Brain Center Rudolf Magnus Department of Neurology and Neurosurgery, PO Box 85500, Utrecht (Netherlands); Vos, Pieter C. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-05-01

    Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm may also overestimate the extent of ischemia. We investigated the diagnostic accuracy of tracer delay-sensitive and tracer delay-insensitive algorithms for detecting DCI. From a prospectively collected series of aSAH patients admitted between 2007-2011, we included patients with any clinical deterioration other than rebleeding within 21 days after SAH who underwent NCCT/CTP/CTA imaging. Causes of clinical deterioration were categorized into DCI and no DCI. CTP maps were calculated with tracer delay-sensitive and tracer delay-insensitive algorithms and were visually assessed for the presence of perfusion deficits by two independent observers with different levels of experience. The diagnostic value of both algorithms was calculated for both observers. Seventy-one patients were included. For the experienced observer, the positive predictive values (PPVs) were 0.67 for the delay-sensitive and 0.66 for the delay-insensitive algorithm, and the negative predictive values (NPVs) were 0.73 and 0.74. For the less experienced observer, PPVs were 0.60 for both algorithms, and NPVs were 0.66 for the delay-sensitive and 0.63 for the delay-insensitive algorithm. Test characteristics are comparable for tracer delay-sensitive and tracer delay-insensitive algorithms for the visual assessment of CTP in diagnosing DCI. This indicates that both algorithms can be used for this purpose. (orig.)

  6. The comparative study on diagnostic validity of cerebral aneurysm by computed tomography angiography versus digital subtraction angiography after subarachnoid hemorrhage

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    Masih Saboori

    2011-01-01

    Full Text Available Background: In order to declare the preoperative diagnostic value of brain aneurysms, two radiological modalities, computed tomographic angiography and digital subtraction angiography were compared. Methods: In this descriptive analytic study, diagnostic value of computed tomographic angiography (CTA was com-pared with digital subtraction angiography (DSA. Sensitivity, specificity, positive and negative predictive values were calculated and compared between the two modalities. All data were analyzed with SPSS software, version 16. Results: Mean age of patients was 49.5 ± 9.13 years. 57.9 % of subjects were female. CTA showed 89% sensitivity and 100% specificity whereas DSA demonstrated 74% sensitivity and 100% specificity. Positive predictive value of both methods was 100%, but negative predictive value of CTA and DSA was 85% and 69%, respectively. Conclusions: Based on our data, CTA is a valuable diagnostic modality for detection of brain aneurysm and su-barachnoid hemorrhage.

  7. Impaired blood dendritic cell numbers and functions after aneurysmal subarachnoid hemorrhage.

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    Antoine Roquilly

    Full Text Available PREVIOUS PRESENTATION: Portions of this study were presented at the Annual Congress of Société Française d'Anesthésie et de Réanimation in Paris, September 2012. BACKGROUND: Toll-like receptor (TLR agonists are promising therapy for the prevention of nosocomial infections in critical ill patients. We aimed to analyze the TLR-reactivity of circulating dendritic cells (DC as assessed by cytokine production after an ex vivo challenge with TLR agonists in aneurysmal subarachnoid hemorrhage (SAH patients. METHODS AND FINDINGS: A single-center prospective observational study took place in one intensive care unit of a teaching hospital. Blood samples were harvested on days 2, 5 and 10 in 21 severe SAH patients requiring mechanical ventilation and 17 healthy controls. DC production of cytokines (Tumour Necrosis Factor, TNF-α; Interleukin, IL-12; and Interferon, IFN-α was assessed by intracellular immunostaining on TLR-3, 4, 7/8 and 9 stimulations. SAH patients had decreased numbers of blood myeloid (mDCs and plasmacytoid DCs (pDCs on days 2, 5 and 10. Compared with the healthy controls, the frequency of mDCs producing TNF-α after TLR-3 stimulation was decreased in the SAH patients. The frequency of myeloid DCs producing IL-12 after TLR-3 and 4 stimulations was also decreased in the SAH patients. In contrast, the mDCs response to TLR-7/8 was not impaired in the SAH patients. The frequency of pDCs producing TNF-α(+ and IFN-α(+ on TLR-7/8 stimulation were reduced at all of the tested times in the SAH patients, whereas reactivity to TLR-9 was preserved. On day 2, the pDCs from non-survivor patients (n=8 had a decreased ability to produce IFN-α on TLR-9 stimulation compared with the survivors. CONCLUSIONS: These data suggest functional abnormalities of circulating pDCs and mDCs that could be important for immunomodulation after SAH.

  8. Differential regulation of matrix-metalloproteinases and their tissue inhibitors in patients with aneurysmal subarachnoid hemorrhage.

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    Marlene Fischer

    Full Text Available BACKGROUND: Matrix metalloproteinases (MMPs and their tissue inhibitors (TIMPs are involved in vascular remodeling, (neuroinflammation, blood-brain barrier breakdown and neuronal apoptosis. Proinflammatory mechanisms are suggested to play an important role during early brain injury and cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH. This study aimed to analyze MMP-3, MMP-9, TIMP-1 and TIMP-3 in patients with SAH and their respective association with cerebral vasospasm (CVS. METHODS: Blood samples were collected in 20 SAH patients on days 1 to 7, 9, 11, 13 and 15 and 20 healthy age and gender matched volunteers. Serum MMPs and TIMPs were analyzed using enzyme-linked immunosorbent assay. Doppler sonographic CVS was defined as a mean blood flow velocity above 120 cm/sec in the middle cerebral artery. When discharged from hospital and at 6 month follow-up neurological outcome was evaluated using the Glasgow Outcome Score and the modified Rankin Scale. RESULTS: MMP-9 was higher in SAH patients compared to healthy controls (p<0.001. Patients with CVS (n = 11 had elevated MMP-9 serum levels compared to patients without CVS (n = 9, p<0.05. Higher MMP-9 was observed in the presence of cerebral ischemia associated with cerebral vasospasm (p<0.05. TIMP-1 was increased in patients with SAH on day 4 (p<0.05. There was an imbalance of the MMP-9/TIMP-1 ratio in favor of MMP-9 in SAH patients, in particular those with CVS (p<0.001. MMP-3 and TIMP-3 were significantly lower in SAH patients throughout day 4 and day 7, respectively (p<0.05. We did not find an association between MMP-, TIMP levels and neurological outcome after 6 months. CONCLUSIONS: MMP-3 and -9 are differentially regulated in SAH patients with both enzymes showing peak levels correlating with the development of CVS. The inhibitors TIMP-1 and -3 were low during the acute phase after SAH and increased later on which might suggest a preponderance of pro-inflammatory mechanisms.

  9. Diagnostic accuracy of contrast enhancement MRI versus CTA in diagnosis of intracranial aneurysm in patients with non-traumatic subarachnoid hemorrhage

    OpenAIRE

    Gihan Hassan Gamal

    2015-01-01

    Aim of the study: The most common cause of spontaneous SAH is the rupture of cerebral aneurysm. So it is very important to exclude it from circulation as soon as possible using endovascular therapy. The aim was to determine whether contrast enhancement magnetic resonance angiography (CEMRA) is preferable to computed tomography angiography (CTA) in detection of intracranial aneurysm in patients presenting with non-traumatic subarachnoid hemorrhage (SAH). Patients and methods: Twenty-five pa...

  10. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

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    Casulari Luiz Augusto

    2004-01-01

    Full Text Available We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS. In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A 30 patients with SH (21 females and 9 males; 41.7±11.4 years and B a control group including 25 patients with benign diseases of the spine (BDS (lumbar disc hernia or stable spinal trauma (8 females and 17 males; 41.3±14.2 years. In a subgroup of eight patients of each group serum triiodothyronine (T3 and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (p<0.05: T3 (ng/mL: SH = 58.7±1.1 and BDS = 74.5±13.9; free T4 (ng/dL: SH = 0.9±0.2 and BDS = 1.1±0.3. There was no significant difference in the serum levels of total thyroxine (T4 and thyroid-stimulating hormone (TSH between the two groups: T4 (µg/dL: SH = 6.9±1.1 and BDS = 7.4±2.1; TSH (µUI/mL: SH = 1.5±0.8 and BDS = 1.8±1,0. In the sample of eight patients of each group we had the following results: T3 (ng/mL: SH = 66.8±3.8 and BDS = 77.2±1.1 (p <0.05; reverse T3 (ng/dL: SH = 32.8±8 and BDS = 24.7±2.2 (NS; T3/ reverse T3 ratio: SH = 2.6±0.3 and BDS = 3.3±0.4 (NS. Thyreoglobulin and microsomal antibodies were not detectable, except in one patient in the SH group. In conclusion, the SH patients present serum levels of T3 and free T4 significantly lower than that of BDS patients; the thyroidal hormone profile suggests that SH patients have developed the nonthyroidal

  11. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

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    Lee, Jin Young; Shin, Hwa Seon; Choi, Hye Young; Chung, Sung Hoon; You, Jin Jong; Choi, Dae Seob; Son, Seung Nam [Gyeongsang National Univ. Hospital/Gyeongsang National Univ. School of Medicine, Jinju (Korea, Republic of); Ryu, Jae Wook [Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed.

  12. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed

  13. Intra-arterial colforsin daropate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Cerebral vasospasm (CV) remains a major cause of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). Here, we examined the effectiveness and safety of intra-arterial injection of colforsin daropate hydrochloride (CDH). A consecutive series of 29 patients with angiographically confirmed CV received intra-arterial CDH (IAC) therapy. Angiographic changes in spastic vessels and the cerebral circulation time (CCT) were assessed before and after IAC treatment, together with the change in clinical status. IAC treatment was performed in 53 procedures in 29 patients. Angiographic improvement was observed following all procedures (100%), and clinical improvement was observed following 36 of 42 procedures (86%) in symptomatic cases. CCT improved significantly. At the 3-month follow-up, 19 patients (66%) showed good recovery or moderate disability on the Glasgow Outcome Scale. Major adverse effects were headache and increased heart rate. IAC treatment was effective and safe for the treatment of CV after SAH. (orig.)

  14. Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach.

    Science.gov (United States)

    Schöller, Karsten; Massmann, Maike; Markl, Gertraud; Kunz, Mathias; Fesl, Gunther; Brückmann, Hartmut; Pfefferkorn, Thomas; Tonn, Jörg-Christian; Schichor, Christian

    2013-04-01

    The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥ 60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60-69, 70-79, and ≥ 80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥ 80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1-154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I-III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I-III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥ 70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.

  15. Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage

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    Ekkehard Kunze

    2012-01-01

    Full Text Available Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD, and Perfusion-CT (PCT to detect angiographic vasospasm. Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND, pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF were calculated. Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH.

  16. Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage

    International Nuclear Information System (INIS)

    Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm. Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF) were calculated. Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH

  17. Detection and assessment of circle of Willis aneurysms in acute subarachnoid hemorrhage with three-dimensional computed tomographic angiography: correlation with digital substraction angiography findings.

    Science.gov (United States)

    Lai, P H; Yang, C F; Pan, H B; Chen, C; Ho, J T; Hsu, S S

    1999-10-01

    In this retrospective study, we examined the usefulness of computed tomographic angiography (CTA) for the detection and assessment of circle of Willis aneurysms in patients with acute nontraumatic subarachnoid hemorrhage (SAH), using selective digital substraction angiography (DSA) as the gold standard. Thirty-five patients who presented with acute, nontraumatic SAH, diagnosed on the basis of unenhanced computed tomography or lumbar puncture findings or both, underwent both CTA and DSA. The CTA images were interpreted for the presence, location, size, and shape of the aneurysm, presence of a neck, and relationship of the aneurysm to adjacent arterial branches. The CTA and DSA images were then compared, with the latter images serving as the gold standard. DSA revealed 37 aneurysms in 32 patients and ruled out intracranial aneurysms in the remaining three. The sensitivity and specificity of CTA for aneurysm detection were 97% and 100%, respectively. The size of the smallest aneurysm shown was 4 mm, and the largest aneurysm was 21 mm. The size and lobularity of the aneurysms estimated from CTA images corresponded well with those estimated from DSA images. In addition, CTA provided a three-dimensional representation of the aneurysmal lesion, which was considered useful for surgical planning. Our results confirm the accuracy of CTA in comparison with DSA. Because of its reliability, minimal invasiveness, and rapidity, CTA may become the technique of choice for neuroradiologic work-up of SAH patients. DSA then would be used to diagnose intracranial aneurysms only in selected, questionable cases. PMID:10575836

  18. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses

    OpenAIRE

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup; Lee, Jae Il

    2015-01-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed an upper basilar trunk saccular lesion suggesting ruptured aneurysm. However, immediate subsequent digital subtraction angiography (DSA) failed to show a vascular lesion. In one case, repeated follow up DSA was also negative. The patient wa...

  19. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses

    OpenAIRE

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup; Lee, Jae Il

    2015-01-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed a saccular lesion of the upper basilar trunk suggesting a ruptured aneurysm. However, no vascular lesion was observed on immediate subsequent digital subtraction angiography (DSA). In one case, repeated follow up DSA was also negative. The ...

  20. Poor outcome is associated with less negative fluid balance in patients with aneurysmal subarachnoid hemorrhage treated with prophylactic vasopressor-induced hypertension

    OpenAIRE

    Sakr, Yasser; Dünisch, Pedro; Santos, Clesar; Matthes, Lena; Zeidan, Mohamed; Reinhart, Konrad; Kalff, Rolf; Ewald, Christian

    2016-01-01

    Background Aneurysmal subarachnoid hemorrhage (SAH) is a serious condition associated with high mortality rates and long-term disability. We investigated the impact of fluid balance on neurologic outcome after adjustment for possible confounders related to intensive care therapy and extra-cerebral organ failure during the early phase after SAH. Methods In this retrospective study, we analyzed data from all 142 adult patients admitted to our university hospital surgical intensive care unit (IC...

  1. Troponin elevation in subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Ioannis N Mavridis; Maria Meliou; Efstratios-Stylianos Pyrgelis

    2015-01-01

    Troponin (tr) elevation in aneurysmal subarachnoid hemorrhage (SAH) patients is often difficult to be appropriately assessed by clinicians, causing even disagreements regarding its management between neurosurgeons and cardiologists. The purpose of this article was to review the literature regarding the clinical interpretation of tr elevation in SAH. We searched for articles in PubMed using the key words:“troponin elevation”and“subarachnoid hemorrhage”. All of them, as well as relative neurosurgical books, were used for this review. Some type of cardiovascular abnormality develops in most SAH patients. Neurogenic stunned myocardium is a frequent SAH complication, due to catecholamine surge which induces cardiac injury, as evidenced by increased serum tr levels, electrocardiographic (ECG) changes and cardiac wall motion abnormalities. Tr elevation, usually modest, is an early and specific marker for cardiac involvement after SAH and its levels peak about two days after SAH. Cardiac tr elevation predictors include poor clinical grade, intraventricular hemorrhage, loss of consciousness at ictus, global cerebral edema, female sex, large body surface area, lower systolic blood pressure, higher heart rate and prolonged Q-Tc interval. Elevated tr levels are associated with disability and death (especially tr>1μg/L), worse neurological grade, systolic and diastolic cardiac dysfunction, pulmonary congestion, longer intensive care unit stay and incidence of vasospasm. Tr elevation is a common finding in SAH patients and constitutes a rightful cause of worry about the patients’ cardiac function and prognosis. It should be therefore early detected, carefully monitored and appropriately managed by clinicians.

  2. The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage

    OpenAIRE

    Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

    2014-01-01

    Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic...

  3. Medical Management of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage: A Review of Current and Emerging Therapeutic Interventions.

    Science.gov (United States)

    Adamczyk, Peter; He, Shuhan; Amar, Arun Paul; Mack, William J

    2013-01-01

    Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials evaluating medical treatments in patients with cerebral vasospasm secondary to aSAH. Currently, the strongest evidence supports use of prophylactic oral nimodipine and initiation of triple-H therapy for patients in cerebral vasospasm. Other agents presented in this report include magnesium, statins, endothelin receptor antagonists, nitric oxide promoters, free radical scavengers, thromboxane inhibitors, thrombolysis, anti-inflammatory agents and neuroprotectants. Although promising data is beginning to emerge for several treatments, few prospective randomized clinical trials are presently available. Additionally, future investigational efforts will need to resolve discrepant definitions and outcome measures for cerebral vasospasm in order to permit adequate study comparisons. Until then, definitive recommendations cannot be made regarding the safety and efficacy for each of these therapeutic strategies and medical management practices will continue to be implemented in a wide-ranging manner.

  4. Medical Management of Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage: A Review of Current and Emerging Therapeutic Interventions

    Directory of Open Access Journals (Sweden)

    Peter Adamczyk

    2013-01-01

    Full Text Available Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH. Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials evaluating medical treatments in patients with cerebral vasospasm secondary to aSAH. Currently, the strongest evidence supports use of prophylactic oral nimodipine and initiation of triple-H therapy for patients in cerebral vasospasm. Other agents presented in this report include magnesium, statins, endothelin receptor antagonists, nitric oxide promoters, free radical scavengers, thromboxane inhibitors, thrombolysis, anti-inflammatory agents and neuroprotectants. Although promising data is beginning to emerge for several treatments, few prospective randomized clinical trials are presently available. Additionally, future investigational efforts will need to resolve discrepant definitions and outcome measures for cerebral vasospasm in order to permit adequate study comparisons. Until then, definitive recommendations cannot be made regarding the safety and efficacy for each of these therapeutic strategies and medical management practices will continue to be implemented in a wide-ranging manner.

  5. Role of Endothelial Nitric Oxide Synthase Gene Polymorphisms in Predicting Aneurysmal Subarachnoid Hemorrhage in South Indian Patients

    Directory of Open Access Journals (Sweden)

    Linda Koshy

    2008-01-01

    Full Text Available Endothelial nitric oxide synthase (eNOS gene polymorphisms have been implicated as predisposing genetic factors that can predict aneurysmal subarachnoid hemorrhage (aSAH, but with controversial results from different populations. Using a case-control study design, we tested the hypothesis whether variants in eNOS gene can increase risk of aSAH among South Indian patients, either independently, or by interacting with other risk factors of the disease. We enrolled 122 patients, along with 224 ethnically matched controls. We screened the intron-4 27-bp VNTR, the promoter T-786C and the exon-7 G894T SNPs in the eNOS gene. We found marked interethnic differences in the genotype distribution of eNOS variants when comparing the South Indian population with the reported frequencies from Caucasian and Japanese populations. Genotype distributions in control and patient populations were found to be in Hardy-Weinberg equilibrium. In patients, the allele, genotype and estimated haplotype frequencies did not differ significantly from the controls. Multiple logistic regression indicated hypertension and smoking as risk factors for the disease, however the risk alleles did not have any interaction with these risk factors. Although the eNOS polymorphisms were not found to be a likely risk factor for aSAH, the role of factors such as ethnicity, gender, smoking and hypertension should be evaluated cautiously to understand the genotype to phenotype conversion.

  6. [Increased urinary sodium excretion in the early phase of aneurysmal subarachnoid hemorrhage as a predictor of cerebral salt wasting syndrome].

    Science.gov (United States)

    Nakagawa, Ichiro; Kurokawa, Shinichiro; Takayama, Katsutoshi; Wada, Takeshi; Nakase, Hiroyuki

    2009-12-01

    Cerebral salt wasting syndrome (CSWS) in patients with aneurysmal subarachnoid hemorrhage (SAH) is considered to correlate with delayed ischemic neurological deficits (DIND) induced by cerebral vasospasm; however, its exact mechanism is still not well-known. The purpose of the present study is to evaluate the relationship between hyponatremia caused by CSWS and the increase of the urinary sodium excretion in early phase following SAH. Fifty-four patients with SAH were divided into 2 groups, normonatremia group and hyponatremia group which suffered hyponatremia after SAH. The hyponatremia group comprise 14 patients (26%) in whom the hyponatremia developed of the SAH. In this group, the serum level of sodium significantly decreased 7 days after SAH and then gradually normalised. Further, excretion of sodium in the urine tended to increase 3 days after SAH and significantly increased 7 days after SAH. In conclusion, the increased urinary sodium excretion in the early phase of SAH would serve as a predictive factor for CSWS after SAH. We consider that it is important to start sodium and fluid supplementation and inhibit natriuresis by fludrocortisone acetate administration before hyponatremia occurs in order to prevention delayed ischemic neurological deficits in SAH patients.

  7. Accuracy of computed tomography perfusion in detecting delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Haogeng Sun

    2013-01-01

    Full Text Available Background and Purpose: In recent years, significant literature shows that computed tomography perfusion (CTP can provide sufficient information on cerebral hemodynamics and effectively indicate delayed cerebral ischemia (DCI before the development of infarction. We aimed at performing a meta-analysis to provide a more full and accurate evaluation of CTP and CTP parameters in detecting DCI in patients with aneurysmal subarachnoid hemorrhage. Materials and Methods: We searched the PubMed, MedLine, Embase and Cochrane databases for analysis published from February 2005 to February 2013. We extracted CTP parameters, including cerebral blood volume (CBV, cerebral blood flow (CBF, mean transit time (MTT, time to peak (TTP, interhemispheric ratios for CBV and CBF and interhemispheric differences for MTT and TTP. Pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR, negative likelihood ratio (NLR, diagnostic odds ratio (DOR and the summary receiver-operating characteristic curve were determined. Results: Four research studies are met the inclusion criteria for the analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of CTP for detecting the DCI were 82%, 82%, 4.56, 0.22 and 20.96, respectively. Through the evaluation of absolute CTP parameters, CBF and MTT showed diagnostic value for DCI, but CBF and TTP did not. Moreover, CBF ratio, MTT difference and TTP difference showed more diagnostic value than CBV ratio in DCI detection by the assessment of relative CTP parameters. Conclusions: As a non-invasive and short time consuming screening method, CTP own a high diagnostic value for the detection of DCI after aneurysm rupture.

  8. Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage: A Risk Modeling Study for Individual Elderly Patients.

    Science.gov (United States)

    Duan, Guoli; Yang, Pengfei; Li, Qiang; Zuo, Qiao; Zhang, Lei; Hong, Bo; Xu, Yi; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2016-02-01

    The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT. The aim of this study was to develop and validate a predictive score for 1-year outcomes in individual elderly patients with aSAH underwent EVT.In this 10-year prospective study, 520 consecutive aSAH elderly (age ≥ 60 years) patients underwent EVT in a single center were included. The risk factors, periprocedural, and 1-year follow-up data of all patients were entered in a specific prospective database. The modified Rankin scale was used for evaluating clinical outcome. To optimize the model's predictive capacity, the original matrix was randomly divided in 2 submatrices (learning and testing). The predictive score was developed using Arabic numerals for all variables based on the variable coefficients (β) of multivariable logistic regression analysis in the learning set and the predictive performance evaluation was assessed in the testing set. The risk classes were constructed using classification criteria based on sensitivity and specificity. The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, Hunt-Hess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. The discriminative power analysis with the area under the receiver operating characteristic curve (AUC) of the Changhai score was statistically significant (0.864, 0.824-0.904, P EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application. PMID:26886607

  9. Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography.

    Science.gov (United States)

    Nakajima, Y; Yoshimine, T; Mori, H; Nakamuta, K; Fujimura, I; Sakashita, K; Kohmura, E; Hayakawa, T; Yokota, J

    2000-09-01

    The spontaneous disappearance and reappearance of a ruptured cerebral aneurysm is generally assumed to be a rare phenomenon although the actual incidence is unknown. Among 39 consecutive cases of acute subarachnoid hemorrhage (SAH), 33 were studied by three-dimensional computed tomographic angiography (CTA) within 6 h after the onset of SAH, followed by digital subtraction angiography (DSA) within 24 h after the ictus. Of those patients, one, a 58-year-old woman, had a saccular aneurysm at the distal anterior cerebral artery; the aneurysm was clearly demonstrated by CTA 2.5 h after the SAH onset, but was not shown by a subsequent DSA performed 8.5 h after the ictus. A follow-up DSA detected the neck of aneurysm on day 11, and the whole aneurysm was visualized on day 19. The observations in this particular case suggest that the spontaneous disappearance of a ruptured cerebral aneurysm may occur during the ultra-early stage of SAH and that reappearance may follow during the next few weeks. The patient did not suffer complications such as vasospasm or systemic hypotension nor was she treated with antifibrinolytic agents. The aneurysmal shape and the surrounding clot are considered as putative factors possibly related to the intermittent appearance of the aneurysm. PMID:11045020

  10. Using CT perfusion during the early baseline period in aneurysmal subarachnoid hemorrhage to assess for development of vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Sanelli, Pina C. [New York-Presbyterian Hospital/Weill Cornell Medical College, Department of Radiology, New York, NY (United States); New York-Presbyterian Hospital/Weill Cornell Medical College, Department of Public Health, New York, NY (United States); Jou, Austin; Reichman, Melissa; Greenberg, Edward; Cayci, Zuzan [New York-Presbyterian Hospital/Weill Cornell Medical College, Department of Radiology, New York, NY (United States); Gold, Rachel [New York College of Osteopathic Medicine, 1 Northern Boulevard, P.O. Box 8000, Old Westbury, NY (United States); John, Majnu [New York-Presbyterian Hospital/Weill Cornell Medical College, Department of Public Health, New York, NY (United States); Ugorec, Igor [Atlantic Neurosurgical Specialists, Department of Neurology, Morristown, NJ (United States); Rosengart, Axel [New York-Presbyterian Hospital/Weill Cornell Medical College, Department of Neurology, New York, NY (United States)

    2011-06-15

    The aim of this study is to evaluate computed tomography perfusion (CTP) during admission baseline period (days 0-3) in aneurysmal subarachnoid hemorrhage (A-SAH) for development of vasospasm. Retrospective analysis was performed on A-SAH patients from Dec 2004 to Feb 2007 with CTP on days 0-3. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were analyzed for qualitative perfusion deficits. Quantitative analysis was performed using region-of-interest placement to obtain mean CTP values. Development of vasospasm was determined by a multistage hierarchical reference standard incorporating both imaging and clinical criteria. Student's t test and threshold analysis were performed. Seventy-five patients were included, 37% (28/75) were classified as vasospasm. Mean CTP values in vasospasm compared to no vasospasm groups were: CBF 31.90 ml/100 g/min vs. 39.88 ml/100 g/min (P < 0.05), MTT 7.12 s vs. 5.03 s (P < 0.01), and CBV 1.86 ml/100 g vs. 2.02 ml/100 g (P = 0.058). Fifteen patients had qualitative perfusion deficits with 73% (11/15) developed vasospasm. Optimal threshold for CBF is 24-25 mL/100 g/min with 91% specificity and 50% sensitivity, MTT is 5.5 s with 70% specificity and 61% sensitivity and CBV is 1.7 mL/100 g with 89% specificity and 36% sensitivity. These initial results support our hypothesis that A-SAH patients who develop vasospasm may demonstrate early alterations in cerebral perfusion, with statistically significant CBF reduction and MTT prolongation. Overall, CTP has high specificity for development of vasospasm. Future clinical implications include using CTP during the baseline period for early identification of A-SAH patients at high risk for vasospasm to prompt robust preventative measures and treatment. (orig.)

  11. Quantification of structural cerebral abnormalities on MRI 18 months after aneurysmal subarachnoid hemorrhage in patients who received endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bresser, Jeroen de [University Medical Center Utrecht, Department of Radiology, P.O. Box 85500, Utrecht (Netherlands); Schaafsma, Joanna D.; Luitse, Merel J.A.; Rinkel, Gabriel J.E.; Biessels, Geert Jan [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Viergever, Max A. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

    2015-03-01

    Volume measurements performed on brain MRI after aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into the structural abnormalities that underlie the commonly occurring and persistent long-term functional deficits after aSAH. We examined the pattern of long-term cerebral structural changes on MRI in relation to known risk factors for poor functional outcome. We studied MRI scans from 38 patients who received endovascular treatment and were not dependent for activities of daily life at 18 months after aSAH. Risk factors for poor functional outcome (clinical condition, Hijdra score, and bicaudate index on admission; occurrence of hydrocephalus or delayed cerebral infarction during hospitalization) were related to supratentorial cerebral parenchymal and lateral ventricular volumes on MRI with linear regression analyses adjusted for age, sex, and intracranial volume. Clinical condition, Hijdra score, and bicaudate index on admission were not related to cerebral parenchymal volume at 18 months. A higher bicaudate index on admission was related to lateral ventricular enlargement at 18 months after aSAH (Beta; 95%CI: 0.51; 0.14<->0.88). Delayed cerebral infarction was related to smaller cerebral parenchymal volumes (-0.14; -0.25<->-0.04) and to lateral ventricular enlargement (0.49; 0.16<->0.83) at 18 months. Volume measurements of the brain are able to quantify patterns of long-term cerebral damage in relation to different risk factors after aSAH. Application of volumetric techniques may provide more insight into the heterogeneous underlying pathophysiological processes. After confirmation of these results in larger studies, volumetric measures might even be used as outcome measures in future treatment studies. (orig.)

  12. Genetic Epidemiology of Spontaneous Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Korja, Miikka; Silventoinen, Karri; McCarron, Peter;

    2010-01-01

    and environmental factors to SAH. METHODS: We constructed the largest twin cohort to date, the population-based Nordic Twin Cohort, which comprised 79 644 complete twin pairs of Danish, Finnish, and Swedish origin. The Nordic Twin Cohort was followed up for 6.01 million person-years using nationwide cause......BACKGROUND AND PURPOSE: It would be essential to clinicians, familial aneurysm study groups, and aneurysm families to understand the genetic basis of subarachnoid hemorrhage (SAH), but there are no large population-based heritability estimates assessing the relative contribution of genetic......: SAH appears to be mainly of nongenetic origin, and familial SAHs can mostly be attributed to environmental risk factors....

  13. Fusiform aneurysm of a persistent trigeminal artery associated with rare intracranial arterial variations and subarachnoid hemorrhage.

    Science.gov (United States)

    Kimball, David; Ples, Horia; Kimball, Heather; Miclaus, Gratian D; Matusz, Petru; Loukas, Marios

    2015-01-01

    The trigeminal artery is one of four primitive anastomoses between the internal carotid artery and vertebrobasilar system that regresses in the sixth week of fetal development. A persistent trigeminal artery (PTA) is generally an incidental finding but may also be associated with intracranial vascular pathologies such as aneurysms, arteriovenous malformations, and cranial nerve compression syndromes. We present an extremely rare case of a right PTA with an associated bleeding fusiform aneurysm located in the carotidian (lateral) part of the PTA. In addition, this rare anatomic variation was associated with bilateral absence of the posterior communicating arteries, a left posterior cerebral artery originating from the left internal carotid artery, and agenesis of the A1 segment of the left anterior cerebral artery. PMID:25053265

  14. Nimodipine in aneurysmal subarachnoid hemorrhage: a randomized study of intravenous or peroral administration

    DEFF Research Database (Denmark)

    Kronvall, Erik; Undrén, Per; Rommer, Bertil Roland;

    2009-01-01

    treatment. The patients were monitored for at least 10 days after bleeding in terms of delayed ischemic neurological deficits (DINDs) and with daily measurements of blood flow velocities in the middle cerebral arteries by using transcranial Doppler ultrasonography. Three months after SAH, clinical outcome...... is an alternative and the preferred mode of treatment in many centers. It is unknown whether the route of administration is of any importance for the clinical efficacy of the drug. METHODS: One hundred six patients with acute aneurysmal SAH were randomized to receive either peroral or intravenous nimodipine...... and new cerebral infarctions according to MR imaging studies were recorded. RESULTS: Baseline characteristics (age, sex distribution, clinical status on admission, radiological findings, and aneurysm treatment) did not differ between the treatment groups. There was no significant difference...

  15. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses.

    Science.gov (United States)

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup; Lee, Jae Il

    2015-12-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed an upper basilar trunk saccular lesion suggesting ruptured aneurysm. However, immediate subsequent digital subtraction angiography (DSA) failed to show a vascular lesion. In one case, repeated follow up DSA was also negative. The patient was treated conservatively and discharged without any neurologic deficit. In the other case, the patient showed sudden mental deterioration on the third hospital day and her brain CT showed rebleeding. The immediate follow up DSA showed contrast stagnation in the vicinity of the upper basilar artery, suggestive of pseudoaneurysm. Double stents deployment at the disease segment was performed. Due to the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm. PMID:27066442

  16. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    Masih Saboori

    2011-05-01

    Full Text Available Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indications were operated."nAfter surgery and detecting the existence of aneurysms"nand their location, the data were recorded in a"nchecklist. Sensitivity, specificity, positive and negative"npredictive values were calculated and compared in"nboth methods."nResults: The mean age of the 30 patients were"n49.5±9.13 years. 57.9 % of the subjects were female"nand the others were male. On CTA reports 100% true"npositive, 0% false positive, 85% true negative, and 15%"nfalse negative were calculated. DSA reports were true"npositive, false positive, true negative and false negative"nin 100%, 0%, 69% and 31%, respectively. CTA showed"n89% of sensitivity, and 100% of specificity in contrast"nto 74% sensitivity and 100% specificity of DSA."nPositive predictive values of both methods were 100%,"nbut negative predictive values of CTA and DSA were"n85% and 69%, respectively."nConclusion: Based on our data, CTA is more preferable"ndiagnostic modality for the brain aneurysm's site and"nanatomy in patients with subarachnoid hemorrhage"nthan DSA."nKeywords: CT Scan Angiography, Digital Subtraction"nAngiography, Cerebral Aneurysm, Subarachnoid"nHemorrhage

  17. Spontaneous subarachnoid hemorrhage in the emergency department

    Directory of Open Access Journals (Sweden)

    Diego Garbossa

    2012-07-01

    Full Text Available Subarachnoid hemorrhage (SAH is one of the major cause of mortality for stroke. The leading cause is the rupture of an intracrnial aneurym. Acute aneurysmal subarachnoid hemorrhage (SAH is a complex multifaceted disorder that plays out over days to weeks. The development of aneurysms is mainly due to a hemodynamic stress. Considerableadvances have been made in endovascular techniques, diagnostic methods, and surgical and perioperative management guidelines. Rebleeding remains the most imminent danger until the aneurysm is excluded from cerebral circulation. The only effective prevention of rebleeding is repair the aneurysm; choosing the right way with surgical or an endovascular approach. Outcome for patients with SAH remains poor, with population-based mortality rates as high as 45% and significant morbidity among survivors. In this work we analyzed the diagnostic-therapeutic course of patients presenting SAH. We analyzed the types and the occurrence of complications. We present two cases report to better demonstrate that treatments for specific patients need to be individualized.

  18. Effect of magnesium treatment and glucose levels on delayed cerebral ischemia in patients with subarachnoid hemorrhage : a substudy of the Magnesium in Aneurysmal Subarachnoid Haemorrhage trial (MASH-II)

    NARCIS (Netherlands)

    Leijenaar, Jolien F.; Mees, Sanne M. Dorhout; Algra, Ale; van den Bergh, Walter M.; Rinkel, Gabriel J. E.

    2015-01-01

    BackgroundMagnesium treatment did not improve outcome in patients with aneurysmal subarachnoid haemorrhage in the Magnesium in Aneurysmal Subarachnoid Haemorrhage II trial. We hypothesized that high glucose levels may have offset a potential beneficial effect to prevent delayed cerebral ischemia. We

  19. Postpartum cerebral angiopathy presenting with non-aneurysmal subarachnoid hemorrhage and interval development of neurological deficits: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Li Yang

    2013-01-01

    Full Text Available Postpartum cerebral angiopathy (PCA is a cerebrovascular disease that occurs during the postpartum period. It is characterized by reversible multifocal vasoconstriction of the cerebral arteries. We report a patient with PCA proven by cerebral angiography that revealed multifocal, segmental narrowing of the cerebral arteries and non-aneurysmal subarachnoid hemorrhage. The patient suddenly deteriorated with focal neurological deficits on the 5 th day of hospitalization. She was treated with calcium-channel blockers and monitored with daily transcranial Doppler ultrasound. Her symptoms gradually improved and she was discharged on the 11 th day of hospitalization. At 1-month follow-up, patient was completely symptom-free with no neurological deficits.

  20. Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Hee; You, Jin Jong; Choi, Ho Cheol; Kim, Ji Eun [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Choi, Dae Seob [Gyeongsang Institue of Health Science, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of); Ryoo, Jae Wook [Dept. of Radiology, Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the usefulness of multidetector-row CT angiography (MDCTA) for the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) by comparison of digital subtraction angiography (DSA) and to compare the bone subtraction CT angiography (BS-CTA) and standard CT angiography (S-CTA). Thirty-three patients who were treated with intraarterial nimodipine infusion for the cerebral vasospasm after aneurysmal SAH were evaluated with MDCTA and DSA. BS-CTA images were reconstructed from the S-CTA and unenhanced CT source images. A total of 207 vascular segments were evaluated. A four-step scale for the degree of stenosis was applied for each segment. With DSA as the standard images, BS-CTA and S-CTA images were comparied. On DSA, 56 segments (27%) presented vasospasm. Concordance between the DSA and S-CTA and between DSA and BS-CTA were 94.7% and 82.1%, respectively. Overestimation for the degree of stenosis was shown in 37 segments on BS-CTA and in 8 segments on S-CTA, but underestimated segments were only shown on S-CTA (n = 4). MDCTA with standard technique seems to be a useful imaging tool for the evaluation of the cerebral vasospasm after aneurysmal SAH. However, BS-CTA is not needed because of additional radiation and overestimation of the degree of stenosis.

  1. Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Objective: Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage. Materials and methods: After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded. Results: 2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively. Conclusions: 3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm

  2. HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA) : a randomized single- blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Gathier, C. S.; van den Bergh, W. M.; Slooter, A. J. C.

    2014-01-01

    RationaleDelayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (SAH). One option to treat delayed cerebral ischemia is to use induced hypertension, but its efficacy on the eventual outcome has not been proven in a randomized clinical trial. This article des

  3. Anaplastic Medullary Ependymoma Presenting as Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Nicolas Nicastro

    2013-01-01

    Full Text Available A-41-year old man presented with violent thunderclap headache and a bilateral proprioceptive sensibility deficit of the upper limbs. Cerebral CT scan and MRI were negative. Lumbar puncture confirmed subarachnoid hemorrhage (SAH, but cerebral angiography was negative. Three months later, the patient presented with paraparesis, and a thorough work-up revealed a diffuse, anaplastic extramedullary C7-D10 ependymoma with meningeal carcinomatosis considered the source of hemorrhage. The patient went through a D5-D8 laminectomy, temozolomide chemotherapy, and radiotherapy. The situation remained stable for a few months. In this paper, we would like to emphasize that spinal masses should be considered in cases of SAH with negative diagnostic findings for aneurysms or arteriovenous malformation.

  4. Perimesencephalic subarachnoid hemorrhage: when to stop imaging?

    Science.gov (United States)

    Cruz, Juan Pablo; Sarma, Dipanka; Noel de Tilly, Lyne

    2011-06-01

    To evaluate the yield of digital subtraction angiography (DSA) and repeated follow-up imaging in patients with initial pattern of perimesencephalic subarachnoid hemorrhage (PSAH) and negative computed tomography angiography (CTA) in excluding an underlying aneurysm. We conducted a retrospective analysis of all nontraumatic SAH who underwent a DSA between January 2006 and January 2010 and selected those with a PSAH pattern on CT done within 72 h from ictus. All CTAs were performed with a 64-section multidetector row CT scanner, and findings were compared with DSA and to follow-up imaging. Forty-nine patients with initial PSAH pattern and negative CTA who underwent subsequent DSA were identified. Six patients were excluded because CTA was not available in hospitals or 72 h after ictus. Only one patient (2.4%) had a false negative CTA with a 1-mm left ICA aneurysm seen on DSA, considered not to be the source of hemorrhage. An average of 2.0 ± 1.2 follow-up exams per patient (range 0-5) revealed no source of bleeding. One patient had a procedure-related transient complication, but evolved with no sequels. In patients with PSAH, CTA is reliable for ruling out an underlying aneurysm. DSA and, especially, further follow-up imaging have no increased diagnostic yield compared to initial negative CTA. PMID:21360167

  5. 无蛛网膜下腔出血的破裂脑动脉瘤%Ruptured cerebral aneurysms without subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    梁玉敏; 江基尧; 潘耀华; 万杰清; 殷玉华; 包映晖; 高国一; 熊文浩; 徐纪文; 罗其中

    2009-01-01

    Objective To summarize the experiences of diagnosis and treatment of ruptured cerebral aneurysm without subarachnoid hemorrhage(SAH). Methods The clinical manifestations, neuroradiological results, methods of treatment and outcome of 15 cases of ruptured cerebral anenrysm which presented with intracerebral hemorrhage (ICH), and/or intraventricular hemorrhage (IVH), subdural hematoma (SDH) or intramural hemorrhage(IMH) without SAH on initial CT or MRI were reviewed retrospectively. Results The initial CT or MRI in 15 cases was obtained within 2 days after onset. Of these cases, three patients presented with ICH, six with ICH and IVH, one with IVH, one with SDH, three with IMH and 1 with mixed density. There are six middle cerebral artery, four anterior communicating artery, three posterior communicating artery, one anterior cerebral artery and one posterior inferior cerebellar artery aneurysms. Thirteen patients underwent a craniotomy for clipping and two patients endovascular coiling. According Glasgow Outcome Scale (GOS),8 patients recovered well, 3 became moderately disabled, 3 were severely disabled and 1 was in vegetative state on discharge. The incidence of aneurysm rupture with ICH and/or IVH, SDH, IMH without SAH is 3.8% in this report. Conclusions Initial CT or MRI of ruptured cerebral aneurysms may presented with ICH, and/or IVH, SDH and IMH without SAH, which may have a muhifactorial cause attributable to the timing of CT or MRI, location of the aneurysm and direction of its dome, and the amount of hemorrhage. The key points to improve the outcome of such cases are to control increased intracranial pressure earlier, diagnose and manage ruptured aneurysms promptly.%目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床

  6. 动脉瘤性蛛网膜下腔出血的病因诊断%The etiological diagnosis of subarachnoid hemorrhage caused by aneurysm

    Institute of Scientific and Technical Information of China (English)

    钱伟东; 屈洪党; 陈育华; 张扬

    2012-01-01

    目的:探讨CT血管造影(CTA)诊断动脉瘤性蛛网膜下腔出血(SAH)病因的价值.方法:对经CT平扫明确诊断的自发性SAH 24例患者,在入院后均做CTA和数字减影血管造影(DSA),并就CTA和DSA诊断作一比较.结果:24例CTA检查后22例共发现26个脑动脉瘤,CTA能清楚显示动脉瘤的位置、大小、形态、瘤颈位置及周围组织的情况,以DSA作为金标准,CTA灵敏度92.86%,特异度100.00%.结论:CTA可作为蛛网膜下腔出血尤其是危重患者早期病因学诊断的首选方法.%Objective: To explore the value of CT angiography(CTA) in the etiological diagnosis of subarachnoid hemorrhage ( SAH ) caused by aneurysm. Methods; Twenty-four spontaneous SAH patients diagnosed by CT plain scan were detected for comparative analysis using CTA and digital subtraction angiography( DSA). Results: Twenty-two cases with 26 aneurysms in 24 cases were found by CTA. CTA displayed the location,size,shape,neck and surrounding tissue of aneurysm. Using DSA as the gold standard,the sensitivity and specificity of CTA were 92. 86% and 100. 00% respectively. Conclusions: CTA can be a preferred method for the early etiological diagnosis of SAH patients, especially for critical patients.

  7. Leptomeningeal transthyretin-type amyloidosis presenting as acute hydrocephalus and subarachnoid hemorrhage.

    Science.gov (United States)

    Bevers, Matthew B; McGuone, Declan; Jerath, Nivedita U; Musolino, Patricia L

    2016-07-01

    We present a report of a 47-year-old woman with developmental delay who presented with subarachnoid hemorrhage and acute hydrocephalus. She did not have an aneurysm, but there was symmetric calcification and gadolinium-enhancement of the meninges within the Sylvian fissure. Biopsy and genetic testing confirmed transthyretin-type amyloidosis. It is important to consider such rare causes in atypical presentations of non-aneurysmal subarachnoid hemorrhage. PMID:26896372

  8. Association between S100B Levels and Long-Term Outcome after Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Pooled Analysis.

    Science.gov (United States)

    Lai, Pui Man Rosalind; Du, Rose

    2016-01-01

    S100 calcium binding protein B (S100B), a well-studied marker for neurologic injury, has been suggested as a candidate for predicting outcome after subarachnoid hemorrhage. We performed a pooled analysis summarizing the associations between S100B protein in serum and cerebrospinal fluid (CSF) with radiographic vasospasm, delayed ischemic neurologic deficit (DIND), delayed cerebral infarction, and Glasgow Outcome Scale (GOS) outcome. A literature search using PubMed, the Cochrane Library, and the EMBASE databases was performed to identify relevant studies published up to May 2015. The weighted Stouffer's Z method was used to perform a pooled analysis of outcome measures with greater than three studies. A total of 13 studies were included in this review. Higher serum S100B level was found to be associated with cerebral infarction as diagnosed by CT (padj = 3.1 x 10(-4)) and worse GOS outcome (padj = 5.5 x 10(-11)). There was no association found between serum and CSF S100B with radiographic vasospasm or DIND. S100B is a potential prognostic marker for aSAH outcome.

  9. Association between S100B Levels and Long-Term Outcome after Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Pooled Analysis.

    Directory of Open Access Journals (Sweden)

    Pui Man Rosalind Lai

    Full Text Available S100 calcium binding protein B (S100B, a well-studied marker for neurologic injury, has been suggested as a candidate for predicting outcome after subarachnoid hemorrhage. We performed a pooled analysis summarizing the associations between S100B protein in serum and cerebrospinal fluid (CSF with radiographic vasospasm, delayed ischemic neurologic deficit (DIND, delayed cerebral infarction, and Glasgow Outcome Scale (GOS outcome. A literature search using PubMed, the Cochrane Library, and the EMBASE databases was performed to identify relevant studies published up to May 2015. The weighted Stouffer's Z method was used to perform a pooled analysis of outcome measures with greater than three studies. A total of 13 studies were included in this review. Higher serum S100B level was found to be associated with cerebral infarction as diagnosed by CT (padj = 3.1 x 10(-4 and worse GOS outcome (padj = 5.5 x 10(-11. There was no association found between serum and CSF S100B with radiographic vasospasm or DIND. S100B is a potential prognostic marker for aSAH outcome.

  10. Subarachnoid hemorrhage due to retained lumbar drain.

    Science.gov (United States)

    Guppy, Kern H; Silverthorn, James W; Akins, Paul T

    2011-12-01

    Intrathecal spinal catheters (lumbar drains) are indicated for several medical and surgical conditions. In neurosurgical procedures, they are used to reduce intracranial and intrathecal pressures by diverting CSF. They have also been placed for therapeutic access to administer drugs, and more recently, vascular surgeons have used them to improve spinal cord perfusion during the treatment of thoracic aortic aneurysms. Insertion of these lumbar drains is not without attendant complications. One complication is the shearing of the distal end of the catheter with a resultant retained fragment. The authors report the case of a 65-year-old man who presented with a subarachnoid hemorrhage due to the migration of a retained lumbar drain that sheared off during its removal. To the best of the authors' knowledge, this is the first case of rostral migration of a retained intrathecal catheter causing subarachnoid hemorrhage. The authors review the literature on retained intrathecal spinal catheters, and their findings support either early removal of easily accessible catheters or close monitoring with serial imaging.

  11. Hyponatremia in aneurysmal subarachnoid hemorrhage is due to the syndrome of inappropriate antidiuresis and acute glucocorticoid deficiency

    LENUS (Irish Health Repository)

    Hannon, M J

    2011-06-01

    Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH) and contributes to increased morbidity and mortality. Retrospective data suggests that the syndrome of inappropriate diuresis (SIAD) is the most common cause of hyponatraemia in SAH, though cerebral salt wasting has been postulated by some workers to be the predominant abnormality. Data which has shown acute glucocorticoid deficiency following SAH has suggested that some cases of euvolaemic hyponatraemia may also be caused by this mechanism.We prospectively studied the hormonal and haemodynamic influences involved in the development of hyponatraemia in 100 patients (61% female, median age 53 (range 16-82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (pNa), urea, osmolality, glucose and 0900h cortisol (PC), and urinary sodium and osmolality measured on days 1, 2, 3, 4, 6, 8, 10 and 12 following SAH. Fluid balance and haemodynamic parameters were recorded daily. Results were compared with 15 patients admitted to ITU following vascular surgery. A PC<300nmol\\/L in a patient in ITU was regarded clinically as inappropriately low.49% of patients developed hyponatraemia (pNa<135 mmol\\/L), including 14% who developed clinically significantly hyponatraemia (pNa<130 mmol\\/L). 36\\/49 (73.4%) developed hyponatraemia between days 1 and 3 post SAH. The median duration of hyponatraemia was 3 days (range 1–10 days).In 35\\/49 (71.4%), hyponatraemia was due to SIAD as defined by standard diagnostic criteria. 14% of SAH patients had at least one PC<300nmol\\/L; 5 of these (35.7%) developed hyponatraemia. In 4 patients hyponatraemia was preceded by acute cortisol deficiency and responded to hydrocortisone treatment. In contrast, all controls had PC>500 nmol\\/L on day 1, and >300 nmol on days 3–12. There were no cases of cerebral salt wasting. There was no relationship between the incidence of hyponatraemia and the defined anatomical territory or severity of

  12. The changes of von willebrand factor/a disintegrin-like and metalloprotease with thrombospondin type I repeats-13 balance in aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Tang, Qi-Feng; Lu, Shi-Qi; Zhao, Yi-Ming; Qian, Jin-Xian

    2015-01-01

    The aim of this study was to investigate the role of Von Willebrand Factor/thrombospondin type I repeats-13 (VWF/ADAMTS13) balance in aSAH. Fifty eight patients with aSAH at the First Affiliated hospital of Soochow University, Suzhou, China, between January 2012 and January 2014 were eligible for the study. They were divided into delayed cerebral ischemia group (DCI group) and non-delayed cerebral ischemia group (no DCI group), or cerebral vasospasm group (CVS group) and no spasm group (no CVS group), or good outcome group and poor outcome group. The control group consisted of twenty healthy people. All patients underwent CT, DSA, or (and) CTA diagnosed with intracranial subarachnoid hemorrhage which is caused by aneurysm rupture. Venous blood was drawn in tubes at 3 time points: 1 day after SAH (T1), (4±1) days after SAH (T2), and (9±1) days after SAH (T3) to determine plasma concentrations of ADAMTS13, VWF, P-selectin and IL-6 via enzyme-linked immunosorbent assay (ELISA). Transcranial doppler sonography (TCD) was used to measure mean blood flow velocity of the middle cerebral artery (VMCA). Glasgow Outcome Scale (GOS) was measured before discharge. Among 58 patients, 12 (20.7%) had DCI, 40 (68.9%) had TCD evidence of CVS, and 20 (34.5%) had poor outcome. The concentrations of VWF, P-selectin and IL-6 on T1, T2 and T3 after SAH were significantly higher in DCI, CVS and poor outcome groups compared with those of the control group (P 0.05). The results of our study suggest that the increased VWF and decreased ADAMTS13 activity were associated with DCI and poor outcome. The balance of VWF/ADAMTS13 could be used to predict the clinical outcome. The deficiency of ADAMTS13 can not only induce DCI but also accelerate inflammatory reaction. Our results reported in this paper may provide new insights into the possible use of ADAMTS13 as a therapeutic agent in aneurysmal subarachnoid hemorrhage. PMID:25785135

  13. Superior cerebellar aneurysm causing subarachnoid haemorrhage in a 17-year-old with alagille syndrome.

    LENUS (Irish Health Repository)

    O'Connell, David

    2012-04-01

    Alagille syndrome is a rare autosomal dominant condition characterised by mutation in Jagged1 gene. Intracranial aneurysms may be seen in this condition and may present as subarachnoid hemorrhage. We describe the first case of superior cerebellar aneurysm rupture causing WFNS grade 1 subarachnoid haemorrhage in a 17-year-old girl. The clinical condition and management of this rare occurrence is discussed with a review of literature.

  14. Correlation between plasma total nitric oxide levels and cerebral vasospasm and clinical outcome in patients with aneurysmal subarachnoid hemorrhage in Indian population

    Directory of Open Access Journals (Sweden)

    Shruthi Shimoga Ramesh

    2014-01-01

    Full Text Available Context: Cerebral vasospasm remains a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH. Reduced bioavailability of nitric oxide has been associated with the development of cerebral vasospasm after aSAH. Such data is not available in Indian population. Aims: The objective of the study was to measure the plasma total nitric oxide (nitrite and nitrate-NOx level in aSAH patients and healthy controls treated at a tertiary hospital in India and to investigate a possible association between plasma total nitric oxide level and cerebral vasospasm and clinical outcome following treatment in patients with aSAH. Settings and Design: A case-control study of aSAH patients was conducted. Plasma total NOx levels were estimated in aSAH patients with and without vasospasm and compared the results with NOx levels in healthy individuals. Materials and Methods: aSAH in patients was diagnosed on the basis of clinical and neuro-imaging findings. Plasma total NOx levels in different subject groups were determined by Griess assay. Results: Plasma total NOx level was found to be significantly decreased in patients with aSAH when compared to controls. Plasma total NOx level in the poor-grade SAH group was lower than that in the good-grade SAH group. Plasma total NOx level further reduced in patients with angiographic (P < 0.05 and clinical vasospasm. Conclusions: Reduced plasma NOx level is seen in aSAH patients as compared to normal individuals. In aSAH patients reduced levels are associated with increased incidence of cerebral vasospasm and poor outcome. Plasma total NOx level could be used as a candidate biomarker for predicting vasospasm and outcome for this pathology.

  15. Subarachnoid Hemorrhage from a Dissecting Aneurysm of the Posterior Cerebral Artery in a Child : Rebleeding after Stent-Assisted Coiling Followed by Stent-Within-Stent Technique

    OpenAIRE

    Lee, Ji Yeoun; Kwon, Bae Ju; Kang, Hyun-Seung; Wang, Kyu-Chang

    2011-01-01

    Pediatric patients with dissecting aneurysms usually present with ischemia rather than bleeding. We report a case of a 15-year-old boy with a dissecting aneurysm of the posterior cerebral artery (PCA) presenting with hemorrhage. He was first treated with stent-assisted coil embolization, in an attempt to avoid trapping of the PCA and preserve the perforators. After the procedure, he recovered well from general anesthesia, but rebleeding occurred from the same lesion 6 hours after the procedur...

  16. Quality of life after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Passier, P.E.C.A.

    2011-01-01

    The general aim of this thesis was to increase our understanding of quality of life (QoL) after aneurysmal subarachnoid haemorrhage (SAH), and the most important determinants of QoL, in order to tailor appropriate rehabilitation programs and thereby enhance their effectiveness. We reviewed the liter

  17. Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery.

    Science.gov (United States)

    Bozkurt, Gokhan; Yaman, Mesut Emre

    2016-01-01

    Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action.

  18. Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

    Directory of Open Access Journals (Sweden)

    Pinaki Dutta

    2012-01-01

    Full Text Available Background: The data on incidence of hypopituitarism after SAH are conflicting. Furthermore, it is still not known whether there is any difference in hormonal deficiencies between SAH due to anterior communicating artery (A-com and middle cerebral artery (MCA aneurysms. Materials and Methods: This study includes both retrospective and prospective arms. The data collected included baseline demographic profile, clinical severity on admission to the hospital by the Hunt and Hess grading system and World Federation of Neurological Surgeons (WFNS grading, radiological severity of bleed by the Fisher′s classification, and treatment details. All the patients underwent detailed hormonal evaluation at baseline and 6 months in prospective group while at the end of 1 year in the retrospective group. Hormonal deficiencies between patients with A-com and MCA aneurysmal SAH were compared using appropriate statistical tests. Results: Of 60 patients studied, 47 patients (A-com: 28 and MCA: 19 were in the retrospective group, while 13 patients (A-com-9, MCA-4 were in the prospective group. The baseline data were comparable between the two groups. At or after 6 months follow-up, 19 (31.6% patients, 10 patients with A-com and 9 patients with MCA aneurysmal SAH, had some form of hormone deficiency. Furthermore, there was no difference in endocrine dysfunctions between the two groups. There was no correlation between the severity of hormonal deficiency and the clinical severity of SAH grade by Hunt and Hess and radiological grade of SAH by Fisher′s grade. Conclusion: Hormonal deficiencies are not uncommon in patients with SAH. There is no difference in hormonal deficiencies and severity of hypopituitarism in patients with SAH due to A-com and MCA bleed.

  19. Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections

    OpenAIRE

    Park, Yung Ki; Yi, Hyeong-Joong; Lee, Young Jun; Kim, Young-Seo

    2013-01-01

    Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subseque...

  20. 三维CT血管造影对动脉瘤性蛛网膜下腔出血诊断的可靠性研究%Reliability of 3D CT angiography in diagnosis of aneurysmal subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      目的评价三维CT血管造影(3D-CTA)在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)诊断的可靠性。方法对我科2010年12月-2011年11月间192名急性蛛网膜下腔出血患者行CT血管造影检查(CTA)检查并应用3D Slicer软件进行三维重建,与数字减影血管造影(digital subtraction angiography,DSA)或术中实际情况进行对比,评价CTA在动脉瘤性蛛网膜下腔出血诊断中的可靠性。结果192例中,CTA检查出动脉瘤162例,脑血管畸形12例;另有假阴性1例,假阳性1例,均通过DSA及手术证实,3D-CTA在aSAH诊断的灵敏性为96.17%,特异性为94.11%。结论3D-CTA是动脉瘤性蛛网膜下腔出血的首选检查方法。%Objective To evaluate the reliability of 3D-CT angiography (3D-CTA) in diagnosis of aneurysmal subarachnoid hemorrhage (SAH). Methods One hundred and ninety-two patients with acute SAH who underwent CTA in our department from December 2010 to November 2012 were included in this study. Their 3D-CTA images were reconstructed with 3D Slicer software and compared with digital subtraction angiography (DSA) images or intraoperative actual situation. The reliability of CTA was assessed in diagnosis of aneurysmal SAH. Results 3D-CTA showed aneurysm in 162 patients, cerebral vascular malformation in 12 patients, false negative aneurysm in 1 patient, and false-positive aneurysm in 1 patient, which were confirmed by DSA or surgery, with a sensitivity of 96.17%and a specificity of 94.11%. Conclusion 3D-CTA is the first choice of method in diagnosis of aneurysmal SAH.

  1. Meta-analysis of APOE genotype and subarachnoid hemorrhage - Clinical outcome and delayed ischemia

    NARCIS (Netherlands)

    Lanterna, L. A.; Ruigrok, Y.; Alexander, S.; Tang, J.; Biroli, F.; Dunn, L. T.; Poon, S.

    2007-01-01

    Background: Emerging evidence suggests that the APOE4 allele may increase the risk of a negative outcome in patients with aneurysmal subarachnoid hemorrhage (SAH), but the results are conflicting. A genetic variable predicting the individual clinical course is currently lacking. Objective: To examin

  2. Effect of interferon-β on neuroinflammation, brain injury and neurological outcome after experimental subarachnoid hemorrhage

    NARCIS (Netherlands)

    Tiebosch, Ivo A C W; Dijkhuizen, Rick M; Cobelens, Pieter M; Bouts, Mark J R J; Zwartbol, René; van der Meide, Peter H; van den Bergh, Walter M

    2013-01-01

    INTRODUCTION: Aneurysmal subarachnoid hemorrhage (SAH) has a poor outcome, particularly attributed to progressive injury after the initial incident. Several studies suggest a critical role for inflammation in lesion progression after SAH. Our goal was to test whether treatment with anti-inflammatory

  3. The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

    NARCIS (Netherlands)

    Oliveira Manoel, A.L. de; Jaja, B.N.; Germans, M.R.; Yan, H.; Qian, W.; Kouzmina, E.; Marotta, T.R.; Turkel-Parrella, D.; Schweizer, T.A.; Macdonald, R.L.

    2015-01-01

    BACKGROUND AND PURPOSE: Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI. METHODS: We used data of 3 phase II randomized clinical trials and a single hospital series to asses

  4. CT对动脉瘤破裂所致蛛网膜下腔出血的诊断价值%Diagnostic value of CT in subarachnoid hemorrhage induced by aneurysm rupture

    Institute of Scientific and Technical Information of China (English)

    宋同均; 魏建功; 王士强; 刘道斌; 董世节

    2013-01-01

    Objective To explore the diagnosis value of CT in subarachnoid hemorrhage(SAH) induced by aneurysm rupture.Methods The clinical and CT data of 119 patients with SAH induced by aneurysm rupture were analyzed respectively.Results The CT characteristic of SAH induced by aneurysm rupture was full of hyperderse in sulcus and schizenceplay,or accompaning intracerebral hematoma in the straight gyrus of frontal lobe and the hippocampal gyrus of parietal lobe.Conclusion The CT has important value for diagnosing SAH induced by aneurysm rupture in the location and the nature.But it is indispensable that the CTA or DSA must be done for ascertaining the artery of responsibility of rupturing aneurysm.%目的 探讨CT对动脉瘤破裂所致蛛网膜下腔出血(SAH)的诊断价值.方法 回顾性分析119例动脉瘤破裂所致SAH患者的临床和CT影像资料.结果 动脉瘤破裂所致的SAH的CT表现为侧裂、纵裂、脑池铸型高密度影,或伴有额叶直回、侧裂周围的额、颞叶血肿.结论 头颅CT在动脉瘤破裂所致SAH的定性诊断中具有一定的重要价值,根据CT显示颅内特定部位的SAH,还可以间接推测颅内动脉瘤的部位.但确定动脉瘤的责任血管来源还需行CTA或DSA检查.

  5. A model of subarachnoid hemorrhage in rats

    Institute of Scientific and Technical Information of China (English)

    Liao-liaoLI; Xiao-liangWANG

    2004-01-01

    AIM: To build a simple and repeatable animal model of subarachnoid hemorrhage (SAH). METHODS: SAH was introduced by passing a nylon thread up through the right internal carotid artery and piercing a hone in the right anterior cerebral artery. At 12 and 24 h, the rats were evaluated with rotarod test and the behavior scale (5-point scale). RESULTS: The ratswere trained through rotarod test and then randomly divided into

  6. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  7. CT findings of fundal hemorrhage in subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    The patient was a 66-year-old man. He lost consciousness as a result of a third subarachnoid hemorrhage attack. On neurological examination, he was found to be comatose and to have no spontaneous respiration. A mydriasis was noticed on both eyes. Bilateral retinal bleeding was also observed, with the bleeding of the left side more severe than that of the right side. After his death, his brain and eyes were examined by means of a CT scan. The CT films showed a severe subarachnoid hemorrhage and ventricular hematoma. The thin-sliced CT films showed left retinal bleeding. Retinal bleeding may be caused by a subarachnoid hemorrhage. Usually we make a sketch of the retinal bleeding on the basis of a doctor's report. A photo of an optic fundus is a good record; however, taking a photo is troublesome for severely ill patients. The CT finding of retinal bleeding is gross, but a CT image is one good way to record retinal bleeding. (author)

  8. Treatment of acute hydrocephalus and cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    D. Hasan (Djo)

    1990-01-01

    textabstractOnly recently has acute hydrocephalus after subarachnoid hemorrhage been recognized as a clinical important problem. The mortality rate in patients with acute hydrocephalus after subarachnoid hemorrhage is higher than in those without, which is mainly caused by cerebral ischemia. An expl

  9. Natural course of subarachnoid hemorrhage is worse in elderly patients

    Directory of Open Access Journals (Sweden)

    Felix Hendrik Pahl

    2014-11-01

    Full Text Available Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH patients according to age. Method Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.

  10. Diagnosis and treatment of the chronic hydrocephalus following aneurysmal subarachnoid hemorrhage%动脉瘤性蛛网膜下腔出血后慢性脑积水的诊治

    Institute of Scientific and Technical Information of China (English)

    吴志敏; 李俊

    2011-01-01

    Objective To explore the diagnosis and treatment of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage (aSAH). Method The clinical data of 33 patients with hydrocephalus following aSAH who underwent ventriculo-peritoneal shunt in our department were analyzed retrospectively. Result Of 33 patients, 27 were recovered well, 3 mild disabled, 2 severely disabled and 1 died. Conclusions The chronic hydrocephalus is a common complication following aSAH. The ventriculo-peritoneal shunt is an effective method to treat the chronic hydrocephalus following aSAH.%目的 探讨动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑积水的诊断与治疗方法.方法 回顾性分析33例经手术治疗的aSAH后慢性脑积水患者的临床资料.结果 治疗后随访6月~2年,按GOS评分,恢复良好27例,轻残3例,重残2例,死亡1例.结论 慢性脑积水是aSAH后的常见并发症,脑室-腹腔分流术是aSAH后慢性脑积水的有效治疗方法.

  11. 64排CT血管造影在动脉瘤性蛛网膜下腔出血的临床研究%Clinical research of 64-slice CT angiography in aneurysmal subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈立朝; 许民辉; 邹咏文; 杨东虹; 张云东; 徐伦山; 张溢华

    2011-01-01

    目的:评估CT血管造影(CTA)在动脉瘤性蛛网膜下腔出血(SAH)病人中选择治疗策略的作用.方法:对231例动脉瘤性SAH病人行64排CTA检查.选择临床治疗方案,并通过DSA或外科手术验证CTA检查的准确性.结果:CTA检查与DSA或术中探查一致228例,CTA信息不充分2例,CTA漏诊1例;CTA检查的敏感性98.7%,特异性100%.根据CTA检查确定治疗方案228例(98.7%),其中采用血管内栓塞治疗141例,夹闭术87例;根据DSA检查,采用血管内栓塞治疗3例.结论:64排CTA能准确检测颅内动脉瘤及其特征,有助于选择治疗策略.%Objective To evaluate the clinical application of CT angiography (CTA) in making therapeutic strategy for patients with aneurysmal subarachnoid hemorrhage (SAH). Methods The 64-slice CTA examination was performed in 231 patients with aneurysmal SAH to select appropriate treatment strategies. CTA findings should be confirmed by DSA or surgical exploration. Results CTA findings were coincident with the findings by DSA or surgical exploration in 228 cases, CTA findings were insufficient in 2 cases, and missed diagnosis by CTA in 1 case. The sensitivity of CTA examination was 98.7% and specificity was 100%. The therapeutic measures were decided based on CTA in 228 cases (98.7%), including endovascular treatment in 141 cases, clipping of aneurysm in 87. Endovascular treatment was adopted based on DSA in 3 cases. Conclusions The 64-slice CTA as an accurate tool for detecting intracranial aneurysms is useful to decide therapeutic strategy.

  12. Are Isofurans and Neuroprostanes Increased After Subarachnoid Hemorrhage and Traumatic Brain Injury?

    OpenAIRE

    Corcoran, Tomas B; Mas, Emilie; Barden, Anne E.; Durand, Thierry; Galano, Jean-Marie; Roberts, L. Jackson; Phillips, Michael; Ho, Kwok M.; Mori, Trevor A.

    2011-01-01

    Current diagnostic tools to assess neurological injury after aneurysmal subarachnoid hemorrhage (aSAH) and traumatic brain injury (TBI) have poor discriminatory abilities. Free radicals are associated with the pathophysiology of secondary damage after brain trauma. We examined cerebrospinal fluid (CSF) lipid markers of oxidative stress, isofurans (IsoFs), F4-neuroprostanes (F4-NeuroPs), and F2-isoprostanes (F2-IsoPs), in two case-controlled studies in patients with aSAH or severe TBI. Patient...

  13. Secondary infarction in single or in multiple vascular territories: two different entities following subarachnoid hemorrhage?

    OpenAIRE

    de Rooij, N. K.; Frijns, C. J. M.; Velthuis, B.K.; Rinkel, G J E

    2011-01-01

    The pathogenesis of secondary infarctions (SI) after aneurysmal subarachnoid hemorrhage (SAH) is poorly understood. To assess whether SI in single (SSI) or multiple (MSI) vascular territories represent different disease entities, we compared clinical profiles of patients with these patterns of SI. CT/MRI-examinations of 448 patients were reviewed for new infarctions within 28 days after SAH, and categorized into SSI or MSI. Only patients with adequate follow-up imaging excluding any new infar...

  14. Electroencephalographic response to sodium nitrite may predict delayed cerebral ischemia after severe subarachnoid hemorrhage

    OpenAIRE

    Garry, Payashi S.; Rowland, Matthew J.; Ezra, Martyn; Herigstad, Mari; Hayen, Anja; Sleigh, Jamie W.; Westbrook, Jon; Warnaby, Catherine E; Pattinson, Kyle T.

    2016-01-01

    OBJECTIVES: Aneurysmal subarachnoid hemorrhage often leads to death and poor clinical outcome. Injury occurring during the first 72 hours is termed "early brain injury," with disruption of the nitric oxide pathway playing an important pathophysiologic role in its development. Quantitative electroencephalographic variables, such as α/δ frequency ratio, are surrogate markers of cerebral ischemia. This study assessed the quantitative electroencephalographic response to a cerebral nitric oxide...

  15. Fluctuating Electrocardiographic Changes Predict Poor Outcomes After Acute Subarachnoid Hemorrhage

    Science.gov (United States)

    Elsharkawy, Hesham; Abd-Elsayed, Alaa; El-Hadi, Sherif; Provencio, Javier; Tetzlaff, John

    2016-01-01

    Background: Electrocardiogram (ECG) abnormalities following aneurysmal subarachnoid hemorrhage (SAH) have been well documented. Evidence suggests that ECG changes and cardiac dysfunction worsen outcome. Determining which patients are at most risk is unclear but important to ascertain. Methods: We prospectively studied clinical markers, cardiac abnormalities, and clinical outcomes in 20 patients admitted within 48 hours of aneurysmal SAH. All patients had ECGs prior to surgical clipping, during the clipping surgery, and during the postoperative period. Results: The aneurysm was located in the anterior circulation in 17 patients (85%) and in the posterior circulation in 3 patients (15%). Abnormal ECG changes in patients with acute SAH were observed, with a total incidence rate of 65%. The incidence of T wave abnormalities was 53.8% among the patients with ECG changes, 46.2% had ST segment change, and 30.8% had QT interval prolongation. Of the 13 patients with ECG changes, 4 (30.8%) had fluctuating ECG abnormalities (an abnormality that presented and disappeared during the study period or changed in character). All 4 patients with fluctuating ECG changes had a poor outcome (100%) compared to 3 of the 9 patients (33.3%) patients with fixed abnormalities (Paneurysmal SAH. In our group, all the patients who had ECG changes that fluctuated from one abnormal change to another had a poor outcome. The etiology of this finding is not clear but may open the door to further study into the pathogenesis of cardiac changes in aneurysmal SAH. The clinical utility of the variability of ECG abnormalities needs to be validated in a larger cohort of patients with longer follow-up than was possible in this study.

  16. Magnesium sulfate administration in subarachnoid hemorrhage.

    Science.gov (United States)

    Suarez, Jose I

    2011-09-01

    Magnesium offers theoretic vascular and neuroprotective benefits for patients with subarachnoid hemorrhage. An electronic literature search was conducted to identify original research studies describing intravenous magnesium treatment in patients with SAH published in English between January 1990 and October 2010. Seventeen articles were identified and reviewed, including one phase III randomized-controlled clinical trial and six phase II randomized-controlled trials. Study quality was low for most of the included studies, with the phase III trial considered to be of moderate quality. Due to inconsistently reported benefits and the occurrence of side effects, phase II data suggested that intravenous magnesium for SAH provided either no overall net benefit or uncertain trade-offs. Benefit was likewise not supported in the single phase III clinical trial. PMID:21748496

  17. Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome

    International Nuclear Information System (INIS)

    To determine the outcome of treatment of microsurgical clipping in elderly (60 - 70 years) patients with aneurysmal subarachnoid hemorrhage and determine the predictors of poor outcome. Study Design: Longitudinal analytical study. Place and Duration of Study: Nishtar Hospital, Multan, Mayo Hospital, Lahore, Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2000 to January 2010. Methodology: Elderly patients (60 - 70 years) with ruptured cerebral aneurysm were enrolled and graded on the basis of World Federation of Neurosurgeons Scale (WFNS). Aneurysm sac obliteration was done in all the patients with microsurgical clipping. Postoperatively, the patients were assessed upto 3 months for outcome parameters i.e., neurological deterioration (based on WFNS grade and modified Rankin scale as favourable (mRS score 2). The factors associated with unfavourable outcome were also noted which included age > 65 years, poor initial WFNS grade, and the occurrence of ischaemia. Results: The mean age of the 48 patients was 65 + 5.45 years. There were 31 (64.6%) male and 17 (35.4%) female patients. Postprocedural neurological deterioration occurred in 23 patients (47.9%) related to ischaemia in 14 (29.16%), rebleeding in 1 (2%), and hydrocephalus in 8 (16.66%). At 03 months, the outcome was favourable in 25 patients (52.08%) and unfavourable in 23 (47.91%). Conclusion: In old patients, careful pre-operative assessment, interdisciplinary approach and meticulous tissue handling during aneurysm clipping may decrease the unfavourable outcome. (author)

  18. Extracerebral Organ Dysfunction and Sleep Disorders in Subarachnoid Hemorrhage

    NARCIS (Netherlands)

    Schuiling, Wouter Jan

    2006-01-01

    Cardiac and pulmonary complications are common in subarachnoid hemorrhage (SAH), but also other extracerebral complications are frequently observed. This thesis focuses on the occurrence of extracerebral organ dysfunction and the additional value of markers of these medical complications in prognost

  19. The Early Clinical Value of Combined CT and CTA in Aneurysmal Subarachnoid Hemorrhage%CT和CTA联合检查在动脉瘤性蛛网膜下腔出血早期的临床价值

    Institute of Scientific and Technical Information of China (English)

    傅顺斌; 杨海丽; 勾振恒; 任阿红; 李莉; 宋英

    2014-01-01

    Objective To analyze the early diagnosis potentiality of CT and CTA in the aneurismal subarachnoid hemorrhage (ASAH).Methods 75 cases of aneurismal subarachnoid hemorrhage (SAH)patients underwent CT,computed tomographic angiography (CTA) and digital substraction angiography (DSA).Relationship of bleeding morphological characteristic and aneurysm site was retrospectively analyzed.The releance of symptomatic cerebral vasospasm(SCVS) and blood volume was determined.The dif erence between CTA and DSA were retrospectively analyzed.Results According to Fisher grading standards,class Ⅰ7 cases (9.33%), Ⅱgrade 17 cases (22.67%),Ⅲgrade 32 cases (42.67%), Ⅳgrade 19 cases (25.33%).There were significant dif erences between the bleeding morphological characteristic and aneurysm site (P﹤0.05). SCVS occurred in 19 cases(25.33%),the incidence of SCVS among dif erent Fisher grades were statistical y significantly dif erent(P0.05). Conclusion CT can indirectly speculate the position of aneurysm,help to diagnose the SCVS according Fisher grade prospectively.CTA has good consistency compared with DSA.CT combined CTA play an important role in diagnosing and guiding the treadment of ASAH and preventing complications.%目的:探讨CT联合CTA对动脉瘤性蛛网膜下腔出血(ASAH)的早期诊断价值。方法搜集75例动脉瘤性蛛网膜下腔出血患者,所有病例均有急性期 CT平扫、CTA和DSA检查。对出血分布和出血量与破裂动脉瘤部位、出血与症状性脑血管痉挛(SCVS)以及CTA进行回顾性分析。结果 SAH按改良Fisher分级,Ⅰ级7例(9.33%),Ⅱ级17例(22.67%),Ⅲ级32例(42.67%),Ⅳ级19例(25.33%)。 ASAH的分布与动脉瘤的位置有一定规律,差异有统计学意义(P﹤0.05)。其中19例(25.33%)出现SCVS,不同Fisher分级与SCVS发生率具有统计学差异(P<0.05)。在检出动脉瘤方面,DSA共发现87个,CTA共发现85个,P>0.05,两种检查方

  20. Risk factors for SDHC in aneurysmal subarachnoid hemorrhage patients%动脉瘤性蛛网膜下腔出血后 SDHC 的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    郭芳; 张铭; 李中振; 梁恩和

    2015-01-01

    目的:探讨动脉瘤性蛛网膜下腔出血( aneurysmal subarachnoid hemorrhage, aSAH)后分流依赖性脑积水( shunt-dependent hydrocephalus, SDHC)的危险因素,比较Fisher分级系统中开颅动脉瘤夹闭或血管内栓塞对aSAH后SDHC的影响。方法回顾性分析我院2011年7月至2014年6月收治的768例经开颅夹闭或血管内栓塞治疗的aSAH患者的临床资料,分为分流组(151例)与非分流组(617例)探讨SDHC的危险因素,并根据Fisher分级系统,分析不同治疗方式对SDHC的影响。结果 SDHC发生的危险因素包括:年龄大于等于40岁,Hunt-Hess( H-H)分级Ⅲ、Ⅳ、Ⅴ级,Fisher分级Ⅲ、Ⅳ级,急性脑积水,脑室内出血( intraventricular hemorrhage, IVH)。 Fisher分级Ⅱ级的患者,栓塞治疗有较低的SDHC发生率;Fisher分级Ⅳ级的患者,开颅夹闭治疗有较低的SDHC发生率。结论SDHC的高发生率与患者的高龄、较差的起始神经系统状态、急性脑积水、脑室内出血有关。 Fisher分级Ⅱ级的患者选取栓塞治疗,Ⅳ级的患者选取夹闭治疗,可明显降低SDHC发生,改善患者预后;Fisher分级Ⅰ、Ⅲ级的患者,两种治疗方式对SDHC的发生无影响。%Objective The risk factors for shunt-dependent hydrocephalus ( SDHC ) in aneurysmal subarachnoid hemorrhage (aSAH) patients are discussed and the influence of microsurgical clipping or endovascular coil embolization treatment for SDHC in aSAH patients are compared according to Fisher grading system.Methods A retrospective review was conducted in 768 patients with aSAH who underwent microsurgical clipping or endovascular coiling in our hospital from July 2011 to June 2014.The patients were divided into two groups ( shunt group, 151 patients;non-shunt group, 617 patients ) and risk factors for SDHC were analyzed.The effects of two different treatments for aSAH patients with SDHC according to Fisher grading system

  1. The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christoffer Nyberg

    Full Text Available In patients with severe illness, such as aneurysmal subarachnoid hemorrhage (SAH, a physiologic stress response is triggered. This includes activation of the hypothalamic-pituitary-adrenal (HPA axis and the sympathetic nervous system. The aim of this study was to investigate the very early responses of these systems.A porcine animal model of aneurysmal SAH was used. In this model, blood is injected slowly to the basal cisterns above the anterior skull base until the cerebral perfusion pressure is 0 mm Hg. Sampling was done from blood and urine at -10, +15, +75 and +135 minutes from time of induction of SAH. Analyses of adrenocorticotropic hormone (ACTH, cortisol, aldosterone, catecholamines and chromogranin-A were performed.Plasma ACTH, serum cortisol and plasma aldosterone increased in the samples following induction of SAH, and started to decline after 75 minutes. Urine cortisol also increased after SAH. Urine catecholamines and their metabolites were found to increase after SAH. Many samples were however below detection level, not allowing for statistical analysis. Plasma chromogranin-A peaked at 15 minutes after SAH, and thereafter decreased.The endocrine stress response after aneurysmal SAH was found to start within 15 minutes in the HPA axis with early peak values of ACTH, cortisol and aldosterone. The fact that the concentrations of the HPA axis hormones decreased 135 minutes after SAH may suggest that a similar pattern exists in SAH patients, thus making it difficult to catch these early peak values. There were also indications of early activation of the sympathetic nervous system, but the small number of valid samples made interpretation difficult.

  2. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

  3. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Bechan, R.S.; Peluso, J.P.; Sluzewski, M.; Rooij, W.J. van [Sint Elisabeth Ziekenhuis Tilburg, Department of Radiology, Tilburg (Netherlands); Rooij, S.B. van [Medisch Centrum Alkmaar, Department of Radiology, Alkmaar (Netherlands); Sprengers, M.E.; Majoie, C.B. [Academisch Medisch Centrum, Department of Radiology, Amsterdam (Netherlands)

    2015-12-15

    CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA. (orig.)

  4. Incidence and Mortality of Spontaneous Subarachnoid Hemorrhage in Martinique.

    Directory of Open Access Journals (Sweden)

    Mathieu Schertz

    Full Text Available Incidence of spontaneous subarachnoid hemorrhages (SAH varies wildly across the world and seems to be low in Central and South America (4.2 per 100 000 person-years; CI 95%; 3.1-5.7. The objective of our study was to describe the characteristics of SAH and to estimate its incidence and severity in Martinique, a small French island located in the Caribbean Sea.Due to its insular nature and small captive population, Martinique is ideal for the setting up of population-based epidemiological studies with good exhaustiveness. Our study, spanning a 7 year period (2007-2013, consisted of retrospective case ascertainment with multiple overlapping methods. Crude incidence and 30 day case-fatality rates for SAH among the Martinican population were computed for the study period. Incidence and disease severity was also analyzed according to age, gender and aneurysm presence. World age-standardized incidence rates were also calculated.A total of 121 patients had a SAH during the study period, with a higher frequency of female cases (71.1% versus 28.9%, p<0.001. Patient mean age was 57.1 years (median = 55 [46-66]. An aneurysmal origin was found in 96 SAH cases (79.3%. Crude annual incidence was 4.36 per 100 000 person-years (CI 95% 2.30-6.42. World age-standardized incidence was 3.29 per 100 000 person-years (CI 95% 1.74-4.84. During the 30 days following SAH diagnosis, 29 patients died (case fatality rate: 24% (CI 95% 16.4-31.6.The incidence of spontaneous subarachnoid hemorrhage in Martinique is much lower than in other parts of the world and similar to countries in Central and South America. These results are possibly related to environmental factors and most particularly to a low rate of smoking in the Martinican population. Thirty-day case-fatality rate is similar to what is observed in developed countries.

  5. The analysis of cerebral hemodynamics in patients with aneurysmal subarachnoid hemorrhage%动脉瘤性蛛网膜下腔出血患者的脑血流动力学分析

    Institute of Scientific and Technical Information of China (English)

    颜燕红; 惠品晶; 王中; 张世明; 郭亮

    2012-01-01

    Objective To study the clinical value of hemodynamic changes in cerebral circulation detected by transcranial Doppler (TCD) in the patients with aneurysm subarachnoid hemorrhage(SAH). Methods SAH in 35 patients was confirmed by CTA and/or DSA, who were operated for aneurysm clipping and underwent periodic TCD monitoring. The changes of mean flow velocities in the middle cerebral artery (MCA Vm) were record and Lindegaard index (LI) was calculated The hemodynamic changes of cerebral circulation were analyzed and the onset of cerebral vasospasm(CVS) detected by TCD with CTA during 7-10 days after aneurysm SAH was compared. Results MCA Vm and LI usually increased during 3-6 days,peaked in 7-9 days and lasted until 13-16 days after aneurysm SAH. Taking MCA Vm> 120 cm/s and Ll>3 as the criteria for CVS. the incidence rate of CVS was 51.4%. The results of TCD were well accordant to those of CTA (Kappa= 0. 727). Conclusion TCD is a noninvasive method for detecting CVS after aneurysm SAH with an advantage of simple and repeated examination.%目的 探讨经颅多普勒(TCD)检测动脉瘤性蛛网膜下腔出血(SAH)患者脑血流动力学改变的临床意义.方法 35例CT检查为SAH患者,均行CTA和(或)DSA检查证实为动脉瘤并行动脉瘤夹闭术.于SAH后备时间段行TCD检测,动态检测大脑中动脉平均血流速度(MCA Vm)、阻力指数(RI)等血流动力学参数,计算同侧大脑中动脉与颅外段颈内动脉之比(LI)指数,分析血流频谱形态等脑血流动力学改变,并且与SAH后7-10 d CTA检测结果进行对比分析.结果 TCD检测显示,MCA Vm、LI指数于动脉瘤性SAH后3-6 d开始升高,7-9d达高峰,持续至13-16 d;以MCA Vm高于120 cm/s及LI指数>3作为判断脑血管痉挛(CVS)的标准,CVS发生率51.4% (18/35),且TCD与CTA检测结果有良好的一致性(Kappa=0.727).结论 TCD是判断动脉瘤性SAH后CVS的一项无创的检查手段,具有操作简便、可重复检测等优势.

  6. Pial arteriovenous fistulas associated with multiple aneurysms presenting as intracerebral hemorrhage: a case report.

    Science.gov (United States)

    Cai, Wu; Gong, Jianping; Cheng, Bochao; Qiao, Fang; Zhang, Wei; Zhu, Qing; Lan, Qing

    2014-01-01

    Intracranial pial arteriovenous fistulas (AVFs) associated with multiple aneurysms of the main feeding arteries are very rare cerebrovascular lesions. We report a unique case of pial AVFs associated with four aneurysms of the feeding anterior cerebral artery (ACA) which presented as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) and spontaneous subarachnoid hemorrhage (SAH). CT angiography (CTA) and digital subtraction angiography (DSA) images demonstrated clearly the direct connection without nidus between the first and second segment of right ACA accompanied by four irregular aneurysms and an abnormally dilated draining vein into the superior sagittal sinus (SSS). Owing to the superficial-seated fistulas, the morphology of feeding arteries and associated four aneurysms and intracranial hemorrhage, the lesions were surgically treated. Postoperative cerebral angiography certified closure of the fistulas and exclusion of the four aneurysms as well as disappearance of early venous drainage. However, subsequent precontrast brain CT showed hydrocephalus underwent left ventriculoperitoneal shunt placement. PMID:25269054

  7. Post-traumatic subarachnoid hemorrhage: A review.

    Science.gov (United States)

    Modi, Nikhilkumar J; Agrawal, Manish; Sinha, Virendra Deo

    2016-01-01

    Head injury has been the leading cause of death and disability in people younger than 40 years and the incidence is rising continuously. Anticipation of the pathological consequences of post-traumatic subarachnoid hemorrhage (tSAH) and an outcome-oriented management are very important in these cases. To encounter the complications pertaining to traumatic brain injury (TBI) and tSAH, various classifications have been proposed and goal-oriented screening strategies have been offered. The role of serial computed tomography (CT) scans, perfusion studies, transcranial Doppler, magnetic resonance imaging (MRI), and angiographic studies as diagnostic tools, has been described. Recently, MRI fluid-attenuated inversion recovery (FLAIR), gradient reversal echo (GRE), and susceptibility weighted imaging (SWI) have emerged as excellent complimentary MRI sequences, and the authors of this article have evaluated their role in the diagnosis and prognostication of patients with tSAH. Numerous studies have been conducted on the various complications associated with tSAH such as vasospasm, hydrocephalus, and electrolyte disturbances and their management. This article discusses these aspects of tSAH and their management nuances. PMID:26954974

  8. Post eclamptic aneurysmal rupture subarachnoid haemorrhage diagnosed in the puerperium

    International Nuclear Information System (INIS)

    The incidence of subarachnoid and/or intracerebral haemorrhage in women during pregnancy is rare. The risk depends on the stage of pregnancy, but seems to be highest during the late third trimester, during delivery and in the puerperium. Headache can be a symptom of both preeclampsia, subarachnoid haemorrhage and other pathologies or conditions. It is essential for pregnant women with a suspected ruptured aneurysm to be investigated and treated without delay, irrespective of fear of harm to the foetus, to avoid complications from aneurysm rupture. This case study presents a 39-year-old woman who was 35 weeks and 3 days pregnant with known preeclampsia. She endured a headache for the three days leading up to the delivery with associated diplopia on the third day, but these symptoms were thought to be related to her preeclampsia. Over the three hours following childbirth, her headache became more severe and she suffered from vomiting, loss of vision, torticollis and seizures. Computed tomography (CT) of her head revealed a subarachnoid haemorrhage while CT angiography of the Circle of Willis failed to reveal an aneurysm and 4-vessel angiography only demonstrated an area slightly suspicious for the presence of an aneurysm. 3D rotational angiography clearly demonstrated a 1-2 mm aneurysm superior to the left terminal internal carotid artery. In this case, 3D rotational angiography proved to be a valuable additional technique. This patient underwent surgery for her ruptured aneurysm and has made an excellent recovery

  9. 动脉瘤性蛛网膜下腔出血诊治热点问题及展望%Guidelines for diagnosis and management of aneurysmal subarachnoid hemorrhage:top issues and prospective

    Institute of Scientific and Technical Information of China (English)

    张建民

    2015-01-01

    动脉瘤性蛛网膜下腔出血( aSAH)是一类致死率和致残率极高的出血性脑卒中。尽管aSAH临床术前诊断、术中治疗和术后重症监护等方面都获得了很大的进展,但aSAH患者的总体预后并无明显改善。2011年,美国神经危重症协会发布了aSAH患者重症医学处理的推荐意见;2012年,心脏病协会和美国卒中协会更新了2009年aSAH的诊治指南;2013年,欧洲卒中组织制定了欧洲颅内动脉瘤和aSAH诊疗指南2;014年,韩国神经介入学会发布了破裂和未破裂动脉瘤的治疗指南。2015年,中国医师协会神经外科专家委员会也发布了重症aSAH管理专家共识。可见,aSAH的诊治成为神经外科研究的重点和热点。本文总结上述指南中关于aSAH诊断和治疗方面的重点内容、新进展或更新,比较各种用于aSAH诊断的影像学检查的优缺点,探讨手术治疗和血管内治疗的适应证,以期提高aSAH诊治水平,改善患者的预后。%Objective: Aneurysmal subarachnoid hemorrhage (aSAH) is a kind of hemorrhagic stroke with high mortality and morbidity. Although the preoperative diagnosis, surgical clipping, endovascular treatment, and intensive care have progressed in recent years, the overall prognosis of aSAH patients remains poor.In 2011, the Neurocritical Care Society organized an international, multidisciplinary consensus conference addressed the critical care management of SAH.In 2012, the American Stroke Association ( AHA) updated the guidelines of diagnosis and treatment of aSAH published in 2009 .In 2013 , European Stroke Organization established the guideline for management of intracranial aneurysms and SAH.In 2014, the Korean Society of Interventional Neuroradiology ( KSIN ) published clinical practice guideline for the management of ruptured and unruptured aneurysms.The guideline for diagnosis and management of aSAH for Chinese patients has been drafted in this year

  10. Subarachnoid Hemorrhage, Spreading Depolarizations and Impaired Neurovascular Coupling

    Directory of Open Access Journals (Sweden)

    Masayo Koide

    2013-01-01

    Full Text Available Aneurysmal subarachnoid hemorrhage (SAH has devastating consequences on brain function including profound effects on communication between neurons and the vasculature leading to cerebral ischemia. Physiologically, neurovascular coupling represents a focal increase in cerebral blood flow to meet increased metabolic demand of neurons within active regions of the brain. Neurovascular coupling is an ongoing process involving coordinated activity of the neurovascular unit—neurons, astrocytes, and parenchymal arterioles. Neuronal activity can also influence cerebral blood flow on a larger scale. Spreading depolarizations (SD are self-propagating waves of neuronal depolarization and are observed during migraine, traumatic brain injury, and stroke. Typically, SD is associated with increased cerebral blood flow. Emerging evidence indicates that SAH causes inversion of neurovascular communication on both the local and global level. In contrast to other events causing SD, SAH-induced SD decreases rather than increases cerebral blood flow. Further, at the level of the neurovascular unit, SAH causes an inversion of neurovascular coupling from vasodilation to vasoconstriction. Global ischemia can also adversely affect the neurovascular response. Here, we summarize current knowledge regarding the impact of SAH and global ischemia on neurovascular communication. A mechanistic understanding of these events should provide novel strategies to treat these neurovascular disorders.

  11. Management of subarachnoid hemorrhage classified grade V. Possibility of intravascular treatment

    International Nuclear Information System (INIS)

    Management outcomes in poor-grade patients (World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale Grade V) with ruptured cerebral aneurysms have historically been unsatisfactory. In the present study, we examined the possibility of intravascular treatment for ruptured aneurysm detected by 3-Dimensional CT angiography (3D-CTA) in poor-grade SAH patients. From April 1997 to July 2000, 3D-CTA was performed on 54 of 73 patients admitted with Grade V subarachnoid hemorrhage (SAH). Excluding 3 patients who underwent emergency surgery for ruptured aneurysms and intracerebral hematomas, CT findings from the remaining 51 patients were analyzed. The study included 23 men and 28 women, ranging in age from 28 to 91 with an average age of 63.6. The patients' initial scores on the Glasgow Coma Scale upon admission were 3 in 36 patients (including 19 patients who had undergone cardio-pulmonary arrest), 4 in 11 patients, 5 in 2 patients, and 6 in 2 patients. Ruptured aneurysms responsible for SAH were clearly delineated in 41 aneurysms from 39 patients, with 32 aneurysms in the anterior circulation and 9 in the posterior circulation. Patients with Glasgow Coma Scale of 4 or higher whose score did not progressively decrease for 12 hours after symptom onset were considered for intravascular treatment. In our study, 4 of 39 patients (10.3%) met these criteria. Glasgow Outcome Scale results were good recovery in 1 case, moderate disability in 1 case, severe disability in 1 case, and death in the remaining 48 cases. These results suggest that the management course for poor-grade (WFNS Grade V) SAH patients who retain brain stem reflexes contain the following: identification of aneurysms by 3D-CTA, maintenance of adequate sedation and external drainage to treat acute hydrocephalus, continued minimum 12-hour observation, monitoring levels of consciousness where possible, and consideration of aggressive therapy including intravascular

  12. Recent advances in diagnostic approaches for sub-arachnoid hemorrhage.

    Science.gov (United States)

    Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, Oda; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi

    2011-07-01

    Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard" DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies. PMID:22347331

  13. CT Angiography May Be a More Useful Modality Than Digital Subtractional Angiography in the Diagnosis of Patients with Subarachnoid Hemorrhage Due to Cerebral Aneurysms

    OpenAIRE

    Masih Saboori; Ali Reza Hekmatnia; Navid Omidifar; Amirhossein Ghazavi; Farzaneh Hekmatnia

    2011-01-01

    Background/Objective: The preoperative diagnostic"nvalidity of two radiological modalities (computed"ntomographic angiography and digital subtractional"nangiography) in the diagnosis of brain aneurysms were"ncompared."nPatients and Methods: During 2 years of study,"nreferred patients with signs of SAH to the emergency"nward underwent routine CT scan and after SAH was"nfirmly diagnosed, CTA and DSA methods were done"nand patients with correct indica...

  14. Chronic hydrocephalus after experimental subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Peter Lackner

    Full Text Available Chronic communicating hydrocephalus is a significant health problem affecting up to 20% of survivors of spontaneous subarachnoid hemorrhage (SAH. The development of new treatment strategies is hampered by the lack of well characterized disease models. This study investigated the incidence of chronic hydrocephalus by evaluating the temporal profile of intracranial pressure (ICP elevation after SAH, induced by endovascular perforation in rats. Twenty-five adult male Sprague-Dawley rats (260-320 g were subjected to either endovascular perforation or sham surgery. Five animals died after SAH induction. At 7, 14 and 21 days after surgery ICP was measured by stereotaxic puncture of the cisterna magna in SAH (n=10 and SHAM (n=10 animals. On day 21 T-maze test was performed and the number of alterations and latency to decision was recorded. On day 23, samples were processed for histological analyses. The relative ventricle area was evaluated in coronal Nissl stained sections. On day 7 after surgery all animals showed normal ICP. The absolute ICP values were significantly higher in SAH compared to SHAM animals on day 21 (8.26±4.53 mmHg versus 4.38±0.95 mmHg but not on day 14. Observing an ICP of 10 mmHg as cut-off, 3 animals showed elevated ICP on day 14 and another animal on day 21. The overall incidence of ICP elevation was 40% in SAH animals. On day 21, results of T-maze testing were significantly correlated with ICP values, i.e. animals with elevated ICP showed a lower number of alterations and a delayed decision. Histology yielded a significantly higher (3.59 fold increased relative ventricle area in SAH animals with ICP elevation compared to SAH animals without ICP elevation. In conclusion, the current study shows that experimental SAH leads to chronic hydrocephalus, which is associated with ICP elevation, behavioral alterations and ventricular dilation in about 40% of SAH animals.

  15. Potentials of magnesium treatment in subarachnoid haemorrhage

    NARCIS (Netherlands)

    van den Bergh, W M; Dijkhuizen, R M; Rinkel, G J E

    2004-01-01

    Subarachnoid hemorrhage from a ruptured aneurysm is a subset of stroke. The young age (median 55 years) and poor outcome (50% of patients die; 30% of survivors remain dependent) explain why in the population the loss of productive life years from aneurysmal subarachnoid hemorrhage (SAH) is as large

  16. Recovery from a Subarachnoid Hemorrhage: Days 1 through 22

    Science.gov (United States)

    Brice, Alejandro E.; Brice, Roanne G.; Wallace, Sarah E.

    2016-01-01

    Subarachnoid hemorrhages (SAHs) are a serious medical emergency, as 30% to 50% of all SAHs can result in death. Personal accounts and case studies are an important aspect of evidence-based practice. This first article of two presents a review of AB's (patient) condition immediately following an SAH in the intensive care and immediately post…

  17. Intracranial hemorrhage from undetected aneurysmal rupture complicating transphenoidal pituitary adenoma resection.

    Science.gov (United States)

    Rustagi, Tarun; Uy, Edilfavia Mae; Rai, Mridula; Kannan, Subramanian; Senatus, Patrick

    2011-08-01

    We report a case of a 39-year-old man who presented with a nonfunctioning pituitary macroadenoma which extended into the suprasellar region. He underwent a transcranial resection of the tumor followed eight months later by transsphenoidal surgery for the residual tumor. Postoperatively he developed massive subarachnoid and intraventricular hemorrhage. A cerebral angiogram revealed a leaking anterior communicating artery aneurysm which was not seen on the computed tomography angiography and magnetic resonance angiography before the surgery. Complications of transsphenoidal surgery, particularly vascular hemorrhagic complications, and risk of rupture of undetected aneurysms are discussed.

  18. Electroencephalographic Response to Sodium Nitrite May Predict Delayed Cerebral Ischemia After Severe Subarachnoid Hemorrhage

    Science.gov (United States)

    Rowland, Matthew J.; Ezra, Martyn; Herigstad, Mari; Hayen, Anja; Sleigh, Jamie W.; Westbrook, Jon; Warnaby, Catherine E.; Pattinson, Kyle T. S.

    2016-01-01

    Objectives: Aneurysmal subarachnoid hemorrhage often leads to death and poor clinical outcome. Injury occurring during the first 72 hours is termed “early brain injury,” with disruption of the nitric oxide pathway playing an important pathophysiologic role in its development. Quantitative electroencephalographic variables, such as α/δ frequency ratio, are surrogate markers of cerebral ischemia. This study assessed the quantitative electroencephalographic response to a cerebral nitric oxide donor (intravenous sodium nitrite) to explore whether this correlates with the eventual development of delayed cerebral ischemia. Design: Unblinded pilot study testing response to drug intervention. Setting: Neuroscience ICU, John Radcliffe Hospital, Oxford, United Kingdom. Patients: Fourteen World Federation of Neurosurgeons grades 3, 4, and 5 patients (mean age, 52.8 yr [range, 41–69 yr]; 11 women). Interventions: IV sodium nitrite (10 μg/kg/min) for 1 hour. Measurements and Main Results: Continuous electroencephalographic recording for 2 hours. The alpha/delta frequency ratio was measured before and during IV sodium nitrite infusion. Seven of 14 patients developed delayed cerebral ischemia. There was a +30% to +118% (range) increase in the alpha/delta frequency ratio in patients who did not develop delayed cerebral ischemia (p < 0.0001) but an overall decrease in the alpha/delta frequency ratio in those patients who did develop delayed cerebral ischemia (range, +11% to –31%) (p = 0.006, multivariate analysis accounting for major confounds). Conclusions: Administration of sodium nitrite after severe subarachnoid hemorrhage differentially influences quantitative electroencephalographic variables depending on the patient’s susceptibility to development of delayed cerebral ischemia. With further validation in a larger sample size, this response may be developed as a tool for risk stratification after aneurysmal subarachnoid hemorrhage. PMID:27441898

  19. In vitro study of cerebrospinal fluid dynamics in a shaken basal cistern after experimental subarachnoid hemorrhage.

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    Ulrich Kertzscher

    Full Text Available BACKGROUND: Cerebral arterial vasospasm leads to delayed cerebral ischemia and constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage. Cerebral vasospasm can be reduced by increased blood clearance from the subarachnoid space. Clinical pilot studies allow the hypothesis that the clearance of subarachnoid blood is facilitated by means of head shaking. A major obstacle for meaningful clinical studies is the lack of data on appropriate parameters of head shaking. Our in vitro study aims to provide these essential parameters. METHODOLOGY/PRINCIPAL FINDINGS: A model of the basal cerebral cistern was derived from human magnetic resonance imaging data. Subarachnoid hemorrhage was simulated by addition of dyed experimental blood to transparent experimental cerebrospinal fluid (CSF filling the model of the basal cerebral cistern. Effects of various head positions and head motion settings (shaking angle amplitudes and shaking frequencies on blood clearance were investigated using the quantitative dye washout method. Blood washout can be divided into two phases: Blood/CSF mixing and clearance. The major effect of shaking consists in better mixing of blood and CSF thereby increasing clearance rate. Without shaking, blood/CSF mixing and blood clearance in the basal cerebral cistern are hampered by differences in density and viscosity of blood and CSF. Blood clearance increases with decreased shaking frequency and with increased shaking angle amplitude. Head shaking facilitates clearance by varying the direction of gravitational force. CONCLUSIONS/SIGNIFICANCE: From this in vitro study can be inferred that patient or head shaking with large shaking angles at low frequency is a promising therapeutic strategy to increase blood clearance from the subarachnoid space.

  20. Detecting subarachnoid hemorrhage: Comparison of combined FLAIR/SWI versus CT

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Rajeev Kumar, E-mail: rajeev.verma@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Kottke, Raimund, E-mail: raimund.kottke@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Andereggen, Lukas, E-mail: lukas.andereggen@insel.ch [Department of Neurosurgery, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Weisstanner, Christian, E-mail: christian.weisstanner@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Zubler, Christoph, E-mail: christoph.zubler@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Gralla, Jan, E-mail: jan.gralla@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Kiefer, Claus, E-mail: claus.kiefer@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); Slotboom, Johannes, E-mail: johannes.slotboom@insel.ch [University Institute of Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern (Switzerland); and others

    2013-09-15

    Objectives: Aim of this study was to compare the utility of susceptibility weighted imaging (SWI) with the established diagnostic techniques CT and fluid attenuated inversion recovery (FLAIR) in their detecting capacity of subarachnoid hemorrhage (SAH), and further to compare the combined SWI/FLAIR MRI data with CT to evaluate whether MRI is more accurate than CT. Methods: Twenty-five patients with acute SAH underwent CT and MRI within 6 days after symptom onset. Underlying pathology for SAH was head trauma (n = 9), ruptured aneurysm (n = 6), ruptured arteriovenous malformation (n = 2), and spontaneous bleeding (n = 8). SWI, FLAIR, and CT data were analyzed. The anatomical distribution of SAH was subdivided into 8 subarachnoid regions with three peripheral cisterns (frontal-parietal, temporal-occipital, sylvian), two central cisterns and spaces (interhemispheric, intraventricular), and the perimesencephalic, posterior fossa, superior cerebellar cisterns. Results: SAH was detected in a total of 146 subarachnoid regions. CT identified 110 (75.3%), FLAIR 127 (87%), and SWI 129 (88.4%) involved regions. Combined FLAIR and SWI identified all 146 detectable regions (100%). FLAIR was sensitive for frontal-parietal, temporal-occipital and Sylvian cistern SAH, while SWI was particularly sensitive for interhemispheric and intraventricular hemorrhage. Conclusions: By combining SWI and FLAIR, MRI yields a distinctly higher detection rate for SAH than CT alone, particularly due to their complementary detection characteristics in different anatomical regions. Detection strength of SWI is high in central areas, whereas FLAIR shows a better detection rate in peripheral areas.

  1. Effect of continuous cisternal cerebrospinal fluid drainage for patients with thin subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Yasunari Otawara

    2007-09-01

    Full Text Available Yasunari Otawara, Kuniaki Ogasawara, Yoshitaka Kubo, Masayuki Sasoh, Akira OgawaDepartment of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, JapanAbstract: External cerebrospinal fluid (CSF drainage is an effective method to remove massive subarachnoid hemorrhage (SAH, but carries the risk of meningitis and shunt-dependent hydrocephalus. This study investigated whether postoperative cisternal CSF drainage affects the incidence of cerebral vasospasm and clinical outcome in patients with thin SAH. Seventy-eight patients with thin SAH, 22 men and 56 women aged from 17 to 73 years (mean 51.2 years, underwent surgical repair for ruptured anterior circulation aneurysm. Patients were divided into groups with (38 patients and without (40 patients postoperative cisternal CSF drainage, and the incidences of angiographical and symptomatic vasospasm, shunt-dependent hydrocephalus, meningitis, and the clinical outcome were compared. The incidences of angiographical vasospasm (31.6% vs 50.0%, symptomatic vasospasm (7.9% vs 12.5%, shunt-dependent hydrocephalus (5.3% vs 0%, and meningitis (2.6% vs 0% did not differ between patients with and without cisternal CSF drainage. All patients in both groups resulted in good recovery. Postoperative cisternal CSF drainage does not affect the incidence of cerebral vasospasm or the clinical outcome in patients with thin SAH.Keywords: subarachnoid hemorrhage; cerebrospinal fluid drainage; cerebral vasospasm; meningitis; hydrocephalus; ruptured intracranial aneurysm

  2. Progression of Brain Lesions in Relation to Hyperperfusion from Subacute to Chronic Stages after Experimental Subarachnoid Hemorrhage : A Multiparametric MRI Study

    NARCIS (Netherlands)

    Tiebosch, Ivo A. C. W.; van den Bergh, Walter M.; Bouts, Mark J. R. J.; Zwartbol, Rene; van der Toorn, Annette; Dijkhuizen, Rick M.

    2013-01-01

    Background: The pathogenesis of delayed cerebral injury after aneurysmal subarachnoid hemorrhage (SAH) is largely unresolved. In particular, the progression and interplay of tissue and perfusion changes, which can significantly affect the outcome, remain unclear. Only a few studies have assessed pat

  3. Neuroprotective Effect of Radix Trichosanthis Saponins on Subarachnoid Hemorrhage

    OpenAIRE

    Ying Chen; Haiyan Sun; Liyong Huang; Juxiang Li; Wenke Zhou; Jingling Chang

    2015-01-01

    Redox homeostasis has been implicated in subarachnoid hemorrhage (SAH). As a result, antioxidants and/or free radical scavengers have become an important therapeutic modality. Considering that radix trichosanthis (RT) saponins exhibited strong antioxidant ability both in vivo and in vitro, the present study aimed to reveal whether the neuroprotective activities of RT saponins were mediated by p38/p53 signal pathway after SAH. An established SAH model was used and superoxide dismutase (SOD), ...

  4. Recent advances in diagnostic approaches for sub-arachnoid hemorrhage

    OpenAIRE

    Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, ODA; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi

    2011-01-01

    Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digit...

  5. Plasticity of cerebrovascular smooth muscle cells after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Edvinsson, Lars; Larsen, Stine Schmidt; Maddahi, Aida;

    2014-01-01

    Subarachnoid hemorrhage (SAH) is most often followed by a delayed phase of cerebral ischemia which is associated with high morbidity and mortality rates. The causes underlying this delayed phase are still unsettled, but are believed to include cerebral vasospasm, cortical spreading depression, in...... signaling involved in the vascular plasticity is discussed with a focus on the Raf-MEK1/2-ERK1/2 pathway which seems to play a crucial role in SAH pathology....

  6. Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse

    International Nuclear Information System (INIS)

    Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. (orig.)

  7. Upregulation of Relaxin after Experimental Subarachnoid Hemorrhage in Rabbits

    OpenAIRE

    Yuichiro Kikkawa; Satoshi Matsuo; Ryota Kurogi; Akira Nakamizo; Masahiro Mizoguchi; Tomio Sasaki

    2014-01-01

    Background. Although relaxin causes vasodilatation in systemic arteries, little is known about its role in cerebral arteries. We investigated the expression and role of relaxin in basilar arteries after subarachnoid hemorrhage (SAH) in rabbits. Methods. Microarray analysis with rabbit basilar artery RNA was performed. Messenger RNA expression of relaxin-1 and relaxin/insulin-like family peptide receptor 1 (RXFP1) was investigated with quantitative RT-PCR. RXFP1 expression in the basilar arter...

  8. Spinal arachnoiditis as a consequence of aneurysm-related subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm-related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo-peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline.

  9. 动脉瘤性蛛网膜下腔出血术后行腰椎穿刺术预防慢性脑积水的临床分析%Clinical Analysis of Lumbar Puncture Prevention of Chronic Hydrocephalus for Postoperative Aneurysmal Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    牟龙; 王道奎; 王金鹏

    2015-01-01

    目的:探讨动脉瘤性蛛网膜下腔出血( aSAH)术后行腰椎穿刺术预防慢性脑积水的效果。方法选取2013年3月~2014年5月本科室收治的经全脑血管造影术( DSA)确诊的aSAH患者57例,其中行开颅动脉瘤夹闭术18例,介入栓塞术39例,并发急性脑积水行侧脑室引流术2例,术后通过早期、间断行腰椎穿刺术引流血性脑脊液来预防慢性脑积水的发生。结果出现亚急性脑积水1例,慢性脑积水3例,其中1例为术前检查存在急性脑积水者,慢性脑积水发生率为5.26%,3例慢性脑积水患者均行脑室-腹腔分流术,术后临床症状有所减轻,其余患者均随访3个月以上,未出现脑积水的情况。结论 aSAH患者术后早期、间断行腰椎穿刺术引流蛛网膜下腔内的积血可降低慢性脑积水的发生率。%[ ABSTRACT] Objective To explore the effect of Lumbar puncture prevention of chronic hydrocephalus for postoperative aneurysmal subarachnoid hemorrhage .Methods Fifty-seven patients of aneurysmal subarachnoid hemor-rhage with a full diagnosis of cerebral angiography (DSA) were selected.Eighteen cases of cranial aneurysm surgery ,39 cases of embolization ,2 cases of lateral drainage with complication of acute hydrocephalus .After surgery , using lumbar puncture to drainage the BCSF early and Intermittently to reduce the incidence of chronic hydrocephalus .Results One case was subacute hydrocephalus ,3 cases were chronic hydrocephalus ,among them one case was acute hydrocephalus of preoperative presence ,the occurrence rate of chronic hydrocephalus was 5.26%.Three cases of chronic hydrocephalus patients had done ventricle-peritoneal shunt ,their clinical symptoms had abated after surgery ,other patients were followed up 3 month or more and no hydrocephalus occurred .Conclusion For the patients of postoperative aneurysmal subarach-noid hemorrhage ,using lumbar puncture to drainage the blood within the

  10. Roller coaster-associated subarachnoid hemorrhage--report of 2 cases.

    Science.gov (United States)

    Rutsch, Sebastian; Niesen, Wolf-Dirk; Meckel, Stephan; Reinhard, Matthias

    2012-04-15

    The most common neurological injuries associated with roller coaster rides are subdural hematoma and cervical artery dissection. We report two cases of roller-coaster associated subarachnoid hemorrhage (SAH). A 40-year-old healthy man developed a strong, holocephalic headache during a roller coaster ride. SAH Hunt & Hess grade II and Fisher grade 3 was diagnosed. An underlying aneurysm of the anterior communicating artery was successfully treated with coil embolization. A 41-year-old female (smoker, otherwise healthy) experienced a sudden, strong headache and diplopia during a roller coaster ride. A perimesencephalic SAH (Hunt & Hess grade II, Fisher grade 3) was disclosed by a CT scan. No aneurysm was detected on angiography. Both patients were discharged without neurological disability. In conclusion, SAH is a rare but relevant differential diagnosis in cases of acute headache during roller coaster rides. Both aneurysmal and non-aneurysmal perimesencephalic SAH can occur. A combination of mechanical factors and excessive blood pressure rises in vulnerable persons is discussed. PMID:22177088

  11. The utility of perfusion CT and CT angiography on early diagnosis and the management of vasospasm after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Samira Zabihyan

    2015-01-01

    Full Text Available Subarachnoid hemorrhage is one of the most important and dangerous neurologic emergencies worldwide. It is characterized by a sudden and severe headache caused most commonly by the rupture of intracranial aneurysm. Cerebral vasospasm is the most important cause of disability and death in whom survived from the first event. Early diagnosis and management of cerebral vasospasm could prevent and reduce its morbidity and mortality. Thus, an ideal technique must be able to detect the vasospasm before the occurrence of neurological deficits. Perfusion computed tomography could assess vascularity of brain including cerebral blood flow, cerebral blood volume, time to peak and mean transit time. For this application, perfusion computed tomography and computed tomography angiography techniques offer significant advantages and can result in early diagnosis of vasospasm. In this review, we discuss the utility of these two techniques and their safety in the diagnosis and the management of vasospasm following subarachnoid hemorrhage.

  12. Subarachnoid hemorrhage associated with cyclosporine A neurotoxicity in a bone-marrow transplant recipient

    Energy Technology Data Exchange (ETDEWEB)

    Teksam, M.; Casey, S.O.; Michel, E.; Truwit, C.L. [Minnesota Univ., Minneapolis, MN (United States). Dept. of Radiology

    2001-03-01

    We report subarachnoid hemorrhage associated with cyclosporine A (CSA) neurotoxicity after bone-marrow transplantation for chronic myelogenous leukemia. CT showed occipital subarachnoid hemorrhage. MRI confirmed this, and demonstrated cortical and subcortical edema in the posterior temporal, occipital, and posterior frontal lobes bilaterally, which was typical of CSA neurotoxicity. Recognition of CSA neurotoxicity as the cause of the subarachnoid hemorrhage obviated angiographic investigation. After cessation of cyclosporine therapy, the cortical and subcortical edema resolved on follow-up MRI with some residual blood products in the subarachnoid space. (orig.)

  13. Prolonged Paroxysmal Sympathetic Storming Associated with Spontaneous Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Yan Liu

    2013-01-01

    Full Text Available Paroxysmal sympathetic storming (PSS is a rare disorder characterized by acute onset of nonstimulated tachycardia, hypertension, tachypnea, hyperthermia, external posturing, and diaphoresis. It is most frequently associated with severe traumatic brain injuries and has been reported in intracranial tumors, hydrocephalous, severe hypoxic brain injury, and intracerebral hemorrhage. Although excessive release of catecholamine and therefore increased sympathetic activities have been reported in subarachnoid hemorrhage (SAH, there is no descriptive report of PSS primarily caused by spontaneous SAH up to date. Here, we report a case of prolonged PSS in a patient with spontaneous subarachnoid hemorrhage and consequent vasospasm. The sympathetic storming started shortly after patient was rewarmed from hypothermia protocol and symptoms responded to Labetalol, but intermittent recurrence did not resolve until 3 weeks later with treatment involving Midazolam, Fentanyl, Dexmedetomidine, Propofol, Bromocriptine, and minimizing frequency of neurological and vital checks. In conclusion, prolonged sympathetic storming can also be caused by spontaneous SAH. In this case, vasospasm might be a precipitating factor. Paralytics and hypothermia could mask the manifestations of PSS. The treatment of the refractory case will need both timely adjustment of medications and minimization of exogenous stressors or stimuli.

  14. Hydrocephalus associated with subarachnoid hemorrhage: clinical study by computed tomography, radioisotope cisternography and constant infusion test.

    Directory of Open Access Journals (Sweden)

    Nosaka,Yoshiki

    1981-02-01

    Full Text Available Thirteen patients exhibited a communicating hydrocephalus following subarachnoid hemorrhage secondary to ruptured intracranial aneurysms and were treated with shunt procedures. The interval between subarachnoid hemorrhage and surgery averaged 9 weeks. Seven of the patients showed improvement. The prognostic value for surgical management was evaluated on the basis of three different diagnostic examinations (computed tomography(CT, cisternography and constant infusion test. A correct diagnosis was obtained in 78 per cent in cisternography, and 63 per cent in infusion test and CT. All patients responding to surgery showed a typical pattern in cisternography, consisting of ventricular retention of radiopharmaceutical tracer for 48 h or longer in association with no radioactivity over the cerebral hemispheres. The constant infusion test correlated well with typical cisternographic patterns. CT is useful in demonstrating pathophysiological changes in hydrocephalus. Periventricular hypodensity was visible in patients with normal or slightly elevated intracranial pressure, accompanied by fairly rapid deterioration. All of them responded well to shunting. In most cases which benefited from the shunt, the postoperative CT showed not only normal-sized ventricles but also marked regression of the hypodensity over a short period.

  15. Hydrocephalus associated with subarachnoid hemorrhage. Clinical study by computed tomography, radioisotope cisternography and constant infusion test

    Energy Technology Data Exchange (ETDEWEB)

    Nosaka, Y. (Okayama Univ. (Japan). School of Medicine)

    1981-02-01

    Thirteen patients exhibited a communicating hydrocephalus following subarachnoid hemorrhage secondary to ruptured intracranial aneurysms and were treated with shunt procedures. The interval between subarachnoid hemorrhage and surgery averaged 9 weeks. Seven of the patients showed improvement. The prognostic value for surgical management was evaluated on the basis of three different diagnostic examinations (computed tomography (CT), cisternography and constant infusion test). A correct diagnosis was obtained in 78 per cent in cisternography, and 63 per cent in infusion test and CT. All patients responding to surgery showed a typical pattern in cisternography, consisting of ventricular retention of radiopharmaceutical tracer for 48 h or longer in association with no radioactivity over the cerebral hemispheres. The constant infusion test correlated well with typical cisternographic patterns. CT is useful in demonstrating pathophysiological changes in hydrocephalus. Periventricular hypodensity was visible in patients with normal or slightly elevated intracranial pressure, accompanied by fairly rapid deterioration. All of them responded well to shunting. In most cases which benefited from the shunt, the postoperative CT showed not only normal-sized ventricles but also marked regression of the hypodensity over a short period.

  16. Encephalic hemodynamic phases in subarachnoid hemorrhage: how to improve the protective effect in patient prognoses

    Directory of Open Access Journals (Sweden)

    Marcelo de Lima Oliveira

    2015-01-01

    Full Text Available Subarachnoid hemorrhage is frequently associated with poor prognoses. Three different hemodynamic phases were identified during subarachnoid hemorrhage: oligemia, hyperemia, and vasospasm. Each phase is associated with brain metabolic changes. In this review, we correlated the hemodynamic phases with brain metabolism and potential treatment options in the hopes of improving patient prognoses.

  17. Propofol Attenuates Early Brain Injury After Subarachnoid Hemorrhage in Rats.

    Science.gov (United States)

    Shi, Song-sheng; Zhang, Hua-bin; Wang, Chun-hua; Yang, Wei-zhong; Liang, Ri-sheng; Chen, Ye; Tu, Xian-kun

    2015-12-01

    Our previous studies demonstrated that propofol protects rat brain against focal cerebral ischemia. However, whether propofol attenuates early brain injury after subarachnoid hemorrhage in rats remains unknown until now. The present study was performed to evaluate the effect of propofol on early brain injury after subarachnoid hemorrhage in rats and further explore the potential mechanisms. Sprague-Dawley rats underwent subarachnoid hemorrhage (SAH) by endovascular perforation then received treatment with propofol (10 or 50 mg/kg) or vehicle after 2 and 12 h of SAH. SAH grading, neurological scores, brain water content, Evans blue extravasation, the myeloperoxidase activity, and malondialdehyde (MDA) content were measured 24 h after SAH. Expression of nuclear factor erythroid-related factor 2 (Nrf2), nuclear factor-kappa B (NF-κB) p65, and aquaporin 4 (AQP4) expression in rat brain were detected by Western blot. Expression of cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) were determined by reverse transcription-polymerase chain reaction (RT-PCR). Expressions of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were assessed by ELISA. Neurological scores, brain water content, Evans blue extravasation, the myeloperoxidase activity, and MDA content were significantly reduced by propofol. Furthermore, expression of Nrf2 in rat brain was upregulated by propofol, and expression of NF-κB p65, AQP4, COX-2, MMP-9, TNF-α, and IL-1β in rat brain were attenuated by propofol. Our results demonstrated that propofol improves neurological scores, reduces brain edema, blood-brain barrier (BBB) permeability, inflammatory reaction, and lipid peroxidation in rats of SAH. Propofol exerts neuroprotection against SAH-induced early brain injury, which might be associated with the inhibition of inflammation and lipid peroxidation. PMID:26342279

  18. International Subarachnoid Aneurysm Trial 2009 : Endovascular Coiling of Ruptured Intracranial Aneurysms Has No Significant Advantage Over Neurosurgical Clipping

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Metzemaekers, Jan D. M.; Groen, Rob J. M.; Mooij, Jan Jakob A.; Van Dijk, J. Marc C.

    2010-01-01

    In the May 2009 issue of The Lancet Neurology, the 5-year follow-up results of the International Subarachnoid Aneurysm Trial (ISAT) were published. The authors concluded that, although the significant difference between coiling and neurosurgical clipping of ruptured intracranial aneurysms in terms o

  19. Exploration the application value of 320-slice three-dimensional CTA technique in aneurysmal spontaneity subarachnoid hemorrhage%320排3D-CTA在动脉瘤性自发性蛛网膜下腔出血中的应用价值探讨

    Institute of Scientific and Technical Information of China (English)

    吴遵富

    2015-01-01

    ObjectiveTo explore the application value of 320-slice three-dimensional CTA technique in aneurysmal spontaneity Subarachnoid Hemorrhage(SAH).Methods58 patients with SAH is chosen as the research object,all do 320-slice 3d-CTA examination,And according to the results of Digital Subtraction Angiography(DSA)and operation were retrospectively analyzed.Results58 patients with SAH were completed 320-slice 3d- CTA examination,Check out of 56 patients with intracranial aneurysm,were diagnosed by DSA and surgery. Single aneurysm 51 cases,There are 2 aneurysms in 5 cases. The other 2 cases of SAH patients with 3d-CTA and DSA are found no intracranial aneurysm.Conclusion320-slice 3d-CTA For diagnosing SAH cause very high accuracy、Safe noninvasive、Imaging fast and easy to operate,for clinicians to choose treatment and surgery to provide reliable basis,is bound to become a major means of Checking and excluding intracranial aneurysm.%目的:探讨320排螺旋CT三维血管造影(3D-CTA)在动脉瘤性自发性蛛网膜下腔出血(SAH)中的应用价值。方法选择SAH患者58例作为研究对象,均行320排3D-CTA检查,并根据数字减影血管造影(DSA)及手术结果进行回顾性分析。结果58例SAH患者检查出颅内动脉瘤56例,均经DSA及手术确诊,其中单发动脉瘤51例,存在2个动脉瘤的5例。另2例SAH患者3D-CTA及DSA均未发现颅内动脉瘤。结论320排3D-CTA用于诊断SAH病因准确率极高、安全无创、且操作简便成像快速,为临床医师选择治疗及手术方案提供了可靠的依据,势必会成为检查和排除颅内动脉瘤的主要手段。

  20. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Springborg, J B; Frederiksen, H-J; Eskesen, V;

    2005-01-01

    After aneurysmal subarachnoid haemorrhage (SAH), the clinical outcome depends upon the primary haemorrhage and a number of secondary insults in the acute post-haemorrhagic period. Some secondary insults are potentially preventable but prevention requires prompt recognition of cerebral or systemic....... Furthermore, the use of multi-modality monitoring is hampered by a lack of clinical studies that identify combinations of specific techniques in terms of clinical information and reliability. However, ischaemia at the tissue level can be detected by intracerebral microdialysis technique. Used together...... with the conventional monitoring systems, for example intracranial pressure measurements, transcranial Doppler ultrasound and modern neuro-imaging, direct assessment of biochemical markers by intracerebral microdialysis is promising in the advancement of neurointensive care of patients with SAH. A successfully...

  1. Systolic Blood Pressure Variability is a Novel Risk Factor for Rebleeding in Acute Subarachnoid Hemorrhage

    Science.gov (United States)

    Lin, Qing-Song; Ping-Chen; Lin, Yuan-Xiang; Lin, Zhang-Ya; Yu, Liang-Hong; Dai, Lin-Sun; Kang, De-Zhi

    2016-01-01

    Abstract Rebleeding of an aneurysm is a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Whereas numerous studies have demonstrated predictors of rebleeding and effect of systolic blood pressure variability (SBPV) on stroke, few data on the association between SBPV and rebleeding. Here, we sought to identify the effect of SBPV on rebleeding in acute aneurysmal SAH. Case–control study. From January 2010 to June 2015, 612 patients with aneurysmal SAH were enrolled in our tertiary care medical center. Main outcome measures: Consecutive patients with acute (<3 days from ictus) aneurismal rebleeding or repair or death were retrospectively included. Antihypertensive therapy based on a predefined standardized protocol was prescribed to lower and maintain SBP between 120 and 160 mm Hg. SBP was measured hourly until a censoring event occurred. SBPV was determined as standard deviation (SD) and successive variation (SV). Binary logistic regression was used to assess the association between SBPV and rebleeding. Rebleeding occurred in 61 (10.0%) of the 612 patients. We identified 47 acute rebleeding as cases and 382 early repair or early death as controls. On binary logistic regression analysis, rebleeding was associated with the SD of SBP (odds ratio [OR], 1.254; 95% confidence interval [CI], 1.131–1.391; P < 0.001) and the SV of SBP (OR, 1.131; 95% CI, 1.039–1.231; P = 0.004). No significant difference was seen between rebleeding and mean systolic blood pressure (MSBP). SBPV is associated with increased rates of acute aneurysmal rebleeding. Further prospective research is warranted to confirm that SBP stability prevents acute aneurysm rebleeding. PMID:26986118

  2. Leisure and social participation in patients 4–10 years after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Buunk, Anne M.; Groen, Rob J. M.; Veenstra, Wencke S.; Spikman, Jacoba M.

    2015-01-01

    Objective: To investigate the long-term resumption of leisure and social activities in patients with aneurysmal subarachnoid haemorrhage (aSAH) and to determine the role of executive dysfunction and aneurysms in anterior brain regions in particular. Method: Leisure and social functioning of 200 pati

  3. Can CT angiography rule out aneurysmal subarachnoid haemorrhage in CT scan-negative subarachnoid haemorrhage patients?

    Science.gov (United States)

    Lim, Lee Kai; Dowling, Richard J; Yan, Bernard; Mitchell, Peter J

    2014-01-01

    Current management guidelines for CT scan-negative subarachnoid haemorrhage (SAH) patients recommend cerebral digital subtraction angiography (DSA). We aimed to investigate the utility of CT angiography (CTA) as a substitute for DSA in these patients. We included patients who presented with SAH confirmed by spectrophotometric xanthochromia analysis of cerebrospinal fluid (CSF) whereby the CT scan was negative. Electronic records were reviewed to collect data on non-contrast CT scan, CTA and DSA results. Patients without DSA or with other explanations for CSF xanthochromia were excluded. Sixty-three patients with CT scan-negative SAH were included. The diagnosis of SAH was confirmed by CSF analysis. All 63 patients underwent both DSA and CTA. Using DSA as the benchmark, CTA demonstrated a negative predictive value, positive predictive value, sensitivity and specificity of 98%, 82%, 90% and 96%, respectively, for the detection of intracranial aneurysms. CTA correctly identified patients in whom there were no underlying aneurysms responsible for SAH, with one patient with suspected dissection referred for further evaluation using MRI and DSA. PMID:23954458

  4. [Aneurysm of the anterior inferior cerebellar artery: case report].

    Science.gov (United States)

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  5. Risk factors correlated with hydrocephalus after aneurysmal subarachnoid hemorrhage%动脉瘤性蛛网膜下腔出血后慢性脑积水形成相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈璇; 程万春; 高小平; 梁辉; 余翔

    2011-01-01

    Objective To study the risk factors of chronic hydrocephalus after aneurismal subarachnoid hemorrhage (aSAH). Methods The clinical data of 170 patients with aSAH were respectively studied. Hydrocephalus was confirmed on the basis of the findings of CT scans 3 week after aSAH. Univariate analysis was performed to assess the relationship between the possible risk factors and the occurrence of hydrocephalus. Those factors statistically associated with the occurrence of hydrocephalus were further analyzed using the logistic regression analysis. Results There were three risk factors for the development of hydrocephalus after aSAH: Hunt-Hess grade ( high) at admission (P = 0.006), repeated SAH (P = 0.007) and increasing age (P = 0.010). Conclusions The development of hydrocephalus after aSAH is multifactorial.%目的 探讨动脉瘤性蛛网膜下腔出血( aSAH)后慢性脑积水形成的危险因素.方法 回顾分析170例aSAH患者临床资料,应用出血后3周的CT评价aSAH后慢性脑积水;先将可能的危险因素与脑积水之间行显著性检验,再用多元回归加以明确,得到回归方程.结果 aSAH后慢性脑积水易患因素依次为入院时较高Hunt - Hess分级(P=0.006)、反复多次出血(P=0.007)、高龄(P=0.010).结论 aSAH后慢性脑积水形成为多因素共同作用的结果.

  6. 动脉瘤性蛛网膜下腔出血致迟发性脑血管痉挛危险因素的Meta分析%A Meta-analysis of risk factors for de1ayed cerebral vasospasm after aneurysm subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    吴政俊; 蒋永祥; 程远; 马颖

    2014-01-01

    Objective To systematically analyze the risk factors for de1ayed cerebral vasospasm after aneurysm subarachnoid hemorrhage in order to provide evidence for prevention and treatment of the disease .Methods Articles of risk factors for de1ayed cerebral vasospasm after aneurysm subarachnoid hemorrhage from VIP ,CBM ,CNKI ,Wangfang and pubmed ,springlink ,highwire database ,and correlated indexes were extracted for Meta‐analysis by using RevMan 5 .1 .Results Thirteen articles were selected . The heterogeneity of all data was equilibrium ,and used fixed effects model .The difference showed statistical significance in the his‐tory of hypertension ,Fisher > Ⅱ ,age>50 years and the posterior circulation aneurysm (P0 .05) .The symmetry of funnel plots prompted no publication bias .Conclusion Patients with history of hypertension ,Fisher > Ⅱ ,age< 50 years and the posterior circulation aneurysm are at higher risk of de1ayed cerebral vasospasm ,strengthen close monitoring and management are crucial in these patients .%目的:运用Meta分析方法综合分析动脉瘤性蛛网膜下腔出血致迟发性脑血管痉挛(DCVS)的相关危险因素,为疾病的预防、治疗决策提供依据。方法用关键词途径从维普中文科技期刊、中国知网和万方以及Pubmed、Springlink和 Highwire等外文数据库收录有关动脉瘤性蛛网膜下腔出血致DCVS相关危险因素的文献进行检索,经严格筛选后对最后纳入的文献用RevMan5.1软件进行Meta分析。结果共纳入13篇文献,经检验所有数据均均衡,采用固定效应模式进行Meta分析。高血压病史、Fisher分级(>2级)、年龄(>50岁)、动脉瘤位置(后循环)差异有统计学意义( P<0.05),性别(男性)、吸烟史、手术方式(夹闭)差异无统计学意义(P>0.05)。数据漏斗图分析对称,提示文献无发表偏倚。结论有高血压病史、Fisher分级(>2级)、年龄(<50

  7. Role of unphosphorylated transcription factor STAT3 in late cerebral ischemia after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Samraj, Ajoy K; Müller, Anne H; Grell, Anne-Sofie;

    2014-01-01

    Molecular mechanisms behind increased cerebral vasospasm and local inflammation in late cerebral ischemia after subarachnoid hemorrhage (SAH) are poorly elucidated. Using system biology tools and experimental SAH models, we have identified signal transducer and activator of transcription 3 (STAT3...

  8. The value of hyperbaric oxygen therapy in postoperative care of subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Griessenauer Christoph J

    2012-12-01

    Full Text Available Abstract In this editorial, the issues related to the hyperbaric oxygen therapy and its utility in managing cerebral vasospasm in patients with subarachnoid hemorrhage is discussed.

  9. An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review

    OpenAIRE

    Manoj Kumar Roy; Joydip Dutta; Apratim Chatterjee; Anup Sarkar; Koushik Roy; Rakhesh Agarwal; Durjoy Lahiri; Amrito Biswas; Anupam Mondal; Pranab Maity; Jotideb Mukhopadhyay

    2015-01-01

    Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS) along with other conservative management. Subarachnoid hemorrhage as an initial presentation...

  10. Brain Aneurysm Foundation

    Science.gov (United States)

    ... … Continue Reading Read All News Latest Research NEWTON 2 Study Details October 7, 2016 05/29/ ... Oral Nimodipine in Adults With Aneurysmal Subarachnoid Hemorrhage (NEWTON 2) Details: Edge Therapeutics is recruiting patients ...

  11. Surgical Clipping versus Endovascular Intervention for the Treatment of Subarachnoid Hemorrhage Patients in New York State.

    Directory of Open Access Journals (Sweden)

    Kimon Bekelis

    Full Text Available Randomized trials have demonstrated a survival benefit for endovascular treatment of ruptured cerebral aneurysms. We investigated the association of surgical clipping and endovascular coiling with outcomes in subarachnoid hemorrhage (SAH patients in a real-world regional cohort.We performed a cohort study involving patients with ruptured cerebral aneurysms, who underwent surgical clipping, or endovascular coiling from 2009-2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes.Of the 4,098 patients undergoing treatment, 2,585 (63.1% underwent coiling, and 1,513 (36.9% underwent clipping. Using an instrumental variable analysis, we did not identify a difference in inpatient mortality [marginal effect (ME, -0.56; 95% CI, -1.03 to 0.02], length of stay (LOS (ME, 1.72; 95% CI, -3.39 to 6.84, or the rate of 30-day readmissions (ME, -0.30; 95% CI, -0.82 to 0.22 between the two treatment techniques for patients with SAH. Clipping was associated with a higher rate of discharge to rehabilitation (ME, 0.63; 95% CI, 0.24 to 1.01. In sensitivity analysis, mixed effect regression, and propensity score adjusted regression models demonstrated identical results.Using a comprehensive all-payer cohort of patients in New York State presenting with aneurysmal SAH we did not identify an association of treatment method with mortality, LOS or 30-day readmission. Clipping was associated with a higher rate of discharge to rehabilitation.

  12. Subarachnoid Hemorrhage Associated with Epidemic Hemorrhagic Fever: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Zucai Xu, Ping Xu, Xianze Lei, Zhongxiang Xu, Qisi Wu, Jun Zhang

    2011-01-01

    Full Text Available Nervous system injuries associated with epidemic hemorrhagic fever (EHF are not rarely seen. However, cerebrovascular disease arising from EHF is rarely reported in the literature. A 50-year-old male patient suffered from subarachnoid hemorrhage (SAH. No abnormal condition was found in intracranial vascular digital subtraction angiography (DSA. But, this patient presented with positive hantavirus-IgM and IgG, with typical clinical process, which lead to the diagnosis of EHF followed by SAH. To our knowledge, SAH associated with EHF has not been previously reported. A meticulous assessment of EHF patients with a serious condition had one or more central nervous system (CNS abnormalities, such as sudden headache, vomiting, confusion, meningismus, and convulsions, which is necessary for diagnosing and giving timely treatment to improve the prognosis.

  13. Cerebral computed tomographic angiography scan delay in subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Lukosevicius Saulius

    2005-01-01

    Full Text Available CONTEXT: Computed tomographic angiography (CTA is widely applied in the evaluation of cerebral vessels. Contrast enhancement in cerebral CTA without care or test bolus is not always sufficient for high-quality images. AIMS: Evaluation of the possibilities of calculation of scan delay for cerebral CTA in case of subarachnoid hemorrhage (SAH, based on clinical data of a patient and to find out prognostic error of the model. SETTINGS AND DESIGN: Prospective study in Neurosurgery and Radiology departments. MATERIALS AND METHODS: Scan delay in 53 patients suffering an acute SAH was measured employing test bolus technique. Cerebral CTA was performed afterwards. STATISTICAL ANALYSIS USED: SPSS for Windows v.10.1 software package was applied for dispersion analysis, including one-sample Kolmogorov-Smirnov′s test and Levene′s Test of Equality of Error Variances. RESULTS: A statistical model for the prediction of scan delay in SAH was developed. Cerebral CTA scan delay was dependent upon age, neurological status and impact of the latter factors together (P<0.05. The determined mean square error of prognosis of scan delay of the developed model equals 3.3 sec. CONCLUSION: Using our proposed model it is possible to estimate an optimal delay time for CTA in most patients with SAH with a determined error.

  14. Upregulation of Relaxin after Experimental Subarachnoid Hemorrhage in Rabbits

    Directory of Open Access Journals (Sweden)

    Yuichiro Kikkawa

    2014-01-01

    Full Text Available Background. Although relaxin causes vasodilatation in systemic arteries, little is known about its role in cerebral arteries. We investigated the expression and role of relaxin in basilar arteries after subarachnoid hemorrhage (SAH in rabbits. Methods. Microarray analysis with rabbit basilar artery RNA was performed. Messenger RNA expression of relaxin-1 and relaxin/insulin-like family peptide receptor 1 (RXFP1 was investigated with quantitative RT-PCR. RXFP1 expression in the basilar artery was investigated with immunohistochemistry. Relaxin concentrations in cerebrospinal fluid (CSF and serum were investigated with an enzyme-linked immunosorbent assay. Using human brain vascular smooth muscle cells (HBVSMC preincubated with relaxin, myosin light chain phosphorylation (MLC was investigated with immunoblotting after endothelin-1 stimulation. Results. After SAH, RXFP1 mRNA and protein were significantly downregulated on day 3, whereas relaxin-1 mRNA was significantly upregulated on day 7. The relaxin concentration in CSF was significantly elevated on days 5 and 7. Pretreatment with relaxin reduced sustained MLC phosphorylation induced by endothelin-1 in HBVSMC. Conclusion. Upregulation of relaxin and downregulation of RXFP1 after SAH may participate in development of cerebral vasospasm. Downregulation of RXFP1 may induce a functional decrease in relaxin activity during vasospasm. Understanding the role of relaxin may provide further insight into the mechanisms of cerebral vasospasm.

  15. Noninvasive Intracranial Pressure Determination in Patients with Subarachnoid Hemorrhage.

    Science.gov (United States)

    Noraky, James; Verghese, George C; Searls, David E; Lioutas, Vasileios A; Sonni, Shruti; Thomas, Ajith; Heldt, Thomas

    2016-01-01

    Intracranial pressure (ICP) should ideally be measured in many conditions affecting the brain. The invasiveness and associated risks of the measurement modalities in current clinical practice restrict ICP monitoring to a small subset of patients whose diagnosis and treatment could benefit from ICP measurement. To expand validation of a previously proposed model-based approach to continuous, noninvasive, calibration-free, and patient-specific estimation of ICP to patients with subarachnoid hemorrhage (SAH), we made waveform recordings of cerebral blood flow velocity in several major cerebral arteries during routine, clinically indicated transcranial Doppler examinations for vasospasm, along with time-locked waveform recordings of radial artery blood pressure (APB), and ICP was measured via an intraventricular drain catheter. We also recorded the locations to which ICP and ABP were calibrated, to account for a possible hydrostatic pressure difference between measured ABP and the ABP value at a major cerebral vessel. We analyzed 21 data records from five patients and were able to identify 28 data windows from the middle cerebral artery that were of sufficient data quality for the ICP estimation approach. Across these windows, we obtained a mean estimation error of -0.7 mmHg and a standard deviation of the error of 4.0 mmHg. Our estimates show a low bias and reduced variability compared with those we have reported before. PMID:27165879

  16. Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography.

    Science.gov (United States)

    Dehdashti, A R; Rufenacht, D A; Delavelle, J; Reverdin, A; de Tribolet, N

    2003-02-01

    The purpose of this study was to evaluate the potential of high quality computed tomographic angiography (CTA) to replace digital subtraction angiography (DSA) in cases of ruptured saccular aneurysms and perform early surgical clipping or coiling on the basis of CTA alone. In a prospective study, 100 patients with aneurysmal subarachnoid haemorrhage (SAH) diagnosed by computed tomography underwent CTA. CTA revealed a total of 118 aneurysms including all ruptured aneurysms. A decision of direct surgical clipping, endovascular coiling or therapeutic abstention was made in 89 cases (89%) on the basis of CTA alone. Sixty-one direct surgical procedures were performed after CTA. Twenty-six cases underwent DSA for immediate endovascular treatment of the ruptured aneurysm. In 11 cases (11%), a DSA was performed prior to the therapeutic decision because of unclear aneurysm. Four cases were not treated because of initial poor clinical grade. The surgical findings were compared with CTA data and were considered accurate in all but one case. All patients underwent postoperative DSA within 10 days after SAH. The sensitivity and the specificity of CTA for the detection of all aneurysms, as compared with postoperative DSA, were 95.1 and 100%, respectively. A total of six unruptured aneurysms were missed initially, but were visible retrospectively on CTA in all but one case and were found in patients with multiple aneurysms in whom the ruptured aneurysm was detected by CTA. Current quality CTA allows reliable pretreatment planning for the majority of cases of aneurysmal subarachnoid haemorrhage and diminishes the pretreatment evaluation time critically. Complementary pretreatment DSA is required in situations where CTA characteristics of the ruptured aneurysm is unsatisfactory. PMID:12779201

  17. CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Wajer, Irene M. C. Huenges; Cremers, Charlotte H. P.; van Zandvoort, Martine J. E.; Vergouwen, Mervyn D. I.; van der Schaaf, Irene C.; Velthuis, BK; Dankbaar, Jan Willem; Vos, Pieter C.; Visser-Meily, Johanna M. A.; Rinkel, Gabriel J. E.

    2015-01-01

    Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive out

  18. Magnesium therapy after aneurysmal subarachnoid haemorrhage a dose-finding study for long term treatment

    NARCIS (Netherlands)

    van den Bergh, W M; Albrecht, K W; Berkelbach van der Sprenkel, J W; Rinkel, G J E

    2003-01-01

    BACKGROUND: Magnesium is a neuroprotective agent which might prevent or reverse delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH). Although the dosage for short-term magnesium therapy is well established, there is lack of knowledge on the dosage for extended use of magn

  19. Dose evaluation for long-term magnesium treatment in aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    van Norden, A G W; van den Bergh, W M; Rinkel, G J E

    2005-01-01

    BACKGROUND: Magnesium is a neuroprotective agent that might prevent or reverse delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). We are presently running a randomized, placebo-controlled, double blind trial with magnesium sulphate (64 mmol/day intravenously). We studied whe

  20. Improvement after treatment of hydrocephalus in aneurysmal subarachnoid haemorrhage : implications for grading and prognosis

    NARCIS (Netherlands)

    ter Laan, M; Mooij, JJA

    2006-01-01

    Two patients with aneurysmal subarachnoid haemorrhage and hydrocephalus are presented. On admission they scored E1M4V1 and E1M3Vtube on the Glasgow Coma Scale. The first patient recovered to E3M5Vtube after treatment of hydrocpehalus by extraventricular drainage. The second recovered to E2M5Vtube an

  1. Cerebral Blood Flow Dynamics and Head-of-Bed Changes in the Setting of Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    David K. Kung

    2013-01-01

    Full Text Available Head-of-bed (HOB elevation is usually restricted in patients with aneurysmal subarachnoid hemorrhage (SAH. The goal of this study is to correlate HOB changes ( and with cerebral blood flow using transcranial Doppler (TCD and thermal diffusion probe in SAH patients. Thirteen patients with SAH were prospectively enrolled in the study. Eight patients underwent placement of a thermal diffusion probe for regional CBF measurement. CBF values were measured with the patients in flat ( and upright sitting positions ( at days 3, 7, and 10. The average increase in blood flow velocity when changing HOB from to was 7.8% on day 3, 0.1% on day 7, and 13.1% on day 10. The middle cerebral artery had the least changes in velocity. The average regional CBF measurement was 22.7 ± 0.3 mL/100 g/min in the supine position and 23.6 ± 9.1 mg/100 g/min in the sitting position. The changes were not statistically significant. None of the patients developed clinical cerebral vasospasm. Changing HOB position in the setting of SAH did not significantly affect cerebral or regional blood flow. These data suggest that early mobilization should be considered given the detrimental effects of prolonged bed rest.

  2. fMRI of Working Memory Impairment after Recovery from Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Timothy Michael Ellmore

    2013-11-01

    Full Text Available Recovery from aneurysmal subarachnoid hemorrhage (SAH is often incomplete and accompanied by subtle but persistent cognitive deficits. Previous neuropsychological reports indicate these deficits include most prominently memory impairment, with working memory particularly affected. The neural basis of these memory deficits remains unknown and unexplored by functional magnetic resonance imaging (fMRI. In the present study, patients who experienced (SAH underwent fMRI during the performance of a verbal working memory paradigm. Behavioral results indicated a subtle but statistically significant impairment relative to healthy subjects in working memory performance accuracy, which was accompanied by relatively increased blood oxygen level dependent signal in widespread left and right hemisphere cortical areas during periods of encoding, maintenance, and retrieval. Activity increases remained after factoring out inter-individual differences in age and task performance, and included most notably left hemisphere regions associated with the phonological loop processing, bilateral sensorimotor regions, and right hemisphere dorsolateral prefrontal cortex. We conclude that deficits in verbal working memory following recovery from (SAH are accompanied by widespread differences in hemodynamic correlates of neural activity. These differences are discussed with respect to the immediate and delayed focal and global brain damage that can occur following (SAH, and the possibility that this damage induces subcortical disconnection and subsequent decreased efficiency in neural processing.

  3. Angio negative spontaneous subarachnoid hemorrhage: Is repeat angiogram required in all cases?

    Directory of Open Access Journals (Sweden)

    Rajan Kumar

    2014-01-01

    Full Text Available Background: In some cases of spontaneous subarachnoid hemorrhage (SAH, the cause of bleed remains obscure on initial evaluation. These patients may harbor structural lesions. We aim to determine the utility of repeat angiogram in these subsets of patients. Methods: In this prospective study, patients with SAH with a negative computed tomographic angiogram (CTA and digital subtraction angiogram (DSA were included. A repeat angiogram was done after 6 weeks of initial angiogram. Patients were divided into perimesencephalic SAH (PM-SAH and diffuse classic SAH (Classic-SAH groups. Outcome was determined by modified Rankin score (mRS. Results: A total of 22% (39/178 of all SAH were angio-negative. A total of 90% (n = 35 of these were in Hunt and Hess grade 1-3. A total of 22 patients had PM-SAH and 17 had a Classic-SAH. Repeat angiogram did not reveal any pathology in the PM-SAH group, whereas two patients with Classic-SAH were found to have aneurysms. At 6 months follow-up, 95% patients of PM-SAH and 83.3% of Classic-SAH had mRS of 0. Conclusion: Repeat angiogram is probably not necessary in patients of PM-SAH and they tend to have better outcome. Classic-SAH pattern of bleed is associated with fair chances of an underlying pathology and a repeat angiogram is recommended and these cases and they have poorer outcome.

  4. Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients

    Energy Technology Data Exchange (ETDEWEB)

    Ramgren, B; Cronqvist, M; Holtaas, S; Larsson, E-M [Center for Medical Imaging and Physiology, Lund University Hospital, Department of Neuroradiology, Lund (Sweden); Romner, B; Brandt, L [Lund University Hospital, Department of Neurosurgery, Lund (Sweden)

    2005-02-01

    We have reviewed initial diagnostic features, treatment, and outcome in 29 patients with acute subarachnoid hemorrhage due to non-traumatic vertebrobasilar artery dissection diagnosed in our hospital between 1993 and 2003. The dissections occurred in the vertebral artery in 19 patients, the posterior inferior cerebellar artery (PICA) in two patients, the basilar artery in four patients, and in the vertebral artery extending into the PICA in four patients. A pseudoaneurysm was found in 20 patients. Clinical manifestations typically included sudden onset of moderate to severe headache, nuchal rigidity, and drowsiness. Fourteen patients were treated conservatively. Fifteen patients underwent endovascular treatment with either parent artery occlusion (13 patients) or aneurysmal coil occlusion with preservation of the parent artery (2 patients). Re-bleeding occurred within 12 days and before treatment in nine patients. Eight of these had a pseudoaneurysm. No patient bled after endovascular treatment. Poor grade and early re-bleeding were associated with less favorable outcome. Outcome at 6 months did not differ significantly between endovascular and conservative treatment. Altogether, good recovery was achieved for 16 patients, moderate disability was seen in one, severe disability in four, and eight patients (27%) died. The absence of bleeding subsequent to endovascular treatment in this study suggests that endovascular treatment may be a rational approach in these patients at high risk of re-bleeding, especially those with a pseudoaneurysm. (orig.)

  5. High dose Erythropoietin increases Brain Tissue Oxygen Tension in Severe Vasospasm after Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Helbok Raimund

    2012-06-01

    Full Text Available Abstract Background Vasospasm-related delayed cerebral ischemia (DCI significantly impacts on outcome after aneurysmal subarachnoid hemorrhage (SAH. Erythropoietin (EPO may reduce the severity of cerebral vasospasm and improve outcome, however, underlying mechanisms are incompletely understood. In this study, the authors aimed to investigate the effect of EPO on cerebral metabolism and brain tissue oxygen tension (PbtO2. Methods Seven consecutive poor grade SAH patients with multimodal neuromonitoring (MM received systemic EPO therapy (30.000 IU per day for 3 consecutive days for severe cerebral vasospasm. Cerebral perfusion pressure (CPP, mean arterial blood pressure (MAP, intracranial pressure (ICP, PbtO2 and brain metabolic changes were analyzed during the next 24 hours after each dose given. Statistical analysis was performed with a mixed effects model. Results A total of 22 interventions were analyzed. Median age was 47 years (32–68 and 86 % were female. Three patients (38 % developed DCI. MAP decreased 2 hours after intervention (P btO2 significantly increased over time (P  Conclusions EPO increases PbtO2 in poor grade SAH patients with severe cerebral vasospasm. The effect on outcome needs further investigation.

  6. Subarachnoid hemorrhage with transient ischemic attack: Another masquerader in cerebral venous thrombosis

    Directory of Open Access Journals (Sweden)

    Bhawna Sharma

    2010-01-01

    Full Text Available Cerebral venous thrombosis has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to frequent misdiagnoses or delay in diagnosis. The most frequent symptoms and signs are headache, seizures, focal deficits, and papilledema. A number of rare atypical manifestations have been described. Cerebral venous thrombosis may present with an isolated intracranial hypertension type picture, thunderclap headache, attacks of migraine with aura, isolated psychiatric disturbances, pulsatile tinnitus, isolated or multiple cranial nerve involvement, and occasionally as subarachnoid hemorrhage (SAH or transient ischemic attack. Our patient presented with thunderclap headache and transient ischemic attack like episode with obvious SAH on CT scan. Acute SAH suggests the presence of a vascular lesion, such as ruptured aneurysm, and CVT is not generally considered in the diagnostic workup of SAH. The case emphasizes the importance of cerebral venous study in nonaneurysmal cases of SAH. It is important to have a high index of suspicion in such atypical cases to avoid delay in diagnosis.

  7. Management of poor grade subarachnoid hemorrhage. Unsolved problems in the ultra-acute phase

    International Nuclear Information System (INIS)

    We evaluated the management of patients with subarachnoid hemorrhage (SAH) after arrival for surgical intervention in the ultra-acute stage. Immediately after brief neurological and systemic examination, patients were deeply sedated to prevent aneurysmal rerupture. Principally they were intubated with intensive control of systolic blood pressure below 120 mmHg by radial arterial monitoring. Buprenorphine, midazolam, and vecuronium were routinely intravenously administered; and propofol, barbiturate, nicardipine, or prostaglandin was added to lower blood pressure if necessary. A total of 163 consecutive patients with SAH (59 men and 104 women, mean age of 61.1 years) arrived between 2003 and 2005 were enrolled. The majority of patients were in poor grade: 26 with Grade IV, 54 with Grade V by grading scale of the World Federation of Neurological Society, and 32 with cardiopulmonary arrest. Eighty-seven patients (53%) arrived within 1 hour after onset of SAH and 127 patients (78%) arrived within 3 hours. Most of the poor-grade patients were intubated before initial brain CT scan. Mean systolic blood pressure was around 170 mmHg at the time of arrival, which was controlled around 120 mmHg or less during resuscitation and angiography. A total of 117 patients had DSA, 111 of them (68%) within 3 hours, and 111 patients underwent surgery, 81 of them (85%) within 6 hours. Despite intensive resuscitation, 36 episodes of rebleeding were detected in 32 patients, 24 before and 12 after arrival. Extravasation of contrast media was seen in 6 patients during cerebral angiography. Favorable outcome (good recovery and moderate disability) was obtained in 69% of Grade IV and 24% of the Grade V patients. The risk of ultra-early rebleeding is highest for patients with poor grades. Deep sedation and strict blood pressure control followed by urgent obliteration of the ruptured aneurysm have a strong rationale to prevent rerupture and to achieve better overall outcome. (author)

  8. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to ''triage'' patients' treatment

    Energy Technology Data Exchange (ETDEWEB)

    Agid, R.; Lee, S.K.; Willinsky, R.A.; Farb, R.I.; TerBrugge, K.G. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2006-11-15

    To evaluate the clinical role of CT angiography (CTA) in patients with acute subarachnoid hemorrhage (SAH) for treatment decision-making. Consecutive patients with acute SAH had CTA using a 64-slice scanner for initial clinical decision-making. Image processing included multiplanar volume reformatted (MPVR) maximum intensity projections (MIP) and 3D volume-rendered reconstructions. CTAs were used for (1) evaluating the cause of SAH, and (2) triaging aneurysm-bearing patients to the more appropriate management, either surgical clipping or endovascular coiling. CTA findings were confirmed by neurosurgical exploration or catheter angiography (digital subtraction angiography, DSA). Successful coiling provided evidence that triaging to endovascular treatment was correct. Included in the study were 73 patients. CTA findings were confirmed by DSA or neurosurgical operation in 65 patients, and of these 65, 47 had aneurysmal SAH, 3 had vasculitis, 1 had arterial dissection and 14 had no underlying arterial abnormality. The cause of SAH was detected with CTA in 62 out of the 65 patients (95.4%, sensitivity 94%, specificity 100%). CTA revealed the aneurysm in 46 of 47 patients (98%, sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 82.3%), 1 of 3 vasculitides and 1 of 1 dissection. Of the 46 patients with aneurysm, 44 (95.7%) were referred for treatment based on CTA. In 2 patients (2 of 46, 4.4%) CTA was not informative enough to choose treatment requiring DSA. Of the 44 patients, 27 (61.4%) were referred to endovascular treatment and successful coiling was achieved in 25 (25 of 27, 92.6%). CTA using a 64-slice scanner is an accurate tool for detecting and characterizing aneurysms in acute SAH. CTA is useful in the decision process whether to coil or clip an aneurysm. (orig.)

  9. Risk of Familial Intracranial Aneurysm

    OpenAIRE

    J Gordon Millichap; John J Millichap

    2014-01-01

    Investigators at University Medical Center Utrecht, Netherlands, studied the yield of long-term (up to 20 years) screening for intracranial aneurysms in individuals with a positive family history (2 or more first-degree relatives) of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysm (1993-2013).

  10. An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review.

    Science.gov (United States)

    Roy, Manoj Kumar; Dutta, Joydip; Chatterjee, Apratim; Sarkar, Anup; Roy, Koushik; Agarwal, Rakhesh; Lahiri, Durjoy; Biswas, Amrito; Mondal, Anupam; Maity, Pranab; Mukhopadhyay, Jotideb

    2015-01-01

    Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS) along with other conservative management. Subarachnoid hemorrhage as an initial presentation in viper bite is very rare and we discuss the case with proper literature review. PMID:26425018

  11. An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Roy

    2015-01-01

    Full Text Available Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS along with other conservative management. Subarachnoid hemorrhage as an initial presentation in viper bite is very rare and we discuss the case with proper literature review.

  12. Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Jabbarli, Ramazan; Shah, Mukesch; Hippchen, Beate; Velthoven, Vera van [University Hospital of Freiburg, Department of Neurosurgery, Freiburg/Breisgau (Germany); Taschner, Christian [University Hospital of Freiburg, Department of Neuroradiology, Freiburg (Germany); Kaier, Klaus [University Hospital of Freiburg, Institute for Medical Biometry and Medical Informatics, Freiburg (Germany)

    2014-10-15

    CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs - the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness. (orig.)

  13. 动脉瘤性蛛网膜下腔出血后慢性脑积水与TGF-β1的关系及相关多因素分析%Association of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage with transforming growth factor-β1 levels and other risk factors

    Institute of Scientific and Technical Information of China (English)

    刘飞; 袁文; 廖达光; 张天一; 王知非

    2013-01-01

    Objective To study the role of transforming growth factor-β1 (TGF-β1) levels and other risk factors in the occurrence of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). Methods Patients treated for aSAH in our hospital between January, 2007 and June, 2012 were divided into non-hydrocephalus group and hydrocephalus group. TGF-β1 levels in the cerebrospinal fluid (CSF) were compared between the two groups at different time points. A retrospective analysis was conducted to identify the potential risk factors for chronic hydrocephalus, which were subsequently confirmed by Logistic regression analysis. Results Of the 129 patients enrolled, 16 (12.4%) developed chronic hydrocephalic with an average diagnosis time of 31.6±17.0 days. In patients with chronic hydrocephalus, TGF-β1 level in the CSF increased significantly on the 13th day following aSAH (P<0.05). Retrospective analysis showed that the patients with hydrocephalus and those without had significant differences in history of hypertension, times of SAH, Hunt-Hess classification, ventricular expansion, aneurysm position, Fisher classification, ventricular hemorrhage score and intracranial infections (P<0.05). Logistic regression analysis identified ventricular expansion, aneurysm position, Fisher classification, ventricular hemorrhage score and postoperative intracranial infections as significant risk factors for the occurrence of chronic hydrocephalus (P<0.05). Conclusions In adult patients with aSAH, the risk factors for chronic hydrocephalus include ventricular expansion, aneurysm position, Fisher classification, ventricular hemorrhage score and postoperative intracranial infections. These risk factors can have greater clinical value than TGF-β1 levels in the CSF in predicting the occurrence of chronic hydrocephalus following aSAH.%目的 探讨脑脊液中转化生长因子-β1(TGF-β1)浓度及其他临床因素在成年动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑

  14. Changes in Cerebral Perfusion around the Time of Delayed Cerebral Ischemia in Subarachnoid Hemorrhage Patients

    NARCIS (Netherlands)

    Dankbaar, J. W.; de Rooij, N. K.; Smit, E. J.; Velthuis, B. K.; Frijns, C. J. M.; Rinkel, G. J. E.; van der Schaaf, I. C.

    2011-01-01

    Background: Because the pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is unclear, we studied cerebral perfusion at different time points around the occurrence of DCI. Methods: We prospectively enrolled 53 patients admitted to the University Medical Center Utrech

  15. Ficolin-3-mediated lectin complement pathway activation in patients with subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Zanier, Elisa R; Zangari, Rosalia; Munthe-Fog, Lea;

    2014-01-01

    OBJECTIVES: To assess the involvement of ficolin-3, the main initiator of the lectin complement pathway (LCP), in subarachnoid hemorrhage (SAH) pathology and outcome. METHODS: In this preliminary exploratory study, plasma concentration of ficolin-3 and of ficolin-3-mediated functional LCP activity...

  16. Role of magnesium in the reduction of ischemic depolarization and lesion volume after experimental subarachnoid hemorrhage

    NARCIS (Netherlands)

    van den Bergh, Walter M; Zuur, J Karel; Kamerling, Niels A; van Asseldonk, Jan Thies H; Rinkel, Gabriël J E; Tulleken, Cornelis A F; Nicolay, Klaas

    2002-01-01

    OBJECT: Ischemia-induced tissue depolarizations probably play an important role in the pathophysiology of cerebral ischemia caused by parent vessel occlusion. Their role in ischemia caused by subarachnoid hemorrhage (SAH) remains to be investigated. The authors determined whether ischemic depolariza

  17. Functional analysis of Pro-inflammatory properties within the cerebrospinal fluid after subarachnoid hemorrhage in vivo and in vitro

    Directory of Open Access Journals (Sweden)

    Schneider Ulf C

    2012-02-01

    Full Text Available Abstract Background To functionally characterize pro-inflammatory and vasoconstrictive properties of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage (SAH in vivo and in vitro. Methods The cerebrospinal fluid (CSF of 10 patients suffering from SAH was applied to the transparent skinfold chamber model in male NMRI mice which allows for in vivo analysis of the microcirculatory response to a superfusat. Microvascular diameter changes were quantified and the numbers of rolling and sticking leukocytes were documented using intravital multifluorescence imaging techniques. Furthermore, the pro-inflammatory properties of CSF were assessed in vitro using a monocyte transendothelial migration assay. Results CSF superfusion started to induce significant vasoconstriction on days 4 and 6 after SAH. In parallel, CSF superfusion induced a microvascular leukocyte recruitment, with a significant number of leukocytes rolling (day 6 and sticking (days 2-4 to the endothelium. CSF of patients presenting with cerebral edema induced breakdown of blood vessel integrity in our assay as evidenced by fluorescent marker extravasation. In accordance with leukocyte activation in vivo, significantly higher in vitro monocyte migration rates were found after SAH. Conclusion We functionally characterized inflammatory and vasoactive properties of patients' CSF after SAH in vivo and in vitro. This pro-inflammatory milieu in the subarachnoid space might play a pivotal role in the pathophysiology of early and delayed brain injury as well as vasospasm development following SAH.

  18. Post-operative monitoring of cortical taurine in patients with subarachnoid hemorrhage: a microdialysis study.

    Science.gov (United States)

    De Micheli, E; Pinna, G; Alfieri, A; Caramia, G; Bianchi, L; Colivicchi, M A; Della Corte, L; Bricolo, A

    2000-01-01

    Intracerebral MD enables the retrieval of endogenous substances from the extracellular fluid (ECF) of the brain and has been demonstrated to be a sensitive technique for early detection of subtle vasospasm-induced neurometabolic abnormalities in patients with subarachnoid hemorrhage (SAH). The aim of this study was to monitor cortical extracellular concentrations of energy metabolism markers, such as glucose and lactate, neurotransmitter amino acids, such as glutamate, aspartate, GABA and taurine to identify any neurochemical patterns of cerebral ischemia. A prospective clinical study was conducted on a group of 16 patients with non-severe SAH operated on within 72 hours after initial bleeding. Following aneurysm clipping, an MD catheter was inserted in the cortical region where vasospasm could be expected to develop, and perfused with artificial CSF at 0.3 microl/min flow rate. Dialysate was collected every 6 hours and then analyzed on High Performance Liquid Cromatography (HPLC) for glucose, lactate, pyruvate, glutamate, aspartate, GABA and taurine. Mean ECF taurine concentrations ranged from 1.4 + 0.7 to 12.3 + 7.8 micromol/l in single patients: global mean value was 5.8 + 3.8 micromol/l. In this series, the highest absolute taurine value was 25.7 micromol/l, observed in a patient who developed clinical and radiological signs of cerebral ischemia. Nine patients presented clinical disturbances related to cerebral vasospasm. In this setting, representing a mild-to-moderate hypoxic condition, MD data demonstrated that lactate is the most sensitive marker of cellular energy imbalance. Increased lactate levels positively correlated with glutamate (P<0.0001), aspartate (P<0.0001), GABA (P<0.0001) and taurine (P<0.0001) concentrations. These results suggest that also in humans increased taurine levels reflect a condition of cellular stress. This study confirms that MD is a sensitive technique to reveal subtle metabolic abnormalities possibly resulting in cell damage

  19. Dynamic expression of nerve growth factor and its receptor TrkA after subarachnoid hemorrhage in rat brain.

    Science.gov (United States)

    Song, Jin-Ning; Liu, Zun-Wei; Sui, Long; Zhang, Bin-Fei; Zhao, Yong-Lin; Ma, Xu-Dong; Gu, Hua

    2016-08-01

    Delayed ischemic neurologic deficit after subarachnoid hemorrhage results from loss of neural cells. Nerve growth factor and its receptor TrkA may promote regeneration of neural cells, but their expression after subarachnoid hemorrhage remains unclear. In the present study, a rat model of subarachnoid hemorrhage was established using two injections of autologous blood into the cistern magna. Immunohisto-chemical staining suggested that the expression of nerve growth factor and TrkA in the cerebral cortex and brainstem increased at 6 hours, peaked at 12 hours and decreased 1 day after induction of subarachnoid hemorrhage, whereas the expression in the hippocampus increased at 6 hours, peaked on day 1, and decreased 3 days later. Compared with those for the rats in the sham and saline groups, neurobehavioral scores decreased significantly 12 hours and 3 days after subarachnoid hemorrhage (P < 0.05). These results suggest that the expression of nerve growth factor and its receptor TrkA is dynamically changed in the rat brain and may thus participate in neuronal survival and nerve regeneration after subarachnoid hemorrhage. PMID:27651776

  20. Assay of Serum Sodium Balance Disturbance in Spontaneous Subarachnoid Hemorrhage and Relation to Prognosis of Disease

    OpenAIRE

    M. Sabouri; H. Moradian Lotfi; S.M. Norian

    2006-01-01

    Introduction & Objective: Electrolyte disturbances are frequently observed during the acute period after spontaneous subarachnoid hemorrhage (SAH). Hyponatremia and hypernatremia are the most common electrolyte disturbance in acute period of disease, and these disturbances may worsen cerebral edema and mass effect. We performed this study to determine the prognostic significance of serum sodium concentration abnormalities.Materials & Methods: This study was performed as prospective analytic c...

  1. [Subarachnoid hemorrhage due to autonomic dysreflexia: rare consequence of sexual stimulation in a paraplegic].

    Science.gov (United States)

    Galiart, E; Baumberger, M; Pannek, J

    2013-11-01

    Nearly all men with spinal cord injury suffer from neurogenic sexual dysfunction which is often treated with phosphodiesterase-5 (PDE5) inhibitors. We describe a case of subarachnoid hemorrhage due to autonomic dysreflexia (AD) caused by sexual stimulation. Nitrates are frequently used for acute treatment of AD; however, the use of these drugs in combination with PDE5 inhibitors is contraindicated. Therefore, meticulous information from patients and relatives on the risk of AD and possible drug interactions is of vital importance. PMID:23784679

  2. Angio negative spontaneous subarachnoid hemorrhage: Is repeat angiogram required in all cases?

    OpenAIRE

    Rajan Kumar; Kuntal Kanti Das; Rajni K Sahu; Pradeep Sharma; Anant Mehrotra; Arun K. Srivastava; Rabi N Sahu; Jaiswal, Awadhesh K.; Sanjay Behari

    2014-01-01

    Background: In some cases of spontaneous subarachnoid hemorrhage (SAH), the cause of bleed remains obscure on initial evaluation. These patients may harbor structural lesions. We aim to determine the utility of repeat angiogram in these subsets of patients. Methods: In this prospective study, patients with SAH with a negative computed tomographic angiogram (CTA) and digital subtraction angiogram (DSA) were included. A repeat angiogram was done after 6 weeks of initial angiogram. Patients ...

  3. Evaluation of pituitary and thyroid hormones in patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm Avaliação dos hormônios hipofisários e tireoidianos em pacientes com hemorragia subaracnoidea devido a ruptura de aneurisma intracraniano

    Directory of Open Access Journals (Sweden)

    Paola Mangieri

    2003-03-01

    Full Text Available It is well known that the central nervous system (CNS influences the pituitary hormone secretions and that diseases of CNS are frequently associated with an altered endocrine function. The aim of this study has been the evaluation of the serum concentrations of the pituitary and thyroid hormones in a series of patients with subarachnoid hemorrhage due to a ruptured cerebral aneurysm. Thirty-five patients (23 females and 12 males, aged 51.9±13.3 years on the mean were admitted. They were evaluated to assess the clinical severity of the subarachnoid hemorrhage by Hunt & Hess scale: nine patients were in the grade I, 14 in the grade II, and 12 in the grade III. Blood samples were obtained between 8:00 and 9:00 a.m. and serum hormones were measured by commercial kits (IRMA or MEIA methods. Cortisol serum levels (normal range (NR = 5 to 18 µg/dL were increased in all the patients (mean ± standard deviation = 31.4±12.4 µg/dL. Mean prolactin levels (NR É bem conhecido que o sistema nervoso central (SNC influencia as secreções dos hormônios hipofisários e que doenças do SNC são frequentemene associadas com função endócrina alterada. O objetivo deste estudo foi avaliar as concentrações séricas dos hormônios hipofisários e tireoidianos em uma série de pacientes acometidos de hemorragia subaracnóidea devida a ruptura de aneurisma cerebral. Foram avaliados 35 pacientes (23 mulheres e 12 homens, com média de idade de 51,9±13,3 anos. Foram avaliados para a severidade da doença pela escala de Hunt & Hess: nove deles estavam no grau I, 14 no grau II e 12 no grau III. As amostras de sangue foram obtidas entre 8:00 e 9:00 horas e os hormônios foram medidos pelos métodos de IRMA ou de MEIA. Os níveis séricos de cortisol (valor normal (VN 5 a 18 µg/dl estavam aumentados em todos os pacientes (média±desvio padrão = 31,4±12,4 µg/dl. Os níveis de prolactina (VN <20 ng/ml foram de 18,6±17,1 ng/ml e cinco (14,2% tiveram n

  4. Evaluation of headache severity after aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Rachel Swope, PharmD, BCPS

    2014-12-01

    Conclusions: Headache after SAH is persistent and treatment refractory. There may be an association with development of vasospasm and worsening of headache. Novel treatment strategies to attenuate headache in this population are needed.

  5. Automatic quantification of subarachnoid hemorrhage on noncontrast CT

    NARCIS (Netherlands)

    Boers, A.M.; Zijlstra, I.A.; Gathier, C.S.; Berg, van den R.; Slump, C.H.; Marquering, H.A.; Majoie, C.B.

    2014-01-01

    Quantification of blood after SAH on initial NCCT is an important radiologic measure to predict patient outcome and guide treatment decisions. In current scales, hemorrhage volume and density are not accounted for. The purpose of this study was to develop and validate a fully automatic method for SA

  6. [A case of moyamoya disease with a subarachnoid hemorrhage treated with endovascular technique].

    Science.gov (United States)

    Wada, Kentaro; Hattori, Kenichi; Araki, Yoshio; Noda, Tomoyuki; Maki, Hideki; Oyama, Hirofumi; Kito, Akira; Wakabayashi, Toshihiko

    2014-11-01

    We report a case of a moyamoya disease presenting with subarachonoid hemorrhage (SAH) due to a ruptured aneurysm. A 40-year-old woman presented with sudden onset of headache and vomiting. Computed tomography (CT) showed diffuse thick SAH localized around basal cistern. 3D-CT Angiography (3D-CTA) and digital subtraction angiography (DSA) demonstrated a saccular aneurysm at the bifurcation of the left superior cerebellar artery and basilar artery. In addition, the both carotid arteries were occluded at the terminal portion and the territory of both middle cerebral arteries were perfused by abnormal moyamoya vessels. The aneurysm was completely embolized by endovascular embolization. The SAH due to a ruptured aneurysm associated with moyamoya disease is rare. We think endovascular therapy is safe and effective. However, a vasospasm of the catheter technique occurred during the operation. This fact is very important to consider when we treat diseases such as this in the future. PMID:25351798

  7. Equal contribution of increased intracranial pressure and subarachnoid blood to cerebral blood flow reduction and receptor upregulation after subarachnoid hemorrhage. Laboratory investigation

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2009-01-01

    OBJECT: Cerebral ischemia remains the key cause of disability and death in the late phase after subarachnoid hemorrhage (SAH), and its pathogenesis is still poorly understood. The purpose of this study was to examine whether the change in intracranial pressure or the extravasated blood causes the...

  8. Spreading Depolarizations: A Therapeutic Target Against Delayed Cerebral Ischemia After Subarachnoid Hemorrhage.

    Science.gov (United States)

    Chung, David Y; Oka, Fumiaki; Ayata, Cenk

    2016-06-01

    Delayed cerebral ischemia is the most feared cause of secondary injury progression after subarachnoid hemorrhage. Initially thought to be a direct consequence of large artery spasm and territorial ischemia, recent data suggests that delayed cerebral ischemia represents multiple concurrent and synergistic mechanisms, including microcirculatory dysfunction, inflammation, and microthrombosis. Among these mechanisms, spreading depolarizations (SDs) are arguably the most elusive and underappreciated in the clinical setting. Although SDs have been experimentally detected and examined since the late 1970s, their widespread occurrence in human brain was not unequivocally demonstrated until relatively recently. We now know that SDs occur with very high incidence in human brain after ischemic or hemorrhagic stroke and trauma, and worsen outcomes by increasing metabolic demand, decreasing blood supply, predisposing to seizure activity, and possibly worsening brain edema. In this review, we discuss the causes and consequences of SDs in injured brain. Although much of our mechanistic knowledge comes from experimental models of focal cerebral ischemia, clinical data suggest that the same principles apply regardless of the mode of injury (i.e., ischemia, hemorrhage, or trauma). The hope is that a better fundamental understanding of SDs will lead to novel therapeutic interventions to prevent SD occurrence and its adverse consequences contributing to injury progression in subarachnoid hemorrhage and other forms of acute brain injury. PMID:27258442

  9. [Giant intracranial aneurysm in three years old boy: case report].

    Science.gov (United States)

    de Tella, Osvaldo Inácio; Crosera, João Francisco; Herculano, Marco Antonio; de Paiva Neto, Manoel Antonio

    2006-06-01

    Cerebral aneurysms are rare in the pediatric age group and differ from adults' aneurysms in size, localization and incidence. We report a 3-year-old boy with giant middle cerebral artery aneurysms who presented with subarachnoid hemorrhage. The patient was submitted to surgical treatment and the postoperative period was uneventful.

  10. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    R. Risselada (Roelof); B. Roozenbeek (Bob); A.J. Molyneux (Andrew); R.S.C. Kerr; J. Yarnold (Julia); M. Sneade (Mary); E.W. Steyerberg (Ewout); M.C.J.M. Sturkenboom (Miriam)

    2010-01-01

    textabstractBackground. Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods. We studied patients enrolled in the Internatio

  11. High mean fasting glucose levels independently predict poor outcome and delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Kruyt, N. D.; Roos, Y. W. B. M.; Mees, S. M. Dorhout; van den Bergh, W. M.; Algra, A.; Rinkel, G. J. E.; Biessels, G. J.

    2008-01-01

    Background: Hyperglycaemia has been related to poor outcome and delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH). Objective: This study aimed to assess whether in patients with aSAH, levels of mean fasting glucose within the first week predict poor outcome and DCI be

  12. A case of angiographically occult, distal small anterior inferior cerebellar artery aneurysm

    OpenAIRE

    Hisashi Kubota; Yasuhiro Sanada; Kazuhiro Nagatsuka; Amami Kato

    2015-01-01

    Background: A small aneurysm at an unusual location, such as a distal anterior inferior cerebellar artery (AICA) aneurysm, may conceal as a computed tomography angiography (CTA) and digital subtraction angiography (DSA)-occult aneurysm. Case Description: We herein present the case of a patient suffering from a subarachnoid hemorrhage (SAH) with two aneurysms in which the AICA aneurysm was negative by CTA and DSA. CTA demonstrated a right anterior choroidal artery aneurysm, which was revea...

  13. Melatonin mitigate cerebral vasospasm after experimental subarachnoid hemorrhage: a study of synchrotron radiation angiography

    Science.gov (United States)

    Cai, J.; He, C.; Chen, L.; Han, T.; Huang, S.; Huang, Y.; Bai, Y.; Bao, Y.; Zhang, H.; Ling, F.

    2013-06-01

    Cerebral vasospasm (CV) after subarachnoid hemorrhage (SAH) is a devastating and unsolved clinical issue. In this study, the rat models, which had been induced SAH by prechiasmatic cistern injection, were treated with melatonin. Synchrotron radiation angiography (SRA) was employed to detect and evaluate CV of animal models. Neurological scoring and histological examinations were used to assess the neurological deficits and CV as well. Using SRA techniques and histological analyses, the anterior cerebral artery diameters of SAH rats with melatonin administration were larger than those without melatonin treatment (p experimental SAH.

  14. Radiological findings in cerebral venous thrombosis presenting as subarachnoid hemorrhage: a series of 22 cases

    Energy Technology Data Exchange (ETDEWEB)

    Boukobza, Monique [APHP - Paris-Diderot University, Department of Neuroradiology and Therapeutic Angiography, Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, Paris (France); Crassard, Isabelle; Bousser, Marie-Germaine [Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, APHP - Paris-Diderot University Paris, France, Department of Neurology, Paris (France); Chabriat, Hugues [Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, APHP - Paris-Diderot University Paris, France, Department of Neurology, Paris (France); INSERM UMR 1161 and DHU NeuroVasc, Paris (France)

    2016-01-15

    The main objectives of the present study are to assess the incidence of cerebral venous thrombosis (CVT) presenting as isolated subarachnoid hemorrhage (SAH) and to determine the occurrence of cortical venous thrombosis (CoVT). Among 332 patients with CVT, investigated with the same CT and MR standardized protocol, 33 (10 %) presented with SAH, associated in 11 cases with hemorrhagic infarct or intracerebral hemorrhage. This study is based on 22 cases of CVT presenting as SAH in the absence of hemorrhagic brain lesion. Diagnosis of sinus thrombosis was established on T2* and magnetic resonance venography and that of CoVT on T2* sequence. Diagnostic of SAH was based on fluid-attenuated inversion recovery (FLAIR) sequence. CVT involved lateral sinus in 18 patients, superior sagittal sinus in 16, and straight sinus in 1. Cortical veins were involved in all patients, in continuity with dural sinus thrombosis when present. SAH was circumscribed to few sulci in all cases and mainly localized at the convexity (21 cases). CoVT implied different areas on the same side in four patients and was bilateral in seven. There was no perimesencephalic or basal cisterns hemorrhage. Cortical swelling was present in 12 cases, associated with localized edema. All patients except one had a favorable outcome. This report shows that the incidence of CVT presenting as isolated SAH is evaluated to 6.4 % and that SAH is, in all cases, in the vicinity of CoVT and when dural thrombosis is present in continuity with it. (orig.)

  15. Methemoglobin Is an Endogenous Toll-Like Receptor 4 Ligand—Relevance to Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Min Seong Kwon

    2015-03-01

    Full Text Available Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage (SAH, and may be responsible for important complications of SAH. Signaling by Toll-like receptor 4 (TLR4-mediated nuclear factor κB (NFκB in microglia plays a critical role in neuronal damage after SAH. Three molecules derived from erythrocyte breakdown have been postulated to be endogenous TLR4 ligands: methemoglobin (metHgb, heme and hemin. However, poor water solubility of heme and hemin, and lipopolysaccharide (LPS contamination have confounded our understanding of these molecules as endogenous TLR4 ligands. We used a 5-step process to obtain highly purified LPS-free metHgb, as confirmed by Fourier Transform Ion Cyclotron Resonance mass spectrometry and by the Limulus amebocyte lysate assay. Using this preparation, we show that metHgb is a TLR4 ligand at physiologically relevant concentrations. metHgb caused time- and dose-dependent secretion of the proinflammatory cytokine, tumor necrosis factor α (TNFα, from microglial and macrophage cell lines, with secretion inhibited by siRNA directed against TLR4, by the TLR4-specific inhibitors, Rs-LPS and TAK-242, and by anti-CD14 antibodies. Injection of purified LPS-free metHgb into the rat subarachnoid space induced microglial activation and TNFα upregulation. Together, our findings support the hypothesis that, following SAH, metHgb in the subarachnoid space can promote widespread TLR4-mediated neuroinflammation.

  16. Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage.

    Science.gov (United States)

    Sen, Jon; Belli, Antonio; Albon, Helen; Morgan, Laleh; Petzold, Axel; Kitchen, Neil

    2003-10-01

    Cerebral vasospasm is a recognised but poorly understood complication for many patients who have aneurysmal subarachnoid haemorrhage and can lead to delayed ischaemic neurological deficit (stroke). Morbidity and mortality rates for vasospasm are high despite improvements in management. Since the middle of the 1970s, much has been written about the treatment of cerebral vasospasm. Hypervolaemia, hypertension, and haemodilution (triple-H) therapy in an intensive-care setting has been shown in some studies to improve outcome and is an accepted means of treatment, although a randomised controlled trial has never been undertaken. In this review, the rationale for this approach will be discussed, alongside new thoughts and future prospects for the management of this complex disorder.

  17. Subarachnoid hemorrhage enhances endothelin receptor expression and function in rat cerebral arteries

    DEFF Research Database (Denmark)

    Hansen-Schwartz, Jacob; Hoel, Natalie Løvland; Zhou, Mingfang;

    2003-01-01

    OBJECTIVE: Inspired by organ culture-induced changes in the vascular endothelin (ET) receptor population, we investigated whether such changes occur in cerebral arteries in a rat subarachnoid hemorrhage (SAH) model. METHODS: SAH was induced with injection of 250 microl of blood into the prechiasm......OBJECTIVE: Inspired by organ culture-induced changes in the vascular endothelin (ET) receptor population, we investigated whether such changes occur in cerebral arteries in a rat subarachnoid hemorrhage (SAH) model. METHODS: SAH was induced with injection of 250 microl of blood...... into the prechiasmatic cistern. After 2 days, the middle cerebral artery, basilar artery, and posterior communicating artery were harvested. Pharmacological studies were performed in vitro, and levels of messenger ribonucleic acid (mRNA) were quantified in real-time reverse transcriptase-polymerase chain reaction assays....... RESULTS: In the middle cerebral artery and basilar artery from rats with induced SAH, enhanced biphasic responses to ET-1 were observed. The -log(50% effective concentration) value for the high-affinity phase was approximately 12, compared with approximately 8.5 for sham-operated animals...

  18. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    Science.gov (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms. PMID:26072457

  19. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    Science.gov (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms.

  20. Familial aggregation of intracranial aneurysms in an Inuit patient population in Kalaallit Nunaat (Greenland)

    DEFF Research Database (Denmark)

    Lindgaard, Lars; Eskesen, Vagn; Gjerris, Flemming;

    2003-01-01

    The incidence of subarachnoid hemorrhage (SAH) and intracranial aneurysm (IA) has been reported to be higher in Greenlandic Inuits than in Caucasian Danes, but the rate of familial aggregation in Inuits is unknown....

  1. Low plasma arginine:asymmetric dimethyl arginine ratios predict mortality after intracranial aneurysm rupture

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Bergström, Anita; Edsen, Troels;

    2013-01-01

    Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthases, predicts mortality in cardiovascular disease and has been linked to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In this prospective study, we assessed whether circulating ADMA, arginine...

  2. Long-term impact of perfusion CT data after subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Mathys, Christian; Martens, Daniel; Reichelt, Dorothea C.; Caspers, Julian; Aissa, Joel; May, Rebecca; Antoch, Gerald; Turowski, Bernd [University Duesseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Duesseldorf (Germany); Haenggi, Daniel [University Duesseldorf, Medical Faculty, Department of Neurosurgery, Duesseldorf (Germany)

    2013-11-15

    Dynamic perfusion computed tomography (PCT) has been established as a diagnostic instrument for the detection of vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to assess the prognostic impact of PCT parameters after SAH on the long-term outcome of patients. Three hundred twelve patients were retrospectively interrogated with a questionnaire 23.06 {+-} 14.33 months after spontaneous subarachnoid hemorrhage. The modified Rankin scale (mRS) was determined, respectively. Scheduled PCT data sets from the first days after ictus were available for all patients. The maximum mean transit time over several examinations per hemisphere (MTT{sub PEAK}) values were significantly correlated (p {<=} 0.001, r = 0.422) with the clinical long-term outcome (mRS). Corresponding to our linear regression analysis, MTT{sub PEAK} is the second most important regressor (behind clinical severity of the initial hemorrhage) for the prediction of long-term mRS. An MTT{sub PEAK} threshold of 3.98 s (identified by receiver operating characteristic analysis, area under the curve = 0.75) predicted an unfavorable long-term outcome (mRS {>=} 2) with a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 67.3, 74.3, 84.5, 52.1, and 69.6 %, respectively. The presented data corroborate the relevance of PCT data for the clinical long-term outcome of SAH patients. By identification of patients who are at risk for a bad outcome and may need escalation of therapy, risk-benefit analysis is supported. (orig.)

  3. Subarachnoid Hemorrhage

    Science.gov (United States)

    ... and requires the expertise of specialized doctors and nurses working in teams. Patients with this condi- tion need the close attention given in the intensive care unit, ideally one dedicated to the care of patients with critical brain disease. Patients with SAH may need a ...

  4. Subarachnoid Hemorrhage

    Science.gov (United States)

    ... The Christopher C. Getch, MD Chair of Research Carol W. Harvey Memorial Chair of Research The Karen ... The Christopher C. Getch, MD Chair of Research Carol W. Harvey Memorial Chair of Research The Karen ...

  5. The Development of Neuroendocrine Disturbances over Time: Longitudinal Findings in Patients after Traumatic Brain Injury and Subarachnoid Hemorrhage.

    Science.gov (United States)

    Kopczak, Anna; Krewer, Carmen; Schneider, Manfred; Kreitschmann-Andermahr, Ilonka; Schneider, Harald Jörn; Stalla, Günter Karl

    2015-12-22

    Previous reports suggest that neuroendocrine disturbances in patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH) may still develop or resolve months or even years after the trauma. We investigated a cohort of n = 168 patients (81 patients after TBI and 87 patients after SAH) in whom hormone levels had been determined at various time points to assess the course and pattern of hormonal insufficiencies. Data were analyzed using three different criteria: (1) patients with lowered basal laboratory values; (2) patients with lowered basal laboratory values or the need for hormone replacement therapy; (3) diagnosis of the treating physician. The first hormonal assessment after a median time of three months after the injury showed lowered hormone laboratory test results in 35% of cases. Lowered testosterone (23.1% of male patients), lowered estradiol (14.3% of female patients) and lowered insulin-like growth factor I (IGF-I) values (12.1%) were most common. Using Criterion 2, a higher prevalence rate of 55.6% of cases was determined, which correlated well with the prevalence rate of 54% of cases using the physicians' diagnosis as the criterion. Intraindividual changes (new onset insufficiency or recovery) were predominantly observed for the somatotropic axis (12.5%), the gonadotropic axis in women (11.1%) and the corticotropic axis (10.6%). Patients after TBI showed more often lowered IGF-I values at first testing, but normal values at follow-up (p hormone results at follow-up were obtained in 78% (free thyroxine (fT4) values) to 94.6% (prolactin values).

  6. Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage.

    Science.gov (United States)

    Malinova, Vesna; Dolatowski, Karoline; Schramm, Peter; Moerer, Onnen; Rohde, Veit; Mielke, Dorothee

    2016-07-01

    OBJECT This prospective study investigated the role of whole-brain CT perfusion (CTP) studies in the identification of patients at risk for delayed ischemic neurological deficits (DIND) and of tissue at risk for delayed cerebral infarction (DCI). METHODS Forty-three patients with aneurysmal subarachnoid hemorrhage (aSAH) were included in this study. A CTP study was routinely performed in the early phase (Day 3). The CTP study was repeated in cases of transcranial Doppler sonography (TCD)-measured blood flow velocity (BFV) increase of > 50 cm/sec within 24 hours and/or on Day 7 in patients who were intubated/sedated. RESULTS Early CTP studies revealed perfusion deficits in 14 patients, of whom 10 patients (72%) developed DIND, and 6 of these 10 patients (60%) had DCI. Three of the 14 patients (21%) with early perfusion deficits developed DCI without having had DIND, and the remaining patient (7%) had neither DIND nor DCI. There was a statistically significant correlation between early perfusion deficits and occurrence of DIND and DCI (p 50 cm/sec within 24 hours, revealing a perfusion deficit in 3 of them (38%). Two of the 3 patients (67%) developed DCI without preceding DIND and 1 patient (33%) had DIND without DCI. In 4 of the 7 patients (57%) who were sedated and/or comatose, additional CTP studies on Day 7 showed perfusion deficits. All 4 patients developed DCI. CONCLUSIONS Whole-brain CTP on Day 3 after aSAH allows early and reliable identification of patients at risk for DIND and tissue at risk for DCI. Additional CTP investigations, guided by TCD-measured BFV increase or persisting coma, do not contribute to information gain.

  7. CT perfusion during delayed cerebral ischemia after subarachnoid hemorrhage: distinction between reversible ischemia and ischemia progressing to infarction

    Energy Technology Data Exchange (ETDEWEB)

    Cremers, Charlotte H.P. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, PO Box 85500, Utrecht, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vos, Pieter C. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Schaaf, Irene C. van der; Velthuis, Birgitta K.; Dankbaar, Jan Willem [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Vergouwen, Mervyn D.I.; Rinkel, Gabriel J.E. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, PO Box 85500, Utrecht, Utrecht (Netherlands)

    2015-09-15

    Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) can be reversible or progress to cerebral infarction. In patients with a deterioration clinically diagnosed as DCI, we investigated whether CT perfusion (CTP) can distinguish between reversible ischemia and ischemia progressing to cerebral infarction. From a prospectively collected series of aSAH patients, we included those with DCI, CTP on the day of clinical deterioration, and follow-up imaging. In qualitative CTP analyses (visual assessment), we calculated positive and negative predictive value (PPV and NPV) with 95 % confidence intervals (95%CI) of a perfusion deficit for infarction on follow-up imaging. In quantitative analyses, we compared perfusion values of the least perfused brain tissue between patients with and without infarction by using receiver-operator characteristic curves and calculated a threshold value with PPV and NPV for the perfusion parameter with the highest area under the curve. In qualitative analyses of 33 included patients, 15 of 17 patients (88 %) with and 6 of 16 patients (38 %) without infarction on follow-up imaging had a perfusion deficit during clinical deterioration (p = 0.002). Presence of a perfusion deficit had a PPV of 71 % (95%CI: 48-89 %) and NPV of 83 % (95%CI: 52-98 %) for infarction on follow-up. Quantitative analyses showed that an absolute minimal cerebral blood flow (CBF) threshold of 17.7 mL/100 g/min had a PPV of 63 % (95%CI: 41-81 %) and a NPV of 78 % (95%CI: 40-97 %) for infarction. CTP may differ between patients with DCI who develop infarction and those who do not. For this purpose, qualitative evaluation may perform marginally better than quantitative evaluation. (orig.)

  8. A Hypothesis: Hydrogen Sulfide Might Be Neuroprotective against Subarachnoid Hemorrhage Induced Brain Injury

    Directory of Open Access Journals (Sweden)

    Yong-Peng Yu

    2014-01-01

    Full Text Available Gases such as nitric oxide (NO and carbon monoxide (CO play important roles both in normal physiology and in disease. Recent studies have shown that hydrogen sulfide (H2S protects neurons against oxidative stress and ischemia-reperfusion injury and attenuates lipopolysaccharides (LPS induced neuroinflammation in microglia, exhibiting anti-inflammatory and antiapoptotic activities. The gas H2S is emerging as a novel regulator of important physiologic functions such as arterial diameter, blood flow, and leukocyte adhesion. It has been known that multiple factors, including oxidative stress, free radicals, and neuronal nitric oxide synthesis as well as abnormal inflammatory responses, are involved in the mechanism underlying the brain injury after subarachnoid hemorrhage (SAH. Based on the multiple physiologic functions of H2S, we speculate that it might be a promising, effective, and specific therapy for brain injury after SAH.

  9. Transpulmonary Thermodilution-Based Management of Neurogenic Pulmonary Edema After Subarachnoid Hemorrhage.

    Science.gov (United States)

    Mutoh, Tatsushi; Kazumata, Ken; Ueyama-Mutoh, Tomoko; Taki, Yasuyuki; Ishikawa, Tatsuya

    2015-11-01

    Neurogenic pulmonary edema (NPE) is a potentially catastrophic but treatable systemic event after subarachnoid hemorrhage (SAH). The development of NPE most frequently occurs immediately after SAH, and the severity is usually self-limiting. Despite extensive research efforts and a breadth of collective clinical experience, accurate diagnosis of NPE can be difficult, and effective hemodynamic treatment options are limited. Recently, a bedside transpulmonary thermodilution device has been introduced that traces physiological patterns consistent with current theories regarding the mechanism (hydrostatic or permeability PE) of NPE. This article provides an overview of the clinical usefulness of the advanced technique for use in the neurointensive care unit for the diagnosis and management of post-SAH NPE.

  10. EFFECT OF GINKGO BILOBA EXTRACT ON BRAIN EDEMA AFTER SUBARACHNOID HEMORRHAGE IN RATS

    Institute of Scientific and Technical Information of China (English)

    孙保亮; 夏作理; 杨明峰; 邱平明

    2001-01-01

    @@ The aim of this study was to investigate the protectiveeffect of Ginkgo biloba extract (EGb) on brain edemaafter subarachnoid hemorrhage . Eighty male and femaleWistar rats, weighing 300~ 350g, were used in the ex-periment. Animals were divided into pure SAH group andEGb-treated group. Dynamic changes of regional cerebralblood flow (rCBF) were detected in eight rats from eachgroup. Brain water and electrolytes contents at differenttime points were detected in thirty-two rats from eachgroup (eight rats at each time point from each group) .EGb. provided by Pizhou Pharmaceutical Factory(Xuzhou, Jiangsu, China), was injected intraperi-toneally 30 minutes before operation and repeated withsingle dose of 15mg/kg .every 6 hours.

  11. Neurokinin-1 receptor antagonism in a rat model of subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Ansar, Saema; Svendgaard, Niels-Aage; Edvinsson, Lars

    2007-01-01

    ) were investigated using sensitive myographs. To determine whether NKIR inhibition had an influence on local CBF after post-SAH, a quantitative autoradiographic technique was used. After SAH, the vascular receptor phenotype was changed in cerebral arteries through upregulation of contractile ET, and 5......OBJECT: Cerebral vasospasm following subarachnoid hemorrhage (SAH) leads to reduced cerebral blood flow (CBF) and to cerebral ischemia, in some cases even producing infarction and long-term disability. The goal of the present study was to investigate the hypothesis that inhibition of neurokinin-1......-HT1B receptors, while regional and total CBF were markedly reduced. Treatment with the selective NK1R inhibitor L-822429 prevented both the receptor upregulation and the reduction in regional and global CBF. CONCLUSIONS: The data reveal the coregulation of vascular receptor changes and blood flow...

  12. Gene expression and molecular changes in cerebral arteries following subarachnoid hemorrhage in the rat

    DEFF Research Database (Denmark)

    Vikman, Petter; Beg, Saema; Khurana, Tejvir S;

    2006-01-01

    OBJECT: The authors investigated early changes in the cerebral arteries of rats that occur after subarachnoid hemorrhage (SAH). METHODS: Messenger RNA was investigated by performing microarray and quantitative real-time polymerase chain reaction (PCR) analyses, and protein expression was shown...... by performing immunohistochemical studies. The array data indicated that the initial processes that occur after SAH involve activation of genes involved in angiogenesis, inflammation, and extracellular matrix (ECM) remodeling. The real-time PCR investigation confirmed upregulation of genes that were observed...... using the microarray to be regulated, including iNOS, MMP13, and cxcl2. The authors also verified the upregulation of previously implicated genes for G-protein-coupled receptors (endothelin B [ETB], angiotensin 1 [AT1], and AT2) and metalloproteinase 9. The results of an immunohistochemical study...

  13. Spontaneous subarachnoid hemorrhage as a differential diagnosis of pre-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Sohil Pothiawala

    2012-01-01

    Full Text Available Spontaneous subarachnoid hemorrhage is the most common neurological disorder leading to pre-hospital cardiac arrest. ECG changes in SAH may mimic myocardial infarction or ischemia, and thus lead to delayed treatment of the primary problem. Early identification of SAH-induced cardiac arrest with the use of computed tomography scan of the brain obtained immediately after resuscitation will aid emergency physicians make further decisions. The overall prognosis of patients who are resuscitated is extremely poor. But, prompt neurosurgical referral and multidisciplinary intensive care management can improve the survival rate and the functional outcome. Thus, physicians should consider SAH as a differential diagnosis in patients presenting with pre-hospital cardiac arrest.

  14. Distal posterior inferior cerebellar artery aneurysm in a child

    OpenAIRE

    J. FRANCISCO SALOMÃO; René D. Leibinger; Yara M. S. Lima Ciro de A. Cunha; Ilton G. Shinzato; Paulo de T. L. Dantas

    1992-01-01

    The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA), successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  15. Insurance status is associated with treatment allocation and outcomes after subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Charles Hobson

    Full Text Available Subarachnoid hemorrhage (SAH is a particularly devastating type of stroke which is responsible for one third of all stroke-related years of potential life lost before age 65. Surgical treatment has been shown to decrease both morbidity and mortality after subarachnoid hemorrhage. We hypothesized that payer status other than private insurance is associated with lower allocation to surgical treatment for patients with SAH and worse outcomes.We examined the association between insurance type and surgical treatment allocation and outcomes for patients with SAH while adjusting for a wide range of patient and hospital factors. We analyzed the Nationwide Inpatient Sample hospital discharge database using survey procedures to produce weighted estimates representative of the United States population.We studied 21047 discharges, representing a weighted estimate of 102595 patients age 18 and above with a discharge diagnosis of SAH between 2003 and 2008.Multivariable logistic and generalized linear regression analyses were used to assess for any associations between insurance status and surgery allocation and outcomes.Despite the benefits of surgery 66% of SAH patients did not undergo surgical treatment to prevent rebleeding. Mortality was more than twice as likely for patients with no surgical treatment compared to those who received surgery. Medicare patients were significantly less likely to receive surgical treatment.Nearly two thirds of patients with SAH don't receive operative care, and Medicare patients were significantly less likely to receive surgical treatment than other patients. Bias against the elderly and those with chronic illness and disability may play a part in these findings. A system of regionalized care for patients presenting with SAH may reduce disparities and improve appropriate allocation to surgical care and deserves prospective study.

  16. Gender differences in cerebral aneurysm location

    OpenAIRE

    Ali Jourabchi Ghods; Demetrius eLopes; Michael eChen

    2012-01-01

    Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid-hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress (WSS). This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there ...

  17. Predictor’s of Mortality in Patients with Aneurysmal Subarachnoid Haemorrhage and Reebleding

    Directory of Open Access Journals (Sweden)

    Dannys Rivero Rodríguez

    2015-01-01

    Full Text Available Methods. “Ameijeiras Brother’s” and “Cmdt. Manuel Fajardo” Hospitals enrolled 64 patients (multicentre retrospective cohort with aneurysmal subarachnoid haemorrhage and rebleeding. The patients were admitted to the Stroke Unit (SU between January 1, 2006, and December 1, 2013. Demographic, clinical, and radiological variables were examined in logistic regression to evaluate independent factors for increasing the risk of death. Results. Patients with systolic blood pressure >160 mmHg (P=0.02, serum glucose >7 mmol/L (P=0.02, aneurysm location in artery communicant anterior (P=0.03, and black/mixed race (P=0.008 were significant related to death in univariate analysis. Risk factors (HTA, smoke, alcohol consumption, and DM, complication, multiplex rebleeding and stage of WFNS, and Fisher’s scale were not related to mortality. Patients with three or more complications had a higher mortality rate (P=0.002. The results of the multivariate logistic regression analysis indicated that race (black/mixed, P=0.00, OR 4.62, and 95% IC 1.40–16.26, systolic blood pressure (>160 mmHg, P=0.05, OR 2.54, and 95% IC 1.01–3.13, and serum glucose (>7.0 mmol/L, P=0.05, OR 1.82, and 95% IC 1.27–2.67 were independent risk factors for death. Conclusions. The black/mixed race, SBP, and serum glucose were independent predictors of mortality. Three or more complications were associated with increasing the probability to death. Further investigation is necessary to validate these findings.

  18. Giant malignant peripheral nerve sheath tumor with cauda equina syndrome and subarachnoid hemorrhage: Complications in a case of type 1 neurofibromatosis

    OpenAIRE

    Tushar B Patil; Singh, Maneesh Kumar; Lalla, Rakesh

    2015-01-01

    Type 1 neurofibromatosis (NF1), which mainly involves ectodermal tissue arising from the neural crest, can increase the risk of developing malignant peripheral nerve sheath tumors (MPNSTs), soft tissue sarcomas and subarachnoid hemorrhage. We describe a patient with neurofibromatosis type 1 who developed soft tissue sarcoma, MPNST, and subarachnoid hemorrhage. A 22-year-old male reported right focal seizures consequence to severe headache. He had a weakness in both legs, could walk only with ...

  19. Cerebral haemodynamics in patients with hydrocephalus after subarachnoid haemorrhage due to ruptured aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Chia-Cheng; Kuwana, Nobumasa; Ito, Susumu; Yokoyama, Takaakira [Department of Neurosurgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama (Japan); Kanno, Hiroshi; Yamamoto, Isao [Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama (Japan)

    2003-01-01

    Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) may be reduced in patients with normal pressure hydrocephalus (NPH) after subarachnoid haemorrhage (SAH). However, little is known about brain circulation in asymptomatic patients with ventriculomegaly after SAH. This study investigated CBF and CVR in symptomatic and asymptomatic patients with ventriculomegaly to clarify the mechanism of NPH. CBF and CVR were investigated in 48 patients with ventriculomegaly after SAH due to ruptured aneurysm. Mean CBF of the whole brain was measured by first-pass radionuclide angiography using technetium-99m hexamethylpropylene amine oxime. CVR was measured as the percentage change from the baseline mean CBF value after administration of 500 mg acetazolamide. Thirty patients with NPH who responded to shunting had significantly (P<0.01) reduced mean CBF and CVR compared with normal controls. Fourteen asymptomatic patients with ventriculomegaly showed significant (P<0.01) reduction in CVR but no difference in mean CBF. Four symptomatic patients who did not respond to shunting showed significantly (P<0.01) reduced mean CBF but had preserved CVR. Postoperative mean CBF and CVR increased significantly (P<0.01) in 21 patients who responded to shunting, but showed no significant change in four symptomatic patients who did not respond to shunting. Reduction of CBF superimposed on pre-existing impairment of CVR may be an essential step in the mechanism responsible for the manifestation of symptoms of NPH. (orig.)

  20. Classification of non-aneurysmal subarachnoid haemorrhage: CT correlation to the clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Nayak, S., E-mail: sanjeevnayak@hotmail.co [Department of Neuroradiology, University Hospital of North Staffordshire, North Staffordshire Royal Infirmary, Princes Road, Stoke-on-Trent, Staffordshire, ST4 7LN (United Kingdom); Kunz, A.B.; Kieslinger, K. [University Clinic of Neurology, Paracelsus Medical University Salzburg (Austria); Ladurner, G.; Killer, M. [University Clinic of Neurology, Paracelsus Medical University Salzburg (Austria); Neuroscience Institute, Christian Doppler Clinic, Paracelsus Medical University Salzburg (Austria)

    2010-08-15

    Aim: To propose a new computed tomography (CT)-based classification system for non-aneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. Methods and materials: A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with non-aneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1-4) was devised based on the topography of the initial haemorrhage pattern. Results: Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of {<=}1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of {<=}1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1(1a and 1b) and type 2 (p = 0.003); type 2 and type 3 (p = 0.002); type 3 and type 4 (p = 0.001). Conclusion: Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause.

  1. Classification of non-aneurysmal subarachnoid haemorrhage: CT correlation to the clinical outcome

    International Nuclear Information System (INIS)

    Aim: To propose a new computed tomography (CT)-based classification system for non-aneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. Methods and materials: A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with non-aneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1-4) was devised based on the topography of the initial haemorrhage pattern. Results: Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of ≤1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of ≤1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1(1a and 1b) and type 2 (p = 0.003); type 2 and type 3 (p = 0.002); type 3 and type 4 (p = 0.001). Conclusion: Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause.

  2. Establishment of artery smooth muscle cell proliferation model after subarachnoid hemorrhage in rats

    Directory of Open Access Journals (Sweden)

    Yu-jie CHEN

    2011-12-01

    Full Text Available Objective The current paper aims to simulate the effects of hemolytic products on intracranial vascular smooth muscle cell after subarachnoid hemorrhage(SAH,and probe into the molecular mechanism and strategy for the prevention and cure of vascular proliferation after SAH.Methods Thirty Sprague-Dawley rats were randomly divided into three groups,including sham-operated,24 h after SAH,and 72 h after SAH groups.The artificial hemorrhage model around the common carotid artery was established for the latter two groups.The animals were put to death after 24 h and 72 h to take the common carotid artery,and to measure the expression level of PCNA,SM-α-actin protein,and mRNA in the smooth muscle cell.Results The PCNA mRNA expression was significantly up-regulated in the 24-h group(P < 0.01.The expression in the 72-h group was lower than that of the 24-h group(P < 0.01,whereas it was still remarkably higher than that of the sham group(P < 0.01.The SM-α-actin mRNA expression in the smooth muscle cell in the 24-h and 72-h groups decreased compared with that of the Sham group(P < 0.05,whereas the 72-h group was significantly lower than that of the 24-h group(P < 0.05.The protein expression of PCNA and SM-α-actin showed a similar trend.Conclusion The current experiment simulates better effects of the hemolytic products on vascular smooth muscle cell after SAH.It also shows that artificial hemorrhage around the common carotid artery could stimulate vascular smooth muscle cell to change from contractile phenotype into synthetic phenotype,and improve it to proliferate.

  3. Diagnosis and Management of Subarachnoid Hemorrhage%蛛网膜下腔出血的诊断和处理

    Institute of Scientific and Technical Information of China (English)

    J. van Gijin

    2004-01-01

    The incidence of subarachnoid hemorrhage (SAH) is stable, at around 6 per 100 000 per annum, but higher in Japan and Finland. Any apparent decrease is attributable to a higher rate of computed tomography (CT) scanning, by which other haemorrhagic conditions are excluded. Most patients are below 60 years of age. Risk factors are similar to those for stroke in general; genetic factors operate in a minority. Case fatality is around 50% overall (including prehospital deaths); one third of survivors remain dependent. Sudden, explosive headache is a cardinal but non-specific feature in the diagnosis of SAH: in general practice the cause is innocuous in 9 out of 10 patients in whom this is the only symptom. CT scanning is mandatory in all, to be followed by (delayed) lumbar puncture if CT is negative. The cause of SAH is a ruptured aneurysm in 85%, non-aneurysmal perimesencephalic hemorrhage (with excellent prognosis) in 10%, and a variety of rare conditions in 5%. Catheter angiography for detecting aneurysms is gradually being replaced by CT or MR angiography. A poor clinical condition on admission may be caused by a remediable complication of the initial bleed or a recurrent hemorrhage: intracranial haematoma, acute hydrocephalus, or global brain ischemia. Occlusion of the aneurysm effectively prevents rebleeding, but there is a dearth of controlled trials assessing the relative benefits of early operation (within three days) versus late operation (day 10-12). Endovascular occlusion is now clearly preferable to operation if the location and structure of the aneurysm make this feasible. Antifibrinolytic drugs reduce the risk of rebleeding but do not improve overall outcome. The risk of delayed cerebral ischemia can be decreased by oral administration of nimodipine; other measures, with some support from observational studies,are a liberal supply of fluids and avoidance of antihypertensive drugs. Once ischemia has occurred treatment regimens such as a combination of

  4. Posterior reversible leukoencephalopathy syndrome presenting in a post-partum, 25-year-old-female with concomitant subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Daniel M Aronovich; Kirsten L Ritchie; Alexander J Scumpia

    2014-01-01

    Hincheyet al., first described that posterior reversible leukoencephalopathy syndrome has having a unique neuroradiographical finding of vasogenic edema and clinical symptoms including headache, altered mental status, seizure and visual disturbances in1996.We present a rare case of posterior reversible leukoencephalopathy syndrome in a2-week, post-partumG2P2A0(normal spontaneous vaginal delivery at forty-weeks, without complications)25-year-old-female with subarachnoid hemorrhage.

  5. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury

    OpenAIRE

    Lauritzen, Martin; Dreier, Jens Peter; Fabricius, Martin; Hartings, Jed A.; Graf, Rudolf; Strong, Anthony John

    2010-01-01

    Cortical spreading depression (CSD) and depolarization waves are associated with dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells, increased energy metabolism and changes in cerebral blood flow (CBF). There is strong clinical and experimental evidence to suggest that CSD is involved in the mechanism of migraine, stroke, subarachnoid hemorrhage and traumatic brain injury. The implications of these findings are widespread and suggest that intrinsic br...

  6. Posterior reversible leukoencephalopathy syndrome presenting in a post-partum, 25-year-old-female with concomitant subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Daniel M. Aronovich

    2014-01-01

    Full Text Available Hinchey et al., first described that posterior reversible leukoencephalopathy syndrome has having a unique neuroradiographical finding of vasogenic edema and clinical symptoms including headache, altered mental status, seizure and visual disturbances in 1996. We present a rare case of posterior reversible leukoencephalopathy syndrome in a 2-week, post-partum G2P2A0 (normal spontaneous vaginal delivery at forty-weeks, without complications 25-year-old-female with subarachnoid hemorrhage.

  7. 非动脉瘤性自发性蛛网膜下腔出血分析%Clinical study on nonaneurysmal subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    王斌; 汤天凤; 黄玉杰; 那世杰; 杨咏波; 孙剑涛

    2012-01-01

    Objective To investigate the clinical characters of nonaneurysmal subarachnoid hemorrhage and compare perimesencephalic nonaneurysmal subarachnoid hemorrhage (PMN SAH) , nonperimesencephalic nonaneurysmal subarachnoid hemorrhage ( nPMN SAH ). Methods Patients with spontaneous SAH, in whom the initial DSA or CTA result was normal, underwent another investigation( CTA/DSA). If the results of both of these were negative,a second CTA/DSA was done after 3 to 4 weeks. Patients in whom even the second DSA failed to reveal an aneurysm or any other vascular abnormality were labeled as nonaneurysmal SAH. Within this group,2 different types were identified as PMN SAH and n-PMN SAH. Results There were 51 patients in whom the results of the first DSA and CTA were both negative. Of 51 patients, an aneurysm was demonstrated at a second CTA/DSA in 4 patients and 6 died before a second DSA could be done. After excluding these, there were 29 patients with PMN SAH and 12 with nPMN SAH. There was no mortality in these patients with a mean follow-up of 2. 3 years,all patients with PMN SAH and 83. 3% of patients with nPMN SAH had a good outcome. Conclusions The nPMN SAH group have a better clinical course and prognosis than those with aneurismal SAH, but not as good as that in the PMN SAH group. A second DSA is mandatory to avoid missing an aneurysm.%目的 总结非动脉瘤性自发性蛛网膜下腔出血的临床特点.方法 自发性SAH患者首次CTA和DSA均未发现动脉瘤和其他血管病变者,3~4周复查CTA或DSA,结果仍为阴性者诊断为非动脉瘤性SAH.分为中脑周围非动脉瘤性蛛网膜下腔出血(PMN)组和非中脑周围非动脉瘤性蛛网膜下腔出血( nPMN)组.结果 51例患者首次CTA和DSA未发现动脉瘤和其他血管病变,其中4例复查CTA或DSA发现动脉瘤,另有6例患者未复查即死亡.诊断为非动脉瘤性蛛网膜下腔出血共41例,其中PMN组29例,nPMN组12例.平均随访2.3年,两组均

  8. Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies. PMID:27443382

  9. Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Dreier, Jens P; Major, Sebastian; Manning, Andrew;

    2009-01-01

    , multicentre study in 13 patients with aneurysmal subarachnoid haemorrhage, using novel subdural opto-electrode technology for simultaneous laser-Doppler flowmetry (LDF) and direct current-electrocorticography, combined with measurements of tissue partial pressure of oxygen (ptiO(2)). Regional cerebral blood....... Thus, oxygen depletion caused by the inverse haemodynamic response may contribute to the establishment of clusters of prolonged CSDs and lesion progression. Combined electrocorticography and perfusion monitoring also revealed a characteristic vascular signature that might be used for non-invasive...

  10. Atypical radiological and intraoperative findings of acute cerebral hemorrhage caused by ruptured cerebral aneurysm in a patient with severe chronic anemia.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Nakagawa, Shunsuke; Kato, Taisei; Kitamura, Takayuki; Sekine, Tetsuro; Takagi, Ryo; Teramoto, Akira

    2014-01-01

    Acute intracerebral hemorrhage (ICH) associated with mild anemia is commonly observed on radiological examination, and there are several reports of ruptured aneurysms occurring with ICH but without accompanying subarachnoid hemorrhage. However, the relationship among computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia has been rarely reported and is poorly understood. Here, we report atypical radiological and intraoperative findings of acute ICH caused by ruptured cerebral aneurysm in a patient with severe chronic anemia. A 64-year-old man with anemia was admitted to our hospital after he experienced left hemiparesis and a disturbance of consciousness. At a referring institution, he showed evidence of macrocytic anemia (white blood cell count, 9,000/μL; red blood cell count, 104×10(4)/μL; hemoglobin, 4.0 g/dL; hematocrit, 12.2%; and platelet count, 26.6×10(4)/μL). Both CT and MRI showed a right frontal ICH. The outer ring of the hematoma appeared as low-density area on CT, a low-intensity area on T1-weighted MRI, and a high-intensity area on T2-weighted MRI with a serous component. The patient received a blood transfusion and underwent surgical removal of the hematoma the following day. The white serous effusion visualized with CT and MRI was identified as a blood clot in the hematoma cavity. The blood that leaks from blood vessels appears as a high-intensity area on CT because it undergoes plasma absorption in a solidification shrinkage process, and is, therefore, concentrated. Although we did not examine the white effusion to determine if serous components were present, we speculated that the effusion may have contained serous components. Therefore, we removed the part of the effusion that appeared as a low-density area on CT. The presence of ICH without subarachnoid hemorrhage suggested the possible adhesion and rupture of a previous

  11. Long-Term Functional Consequences and Ongoing Cerebral Inflammation after Subarachnoid Hemorrhage in the Rat

    Science.gov (United States)

    Kooijman, Elke; Nijboer, Cora H.; van Velthoven, Cindy T. J.; Mol, Wouter; Dijkhuizen, Rick M.; Kesecioglu, Jozef; Heijnen, Cobi J.

    2014-01-01

    Subarachnoid hemorrhage (SAH) represents a considerable health problem with an incidence of 6–7 per 100.000 individuals per year in Western society. We investigated the long-term consequences of SAH on behavior, neuroinflammation and gray- and white-matter damage using an endovascular puncture model in Wistar rats. Rats were divided into a mild or severe SAH group based on their acute neurological score at 24 h post-SAH. The degree of hemorrhage determined in post-mortem brains at 48 h strongly correlated with the acute neurological score. Severe SAH induced increased TNF-α, IL-1β, IL-10, MCP-1, MIP2, CINC-1 mRNA expression and cortical neutrophil influx at 48 h post-insult. Neuroinflammation after SAH was very long-lasting and still present at day 21 as determined by Iba-1 staining (microglia/macrophages) and GFAP (astrocytes). Long-term neuroinflammation was strongly associated with the degree of severity of SAH. Cerebral damage to gray- and white-matter was visualized by immunohistochemistry for MAP2 and MBP at 21 days after SAH. Severe SAH induced significant gray- and white-matter damage. MAP2 loss at day 21 correlated significantly with the acute neurological score determined at 24 h post-SAH. Sensorimotor behavior, determined by the adhesive removal task and von Frey test, was affected after severe SAH at day 21. In conclusion, we are the first to show that SAH induces ongoing cortical inflammation. Moreover, SAH induces mainly cortical long-term brain damage, which is associated with long-term sensorimotor damage. PMID:24603553

  12. Isolated acute nontraumatic cortical subarachnoid hemorrhage: Etiologies based on MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eun; Kang, Myung Jin; Kim, Sang Hyeon [Dept. of Radiology, Dong-A University Medical Center, Busan (Korea, Republic of)

    2016-06-15

    The purpose of this study was to identify common underlying etiologies that may be responsible for isolated acute nontraumatic cortical subarachnoid hemorrhage (cSAH) by analysis of magnetic resonance imaging (MRI) findings of the brain. From August 2005 to February 2014, 15 cSAH patients were admitted to our institution. All patients with cSAH underwent brain MRI and magnetic resonance angiography as a part of their initial evaluation. An analysis of the patients' medical history, clinical presentations, and brain MRI findings was retrospectively performed. Among the combined pathologies that were suspected causes of cSAH, 11 patients showed acute or subacute cerebral infarctions at the ipsilateral hemisphere of cSAH on the diffusion-weighted images. Four of 11 patients had only cerebral infarction, but the other 7 had combined vasculopathy of extra- and intracranial arteries. Four of 15 patients who did not have cerebral infarction, had intracranial artery stenosis, or showed possible cerebral amyloid angiopathy, or no abnormal findings on the brain MRI. Ischemic stroke, such as cerebral infarction or vasculopathy of the extra and intracranial arteries is regarded as a common underlying etiology of the cSAH based on MRI findings.

  13. Sequential changes in cerebral blood flow and outcome in patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    The sequential cerebral blood flow (CBF) and the CBF response to acetazolamide (AZ; 1 g I.V.; cerebrovascular reserve capacity rate (CRCR)) were studied within four days after the initial subarachnoid hemorrhage (SAH) in 42 patients. Stable xenon-enhanced computed tomography (xenon-CT) was used. The mean global CBF of the patients was reduced in accordance with the severity of the neurological grade (Hunt and Kosnik (H-K) grading). In the subacute stage of SAH, the CBF had the tendency to decline in patients with H-K grades I and II. By comparison, in the chronic stage there was an increase in the CBF in all patients. On the other hand, the CBF response to AZ declined in accordance with the severity of neurological grading. The CRCR at the acute phase of SAH was significantly diminished in patients who had a poor outcome as compared to that of individuals who had a good outcome. Questions pertaining to the usefulness of the CBF response to AZ in the acute phase of SAH are being addressed in the present report. (author)

  14. Assay of Serum Sodium Balance Disturbance in Spontaneous Subarachnoid Hemorrhage and Relation to Prognosis of Disease

    Directory of Open Access Journals (Sweden)

    M. Sabouri

    2006-07-01

    Full Text Available Introduction & Objective: Electrolyte disturbances are frequently observed during the acute period after spontaneous subarachnoid hemorrhage (SAH. Hyponatremia and hypernatremia are the most common electrolyte disturbance in acute period of disease, and these disturbances may worsen cerebral edema and mass effect. We performed this study to determine the prognostic significance of serum sodium concentration abnormalities.Materials & Methods: This study was performed as prospective analytic cross sectional in Kashani and Alzahra Hospitals of Isfahan during 2003-2004. The presence of hypernatremia (serum sodium concentration of>145m mol/L and hyponatremia (serum sodium concentration of<135mmol/l was determined with serum sodium measurements at admission and 3, 6 and 9 days after SAH, then the effects of hypernatremia and hyponatremia on three-month outcomes were analyzed after adjustment for age, sex, preexiting HTN , admission GCS score, initial mean arterial pressure and finding of Brain CT Scan and Brain angiography. Patients with symptomatic vasospasm were excluded.Results: The analysis of data showed that from 100 participated patients in this study 18% developed hypernatremia and 42% developed hyponatremria. Hypernatemia was significantly assiociated with poor outcomes compared with hyponatremia (odds ratio, 2.63- CI 95% . Conclusion: Hyponatremia seems to be more common than hypernatremia after SAH. Hypernatrenia after SAH associted with poor outcome and this association is independet of previously identified outcome predictors, including age, sex, admission GCS Score, and X.Ray finding.

  15. CSF and Serum Biomarkers Focusing on Cerebral Vasospasm and Ischemia after Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Carla S. Jung

    2013-01-01

    Full Text Available Delayed cerebral vasospasm (CVS and delayed cerebral ischemia (DCI remain severe complications after subarachnoid hemorrhage (SAH. Although focal changes in cerebral metabolism indicating ischemia are detectable by microdialysis, routinely used biomarkers are missing. We therefore sought to evaluate a panel of possible global markers in serum and cerebrospinal fluid (CSF of patients after SAH. CSF and serum of SAH patients were analyzed retrospectively. In CSF, levels of inhibitory, excitatory, and structural amino acids were detected by high-performance liquid chromatography (HPLC. In serum, neuron-specific enolase (NSE and S100B level were measured and examined in conjunction with CVS and DCI. CVS was detected by arteriography, and ischemic lesions were assessed by computed tomography (CT scans. All CSF amino acids were altered after SAH. CSF glutamate, glutamine, glycine, and histidine were significantly correlated with arteriographic CVS. CSF glutamate and serum S100B were significantly correlated with ischemic events after SAH; however, NSE did not correlate neither with ischemia nor with vasospasm. Glutamate, glutamine, glycine, and histidine might be used in CSF as markers for CVS. Glutamate also indicates ischemia. Serum S100B, but not NSE, is a suitable marker for ischemia. These results need to be validated in larger prospective cohorts.

  16. CSF and Serum Biomarkers Focusing on Cerebral Vasospasm and Ischemia after Subarachnoid Hemorrhage

    Science.gov (United States)

    Jung, Carla S.; Lange, Bettina; Zimmermann, Michael; Seifert, Volker

    2013-01-01

    Delayed cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) remain severe complications after subarachnoid hemorrhage (SAH). Although focal changes in cerebral metabolism indicating ischemia are detectable by microdialysis, routinely used biomarkers are missing. We therefore sought to evaluate a panel of possible global markers in serum and cerebrospinal fluid (CSF) of patients after SAH. CSF and serum of SAH patients were analyzed retrospectively. In CSF, levels of inhibitory, excitatory, and structural amino acids were detected by high-performance liquid chromatography (HPLC). In serum, neuron-specific enolase (NSE) and S100B level were measured and examined in conjunction with CVS and DCI. CVS was detected by arteriography, and ischemic lesions were assessed by computed tomography (CT) scans. All CSF amino acids were altered after SAH. CSF glutamate, glutamine, glycine, and histidine were significantly correlated with arteriographic CVS. CSF glutamate and serum S100B were significantly correlated with ischemic events after SAH; however, NSE did not correlate neither with ischemia nor with vasospasm. Glutamate, glutamine, glycine, and histidine might be used in CSF as markers for CVS. Glutamate also indicates ischemia. Serum S100B, but not NSE, is a suitable marker for ischemia. These results need to be validated in larger prospective cohorts. PMID:23509668

  17. Role of Mitochondrial Calcium Uniporter in Early Brain Injury After Experimental Subarachnoid Hemorrhage.

    Science.gov (United States)

    Yan, Huiying; Zhang, Dingding; Hao, Shuangying; Li, Kuanyu; Hang, Chun-Hua

    2015-12-01

    Previous studies have shown that mitochondrial Ca(2+) is undertaken by mitochondrial calcium uniporter (MCU), and its accumulation is associated with the development of many diseases. However, little was known about the role of MCU in early brain injury (EBI) after subarachnoid hemorrhage (SAH). MCU can be opened by spermine under a physiological condition and inhibited by ruthenium red (RR). Herein, we investigated the effects of RR and spermine to reveal the role of MCU in SAH animal model. The data obtained with biochemical and histological assays showed that mitochondrial Ca(2+) concentration was significantly increased in the temporal cortex of rats 1, 2, and 3 days after SAH, consistent with constant high levels of cellular Ca(2+) concentration. In agreement with the observation in the acute phase, SAH rats showed an obvious increase of reactive oxygen species (ROS) level and decrease of ATP production. Blockage of MCU prevented Ca(2+) accumulation, abated the level of oxidative stress, and improved the energy supply. Translocation of cytochrome c, increased cleaved caspase-3, and a large amount of apoptotic cells after SAH were reversed by RR administration. Surprisingly, exogenous spermine did not increase cellular Ca(2+) concentration, but lessened the Ca(2+) accumulation after SAH to benefit the rats. Taken together, our results demonstrated that blockage of MCU or prevention of Ca(2+) accumulation after SAH is essential in EBI after SAH. These findings suggest that MCU is considered to be a therapeutic target for patients suffering from SAH.

  18. Blockage of mitochondrial calcium uniporter prevents iron accumulation in a model of experimental subarachnoid hemorrhage.

    Science.gov (United States)

    Yan, Huiying; Hao, Shuangying; Sun, Xiaoyan; Zhang, Dingding; Gao, Xin; Yu, Zhuang; Li, Kuanyu; Hang, Chun-Hua

    2015-01-24

    Previous studies have shown that iron accumulation is involved in the pathogenesis of brain injury following subarachnoid hemorrhage (SAH) and chelation of iron reduced mortality and oxidative DNA damage. We previously reported that blockage of mitochondrial calcium uniporter (MCU) provided benefit in the early brain injury after experimental SAH. This study was undertaken to identify whether blockage of MCU could ameliorate iron accumulation-associated brain injury following SAH. Therefore, we used two reagents ruthenium red (RR) and spermine (Sper) to inhibit MCU. Sprague-Dawley (SD) rats were randomly divided into four groups including sham, SAH, SAH+RR, and SAH+Sper. Biochemical analysis and histological assays were performed. The results confirmed the iron accumulation in temporal lobe after SAH. Interestingly, blockage of MCU dramatically reduced the iron accumulation in this area. The mechanism was revealed that inhibition of MCU reversed the down-regulation of iron regulatory protein (IRP) 1/2 and increase of ferritin. Iron-sulfur cluster dependent-aconitase activity was partially conserved when MCU was blocked. In consistence with this and previous report, ROS levels were notably reduced and ATP supply was rescued; levels of cleaved caspase-3 dropped; and integrity of neurons in temporal lobe was protected. Taken together, our results indicated that blockage of MCU could alleviate iron accumulation and the associated injury following SAH. These findings suggest that the alteration of calcium and iron homeostasis be coupled and MCU be considered to be a therapeutic target for patients suffering from SAH.

  19. Prevention and correction of hypocalaemia during systematic hypothermia in patients with aneurismal subarachnoid hemorrhages

    Directory of Open Access Journals (Sweden)

    Dudukina S.

    2013-10-01

    Full Text Available The effectiveness of hypothermia as a method of neuroprotection in brain damage has been proved in many studies, but a large number of complications requires development of further protocols of its management. The article presents experience of treatment of aneurismal subarachnoid hemorrhage under conditions of preventive hypothermia. 84 patients were examined. In 56 of them the efficacy of developed method on prevention and correction of hypocalaemia developed as a result of cold diuresis has been proposed. It has been found that decrease in plasma potassium occurs in parallel with decrease in body temperature regardless the technique of potassium chloride injection. Introduction of potassium chloride solution in physiological dose of 0.2 mmol/kg prevents hypocalaemia development during preventive hypothermia. Injection of potassium chloride in the physiological dose of 0.2 mmol/kg/h and after beginning of patient’s rewarming – 0.8 mmol/kg within the period of one postsurgery day prevents the development of postoperative hypocalaemia in the postoperative period; and after patient’s rewarming– 0.8. mmol/kg within the period of one postoperative day prevents development of postoperative cardiac complications in the perioperative period by 20%.

  20. Neuropeptide Y and vasoactive intestinal peptide in experimental subarachnoid hemorrhage; Immunocytochemistry, radioimmunoassay and pharmacology

    Energy Technology Data Exchange (ETDEWEB)

    Alafaci, C.; Jansen, I. (Department of Experimental Research, Lund University, Malmoe General Hospital (Sweden)); Uddman, R. (Department of Otorhinolaryngology, Lund University, Malmoe General Hospital (Sweden)); Delgado, T.; Svendgaard, N.A. (Department of Neurosurgery, University Hospital, Lund (Sweden)); Edvinsson, L. (Department of Internal Medicine, University Hospital, Lund (Sweden)); Ekman, R. (Department of Psychiatry and Neurochemistry, University Hospital, Lund (Sweden))

    1991-01-01

    The involvement of noradrenaline (NA), neuropeptide Y, (NPY), 5-hydroxytryptamine (5-HT), acetylcholine (ACh) and vasoactive intestinal polypeptide (VIP) has been examined in the late phase of spasm after an experimental subarachnoid hemorrhage (SAH) in a rat model. Immunocytochemistry and radioimmunoassay of blood vessels from the circle of Willis did not show significant differences in NPY- and VIP-like immunoreactivity 2 days post SAH as compared to control vessels. The postjunctional effects of NA, NPY, 5-HT, Ach and VIP were studied two days after SAH using a sensitive in vitro system. NPY induced contractions were significantly (p<0.01) weaker (lower E{sub max}) in SAH as compared to control rats while the relaxant responses to ACh and VIP were slightly increased after SAH. These observations reveal that in a rat model of SAH, with an approximately 20% in vivo constriction at two days, dynamic changes occur in cerebral artery reactivity without any obvious change in sympathetic or parasympathetic perivascular nerve networks. (author).

  1. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage [version 1; referees: 4 approved

    Directory of Open Access Journals (Sweden)

    Liam Flynn

    2015-11-01

    Full Text Available Delayed cerebral ischaemia has been described as the single most important cause of morbidity and mortality in patients who survive the initial aneurysmal subarachnoid haemorrhage. Our understanding of the pathophysiology of delayed cerebral ischaemia is meagre at best and the calcium channel blocker nimodipine remains the only intervention to consistently improve functional outcome after aneurysmal subarachnoid haemorrhage. There is substantial evidence to support cerebral vessel narrowing as a causative factor in delayed cerebral ischaemia, but contemporary research demonstrating improvements in vessel narrowing has failed to show improved functional outcomes. This has encouraged researchers to investigate other potential causes of delayed cerebral ischaemia, such as early brain injury, microthrombosis, and cortical spreading depolarisation. Adherence to a common definition of delayed cerebral ischaemia is needed in order to allow easier assessment of studies using multiple different terms. Furthermore, improved recognition of delayed cerebral ischaemia would not only allow for faster treatment but also better assessment of interventions. Finally, understanding nimodipine’s mechanism of action may allow us to develop similar agents with improved efficacy.

  2. Decorin alleviated chronic hydrocephalus via inhibiting TGF-β1/Smad/CTGF pathway after subarachnoid hemorrhage in rats.

    Science.gov (United States)

    Yan, Hui; Chen, Yujie; Li, Lingyong; Jiang, Jiaode; Wu, Guangyong; Zuo, Yuchun; Zhang, John H; Feng, Hua; Yan, Xiaoxin; Liu, Fei

    2016-01-01

    Chronic hydrocephalus is one of the severe complications after subarachnoid hemorrhage (SAH). However, there is no efficient treatment for the prevention of chronic hydrocephalus, partially due to poor understanding of underlying pathogenesis, subarachnoid fibrosis. Transforming growth factor-β1(TGF-β1) is a potent fibrogenic factor implicated in wide range of fibrotic diseases. To investigate whether decorin, a natural antagonist for TGF-β1, protects against subarachnoid fibrosis and chronic hydrocephalus after SAH, two-hemorrhage-injection SAH model was conducted in 6-week-old rats. Recombinant human decorin(rhDecorin) (30ug/2ul) was administered before blood injection and on the 10th day after SAH. TGF-β1, p-Smad2/3, connective tissue growth factor (CTGF), collagen I and pro-collagen I c-terminal propeptide were assessed via western blotting, enzyme-linked immunosorbent assay, radioimmunoassay and immunofluorescence. And neurobehavioral tests and Morris water maze were employed to evaluate long-term neurological functions after SAH. We found that SAH induced heightened activation of TGF-β1/Smad/CTGF axis, presenting as a two peak response of TGF-β1 in cerebrospinal fluid, elevation of TGF-β1, p-Smad2/3, CTGF, collagen I in brain parenchyma and pro-collagen I c-terminal propeptide in cerebrospinal fluid, and increased lateral ventricle index. rhDecorin treatment effectively inhibited up-regulation of TGF-β1, p-Smad2/3, CTGF, collagen I and pro-collagen I c-terminal propeptide after SAH. Moreover, rhDecorin treatment significantly reduced lateral ventricular index and incidence of chronic hydrocephalus after SAH. Importantly, rhDecorin improved neurocognitive deficits after SAH. In conclusion, rhDecorin suppresses extracellular matrix accumulation and following subarachnoid fibrosis via inhibiting TGF-β1/Smad/CTGF pathway, preventing development of hydrocephalus and attenuating long-term neurocognitive defects after SAH.

  3. Regional cerebral blood flow levels as measured by xenon-CT in vascular territorial low-density areas after subarachnoid hemorrhage are not always ischemic

    Energy Technology Data Exchange (ETDEWEB)

    Fainardi, E. [Arcispedale S. Anna, Neuroradiology Unit, Department of Neurosciences, Ferrara (Italy); Tagliaferri, M.F.; Compagnone, C.; Tanfani, A.; Cocciolo, F.; Targa, L.; Chieregato, A. [Ospedale M. Bufalini, Neurocritical Care Unit, Cesena (Italy); Battaglia, R.; Frattarelli, M. [Ospedale M. Bufalini, Neurosurgery Unit, Cesena (Italy); Pascarella, R. [Ospedale M. Bufalini, Neuroradiology Unit, Cesena (Italy)

    2006-09-15

    The aim of this study was to assess regional cerebral blood flow (rCBV) in areas of CT hypoattenuation appearing in the postoperative period in patients treated for aneurysmal subarachnoid hemorrhage (SAH) using xenon-enhanced CT scanning (Xe-CT). We analyzed 15 patients (5 male and 10 female; mean age 49.7{+-}12.1 years) with SAH on CT performed on admission to hospital and who showed a low-density area within a well-defined vascular territory on CT scans after clipping or coiling of a saccular aneurysm. All zones of hypoattenuation were larger than 1 cm{sup 2} and showed signs of a mass effect suggesting a subacute phase of evolution. Two aneurysms were detected in two patients. Aneurysms were located in the middle cerebral artery (n=7), in the anterior communicating artery (n=6), in the internal carotid artery (n=3), and in the posterior communicating artery (n=1). Treatments were surgical (n=8), endovascular (n=2) or both (n=1). A total of 36 Xe-CT studies were performed and rCBF values were measured in two different regions of interest (ROI): the low-density area, and an area of normal-appearing brain tissue located symmetrically in the contralateral hemisphere. rCBF levels were significantly lower in the low-density area than in the contralateral normal-appearing area (P<0.01). In the low-density areas, irreversible ischemia (CBF <10 ml/100 g per minute) was present in 11/36 lesions (30.6%), ischemic penumbra (CBF 10-20 ml/100 g per minute) and oligemia (CBF 20-34 ml/100 g per minute) in 8/36 lesions (22.2%), relative hyperemia (CBF 34-55 ml/100 g per minute) in 7/36 lesions (19.4%), and absolute hyperemia (CBF >55 ml/100 g per minute) in 2/36 lesions (5.6%). Our study confirmed that rCBF is reduced in new low-density lesions related to specific vascular territories. However, only about one-third of the lesions showed rCBF levels consistent with irreversible ischemia and in a relatively high proportion of lesions, rCBF levels indicated penumbral, oligemic and

  4. Hydrogen Sulfide Ameliorates Early Brain Injury Following Subarachnoid Hemorrhage in Rats.

    Science.gov (United States)

    Cui, Yonghua; Duan, Xiaochun; Li, Haiying; Dang, Baoqi; Yin, Jia; Wang, Yang; Gao, Anju; Yu, Zhengquan; Chen, Gang

    2016-08-01

    Increasing studies have demonstrated the neuroprotective effect of hydrogen sulfide (H2S) in central nervous system (CNS) diseases. However, the potential application value of H2S in the therapy of subarachnoid hemorrhage (SAH) is still not well known. This study was to investigate the potential effect of H2S on early brain injury (EBI) induced by SAH and explore the underlying mechanisms. The role of sodium hydrosulfide (NaHS), a donor of H2S, in SAH-induced EBI, was investigated in both in vivo and in vitro. A prechiasmatic cistern single injection model was used to produce experimental SAH in vivo. In vitro, cultured primary rat cortical neurons and human umbilical vein endothelial cells (HUVECs) were exposed to OxyHb at concentration of 10 μM to mimic SAH. Endogenous production of H2S in the brain was significantly inhibited by SAH. The protein levels of the predominant H2S-generating enzymes in the brain, including cystathionineb-synthase (CBS) and 3-mercaptopyruvate sulfur transferase (3MST), were also correspondingly reduced by SAH, while treatment with NaHS restored H2S production and the expressions of CBS and 3MST. More importantly, NaHS treatment could significantly attenuate EBI (including brain edema, blood-brain barrier disruption, brain cell apoptosis, inflammatory response, and cerebral vasospasm) after SAH. In vitro, H2S protects neurons and endothelial function by functioning as an antioxidant and antiapoptotic mediator. Our results suggest that NaSH as an exogenous H2S donor could significantly reduce EBI induced by SAH.

  5. Angiopoietin-1 is associated with cerebral vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Pfausler Bettina

    2011-05-01

    Full Text Available Abstract Background Angiopoietin-1 (Ang-1 and -2 (Ang-2 are keyplayers in the regulation of endothelial homeostasis and vascular proliferation. Angiopoietins may play an important role in the pathophysiology of cerebral vasospasm (CVS. Ang-1 and Ang-2 have not been investigated in this regard so far. Methods 20 patients with subarachnoid hemorrhage (SAH and 20 healthy controls (HC were included in this prospective study. Blood samples were collected from days 1 to 7 and every other day thereafter. Ang-1 and Ang-2 were measured in serum samples using commercially available enzyme-linked immunosorbent assay. Transcranial Doppler sonography was performed to monitor the occurrence of cerebral vasospasm. Results SAH patients showed a significant drop of Ang-1 levels on day 2 and 3 post SAH compared to baseline and HC. Patients, who developed Doppler sonographic CVS, showed significantly lower levels of Ang-1 with a sustained decrease in contrast to patients without Doppler sonographic CVS, whose Ang-1 levels recovered in the later course of the disease. In patients developing cerebral ischemia attributable to vasospasm significantly lower Ang-1 levels have already been observed on the day of admission. Differences of Ang-2 between SAH patients and HC or patients with and without Doppler sonographic CVS were not statistically significant. Conclusions Ang-1, but not Ang-2, is significantly altered in patients suffering from SAH and especially in those experiencing CVS and cerebral ischemia. The loss of vascular integrity, regulated by Ang-1, might be in part responsible for the development of cerebral vasospasm and subsequent cerebral ischemia.

  6. Blockage of mitochondrial calcium uniporter prevents iron accumulation in a model of experimental subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Highlights: • Iron accumulation was involved in the acute phase following SAH. • Blockage of MCU could attenuate cellular iron accumulation following SAH. • Blockage of MCU could decrease ROS generation and improve cell energy supply following SAH. • Blockage of MCU could alleviate apoptosis and brain injury following SAH. - Abstract: Previous studies have shown that iron accumulation is involved in the pathogenesis of brain injury following subarachnoid hemorrhage (SAH) and chelation of iron reduced mortality and oxidative DNA damage. We previously reported that blockage of mitochondrial calcium uniporter (MCU) provided benefit in the early brain injury after experimental SAH. This study was undertaken to identify whether blockage of MCU could ameliorate iron accumulation-associated brain injury following SAH. Therefore, we used two reagents ruthenium red (RR) and spermine (Sper) to inhibit MCU. Sprague–Dawley (SD) rats were randomly divided into four groups including sham, SAH, SAH + RR, and SAH + Sper. Biochemical analysis and histological assays were performed. The results confirmed the iron accumulation in temporal lobe after SAH. Interestingly, blockage of MCU dramatically reduced the iron accumulation in this area. The mechanism was revealed that inhibition of MCU reversed the down-regulation of iron regulatory protein (IRP) 1/2 and increase of ferritin. Iron–sulfur cluster dependent-aconitase activity was partially conserved when MCU was blocked. In consistence with this and previous report, ROS levels were notably reduced and ATP supply was rescued; levels of cleaved caspase-3 dropped; and integrity of neurons in temporal lobe was protected. Taken together, our results indicated that blockage of MCU could alleviate iron accumulation and the associated injury following SAH. These findings suggest that the alteration of calcium and iron homeostasis be coupled and MCU be considered to be a therapeutic target for patients suffering from SAH

  7. Effect of the drainage of cerebrospinal fluid in patients with aneurismal subarachnoid hemorrhage

    Science.gov (United States)

    Qian, Cong; Yu, Xiaobo; Chen, Jingyin; Gu, Chi; Wang, Lin; Chen, Gao; Dai, Yuying

    2016-01-01

    Abstract Background and objectives: Vasospasm-related injury such as delayed ischemic neurological defect (DIND) or cerebral infarction is an important prognostic factor for aneurismal subarachnoid hemorrhage (SAH). Whether cerebrospinal fluid (CSF) drainage can achieve a better outcome in aneurismal SAH patients after coiling or clipping remains the subject of debate. Here, we report a meta-analysis of the related available literature to assess the effect of continuous CSF drainage on clinical outcomes in patients with aneurismal SAH. Methods: Case-control studies regarding the association between aneurismal SAH and CSF drainage were systematically identified through online databases (PubMed, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated. Alternatively, the random-effects model was utilized. Results: This meta-analysis included 11 studies. Continuous CSF drainage obviously improved patients’ long-term outcome (odds ratio [OR] of 2.86, 95% confidence interval [CI], 1.37–5.98, P hydrocephalus (SDHC) prevention (OR of 1.04, 95% CI, 0.52–2.07, P = 0.91). Further analysis on lumbar drainage (LD) and external ventricular drainage (EVD) indicated that LD had a better outcome (OR of 3.11, 95% CI, 1.18–8.23, P = 0.02), whereas no significant difference in vasospasm-related injury was detected between the groups (OR of 1.13, 95% CI, 0.54–2.37, P = 0.75). Conclusion: Continuous CSF drainage is an effective treatment for aneurismal SAH patients; lumbar drainage showed lower complications, but more well-designed studies are required to verify and consolidate this conclusion. PMID:27741143

  8. Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: a single-center experience

    Science.gov (United States)

    2012-01-01

    Background Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting syndrome is a common complication in patients with subarachnoid hemorrhage (SAH). The efficacy and safety of urea as treatment for SIADH-induced hyponatremia has not been reported in this population. Methods This is a retrospective analysis of all patients admitted to our department for nontraumatic SAH between January 2003 and December 2008 (n = 368). All patients with SIADH-induced hyponatremia (plasma sodium  20 mEq/L, and osmolality > 200 mOsm/kg; absence of overt dehydration or hypovolemia; no peripheral edema or renal failure; no history of adrenal or thyroid disease) routinely received urea per os when hyponatremia was associated with clinical deterioration or remained less than 130 mEq/L despite saline solution administration. Results Forty-two patients developed SIADH and were treated with urea. Urea was started after a median of 7 (IQR, 5–10) days and given orally at doses of 15–30 g tid or qid for a median of 5 (IQR, 3–7) days. The median plasma sodium increase over the first day of treatment was 3 (IQR, 1–6) mEq/L. Hyponatremia was corrected in all patients, with median times to Na+ >130 and >135 mEq/L of 1 (IQR, 1–2) and 3 (IQR, 2–4) days, respectively. Urea was well tolerated, and no adverse effects were reported. Conclusions Oral urea is an effective and well-tolerated treatment for SIADH-induced hyponatremia in SAH patients. PMID:22647340

  9. Blockage of mitochondrial calcium uniporter prevents iron accumulation in a model of experimental subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Huiying [Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province (China); Hao, Shuangying; Sun, Xiaoyan [Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, 22 Hankou Road, Nanjing 210093, Jiangsu Province (China); Zhang, Dingding; Gao, Xin; Yu, Zhuang [Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province (China); Li, Kuanyu, E-mail: likuanyu@nju.edu.cn [Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, 22 Hankou Road, Nanjing 210093, Jiangsu Province (China); Hang, Chun-Hua, E-mail: hang_neurosurgery@163.com [Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province (China)

    2015-01-24

    Highlights: • Iron accumulation was involved in the acute phase following SAH. • Blockage of MCU could attenuate cellular iron accumulation following SAH. • Blockage of MCU could decrease ROS generation and improve cell energy supply following SAH. • Blockage of MCU could alleviate apoptosis and brain injury following SAH. - Abstract: Previous studies have shown that iron accumulation is involved in the pathogenesis of brain injury following subarachnoid hemorrhage (SAH) and chelation of iron reduced mortality and oxidative DNA damage. We previously reported that blockage of mitochondrial calcium uniporter (MCU) provided benefit in the early brain injury after experimental SAH. This study was undertaken to identify whether blockage of MCU could ameliorate iron accumulation-associated brain injury following SAH. Therefore, we used two reagents ruthenium red (RR) and spermine (Sper) to inhibit MCU. Sprague–Dawley (SD) rats were randomly divided into four groups including sham, SAH, SAH + RR, and SAH + Sper. Biochemical analysis and histological assays were performed. The results confirmed the iron accumulation in temporal lobe after SAH. Interestingly, blockage of MCU dramatically reduced the iron accumulation in this area. The mechanism was revealed that inhibition of MCU reversed the down-regulation of iron regulatory protein (IRP) 1/2 and increase of ferritin. Iron–sulfur cluster dependent-aconitase activity was partially conserved when MCU was blocked. In consistence with this and previous report, ROS levels were notably reduced and ATP supply was rescued; levels of cleaved caspase-3 dropped; and integrity of neurons in temporal lobe was protected. Taken together, our results indicated that blockage of MCU could alleviate iron accumulation and the associated injury following SAH. These findings suggest that the alteration of calcium and iron homeostasis be coupled and MCU be considered to be a therapeutic target for patients suffering from SAH.

  10. Identification of blood-brain barrier function following subarachnoid hemorrhage in rats at different stages

    Institute of Scientific and Technical Information of China (English)

    Zongyi Xie; Weiwei Shen; Ying Ma; Yuan Cheng

    2008-01-01

    BACKGROUND: Recent studies have indicated that blood-brain barrier (BBB) disruption following subarachnoid hemorrhage (SAH) significantly correlates with the development of brain injury and poor prognosis of patients subjected to SAH. OBJECTIVE: To investigate both functional and structural changes related to BBB in various phases after SAH in rats through quantitative and qualitative methods.DESIGN, TIME AND SETTING: This experiment, a completely randomized design and controlled experiment, was performed at the Department of Neurosurgery, the Second Affiliated Hospital of Chongqing University of Medical Sciences from June 2006 to March 2007.MATERIALS: A total of 128 female, healthy, Sprague-Dawley rats were selected for this study. Main reagents and instruments: Evans Blue dye (Sigma Company, USA), fluorescence spectrophotometer (Shimadzu Company, Japan), and transmission electron microscope (Olympus Company, Japan). MAIN OUTCOME MEASURES: Brain tissue water content was determined by the wet-dry method. BBB permeability in the cerebral cortex was determined by Evans Blue dye and fluorescent spectrophotometer. The ultrastructural changes in BBB were observed with transmission electron microscope.RESULTS: Compared with the sham-operated group, SAH induced a significant increase in brain water content between 24 and 60 hours (F = 888.32, P 0.05). Electron microscopy demonstrated only a mild perivascular edema at 24 hours after SAH. By 36 hours, a notable perivascular edema was associated with a collapse of the capillary. Astrocytic endfeet surrounding the capillary were prominently swollen in the edematous areas. The above-mentioned abnormal ultrastructural changes in the BBB were reversed by 72 hours after SAH. No obvious morphological changes in the BBB were detected in the sham-operated rats.CONCLUSION: These results directly suggest that SAH could induce rapid changes in BBB function and structure during the acute phases of BBB breakdown. Moreover, these dynamic

  11. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

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    Sneade Mary

    2010-09-01

    Full Text Available Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT, a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS at two months after aSAH. Our final model was validated internally with bootstrapping techniques. Results The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%. Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65, with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64. Conclusion We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. Trial Registration International Standard Randomised Controlled Trial, Number ISRCTN49866681

  12. Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome.

    Directory of Open Access Journals (Sweden)

    Gian Marco De Marchis

    Full Text Available OBJECTIVE: Tonic-clonic activity (TCA at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH. The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months. METHODS: Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses. RESULTS: TCA at onset was described in 170 patients (11%. Patients with onset TCA were younger (P = 0.002, presented more often with poor clinical grade (55% vs. 26%, P<0.001 and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001. After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43-5.96, P<0.001, in-hospital pneumonia (OR 1.56, 95%-CI: 1.06-2.31, p = 0.02, and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21-2.58, P = 0.003. At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume. CONCLUSIONS: Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months.

  13. Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review

    Directory of Open Access Journals (Sweden)

    Benjamin W. Y. Lo

    2015-01-01

    Conclusions: This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.

  14. Brainstem hemorrhage following clipping of anterior communicating aneurysm: Is lumbar drain responsible?

    Directory of Open Access Journals (Sweden)

    Arindom Kakati

    2012-01-01

    Full Text Available Remote brainstem hemorrhage is an extremely rare complication following supratentorial surgery. We describe here a 55-year-old patient with ruptured anterior communicating artery aneurysm, who underwent an uneventful clipping of the aneurysm, and had a lumbar drainage intra-operatively to facilitate brain relaxation. In the postoperative period, he developed pontomesencephalic hemorrhage, and had a fatal outcome. The potential causative factors are discussed, and the relevant literature reviewed. This is probably the first reported case of this complication in the literature.

  15. Cerebrovascular ETB, 5-HT1B, and AT1 receptor upregulation correlates with reduction in regional CBF after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Ansar, Saema; Vikman, Petter; Nielsen, Marianne;

    2007-01-01

    We hypothesize that cerebral ischemia leads to enhanced expression of endothelin (ET), 5-hydroxytryptamine (5-HT), and angiotensin II (ANG II) receptors in the vascular smooth muscle cells. Our aim is to correlate the upregulation of cerebrovascular receptors and the underlying molecular mechanisms...... with the reduction in regional and global cerebral blood flow (CBF) after subarachnoid hemorrhage (SAH). SAH was induced by injecting 250 microl blood into the prechiasmatic cistern in rats. The cerebral arteries were removed 0, 1, 3, 6, 12, 24, and 48 h after the SAH for functional and molecular studies...

  16. Endovascular treatment of an adolescent patient with ruptured intracranial aneurysm

    International Nuclear Information System (INIS)

    The occurrence of intracranial aneurysms in pediatric patients under 18 years of age is between 0,5-2% of all diagnosed aneurysms. We describe our experience with a patient of 10 years old with subarachnoid hemorrhage due to ruptured trilobular aneurysm on the top of the basilar artery, evidenced by CT angiography and DSA. Powered been consistently excluded from the bloodstream of two lobules of the aneurysm through coiling. Changed conditions of hemodynamics in aneurysmal sac fed to subsequent selftrombosing the third lobe of the aneurysm. Made control angiography after 10 months confirmed the good result of endovascular treatment and no neurological deficit. In conclusion it can be noted that in present conditions with a multidisciplinary approach endovascular treatment can be applied in this group of patients. (authors) Key words: SUBARACHNOID HEMORRHAGIA. CEREBRAL VESSEL ANEURYSM. BASILAR CEREBRAL ARTERY. COIL EMBOLIZATION

  17. Subarachnoid Hemorrhage during Pregnancy:A Case Report%妊娠期蛛網膜下腔出血1例

    Institute of Scientific and Technical Information of China (English)

    李雁; 駱一凡

    2001-01-01

    妊娠期發生蛛網膜下腔出血是很罕見但是一極嚴重的疾病,母親的死亡率很高.本文報告一例為42歲的孕婦,懷孕31週,持續性劇烈地頸痛伴多次嘔吐,CT檢查顯示蛛網膜下腔出血,臨床發現病人雙側瞳孔不等大,同時伴有頻繁的子宮收縮預示先兆早産,為保母兒的安全,先採用積極的保守治療穩定病情,同時使用皮質激素促進胎兒肺成熟,並於三個星期後行剖宮産術取出一健康嬰兒.稍後該産婦進行腦血管造影顯示顱內有一血管瘤,並行左側頸內動脈血管瘤栓塞術.術後病人恢複良好.妊娠期發生蛛網膜下腔出血常用外科手術治療,但在條件許可的情況下,盡可能採用創傷性低、安全有效的腦血管栓塞術來治療先天性腦血管瘤.%Subarachnoid hemorrhage (SAH) is a rare occurrence during pregnancy but often catastrophic,maternal mortality is high, and the primary approach is surgical. This is a 42-year-old multipara with severe headache and persistent frequent vomiting presented at 31 weeks' gestation, subarachnoid hemorrhage was found. She underwent a cesarean delivery with a health boy. Cerebral angiography revealed an aneurysm located at left carotic artery and angiographic embolization was done successfully. After that she was completely recover. Conclusion: Urgent surgical management for SAH during pregnancy is indicated, but sometimes conservative therapy is considered until the patient's situation is stable. Angiographic embolization is an alternate approach.

  18. Mycotic brain aneurysm and cerebral hemorrhagic stroke: a pediatric case report.

    Science.gov (United States)

    Flor-de-Lima, Filipa; Lisboa, Lurdes; Sarmento, António; Almeida, Jorge; Mota, Teresa

    2013-09-01

    Endocarditis due to Abiotrophia spp. is rare and often associated with negative blood cultures, infection relapse, and high rates of treatment failure and mortality (Lainscak et al., J Heart Valve Dis 14(1):33-36, 2005). The authors describe a case of an adolescent with cerebral hemorrhagic stroke due to mycotic brain aneurysm rupture.

  19. Functional response of cerebral blood flow induced by somatosensory stimulation in rats with subarachnoid hemorrhage

    Science.gov (United States)

    Li, Zhiguo; Huang, Qin; Liu, Peng; Li, Pengcheng; Ma, Lianting; Lu, Jinling

    2015-09-01

    Subarachnoid hemorrhage (SAH) is often accompanied by cerebral vasospasm (CVS), which is the phenomenon of narrowing of large cerebral arteries, and then can produce delayed ischemic neurological deficit (DIND) such as lateralized sensory dysfunction. CVS was regarded as a major contributor to DIND in patients with SAH. However, therapy for preventing vasospasm after SAH to improve the outcomes may not work all the time. It is important to find answers to the relationship between CVS and DIND after SAH. How local cerebral blood flow (CBF) is regulated during functional activation after SAH still remains poorly understood, whereas, the regulation of CBF may play an important role in weakening the impact of CVS on cortex function. Therefore, it is worthwhile to evaluate the functional response of CBF in the activated cortex in an SAH animal model. Most evaluation of the effect of SAH is presently carried out by neurological behavioral scales. The functional imaging of cortical activation during sensory stimulation may help to reflect the function of the somatosensory cortex more locally than the behavioral scales do. We investigated the functional response of CBF in the somatosensory cortex induced by an electrical stimulation to contralateral forepaw via laser speckle imaging in a rat SAH model. Nineteen Sprague-Dawley rats from two groups (control group, n=10 and SAH group, n=9) were studied. SAH was induced in rats by double injection of autologous blood into the cisterna magna after CSF aspiration. The same surgical procedure was applied in the control group without CSF aspiration or blood injection. Significant CVS was found in the SAH group. Meanwhile, we observed a delayed peak of CBF response in rats with SAH compared with those in the control group, whereas no significant difference was found in magnitude, duration, and areas under curve of relative CBF changes between the two groups. The results suggest that the regulation function of local CBF during

  20. Clinical utility of multislice computed tomographic angiography for detection of cerebral vasospasm in acute subarachnoid hemorrhage.

    Science.gov (United States)

    Joo, S P; Kim, T S; Kim, Y S; Moon, K S; Lee, J K; Kim, J H; Kim, S H

    2006-10-01

    Digital subtraction angiography (DSA) has been used as the standard method for detecting cerebral vasospasm after subarachnoid hemorrhage (SAH). Multislice computed tomographic angiography (CTA) is a relatively recent method used for evaluating the vasculature of the intracranial arteries. The purpose of this study was to compare multislice CTA and DSA for the detection and quantification of cerebral vasospasm after SAH, and to analyze the usefulness of multislice CTA. Eight patients with SAH underwent initial CTA with DSA within 72 hours after the onset of symptoms and follow-up multislice CTA and DSA 8 to 48 days after SAH. Five arterial locations were established in the A1 and A2 segments of the anterior cerebral artery, the M1 and M2 segments of the middle cerebral artery and the posterior cerebral artery (PCA) on both multislice CTA and DSA images. Vasospasm was classified as none, mild (up to 30% reduction in luminal diameter), moderate (31-60% reduction), and marked (at least 60% reduction) using the scale of Schneck and Kricheff. The multislice CT system used the following parameters: 1.25 mm collimation and 3.75 pitch with a 4-channel system. The degree of vasospasm revealed by the multislice CTA was significantly correlated with the degree of vasospasm revealed by DSA. In general, most discrepancies between CTA and DSA were in the detection of mild and moderate vasospasm. We found that the consistency between multislice CTA and DSA was greater for mild (100%, n=3) or moderate (100%, n=3) vasospasm than none (n=1) or marked vasospasm (n=1). However, it was unclear whether multislice CTA was more specific for a proximal location (A1, M1, PCA) or distal location (A2, M2) for evaluation of cerebral arteries. Multislice CTA can detect angiographic vasospasm after SAH with an accuracy similar to that of DSA. Multislice CTA is highly sensitive, specific and accurate in detecting mild and moderate cerebral vasospasm. It is less accurate for detecting no vasospasm

  1. Early change of plasma and cerebrospinal fluid arginine vasopressin in traumatic subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    YUAN Zhi-hua; ZHU Jian-yong; HUANG Wei-dong; JIANG Jiu-kun; LU Yuan-qiang; XU Miao; SU Wei; JIANG Ting-ying

    2010-01-01

    Objective:To investigate the changes and effects of arginine vasopressin(AVP)in patients with acute traumatic subarachnoid hemorrhage(tSAH).Methods:The plasma and cerebrospinal fluid(CSF)level of AVP,and intracraniai pressure(ICP)were measured in a total of 21 patients within 24 hours after tSAH.The neurological status of the patients was evaluated by Glasgow Coma Scale(GCS).Correlation between AVP and ICP,CrCS was analyzed respectively.Meanwhile,18 healthy volunteers were recruited as control group.Results:Compared with control group,the levels(pg/ml)of AVP in plasma and CSF((x)±s)in tSAH group were significantly increased within 24 hours(38.72±24.71 vs 4.54±1.38and 34.61±21.43 vs 4.13±1.26,P<0.01),and was remarkably higher in GCS≤8 group than GCS>8 group(50.96±36.81 vs 25.26±12.87 and 44.68±31.72 vs 23.53±10.94,P<0.05).The CSF AVP level was correlated with ICP(r= 0.46,P<0.05),but no statistically significant correlation was found between plasma AVP,CSF AVP and initial GCS(r=-0.29,P>0.05 and r=-0.32,P>0.05,respectively).The ICP(mm Hg)in tSAH patients was elevated and higher in GCS≤8 group than in GCS>8 group(25.9±9.7 vs 17.6±5.2,P<0.05=.Conclusion:Our research suggests that AVP is correlated with the severity of tSAH,and may be involved in the pathophysiological process of brain damage in the early stage after tSAH.It seems that compared with the plasma AVP concentration,CSF AVP is more related to the severity of tSAH.

  2. Neuroprotective effects of edaravone on early brain injury in rats after subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    GAO Yang; DING Xin-sheng; XU Shu; WANG Wei; ZUO Qi-long; KUAI Feng

    2009-01-01

    Background The underlying mechanism of early neurobiological impairment after subarachnoid hemorrhage (SAH) is not well understood,but the system of reactive oxygen superoxide (ROS) might be involved.Edaravone (MC1-186),a potent free radical scavenger that prevents apoptosis of neurons,was thus used in this study to see its possible therapeutic effect in early brain injury due to SAH in a rat model.Methods One hundred and twenty male Sprague-Dawley rats were randomly assigned to four groups:group 1,control rats receiving sham operation only;group 2,rats with SAH treated by saline;group 3,rats with SAH treated with 1 mg/kg MCI-186 injected intraperitoneally;and group 4,rats with SAH treated with 3 mg/kg MC1-186.Treated with either saline or MC1-186 twice daily for two consecutive days after SAH,the rats were sacrificed for measurements of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) and histological analysis of caspase-3 protein by Western blotting and immunohistochemical staining.In addition,mortality and neurological scores were statistically analyzed by the chi-square test and Dunn's procedure respectively for each group.One-way analysis of variance followed by the Tukey's procedure was also used in data analysis.Results The rats in group 2 that received saline only showed neurological impairment as well as elevated mortality,and were found to have significantly increased levels of MDA and caspase-3,but reduced SOD activities in brain tissues (P<0.05).When treated with MC1-186 at two different dosages,the rats in groups 3 and 4 had markedly decreased levels of MDA and caspase-3 but increased SOD activities in the brain tissue (P<0.05),along with improved scores of neurological evaluation (P<0.05).Conclusions This study sheds some lights on the therapy of SAH-induced early brain injury by providing the promising data indicating that MC1-186,a radical scavenger,can efficiently diminish apoptosis of neurons and thus prevent the function

  3. Alterations in amyloid beta-protein and apolipoprotein E in cerebrospinal fluid after subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Xinzhong Wen; Yonghong Zhang; Leiming Huo

    2007-01-01

    BACKGROUND: The findings about the alterations in cerebrospinal fluid beta-amyloid protein (Aβ) and apolipoprotein E (ApoE) after subarachnoid hemorrhage indicate that they have significant correlation with prognosis of patients.OBJECTIVE: To observe the alterations in cerebrospinal fluid Aβ and ApoE after subarachnoid hemorrhage (SAH).DESIGN: Contrast observation.SETTING: Department of Neurosurgery, the First Hospital of Lanzhou University.PARTICIPANTS: A total of 25 SAH patients including 16 males and 9 females aged from 13 to 72 years were selected form Department of Neurosurgery, the First Affiliated Hospital of Lanzhou University from October 2003 to February 2004. The Hunt-Hess grade ranged from Ⅰ to Ⅳ, and patients admitted hospital in 24 hours after invasion, affirmed by the brain CT scan and lumbar vertebra puncture, no other severe complications and important organs' functional defect and severe infection, no hematological system disease.METHODS: All admitted patients were collected CSF by lumbar vertebra puncture in 24 hours. The cerebrospinal fluid (CSF) of control group came from the admitted 15 patients of our hospital that have no nervous system disease. Aβ content was detected by enzyme linked immunosorbent assay (ELISA), the kit was provided by the Central Laboratory of the First Hospital of Lanzhou University; ApoE concentration was detected by monoclone enzyme linked immunosorbent assay (ELISA), the kit was provided by the Immunotechnique Research Institute of the Fourth Military Medical University. S100B concentration was detected by enzyme linked immunosorbent assay double antibody sandwich method, the kit was provided by the Physiological Research Room of the Fourth Military Medical University. The data were indicated on Mean±SD and were analyzed by SPSS 10.0 statistical package. All data were handled through test of significance variance analysis, and groups were compared through independent sampler t test. The concentration was

  4. Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage : A pooled data meta-analysis. A systematic review

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Groen, Rob J. M.; Foumani, Mahrouz; Uyttenboogaart, Maarten; Eshghi, Omid S.; Metzemaekers, Jan D. M.; Lammers, Natasja; Luijckx, Gert-Jan; Van Dijk, J.M.C.

    2014-01-01

    Object. A repeat digital subtraction angiography (DSA) study of the cranial vasculature is routinely performed in patients with diffuse nonperimesencephalic subarachnoid hemorrhage (SAH) after negative baseline CT angiography (CTA) and DSA studies. However, DSA carries a low but substantial risk of

  5. Long-term mortality and vascular event risk after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Wermer, M. J. H.; Greebe, P.; Algra, A.; Rinkel, G. J. E.

    2009-01-01

    Background: Patients with a history of subarachnoid haemorrhage (SAH) may be at risk for vascular events and excess mortality. Methods: We interviewed 752 patients ( mean age 50 years, 67% women, mean follow-up 8.1 years) clipped between 1985 and 2001 after SAH who had been discharged home or to a r

  6. Endovascular Treatment of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm during Pregnancy

    OpenAIRE

    Kim, Ki Dae; Chang, Chul Hoon; Choi, Byung Yon; Jung, Young Jin

    2014-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is quite rare, however it has a high maternal mortality rate. A pregnant woman in the 16th gestational week was admitted to our hospital with a drowsy level of consciousness. A brain magnetic resonance (MR) image showed hemorrhage on the prepontine cistern, and both sylvian fissures, and MR angiography and cerebral digital subtraction angiography demonstrated an aneurysm at the left posterior inferior cerebellar artery (PICA). We perfo...

  7. Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature.

    Science.gov (United States)

    Nieuwkamp, D J; de Gans, K; Rinkel, G J; Algra, A

    2000-02-01

    Severe intraventricular hemorrhage caused by extension from subarachnoid hemorrhage or intracerebral hemorrhage leads to hydrocephalus and often to poor outcome. We conducted a systematic review to compare conservative treatment, extraventricular drainage, and extraventricular drainage combined with fibrinolysis. We carried out a search in Medline of the literature between January 1966 and December 1998 and an additional hand-search from January 1990 to December 1998. Pharmaceutical companies were contacted to gather unpublished data. We reviewed the reference lists of all relevant articles. Two authors independently assessed eligibility of the studies and extracted data on characteristics of study design, patients, and treatment. Patients with primary intraventricular hemorrhage were excluded. Main outcome measures were death and poor outcome (defined as death or dependency) at the end of follow-up. No randomized clinical trial has yet been conducted so far, and we therefore reviewed only observational studies. The case fatality rate for conservative treatment (ten studies) was 78%. For extraventricular drainage (seven studies) it was 58% [relative risk versus conservative treatment (RR) 0.74; 95% confidence interval (CI) 0.55-0.99]. For extraventricular drainage with fibrinolytic agents (five studies) the case fatality rate was 6% (RR 0.08; 95% CI 0.02-0.24). The poor outcome rate for conservative treatment was 90%, that for extraventricular drainage 89% (RR 0.98; 95% CI 0.75-1.30) and that for extraventricular drainage with fibrinolytic agents 34% (RR 0.38; 95% CI 0.21-0.68). All RR values remained essentially the same after adjusting for age, sex, World Federation of Neurological Surgeons scale, study design, and year of publication for the studies that provided these data. Outcome is thus poor in patients with intraventricular extension of subarachnoid or intracerebral hemorrhage. This meta-analysis suggests that treatment with ventricular drainage combined

  8. Effect of ecdysterone on the nervous lesions of rabbits acquired after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Zhi LIU

    2011-12-01

    Full Text Available Objective The present study aims to probe into the effect and mechanism of ecdysterone(EDS on rabbit brains after suffering subarachnoid hemorrhage(SAH.Methods A total of 18 male Japanese rabbits,aged 6 months to 9 months and weighing 2.2 kg to 3.4 kg,were randomly divided into three groups.Each group,namely,the Sham operation control(L,SAH,and EDS groups,had six rabbits.The SAH group was treated using the quadric cisterna magna blood injection method followed by the ligation of the right common carotid artery,whereas the EDS group was treated with EDS intravenously(3 mg/kg,4 times/day,12 times in all.The changes in the neurological function of the animals in each group were observed using the Strong neurological score.Then,the animals were killed after three days to measure their brain water contents.The changes in the hippocampal tissue structure and in the Bax and Bcl-2 expressions in the hippocampal tissue were observed using HE and immunohistochemistry staining,respectively.The apoptosis of the hippocampal neuron was also observed by TUNEL staining.Finally,PCR and Western blot analysis were adopted to observe the PI3K mRNA and protein expression in the hippocampus.Results The neurological scores of the SAH group for the first three days after modeling were 6.00±1.79,8.00±1.90,and 8.00±2.37,respectively,whereas those for the EDS/SAH group were 4.16±0.75,5.17±0.75,and 4.83±1.17.The neurological functions of the rabbits in the EDS group(P < 0.05 two to three days after treatment were evidently better than those in the SAH group(P < 0.01.The brain water contents in the SAH group(78.6%±0.5% were higher than those in the L group(77.7%±0.4%,P < 0.01,whereas the brain water contents in the EDS group after treatment(78.1%±0.5% were significantly lower than those in the SAH group(P < 0.05.HE staining revealed that the neurons in the hippocampal CA1 regions of the rabbits in the SAH group were disorganized due to cell pycnosis and

  9. Retrospective analysis of the prevalence of asymptomatic cerebral aneurysm in 4518 patients undergoing magnetic resonance angiography. When does cerebral aneurysm develop?

    Energy Technology Data Exchange (ETDEWEB)

    Horikoshi, Toru; Yamagata, Zentaro; Nukui, Hideaki [Yamanashi Medical Univ., Tamaho (Japan); Akiyama, Iwao [Akiyama Neurosurgical Clinic, Nirasaki, Yamanashi (Japan)

    2002-03-01

    The natural history of cerebral aneurysms was investigated by measuring the prevalence of incidentally found unruptured aneurysms in the general population and evaluating the characteristics including risk factors. 'De novo' formation of aneurysm was also demographically estimated. The prevalence of incidental aneurysm was evaluated among 4518 patients who underwent magnetic resonance (MR) angiography for various reasons in a neurosurgical institute. Double the number of patients were randomly selected from the remaining patients without aneurysm as the Control group so that sex and age group were matched to the Aneurysm group. One hundred twenty seven patients (2.8%) had diagnoses of aneurysm. The prevalence of asymptomatic aneurysm among middle-aged and elderly patients were predominant in women and increased with age in both sexes. Patients with aneurysms had significantly more hypertension and family history of subarachnoid hemorrhage compared to the controls. The prevalence was markedly increased in the 8th decade in men and the 7th decade in women, and new aneurysms seemed to develop predominantly around these decades. Cerebral aneurysms become detectable on MR angiography in the middle or later decades, and women tend to develop aneurysm earlier than men. Hypertension and family history of subarachnoid hemorrhage are probably risk factors for the development of aneurysm. (author)

  10. The “focus on aneurysm” principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage

    Science.gov (United States)

    Jha, Vikas; Behari, Sanjay; Jaiswal, Awadhesh K.; Bhaisora, Kamlesh Singh; Shende, Yogesh P.; Phadke, Rajendra V.

    2016-01-01

    Context: Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. Aim: We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. Setting: Tertiary care academic institute. Statistics: Test of significance applied to determine the factors causing rebleeding in the groups of patients with concurrent AVM and aneurysm and those with only AVMs. Subjects and Methods: Sixteen patients (5 with subarachnoid hemorrhage and 11 with intracerebral/intraventricular hemorrhage; 10 with low flow [LF] and 6 with high flow [HF] AVMs) underwent radiological assessment of Spetzler Martin (SM) grading and flow status of AA + AVM. Their modified Rankin's score (mRS) at admission was compared with their follow-up (F/U) score. Results: Pre-operative mRS was 0 in 5, 2 in 6, 3 in 1, 4 in 3 and 5 in 1; and, SM grade I in 5, II in 3, III in 3, IV in 4 and V in 1 patients, respectively. AA associated AVMs were classified as: (I) Flow-related proximal (n = 2); (II) flow-related distal (n = 3); (III) intranidal (n = 5); (IV) extra-intranidal (n = 2); (V) remote major ipsilateral (n = 1); (VI) remote major contralateral (n = 1); (VII) deep perforator related (n = 1); (VIII) superficial (n = 1); and (IX) distal (n = 0). Their treatment strategy included: Flow related AA, SM I-III LF AVM: aneurysm clipping with AVM excision; nidal-extranidal AA, SM I-III LF AVM: Excision or embolization of both AA + AVM; nidal-extranidal and perforator-related AA, SM IV-V HF AVM: Only endovascular embolization or radiosurgery. Surgical decision-making for remote AA took into account their ipsilateral/contralateral filling status and vessel dominance; and, for AA associated with SM III HF AVM, it varied in each patient based on diffuseness of AVM nidus, flow

  11. Subarachnoid hemorrhage in the rat: cerebral blood flow and glucose metabolism during the late phase of cerebral vasospasm

    International Nuclear Information System (INIS)

    A double-isotope technique for the simultaneous measurement of CBF and CMRglu was applied to a subarachnoid hemorrhage (SAH) model in the rat. Cisternal injection of 0.07 ml blood caused a rather uniform 20% reduction in CBF together with an increase in glucose utilization of 30% during the late phase of vasospasm. In one-third of the SAH animals, there were focal areas where the flow was lowered to 30% of the control values and the glucose uptake increased to approximately 250% of control. We suggest that blood in the subarachnoid space via a neural mechanism induces the global flow and metabolic changes, and that the foci are caused by vasospasm superimposed on the global flow and metabolic changes. In the double-isotope autoradiographic technique, [14C]iodoantipyrine and [3H]deoxyglucose were used for CBF and CMRglu measurements, respectively, in the same animal. In half of the sections, the [14C]iodoantipyrine was extracted using 2,2-dimethoxypropane before the section was placed on a 3H- and 14C-sensitive film. The other sections were placed on x-ray film with an emulsion insensitive to 3H. The validity of the double-isotope method was tested by comparing the data with those obtained in animals receiving a single isotope. The CBF and metabolic values obtained in the two groups were similar

  12. Pathomechanisms and treatment of pediatric aneurysms.

    Science.gov (United States)

    Krings, Timo; Geibprasert, Sasikhan; terBrugge, Karel G

    2010-10-01

    Pediatric aneurysms are rare diseases distinct from classical adult aneurysms and therefore require different treatment strategies. Apart from saccular aneurysms that are more commonly found in older children, three major pathomechanisms may be encountered: trauma, infection, and dissection. The posterior circulation and more distal locations are more commonly encountered in children compared to adults, and there is an overall male predominance. Clinical findings are not only confined to subarachnoid hemorrhage but may also comprise mass effects, headaches or neurological deficits. In traumatic aneurysms, the skull base and distal anterior communicating artery are commonly affected, and the hemorrhage occurs often delayed (2-4 weeks following the initial trauma). Infectious aneurysms are mostly bacterial in origin, and hemorrhage occurs early after a septic embolic shower. Dissecting aneurysms are the most often encountered aneurysm type in children and can lead to mass effect, hemorrhage, or ischemia depending on the fate of the intramural hematoma. Treatment strategies in pediatric aneurysms include endosaccular coil treatment only for the "classical berry-type" aneurysms; in the other instances, parent vessel occlusion, flow reversal, surgical options, or a combined treatment with bypass and parent vessel occlusion have to be contemplated.

  13. Erythropoietin in patients with aneurysmal subarachnoid haemorrhage: a double blind randomised clinical trial

    DEFF Research Database (Denmark)

    Springborg, J B; Møller, C; Gideon, P;

    2007-01-01

    BACKGROUND: Erythropoietin (EPO) is neuroprotective in experimental models of stroke and subarachnoid haemorrhage (SAH) and possibly in patients with thromboembolic stroke. We studied the efficacy and safety of EPO in patients with SAH. METHODS: A larger scale clinical trial was planned but preli......BACKGROUND: Erythropoietin (EPO) is neuroprotective in experimental models of stroke and subarachnoid haemorrhage (SAH) and possibly in patients with thromboembolic stroke. We studied the efficacy and safety of EPO in patients with SAH. METHODS: A larger scale clinical trial was planned...... group but the difference was statistically insignificant. In the EPO-treated patients the CSF concentration of EPO increased 600-fold. Except for a higher extracelullar concentration of glycerol in the EPO group probably caused by the poorer clinical condition of these patients, there were...

  14. Clinical presentation of cerebral aneurysms

    International Nuclear Information System (INIS)

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls

  15. Clinical presentation of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cianfoni, Alessandro [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Pravatà, Emanuele, E-mail: emanuele.pravata@gmail.com [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); De Blasi, Roberto [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Tschuor, Costa Silvia [Dipartimento di Radiologia, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Bonaldi, Giuseppe [U.O. Neuroradiologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24128 Bergamo (Italy)

    2013-10-01

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.

  16. Soluble Toll-Like Receptors 2 and 4 in Cerebrospinal Fluid of Patients with Acute Hydrocephalus following Aneurysmal Subarachnoid Haemorrhage.

    Directory of Open Access Journals (Sweden)

    Bartosz Sokół

    Full Text Available Toll-like receptor (TLR signalling begins early in subarachnoid haemorrhage (SAH, and plays a key role in inflammation following cerebral aneurysm rupture. Available studies suggest significance of endogenous first-line blockers of a TLR pathway-soluble TLR2 and 4.Eighteen patients with SAH and acute hydrocephalus underwent endovascular coiling and ventriculostomy; sTLR2 and 4 levels were assayed in cerebrospinal fluid (CSF collected on post-SAH days 0-3, 5, and 10-12. Release kinetics were defined. CSF levels of sTLR2 and 4 were compared with a control group and correlated with the clinical status on admission, the findings on imaging, the degree of systemic inflammation and the outcome following treatment.None of study group showed detectable levels of sTLR2 and 4 on post-SAH day 0-3. 13 patients showed increased levels in subsequent samples. In five SAH patients sTLR2 and 4 levels remained undetectable; no distinctive features of this group were found. On post-SAH day 5 the strongest correlation was found between sTLR2 level and haemoglobin level on admission (cc = -0.498, P = 0.037. On post-SAH day 10-12 the strongest correlation was revealed between sTLR2 and treatment outcome (cc = -0.501, P = 0.076. Remaining correlations with treatment outcome, status at admission, imaging findings and inflammatory markers on post-SAH day 5 and 10-12 were negligible or low (-0.5 ≤ cc ≤ 0.5.In the majority of cases, rupture of a cerebral aneurysm leads to delayed release of soluble TLR forms into CSF. sTLR2 and 4 seem to have minor role in human post-SAH inflammation due to delayed release kinetics and low levels of these protein.

  17. Neurosurgical versus endovascular treatment of subarachnoid haemorrhage caused by ruptured cerebral aneurysm: comparison of patient outcomes.

    Science.gov (United States)

    Kamensky, J

    2015-03-01

    The aim of this critical review is to determine whether endovascular treatment (EVT) of a subarachnoid haemorrhage (SAH) has better patient outcomes than neurosurgical treatment (NST). A review of six cohort studies (listed in Table 1) was carried out and the main findings were summarised in the conclusion. In addition the list of author's recommendations is included at the end of the paper. Theatre practitioners involved in neurosurgery might find this review useful in enhancing their understanding of how SAH is currently treated. It could also bring some insights about the reasons why a particular modality of the treatment was chosen for their patient. PMID:26016283

  18. Role of hepcidin and its downstream proteins in early brain injury after experimental subarachnoid hemorrhage in rats.

    Science.gov (United States)

    Tan, Guanping; Liu, Liu; He, Zhaohui; Sun, Jiujun; Xing, Wenli; Sun, Xiaochuan

    2016-07-01

    Early brain injury (EBI) is a major cause of mortality from subarachnoid hemorrhage (SAH). We aimed to study the pathophysiology of EBI and explore the role of hepcidin, a protein involved in iron homeostatic regulation, and its downstream proteins. One hundred and thirty-two male Sprague-Dawley rats were assigned into groups (n = 24/group): sham, SAH, SAH + hepcidin, SAH + hepcidin-targeting small interfering ribonucleic acid (siRNA), and SAH + scramble siRNA. Three hepcidin-targeting siRNAs and one scramble siRNA for hepcidin were injected 24 h before hemorrhage induction, and hepcidin protein was injected 30 min before induction. The rats were neurologically evaluated at 24 h and euthanized at 72 h. Hepcidin, ferroportin-1, and ceruloplasmin protein expression were measured by immunohistochemistry and Western blotting. Brain water content, blood-brain barrier (BBB) leakage, non-heme tissue iron and Garcia scale were evaluated. Hepcidin expression increased in the cerebral cortex and hippocampus after experimental SAH (P Hepcidin injection lowered the expression of ferroportin-1 and ceruloplasmin further but siRNA reduced the levels of hepcidin (P hepcidin, but decreased by siRNA (P hepcidin enhanced iron-dependent oxidative damage and may be the potential mechanism of SAH. PMID:27250827

  19. Purpurogallin, a Natural Phenol, Attenuates High-Mobility Group Box 1 in Subarachnoid Hemorrhage Induced Vasospasm in a Rat Model

    Directory of Open Access Journals (Sweden)

    Chih-Zen Chang

    2014-01-01

    Full Text Available High-mobility group box 1 (HMGB1 was shown to be an important extracellular mediator involved in vascular inflammation of animals following subarachnoid hemorrhage (SAH. This study is of interest to examine the efficacy of purpurogallin, a natural phenol, on the alternation of cytokines and HMGB1 in a SAH model. A rodent double hemorrhage SAH model was employed. Basilar arteries (BAs were harvested to examine HMGB1 mRNA and protein expression (Western blot. CSF samples were to examine IL-1β, IL-6, IL-8, and TNF-α (rt-PCR. Deformed endothelial wall, tortuous elastic lamina, and necrotic smooth muscle were observed in the vessels of SAH groups but were absent in the purpurogallin group. IL-1β, IL-6, and TNF-α in the SAH only and SAH plus vehicle groups were significantly elevated (P<0.01. Purpurgallin dose-dependently reduced HMGB1 protein expression. Likewise, high dose purpurogallin reduced TNF-α and HMGB1 mRNA levels. In conclusion, purpurogallin exerts its neuroinflammation effect through the dual effect of inhibiting IL-6 and TNF-α mRNA expression and reducing HMGB1 protein and mRNA expression. This study supports purpurogallin could attenuate both proinflammatory cytokines and late-onset inflammasome in SAH induced vasospasm.

  20. Cerebral vasospasm following subarachnoid hemorrhage: time for a new world of thought

    DEFF Research Database (Denmark)

    Pluta, Ryszard M; Hansen-Schwartz, Jacob; Dreier, Jens;

    2009-01-01

    OBJECTIVE: Delayed cerebral vasospasm has long been recognized as an important cause of poor outcome after an otherwise successful treatment of a ruptured intracranial aneurysm, but it remains a pathophysiological enigma despite intensive research for more than half a century. METHOD: Summarized ...

  1. Polymorphisms of apolipoprotein E and aneurysmal subarachnoid haemorrhage: A meta-analysis.

    Science.gov (United States)

    Arati, S; Sibin, M K; Bhat, Dhananjaya I; Narasingarao, K V L; Chetan, G K

    2016-09-01

    Subarachnoid haemorrhage (SAH) is characterised by bleeding in the subarachnoid space in the brain. There are various polymorphisms in genes which are associated with this disease. We performed a systematic meta- analysis to investigate the relationship of APOE polymorphism on aSAH. A comprehensive literature search was done in the Pubmed database, Science Direct, Cochrane library and Google Scholar. The OR and 95% CI were evaluated for the gene and aSAH association using fixed and random effect models. Publication bias was assessed using Begg's funnel plot and Egger's regression test. All statistical evaluations were done using the software Review Manager 5.0 and Comprehensive Meta Analysis v2.2.023. A total of 9 studies were assessed on APOE polymorphism (1100 Cases, 2732 Control). Meta analysis results showed significant association in ε2/ ε2 versus ε3/ε3, ε2 versus ε3 genetic models and ε2 allele frequency. In subgroup analysis statistically significant association was observed in Asians in the genetic models ε2/ ε2 versus ε3/ε3, ε2/ε3 versus ε3/ε3, ε2 versus ε3 and also in ε2 allele frequency. However, in Caucasian population only ε2/ε2 versus ε3/ε3 genetic model showed significant association between APOE and risk of aSAH. In this meta-analysis study, the ε2/ε2 genotype is associated with increased risk of aSAH. PMID:27408823

  2. Pituitary apoplexy complicated with subarachnoid hemorrhage caused by incidentaloma following a head injury:case report

    Institute of Scientific and Technical Information of China (English)

    BAO Yi-jun; LI Xin-guo; JING Zhi-tao; OU Shao-wu; WU An-hua; WANG Yun-jie

    2007-01-01

    @@ Pituitary apoplexy is a rare clinical syndrome caused by acute enlargement of pituitary adenomas,which may be secreting or nonfunctioning,and symptomatic or asymptomatic,resulted from hemorrhage or infarction.1

  3. 三维CT血管重建成像在急性蛛网膜下腔出血的应用分析%The analysis of three-dimensional computed tomographic angiography in acute subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    巴特尔; 李萌; 支兴龙; 石磊

    2013-01-01

    目的:探讨三维CT血管重建成像在急性蛛网膜下腔出血的应用及局限性分析.方法:对147例CT表现为急性蛛网膜下腔出血患者进行CTA检查,由神经和放射两名医生对结果分析,对CTA阴性以及诊断有争议患者进行DSA检查.结果:在147例急性蛛网膜下腔出血患者中,109例患者3D-CTA结合出血CT图像确诊动脉瘤,瘤体直径2~12 mm,均在手术或者介入治疗中证实;其余病例中,7例CT图像有明显的责任灶的蛛网膜下腔出血,3D-CTA阴性,通过DSA发现并经手术证实为动脉瘤,23例普通CT表现为中脑周围出血以及均匀弥漫蛛网膜下腔出血病例CTA提示阴性患者DSA检查也为阴性;3例CTA可疑动脉瘤均被DSA证实为动脉起始的壶腹,CTA在诊断颅内动脉瘤的敏感性和特异性分别为94%和100%.结论:对急性蛛网膜下腔出血患者使用CTA筛查是相对快捷、低风险检查方式,但结果的分析需结合CT图像出血形式以及放射和神经外科医生共同阅片可以完成CTA的诊断效能.%Objective:To investigate the application and limitation of three-dimensional muhislice helical CT angiography (3D-CTA) in the diagnosis of acute subarachnoid hemorrhage (SAH).Method:A total of 147 patients with subarachnoid hemorrhage underwent 64-slice spiral CTA.Images of CT and 3D-CTA wereanalyzed by neurosurgeon and neuroradiologist.Due to undefined or negative diagnosis by CTA,conventional digital subtraction angiography was underwent.Result:CTA confirmed the diagnosis of intracranial aneurysms(2~ 12 mm in diameter) in 106 patients that were confirmed by operation and interventional therapy.intra-arterial digital subtraction angiography was performed in other patients,CT scan demonstrated in 7 case with aneurismal SAH by CT scan were further confirmed with aneurysms by DSA.23 cases suspected with perimesencephalic or as suffused SAH in CT scan were denied both in CTA and DSA.3 case suspected with aneurysm in CTA

  4. 蛛网膜下腔出血护理的伦理学探讨%The Ethical Consideration for Nursing Patients with Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    颜超; 张敏; 祝刚

    2011-01-01

    Care for patients with subarachnoid hemorrhage involved in four aspects: professional competence of nursing staff; doctor - nurse communication related to treat the patients; psychological care of patients with sub-arachnoid hemorrhage and communication and psychological counseling with families of patients; humanistic hospice care. These tissues were explored from the perspective of medical ethics .%针对蛛网膜下腔出血护理工作实践中涉及的四个方面:护理人员的专业能力;针对患者治疗的医护沟通;蛛网膜下腔出血患者的心理护理及患者家属的心理沟通和疏导;临终的人文关怀,从医学伦理学的角度予以探讨.

  5. High Plasma Levels of Neuropeptide Y Correlate With Good Clinical Outcome But are not Correlated to Cerebral Blood Flow or Vasospasm After Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Stavngaard, Trine; Jessing, Iben R;

    2016-01-01

    BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a serious and frequent complication following subarachnoid hemorrhage. Treatments with convincing effect are lacking and the pathophysiology behind DCI remains poorly understood. Neuropeptide Y (NPY) is a potent endogenous vasoconstrictor...... and a role of NPY in the development of DCI has been proposed. This study investigated the relationship between plasma-NPY and cerebral blood flow (CBF), cerebral vasospasm, DCI, and clinical outcome. METHODS: In 90 patients with subarachnoid hemorrhage, NPY was measured in peripheral blood days 2 to 11. Any...... occurrence of DCI was recorded and CBF was quantified day 3 and day 8 using computed tomography (CT) perfusion. CT angiography was performed day 8. Clinical outcome was assessed after 3 months. RESULTS: No correlation was found between plasma-NPY and CBF or angiographic vasospasm. The correlation between...

  6. Comparison of extent of postoperative hydrocephalus in patients between intervertional therapy with embolism and craniotomy occlusion in Hunt-HessⅢ-Ⅳ level aneurysm induced subarachnoid hemorrhage and their prognosis%Hunt-HessⅢ~Ⅳ级动脉瘤性蛛网膜下腔出血患者血管介入栓塞与开颅夹闭手术后并发脑积水差异的比较及预后分析

    Institute of Scientific and Technical Information of China (English)

    刘洋; 孙圣凯; 陈旭义; 程世翔; 秦至臻; 刘秀; 陈孝储; 宁莉莉; 王志宏

    2015-01-01

    6/296),χ2=4.411,P=0.027〕;而行脑室引流者脑积水发生率差异无统计学意义〔2.59%(9/347)比2.96%(10/338),χ2=0.085,P=0.819〕。56例行介入栓塞术后出现脑积水的患者,出院时预后良好(GOS评分4~5分)23例(41.07%),预后不良(GOS评分1~3分)33例(58.93%);33例行开颅夹闭手术后出现脑积水的患者,出院时预后良好(GOS评分4~5分)21例(63.64%),预后不良(GOS评分1~3分)12例(36.36%),两组预后差异有统计学意义(χ2=4.230,P=0.039)。结论血肿清除是造成Hunt-HessⅢ~Ⅳ级患者血管介入栓塞和开颅夹闭手术后脑积水差异形成的主要因素之一;侧脑室引流可能不是造成Hunt-HessⅢ~Ⅳ级患者血管介入栓塞和开颅夹闭手术术后脑积水差异形成的因素;患者开颅夹闭手术短期预后优于血管介入栓塞治疗。%ObjectiveTo analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with Hunt-Hess levelⅢ-Ⅳ, and acute postoperative hydrocephalus.Methods A retrospective study was conducted on 767 patients who had undergone vascular embolization (vascular embolization group,n = 403) or craniotomy occlusion operation (craniotomy occlusion operation group,n = 364), and the patients with postoperative acute hydrocephalus were screened. The clinical data of patients of both groups was analyzed. By judging short-term prognosis in patients with hydrocephalus with Glasgow outcome scale (GOS) score estimated at discharge, the advantages and disadvantages of two surgical procedures were compared.Results The number of cases with postoperative hydrocephalus in vascular embolization group was 56 (13.90%), while that in craniotomy occlusion group was 33 (9.07%). The difference between the two groups of incidence of hydrocephalus was statistically

  7. CTA对蛛网膜下腔出血并DSA阴性患者诊断价值的研究%Diagnostic accuracy of computed tomography angiography in patients with catheter angiography-negative subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    李敏; 丁娟; 翟继良; 孙钢

    2012-01-01

    目的 探讨CT脑血管造影(CTA)对蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)且首次DSA阴性患者再次血管成像的诊断准确性.方法 对56例SAH且DSA检查为阴性患者行CTA及DSA成像.以DSA结果为金标准,计算CTA诊断动脉瘤的敏感度、特异度、阳性预测值(PP V)和阴性预测值(NPV).结果 7例与SAH相关动脉瘤中,CTA发现5例.49例DSA无阳性结果患者中,CTA均无阳性结果.以DSA为金标准,CTA诊断颅内动脉瘤的敏感度为71.43%(95CI,35.89~91.78),特异度为100%(95CI,92.73~100),PPV100%(95CI,56.55~100),NPV96.08%(95CI,86.78~98.92).结论 CTA作为一种无创性检查手段,可准确地诊断首次DSA阴性SAH患者动脉瘤的存在.未来需要大样本研究证明CTA在临床诊疗过程中的有效性及安全性.%Objective To evaluate the accuracy of computed tomography angiography (CTA) to diagnose cerebral aneu-rysms in patients with hemorrhage (SAH) and a negative initial catheter angiogratn. Methods 56 patients with SAH and a negative initial catheter angiogram underwent CTA and DSA. With DSA as reference standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Among 7 aneurysms, 5 aneurysms were detected by CTA; among 49 patients without aneurysms, no positive symptom was found by CTA. The accuracy of CTA was as followed: sensitivity: 71.43%(95CI, 35.89 ~ 91.78), specificity: 100%(95CI, 92.73 ~ 100), PPV: 100%(95CI, 56. 55~100), NPV: 96.08%(95CI, 86.78-98.92). Conclusion CTA is a valuable tool to evaluate patients with SAH and a negative initial catheter angiogram, whose efficiency and safety, however, should be proven by large sample study in the future.

  8. Erythropoietin in the cerebrospinal fluid of patients with aneurysmal subarachnoid haemorrhage originates from the brain

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Sonne, Bjarne; Frederiksen, Hans Jørgen;

    2003-01-01

    a synthesis in CNS rather than a blood-derived origin. Furthermore, the median CSF:serum ratio (Q(protein)) of EPO was similar to those of prealbumin and apolipoprotein E, and much higher than those of albumin, transferrin and alpha(2)-macroglobulin. When the Q(protein) of all proteins were plotted against Q......(albumin), EPO showed dynamics similar to CNS-derived proteins. Our data indicate that EPO in the CSF of patients with aneurysmal SAH originates mainly from the CNS....

  9. Glioblastoma and intracranial aneurysms: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Rushna Ali

    2015-01-01

    Conclusion: Several theories stand to explain the coincidental occurrence of intracranial aneurysms and GBM. The treating physician should be aware of this association when patients with intraaxial tumors present with unusual manifestation such as an intratumoral hemorrhage or angiogram negative subarachnoid hemorrhage. No guidelines exist to assist in the management of such patients; therefore, authors have attempted to address this issue using a classification and treatment algorithm.

  10. Spontaneous thrombosis of a recurrent clipped intracranial aneurysm.

    Science.gov (United States)

    Hassan, F; Taschner, C-A; Thines, L; Lejeune, J-P; Pruvo, J-P; Leclerc, X

    2009-06-01

    Spontaneous thrombosis of an intracranial aneurysm is a rare event. It is predominantly observed with aneurysms that are large and have relatively narrow necks. We report here a case of a 48-year-old woman presenting with subarachnoid hemorrhage (SAH) due to rupture of a 2-mm aneurysm of the anterior cerebral artery treated by microsurgical clipping. Six months after treatment of the aneurysm, the patient presented with severe headache. SAH was excluded, but computed tomographic angiography (CTA) revealed the recurrence of a large aneurysm (7 mm) that was confirmed by cerebral angiography (DSA). Endovascular treatment was scheduled for several days later, but DSA also revealed spontaneous occlusion of the recurrent aneurysm. On the control CTA performed one week later, the recurrent aneurysm had again reappeared, again confirmed by DSA, and was subsequently treated by coil embolization. PMID:19144409

  11. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    Science.gov (United States)

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  12. 原发性蛛网膜下腔出血502例临床分析%Clinical analysis of 502 cases of subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈兴泳; 唐荣华; 陈云; 张旭; 雷惠新; 汪银洲

    2009-01-01

    Objective To summarize the clinical and imaging features of subarachnoid hemorrhage(SAH) and its complications and prognosis. Methods The clinical data of 502 cases of SAH were retrospectively analyzed and summarized. Results There were 84.3 % (423/496) patients sufferring from intense headache, dizziness or vertigo (13. 1%, 66/496 ), disturbance of consciousness ( 27. 5%, 138/496 ), partial neurologic impairment (58.2% ,292/496) ,meningeal irritation sign(72.5% ,364/496). The positive rate of digital subtraction angiogra-phy was 54.1% (93/172). Aneurysm was the common reason of SAH (20. 1%, 101/496). Prognosis in most pa-tients was better,but the old patients suffered from high mortality. Conclusions The cause and clinical manifesta-tion of SAH varies,cerebral angiography often could help find the cause of SAH. Most SAH patients recover well.%目的 总结原发性蛛网膜下腔出血(SAH)的临床特点、影像学特征、并发症和预后.方法 回顾性分析总结502例SAH患者的临床资料.结果 84.3%(423/496)患者以剧烈头痛为主要症状,13.1%(66/496)出现头晕或眩晕,意识障碍占27.5%(138/496),局灶性神经功能缺损体征58.2%(292/496),脑膜刺激征阳性72.5%(364/496),数字减影血管造影术检查阳性率54.1%(93/172),病因以动脉瘤最常见占20.1%(101/496).绝大部分预后好,老年人病死率高.结论 SAH病因复杂,临床表现多样化,脑血管造影常可明确病因,多数患者恢复良好.

  13. Indications for CSF shunting in normal pressure hydrocephalus following subarachnoid hemorrhage with lateral ventricular size change on cine-MR

    Energy Technology Data Exchange (ETDEWEB)

    Fujitsuka, Mitsuyuki [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    2002-09-01

    To clarify the indications for cerebrospinal fluid (CSF) shunting in normal pressure hydrocephalus (NPH) following subarachnoid hemorrhage (SAH), the author investigated changes in the pulsatile brain motions during a cardiac cycle in 17 cases with ventriculomegaly following SAH on cardiac gated cine MR images comparing with those in 50 normal adults. In 15 of these seventeen cases, the lateral ventricles not only constricted immediately following the R-wave related to brain expansion but also expanded paradoxically over the initial size during a cardiac diastole. These patterns were different from those of normal adults, and eleven of them showed excellent response to CSF shunting. Theses findings in ventricular motion during a cardiac cycle indicate that the forceful intraventricular CSF flows and stagnancy expand the ventricular walls causing compression of the surrounding brain against the skull. In the remaining two, the lateral ventricles only constricted immediately following the R-wave and the ventricular size change was similar to those of normal adults, and they were diagnosed as not requiring CSF shunting. Assessing ventricular size change on cine-MR enables non-invasive differentiation of NPH from other form of ventriculomegaly, and evaluation of the benefit of CSF shunting is also possible by this technique preoperatively. (author)

  14. Brain edema formation correlates with perfusion deficit during the first six hours after experimental subarachnoid hemorrhage in rats

    Directory of Open Access Journals (Sweden)

    Westermaier Thomas

    2012-07-01

    Full Text Available Abstract Background Severe brain edema is observed in a number of patients suffering from subarachnoid hemorrhage (SAH. Little is known about its pathogenesis and time-course in the first hours after SAH. This study was performed to investigate the development of brain edema and its correlation with brain perfusion after experimental SAH. Methods Male Sprague–Dawley rats, randomly assigned to one of six groups (n = 8, were subjected to SAH using the endovascular filament model or underwent a sham operation. Animals were sacrificed 15, 30, 60, 180 or 360 minutes after SAH. Intracranial pressure (ICP, mean arterial blood pressure (MABP, cerebral perfusion pressure (CPP and bilateral local cerebral blood flow (LCBF were continuously measured. Brain water content (BWC was determined by the wet/dry-weight method. Results After SAH, CPP and LCBF rapidly decreased. The decline of LCBF markedly exceeded the decline of CPP and persisted until the end of the observation period. BWC continuously increased. A significant correlation was observed between the BWC and the extent of the perfusion deficit in animals sacrificed after 180 and 360 minutes. Conclusions The significant correlation with the perfusion deficit after SAH suggests that the development of brain edema is related to the extent of ischemia and acute vasoconstriction in the first hours after SAH.

  15. Indications for CSF shunting in normal pressure hydrocephalus following subarachnoid hemorrhage with lateral ventricular size change on cine-MR

    International Nuclear Information System (INIS)

    To clarify the indications for cerebrospinal fluid (CSF) shunting in normal pressure hydrocephalus (NPH) following subarachnoid hemorrhage (SAH), the author investigated changes in the pulsatile brain motions during a cardiac cycle in 17 cases with ventriculomegaly following SAH on cardiac gated cine MR images comparing with those in 50 normal adults. In 15 of these seventeen cases, the lateral ventricles not only constricted immediately following the R-wave related to brain expansion but also expanded paradoxically over the initial size during a cardiac diastole. These patterns were different from those of normal adults, and eleven of them showed excellent response to CSF shunting. Theses findings in ventricular motion during a cardiac cycle indicate that the forceful intraventricular CSF flows and stagnancy expand the ventricular walls causing compression of the surrounding brain against the skull. In the remaining two, the lateral ventricles only constricted immediately following the R-wave and the ventricular size change was similar to those of normal adults, and they were diagnosed as not requiring CSF shunting. Assessing ventricular size change on cine-MR enables non-invasive differentiation of NPH from other form of ventriculomegaly, and evaluation of the benefit of CSF shunting is also possible by this technique preoperatively. (author)

  16. Carnosine attenuates early brain injury through its antioxidative and anti-apoptotic effects in a rat experimental subarachnoid hemorrhage model.

    Science.gov (United States)

    Zhang, Zong-yong; Sun, Bao-liang; Yang, Ming-feng; Li, Da-wei; Fang, Jie; Zhang, Shuai

    2015-03-01

    Carnosine (β-alanyl-L-histidine) has been demonstrated to provide antioxidative and anti-apoptotic roles in the animal of ischemic brain injuries and neurodegenerative diseases. The aim of this study was to examine whether carnosine prevents subarachnoid hemorrhage (SAH)-induced early brain injury (EBI) in rats. We found that intraperitoneal administration of carnosine improved neurobehavioral deficits, attenuated brain edema and blood-brain barrier permeability, and decreased reactive oxygen species level at 48 h following SAH in rat models. Carnosine treatment increased tissue copper/zinc superoxide dismutase (CuZn-SOD) and glutathione peroxidase (GSH-Px) enzymatic activities, and reduced post-SAH elevated lactate dehydrogenase (LDH) activity, the concentration of malondialdehyde (MDA), 3-nitrotyrosine (3-NT), 8-hydroxydeoxyguanosine (8-OHDG), interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) in rats. Furthermore, carnosine treatment attenuated SAH-induced microglia activation and cortical neuron apoptosis. These results indicated that administration of carnosine may provide neuroprotection in EBI following SAH in rat models. PMID:25179154

  17. Inhibition of mammalian target of rapamycin attenuates early brain injury through modulating microglial polarization after experimental subarachnoid hemorrhage in rats.

    Science.gov (United States)

    You, Wanchun; Wang, Zhong; Li, Haiying; Shen, Haitao; Xu, Xiang; Jia, Genlai; Chen, Gang

    2016-08-15

    Here, we aimed to study the role and underlying mechanism of mTOR in early brain injury (EBI) after subarachnoid hemorrhage (SAH). Experiment 1, the time course of mTOR activation in the cortex following SAH. Experiment 2, the role of mTOR in SAH-induced EBI. Adult SD rats were divided into four groups: sham group (n=18), SAH+vehicle group (n=18), SAH+rapamycin group (n=18), SAH+AZD8055 group (n=18). Experiment 3, we incubated enriched microglia with OxyHb. Rapamycin and AZD8055 were also used to demonstrate the mTOR's role on microglial polarization in vitro. The phosphorylation levels of mTOR and its substrates were significantly increased and peaked at 24h after SAH. Rapamycin or AZD8055 markedly decreased the phosphorylation levels of mTOR and its substrates and the activation of microglia in vivo, and promoted the microglial polarization from M1 phenotype to M2 phenotype. In addition, administration of rapamycin and AZD8055 following SAH significantly ameliorated EBI, including neuronal apoptosis, neuronal necrosis, brain edema and blood-brain barrier permeability. Our findings suggested that the rapamycin and AZD8055 could attenuate the development of EBI in this SAH model, possibly through inhibiting the activation of microglia by mTOR pathway. PMID:27423593

  18. 中脑周围非动脉瘤性蛛网膜下腔出血的CT诊断价值%CT Diagnostic Value of Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈婕; 陈丹; 张亚林; 瞿中威

    2014-01-01

    Objective To explore image characteristics of perimesencephalic nonaneurysmal subarachnoid hemorrhage(PNSH) by analyzing CT and CTA manifestations of 12 cases with PNSH. Methods The clinical manifestations and CT characteristics of 12 cases with SAH confined to the midbrain and DSA and CTA negative patients were retrospectively analyzed. Results The scope of hemorrhage was limited in the cistern around the brain stem. CTA examination of 9 cases and DSA examination of 3 cases were negative. Conclusion PNSH have typical CT manifestations. The diagnostic value of CTA is even higher than DSA. It could show hemorrhage locations by plain-scanning and eliminate aneurysm rupture. But for the CTA suspected cases can still undergo DSA examination to improve the diagnostic accuracy.%目的:分析中脑周围非动脉瘤性蛛网膜下腔出血(PNSH)12例CT及CTA表现,探讨其影像特性。材料和方法回顾分析12例DSA及CTA检查阴性的局限于中脑周围SAH患者临床表现、CT特点。结果出血范围均位于脑干周围的脑池内,12例中9例CTA检查3例DSA检查均无阳性发现。结论 PNSH具有典型的CT表现,CTA的诊断价值甚至高于DSA,既通过平扫了解出血部位,同时又能排除动脉瘤破裂所致,但对于CTA表示怀疑的仍可以进一步行DSA检查,提高诊断准确性。

  19. [Massive natriuresis and polyuria after triple craniocervical subarachnoid hemorrhage: cerebral salt wasting syndrome?].

    Science.gov (United States)

    Berendes, E; Scherer, R; Schuricht, G; Rol, R; Hengst, K

    1992-11-01

    A thirty-year-old male patient suffered subarachnoidal haemorrhage from an angioma positioned in the cranio-cervical transition. After rebleeding twice the patient developed a hydrocephalus internus malresorptivus and excessive natriuresis and polyuria, accompanied by depressed renin activity and extremely low aldosterone plasma levels. Neither fluid restriction and sodium substitution, nor administration of hydro-chlorothiazide/indomethacin affected natriuresis and polyuria. It was only after treatment with fludrocortisone-acetate/hydrocortisone that hyponatraemia and polyuria were resolved. At the same time a ventriculo-peritoneal shunt was applied. Differential diagnosis excluded the syndromes of inadequate antidiuretic hormone secretion, renal and cerebral diabetes insipidus, osmotic receptor hypofunction, chronic renal dysfunction and tubular necrosis. Natriuresis and polyuria developed under dexamethasone therapy. Since patient history, physical examination and laboratory criteria could not explain the electrolyte and fluid imbalance, this might be attributed to the hydrocephalus. Similar disturbances have been reported from other patients with intracranial disorders. Mechanical pressure exercised on the hypothalamus might cause the disturbance of fluid and sodium balance. Assuming a cerebral salt wasting syndrome, a putative natriuretic factor coming from the brain or an imbalance in the cerebral renin-angiotensin-system, as described in rats and dogs, must be discussed.

  20. Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.

    Science.gov (United States)

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2015-07-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision.

  1. Assessment of feasibility of endovascular treatment of ruptured intracranial aneurysms with 16-detector row CT angiography

    NARCIS (Netherlands)

    M. van der Jagt (Mathieu); H.Z. Flach (Zwenneke); H.L.J. Tanghe (Hervé); S.L.M. Bakker (Stef); M.G.M. Hunink (Myriam); P.J. Koudstaal (Peter Jan); A. van der Lugt (Aad)

    2008-01-01

    textabstractBackground: It is unclear whether 16-detector row CT angiography (CTA) can replace digital subtraction angiography (DSA) to assess the feasibility of endovascular treatment (EVT) in the acute phase after aneurysmal subarachnoid hemorrhage. Methods: We studied 80 consecutive patients with

  2. Simultaneous presentation of two cerebral aneurysms.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Sasaki, Kazuto; Chonan, Masashi; Mino, Masaki

    2012-01-01

    A 48-year-old woman experienced sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage (SAH) and intracerebral hematoma in the right frontal lobe. Digital subtraction angiography revealed three aneurysms in the anterior communicating artery (AcomA), the right posterior communicating artery (PcomA), and the right middle cerebral artery. The AcomA aneurysm was treated with endovascular coiling. However, her oculomotor nerve palsy was aggravated after the procedure. Embolization of the right PcomA aneurysm was conducted immediately and her oculomotor nerve palsy recovered completely 3 months later. Simultaneous presentation of multiple aneurysms with separate symptoms is rare. We speculate that the progressive oculomotor nerve palsy was caused by tiny enlargement or morphological change of the aneurysm caused by elevated blood pressure and pulsatile effect after SAH.

  3. Spontaneous healing and complete disappearance of a ruptured posterior inferior cerebellar artery dissecting aneurysm.

    Science.gov (United States)

    Su, Tsung-Ming; Cheng, Ching-Hsiao; Chen, Wu-Fu; Hsu, Shih-Wei

    2014-05-01

    A 7-month-old baby presented with a 4-day history of drowsiness and vomiting after a falling accident. Magnetic resonance imaging demonstrated diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and variable stages of subdural hematoma in bilateral occipital and left temporal subdural spaces. A partially thrombosed aneurysm was noted in the right craniocervical junction. Ophthalmological examination revealed bilateral retinal petechial hemorrhages. Conventional cerebral angiography revealed a dissecting aneurysm in the right posterior inferior cerebellar artery (PICA). Endovascular embolization was suggested, but the family refused. After conservative treatment, follow-up MRI revealed that the PICA aneurysm had remodeled and ultimately disappeared completely at the 10th month. This case illustrates the relatively plastic nature of intracranial aneurysms in pediatric patients. More studies are necessary to clarify the natural history of spontaneously thrombosed aneurysms to assist in their overall management.

  4. Mortality Due to Subarachnoid Hemorrhage from 1999 to 2003. Mortalidad por hemorragia subaracnoidea en el quinquenio 1999-2003.

    Directory of Open Access Journals (Sweden)

    Ángel Luis Zayas Luis

    Full Text Available

    Background: Subarachnoid hemorrhage represents from the 6 to 8 per cent of all ictus. Its prevalence is calculated in 10 cases per 100.000 persons a year. It is accompanied by frequent complications and a high level of lethality. Objectives: To characterize deceased patients who had suffered from this disease from the pathological and clinical standpoint in a 5 year-period of time from 1999 to 2003. Method: A descriptive retrospective study was carried out including all patients deceased due to subarachnoid hemorrhage to whom necropsy was performed in the University Hospital ¨Camilo Cienfuegos¨, in Sancti Spiritus from 1999 to 2003. Results: 51 cases were analyzed where the white female sex was predominant, and who were older than 75 years old. The most important clinical antecedent or history was hypertension. The majority of admissions were carried out in the intensive care unit. The most important complications were cerebral edema with endocrania hypertension, and bronchopneumonia. Two thirds of the deaths were neurological where cerebral edema with endocrania hypertension and herniation followed by bronchopneumonia were predominant. Conclusions: Patients with extreme age, hypertensives were predominant. Cerebral edema with endocrania hypertension, hernia, and low respiratory sepsis were the algorithm of the complications and the cause of death.

    Fundamento: La hemorragia subaracnoidea representa el 6-8% de todos los ictus. Se calcula que la prevalencia es de 10 casos nuevos cada 100 000 personas cada año, se acompaña de frecuentes complicaciones y una alta letalidad. Objetivo: Caracterizar desde el punto de vista clínico patológico a los fallecidos por esta enfermedad en el quinquenio 1999 - 2003. Método: Se realizó un estudio descriptivo retrospectivo, que incluyó todos los fallecidos por

  5. Inhibition of cerebrovascular raf activation attenuates cerebral blood flow and prevents upregulation of contractile receptors after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Maddahi Aida

    2011-10-01

    Full Text Available Abstract Background Late cerebral ischemia carries high morbidity and mortality after subarachnoid hemorrhage (SAH due to reduced cerebral blood flow (CBF and the subsequent cerebral ischemia which is associated with upregulation of contractile receptors in the vascular smooth muscle cells (SMC via activation of mitogen-activated protein kinase (MAPK of the extracellular signal-regulated kinase (ERK1/2 signal pathway. We hypothesize that SAH initiates cerebrovascular ERK1/2 activation, resulting in receptor upregulation. The raf inhibitor will inhibit the molecular events upstream ERK1/2 and may provide a therapeutic window for treatment of cerebral ischemia after SAH. Results Here we demonstrate that SAH increases the phosphorylation level of ERK1/2 in cerebral vessels and reduces the neurology score in rats in additional with the CBF measured by an autoradiographic method. The intracisternal administration of SB-386023-b, a specific inhibitor of raf, given 6 h after SAH, aborts the receptor changes and protects the brain from the development of late cerebral ischemia at 48 h. This is accompanied by reduced phosphorylation of ERK1/2 in cerebrovascular SMC. SAH per se enhances contractile responses to endothelin-1 (ET-1, 5-carboxamidotryptamine (5-CT and angiotensin II (Ang II, upregulates ETB, 5-HT1B and AT1 receptor mRNA and protein levels. Treatment with SB-386023-b given as late as at 6 h but not at 12 h after the SAH significantly decreased the receptor upregulation, the reduction in CBF and the neurology score. Conclusion These results provide evidence for a role of the ERK1/2 pathway in regulation of expression of cerebrovascular SMC receptors. It is suggested that raf inhibition may reduce late cerebral ischemia after SAH and provides a realistic time window for therapy.

  6. Resveratrol Attenuates Acute Inflammatory Injury in Experimental Subarachnoid Hemorrhage in Rats via Inhibition of TLR4 Pathway.

    Science.gov (United States)

    Zhang, Xiang-Sheng; Li, Wei; Wu, Qi; Wu, Ling-Yun; Ye, Zhen-Nan; Liu, Jing-Peng; Zhuang, Zong; Zhou, Meng-Liang; Zhang, Xin; Hang, Chun-Hua

    2016-01-01

    Toll-like receptor 4 (TLR4) has been proven to play a critical role in neuroinflammation and to represent an important therapeutic target following subarachnoid hemorrhage (SAH). Resveratrol (RSV), a natural occurring polyphenolic compound, has a powerful anti-inflammatory property. However, the underlying molecular mechanisms of RSV in protecting against early brain injury (EBI) after SAH remain obscure. The purpose of this study was to investigate the effects of RSV on the TLR4-related inflammatory signaling pathway and EBI in rats after SAH. A prechiasmatic cistern SAH model was used in our experiment. The expressions of TLR4, high-mobility group box 1 (HMGB1), myeloid differentiation factor 88 (MyD88), and nuclear factor-κB (NF-κB) were evaluated by Western blot and immunohistochemistry. The expressions of Iba-1 and pro-inflammatory cytokines in brain cortex were determined by Western blot, immunofluorescence staining, or enzyme-linked immunosorbent assay. Neural apoptosis, brain edema, and neurological function were further evaluated to investigate the development of EBI. We found that post-SAH treatment with RSV could markedly inhibit the expressions of TLR4, HMGB1, MyD88, and NF-κB. Meanwhile, RSV significantly reduced microglia activation, as well as inflammatory cytokines leading to the amelioration of neural apoptosis, brain edema, and neurological behavior impairment at 24 h after SAH. However, RSV treatment failed to alleviate brain edema and neurological deficits at 72 h after SAH. These results indicated that RSV treatment could alleviate EBI after SAH, at least in part, via inhibition of TLR4-mediated inflammatory signaling pathway. PMID:27529233

  7. Resveratrol Attenuates Acute Inflammatory Injury in Experimental Subarachnoid Hemorrhage in Rats via Inhibition of TLR4 Pathway

    Directory of Open Access Journals (Sweden)

    Xiang-Sheng Zhang

    2016-08-01

    Full Text Available Toll-like receptor 4 (TLR4 has been proven to play a critical role in neuroinflammation and to represent an important therapeutic target following subarachnoid hemorrhage (SAH. Resveratrol (RSV, a natural occurring polyphenolic compound, has a powerful anti-inflammatory property. However, the underlying molecular mechanisms of RSV in protecting against early brain injury (EBI after SAH remain obscure. The purpose of this study was to investigate the effects of RSV on the TLR4-related inflammatory signaling pathway and EBI in rats after SAH. A prechiasmatic cistern SAH model was used in our experiment. The expressions of TLR4, high-mobility group box 1 (HMGB1, myeloid differentiation factor 88 (MyD88, and nuclear factor-κB (NF-κB were evaluated by Western blot and immunohistochemistry. The expressions of Iba-1 and pro-inflammatory cytokines in brain cortex were determined by Western blot, immunofluorescence staining, or enzyme-linked immunosorbent assay. Neural apoptosis, brain edema, and neurological function were further evaluated to investigate the development of EBI. We found that post-SAH treatment with RSV could markedly inhibit the expressions of TLR4, HMGB1, MyD88, and NF-κB. Meanwhile, RSV significantly reduced microglia activation, as well as inflammatory cytokines leading to the amelioration of neural apoptosis, brain edema, and neurological behavior impairment at 24 h after SAH. However, RSV treatment failed to alleviate brain edema and neurological deficits at 72 h after SAH. These results indicated that RSV treatment could alleviate EBI after SAH, at least in part, via inhibition of TLR4-mediated inflammatory signaling pathway.

  8. Resveratrol Attenuates Acute Inflammatory Injury in Experimental Subarachnoid Hemorrhage in Rats via Inhibition of TLR4 Pathway

    Science.gov (United States)

    Zhang, Xiang-Sheng; Li, Wei; Wu, Qi; Wu, Ling-Yun; Ye, Zhen-Nan; Liu, Jing-Peng; Zhuang, Zong; Zhou, Meng-Liang; Zhang, Xin; Hang, Chun-Hua

    2016-01-01

    Toll-like receptor 4 (TLR4) has been proven to play a critical role in neuroinflammation and to represent an important therapeutic target following subarachnoid hemorrhage (SAH). Resveratrol (RSV), a natural occurring polyphenolic compound, has a powerful anti-inflammatory property. However, the underlying molecular mechanisms of RSV in protecting against early brain injury (EBI) after SAH remain obscure. The purpose of this study was to investigate the effects of RSV on the TLR4-related inflammatory signaling pathway and EBI in rats after SAH. A prechiasmatic cistern SAH model was used in our experiment. The expressions of TLR4, high-mobility group box 1 (HMGB1), myeloid differentiation factor 88 (MyD88), and nuclear factor-κB (NF-κB) were evaluated by Western blot and immunohistochemistry. The expressions of Iba-1 and pro-inflammatory cytokines in brain cortex were determined by Western blot, immunofluorescence staining, or enzyme-linked immunosorbent assay. Neural apoptosis, brain edema, and neurological function were further evaluated to investigate the development of EBI. We found that post-SAH treatment with RSV could markedly inhibit the expressions of TLR4, HMGB1, MyD88, and NF-κB. Meanwhile, RSV significantly reduced microglia activation, as well as inflammatory cytokines leading to the amelioration of neural apoptosis, brain edema, and neurological behavior impairment at 24 h after SAH. However, RSV treatment failed to alleviate brain edema and neurological deficits at 72 h after SAH. These results indicated that RSV treatment could alleviate EBI after SAH, at least in part, via inhibition of TLR4-mediated inflammatory signaling pathway. PMID:27529233

  9. Role of nitric oxide and mechanisms involved in cerebral injury after subarachnoid hemorrhage: is nitric oxide a possible answer to cerebral vasospasm?

    Science.gov (United States)

    Crobeddu, Emanuela; Pilloni, Giulia; Tardivo, Valentina; Fontanella, Marco M; Panciani, Pier P; Spena, Giannantonio; Fornaro, Riccardo; Altieri, Roberto; Agnoletti, Alessandro; Ajello, Marco; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego

    2016-09-01

    Cerebral vasospasm represents the most critical event that could occur after subarachnoid hemorrhage (SAH). Therapy is only partially effective because cerebral arterial constriction is not fully understood yet. One of the most important biological messenger associated to SAH is nitric oxide (NO), that is considered local regulator of cerebral blood flow. Different nitric oxide synthase (NOS) forms play a role in different biological processes, one of which is to link neuronal activity to blood flow in cerebral cortex. We performed a reassessment of the literature to summarize the role of NO as the main inflammatory pathway activated after SAH to clarify its importance for treatment of vasospasm.

  10. Giant malignant peripheral nerve sheath tumor with cauda equina syndrome and subarachnoid hemorrhage: Complications in a case of type 1 neurofibromatosis.

    Science.gov (United States)

    Patil, Tushar B; Singh, Maneesh Kumar; Lalla, Rakesh

    2015-01-01

    Type 1 neurofibromatosis (NF1), which mainly involves ectodermal tissue arising from the neural crest, can increase the risk of developing malignant peripheral nerve sheath tumors (MPNSTs), soft tissue sarcomas and subarachnoid hemorrhage. We describe a patient with neurofibromatosis type 1 who developed soft tissue sarcoma, MPNST, and subarachnoid hemorrhage. A 22-year-old male reported right focal seizures consequence to severe headache. He had a weakness in both legs, could walk only with the support of a stick for the last 3 months and suffered from constipation and intermittent urinary retention for the past 1 week. The patient had a history of swelling in the back of left thigh for which surgical resection was done 6 months back. Cutaneous examination revealed multiple nodules of varying sizes all over the body, along with many café-au-lait spots and Lisch nodule in iris. Patient had weakness in bilateral hip abduction, extension, knee flexion, extension and ankle dorsiflexion and plantiflexion. Bilateral ankle reflexes were absent while other deep tendon reflexes were sub-optimal. A noncontrast computed tomography brain indicated subarachnoid hemorrhage in left perisylvian region. Ultrasound of left thigh showed a hypoechoic solid lesion in the posterior aspect of left thigh in muscle plane. Histopathology of the lesion following resection showed features suggestive of a low-grade pleomorphic rhabdomyosarcoma. Histology of cutaneous nodules was consistent with neurofibroma. Magnetic resonance imaging of the lumbosacral spine demonstrated a tumor arising from cauda equina. Histopathological examination of the tumor suggested high-grade MPNST. Unfortunately, the patient's MPNST was inoperable, and he received palliative radiotherapy for local control of the disease. The care of a patient with neurofibromatosis requires a comprehensive multisystem evaluation. MPNST occurs in 8-13% patients with neurofibromatosis. Early diagnosis and surgical resection are key

  11. Unilateral supraorbital keyhole approach in patients with middle cerebral artery (M1-M2 segment) symmetrical aneurysms.

    Science.gov (United States)

    Martellotta, N; Gigante, N; Toscano, S; Maddalena, G F; Tripodi, M; Settembrini, G; Stroscio, C; Distefano, G; Citro, E

    2003-08-01

    A left middle cerebral artery aneurysm at the bifurcation (M1-M2 segment) and a right smaller aneurysm, symmetrical to the previous one were diagnosed in a 69-year-old female after angiographic examination for subarachnoid hemorrhage. The preoperative radiological study did not enable us to identify the bleeding aneurysm so a left supraorbital keyhole approach was performed to operate on the bigger aneurysm. In the same surgical session, using the same way of approach, we decided to attack also the right aneurysm which then revealed itself as being responsible for bleeding. The postoperative angiograms confirmed the complete exclusion of both aneurysms and the patient was discharged after good recovery. Although there are remarkable controversies about the surgical strategies for multiple aneurysms, our experience gives us the opportunity to emphasize the supraorbital keyhole approach and to reconsider the "timing" of multiple/bilateral aneurysms.

  12. Endovascular repair of ruptured aneurysm arising from fenestration of the horizontal segment of the anterior cerebral artery: case report.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Sasaki, Kazuto; Chonan, Masashi; Mino, Masaki

    2012-01-01

    A 50-year-old man presented with an aneurysm arising from a fenestration of horizontal portion (A(1)) of the anterior cerebral artery manifesting as subarachnoid hemorrhage. Coil embolization was conducted and the aneurysm was occluded easily. Most reported cases of these types of aneurysms underwent direct surgery. Aneurysm arising from the A(1) fenestration is rare, but the present case shows that coil embolization can be an effective treatment modality. Three-dimensional rotational angiography and aneurysmography were helpful to characterize this complicated vascular structure.

  13. Minocycline Protects Against NLRP3 Inflammasome-Induced Inflammation and P53-Associated Apoptosis in Early Brain Injury After Subarachnoid Hemorrhage.

    Science.gov (United States)

    Li, Jianru; Chen, Jingsen; Mo, Hangbo; Chen, Jingyin; Qian, Cong; Yan, Feng; Gu, Chi; Hu, Qiang; Wang, Lin; Chen, Gao

    2016-05-01

    Minocycline has beneficial effects in early brain injury (EBI) following subarachnoid hemorrhage (SAH); however, the molecular mechanisms underlying these effects have not been clearly identified. This study was undertaken to determine the influence of minocycline on inflammation and neural apoptosis and the possible mechanisms of these effects in early brain injury following subarachnoid hemorrhage. SAH was induced by the filament perforation model of SAH in male Sprague-Dawley rats. Minocycline or vehicle was given via an intraperitoneal injection 1 h after SAH induction. Minocycline treatment markedly attenuated brain edema secondary to blood-brain barrier (BBB) dysfunction by inhibiting NLRP3 inflammasome activation, which controls the maturation and release of pro-inflammatory cytokines, especially interleukin-1β (IL-1β). Minocycline treatment also markedly reduced the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)-positive cells. To further identify the potential mechanisms, we demonstrated that minocycline increased Bcl2 expression and reduced the protein expression of P53, Bax, and cleaved caspase-3. In addition, minocycline reduced the cortical levels of reactive oxygen species (ROS), which are closely related to both NLRP3 inflammasome and P53 expression. Minocycline protects against NLRP3 inflammasome-induced inflammation and P53-associated apoptosis in early brain injury following SAH. Minocycline's anti-inflammatory and anti-apoptotic effect may involve the reduction of ROS. Minocycline treatment may exhibit important clinical potentials in the management of SAH. PMID:26143258

  14. Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review.

    Science.gov (United States)

    Aguiar, G B; Conti, M L M; Veiga, J C E; Jory, M; Souza, R B

    2011-09-01

    The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  15. 内皮一氧化氮合酶基因G894T多态性与动脉瘤性蛛网膜下腔出血的相关性研究%The relationship between G894T polymorphism of endothelial nitric oxide synthase gene and spontaneous aneurismal subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    徐亮; 张世明

    2010-01-01

    目的 研究eNOS基因第7外显子G894T多态性与动脉瘤性蛛网膜下腔出血(aSAH)的相关性.方法 利用聚合酶链反应(PCR)、琼脂糖凝胶电泳验证PCR反应产物,限制性片段长度多态性(RFLP)分析比较aSAH患者和对照者eNOS基因型的构成及等位基因频率的分布.结果 aSAH患者组的GT+TT基因型和T等位基因频率显著高于对照组,差异具有统计学意义.基因型分布在破裂的颅内动脉瘤直径大小之间差异无统计学意义,但是与aSAH患者预后相关.结论 eNOS基因G894T多态性可能是asAH发病的危险因子之一,GT+TT基因型与不良预后密切相关.%Objective To investigated a possible association between aneurysmal SAH and G894T (Clu298Asp) polymorphism in exon 7 of the endothelial nitric oxide synthase gene. Method To compare the allele gene and genotype frequency of polymorphism in exon 7 of the endothelial nitric oxide synthase gene G894T in 58 patients with aneurysmal subarachnoid hemorrhage ( aSAH group) and 67 healthy volunteers (control group) by means of polymerase chain reaction ( PCR), agarose gel electrophoresis and direct sequencing. Results There kinds of genetypes and two kinds of alleles were detected in this test eNOS GT + TT genotype and T allele were significantly more common in the patient group compared to the control group. No significant differences in the distributions of the eNOS G894T genotypes were found with regard to the sizes of ruptured aneurysms. Conclusions Polymorphism in exon 7 of the endothelial nitric oxide synthase gene G894T seems to be a possible risk factor for the onset of aneurismal subarachnoid hemorrhage. No significant relationship in the polymorphism in exon 7 of the eNOS gene were found with regard to the sizes of aneurysms. Multiple logistic regression analysis showed the eNOS GT + TT genotype was independently associated with an unfavorable outcome(GOS grade Ⅲ~Ⅴ) of aSAH.

  16. Endovascular treatment for pediatric intracranial aneurysms

    International Nuclear Information System (INIS)

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged ≤17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  17. Angiographic Findings In Patients With Cerebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Miri S M

    2004-09-01

    Full Text Available Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

  18. Time evolution and hemodynamics of cerebral aneurysms

    Science.gov (United States)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  19. La trapia endovascular: una nueva alternativa en el tratamiento del vasoespasmo cerebral asociado a la hemorragia subaracnoidea espontánea Endovascular therapy: new alternative for treatment of cerebral vasospasm associated with spontaneous subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Sergio Vargas

    1998-04-01

    Full Text Available EI vaso espasmo cerebral es la principal causa tratable de muerte e incapacidad por hemorragia subaracnoidea espontánea secundaria a la ruptura de un aneurisma cerebral. Sin embargo, su tratamiento ha sido tradicionalmente frustrante, con resultados desalentadores. A pesar de que aún no se han aclarado del todo los mecanismos fisiopatológicos a través de los cuales ocurre este intrigante fenómeno, en los últimos 9 años, paralelamente al desarrollo de las técnicas endovasculares para el tratamiento de las enferm~dades cerebrovasculares, han surgido nuevas alternativas en el manejo del vasoespasmo cerebral. Entre ellas se destacan el uso intraarterial de papaverina y la angioplastia con balón de los vasos cerebrales. Se presenta una revisión del estado actual de estos novedosos instrumentos terapéuticos, así como el reporte de un caso en el cual usamos la papaverina intraarterial en el tratamiento del vasoespasmo quese presentó durante un procedimiento endovascular para excluir un aneurisma de la arteria cerebral media. Cerebral vasospasm is the first treatable cause of death and disability secondary to spontaneous subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, its treatment has been disapointing with poor results. Despite the fact that the physiopathologic mechanisms governing this phenomenon are largely unknown, during the last nine years, simultaneously with the development of endovascular therapy techniques for treatment of cerebrovascular diseases, two new alternatives have emerged in order to alleviate cerebral vasospasm: intraarterial papaverine and cerebral balloon angioplasty. We report the use of intraarterial papaverine in one case to treat cerebral vasospasm presented during the endovascular therapy procedure; a review of literature is included.

  20. Coil embolization of an aneurysm located at the trunk of the persistent primitive trigeminal artery.

    Science.gov (United States)

    Kai, Yutaka; Ohmori, Yuki; Watanabe, Masaki; Morioka, Motohiro; Hirano, Teruyuki; Kawano, Takayuki; Sakurama, Tomotaka; Miura, Akiko; Kuratsu, Jun-Ichi

    2011-01-01

    A 71-year-old woman presented with an aneurysm at the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography and three-dimensional computed tomography revealed a wide-necked saccular aneurysm at the trunk of the left PPTA. Coil embolization with the balloon-assist technique was successful and PPTA patency was preserved. Preoperative conventional angiography should be performed to check for cross-filling of the PPTA. This case demonstrates that an aneurysm of the trunk of the PPTA can be successfully treated by coil embolization using the balloon-assist technique. PMID:21613761

  1. Management of Subarachnoid Hemorrhage in Two Important Italian Political Leaders: A Paradigm of Ethical and Technological Evolution of Neurosurgery During the Past Half-Century.

    Science.gov (United States)

    Longatti, Pierluigi; Giombelli, Ermanno; Pavesi, Giacomo; Carteri, Alessandro; Feletti, Alberto

    2016-08-01

    For a curious and extraordinary coincidence, 5 of the 7 most relevant leaders of the Italian Communist Party (Partito Comunista Italiano, which was established in 1921, has been the biggest Communist Party in Western Countries) suffered a cerebral stroke. Cerebrovascular diseases afflicted also Stalin and Lenin, and a number of Presidents of the United States. We present the stories of 2 important Italian political leaders who shared both the leadership role of the major left Italian Party and the dramatic experience of a subarachnoid hemorrhage. Retracing their medical incidents, separated by 50 years of history, we show how a fatal medical disease has become neurosurgical and successfully cured thanks to the advances of neurosurgery, neuroradiology, and hospital organization. A neurologic disease that was disgraceful 50 years ago has lost any disquieting and embarrassing significance in the present time to the light of evolution of vascular neurosurgery.

  2. Subtype activation and interaction of protein kinase C and mitogen-activated protein kinase controlling receptor expression in cerebral arteries and microvessels after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2008-01-01

    BACKGROUND AND PURPOSE: The pathogenesis of cerebral ischemia associated with subarachnoid hemorrhage (SAH) still remains elusive. The aim of this study was to examine the involvement of mitogen-activated protein kinase (MAPK) and protein kinase C (PKC) subtypes in the pathophysiology of cerebral...... enhanced phosphorylation only at 48 hours after SAH. The pattern was identical in large cerebral arteries and in intracerebral microvessels. Treatment with either the PKC (RO-31-7549) or the raf (SB386023-b) inhibitor prevented the kinase activation. CONCLUSIONS: The results show that specific subtypes...... ischemia after SAH in cerebral arteries and microvessels and to examine temporal activation of the kinases. We hypothesize that treatment with a MAPK or PKC inhibitor will prevent the SAH-induced kinase activation in brain vessels. METHODS: SAH was induced by injecting 250 microL blood...

  3. Transcriptional regulation of inflammatory and extracellular matrix-regulating genes in cerebral arteries following experimental subarachnoid hemorrhage in rats. Laboratory investigation

    DEFF Research Database (Denmark)

    Vikman, Petter; Ansar, Saema; Edvinsson, Lars

    2007-01-01

    , and gene regulation in the cerebral arteries was examined at various points in time following SAH by using quantitative polymerase chain reaction (PCR) and immunohistochemistry. RESULTS: Immunohistochemical findings demonstrated that SAH phosphorylates and activates p38 and ERK1/2 as well as the downstream......, IL1beta, CXCL1, CXCL2, CCL20, MMP8, MMP9, MMP13, and iNOS), as demonstrated using real-time PCR. For MMP13 and iNOS, the changes in transcription were translated into functional proteins, as revealed on immunohistochemistry. CONCLUSIONS: Activation of the p38 and ERK1/2 signaling pathways......OBJECT: Subarachnoid hemorrhage (SAH) results in the expression of inflammatory and extracellular matrix (ECM)-related genes and various G protein-coupled receptors. In the present study, the authors evaluated the time course and sequence of the transduction pathways, p38 mitogen-activated protein...

  4. Alterations of voltage-dependent calcium channel currents in basilar artery smooth muscle cells at early stage of subarachnoid hemorrhage in a rabbit model.

    Directory of Open Access Journals (Sweden)

    Xianqing Shi

    Full Text Available OBJECTIVE: To investigate the changes in the currents of voltage-dependent calcium channels (VDCCs in smooth muscle cells of basilar artery in a rabbit model of subarachnoid hemorrhage (SAH. METHODS: New Zealand white rabbits were randomly divided into five groups: sham (C, normal (N, 24 hours (S1, 48 hours (S2 and 72 hours (S3 after SAH. Non-heparinized autologous arterial blood (1 ml/kg was injected into the cisterna magna to create SAH after intravenous anesthesia, and 1 ml/kg of saline was injected into cisterna magna in the sham group. Rabbits in group N received no injections. Basilar artery in S1, S2, S3 group were isolated at 24, 48, 72 hours after SAH. Basilar artery in group C was isolated at 72 hours after physiological saline injection. Basilar artery smooth muscle cells were isolated for all groups. Whole-cell patch-clamp technique was utilized to record cell membrane capacitance and VDCCs currents. The VDCCs antagonist nifedipine was added to the bath solution to block the Ca(++ channels currents. RESULTS: There were no significant differences in the number of cells isolated, the cell size and membrane capacitance among all the five groups. VDCC currents in the S1-S3 groups had higher amplitudes than those in control and sham groups. The significant change of current amplitude was observed at 72 hours after SAH, which was higher than those of 24 and 48 hours. The VDCCs were shown to expression in human artery smooth muscle cells. CONCLUSIONS: The changes of activation characteristics and voltage-current relationship at 72 hours after SAH might be an important event which leads to a series of molecular events in the microenvironment of the basilar artery smooth muscle cells. This may be the key time point for potential therapeutic intervention against subarachnoid hemorrhage.

  5. Value of CT angiography in diagnosing the cause of spontaneous subarachnoid hemorrhage%CT血管成像对自发性蛛网膜下腔出血病因的诊断价值

    Institute of Scientific and Technical Information of China (English)

    赵立辉; 左玉强; 李存瑞; 吕超

    2015-01-01

    Objective To investigate the value of CT angiography (CTA) in the diagnosis of spontaneous subarachnoid hemorrhage (SAH). Methods Forty-two patients suspected with SAH were further examined by CTA and digital subtraction angiography (DSA). The imaging data were analyzed retrospectively. Results According to CTA, among the 42 patients, 31 cases with 35 cerebral aneurysms had been detected (including 1 case of misdiagno-sis), with 2 cases of cerebral arteriovenous malformation (AVM), 1 case of MoyaMoya disease, and 8 cases of nega-tive results (including 3 cases of missed diagnosis). DSA showed 33 cases with 37 cerebral aneurysms, 2 cases of AVM and 1 case of MoyaMoya disease, and 6 cases of negative results. Conclusion CTA can diagnose the causes of SAH rapidly and accurately, which can be used as one of the preferred method.%目的:探讨CT血管成像对自发性蛛网膜下腔出血(SAH)病因的诊断价值。方法42例临床拟诊为SAH的患者进行螺旋CT血管成像(CTA)检查和数字减影血管造影(DSA)检查,对其影像资料进行回顾性分析。结果42例患者中CTA诊断脑血管动脉瘤31例35枚(包括误诊1例),脑动静脉畸形2例,MoyaMoya病1例,阴性8例(包括漏诊3例);DSA诊断脑血管动脉瘤33例37枚;脑动静脉畸形2例,MoyaMoya病1例,阴性6例。结论 CTA成像可以快速、准确的判断自发性蛛网膜下腔出血的病因,可以作为临床筛查的首选检查方法之一。

  6. Diagnostic value of 16-slice spiral CT angiography for pathogenesis of subarachnoid hemorrhage%16层螺旋CT血管成像对蛛网膜下腔出血病因的诊断价值

    Institute of Scientific and Technical Information of China (English)

    叶更新; 周元敏; 康水英

    2015-01-01

    目的:探讨分析16层螺旋CT血管成像对蛛网膜下腔出血(SAH)病因的诊断价值。方法58例蛛网膜下腔出血患者,均先行16层螺旋CT平扫,再行CT血管成像(CTA),之后应用多平面重建、容积再现、最大密度投影等技术,对图像进行处理,观察患者的脑血管情况并对SAH病因进行分析。结果经3D-CTA共发现46例患者有56个动脉瘤、动静脉畸形8例、烟雾病3例、阴性1例;与数字减影血管造影(DSA)或外科手术作为参照,提示3D-CTA诊断颅内动脉瘤的敏感性与特异性分别为97.83%与100.00%。结论16层螺旋CT血管成像在蛛网膜下腔出血的病因诊断中具有较高应用价值,可作为诊断蛛网膜下腔出血病因的首选方法。%Objective To investigate and analyze the diagnostic value of 16-slice spiral CT angiography for pathogenesis of subarachnoid hemorrhage (SAH). Methods A total of 58 patients with SAH received plain scan by 16-slice spiral CT, and then received CT angiography (CTA). Images were processed by multiplanar reconstruction, volume rendering, and maximum intensity projection. Condition of patients’cerebral blood vessel was observed to analysis pathogenesis of SAH. Results After 3D-CTA for the 46 cases, there were 56 cases with arterial aneurysm, 8 cases with arteriovenous malformation, 3 cases with moyamoya disease, and 1 negative case. Comparisons with digital subtraction angiography (DSA) or surgical operation showed the sensibility and specificity of 3D-CTA in diagnosing arterial aneurysm were respectively 97.83% and 100.00%. Conclusion 16-slice spiral CT angiography provides high application value in diagnosis of the pathogenesis of SAH, and it can be taken as the preferred method in diagnosing the pathogenesis of SAH.

  7. Role of 3-D Conventional Angiography In Evaluation of Intra Carnial Aneurysms

    Directory of Open Access Journals (Sweden)

    Ahmed M Bassiouny*, Maher M Arafa*, Sameh M Abdelwahab*,

    2013-04-01

    Full Text Available Introduction: intracranial aneurysms are pathological enlargement of the brain arteries that are most commonly located in the circle of Willis. Intracranial aneurysms are relatively common with a prevalence of approximately 4%. The real danger of aneurysms is subarachnoid hemorrhage. 3D digital subtraction angiography has become a critical imaging tool in neuroradiology allowing for the visualization of detailed cerebral vasculature prior to any intervention. Aim of the work: The aim of this work is to evaluate the diagnostic performance of 3D conventional angiography in the evaluation of intracranial aneurysms compared with the conventional cerebral angiography. Methods: The studied group included 20 patients (5 men and 15 women with subarachnoid hemorrhage or known to have cerebral aneurysms. All patients were subjected to conventional cerebral angiography and 3D cerebral angiography, using C-arm (Toshiba rotational technique.Results: 3D digital subtraction angiography is superior to conventional digital subtraction angiography in 100% of the cases 3D imaging revealed the proper aneurysmal shape, size, precise assessment of its neck and relation to the surrounding vessels. Conclusion: Three-dimensional DSA improves the detection and delineation of intracranial aneurysms

  8. The “focus on aneurysm” principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage

    OpenAIRE

    Jha, Vikas; Behari, Sanjay; Jaiswal, Awadhesh K.; Bhaisora, Kamlesh Singh; Shende, Yogesh P.; Phadke, Rajendra V.

    2016-01-01

    Context: Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. Aim: We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. Setting: Tertiary care academic institute. Statistics: Test of significance applied to determine the factors ...

  9. Arctigenin, a Potent Ingredient of Arctium lappa L., Induces Endothelial Nitric Oxide Synthase and Attenuates Subarachnoid Hemorrhage-Induced Vasospasm through PI3K/Akt Pathway in a Rat Model

    OpenAIRE

    Chih-Zen Chang; Shu-Chuan Wu; Chia-Mao Chang; Chih-Lung Lin; Aij-Lie Kwan

    2015-01-01

    Upregulation of protein kinase B (PKB, also known as Akt) is observed within the cerebral arteries of subarachnoid hemorrhage (SAH) animals. This study is of interest to examine Arctigenin, a potent antioxidant, on endothelial nitric oxide synthase (eNOS) and Akt pathways in a SAH in vitro study. Basilar arteries (BAs) were obtained to examine phosphatidylinositol-3-kinase (PI3K), phospho-PI3K, Akt, phospho-Akt (Western blot) and morphological examination. Endothelins (ETs) and eNOS evaluatio...

  10. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  11. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  12. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child.

    Science.gov (United States)

    Demartini, Zeferino; Matos, Luiz Afonso Dias; Dos Santos, Marcio Luis Tostes; Cardoso-Demartini, Adriane de Andre

    2016-01-01

    The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.

  13. The efficacy of early lamina terminalis fenestration in treating acute hydrocephalus after aneurismal subarachnoid hemorrhage%早期终板造瘘治疗动脉瘤性蛛网膜下腔出血后急性脑积水的疗效

    Institute of Scientific and Technical Information of China (English)

    彭四维; 漆松涛; 冯文峰; 刘忆; 张国忠; 王刚; 李明洲

    2015-01-01

    Objective To explore the efficacy of early lamina terminalis fenestration in the treatment of acute hydrocephalus after aneurismal subarachnoid hemorrhage.Methods Ninety-eight patients of acute hydrocephalus after aneurismal subarachnoid hemorrhage who were treated by clipping were retrospectively analyzed.These cases were divided into two groups,including aneurysm clipping group alone (42 cases) and clipping with lamina terminalis fenestration group(56 cases).The improving rate of acute hydrocephalus and the incidence rate of shunt-dependent hydrocephalus after surgical treatment were compared between two groups.Results All surgical clipping procedures were performed within 72 hours after aneurysm rupture.Ultimately,46 cases of acute hydrocephalus patients acquired improvement and 27 cases developed to chronic hydrocephalus after surgical treatment among 98 patients.Fourteen cases of acute hydrocephalus patients in aneurysm clipping group were improved (the improvement rate was 33.3%) and 14 cases developed into shunt-dependent hydrocephalus (the incidence rate was 33.3%).Thirty-two cases of acute hydrocephalus patients in lamina terminalis fenestration after aneurysm clipping group were improved (the improvement rate was 57.1%) and 13 cases developed into chronic hydrocephalus (the incidence rate was 23.2%).The acute hydrocephalus improvement rate and shunt-dependent hydrocephalus incidence rate in posterior circulation aneurysm group were statistically difference between aneurysm clipping group and lamina terminalis fenestration after aneurysm clipping group (P < 0.05),but not in anterior circulation aneurysm group (P > 0.05).Conclusions The efficacy of early lamina terminalis fenestration in the treatment of acute hydrocephalus after aneurismal subarachnoid hemorrhage was effective in posteriorcirculation aneurysm clipping.%目的 探究早期终板造瘘治疗动脉瘤性蛛网膜下腔出血(aSAH)后急性脑积水的疗效.方法

  14. Sexual Activity as a Risk Factor for the Spontaneous Rupture of Cerebral Aneurysms.

    Science.gov (United States)

    Blanke-Roeser, Constantin; Matschke, Jakob; Püschel, Klaus

    2016-06-01

    Subarachnoid hemorrhages from ruptured cerebral aneurysms have a high clinical relevance and often lead to death. Approximately 2% to 5% of the people worldwide, even of younger age, are said to have aneurysms at cerebral arteries. In many cases, they remain clinically unapparent for decades. However, there are numerous risk factors for the rupture of an aneurysm, including temporary raises of the blood pressure. Such changes of the blood pressure can be induced even by several everyday behaviors. For example, any sort of sexual activities may cause extensive raises of the blood pressure because of several physical and psychological factors. The term "sexual activity" covers sexual intercourse as well as masturbation. In this article, the remarkable case of a 24-year-old woman with a ruptured cerebral aneurysm in the context of masturbation is presented. It is discussed with respect to the possible pathophysiological effects of sexual activity on cerebral aneurysms. PMID:27043460

  15. Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

    Directory of Open Access Journals (Sweden)

    Hidetoshi Ooigawa

    2015-06-01

    Full Text Available We report a case of small internal carotid–posterior communication artery (IC–PC aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated.

  16. Clinical-radiological spectrum of giant supraclinoid internal carotid artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Vinuela, F.; Fox, A.; Chang, J.K.; Drake, C.G.; Peerless, S.J.

    1984-03-01

    A review of a series of 312 giant intracranial aneurysms treated at University Hospital in London, Ontario, showed that 93 of those aneurysms were located between the intracavernous portion and the bifurcation of the internal carotid artery. Sixty-five of those aneurysms were carotid ophthalmic, 12 were located in the internal carotid-posterior communicating-anterior choroidal artery regions and 16 involved the internal carotid artery bifurcation. For the majority, clinical presentation was related to the mass of the aneurysms and compression of surrounding structures such as visual pathways, ocular motor cranial nerves, the fifth nerve, and hypothalamic-pituitary axis. Fourteen patients presented with subarachnoid hemorrhage. Cerebral angiography, computed tomography and xenon inhalation studies of cerebral blood flow were the tools used to study the morphology of the aneurysm and dynamics of the circle of Willis.

  17. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    OpenAIRE

    Kun Tang; Rui Li; Jie Lin; Xiangwu Zheng; Ling Wang; Weiwei Yin

    2015-01-01

    Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA) with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH) were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA) group and low voltage CTA (L-CTA) group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. W...

  18. Analysis of related factor of subarachnoid hemorrhage headache%蛛网膜下腔出血头痛的相关因数分析

    Institute of Scientific and Technical Information of China (English)

    刘立伟

    2015-01-01

    目的:研究分析蛛网膜下腔出血头痛的相关因数.方法:选取2013-04/2014-01我院的96例蛛网膜下腔出血头痛患者作为研究对象,对其临床资料进行回顾性分析,将其分为两组,其中观察组为52例老年SAH患者,对照组为44例非老年性SAH患者,分析蛛网膜下腔出血头痛患者出血量、颅压、脑脊液改变与头痛程度的关系.结果:观察组患者中等量出血及中等量以上出血者发生头痛程度与少量出血者、CT阴性患者比较无明显差异(P>0.05);对照组患者中CT阴性、少量出血者和中等量以上出血者发生头痛程度比较存在显著差异(P <0.01);观察组的头痛程度比照组明显轻(P <0.01).脑脊液为血色或粉红色时,对照组的头痛程度较重(P<0.01),观察组脑脊液为新鲜出血时头痛明显(P <0.01),观察组头痛程度较对照组轻(P<0.01).结论:CSF血性变是造成蛛网膜下腔的炎性反应发生的原因之一,老年人在CSF血性变程度较轻,头痛程度也较非老年人轻.%AIM:To study and analyze the related factor of sub-arachnoid hemorrhage headache.METHODS:Ninety six pa-tients in our hospital,from April 2013 to January 2014,with sub-arachnoid hemorrhage were selected and their clinical data were analyzed retrospectively. All patients were divided into two groups,52 patients of elderly patients with SAH in the observation group and 44 patients of senile patients with SAH in the control group.The relationship of subarachnoid hemorrhage,cranial pres-sure,changes in cerebrospinal fluid and the degree of headache were analyzed.RESULTS:The comparison of the headache de-gree between patients with moderate bleeding/more moderate de-gree in the observation group and patients with small amount of bleeding/CT-negative patients was not significant different (P>0.05);the comparison of the headache degree among CT

  19. Early cerebral circulatory disturbance in patients suffering subarachnoid hemorrhage prior to the delayed cerebral vasospasm stage. Xenon computed tomography and perfusion computed tomography study

    International Nuclear Information System (INIS)

    Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR], moderate disability [MD], severe disability [SD], vegetative state [VS], or death [D]). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients. (author)

  20. GDC血管内栓塞治疗动脉瘤性蛛网膜下腔出血后慢性脑积水的影响机制与预后研究%Pathogenesis and prognosis of chronic hydrocephalus following aneurismal subarachnoid hemorrhage treated by endovascular embolization with Guglielmi detachable coils

    Institute of Scientific and Technical Information of China (English)

    王立江; 段传志; 何旭英; 文军; 汪求精; 李西锋; 柳晓秋; 王建奇

    2010-01-01

    Objective To explore the risk factors and the prognosis of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH) treated by endovaseular embolization with Guglielmi detachable coils (GDCs). Methods Endovascular embolization with GDCs were performed in 132 patients with aneurysmal subarachnoid hemorrhage that satisfied our research standard. After endovascular embolization, ventricular drainage was conventionally performed in patients who occurred intraventricular hemorrhage combined with obstruction in the ventricular system, while cerebrospinal fluid permutation was performed in other patients. Chronic hydrocephalus was evaluated by CT 1 month after SAH. Ventricle-peritoneal shunt was carried out for patients with severe chronic hydrocephalus while only clinical observation was needed for patients with mild chronic hydrocephalus. Clinical follow-up evaluation was carried out 6 months after SAIl according to the modified Rankin scale score. The risk factors related to chronic hydrocephalus were noted through the statistical analysis of the patients' data and the relation between the appearing of chronic hydrocephalus and clinical prognosis of SAH was analyzed. Results The overall incidence rate of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage was 12.12% and age, Fisher grade and Hunt-Hess grade had important value in the prognosis of chronic hydrocephalus. Clinical prognosis of SAH was not significantly related to chronic hydrocephalus following SAH (P >0.05). Conclusion Chronic hydrocephalus following aneurysmal subarachnoid hemorrhage is not only resulted from one single risk factor and good clinical prognosis can be achieved by promptly performing ventricle-peritoneal shunt in patients with severe chronic hydrocephalus.%目的 探讨GDC血管内栓塞治疗动脉瘤性蛛网膜下腔出血后慢性脑积水发生的易患因素和临床预后.方法 纳入研究标准的132例动脉瘤性蛛网膜下腔出血患者均

  1. A fusiform aneurysm of a persistent trigeminal artery variant: case report and literature review.

    Science.gov (United States)

    Yang, Zhigang; Liu, Jianmin; Zhao, Wenyuan; Xu, Yi; Hong, Bo; Huang, Qinghai; He, Shike

    2010-04-01

    A 48-year-old man suffered from spontaneous subarachnoid hemorrhage. Emergent right internal carotid angiography showed the presence of a persistent trigeminal artery (PTA) variant with a fusiform aneurysm on its proximal segment where it branched from the internal carotid artery. This artery supplied the territory of the anterior inferior cerebellar artery. After consideration of the adequacy of the cerebellar circulation without this anomalous artery, intraluminal occlusion of the aneurysm together with the PTA variant was performed using detachable coils. The patient recovered uneventfully without any neurologic deficits. PMID:19690795

  2. Microsurgical management of a complicated aneurysmal endovascular embolisation with GDC coil: a case report.

    Science.gov (United States)

    Pogády, P; Mustafa, H; Wies, W; Lungenschmid, K; Wurm, G; Tomancok, B; Holl, K; Fischer, J

    1998-01-01

    We present a case involving a microsurgical approach to solving the problem of a medial cerebral artery (MCA) occlusion occurring after GDC coiling of an internal cerebral artery (ICA) bifurcation aneurysm in a 40 year old woman. We describe the clinical course of the case and discuss technical possibilities and risks of clipping a coiled aneurysm. One key to success is awareness of changes in the aneurysm's properties after coiling. With loss of elasticity the aneurysm had the effect of a tumor fixed on the vessel. The apposition of the aneurysm to the wall of the vessel, as well as the aneurysm's rigidity and increase of intracranial pressure after subarachnoideal hemorrhage (SAH), may lead to occlusion of the vessel. In cases of an mandatory operation due to the occlusion of a main arterial stem after coiling, it is primarily crucial to perforate the aneurysm's fundus, remove the coils, and, finally, to clip the slack neck of the aneurysm. An attempt to precisely prepare and clip the aneurysmal neck without removing the coils could result in the rupture of the aneurysm's neck. PMID:9795964

  3. Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Masanori Suzuki

    2014-01-01

    Full Text Available Background:  No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a massive subarachnoid hemorrhage mainly in the posterior fossa. Left vertebral angiograms showed an aneurysm on the feeding artery, posterior inferior cerebellar artery. Both the aneurysm and its main feeder were simultaneously treated by a single procedure of embolization using N-butyl cyanoacrylate. Their complete obliteration was confirmed angiographically. Four days after the procedure, we removed the tumor and the embolized aneurysm. The pathological diagnosis was hemangioblastoma and flow-related ruptured aneurysm. Conclusion: Cerebral angiography should be performed to rule out vascular abnormalities such as cerebral aneurysms adjacent to the tumor in patients with hemangioblastoma who present with intracranial hemorrhage. We emphasize the usefulness of embolization with N-butyl cyanoacrylate for hemangioblastoma with ruptured feeder aneurysm, by which the aneurysm and the feeder could be simultaneously embolized.

  4. The dilemma of complicated shunt valves: How to identify patients with posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage who will benefit from a simple valve?

    Directory of Open Access Journals (Sweden)

    Christian von der Brelie

    2016-01-01

    Full Text Available Background: Sophisticated shunt valves provide the possibility of pressure adjustment and antisiphon control but have a higher probability of valve dysfunction especially in a posthemorrhagic setting. The aim of the present study is to analyze the clinical outcome of patients with shunt dependent posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage (SAH in order to identify patients who would benefit from a simple differential pressure valve. Methods: From 2000 to 2013, 547 patients with aneurysmatic SAH were treated at our institution, 114 underwent ventricular shunt placement (21.1%. 47 patients with available pre- and post-operative computed tomography scans, and an available follow-up of minimum 6 months were included. In order to measure the survival time which a nonprogrammable differential pressure valve would have had in an individual patient we defined the initial equalized shunt survival time (IESS. IESS is the time until surgical revisions of fixed differential pressure or flow-regulated valves for the treatment of over- or under-drainage as well as re-programming of adjustable valves due to over- or under-drainage. Results: Twenty patients were treated with fixed differential pressure valves, 15 patients were treated with flow-regulated valves, and 12 underwent ventriculoperitoneal (VP shunt placement with differential pressure valves assisted by a gravitational unit. Patients who reacted with remarkable changes of the ventricular width after the insertion of external ventricular drainage (EVD, before shunt placement, showed a significantly longer IESS. Conclusions: Decline of the ventricular width after EVD placement was a predictor for successful VP shunt therapy in the later course of disease. Possibly, this could allow identifying patients who benefit from a simple differential pressure valve or a flow-regulated valve, and thus could possibly avoid valve-associated complications of a programmable valve in the

  5. Surgical treatment for ruptured anterior inferior cerebellar artery aneurysms

    Directory of Open Access Journals (Sweden)

    TONG Xiao-guang

    2013-03-01

    Full Text Available Background Anterior inferior cerebellar artery (AICA aneurysm is an extremely raretumor, which can cause severe results after ruptured. This article retrospectively analyzed the clinical symptoms, imaging manifestations, surgical approaches, endovascular therapy and postoperative outcomes of 12 cases with AICA aneurysms, so as to provide reference for clinical practice. Methods Clinical data of patients with AICA aneurysms, who were treated in our hospital between June 2004 and June 2012, were carefully collected and studied. Glasgow Outcome Scale (GOS scores were used to evaluate the patients' living status. Results There were 12 patients (the average age was 54 years old with 13 ruptured aneurysms, accounting for 0.19% of all aneurysms (6467 cases treated in the same period. CT showed simple subarachnoid hemorrhage (SAH in 6 patients, simple ventricular hemorrhage in 1 patient and SAH complicated with ventricular hemorrhage in 5 patients. According to Hunt-Hess Grade, 2 patients were classified as Grade Ⅰ; 7 were Grade Ⅱ; 3 were Grade Ⅲ. Digital subtraction angiography (DSA showed there were 10 saccular aneurysms and 3 fusiform aneurysms. Three aneurysms were located in the proximal segment of AICA (the junction of AICA and basilar artery, 3 premeatal segment (first bifurcation of AICA, 3 meatal and 4 postmeatal. The mean diameter was 3.90 mm. Three patients with 4 aneurysms were treated with microsurgery, of which clipping was carried out in 2 patients with 3 aneurysms and trapping in 1 case. Other 9 patients were treated with endovascular therapy, of which 2 cases underwent coil embolization, 3 stent-assisted coil, and 4 parent artery occlusion (PAO. Postoperative complications included facial paralysis (1 case, dysphagia and coughing when drinking (1 case and contralateral hemianopia in both eyes (1 case. Follow-up was available in all of these cases for a mean of 36.41 months, with GOS scores 3 in 1 case, 4 in 2 cases and 5 in 9

  6. Improvement in neurological outcome and abolition of cerebrovascular endothelin B and 5-hydroxytryptamine 1B receptor upregulation through mitogen-activated protein kinase kinase 1/2 inhibition after subarachnoid hemorrhage in rats

    DEFF Research Database (Denmark)

    Larsen, Carl Christian; Povlsen, Gro Klitgaard; Rasmussen, Marianne Nelly Paola;

    2011-01-01

    )) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors has been demonstrated in cerebral artery smooth muscles in the delayed ischemic phase after experimental SAH, and intracellular signaling via the mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase 1/2 pathway has been shown......Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) remains a major cause of death and disability. It has been hypothesized that cerebrovascular upregulation of vasoconstrictor receptors is a key step in the development of delayed cerebral ischemia. Upregulation of endothelin-B (ET(B...

  7. 一种新的兔株网膜下腔出血后症状性脑血管痉挛模型的建立%Establishment of a new symptomatic cerebral vasospasm model following subarachnoid hemorrhage in rabbit

    Institute of Scientific and Technical Information of China (English)

    施国君; 刘俊雄; 王敏

    2002-01-01

    Objective To establish an experimental model of symptomatic cerebral vasospasm(CVS) after subarachnoid hemorrhage( SAH) in rabbits. Method 2 weeks after the ligation of bilateral common carotid arteries, We induced CVS by injecting arterial blood twice via a cranial hole 2 mm× 2 mm and then neurological symptoms ,cerebral blood flow(rCBF) and food intake were evaluated. Results Food intake and rCBF decreased and neurological disorders were observed. Conclusion An experimental rabbit model of symptomatic CVS can be established by injecting blood via a cranial hole after bilateral common carotid arteries ligation. ``

  8. Improvement in neurological outcome and abolition of cerebrovascular endothelin B and 5-hydroxytryptamine 1B receptor upregulation through mitogen-activated protein kinase kinase 1/2 inhibition after subarachnoid hemorrhage in rats

    DEFF Research Database (Denmark)

    Larsen, Carl Christian; Povlsen, Gro Klitgaard; Rasmussen, Marianne Nelly Paola;

    2011-01-01

    Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) remains a major cause of death and disability. It has been hypothesized that cerebrovascular upregulation of vasoconstrictor receptors is a key step in the development of delayed cerebral ischemia. Upregulation of endothelin-B (ET......(B)) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors has been demonstrated in cerebral artery smooth muscles in the delayed ischemic phase after experimental SAH, and intracellular signaling via the mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase 1/2 pathway has been shown...

  9. MEK1/2 Inhibitor U0126 but Not Endothelin Receptor Antagonist Clazosentan Reduces Upregulation of Cerebrovascular Contractile Receptors and Delayed Cerebral Ischemia, and Improves Outcome after Subarachnoid Hemorrhage in Rats

    DEFF Research Database (Denmark)

    Povlsen, Gro K; Edvinsson, Lars

    2015-01-01

    Cerebral vasospasm and late cerebral ischemia (LCI) remain leading causes of mortality in patients experiencing a subarachnoid hemorrhage (SAH). This occurs typically 3 to 4 days after the initial bleeding and peaks at 5 to 7 days. The underlying pathophysiology is still poorly understood. Because...... SAH is associated with elevated levels of endothelin-1 (ET-1), focus has been on counteracting endothelin receptor activation with receptor antagonists like clazosentan, however, with poor outcome in clinical trials. We hypothesize that inhibition of intracellular transcription signaling...

  10. Ruptured cerebral aneurysm associated with a persistent primitive trigeminal artery variant

    Science.gov (United States)

    Yamamoto, Takahiro; Hasegawa, Yu; Ohmori, Yuki; Kawano, Takayuki; Kai, Yutaka; Morioka, Motohiro; Kuratsu, Jun-ichi

    2011-01-01

    Background: Primitive trigeminal artery variants (PTAVs) are one of the rare persistent fetal anastomoses between the carotid and vertebrobasilar circulations. They originate from the internal carotid artery and join one of the cerebellar arteries instead of the basilar artery. Case Description: We present an 82-year-old woman with subarachnoid hemorrhage due to a ruptured aneurysm originating at a PTAV. Three-dimensional computed tomography angiogram and cerebral angiography revealed bilateral PTAV and two aneurysms originating at the left PTAV. The proximal and distal aneurysms were saccular and fusiform, respectively. She underwent surgical treatment and her postoperative course was uneventful. Conclusion: Our case demonstrates that extremely rare cerebral aneurysms associated with PTAV can be addressed successfully by surgical intervention. PMID:22059121

  11. Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report.

    Science.gov (United States)

    Lavoie, Pascale; Raymond, Jean; Roy, Daniel; Guilbert, François; Weill, Alain

    2007-05-01

    The authors report the case of a 12-year-old boy with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery (ASA) aneurysm treated with selective coil placement in the context of subarachnoid hemorrhage (SAH). The patient presented with headache. Head computed tomography scanning revealed no abnormal findings. The cerebrospinal fluid was sampled and analyzed and a diagnosis of SAH was established. Investigation, including magnetic resonance imaging of the cord as well as cerebral and spinal angiography, revealed a conus medullaris AVM and a saccular aneurysm located on the ASA at the T-11 level. The aneurysm was thought to be responsible for the bleeding. Superselective ASA angiography showed that the aneurysm was at the bifurcation between a large coronal artery supplying the AVM and the ASA. The relation of the aneurysm's neck to the main spinal axis and the aneurysm's morphological features indicated that the lesion was suited for endosaccular coil therapy. The aneurysm was selectively occluded, using electrodetachable bare platinum coils. Follow-up angiography immediately after surgery and at 6 months thereafter demonstrated complete occlusion of the aneurysm and a perfectly patent anterior spinal axis. On clinical follow-up examination, the patient remained neurologically intact. When the morphological features of a spinal aneurysm and its relation with the anterior spinal axis are favorable, selective endosaccular coil placement can successfully be achieved. PMID:17542515

  12. [Ruptured aneurysm at the anterior wall of the internal carotid artery in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome].

    Science.gov (United States)

    Chonan, Masashi; Fujimura, Miki; Inoue, Takashi; Tominaga, Teiji

    2011-07-01

    A 60 year-old woman, who had a 45-year history of systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome, presented with subarachnoid hemorrhage due to a ruptured aneurysm at the anterior wall of the non-branching site of the right internal carotid artery. She underwent radical surgery on the day of onset. In light of the possibility of arterial dissection, we performed extracranial-intracranial bypass prior to careful exploration of the aneurysm. Based on the finding of saccular aneurysm, she ultimately underwent neck clipping of the aneurysm without complication. Postoperative course was uneventful, and she did not suffer from cerebral vasospasm. We recommend early surgical intervention in patients with aneurysmal SAH associated with SLE, while intrinsic pathologies of SLE such as fragile vascular structure and the risk for ischemic complication should be considered.

  13. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases

    OpenAIRE

    Yu, Jinlu; Xu, Baofeng; Guo, Yunbao; Xu, Kan

    2015-01-01

    To investigate the method and outcome from direct clipping of a blister-like aneurysm (BBA) of the internal carotid artery supraclinoid segment. This study featured nine BBA patients, including eight females and one male. The patients presented subarachnoid hemorrhage (SAH) as the initial symptom and were diagnosed with BBA in the supraclinoid segment through a vascular exam and imaging. During the exam, the internal carotid artery was pressed to block the blood flow, and a transcranial Doppl...

  14. 老年性蛛网膜下腔出血非典型症状30例分析%Analysis of atypical symptoms in 30 cases of senile Subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    李秋茹; 王晓明; 龙存国

    2003-01-01

    @@ CLINICAL DATA Subjects came from 30 patients with senile subarachnoid hemrrhagetreated in our hospital from January 1999 to December 2001 in-cluding 12 males and 18 females aged 60-78(mean: 65) yearsold. 24 patients presented with onset in action, 6 patients at rest; 26cases presented with acute onset and 4 cases subacute onset. Acuteheadache as first symptom was in 13 cases; pain at neck, waist,sacral as first symptom in 7 cases. 3 patients searched medical ser-vice for headache within 1 week; 2 patients for severe pain of bothlimbs and unable to walk; 2 patients for headache and vomiting at 2week. 7 patients were once treated out of our hospital and sciaticawas diagnosed in 4 cases, cold in 3 cases. Pain at shoulder, back,upper limb in action occurred in 2 cases as first symptom, consciousdisturbance was the first symptom in 4 cases, grand mal of epilepsyas first symptom in 3 cases. 1 patient searched medical service forright head pain, auricle pain for 20 days. Stiff neck ( + ) appeared in25 patients at hospitalization and (-) in 5 patients. 24 patientspresented with positive Kernig' s sign. 21 patients were complicatedwith hypertension, 1 patient was complicated with peripheral facialparalysis and left hemihypoesthesia, 3 patients with transient hemi-paresis of both lower limhs, 2 cases with bilateral ptosis, 1 case withexotropia of bilateral eyeball, pupil dilation, 6 cases with consciousdisturbance. Auxilliary examination: (1) Skull CT scanning: Sub-arachnoid hemorrhage was found in 20 cases, no abnormality in 7cases and 3 cases didn't undergo CT scanning. (2) Examination ofspinal fluid: patients with positive CT findings didn' t undergo lumbarpuncture, even hemic spinal fluid was found in 6 patients and yellowspinal fluid and shrinking red blood cell in 4 cases. Prognosis: Allcases were treated according to subarachnoid hemorrhage, 6 patientsdied and other 24 patients were cured after 6 - 8 weeks of treatment.

  15. Moyamoya disease associated with asymptomatic mosaic Turner syndrome: a rare cause of hemorrhagic stroke.

    Science.gov (United States)

    Manjila, Sunil; Miller, Benjamin R; Rao-Frisch, Anitha; Otvos, Balint; Mitchell, Anna; Bambakidis, Nicholas C; De Georgia, Michael A

    2014-01-01

    Moyamoya disease is a rare cerebrovascular anomaly involving the intracranial carotid arteries that can present clinically with either ischemic or hemorrhagic disease. Moyamoya syndrome, indistinguishable from moyamoya disease at presentation, is associated with multiple clinical conditions including neurofibromatosis type 1, autoimmune disease, prior radiation therapy, Down syndrome, and Turner syndrome. We present the first reported case of an adult patient with previously unrecognized mosaic Turner syndrome with acute subarachnoid and intracerebral hemorrhage as the initial manifestation of moyamoya syndrome. A 52-year-old woman was admitted with a subarachnoid hemorrhage with associated flame-shaped intracerebral hemorrhage in the left frontal lobe. Physical examination revealed short stature, pectus excavatum, small fingers, micrognathia, and mild facial dysmorphism. Cerebral angiography showed features consistent with bilateral moyamoya disease, aberrant intrathoracic vessels, and an unruptured 4-mm right superior hypophyseal aneurysm. Genetic analysis confirmed a diagnosis of mosaic Turner syndrome. Our case report is the first documented presentation of adult moyamoya syndrome with subarachnoid and intracerebral hemorrhage as the initial presentation of mosaic Turner syndrome. It illustrates the utility of genetic evaluation in patients with cerebrovascular disease and dysmorphism.

  16. Usefulness of CT angiography for demonstrating cerebral aneurysm

    International Nuclear Information System (INIS)

    We report the usefulness of computed cerebral angiotomography (CT angiography) for demonstrating cerebral aneurysm and the clinical significance of CT angiography for ruptured cerebral aneurysm. Our modified method of CT angiography was easy and less time-consuming. Fifteen seconds after starting a single bolus injection, 1 ml/kg/25 seconds via cubital vein, of contrast medium (60 % urograffin), 5 serial 5 mm thick-CT slices were scanned in every 6.5 seconds including 2 seconds of interval, beginning from an axial level 20 mm above the orbitomeatal line and ending at a level 40 mm. A total of 103 patients were examined in this report, consisting of 70 unruptured asymptomatic, 8 unruptured symptomatic (oculomotor nerve palsy) and 25 subarachnoid hemorrhage (SAH). Seven unruptured aneurysms in 4 asymptomatic cases, 2 unruptured aneurysms in 2 symptomatic cases 27 aneurysms in 24 SAH cases were suspected by CT angiography. Of these 36 aneurysms suspected by CT angiography 32 aneurysms were confirmed by cerebral angiography. The detection rate of CT angiography in this report was 89 %, higher than those of previous reports. Thirteen aneurysms were located at internal carotidposterior communicating artery (ICPC) junction. 11 at anterior communicating artery (Acom), 7 at middle cerebral artery (MCA). CT angiography showed a false positive findings in 4 cases, which were all located at Acom. Four aneurysms were not detected in CT angiography, which were all located at MCA and were very small (2 - 3 mm) in diameter. There were no deteriorated cases during and after CT angiography. We suggest that CT angiography is a useful and safe method for predicting the location of not only unruptured but ruptured aneurysms. (author)

  17. Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature

    Directory of Open Access Journals (Sweden)

    Menon Girish

    2007-01-01

    Full Text Available Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14%. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days, the mean admission to rebleed was 1.42 days (Range: 0-4 and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while

  18. Mirror aneurysms : a reflection on natural history

    NARCIS (Netherlands)

    Meissner, Irene; Torner, James; Huston III, John; Rajput, Michele L.; Wiebers, David O.; Jones, Lyell K.; Brown, Robert D.; Groen, Rob

    2012-01-01

    OBJECT: Investigators conducting the International Study of Unruptured Intracranial Aneurysms, sponsored by the National Institutes of Health, sought to evaluate predictors of future hemorrhage in patients who had unruptured mirror aneurysms. These paired aneurysms in bilateral arterial positions mi

  19. Experiment on prevention of cerebral vasospasm after subarachnoid hemorrhage and progress of Clinical research%蛛网膜下腔出血并发脑血管痉挛预防的实验与临床研究进展

    Institute of Scientific and Technical Information of China (English)

    梁柯

    2007-01-01

    @@ Cerebral vasospasm(CVS),a common complication of subarachnoid hemorrhage(SAH),is caused by many factors and associated with poor prognosis of SAH.CVS generally occurs 3-4 days after the initial SAH and peaks at 5-7 days.

  20. Microsurgical anatomy of the infratentorial trabecular membranes and subarachnoid cisterns.

    Science.gov (United States)

    Vinas, F C; Dujovny, M; Fandino, R; Chavez, V

    1996-04-01

    The understanding of the anatomy of the subarachnoid cisterns and trabecular membranes is of paramount importance in the surgical treatment of pathology of the posterior fossa. Aneurysms, arteriovenous malformations, and some tumors should be approached through the subarachnoid space. The subarachnoid cisterns provide natural pathways to approach neurovascular and cranial nerve structures. The microsurgical anatomy of the infratentorial subarachnoid cisterns was studied in twenty adult brains, using the 'immersion technique'. Air was injected into the subarachnoid cisterns and brains were dissected under the operative microscope. Six main compartmental trabecular membranes were identified in the infratentorial level. They divide the subarachnoid space into six cisterns. Cisternal divisions and the disposition of the trabecular membranes were closely related to the vascular divisional patterns of the principal arteries. Thorough knowledge of the microsurgical anatomy of the subarachnoid space will aid neurosurgeons during the surgical approach of many vascular and tumoral lesions located in the posterior fossa.

  1. Inflammation and intracranial aneurysms: mechanisms of initiation, growth, and rupture

    Directory of Open Access Journals (Sweden)

    Peter S Amenta

    2015-06-01

    Full Text Available Outcomes following aneurysmal subarachnoid hemorrhage remain poor in many patients, despite advances in microsurgical and endovascular management. Consequently, considerable effort has been placed in determining the mechanisms of aneurysm formation, growth, and rupture. Various environmental and genetic factors are implicated as key components in the aneurysm pathogenesis. Currently, sufficient evidence exists to incriminate the inflammatory response as the common pathway leading to aneurysm generation and rupture. Central to this model is the interaction between the vessel wall and inflammatory cells. Dysfunction of the endothelium and vascular smooth muscle cells (VSMCs promotes a chronic pathological inflammatory response that progressively weakens the vessel wall. We review the literature pertaining to the cellular and chemical mechanisms of inflammation that contribute to aneurysm development. Hemodynamic stress and alterations in blood flow are discussed regarding their role in promoting chronic inflammation. Endothelial cell and VSMC dysfunction are examined concerning vascular remodeling. The contribution of inflammatory cytokines, especially tumor necrosis factor-α is illustrated. Inflammatory cell infiltration, particularly macrophage-mediated deterioration of vascular integrity, is reviewed. We discuss the inflammation as a means to determine aneurysms at greatest risk of rupture. Finally, future therapeutic implications of pharmacologic modulation of the inflammation are discussed.

  2. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Han, Moon Hee; Kang, Hyun Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyoung [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Lim, Jeong Wook [Dept. of Neurosurgery, Sun Hospital, Daejeon (Korea, Republic of)

    2015-02-15

    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  3. Clinical characteristics of subarachnoid hemorrhage patients with nosocomial infections and prevention countermeasures%蛛网膜下腔出血患者的医院感染临床特点与预防措施

    Institute of Scientific and Technical Information of China (English)

    何金峰; 徐小辉; 程珍珍; 洪海

    2015-01-01

    OBJECTIVE To explore the clinical characteristics of the subarachnoid hemorrhage patients with nosoco-mial infections,analyze the risk factors,and put forward the prevention countermeasures so as to provide scientific basis for early prevention and control of nosocomial infections in the subarachnoid hemorrhage patients.METHODS The clinical data of 148 patients with subarachnoid hemorrhage who were hospitalized from Jan 2010 to Dec 2013 were retrospectively analyzed,the clinical characteristics and risk factors for the nosocomial infections were ob-served,and the prevention countermeasures were put forward.RESULTS The nosocomial infections occurred in 30 of 148 subarachnoid hemorrhage patients with the infection rate of 20.27%,among whom the patients with respir-atory tract infections accounted for 43.33%,the patients with urinary tract infections 20.00%,the patients with gastrointestinal tract infections 13.33%,the patients with skin and soft tissue infections 10.00%.A total of 45 strains of pathogens have been isolated from the submitted specimens from the 30 cases of nosocomial infections, including 28 (62.22%)strains of gram-negative bacteria,13 (28.89%)strains of gram-positive cocci,and 4 (8.89%)strains of fungi.The age,underlying disease,disturbance of consciousness,smoking history,hemiple-gia,invasive operation,and hospitalization duration were the risk factors for the nosocomial infections in the sub-arachnoid hemorrhage patients (P<0.05).CONCLUSION The subarachnoid hemorrhage patients is the population at high risk of nosocomial infections.It is necessary to conduct targeted surveillance for the high risk factors and formulate corresponding prevention countermeasures based on the clinical characteristics so as to reduce the inci-dence of nosocomial infections in the subarachnoid hemorrhage patients.%目的:探讨蛛网膜下腔出血医院感染的临床特点、危险因素及预防对策,为早期预防和控制蛛网膜下腔出血医院感染提

  4. Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, Halil; Serifov, Elman; Kahriman, Guven [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Durak, Ahmet Candan [University of Erciyes, School of Medicine, Department of Radiology, Kayseri (Turkey); Menkue, Ahmet [University of Erciyes, School of Medicine, Department of Neurosurgery, Kayseri (Turkey)

    2011-11-15

    Purpose: The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). Materials and methods: One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA reader's interpretation was accepted as the reference standard. Results: A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3 mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. Conclusion: This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3 mm, and it also reveals 100% detection rate for ruptured aneurysms.

  5. [Cerebral vasospasm after subarachnoid hemorrhage].

    Science.gov (United States)

    Milojević, T M; Baljozović, B V; Rakić, M Lj; Nestorović, B D; Dostanić, M M; Milaković, B D; Kojić, Z Z; Repac, N R; Cvrkota, I S

    2008-01-01

    Cerebral vasospasm causes permanent neurolological deficit or death occurance in 13% of clinical cases. Peak frequency is from 8-10th day after SAH. The purpose of this study is factor analysis that may have influence on vasospasm development , as well as predictor determination. The study is prospective and analysis 192 patients treated in Institute of Neurosurgery, Clinical Centre of Serbia, Belgrade. The majority of patients were admitted in hospital in first four days after SAH, and 184 had GCS over 7. Univariate methods of factor analysis were used, and for significance of predictors influence testing multivariante regression analysis was used. Vasospasm occurred in 22,40% of all cases. No relationships have been found between sex, age, previous hypertension, timing of surgery, appearance of hydrocephalus and intracerebral hematoma, hypertermia or mean arterial blood pressure, with occurrence of cerebral vasospasm. Factors with significantly associated with the occurance of vasospasm were: hearth disease, hypernatriemia, Hct, clinical grade on admission as well as preoperative clinical grade and Fisher CT scan grade. In the first four days after SAH, Fisher scan grade, preoperative clinical grade and Hct, appeared as predictors. After four days, clinical grade on admission and hypernatiemia, showed as poredictors. PMID:18792575

  6. Psychological nursing treatment adherence in patients with subarachnoid hemorrhage%心理护理对蛛网膜下腔出血患者治疗依从性的影响

    Institute of Scientific and Technical Information of China (English)

    王中明

    2014-01-01

    目的:浅析心理护理对蛛网膜下腔出血患者临床依从性治疗的影响。方法:随机选取我院2012年7月~2013年9月入院接受治疗的蛛网膜下腔出血患者60例,将患者分成护理组和观察组,每组30例患者。观察组使用常规护理方式,护理组使用心理护理方式,比较两组护理之后的依从性。结果:护理组患者的临床依从性优于观察组,两组差异显著(P<0.05),具有统计学意义。结论:对蛛网膜下腔出血患者开展心理护理的过程中,护理人员需要有充足的热情和耐心,友善的和患者沟通,从心理上拉近与患者之间的距离,增强患者战胜病魔的决心和信心。%Objective: to analyze the psychological nursing in patients with subarachnoid hemorrhage clinical effects of adherence to treatment. Methods: randomly selected from July 2012 to September 2013 hospital treatment of 60 cases of patients with subarachnoid hemorrhage, the patients were divided into nursing group and observation group, 30 cases in each group. Observation group using conventional care, use way of psychological nursing care group, compared two groups of nursing after the compliance. Results: the clinical nursing patients compliance is better than the observation group, significant difference was found in two groups (P < 0.05), with statistical significance. Conclusion: to carry out psychological nursing in patients with subarachnoid hemorrhage in the process of nursing staff need to have enough enthusiasm and patience, friendly and patient communication, psychological y close and the distance between the patients, enhance beat the disease patients of determination and confidence.

  7. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds

    Science.gov (United States)

    Carpenter, Christopher R.; Hussain, Adnan M.; Ward, Michael J.; Zipfel, Gregory J.; Fowler, Susan; Pines, Jesse M.; Sivilotti, Marco L.A.

    2016-01-01

    Background Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic. Objectives To perform a diagnostic accuracy systematic review and meta-analysis of history, physical examination, cerebrospinal fluid (CSF) tests, computed tomography (CT), and clinical decision rules for spontaneous SAH. A secondary objective was to delineate probability of disease thresholds for imaging and lumbar puncture (LP). Methods PUBMED, EMBASE, SCOPUS, and research meeting abstracts were searched up to June 2015 for studies of emergency department (ED) patients with acute headache clinically concerning for spontaneous SAH. QUADAS-2 was used to assess study quality and, when appropriate, meta-analysis was conducted using random effects models. Outcomes were sensitivity, specificity, positive (LR+) and negative (LR−) likelihood ratios. To identify test- and treatment-thresholds, we employed the Pauker-Kassirer method with Bernstein test-indication curves using the summary estimates of diagnostic accuracy. Results A total of 5,022 publications were identified, of which 122 underwent full text-review; 22 studies were included (average SAH prevalence 7.5%). Diagnostic studies differed in assessment of history and physical exam findings, CT technology, analytical techniques used to identify xanthochromia, and criterion standards for SAH. Study quality by QUADAS-2 was variable; however, most had a relatively low-risk of biases. A history of neck pain (LR+ 4.1 [95% CI 2.2-7.6]) and neck stiffness on physical exam (LR+ 6.6 [4.0-11.0]) were the individual findings most strongly associated with SAH. Combinations of findings may rule out SAH, yet promising clinical decision rules await external validation. Non-contrast cranial CT within 6 hours of headache onset accurately ruled-in (LR+ 230 [6-8700]) and ruled-out SAH (LR− 0

  8. Superficial siderosis of the central nervous system induced by a single-episode of traumatic subarachnoid hemorrhage: a study using MRI-enhanced gradient echo T2 star-weighted angiography.

    Directory of Open Access Journals (Sweden)

    Hongwei Zhao

    Full Text Available The purpose of this study was to examine whether a single episode of traumatic subarachnoid hemorrhage (tSAH could cause superficial siderosis of the central nervous system (SS-CNS.This study was approved by the local ethics committee. Thirty-two patients with a history of a single episode of tSAH were enrolled in the study. An episode of tSAH was confirmed in patients based on a CT scan or a lumbar puncture, and a follow-up examination was conducted at least six weeks after the brain trauma. A follow-up MRI examination was performed, using enhanced gradient echo T2 star-weighted angiography (ESWAN to detect hemosiderin deposition on the cortical surface. The extent to which hemosiderin deposition was associated with several clinical factors was investigated. Various degrees of hemosiderin deposition were detected in 31 of 32 (96.9% single-episode tSAH patients. Analysis of contingency tables revealed an association between the regions of subarachnoid bleeding based on CT images and the regions of hemosiderin deposition based on ESWAN images (χ2 = 17.73, P<0.05. SS-CNS was determined to be a common consequence after a single episode of tSAH. The extent of hemosiderin deposition is closely correlated with the initial bleeding sites and bleeding volume.

  9. Superficial siderosis of the central nervous system induced by a single-episode of traumatic subarachnoid hemorrhage: a study using MRI-enhanced gradient echo T2 star-weighted angiography.

    Science.gov (United States)

    Zhao, Hongwei; Wang, Jin; Lu, Zhonglie; Wu, Qingjie; Lv, Haijuan; Liu, Hu; Gong, Xiangyang

    2015-01-01

    The purpose of this study was to examine whether a single episode of traumatic subarachnoid hemorrhage (tSAH) could cause superficial siderosis of the central nervous system (SS-CNS).This study was approved by the local ethics committee. Thirty-two patients with a history of a single episode of tSAH were enrolled in the study. An episode of tSAH was confirmed in patients based on a CT scan or a lumbar puncture, and a follow-up examination was conducted at least six weeks after the brain trauma. A follow-up MRI examination was performed, using enhanced gradient echo T2 star-weighted angiography (ESWAN) to detect hemosiderin deposition on the cortical surface. The extent to which hemosiderin deposition was associated with several clinical factors was investigated. Various degrees of hemosiderin deposition were detected in 31 of 32 (96.9%) single-episode tSAH patients. Analysis of contingency tables revealed an association between the regions of subarachnoid bleeding based on CT images and the regions of hemosiderin deposition based on ESWAN images (χ2 = 17.73, P<0.05). SS-CNS was determined to be a common consequence after a single episode of tSAH. The extent of hemosiderin deposition is closely correlated with the initial bleeding sites and bleeding volume.

  10. Aneurisma da artéria cerebelar ântero-inferior: relato de caso Aneurysm of the anterior inferior cerebellar artery: case report

    Directory of Open Access Journals (Sweden)

    Juan Oscar Alarcón Adorno

    2002-12-01

    Full Text Available Os aneurismas intracranianos do sistema vértebro-basilar representam cerca de 5 a 10% de todos os aneurismas cerebrais. Os aneurismas da artéria cerebelar ântero-inferior (AICA são considerados raros, podendo causar síndrome do ângulo ponto cerebelar, com ou sem hemorragia subaracnóidea. Desde 1948, foram descritos poucos casos na literatura. Apresentamos o caso de uma paciente, de 33 anos, na qual, após investigação de quadro de hemorragia subaracnóidea, diagnosticou-se aneurisma sacular da AICA esquerda. Foi submetida a clipagem do aneurisma, com ótimo resultado pós operatório.The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA are considered rare, can cause cerebello pontine angle (CPA syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  11. Arctigenin, a Potent Ingredient of Arctium lappa L., Induces Endothelial Nitric Oxide Synthase and Attenuates Subarachnoid Hemorrhage-Induced Vasospasm through PI3K/Akt Pathway in a Rat Model.

    Science.gov (United States)

    Chang, Chih-Zen; Wu, Shu-Chuan; Chang, Chia-Mao; Lin, Chih-Lung; Kwan, Aij-Lie

    2015-01-01

    Upregulation of protein kinase B (PKB, also known as Akt) is observed within the cerebral arteries of subarachnoid hemorrhage (SAH) animals. This study is of interest to examine Arctigenin, a potent antioxidant, on endothelial nitric oxide synthase (eNOS) and Akt pathways in a SAH in vitro study. Basilar arteries (BAs) were obtained to examine phosphatidylinositol-3-kinase (PI3K), phospho-PI3K, Akt, phospho-Akt (Western blot) and morphological examination. Endothelins (ETs) and eNOS evaluation (Western blot and immunostaining) were also determined. Arctigenin treatment significantly alleviates disrupted endothelial cells and tortured internal elastic layer observed in the SAH groups (p Arctigenin (p Arctigenin might exert dural effects in preventing SAH-induced vasospasm through upregulating eNOS expression via the PI3K/Akt signaling pathway and attenuate endothelins after SAH. Arctigenin shows therapeutic promise in the treatment of cerebral vasospasm following SAH. PMID:26539501

  12. 蛛网膜下隙出血对皮质神经元损害的实验研究%Damage of cortical neurons after subarachnoid hemorrhage in rabbits

    Institute of Scientific and Technical Information of China (English)

    傅丹; 姚益群; 荣亮; 金杰; 汪凌; 吴星

    2012-01-01

    采用经枕大池注射自体血方法制备蛛网膜下隙出血兔模型,光学显微镜和电子显微镜下观察神经元凋亡并计算凋亡指数.组织病理学观察神经元呈现延迟性损伤,胞体固缩,胞质及胞核深染,核质不均匀,胞核内染色质部分凝聚;甚至胞核溶解,线粒体肿胀、嵴消失.与空白对照组相比,蛛网膜下隙出血组动物细胞凋亡指数明显升高,且组间芹异具有统计学意义(均P<0.05).提示细胞凋亡在蛛网膜下隙出血后的迟发性神经元亡过程中起重要作用.%Fresh autologous blood was injected into the cisterna magna to establish the model of spontaneous subarachnoid hemorrhage (SSAH) in the rabbit groups. The neuron apoptosis was observed by optical microscope and eletron microscope, and determination in apoptoic index. Observation by histopathology, neurons show tardive detriment, as cell body pyknosis, cytoplasm and nucleus hyperchromasis, karyoplasms uneven, fraction intranuclear caryotin agglomeration; even caryolysis, bioblast engorgement, crista resorbed. Contrast to blank groups, apoptotic index increased obviously in SAH groups, and statistical significant difference was seen among groups (all P < 0.05). Apoptosis plays an important role in delayed neuronal death after subarachnoid hemorrhage.

  13. Cigarette Smoke and Inflammation: Role in Cerebral Aneurysm Formation and Rupture

    Directory of Open Access Journals (Sweden)

    Nohra Chalouhi

    2012-01-01

    Full Text Available Smoking is an established risk factor for subarachnoid hemorrhage yet the underlying mechanisms are largely unknown. Recent data has implicated a role of inflammation in the development of cerebral aneurysms. Inflammation accompanying cigarette smoke exposure may thus be a critical pathway underlying the development, progression, and rupture of cerebral aneurysms. Various constituents of the inflammatory response appear to be involved including adhesion molecules, cytokines, reactive oxygen species, leukocytes, matrix metalloproteinases, and vascular smooth muscle cells. Characterization of the molecular basis of the inflammatory response accompanying cigarette smoke exposure will provide a rational approach for future targeted therapy. In this paper, we review the current body of knowledge implicating cigarette smoke-induced inflammation in cerebral aneurysm formation/rupture and attempt to highlight important avenues for future investigation.

  14. Novel role for endogenous hepatocyte growth factor in the pathogenesis of intracranial aneurysms.

    Science.gov (United States)

    Peña-Silva, Ricardo A; Chalouhi, Nohra; Wegman-Points, Lauren; Ali, Muhammad; Mitchell, Ian; Pierce, Gary L; Chu, Yi; Ballas, Zuhair K; Heistad, Donald; Hasan, David

    2015-03-01

    Inflammation plays a key role in formation and rupture of intracranial aneurysms. Because hepatocyte growth factor (HGF) protects against vascular inflammation, we sought to assess the role of endogenous HGF in the pathogenesis of intracranial aneurysms. Circulating HGF concentrations in blood samples drawn from the lumen of human intracranial aneurysms or femoral arteries were compared in 16 patients. Tissue from superficial temporal arteries and ruptured or unruptured intracranial aneurysms collected from patients undergoing clipping (n=10) were immunostained with antibodies to HGF and its receptor c-Met. Intracranial aneurysms were induced in mice treated with PF-04217903 (a c-Met antagonist) or vehicle. Expression of inflammatory molecules was also measured in cultured human endothelial, smooth muscle cells and monocytes treated with lipopolysaccharides in presence or absence of HGF and PF-04217903. We found that HGF concentrations were significantly higher in blood collected from human intracranial aneurysms (1076±656 pg/mL) than in femoral arteries (196±436 pg/mL; P0.05), but significantly increased the prevalence of subarachnoid hemorrhage and decreased survival in mice (Psignaling through c-Met may decrease inflammation in endothelial cells and protect against intracranial aneurysm rupture. PMID:25510828

  15. Sensitivity and specifity of different imaging methods for the detection of cerebral aneurysms; Sensitivitaet und Spezifitaet bildgebender Verfahren fuer den Nachweis intrakranieller Aneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Ringelstein, Adrian; Forsting, Michael [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie

    2015-09-15

    The prevalence or cerebral aneurysms is estimated at 2 %. Out of these aciniform aneurysm, 0,1 % rupture each year. The 30-day-mortality after a subarachnoid hemorrhage (SAH) is estimated at 45 %. Additionally, about 50 % of the patients suffer from severe persistent neurologic deficits. The most reliable way to prevent rupture is early detection and prophylactic therapy of an unruptured aneurysm. For this, knowledge of the different imaging methods currently available and their diagnostic potential is highly desirable. This review describes the potential of CT, MRI and catheter angiography in diagnosing cerebral aneurysms, as well as therapy planning and follow-up care of patients. Based on this, some recommendations are made for management of patients with SAH.

  16. Ruptured intracranial aneurysm during pregnancy with false-negative computed tomography angiography findings: a case report.

    Science.gov (United States)

    Goto, Yukihiro; Ebisu, Toshihiko; Mineura, Katsuyoshi

    2015-06-01

    A 34-year-old female was admitted at 34 weeks of gestation with sudden onset of a severe headache accompanied by vomiting. Neurological examination revealed neck rigidity, and computed tomography (CT) of the brain revealed a subarachnoid hemorrhage (SAH). Although the hemorrhage was located primarily in the left Sylvian fissure, computed tomography angiography (CTA) performed immediately after CT did not reveal any obvious vascular abnormalities such as an intracranial aneurysm. An emergency cesarean section was performed, and a healthy infant was delivered. Cerebral digital subtraction angiography (DSA) was performed the day following surgery, which revealed a saccular aneurysm measuring 4.3 mm × 2.4 mm in the left middle cerebral artery. Left craniotomy and clipping of the aneurysm were performed. The clot around the aneurysm was relatively solid. This case report is of significance given that initial CTA was negative for SAH during pregnancy, suggesting the requirement for immediate DSA or another CTA in such cases. There are many previous reports on false-negative CTA findings or disappearance and reappearance of aneurysms in SAH patients, and various biophysical and dynamic parameters are suggested to cause such phenomena. However, there are no reports on similar occurrences during pregnancy. Although the precise cause remains unclear, multiple factors associated with homeostasis during pregnancy were possibly associated with the transient disappearance in this patient. PMID:25732356

  17. C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients

    Energy Technology Data Exchange (ETDEWEB)

    Kamran, Mudassar; Byrne, James V. [University of Oxford, Nuffield Department of Surgical Sciences, Oxford (United Kingdom)

    2015-09-15

    C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI). Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements. All patients received medical management, while eight patients (31 %) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91 % sensitive and 100 % specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (∼60 % blood flow and ∼40 % blood volume weighting). C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (∼60 %) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia. (orig.)

  18. 家兔自发性蛛网膜下腔出血早期脑损伤模型的初步研究%Establishment of Early Brain Injury Model of Spontaneous Subarachnoid Hemorrhage in Rabbits

    Institute of Scientific and Technical Information of China (English)

    范高阳; 王业忠; 许晖; 刘祺; 姬云翔; 赵冬

    2011-01-01

    Objective: To build a repeatable and typical nerve injury symptoms animal model of symptoms symptomatic subarachnoid hemorrhage (SAH) in rabbit. To provide a dependable animal model to research the mechanism of early brain injury(EBI). Methods: A total of 60 rabbits were divided randomly into 3 groups, including experimental group, control group, blank group. Set up the SAH model using cisternal puncture injection autologous arterial blood one time. To observe and compare the histomorphology and behavior of brain tissue in 4h, 8h, 12h, 24h, 48h,72 h. Results: (1) A lot of blood clots and blood has been found in subarachnoid and cisterna magna of the experimental group. (2) In the subarachnoid space of the experimental group could be observed under the light microscope a lot of red blood cells and nerve cells edema; Under the electron microscope, such changes could be observed as vacuolar changes of glial cells, swelling of neurons mitochondria, vacuole and lamellar separation in myelin sheath. (3)There was apparent significant neurological damage after modeling in the experimental group. Typical nervous system damage was found in the control group at 4h, but returned to normal atl2h. No neurological damage was found in blank group. Conclusion: The method of cisternal puncture injection blood one time is a simple and repeatable model of symptoms spontaneous subarachnoid hemorrhage (SAH), suitable for research on EBI%目的:建立一种可重复的、有典型神经损伤症状的自发性蛛网膜下腔出血(SAH)动物模型,为研究蛛网膜下腔出血后早期脑损伤(EBI)的机制提供可靠的动物模型.方法:选用新西兰大耳白兔60只,随机分为实验组、对照组、空白组.采用枕大池穿刺一次注入自体动脉血法建立SAH模型.在4h、8h、12h、24h、48h、72 h时间点,观察比较行为学与脑组织形态学的变化.结果:(Ⅰ)实验组枕大池和蛛网膜下腔内发现大量的血凝块和血液.(2)实验组光镜下

  19. Encephalic hemodynamic phases in subarachnoid hemorrhage:how to improve the protective effect in patient prognoses

    Institute of Scientific and Technical Information of China (English)

    Marcelo de Lima Oliveira; Daniel Silva de Azevedo; Milena Krajnyk de Azevedo; Ricardo de Carvalho Nogueira; Manoel Jacobsen Teixeira; Edson Bor-Seng-Shu

    2015-01-01

    Subarachnoid hemorrhage is frequently associated with poor prognoses. Three different hemo-dynamic phases were identified during subarachnoid hemorrhage: oligemia, hyperemia, and vasospasm. Each phase is associated with brain metabolic changes. In this review, we correlated the hemodynamic phases with brain metabolism and potential treatment options in the hopes of improving patient prognoses.

  20. Use of the pipeline embolization device to treat recently ruptured dissecting cerebral aneurysms.

    Science.gov (United States)

    Chan, Robert S K; Mak, Calvin H K; Wong, Alain K S; Chan, Kwong Yau; Leung, Kar Ming

    2014-01-01

    The Pipeline embolization device (PED) is one of the flow-diverting stents approved for the treatment of unruptured large or wide-necked cerebral aneurysms in 2011(1). Its use has now been extended to the treatment of recently ruptured dissecting cerebral aneurysm, carotid pseudoaneurysm from radiation injury, and blister aneurysms(2,3). We aimed to evaluate the effectiveness of utilizing the PED as a primary treatment for ruptured dissecting intracranial aneurysms. A single center retrospective review was conducted for all patients primarily treated with PED for acute subarachnoid hemorrhage (SAH) from ruptured dissecting cerebral aneurysms between December 2010 and February 2013. Patients were followed up with CT angiogram (CTA) or digital subtraction angiogram (DSA). Eight patients with a total of eight dissecting aneurysms were identified. The mean duration from SAH to treatment was 2.5 days. Six of the aneurysms arose from vertebral arteries and two from the basilar artery. Immediate check-DSA confirmed satisfactory contrast stasis in all eight cases, and complete aneurysmal obliteration was achieved at six months. There were two (25%) procedure-related complications, but no major procedure-related complications, such as thromboembolic events or rebleeding from aneurysm were encountered. The PED is a feasible treatment option for ruptured dissecting cerebral aneurysms in acute phase. According to our experience, using PED as flow-diverters in acute SAH does not significantly increase the complication risks or mortality rate if the antiplatelet regime is carefully monitored. Future studies shall evaluate the optimal antiplatelet regimen for using the PED in the acute phase. PMID:25207906

  1. Effect of cerebrospinal fluid displacement through lumbar puncture on function recover of nerve system in subarachnoid hemorrhage patients%腰穿脑脊液置换对蛛网膜下腔出血患者神经系统功能恢复的影响

    Institute of Scientific and Technical Information of China (English)

    杨职; 江先娣; 袁莉

    2002-01-01

    Background: Death and disability of subarachnoid hemorrhage(SAH) are caused by lesions of cerebral hernia, spasm of cerebral blood vessels, injuries the blood brain barrier, or communicating hydrocephalus.Cerebrospinal fluid displacement through lumbar puncture can clear the bloody cerebrospinal fluid and reduce the blood pollution of the cerebrospinal fluid, shorten xanthochromia time, reduce the intracranial pressure early and meninges stimulation. Intrathecal injection of dexamethasone can reduce defense reaction of the meninges, tissue adhesion and organization at the same time.

  2. The need for repeat angiography in subarachnoid haemorrhage

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    Urbach, H.; Solymosi, L. [Department of Neuroradiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany); Zentner, J. [Department of Neurosurgery, University of Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany)

    1998-01-01

    This study was designed to assess the necessity for a second angiogram study in patients in whom initial angiography after primary subarachnoid haemorrhage (SAH) was negative. During a 12-year period, 122 of 694 patients (17.5 %) had negative initial angiograms. CT, available for 98 patients, showed a preponderance of subarachnoid blood in the perimesencephalic cisterns in 50 of 73 patients (68.5 %) in whom blood was visible on CT. Angiography, repeated in 67 patients, revealed an aneurysm in 4 (6 %): 2 had an aneurysm of the anterior communicating artery, 1 of the posterior inferior cerebellar artery, and 1 of the P2 segment of the posterior cerebral artery. CT showed subarachnoid blood in the interpeduncular and ambient cisterns in this last case, and a preponderance of subarachnoid blood outside the perimesencephalic cisterns in the remaining 3 patients. (orig.) With 2 figs., 1 tab., 32 refs.

  3. [Ruptured Internal Carotid Artery Aneurysm Coiling in a Patient with Ipsilateral Internal Carotid Artery Occlusion via the Posterior Communicating Artery].

    Science.gov (United States)

    Ashida, Noriaki; Saitoh, Minoru; Fujita, Atsushi; Kohmura, Eiji

    2016-09-01

    Background:De novo aneurysms after internal carotid artery(ICA)occlusion occur in the contralateral ICA or anterior communicating artery. Hemodynamic changes with increased blood flow to the contralateral carotid circulation were considered the main factor for the formation of these aneurysms. We report a rare case of ruptured ICA aneurysm associated with ipsilateral ICA occlusion treated with coil embolization via the vertebrobasilar and posterior communicating arteries. Case Presentation:An 82-year-old woman presented with sudden-onset disturbance of consciousness at our outpatient clinic and went into cardiopulmonary arrest. Computed tomography(CT)performed after cardiopulmonary resuscitation revealed diffuse subarachnoid hemorrhage. Three-dimensional CT angiography revealed a right ICA aneurysm associated with the ipsilateral ICA occlusion. Considering that the patient showed clinical improvement with the critical care for neurogenic pulmonary edema, the aneurysm was treated with endovascular coil embolization via the posterior communicating artery. With this technique, complete obliteration was attained without perioperative complication. Conclusion:Endovascular coil embolization via the posterior communicating artery was proven effective as a treatment method for ruptured ICA aneurysms with ipsilateral ICA occlusion. Hemodynamic stress due to increased blood flow in the posterior communicating artery may play an important role in the growth and rupture of ICA aneurysms. PMID:27605482

  4. Giant, thrombosed, sellar-suprasellar internal carotid artery aneurysm with persistent, primitive trigeminal artery causing hypopituitarism.

    Science.gov (United States)

    Tungaria, Arun; Kumar, Vijendra; Garg, Pallav; Jaiswal, Awadhesh K; Behari, Sanjay

    2011-05-01

    A rare case of a giant, thrombosed, sellar-suprasellar paraclinoid internal carotid artery (ICA) aneurysm with persistent primitive trigeminal artery (PPTA) causing hypopituitarism that manifested as hypogonadism, hypothyroidism, and hypocortisolism is reported. There were no visual/neurological deficits, diabetes insipidus, or episodes of subarachnoid hemorrhage. The alteration in the flow dynamics of the circle of Willis due to the presence of PPTA may have been responsible for both the genesis of the giant aneurysm as well as for the induction of thrombogenesis within its lumen. As the digital subtraction angiogram showed complete thrombosis within the aneurysm and hormonal replacement therapy was effective in ensuring complete normalization of symptoms, the patient was unwilling to undergo surgical clipping of the aneurysm and removal of the suprasellar clot in an attempt to restore pituitary functions. Hypopituitarism recurred when the patient stopped her hormonal supplementation therapy after 7 years, and she again became symptom-free on restarting the therapy. To the best of the authors' knowledge, this represents the first reported case in the literature of hypopituitarism consequent to a giant, thrombosed, sellar-suprasellar ICA aneurysm with an associated PPTA on the side of the aneurysm. PMID:21234615

  5. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

    Directory of Open Access Journals (Sweden)

    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  6. Analysis of 8 cases of the performance of pseudo subarachnoid hemorrhage of acute cerebral infarction%表现为假性蛛网膜下腔出血的急性脑梗死8例分析

    Institute of Scientific and Technical Information of China (English)

    张梅芳; 易婷玉; 吴燕敏; 陈文伙

    2015-01-01

    目的:探讨表现为假性蛛网膜下腔出血的急性脑梗死的原因.方法:收治急性脑梗死患者8例,分析临床表现及影像学表现.结果:右侧偏瘫及失语3例,左侧偏瘫3例,视野异常2例.头颅MRI显示急性脑梗死8例,左侧额叶3例,其中2例合并皮层下分水岭梗死,右侧额叶3例,均合并皮层下分水岭梗死,右侧枕叶2例, MRA提示脑血管狭窄、闭塞5例,左侧大脑中动脉重度狭窄2例,右侧大脑中动脉闭塞2例,右侧大脑中动脉重度狭窄1例.结论:急性大脑皮层梗死早期因代偿脑膜支血流缓慢,易在CT表现为假性蛛网膜下腔出血.%Objective:To explore the manifestations of acute cerebral pseudo subarachnoid hemorrhage causes.Methods:8 patients with acute cerebral infarction were selected,analysis of clinical manifestation and imaging performance.Results:On the right side of 3 cases of hemiplegia and aphasia,3 cases of left hemiplegia,2 cases of abnormal visual field.Brain MRI showed acute cerebral infarction in 8 cases,left frontal lobe in 3 cases,2 cases with cerebral watershed infarction,right frontal lobe in 3 cases,2 cases of right occipital lobe,5 cases of cerebral artery stenosis,2 cases of left middle cerebral artery stenosis,2 cases of right middle cerebral artery occlusion,right middle cerebral artery stenosis in 1 cases.Conclusion:Acute cortical infarction due to compensatory meningeal branch blood flow is slow,easy to show in CT as a pseudo subarachnoid hemorrhage.

  7. 蛛网膜下隙出血患者水钠紊乱的影响因素及护理%Factors Analysis and Nursing Strategy of Water-saline Disorder of Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    郭小叶; 魏艳; 赵书敏

    2014-01-01

    Objective To explore the related factors that affect water-saline disorder in patients with subarachnoid hemorrhage and its nursing strategy.Methods Clinical data of 183 cases of SAH were analyzed retrospectively.Re-sults Water-saline disorder occurred within 5 to 8 days of the onset of the main manifestations of hyponatremia, accounting for 85.5%.The SAH patients water-saline disorder was related to the Hunt-Hess graded,inap-propriate antidiuretic hormone secretion,cerebral salt wasting syndrome and intracranial hypertension. Conclusion Nurses should pay attention to the continuous supervision of water-saline metabolism,and take early and targeted nursing strategies based on the related factors of water-saline disorder to improve SAH patient’s prognosis.%探讨蛛网膜下隙出血(subarachnoid hemorrhage,SAH)患者水钠紊乱的影响因素及护理对策.方法回顾性分析并总结西安交通大学医学院第一附属医院2007年1月至2012年6月收治的183例 SAH 患者的临床资料.结果水钠紊乱多发生在 SAH 患者发病后的5~8 d 内,主要表现为低血钠,占85.5%.SAH 患者水钠紊乱与 Hunt-Hess 分级、抗利尿激素分泌异常综合征(inappropriate antidiuretic hormone secretion,SIADH)、脑盐耗综合征(cerebral salt wasting syndrome, CSWS)及颅内压增高有关.结论护理人员应高度重视对 SAH 患者水钠代谢的持续监护,针对产生水钠紊乱的影响因素及早采取有效的护理对策,从而改善 SAH 患者的预后.

  8. 多层螺旋CT在自发性蛛网膜下腔出血病因诊断中的临床应用价值分析%The Clinical Application Value of Multislice Spiral CT in Etiological Diagnosis of Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    成厚丕

    2015-01-01

    Objective:To investigate the clinical application value of multislice CT angiography (CTA) in the etiological diagnosis of subarachnoid hemorrhage (SAH). Methods:56 cases of SAH patients who admitted from January 2008 to February 2011 were all given CTA examination, includ-ing 52 cases of patients that received DSA at the same time, analyzed the result of CTA and compared it with DSA. Results:In 56 cases of patients, 43 cases of aneurysm, 5 cases of AVM, 3 cases of sinus thrombosis were detected by CTA, and 5 cases invalid;in the patients who received DSA at the same time, 45 cases of aneurysm and 5 cases of AVM were found, and 1 case invalid, expect 1 cases of aneurysm patient who found by CTA and Confirmed by clinical examination but negative in DSA, the rest of patients were all diagnosed by CTA. Conclusion:Multislice CTA is a kind of non-invasive, quick and convenient imaging examination for the diagnosis of SAH, its cerebral vascular stereo imaging technology, which can show the spatial structure and peripheral relationship of blood vessel and is conducive to the selection of surgery and difficulty evaluation, has a high accuracy in the etiological diagnosis of SAH, makes it can be the first choice of diagnosis method for SAH in emergency.%目的:探讨多层螺旋CT血管造影(CTA)在蛛网膜下腔出血(SAH)病因诊断中的临床应用价值.方法:对2008年1月~2011年2月收治入院的56例SAH患者行多层螺旋CT血管造影检查,其中52例患者同时接受数字减影血管造影(DSA)检查,分析CTA检查结果并与DSA检查结果比较.结果:56例患者中,CTA检出动脉瘤43例,动静脉畸形(AVM)5例,静脉窦血栓3例,阴性5例;在同时接受DSA检查的患者中,发现动脉瘤45例,动静脉畸形(AVM)5例,阴性1例,其中除1例CTA发现并经临床证实的动脉瘤DSA检查为阴性外,其余全部证实CTA诊断.结论:多层螺旋CTA对SAH的病因诊断是一种无创、快速、便捷的影像学检查方法,其

  9. Therapeutic approaches to cerebral vasospasm complicating ruptured aneurysm

    Directory of Open Access Journals (Sweden)

    Mohamed Barbarawi

    2009-10-01

    Full Text Available Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH. We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4 and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25% developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7% died from severe vasospasm, 3 patients (5.8% became severely disabled, and 39 patients (75% were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely.

  10. Surgery of intracranial aneurysms at Yonsei University: 780 cases.

    Science.gov (United States)

    Lee, K C

    1991-03-01

    Seven hundred and eighty patients with intracranial aneurysm, which were surgically treated by the author since 1976, were analyzed. Strategies important for intracranial aneurysm surgery were the timing of surgery, preoperative preparation and intraoperative management. The best management outcome could be achieved by early operation, removal of subarachnoid blood clot, maintenance of circulating blood volume, administration of nimodipine, and meticulous surgical tactics to avoid pitfalls. Indications for aneurysm surgery in the acute phase were determined by intracerebral hematoma, angiographic findings, clinical grade, general physical status and readiness of the surgical team. Important goals to be considered during the operation were obtaining a slack brain, preparation of proximal control, protection of the brain, awareness of microsurgical anatomy, and complete dissection of the sac. The morbidity and mortality were 2.7% and 4.0%, respectively. The mortality was attributed to intracranial causes in 20 cases (poor grade, delayed ischemic deficits, rebleeding, postoperative infarction, and postoperative epidural hematoma), extracranial causes in 7 cases (pulmonary embolism, heparin induced intracerebral hemorrhage, hepatic failure, myocardial infarction, and gastrointestinal bleeding), and unknown problems in 5 cases. The postoperative intracerebral hemorrhage occurred in 16 cases and seemed to be caused by one or more of the following events: cerebral infarction developed during the preoperative period, occlusion of the cerebral veins during the Sylvian dissection, cerebral retraction and/or sudden change of intracranial hemodynamics. Hydrocephalus, almost always a communicating type as confirmed by isotope cisternography, was managed by lumboperitoneal shunt.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2046205

  11. Application of 64 slice spiral CT angiography in subarachnoid hemorrhage%64层螺旋 CT 血管成像在自发性蛛网膜下腔出血中的应用

    Institute of Scientific and Technical Information of China (English)

    韩璐璐; 张锡海; 张爱霞; 王俊英; 董乐

    2015-01-01

    目的:为了进一步提高临床对自发性蛛网膜下腔出血(SAH)的治疗效果,分析和探讨64层螺旋 CT血管成像在自发性 SAH 中的应用价值。方法按照随机双盲的原则抽取2014年1月-2015年1月治疗的38例考虑自发性 SAH 的患者作为研究对象,所有入组的患者均常规给予64层螺旋 CT 血管成像(CTA)及数字减影脑血管造影(DSA)检查,其中 CT 血管成像均应用最大密度投影(MIP)、容积再现技术(VR),通过和 DSA 结果对比分析 CTA 在发现自发性 SAH 中的病因诊断中的应用价值和意义。结果以 DSA 诊断结果作为评价标准,CTA 的诊断结果准确率和 DSA 相比较,差异亦无统计学意义(P ﹥0.05);而 CTA 组在诊断血管瘤大小方面和 DSA 诊断结果准确率和 DSA相比较示,差异无统计学意义(P ﹥0.05)。结论临床上在诊断自发性 SAH 的过程中应用64层螺旋 CT 血管成像,不仅简单、快捷和方便,而且有利于发现病因和提高诊断准确率,值得推广。%Objective To further improve the effectiveness of our hospital in terms of t spontaneous subarachnoid hemorrhage(SAH)and to reduce and prevent the occurrence probability of a variety of adverse events,analysis and discussion of the meaning and value of 64-slice CT angiography(CTA). Methods Selected 38 cases of patients with spontaneous sub-arachnoid hemorrhage(SAH)in our hospital from January 2014 to January 2015 according to the randomized double blind controlled principles as a study object,all patients with acute SAH underwent 64-slice CTA and digital subtraction angiography (DSA). Three-dimensional post-processing techniques including volume rendering( VR),maximum intensity projection (MIP),curved planar reformation(CPR)and multi-planar reconstruction(MPR)were underwent. Results Taking the DSA result as the standard,CTA diagnosis accuracy compared with DSA the difference between the two groups weren

  12. Spontaneous subarachnoid hemorrhage as the primary manifestation of carotid cavernous fistulas: case report Hemorragia meníngea espontânea como manifestação inicial de fístula carótido-cavernosa: relato de caso

    Directory of Open Access Journals (Sweden)

    Clement Hamani

    2001-09-01

    Full Text Available We report the case of a 19-year old male patient initially admitted to our service after a motor vehicle accident with a normal neurologic evaluation and a CT scan that revealed no abnormalities. Nineteen months later, he was readmitted after a subtle headache episode, followed by a brief loss of consciousness. He was submitted to a complete evaluation, which revealed no abnormalities (even in the neurologic and ophthalmologic exams. A CT was performed revealing a diffuse subarachnoid hemorrhage. Contrast enhancement displayed a right paraselar lesion, which was first interpreted as a giant aneurysm. The patient underwent a cerebral angiography which showed a right carotid-cavernous fistula with retrograde venous drainage through the superior and inferior petrosal sinuses. Filling of various cortical vessels was observed. The patient was treated with endovascular technique and a control angiographic study assured the complete closure of the fistula. He had an excellent clinical recovery, being discharged in good conditions.Apresentamos o caso de um paciente de 19 anos atendido em nosso Serviço de Emergência após um acidente com veículo automotor apresentando, exame neurológico e tomografia computadorizada de crânio normais. Passados dezenove meses, foi readmitido após episódio súbito de cefaléia e perda de consciência. Foi submetido a avaliação clínica (inclusive neurológica e oftalmológica que não revelou anormalidades. Solicitada então nova tomografia computadorizada de crânio que desta vez mostrou hemorragia meníngea difusa e uma lesão para-selar com captação de contraste à direita, inicialmente encarada como um aneurisma gigante. A angiografia cerebral revelou uma fístula carótido cavernosa à direita, com fluxo retrógrado pelos seios petrosos superior e inferior, com enchimento venoso de vasos corticais. Optou-se pelo tratamento endovascular, cujo controle angiográfico mostrou o fechamento completo da fístula. O

  13. 蛛网膜下腔出血后脑痉挛的临床研究及CT征象分析%Clinical Study of Cerebral Vascular Spasm after Subarachnoid Hemorrhage and Analysis of CT Findings

    Institute of Scientific and Technical Information of China (English)

    李伟钦; 郑华英; 朱玉莉; 江晨辉

    2016-01-01

    Objective To analyze the clinical characteristics and CT findings of cerebral vascular spasm (CVS) after subarachnoid hemorrhage (SAH).Methods The clinical data of 54 patients with SAH who were treated in our hospital between February 2010 and May 2015 were collected. All patients were examined by CT and digital subtraction angiography (DSA) after admission, and the clinical data were complete. With DSA as the golden standard, the accuracy of CT in the diagnosis of CVS after SAH was statistically analyzed. The CT imaging findings were summarized.Results There was 1 cases with ACA, MCA distal segment CVS missed diagnosed by CTA, and the accuracy rate in the diagnosis of CVS was 88.24%, slightly lower than that of DSA (P>0.05); CBV and CBF in patients with SAH and CVS were lower than those in patients with SAH and without CVS (P0.05);SAH并CVS者CBV、CBF低于SAH无CVS者(P<0.05),其MTT、TTP明显长于SAH无CVS者,对比差异有统计学意义(P<0.05)。结论 SAH后CVS患者脑灌注降低,MTT、TTP延长,痉挛血管可见均匀性狭窄,采用CT、CTP诊断与DSA符合率高,可为临床诊治提供影像学依据。

  14. Arctigenin, a Potent Ingredient of Arctium lappa L., Induces Endothelial Nitric Oxide Synthase and Attenuates Subarachnoid Hemorrhage-Induced Vasospasm through PI3K/Akt Pathway in a Rat Model.

    Science.gov (United States)

    Chang, Chih-Zen; Wu, Shu-Chuan; Chang, Chia-Mao; Lin, Chih-Lung; Kwan, Aij-Lie

    2015-01-01

    Upregulation of protein kinase B (PKB, also known as Akt) is observed within the cerebral arteries of subarachnoid hemorrhage (SAH) animals. This study is of interest to examine Arctigenin, a potent antioxidant, on endothelial nitric oxide synthase (eNOS) and Akt pathways in a SAH in vitro study. Basilar arteries (BAs) were obtained to examine phosphatidylinositol-3-kinase (PI3K), phospho-PI3K, Akt, phospho-Akt (Western blot) and morphological examination. Endothelins (ETs) and eNOS evaluation (Western blot and immunostaining) were also determined. Arctigenin treatment significantly alleviates disrupted endothelial cells and tortured internal elastic layer observed in the SAH groups (p < 0.01). The reduced eNOS protein and phospho-Akt expression in the SAH groups were relieved by the treatment of Arctigenin (p < 0.01). This result confirmed that Arctigenin might exert dural effects in preventing SAH-induced vasospasm through upregulating eNOS expression via the PI3K/Akt signaling pathway and attenuate endothelins after SAH. Arctigenin shows therapeutic promise in the treatment of cerebral vasospasm following SAH.

  15. Arctigenin, a Potent Ingredient of Arctium lappa L., Induces Endothelial Nitric Oxide Synthase and Attenuates Subarachnoid Hemorrhage-Induced Vasospasm through PI3K/Akt Pathway in a Rat Model

    Directory of Open Access Journals (Sweden)

    Chih-Zen Chang

    2015-01-01

    Full Text Available Upregulation of protein kinase B (PKB, also known as Akt is observed within the cerebral arteries of subarachnoid hemorrhage (SAH animals. This study is of interest to examine Arctigenin, a potent antioxidant, on endothelial nitric oxide synthase (eNOS and Akt pathways in a SAH in vitro study. Basilar arteries (BAs were obtained to examine phosphatidylinositol-3-kinase (PI3K, phospho-PI3K, Akt, phospho-Akt (Western blot and morphological examination. Endothelins (ETs and eNOS evaluation (Western blot and immunostaining were also determined. Arctigenin treatment significantly alleviates disrupted endothelial cells and tortured internal elastic layer observed in the SAH groups (p<0.01. The reduced eNOS protein and phospho-Akt expression in the SAH groups were relieved by the treatment of Arctigenin (p<0.01. This result confirmed that Arctigenin might exert dural effects in preventing SAH-induced vasospasm through upregulating eNOS expression via the PI3K/Akt signaling pathway and attenuate endothelins after SAH. Arctigenin shows therapeutic promise in the treatment of cerebral vasospasm following SAH.

  16. The Expanding Realm of Endovascular Neurosurgery: Flow Diversion for Cerebral Aneurysm Management

    Science.gov (United States)

    Krishna, Chandan; Sonig, Ashish; Natarajan, Sabareesh K.; Siddiqui, Adnan H.

    2014-01-01

    The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline™ Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden

  17. INITIAL COMPARISON OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH MECHANICAL DETACHABLE SPIRALS AND WITH GUGLIELMI DETACHABLE COILS

    Institute of Scientific and Technical Information of China (English)

    王大明; 凌锋; 王安顺; 蔡艺龄; 李萌

    2003-01-01

    Objective.To compare the embolization effects of intracranial aneurysms with mechanical detachable spirals(MDS)and with Guglielmi detachable coils(GDC). Methods. One hundred and twenty cases with 125 intracranial aneurysms were embolized in Beijing Hospital from March 1995 to July 1999. Sixty-six aneurysms in 64 cases were embolized with MDS,51 in 48 with GDC,and 8 in 8 with both MDS and GDC.Clinical data including sex,age,subarachnoid hemorrhage(SAH),Hunt & Hess grading,diameter and neck width of aneurysms,number and length of coils used per aneurysm,occlusive ratio,and complications were compared between MDS and GDC groups. Results. MDS and GDC groups were comparable(t-test or χ2 -test,all P value >0.10)in terms of age,sex,diameter of aneurysms[(8.46±3.42)mm vs.(7.38±3.45)mm],neck width[(3.49±1.50)mm vs.(3.26±1.52)mm],coils number[(4.65±3.01)vs.(4.24±2.65)]and their length[(460.2±398.5)mm vs.(422.9±387.1)mm]used per aneurysm,occlusive ratio in aneurysms embolized≥80%[(95.00%±6.32%)vs.(94.19%±7.63%)],mortality and permanent complications(7.8% vs. 4.2%). Conclusions. MDS and GDC are all materials for embolization of intracranial aneurysms. MDS is less expensive,but more difficult to control and of propensity to complications while GDC is more compliant,easier to be used,safer,and have many alternative types for use as well as more extensive indications.

  18. [Stent-Assisted Coil Embolization of a Dissecting Aneurysm of the Posterior Cerebral Artery: A Case Report].

    Science.gov (United States)

    Haruma, Jun; Sugiu, Kenji; Yukiue, Tadato; Sasaki, Tatsuya; Hattori, Yasuhiko; Kobayashi, Kazuki; Yoshida, Hideyuki; Muneda, Koji; Date, Isao

    2015-12-01

    Dissecting aneurysms of the posterior cerebral artery (PCA) are rare, especially those at the P1 segment. Here, we describe the case of a 57-year-old woman with a subarachnoid hemorrhage (SAH). Computed tomography angiography (CTA) and digital subtraction angiography (DSA) revealed a small (3 mm) dissecting aneurysm with the typical pearl-and-string sign at the right P1 segment. Fourteen days after onset, the patient developed aphasia. DSA revealed vasospasm of the right middle cerebral artery, and we performed endovascular treatment by the intra-arterial injection of 1-(5-isoquinolinesulfonyl) homopiperazine. After this treatment, the patient's symptoms recovered immediately. Vertebral angiography revealed enlargement of the dissecting aneurysm (up to 7 mm diameter). We started a loading dose of 300 mg aspirin and 400 mg clopidogrel after observing growth of the aneurysm. Fifteen days after onset, we performed a stent-assisted coil embolization, and obtained nearly complete obliteration of the aneurysm with preserved patency of the parent artery. Six-month follow-up DSA demonstrated complete occlusion of the aneurysm with good patency of the stented PCA; the patient was at modified Rankin Scale 1. In the treatment of ruptured dissecting aneurysms, parent vessel occlusion (PVO) with aneurysm is common. However, PVO may cause both cerebral infarction of the distal area and perforator occlusion of the occluded vessel. Stent-assisted coil embolization can preserve parent vessel flow and obliterate the aneurysm. Stents offer a therapeutic alternative for PCA dissecting aneurysms, especially when PVO cannot be tolerated. PMID:26646176

  19. Diffuse, non-traumatic, non-aneurysmal subarachnoid haemorrhage during bevacizumab treatment of high grade glioma: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Arosha S. Dissanayake, MBBS

    2015-06-01

    Full Text Available Background: Bevacizumab is a monoclonal antibody against vascular endothelial growth factor approved by the United States Food and Drug Administration for the treatment of various cancers including refractory high grade glioma. There are case reports of subarachnoid haemorrhage (SAH during bevacizumab treatment though the causative role of the drug in these cases has been obscured by the presence of alternative aetiologies or incomplete investigation. Furthermore, there is no consensus regarding the risk of Central Nervous System (CNS haemorrhage during bevacizumab treatment due to limited available study data. Case Description: A 53 year old female with recurrent gliosarcoma refractory to standard, temozolamide based chemo-radiotherapy presented to our facility in a post-ictal state 16 days after her second dose of intravenous bevacizumab. A Fisher grade III SAH was found on computerised tomography scanning with no causative vascular lesion found on two subsequent digital subtraction angiograms separated by a 10 day period and a Magnetic Resonance Imaging (MRI scan 20 days post-bleed. Given the resolution of symptoms over an uncomplicated 13 day admission, she was discharged home with bevacizumab ceased prior to her scheduled third dose. Conclusion: We discuss here a case of diffuse, non-traumatic SAH during bevacizumab treatment of recurrent gliosarcoma in which alternative aetiologies of haemorrhage were excluded, to our knowledge the first such case in the English language literature. This adverse event is compatible with the known molecular mechanisms of bevacizumab and clinicians should be cognisant of the potential risk of CNS haemorrhage until larger studies are available to quantify this risk.

  20. [The Difference of CT Value Related to Monitor Position in the Head CT-angiography Bolus Tracking Method for Patients with Subarachnoid Hemorrhage].

    Science.gov (United States)

    Mizui, Masato; Mizoguchi, Yuji; Tashiro, Takao

    2016-01-01

    The head computed tomography-angiography (head CT-A) examination is excellent for the detection and diagnosis of cerebral artery aneurysm. If we use bolus tracking method when implementing this examination, we must choose a monitoring point. We investigated the influence which the monitoring point (MCA or carotid-A) exerts on the CT value. As for the result, MCA monitoring point method was more excellent than the carotid artery monitoring point method. The CT value was higher about 50 HU in the MCA monitoring point than in the carotid artery monitoring point (average;carotid artery: 349.6±57.8 HU, MCA: 413.2±67.9 HU). So, we conclude that in the bolus tracking method of monitoring point of head CTA, MCA monitoring point should be used.

  1. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

    Science.gov (United States)

    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

  2. [Large distal anterior cerebral artery aneurysm associated with azygos anterior cerebral artery: case report].

    Science.gov (United States)

    Suzuki, Y; Kawamata, T; Matsumoto, H; Kunii, N; Matsumoto, K

    1998-10-01

    A 51-year-old woman presented with a distal anterior cerebral artery aneurysm (DACAA) manifesting as severe headache and monoparesis of the left lower limb. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, bilateral sylvian fissures, and basal cistern, and a hematoma in the supracallosal region. Angiography showed a large aneurysm (23 x 18 mm) located on the distal end of the azygos anterior cerebral artery (azygos ACA) at the supracallosal portion. T2-weighted magnetic resonance imaging demonstrated the hematoma as a mixed intensity mass, compressing the corpus callosum downward, and the aneurysm as a flow void anterior to the hematoma. Unilateral frontoparietal parasagittal craniotomy was performed with a horse-shoe shaped incision. The aneurysm was clipped via the interhemispheric approach, and the hematoma was aspirated. Postoperative angiography showed disappearance of the aneurysm and intact azygos ACA. The patient was discharged with mild monoparesis, paresthesia of the left lower limb and diagnostic dyspraxia. DACAA almost always arises at or near the genu of the corpus callosum and is often associated with vascular anomaly. In the literature, 22 of 26 cases of large and giant DACAA were located at or near the genu, but only 3 cases, including ours, in the supracallosal area. 11 cases were associated with azygos ACA. Therefore, hemodynamic stress caused by vascular anomaly may be involved in the formation of large or giant DACAA in contrast with cases of normal DACAA. PMID:9789300

  3. The changes of von willebrand factor/a disintegrin-like and metalloprotease with thrombospondin type I repeats-13 balance in aneurysmal subarachnoid hemorrhage

    OpenAIRE

    Tang, Qi-Feng; Lu, Shi-qi; Zhao, Yi-ming; Qian, Jin-xian

    2015-01-01

    The aim of this study was to investigate the role of Von Willebrand Factor/thrombospondin type I repeats-13 (VWF/ADAMTS13) balance in aSAH. Fifty eight patients with aSAH at the First Affiliated hospital of Soochow University, Suzhou, China, between January 2012 and January 2014 were eligible for the study. They were divided into delayed cerebral ischemia group (DCI group) and non-delayed cerebral ischemia group (no DCI group), or cerebral vasospasm group (CVS group) and no spasm group (no CV...

  4. Study of MRI FLAIR and SWI sequence in diagnosis of subarachnoid hemorrhage%高场MRI FLAIR及SWI序列在蛛网膜下腔出血诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    梁长松; 陈忠; 李伟峰; 马超进

    2015-01-01

    Objective:To study the value of magnetic resonance fluid attenuated inversion recovery (FLAIR) sequence and susc-eptibility weighted imaging (SWI) sequence in the diagnosis of subarachnoid hemorrhage (SAH). Methods:Select 47 cases of SAH patients who underwent MRI and CT scan,to compare displayed difference of CT and magnetic resonance FLAIR and SWI sequences for different types of lesions. Results:The FLAIR sequence showed that SAH significantly increased signal shadow,but the SWI sequence all showed different degree low signal,there was low detection rate for diagnosis SAH from T1WI,T2WI. The detection rates for acute SAH and subacute SAH were 75.0% and 52.9% and significantly higher than that of T1WI,T2WI series,SWI and FLAIR detection rate of in acute SAH were 100% and 93.75%,and it for subacute SAH were 94.12% and 82.35% while in the old SAH detection rates were 100% and 92.86%,they were significantly higher than those in CT and T1WI,T2WI sequence,the accuracy of SWI,FLAIR combined diagnosis was 100%,and the difference was significant (P<0.05). Conclusion:FLAIR and SWI sequences have higher sensitivity and important value in the diagnosis of SAH,so it can be used routinely.%目的:探讨高场MRI FLAIR及SWI序列在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)诊断中的价值.方法:回顾性分析我院47例分别行高场MRI和CT检查的SAH患者的临床和影像资料,比较CT、MRI常规序列、FLAIR和SWI对不同类型病变的显示情况. 结果:MRI FLAIR序列显示SAH呈高信号影,而在SWI序列上均呈不同程度的低信号. T1WI、T2WI对于急性SAH检出率较低,对于亚急性SAH和陈旧性SAH检出率更低;CT对急性SAH和亚急性SAH的检出率分别为75.00%和52.94%;SWI、FLAIR对急性SAH的检出率分别为100%和93.75%,对亚急性SAH的检出率分别为94.12%和82.35%,对陈旧性SAH的检出率分别为100%和92.86%,均明显高于CT和T1WI、T2WI序列,SWI、FLAIR联合诊断准确率为100%,

  5. The TEAM trial: Safety and efficacy of endovascular treatment of unruptured intracranial aneurysms in the prevention of aneurysmal hemorrhages: A randomized comparison with indefinite deferral of treatment in 2002 patients followed for 10 years

    Directory of Open Access Journals (Sweden)

    Collet Jean-Paul

    2008-07-01

    Full Text Available Abstract The management of patients with unruptured aneurysms remains controversial. Patients with unruptured aneurysms may suffer intracranial haemorrhage, but the incidence of this event is still debated; endovascular treatment may prevent rupture, but involves immediate risks. Hence, the balance of risks and benefits of endovascular treatment is uncertain. Here, we report the design of the TEAM trial, the first international, randomized, controlled trial comparing conservative management with endovascular treatment. Primary endpoint is mortality and morbidity (modified Rankin Score ≥ 3 from intracranial haemorrhage or treatment. Secondary endpoints include incidence of hemorrhagic events, morbidity related to endovascular coiling, morphological results, overall clinical outcome and quality of life. Statistical tests compare between probabilities at 5- and 10-years of 1/mortality from haemorrhage related to the lesion, excluding per-operative complications; 2/mortality from haemorrhage or from complications of treatment; 3/combined disease or treatment related mortality and morbidity in the absence of other causes of death or disability. The study will be conducted in 60 international centres and will enrol 2,002 patients equally divided between the two groups, a size sufficient to achieve 80% power at a 0.0167 significance to detect differences in 1 disease or treatment-related poor outcomes from 7–9% to 3–5%; 2 overall mortality from 16 to 11%. Duration of the study is 14 years, the first three years being for patient recruitment plus a minimum of 10 years of follow-up. The TEAM trial thus offers a means to reconcile the introduction of a new approach with the necessity to acknowledge uncertainties. Trial registration Current Controlled Trials ISRCTN62758344 http://www.controlled-trials.com

  6. Effects of AstragalosideⅣon delayed cerebral vasospasm after subarachnoid hemorrhage%黄芪甲苷对大鼠蛛网膜下腔出血后脑血管痉挛的影响

    Institute of Scientific and Technical Information of China (English)

    赵建伍; 于耀宇; 余天垒; 李延良; 唐铸; 桂铮; 周欣; 姬文婕

    2015-01-01

    Objective To explore the effect of Astragaloside Ⅳ(AS-Ⅳ) on delayed cerebral vasospasm after subarachnoid hemorrhage (SAH) and its mechanism. Methods Forty male SD rats were randomly were divided into 4 groups of 10 animals each, i.e. normal, SAH+AS-Ⅳ, SAH+dimothyl sulfoxide (DMSO) and SAH groups. The SAH model was made by endovascularly puncturing the internal carotid artery. The rats were given daily by intraperitoneal injection of AS-Ⅳsuspension in SAH+AS-Ⅳgroup 30 minutes after the establishment of the model, equal volume of 0.1%DMSO in SAH+DMSO group, and equal volume of saline in the normal and SAH groups. The morphological changes in the basilar arteries were observed by a microscope, the expressions of TLR4 and NF-κB p65 in the basilar arteries were determined by immunohistochemical technique, and the plasma levels of TNF-αand IL-6 were determined by enzyme-linked immunosorbent assay. Results The thickness of the basilar artery wall was significantly thinner in the normal group than that in SAH+AS-Ⅳgroup (P0.05)。黄芪甲苷组基底动脉管壁厚度较DMSO组明显变薄(P0.05)。黄芪甲苷组基底动脉TLR4、NF-κB阳性率较DMSO组明显下降(P<0.05)。结论黄芪甲苷可能通过干预TLR4、NF-κB介导的炎症信号通路来缓解大鼠SAH后CVS。

  7. Inhibitory effects of omega-3 fatty acids on early brain injury after subarachnoid hemorrhage in rats: Possible involvement of G protein-coupled receptor 120/β-arrestin2/TGF-β activated kinase-1 binding protein-1 signaling pathway.

    Science.gov (United States)

    Yin, Jia; Li, Haiying; Meng, Chengjie; Chen, Dongdong; Chen, Zhouqing; Wang, Yibin; Wang, Zhong; Chen, Gang

    2016-06-01

    Omega-3 fatty acids have been reported to improve neuron functions during aging and in patients affected by mild cognitive impairment, and mediate potent anti-inflammatory via G protein-coupled receptor 120 (GPR120) signal pathway. Neuron dysfunction and inflammatory response also contributed to the progression of subarachnoid hemorrhage (SAH)-induced early brain injury (EBI). This study was to examine the effects of omega-3 fatty acids on SAH-induced EBI. Two weeks before SAH, 30% Omega-3 fatty acids was administered by oral gavage at 1g/kg body weight once every 24h. Specific siRNA for GPR120 was exploited. Terminal deoxynucleotidyl transferase dUTP nick end labeling, fluoro-Jade B staining, and neurobehavioral scores and brain water content test showed that omega-3 fatty acids effectively suppressed SAH-induced brain cell apoptosis and neuronal degradation, behavioral impairment, and brain edema. Western blot, immunoprecipitation, and electrophoretic mobility shift assays results showed that omega-3 fatty acids effectively suppressed SAH-induced elevation of inflammatory factors, including cyclooxygenase-2, monocyte chemoattractant protein-1, and inducible nitric oxide synthase. In addition, omega-3 fatty acids could inhibit phosphorylation of transforming growth factor β activated kinase-1 (TAK1), MEK4, c-Jun N-terminal kinase, and IkappaB kinase as well as activation of nuclear factor kappa B through regulating GPR120/β-arrestin2/TAK1 binding protein-1 pathway. Furthermore, siRNA-induced GPR120 silencing blocked the protective effects of omega-3 fatty acids. Here, we show that stimulation of GPR120 with omega-3 fatty acids pretreatment causes anti-apoptosis and anti-inflammatory effects via β-arrestin2/TAK1 binding protein-1/TAK1 pathway in the brains of SAH rats. Fish omega-3 fatty acids as part of a daily diet may reduce EBI in an experimental rat model of SAH.

  8. Comparative study of 64-slice CT angiography and digital subtraction angiography in spontaneous subarachnoid hemorrhage cases%自发性蛛网膜下腔出血的CTA与DSA对比研究

    Institute of Scientific and Technical Information of China (English)

    薛波; 高国波; 李勇; 张立军; 李昌晓

    2013-01-01

    目的:探讨64层CTA与DSA对自发性蛛网膜下腔出血(spontaneous subarachnoid hemorrhage,s-SAH)的应用价值及其限度.方法:收集153例s-SAH患者的CTA及DSA检查资料,回顾性分析2种检查方法的图像质量(采取1~3分评分制),并比较2种方法在脑动脉瘤检出方面的灵敏度、特异度及准确度.结果:图像质量评分CTA为(2.63±0.262)分,DSA为(2.73±0.254)分,二者差异无统计学意义(P>0.05).CTA对脑动脉瘤的检出的灵敏度为96.2%,特异度为94.9%,准确度为95.9%;DSA灵敏度为97.7%,特异度为97.4%,准确度为97.6%,二者差异无统计学意义(P>0.05).结论:在s-SAH患者中,CTA与DSA均能准确检出动脉瘤所致破裂出血.相较于DSA,CTA能多方位显示病变,对血管壁及血管周围情况的显示更具价值.

  9. Inhibitory effects of omega-3 fatty acids on early brain injury after subarachnoid hemorrhage in rats: Possible involvement of G protein-coupled receptor 120/β-arrestin2/TGF-β activated kinase-1 binding protein-1 signaling pathway.

    Science.gov (United States)

    Yin, Jia; Li, Haiying; Meng, Chengjie; Chen, Dongdong; Chen, Zhouqing; Wang, Yibin; Wang, Zhong; Chen, Gang

    2016-06-01

    Omega-3 fatty acids have been reported to improve neuron functions during aging and in patients affected by mild cognitive impairment, and mediate potent anti-inflammatory via G protein-coupled receptor 120 (GPR120) signal pathway. Neuron dysfunction and inflammatory response also contributed to the progression of subarachnoid hemorrhage (SAH)-induced early brain injury (EBI). This study was to examine the effects of omega-3 fatty acids on SAH-induced EBI. Two weeks before SAH, 30% Omega-3 fatty acids was administered by oral gavage at 1g/kg body weight once every 24h. Specific siRNA for GPR120 was exploited. Terminal deoxynucleotidyl transferase dUTP nick end labeling, fluoro-Jade B staining, and neurobehavioral scores and brain water content test showed that omega-3 fatty acids effectively suppressed SAH-induced brain cell apoptosis and neuronal degradation, behavioral impairment, and brain edema. Western blot, immunoprecipitation, and electrophoretic mobility shift assays results showed that omega-3 fatty acids effectively suppressed SAH-induced elevation of inflammatory factors, including cyclooxygenase-2, monocyte chemoattractant protein-1, and inducible nitric oxide synthase. In addition, omega-3 fatty acids could inhibit phosphorylation of transforming growth factor β activated kinase-1 (TAK1), MEK4, c-Jun N-terminal kinase, and IkappaB kinase as well as activation of nuclear factor kappa B through regulating GPR120/β-arrestin2/TAK1 binding protein-1 pathway. Furthermore, siRNA-induced GPR120 silencing blocked the protective effects of omega-3 fatty acids. Here, we show that stimulation of GPR120 with omega-3 fatty acids pretreatment causes anti-apoptosis and anti-inflammatory effects via β-arrestin2/TAK1 binding protein-1/TAK1 pathway in the brains of SAH rats. Fish omega-3 fatty acids as part of a daily diet may reduce EBI in an experimental rat model of SAH. PMID:27000704

  10. 脑脊液置换术治疗蛛网膜下腔出血的临床疗效探讨%Clinical Observation of the Effect of Exchange of Cerebrospinal Fluid for the Treatment of Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    宿红伟

    2015-01-01

    Objective To investigate the safety and significance of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage so as to further improve the therapeutic effect and reduce the incidence of adverse events in the treatment of the dis-ease in our hospital. Methods 60 cases with subarachnoid hemorrhage underwent hospitalization in Department of Neurosurgery of Heze Second People's Hospital from January 2014 to January 2015 were selected as the subjects and divided into the observation group and the control group with 30 cases in each in accordance with the random double-blind control principle. Patients in the control group were treated by the conventional regimen, while those in the observation group were treated by exchange of cere-brospinal fluid combined with the conventional regimen. And the therapeutic effect and incidence of complications were compared between the two groups. Results The analysis of the data showed that 8 cases (26.67%) in the observation group while 20 cases (66.67%) in the control group had headache lasting for 7d, 3 cases (10.00%) in the observation group while 12 cases (40.00%) in the control group had headache lasting for 14d, the therapeutic effect of the observation group was much better than that of the control group with statistically significant difference(P<0.05). Conclusion For patients with subarachnoid hemorrhage, conventional drug therapy combined with exchange of cerebrospinal fluid can improve the response rate and reduce the incidence of complica-tions, so it is worthy of clinical promotion.%目的:为了进一步提高该院对蛛网膜下腔出血的治疗效果并减少各种不良事件的发生几率,探讨和研究在治疗过程中采取脑脊液置换术的安全性和意义。方法按照随机双盲对照的原则将2014年1月-2015年1月在菏泽市第二人民医院神经外科住院治疗的60例蛛网膜下腔出血患者作为研究对象并分为观察组和对

  11. Combined application of virtual imaging techniques and three-dimensional computed tomographic angiography in diagnosing intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background The diagnostic value of virtual imaging combined with three-dimensional computed tomographic angiography (3D-CTA) for intracranial aneurysms has not been fully elucidated yet. This study aimed to evaluate the value of combined application of virtual imaging techniques and 3D-CTA in diagnosing patients with aneurismal subarachnoid hemorrhage (SAH) at the acute stage. Methods Eighty patients with non-traumatic SAH received 3D-CTA examinations. The raw CT data of these patients were reconstructed and transferred into the 3D mode through the surgical plan system based on virtual reality (VR) image, and the 3D virtual images of skulls and brain blood vessels were acquired. The location, size and shape of aneurysms and their anatomic relationship with adjacent tissues were measured from many points of view. Results Seventy-three aneurysms were detected in 68 of the 80 patients, but 2 aneurysms were detected in 2 of the 5 patients who had been found free of aneurysms previously and had received 3D-CTA examinations for a second time one month later. The 3D virtual images produced by the virtual imaging system were clear and vivid, and they could reveal the location and size of the aneurysm and its relations to the parent artery and skull directly. Conclusions The imaging of 3D-CTA is convenient, reliable and fast in diagnosing intracranial aneurysms and can be regarded as the first choice for the diagnosis and treatment of ruptured intracranial aneurysms. Combined with the surgical plan system based on the VR image, 3D-CTA may obtain more imaging information about aneurysms.

  12. The clinical characteristics of cognitive impairments in subarachnoid hemorrhage patients with negative digital subtraction angiography%数字减影脑血管造影阴性蛛网膜下腔出血患者认知功能的临床特点

    Institute of Scientific and Technical Information of China (English)

    张新萍; 梁迎春; 赵君; 秦丽晨

    2012-01-01

    目的 通过对原发数字减影脑血管造影(DSA)阴性蛛网膜下腔出血患者认知功能的评估,分析认知功能损害的相关因素及临床特点.方法 选择DSA阴性蛛网膜下腔出血患者96例,根据病情进行Fisher,Hunt-Hess分级,以简易智能量表(mini-mental state examination,MMSE)进行认知功能评估,计算其发病率,统计分析认知功能损害程度与两种分级之间的相关关系.结果 96例DSA阴性蛛网膜下腔出血患者认知功能损害率51.04%;认知功能损害程度与Fisher,Hunt-Hess分级密切相关(P<0.01).结论 DSA阴性蛛网膜下腔出血患者存在不同程度的认知功能损害,Fisher,Hunt-Hess分级越高认知功能损害越严重.%Objective To estimate the cognitive function of subarachnoid hemorrhage patients with negative digital subtraction angiography (DSA),and analyse its relevant factors and clinical characteristics.Methods 96 subarachnoid hemorrhage patients were selected,and the disease condition were classfied into different grades by Fisher scale,Hunt-Hess scale and the cognitive function were estimated by mini-mental state examination (MMSE),then calculated its incidence,analysed the relationship between the classification and cognitive impairments.Results The incidences of cognitive impairment in subarachnoid hemorrhage patients with negative DSA were 51.04%.Cognitive impairment was closely related to Hunt-Hess and Fisher grade (P< 0.01 ).Conclusion Subarachnoid hemorrhage patients with negative DSA exist different extent of cognitive impairment.The higher Hunt-Hess or Fisher grade,the more serious cognitive impairment.

  13. Pediatric intracranial aneurysms.

    Science.gov (United States)

    Tripathy, L N; Singh, S N

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult counterparts. We present four such cases from our own experience. All these children were operated upon, where the solitary aneurysm in each case was clipped and all of them made a good recovery.

  14. Categorical course in neuroradiology cerebral ischemia, hemorrhage, and vascular lesions

    International Nuclear Information System (INIS)

    The diagnostic imaging of acute stroke is primarily directed toward identifying the lesion, characterizing it as either intracranial hemorrhage or ischemia, and assessing the anatomic extent of the lesion. The acute medical or surgical management decisions are best aided by a combination of CT and cerebral angiography, the latter used acutely mostly for intracranial hemorrhage, especially subarachnoid hemorrhage. More complex presentations benefit from MR imaging evaluation as well. After the acute phase, the main goal of treatment, especially for patients who have had reasonable recovery from the acute stroke, is the prevention of recurrent, and perhaps more severe, stroke. Treatments such as aneurysm clipping or arteriovenous malformation removal for hemorrhagic lesions, or anticoagulation or carotid endarterectomy for ischemic lesions, require brain and vascular imaging studies for appropriate treatment planning. Angiography to show the anatomic vascular cause for the bleed or ischemia is therefore usually a requirement. The enlarging experience with MR imaging has contributed greatly to the identification of occult vascular lesions of the brain that may be prone to bleeding and to recognizing blood in the brain accurately. For this purpose MR imaging is sometimes more specific than CT

  15. Primary intraventricular hemorrhage: Clinical features, risk factors, etiology, and yield of diagnostic cerebral angiography

    Directory of Open Access Journals (Sweden)

    Trilochan Srivastava

    2014-01-01

    Full Text Available Background: Primary intraventricular hemorrhage (PIVH is a rare neurological disorder, with bleeding confined to the ventricles only, without recognizable parenchymal or subarachnoid component. Aim: The purpose of this retrospective study was to identify clinical features, predisposing risk factors, etiology, radiological features and yield of diagnostic cerebral angiography in identifying the etiological causes. Settings and Design: Records of patients admitted in neurology division were analyzed in a tertiary care teaching hospital. Materials and Methods: We analyzed the records of 27 patients with PIVH evaluated and treated at our institute from August 2010 to April 2013. PIVH was diagnosed as hemorrhage in the ventricles only, detected by computed tomography scan without evidence of intraparenchymal, subarachnoid hemorrhage or intraventricular hemorrhage associated with trauma. CT angiography (CTA alone was done in 10 patients (37.03%, digital subtraction angiography (DSA in 2 patients (7.4% and both CTA as well as DSA was done in 15 patients (55.5%. Statistical Analysis Used: Categorical and continuous data were analyzed using SPSS version 17. Results: 17 (62.96% patients were females and 10 (37.03% were males with ratio of F:M= 1.7:1. Headache was the commonest mode of presentation (85.18%. Hypertension was most common predisposing factor (29.62% followed by arterio-venous malformations (AVMs (25.92%, moyamoya disease (MMD (11.11%, lenticuostriate artery aneurysm (LSA (11.11%, arterial dissections (7.4% and dural arteriovenous fistula (dAVF (3.7%. Conclusions: PIVH is rare and hypertension is important predisposing factor. Yield of cerebral angiography is high in diagnosing the etiology. AVMs and other rare etiological causes like MMD, LSA aneurysm, arterial dissection, and dAVF should be kept in mind with a high index of suspicion and warrants cerebral angiography in them, as some of the causes are potentially treatable.

  16. Pediatric intracranial aneurysms

    OpenAIRE

    Tripathy L; Singh S

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult...

  17. Risk factors for intracranial aneurysm in a Chinese ethnic population

    Institute of Scientific and Technical Information of China (English)

    GU Yu-xiang; CHEN Xian-cheng; SONG Dong-lei; LENG Bing; ZHAO Fan

    2006-01-01

    Background Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality.Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients.Methods A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean ± standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test,and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors.Results In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01-1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06-3.10), hypertension (OR, 2.32; 95% CI, 1.30-4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P<0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P>0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk

  18. A ruptured aneurysm arising at the leptomeningeal collateral circulation from the extracranial vertebral artery to the posterior inferior cerebellar artery associated with bilateral vertebral artery occlusion.

    Science.gov (United States)

    Chonan, Masashi; Nishimura, Shinjitu; Kimura, Naoto; Ezura, Masayuki; Uenohara, Hiroshi; Tominaga, Teiji

    2014-02-01

    We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to the VA union. In addition, a small aneurysm was observed at the leptomeningeal collateral circulation located between the extracranial left VA and the left PICA. The patient underwent radical surgery on the day of the onset of the symptoms associated with SAH. However, the VA aneurysm was unruptured and surgically trapped. The small aneurysm arising at the leptomeningeal collateral circulation was ruptured during the surgery and was electrocoagulated; the collateral circulation was preserved, and no neurologic deficits were observed. The postoperative course was uneventful. SAH with the occlusion of major vessels should be diagnosed with utmost caution to allow preoperative neurologic and radiological assessments.

  19. Life-threatening allergic vasculitis after clipping an unruptured aneurysm: Case report, weighing the risk of nickel allergy

    Directory of Open Access Journals (Sweden)

    Andrew Grande

    2014-01-01

    Full Text Available Background: This case report represents one of the estimated 17,000 aneurysms clipped annually in the United States, often with nickel-containing clips. The authors highlight the development of life-threatening allergic vasculitis in a 33-year-old woman after aneurysm clipping. Case Description: After suffering subarachnoid hemorrhage, the patient had coil embolization at another facility for rupture of a right internal carotid artery (ICA aneurysm. An incidental finding, an unruptured left posterior communicating artery aneurysm unamenable to coiling, was then successfully clipped via a left pterional craniotomy. Arriving in our emergency department 11 days later, she progressively declined during the next weeks, facing deteriorating clinical status (i.e. seizures and additional infarctions in the left frontal lobe, midline shift, and new infarctions in the bilateral frontal lobe, right sylvian, right insular regions, and posterior cerebral artery distribution. During decompressive surgery, biopsy findings raised the possibility of lymphocytic vasculitis; consultations with rheumatology, allergy, and immunology specialists identified that our patient had a nickel allergy. After reoperation to replace the nickel-containing clip with one of a titanium alloy, the patient had an uncomplicated postoperative course and was discharged 6 days later to a rehabilitation facility. Conclusions: Nickel-related allergies are more common than appreciated, affecting up to 10% of patients. Fortunately, severe reactions are rare; nevertheless, vascular neurosurgeons should be aware of this potential complication when using cobalt alloy aneurysms clips. The use of titanium alloy clips eliminates this risk.

  20. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report.

    Science.gov (United States)

    Goto, Tetsuya; Tanaka, Yuichiro; Kodama, Kunihiko; Kusano, Yoshikazu; Sakai, Keiichi; Hongo, Kazuhiro

    2007-10-01

    The authors report a case in which a 62-year-old woman with a history of subarachnoid hemorrhage due to a ruptured aneurysm was found to have a de novo paraclinoid aneurysm in the right internal carotid artery during a routine medical examination. Surgical clip placement was performed via a contralateral pterional approach under visual evoked potential (VEP) monitoring. The superior hypophyseal artery (SHA) was found to originate from the aneurysm body. The artery was temporarily occluded prior to application of the clip to the aneurysm neck. The VEP signal was lost 3 minutes after the SHA was occluded, and the potentials gradually recovered 10 minutes after the artery was released. The disappearance of VEP signal was reproducible with SHA occlusion. The clip was applied to the aneurysm body to preserve the origin of the SHA. The patient did not have any deterioration of vision after surgery. Intraoperative VEP monitoring can be used to help determine whether the SHA can be sacrificed safely.

  1. Splanchnic artery aneurysms

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2006-01-01

    Full Text Available Introduction. Splanchnic artery aneurysms are uncommon but important vascular entity because nearly 25% of all cases present as surgical emergency. Objective. The purpose of our study was to present nine patients operated on at the Institute of cardiovascular diseases, as well as literature review of clinical presentation of the disease. Method. There were three splenic artery aneurysms, two celiac trunk aneurysms, and one aneurysm of the hepatic, superior mesenteric, inferior mesenteric and gastroduodenal artery. All patients were males, mean aged 67.5 years (60-73. In four patients, splanchnic artery aneurysm was discovered accidentally during routine ultrasonographic and angiographic examinations of the abdominal aorta. At that time, arteriovenous fistula was diagnosed in a patient No 1; it was formed after rupture of the splenic artery aneurysm into the splenic vein. Three aneurysms were manifested by abdominal pain and palpable pulsating abdominal mass. Two patients were admitted as urgent cases in the state of hemorrhagic shock and signs of intraabdominal bleeding due to rupture of the splenic and hepatic arteries. In 7 cases, diagnosis was made preoperatively by means of ultrasonography and angiography; in two patients, accurate diagnosis was confirmed during surgery. Results. Proximal and distal ligation of the artery was performed in a patient with rupture of the splenic aneurysm into the splenic vein that caused arteriovenous fistula. Gastroduodenal artery aneurysm was treated by trans-aneurysmatic ligation of its "entering" and "exiting" branches. Aneurysms of distal part of the superior mesenteric and splenic artery were resected without further reconstruction. Partial resection of the aneurysm and endoaneurysmorrhaphy was carried out in one case of celiac trunk aneurysm, and in another, after aneurysm resection, the restoration of blood flow through the hepatic and lienal artery was achieved by Dacron grafts. In a patient with the

  2. Influencing factors of elderly injury mechanism of traumatic subarachnoid hemorrhage and its prognostic%老年外伤性蛛网膜下腔出血的损伤机制及影响预后的相关因素

    Institute of Scientific and Technical Information of China (English)

    蒋为; 董韬; 李京臣; 丁绍峰

    2015-01-01

    Objective: to study the old age injury mechanism of traumatic subarachnoid hemorrhage and prognosis influencing factor. Methods:of 110 cases of craniocerebral injury in our hospital as the object of study, all patients on admission to offer check imaging methods such as CT, depending on whether a patient with traumatic subarachnoid hemorrhage will be divided in-to two groups, one in 50 patients with traumatic subarachnoid hemorrhage, 45. 5%. Respectively compared with traumatic sub-arachnoid hemorrhage and without traumatic subarachnoid hemorrhage by the prognosis of patients, and elderly patients with traumatic subarachnoid hemorrhage CT score, observe the type of brain damage, and analyzes its injury mechanism and influenc-ing factors. Results:compared two group patients of treatment effect, visible has trauma sex Cobweb film xià cavity bleeding and no trauma sex Cobweb film xià cavity bleeding of patients recovery good, and mild disability, and in the heavy degrees dis-ability by accounted for proportions zhĪ jiān of copared no significantly differences, but has trauma sex Cobweb film xià cavity bleeding of patients bad prognosis (plant survival and death) occurred rate significantly above no trauma sex Cobweb film xià cavity bleeding of patients, compared has statistics differences (P<0. 05) . Conclusions:the traumatic subarachnoid hemor-rhage are common in acute brain injury patients, more serious and traumatic brain injury, traumatic subarachnoid hemorrhage incidence is higher, the prognosis is worse.%目的:研究探讨老年外伤性蛛网膜下腔出血的损伤机制和预后影响因素。方法:选取我院收治的老年颅脑损伤患者110例作为研究对象,所有患者在入院时即给予CT等影像学手段进行检查,根据患者是否合并有外伤性蛛网膜下腔出血的情况将其分为两组,其中50例患者有外伤性蛛网膜下腔出血,占45.5%。分别比较有外伤性蛛网膜下腔出血和没有外伤性

  3. Diagnostic Accuracy of Early Computed Tomographic Angiography for Visualizing Medium Sized Inferior and Posterior Projecting Carotid System Aneurysms

    Directory of Open Access Journals (Sweden)

    Mohammad Hashemi

    2011-11-01

    Full Text Available Background:Conventional angiography, generally referred to as intra-arterial digital subtraction angiography, still remains the gold standard reference method for the diagnosis of intracranial aneurysms,helical computed tomography angiography (CTA is a new non-invasive volumetric imaging method.Objectives:This study was conducted to screen patients presenting with subarachnoidhemorrhage by CTA before conventional digital subtraction angiography (DSA and subsequently comparing the results for various aneurysm projections.Patients and Methods: In a prospective study, 99 consecutive patients with an initial diagnosis of subarachnoid hemorrhage were screened for aneurysms with CTA followed by conventional DSA. There were 17 cases with negative angiograms in whom repeat angiograms, three months later were negative for 15 cases, while two cases were found to bear aneurysm on the repeat examination. Eighty two patients had at least one proven aneurysm on initial DSA and two on the repeat angiogram.Out of 84 patients, five underwent endovascular treatment and 79 patients who underwent surgical clipping were considered for projection evaluation.Results: Sensitivity of CTA was 98.78% (95% confidence interval [CI], 93.4-99.7%, while the specificity was 100% (95% CI, 81.57-100% and the kappa coefficient of agreement between CTA and DSA was 96.5%. The most significant discrepancies with DSA findings were for visualizing the projection of inferior and posterior projecting proximal anterior circulation aneurysms.Conclusions:Helical CTA was in good concordance with DSA for screening of cerebral aneurysms; however, for exact visualization of the aneurysm neck and its projection, especially if it is inferior or posterior, DSA remains the gold standard.

  4. Comparison of the Sensitivity of MRI and CT in the Diagnosis of Subarachnoid Hemorrhage%MRI与CT诊断蛛网膜下腔出血的敏感性比较研究

    Institute of Scientific and Technical Information of China (English)

    吕琦

    2016-01-01

    Objective To compare the sensitivity and the diagnostic value of MRI and CT in subarachnoid hemorrhage (SAH).Methods Retrospective analysed the MRI and CT performance of the 63 SAH patients which was conifrmed by clinical from January 2013 to October 2015 in our hospital. And divided into 2 groups, acute phase (37 cases) and non acute phase (26 cases). A comparative analysis of sensitivity in diagnosis of SAH with CT and MRI respectively on acute and non acute phase.Results In the acute phase group of 37 cases, CT was detected in 34 cases, accounted for 91.9%. MRI was detected in 35 cases, accounting for 94.6%.In the non acute phase in 26 cases, CT was detected in 12 cases, accounting for 46.2%. MRI was detected in 23 cases, accounting for 88.5%.Conclusion The sensitivity of SAH diagnosis as follows, in acute phase MRI≥CT, in non acute phase MRI, CT, the FLAIR and SWI sequence of MRI is greater diagnostic value especially.%目的:从敏感性方面对比MRI与CT对蛛网膜下腔出血(SAH)的诊断价值。方法回顾性分析我院2013年1月~2015年10月63例经临床证实为SAH患者的MRI与CT表现,分为急性期(37例)和非急性期(26例)2组,分别就急性期和非急性期MRI与CT诊断SAH的敏感性进行比较分析。结果敏感性:急性期组37例中,CT检出34例,占91.9%、MRI检出35例,占94.6%,非急性期26例中, CT 检出12例、占46.2%,MRI检出23例、占88.5%。结论在SAH 诊断的敏感性方面,急性期MRI≥CT、非急性期MRI>CT,尤其以MRI的FLAIR、SWI序列诊断价值较大。

  5. DSA检查和介入治疗在蛛网膜下腔出血应用的临床体会%The clinic experience in application of DSA and interventional therapy in subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈中军; 崔桂云; 祖洁; 沈霞

    2009-01-01

    目的 探讨DSA检查及介入治疗在蛛网膜下腔出血(subarachnoid hemorrhage ,SAH)病人的病因诊断和治疗中的应用.方法 回顾性分析我院45例常规行3D-DSA的SAH病例,其中31例同步行3D-CTA检查,28例接受颅内动脉瘤的介入治疗.比较DSA与CTA在上述患者中的颅内动脉瘤的检出情况, 比较DSA与CTA对SAH病人病因诊断的优缺点;并探讨介入治疗在SAH合并颅内动脉瘤病例治疗中的优缺点.结果 在动脉瘤检出率方面DSA与CTA比较,两者无统计学差异(P>0.05);在显示的动脉瘤大小,形状,动脉瘤瘤颈显示情况及其与载瘤动脉的关系方面,DSA检查患者在介入治疗过程证实明显优于CTA检查;28例行弹簧圈栓塞介入治疗的预后明显优于16例行内科保守治疗患者的预后(P<0.05).结论 在SAH的病因诊断中DSA优于CTA检查,但CTA不失为一种良好的动脉瘤筛选手段,DSA检查对要求进一步行病因治疗的患者是不可替代的;动脉瘤弹簧圈栓塞治疗SAH合并动脉瘤是安全有效的,可明显减少动脉瘤再破裂出血,改善预后.

  6. 芬太尼对蛛网膜下腔出血后脑血管痉挛的影响%Effect of Fentanyl on cerebral vasospasm after subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    刘玉明; 马建荣

    2012-01-01

    Objective To study the effect of Fentanyl on cerebral vasospasm after subarachnoid hemorrhage and its mechanism. Methods Seventy-two healthy adult rabbits were randomly divided into four groups: the control group (group A), SAH group (group B), SAH with fentanyl intravenous (group C) and SAH with fentanyl intramuscular (group D). The rabbits underwent neurobiology score every day. The basar artery was stained by HE, and hippocampus undrewent HE staining and Bcl~2\\Bax immunohistochemical staining, then the neuron density as well as the expression of Bax and Bcl-2 were detected. Results After SAH, the expression of Bcl-2 and Bax increased. After intervention with fentanyl, the expression Bcl-2 was increased, while the expression of Bax decreased., The neurological function score, neuron density and Bax and Bcl-2 expression in group B showed statistically significant differences with those in group C and group D (P<0.05). Conclusion Fentanyl can inhibit neuron apoptosis possibly through enhancing Bcl-2 expression and inhibiting Bax expression.%目的 研究芬太尼(Fentanyl)对蛛网膜下腔出血后脑血管痉挛的影响及其作用机制.方法 选用健康成年家兔72只,随机分成假手术对照组(A组)、SAH组(B组)、芬太尼静脉干预组(C组)、芬太尼肌注干预组(D组).每天进行神经生物学评分,并在实验24h、72h、7d后处死,取基底动脉进行H-E染色,观察管壁情况,同时取左侧海马分别行HE染色及免疫组化染色,观测神经元密度、Bcl-2及Bax的表达.结果 SAH后Bcl-2、Bax表达均增加,芬太尼干预后Bcl-2表达升高,Bax表达下降.B组的神经生物学评分、神经元密度、Bcl-2及Bax的表达与C、D组差异有统计学意义(P<0.05).结论 芬太尼可抑制CVS后细胞凋亡,可能通过促进SAH家兔Bcl-2的表达而抑制Bax表达.

  7. Effect on management mortality of a deliberate policy of early operation on supratentorial aneurysms.

    Science.gov (United States)

    Disney, L; Weir, B; Petruk, K

    1987-05-01

    Of 736 patients with intracranial aneurysms seen at the University of Alberta from 1968 to 1985, 437 were admitted on the day of or the day after subarachnoid hemorrhage (SAH) from a supratentorial aneurysm. Of these, 205 were managed from 1968 through 1977 and 232 were managed from 1978 through early 1985 after a policy of early aneurysm operation had been implemented. Postoperative and management mortality and morbidity rates were related to the grade of the patient at the time of admission and the time interval before operation. Overall management mortality (and postoperative mortality) rates for patients treated before 1978 were 47% (19%) for all grades, 17% (12%) for Grades 1 and 2, 51% (25%) for Grades 3 and 4, and 100% (100%) for Grade 5. Since 1978, mortality has been reduced to 38% (11%) for all grades, 10% (5%) for Grades 1 and 2, 39% (17%) for Grades 3 and 4, and 96% (60%) for Grade 5. Management mortality for patients operated on Day 0 to 3 was lower than for those operated later after SAH both before and after 1978. Postoperative mortality was lowered in all patients operated from 1978 to 1985 regardless of the interval from SAH to operation, and management mortality was reduced overall, as well as for patients operated on day 0 to 3, in those treated from 1978 to 1985. The authors conclude that a policy of early aneurysm operation has contributed to a reduction of both postoperative and management mortality.

  8. The Value of Cerebral CT Angiography with Low Tube Voltage in Detection of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Kun Tang

    2015-01-01

    Full Text Available Objective. The aim of this study is to investigate the value of cerebral CT angiography (CTA with low tube voltage in detection of intracranial aneurysms. Materials and Methods. A total of 294 consecutive patients with spontaneous subarachnoid hemorrhage (SAH were enrolled in this study and randomly assigned into conventional voltage CTA (C-CTA group and low voltage CTA (L-CTA group. The objective and subjective image qualities were analyzed and compared between C-CTA and L-CTA groups. With the results of 3D-DSA as “gold standard,” the sensitivity, specificity, and accuracy of C-CTA and L-CTA in diagnosis of aneurysms were calculated and compared with each other. Results. Compared with group C-CTA, the CT dose index volume (CTDIvol of group L-CTA reduced by 35.65%. There were no significant differences between C-CTA and L-CTA groups regarding objective and subjective image qualities. The sensitivity, specificity, and accuracy of L-CTA in diagnosis of aneurysms were 95.16%, 99.72%, and 99.42%, respectively. There were no significant differences in sensitivity, specificity, and accuracy between the C-CTA and L-CTA groups. Conclusion. The value of cerebral CTA with 100 kV low tube voltage in detection of intracranial aneurysms is significant, and it should be recommended as a routine scan method.

  9. The study of prevention and treatment effects of Ligustrazine on experimental cerebral vasospasm following subarachnoid hemorrhage%川芎嗪对实验性SAH后CVS防治作用的研究

    Institute of Scientific and Technical Information of China (English)

    邵国富; 包仕尧; 楚冰; 张志琳

    2003-01-01

    目的研究兔症状性蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)与内皮素(ET)和一氧化氮(NO)的关系及川芎嗪的保护作用.方法采用双侧颈动脉结扎和枕大池二次注血制成兔SAH模型,观察SAH前后动物进食量和神经功能改变,用放射免疫方法和硝酸还原酶法分别测定血液和脑脊液中ET和NOx-含量,以氢清除法测定局部脑血流量(rCBF).结果SAH后大部分动物进食量有不同程度的下降,所有动物均有不同程度的神经功能障碍和rCBF下降.SAH后血液和脑脊液中ET含量增加,NOx-含量下降(P<0.01).上述变化随出血时间延长和出血量的增大而增加.川芎嗪治疗组上述变化均有不同程度的改善.结论双侧颈动脉结扎后枕大池二次注血可制成可靠的兔症状性SAH后CVS的动物模型.兔SAH后ET和NO含量的改变与CVS的发生密切相关,并进而导致临床症状的恶化.川芎嗪可通过抑制SAH后ET和NO的变化而对CVS的发生和发展起到防治作用.%Objective To investigate the relationship between endothelin(ET), nitric oxide(NO) and experimental cerebral vasospasm following subarachnoid hemorrhage, and the protective effect of Ligustrazine(LZ) on cerebral vasospasm. Methods The model of SAH was set up by injecting blood two times via cisternal after occlusion of bilateral carotid in rabbit. The food-intake and behavior of experimental animals were under observation at various stages of experiment. The content of ET in blood and CSF was tested by radioimmunoassay, and the NOx- by HNO3 redutase method. Regional cerebral blood flow(rCBF) was measured by hydrogen clearance method. Results It was observed that the food-intake decrease in most of animals with SAH in various degree, and the neurofunction disturbance appeared in all SAH-animals. rCBF decreases were also observed in all SAH-animals at various degree.The content of ET in blood and CSF increased but NOx- decreased (P < 0.01). All of above mentioned

  10. Research of CT Angiography Combined with CT Perfusion on Prognosis of Delayed Cerebral Ischemia After Onset of Subarachnoid Hemorrhage%CT血管造影联合CT灌注成像对蛛网膜下腔出血与迟发性脑缺血的相关性探讨

    Institute of Scientific and Technical Information of China (English)

    赵一平; 李松柏; 张贺; 徐克

    2013-01-01

    Objective To investigate the clinical value of CT angiography (CTA) combined with CT perfusion (CTP) on prognosis with delayed cerebral ischemia after onset of subarachnoid hemorrhage ( SAH). Methods CTP and CTA were performed in 71 patients with SAH. CTP data were analyzed using Philips Extended Brilliance Workspace Postprocessing workstation and the volume rendering (VR) images of cerebral arteries were reconstructed using advanced vessel analysis (AVA) software. Whole brain CTP maps were created using Brain Perfusion Software. CTP measurements were made on the CTP maps. CTA and CTP images were reconstructed to detect aneurysm and vasospasm. The change of CTP values on vasospasm and the relationship between perfusion characteristics and the prognosis of patients were evaluated. Results Among 71 patients, 67 cases had aneurysms which included 12 cases of two or more aneurysms; 33 cases showed severe vasospasm in CTA performance in which 14 cases occurred in the anterior cerebral artery and 19 cases occurred in the middle cerebral artery; 25 patients with the emergence of delayed cerebral ischemia (DCI) which were located in the anterior cerebral artery dominated area, accounting for 35.2% of the total number of patients with SAH. The CTP Rainbow Color Scheme had high sensitivity and specificity (78. 6% , 78% ) on diagnosis of DCI; patients with DCI whose anterior circulation cerebral blood flow in the brain had obvious hypoperfusion; these changes of cerebral blood flow and circulation time were relatively less in posterior cerebral artery circulation; the CBF which in four parameters of CTP had the highest sensi-tivity and specificity on diagnosis of DCI (72. 4% , 85. 7% ). The bad prognosis of patients had relationship with vaso-spasm, degree of vasospasm and CBF value. Conclusion CTA combined with CTP can detect the cause and vasospasm of the SAH, it can also judge the prognosis of patients on SAH.%目的 探讨CT血管造影(CTA)联合CT脑血流灌注(CTP)

  11. Fronto-temporo-orbitozygomatic craniotomy and "half-and-half" approach for basilar apex aneurysms

    Directory of Open Access Journals (Sweden)

    Behari Sanjay

    2009-01-01

    Full Text Available Background: Basilar apex aneurysms (BAA are located in interpeduncular cistern surrounded by eloquent neurovascular structures. Surgical access is difficult due to narrow surgical corridors and requires traversing through a depth of 6-8 cm of subarachnoid space. Aim: Surgical management of BAAs clipped using frontotemporal craniotomy, orbitozygomatic osteotomy with combined subtemporal and transylvian (half and half approach is discussed. Setting and Design: Tertiary care referral institute; prospective study. Materials and Methods: Five patients with BAA rupture causing subarachnoid hemorrhage presented in modified Hunt and Hess (Hand H grades II (n=1, III (n=1 and IV (n=3, respectively. In 4 patients, the aneurysms were 0.8-1.2 cm in diameter, situated 7 mm-1 cm above dorsum sellae. Two of them had posteriorly projecting aneurysms. One patient had a giant, high BAA with a left parietooccipital arteriovenous malformation. Vasospasm of posterior cerebral/proximal basilar artery was seen in 2 patients. In one patient, internal carotid artery was mobilized by intradural anterior clinoid drilling with carotid collar division. Triple-H therapy was administered following surgery. Results: There was no intraoperative rupture or temporary clipping. Follow up angiography showed complete aneurysmal obliteration with preservation of posterior cerebral and superior cerebellar arteries. Follow up (mean: 8.7 ± 3.5 months H and H grades were II (n=2 and III (n=3, respectively. The morbidity include caudate and thalamic region infarct, transient III rd nerve palsy and cerebrospinal fluid otorrhoea (n=1, respectively. Conclusions: This simple approach provides a wide surgical corridor from 5 mm below to greater than 1 cm above dorsum sellae with adequate proximal control of basilar artery. It is an option to endovascular embolization especially with large and giant, or wide-necked BAA, vertebrobasilar tortuosity, coil compaction or postcoiling re-rupture and

  12. Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

    NARCIS (Netherlands)

    van Dijk, J. Marc C.; Groen, Rob J. M.; Ter Laan, Mark; Jeltema, Johanna Rinck; Mooij, Jan Jacob A.; Metzemaekers, Jan D. M.

    2011-01-01

    In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly u

  13. Transcranial Doppler velocimetry in aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Staalsø, J M; Edsen, T; Romner, B;

    2013-01-01

    -transformed values. Thus, LoA are given as ratios between measurements. There were no systematic intra- or interobserver differences (bias). The intraobserver LoA was 0.62-1.61 in patients and 0.67-1.50 in controls. However, they were 0.55-1.82 in patients with angiographic vasospasm, whereas in patients without...

  14. 早期持续腰大池引流对于脑外伤合并蛛网膜下腔出血的疗效观察%Effect observation of early continuous lumbar drainage on treatment of cerebral traumatic subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陈贵平

    2012-01-01

    目的 观察脑外伤合并蛛网膜下腔出血患者行早期持续腰大池引流的临床疗效.方法 将183例脑外伤合并蛛网膜下腔出血患者随机分为2组,A组(n=92)接受早期持续腰大池引流术治疗,B组(n=91)接受每日腰穿术放脑脊液治疗.比较2组患者疗效及预后.结果 A组每日脑脊液引流量显著多于B组,而脑脊液压力复常时间、转清时间以及临床症状持续时间显著短于B组.A组总并发症发生率、脑积水及癫痫发生率均显著低于B组.2组患者无植物状态和死亡病例,A组预后良好率显著高于B组,而预后不良率显著低于B组.结论 早期持续腰大池引流治疗脑外伤合并蛛网膜下腔出血患者可以有效缓解临床症状,改善预后.%Objective To observe the clinical effect of early continuous lumbar drainage in treatment of cerebral traumatic subarachnoid hemorrhage. Methods 183 patients with cerebral traumatic subarachnoid hemorrhage were randomly divided into 2 groups. Group A (n = 92) received early continuous lumbar drainage, while group B (n = 91) received daily lumbar puncture cerebrospinal fluid drainage. Efficacy and prognosis were compared between 2 groups. Results The drainage amount of cerebrospinal fluid in group A was obviously larger than group B, and normalization time of cerebrospinal fluid pressure, clearness time and duration of clinical symptoms in group A were obviously shorter than group B. Incidence of total complication, hydrocephalus and epilepsia in group A were obviously lower than group B. There was no case of vegetative state or death. The well prognosis rate in group A was obviously higher than group B, while unhealthy prognosis rate was obviously lower. Conclusion Early continuous lumbar drainage for treating cerebral traumatic subarachnoid hemorrhage can effectively alleviate the clinical symptoms and improve prognosis.

  15. CHARACTERIZATION OF PATIENTS WITH ENDOVASCULAR TREATMENT OF DISSECTING ANEURYSMS OF POSTERIOR CEREBRAL CIRCULATION IN CARTAGENA DE INDIAS

    Directory of Open Access Journals (Sweden)

    Rueda-Tamayo Leidy

    2015-12-01

    Full Text Available Introduction: the intracraneal aneurysms are local and permanent dilations in the artery. Objective: to describe the clinical, imagenologic and effectiveness of endovascular treatment in terms of its independence and mortality in patients with dissecting aneurysms of posterior cerebral circulation in Cartagena. Methods: a descriptive study was carried out with patients 18 years or older with a diagnosis of dissecting aneurysms of posterior cerebral circulation who received endovascular treatment in the period between January 2007 and December 2014 in the medical center Neurodinamia. The variables related to personal medical history, diagnosis and characteristics of the aneurysm, devices used for treatment, time clinical and imagenologic follow-up and complications were measured. Descriptive statistical analysis was performed according to the nature of the variables. Results: nineteen patients were analyzed to receive endovascular treatments. The average of age was 55 years. The subarachnoid hemorrhage was the most frequent clinical case; this was diagnosed with CT in 89.5%. The location in the PICA and vertebral artery were 36.8% and 31.6%, respectively. The devices used were coils in 36.8%, followed by coils and stent with 31.6%, and Onyx with 21.0%. At the end of VTE this was classified as favorable outcome in 18 patients (94.7%; however, there was one death during hospital care (5.3%. The Rankin scale showed improvement in 84.2% (16 patients. Conclusions: the endovascular treatment of dissecting aneurysms posterior cerebral circulation and the aneurysm occlusion showed high success rates 94.7%, patients (84.2% showed positive results after 30 days of treatment. Rev.cienc.biomed. 2015;6(2:298-308 KEY WORDS Aneurysm; Neurosurgery; Radiology interventional.

  16. ESBL Escherichia coli Ventriculitis after Aneurysm Clipping: A Rare and Difficult Therapeutic Challenge

    Directory of Open Access Journals (Sweden)

    F. A. Zeiler

    2015-01-01

    Full Text Available Background. Extended spectrum beta-lactamase (ESBL produced Escherichia coli (E. coli ventriculitis is a rare infection of the central nervous system, with increasing rarity in the adult population. The therapeutic strategy to achieve cure may need to involve a combination of intraventricular and intravenous (IV therapy. Objective. To describe a case of ESBL E. coli meningitis/ventriculitis in an adult and outline the antimicrobial therapy that leads to cure. Methods. We retrospectively reviewed the records of a patient admitted to the neurosurgical department for aneurysmal subarachnoid hemorrhage, who developed ESBL E. coli ventriculitis. Results. A 55-year-old female, admitted for a Fisher grade 3, World Federation of Neurological Surgeons grade 1, subarachnoid hemorrhage, developed ESBL E. coli ventriculitis requiring a combination of intraventricular gentamicin and high dose intravenous meropenem for clearance. Cerebrospinal fluid clearance occurred at 7 days after initiation of combined therapy. The patient remained shunt dependent. Conclusions. Meningitis and ventriculitis caused by ESBL E. coli species are rare and pose significant challenges to the treating physician. Early consideration for combined intraventricular and IV therapy should be made.

  17. 蛛网膜下腔出血后脑血管痉挛常规影像诊断方法的研究%Research of Conventional Imaging Methods in Diagnosis of Vasospasm Cause by Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    赵一平; 张贺; 李松柏; 徐克

    2013-01-01

    Objective To investigate the value of conventional imaging methods including CT angiography (CTA ) and transcranial Doppler ultrasound (TCD) in diagnosing cerebral vasospasm (CVS) caused by subarachnoid hemorrhage ( SAH ) . Methods Thirty eight patients with SAH underwent 256 slice computed tomography angiography, TCD and digital subtraction angiography (DSA). DSA was regarded as golden standard for diagnosing CVS caused by SAH. Compared with DSA, the sensitivity and specificity of CTA and TCD were calculated. Results DSA confirmed 11 patients with CVS. CTA images detected CVS in 14 patients,and TCD detected in 15. Compared with DSA, CTA had higher accuracy in displaying proximal segment of anterior, middle cerebral artery, and patients with no or severe vasospasm , low Hunt and Hess grading. TCD had more reliable diagnosis in patients with Ml segment severe cerebral vasospasm and high Hunt and Hess grading. The CTA was more sensitive and had higher sensitivity and specificity in the diagnosis of CVS (62. 5% , 81.8%). Conclusion CTA can detect the cause of SAH. Beside that, CTA has higher diagnostic value than TCD in displaying vasospasm cause by SAH.%目的 探讨蛛网膜下腔出血(SAH)后脑血管痉挛(cvs)的常规影像检查方法的诊断价值,即CT血管造影(CTA)及经颅多普勒超声(TCD).方法 搜集SAH患者38例,通过Philips 256排CT的CTA扫描、TCD和数字减影血管造影(DSA)进行检查.以DSA作为金标准,比较CTA、TCD对SAH后CVS的诊断价值.采用SPSS 13.0统计学软件包进行统计分析,计数资料采用四格表的方法计算阳性预测值、阴性预测值、灵敏性、特异性、假阳性率和假阴性率.结果 38例中CTA共检出14例发生了CVS,TCD检出15例,DSA确诊为11例.经与DSA比较,CTA对于大脑前、中动脉近侧段脑血管、无和重度的血管痉挛及Hunt和Hess低分级的患者检测准确性较高;TCD对于大脑中动脉M1段的重度CVS及Hunt和Hess高分级的患者诊断比

  18. Autopsy case of a giant aneurysm of the anterior communicating artery. Correlation of CT findings and angiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Shinmura, Fujio; Takayasu, Kenji; Ohiwa, Yasuyuki; Sakata, Ryuichi; Ariwa, Rokuro

    1983-06-01

    A 64-year-old female was admitted to the hospital with a history of three previous subarachnoid hemorrhages. Neurological examinations revealed incontinentia urinae, gait disturbance, recent memory disturbance and motor weakness on the left side. Plain X-ray films showed a ring-like calcification in the right frontal region. A plain CT scan showed a ring-shaped iso- and high-density area in the intra hemispheric region, the intra bilateral anterior horn of the lateral ventricle, the intra septum pellucidum, and the intra anterior part of the third ventricle. Left carotid angiography showed a large aneurysmal shadow arising from the anterior communicating artery and another from the left middle cerebral artery. In the venous phase the venous angle was supero-posteriorly shifted, and the septal vein was elevated. She died unexpectedly with a status epilepticus of unknown origin. An autopsy specimen revealed that a giant aneurysm occupied the intra ventricular space, the anterior horn of the lateral ventricle, and the right thalamic region. Also, there was a large berry aneurysm arising from the middle cerebral artery. A coronary section through the giant aneurysm showed a markedly compressed left lateral ventricle, right thalamus, and hypothalamus, while the third ventricle had shifted toward the left side.

  19. Performance of language tasks in patients with ruptured aneurysm of the left hemisphere worses in the post-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Ana Cláudia C. Vieira

    2016-08-01

    Full Text Available ABSTRACT Sub-arachnoid hemorrhage (SAH promotes impairment of upper cortical functions. However, few information is available emphasizing changes in language after aneurismal SAH and aneurysm location influence. Objective To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA, left middle cerebral artery (L-MCA and left posterior comunicating artery (L-PcomA. Methods Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms’ location. Results Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks. Conclusion After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.

  20. Vasopressin in plasma and CSF of patients with subarachnoid haemorrhage.

    OpenAIRE

    Mather, H. M.; Ang, V; Jenkins, J. S.

    1981-01-01

    Arginine vasopressin was measured in the blood and cerebrospinal fluid (CSF) of 42 patients with subarachnoid haemorrhage. Increased concentrations of vasopressin were present in 10 patients, of whom eight had bled from an anterior communicating artery aneurysm. In three patients high blood vasopressin values were associated with gross hyponatraemia. Five patients were found to have increased CSF vasopressin concentrations in the presence of normal plasma values and in all of these the level ...

  1. Experimental Induction of Cerebral Aneurysms by Developmental Low Copper Diet.

    Science.gov (United States)

    Jung, Keun-Hwa; Chu, Kon; Lee, Soon-Tae; Shin, Yong-Won; Lee, Keon-Joo; Park, Dong-Kyu; Yoo, Jung-Suk; Kim, Soyun; Kim, Manho; Lee, Sang Kun; Roh, Jae-Kyu

    2016-05-01

    Optimal models are needed to understand the pathophysiology of human cerebral aneurysms (CA). We investigated the development of experimental CA by decreasing the activity of lysyl oxidases by dietary copper deficiency from the time of gestation and then augmenting vascular stress by angiotensin II infusion in adulthood. Rats were fed copper-free, low-copper, or normal diets at different time periods from gestation to adulthood. The incidences of CAs were evaluated and autopsies performed to determine the coexistence of cardiovascular diseases. A copper-free diet from gestation was associated with high mortality rates (79.1%) resulting from rupture of ascending aorta aneurysms; a low-copper diet led to acceptable mortality rates (13.6%) and produced CAs and subarachnoid hemorrhage in 46.4% and 3.6% of animals, respectively. Higher proportions of CAs (up to 33.3%) in the rats primed for copper deficiency from gestation ruptured following angiotensin II infusion from adulthood. Gene expression array analyses of the CAs indicated that genes involving extracellular matrix and vascular remodeling were altered in this model. This model enables future research to understand the entire pathogenetic basis of CA development and rupture in association with systemic vasculopathies.

  2. Endovascular Coiling of Multiple (More than Four) Intracranial Aneurysms: Case Report

    OpenAIRE

    Kim, Y J; Song, K. Y.

    2004-01-01

    The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests ...

  3. [Experimental Subarachnoid hemmorrhage in dogs--effect of various drugs and sympathectomy on cerebral arterial spasm (author's transl)].

    Science.gov (United States)

    Noda, S

    1975-09-01

    Adult mongrel dogs were used. The posterior communicating artery was punctured with a fine needle and subarachnoid hemorrhage was produced, which simulated aneurysmal rupture in human. The cerebral basal arteries were constricted remarkably after the puncture. However this vasospasm disappeared in about 60-120 minutes. After this restoration, the vessels began to be constricted again and reduced their diameter in greater degree with lapse of time. Effect of various drugs and sympathectomy on the experimental spasm induced by this method were studied utilizing the magnified vertebral angiography. The drugs used were papverine, isoxuprine, methysergide, phentolamine and propranolol. One of these drugs was given to each dog into the vertebral artery 15 minutes after the puncture of the artery for study of the early spasm, and the same procedure was carried out 24 hours after the late spasm. Vertebral arteriograms were taken immediately after and at 5, 10 and 30 minutes after injection of the drug. Diameter changes of the cerebral basal arteries were measured on the film. Smooth muscle relaxtants, papaverine and isoxsuprine, were effective on relieving the early and the late spasm. An antiserotonin agent, methysergide, relieved slightly the early spasm, but it had no effect on the late spasm. Phentolamine, that is an adrenergic blocking agent, relieved the early spam remarkably, but it was less effective on the late spam. A beta adrenergic blocking agent, propranolol, was effective on relieving neither the early nor the late spasm. Two weeks after the removal of the bilateral upper cervical ganglia, subarachnoid hemorrhage was produced by the smae method as mentioned above in four dogs. Arteriograms taken 24 hours after puncture of the posterior communicating artery in these dogs showed vasoconstriction as same as in the non-sympathectomized dogs. From these experimental results, it was suggested that an etiological difference in the early and the late spasm may exist

  4. Akinetic Mutism Following Bilateral Anterior Cerebral Artery Territory Infarction Due to Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Zeynep Özözen Ayas

    2014-04-01

    Full Text Available BACKGROUND AND PURPOSE: Bilateral anterior cerebral artery (ACA territory infarction is rare localization in stroke which should always prompt a search for an anterior communicating artery (ACoA aneurysm. The common neurological manifestations are contralateral weakness predominate in the lower extremite, behavior disturbance, motor inertia, muteness, incontinence, grasp reflex, diffuse rigidity, akinetic mutism. CASE DESCRIPTION: We describe a 38-year-old woman presented with a left sided hemiparesia and decrease of speech for last days. She was a smoker and morbide obese. She had no any diagnosed disease. Her neurological examination had weakness of left extremites affected leg more than the arm and akinetic mutism like as no spontaneously speech and move and grasp reflex. CT showed bilateral ACA infarction which included cingulate gyrus, the right side more than left and subarachnoid hemorrhage in the interhemispheric fissure. MRI angiography showed the appearance of AcoA aneurysm. CONCLUSION: We report a patient with bilateral infarction in the ACA which a rare localization and clinicians must be alert to exist AcoA aneurysm which may bleed, different symptoms and signs like as akinetic mutism, primitive reflexes.

  5. Migraine and risk of hemorrhagic stroke

    DEFF Research Database (Denmark)

    Gaist, David; González-Pérez, Antonio; Ashina, Messoud;

    2014-01-01

    to select 10,000 controls free from hemorrhagic stroke. Using unconditional logistic regression models, we calculated the risk of hemorrhagic stroke associated with migraine, adjusting for age, sex, calendar year, alcohol, body mass index, hypertension, previous cerebrovascular disease, oral contraceptive......BACKGROUND: We investigated the association between hemorrhagic stroke and migraine using data from The Health Improvement Network database. FINDINGS: We ascertained 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH). Density-based sampling was used...

  6. 数字减影CTA诊断破裂颅内动脉瘤的价值%Detection value of ruptured intracranial aneurysms with digital subtraction computed tomographic angiography

    Institute of Scientific and Technical Information of China (English)

    刘元早; 翟昭华; 王霖

    2015-01-01

    Objective:To evaluate the diagnostic performance of 64-section DSCTA to detect ruptured intracranial aneurysms compared with 3D-DSA,as a reference standard. Materials and Methods:This study was approved by the institutional review board;written informed consent was obtained. One hundred and forty-four consecutive patients suspected of having aneurismal subarachnoid hemorrhage were recruited from January 2012 to November 2013. All patients underwent both 64-detector DSCTA and 3D-DSA for the detection of intracranial aneurysms. Source images were post-processed to reconstruct three-dimensional image and measure the aneuris-mal size. With 3D-DSA findings as the reference standard,sensitivity and specificity of digital subtraction CTA in depicting aneurysm were calculated. The sensitivity,specificity of DSCTA in depicting aneurysms of different diameter (ie,< 3 mm,≥3mm and <5 mm,≥5mm and <10 mm,≥10 mm) and of aneurysms at different locations in the anterior and posterior circulation were calculated. Re-sults:One hundred and ninety-nine aneurysms were seen in one hundred and forty-four patients. Of those,DSCTA detected 196. On a per-aneurysm basis,the sensitivity and specificity of CT angiography was 98. 5% and 100%,respectively. For aneurysms smaller than 3 mm,sensitivity was 91. 2%. However,the sensitivity and specificity were both 100% for aneurysms larger than 3 mm and all of ruptured intracranial aneurysms. Conclusion:64-slice DSCTA can be used as the primary screening method for patients who had aneurismal sub-arachnoid hemorrhage in the diagnostic routine.%目的::以3D-DSA为参考标准,探讨64层螺旋CT数字减影CTA对破裂颅内动脉瘤的诊断性能。材料与方法:所有病例经伦理审查委员会批准,患者或家属签订知情同意书。回顾性分析2012年1月至2013年11月期间的144例经过数字减影CTA和3D-DSA检查的动脉瘤性蛛网膜下腔出血(aneurysmal Subarachnoid Hemorrhage,SAH)患者。所有源图像

  7. Operative strategy of complex internal carotid artery-posterior communicating artery aneurysms Defensive effect on perioperative nerve injury

    Institute of Scientific and Technical Information of China (English)

    Xinmin Wang; Wende Xiong; Xuqin Li

    2007-01-01

    BACKGROUND: The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA)aneurysms.OBJECTIVE: To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms, and investigate how to better protect the brain tissue.DESIGN: A retrospective case analysis.SETTING: Department ofNeurosurgery, Dalian Central Hospital.PARTICIPANTS: Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%)of complex ICA-PComA aneurysms, 8 males and 11 females, 38 - 67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS: The clinical manifestations, including initial symptoms and Hunt&Hess grading, were observed. Corresponding strategies were selected for different types of ICA-PComA aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4 - 5 points), bad (2 - 3 points) and dead (1 point). The results at discharge were taken as early results, whereas the follow-up results as late results.MAIN OUTCOME MEASURES: Clinical manifestations and curative effects of the patients.RESULTS: All the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations, the initial symptoms were subarachnoid hemorrhage (n =15), paralysis of oculomotor nerve (n =3), and occasional attack (n =1); The Hunt&Hess grading was grade Ⅰ in 4 cases, grade Ⅱ in 6 cases,grade Ⅲ in 6 cases, grade Ⅳ in 2 cases, and grade Ⅴ in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case. The

  8. Ruptured Intracranial Mycotic Aneurysm in Infective Endocarditis: A Natural History

    Directory of Open Access Journals (Sweden)

    Isabel Kuo

    2010-01-01

    discovered on CT Angiography. His lesion quickly progressed into an intraparenchymal hemorrhage, requiring emergent craniotomy and aneurysm clipping. Current recommendations on the management of intracranial Mycotic Aneurysms are based on few retrospective case studies. The natural history of the patient's ruptured aneurysm is presented, as well as a literature review on the management and available treatment modalities.

  9. Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Preda, L.; Di Maggio, E.M.; La Fianza, A.; Dore, R.; Fulle, I.; Solcia, M.; Campani, R. [Istituto di Radiologia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Gaetani, P.; Rodriguez y Baena, R. [Neurosurgery, Istituto Clinico ``Humanitas``, I-20089 Rozzano (Midway Islands) (Italy); Cecchini, A. [Servizio di Radiodiagnostica, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy); Infuso, L. [Neurochirurgia, Dipartimento di Chirurgia, IRCCS Policlinico S. Matteo, p.le C. Golgi, 2, I-27 100 Pavia (Italy)

    1998-06-02

    We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 {+-} 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 {+-} 0.12 cm vs 1.09 {+-} 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients

  10. Medida da diferença artério-venosa de oxigênio na monitorização de pacientes com hemorragia subaracnóidea por aneurisma cerebral Measurement of arteriovenous oxygen difference in the monitoring of patients with subarachnoid haemorrhage due to cerebral aneurysm

    Directory of Open Access Journals (Sweden)

    Ronaldo Sérgio Santana Pereira

    1997-01-01

    Full Text Available A diferença artério-venosa de oxigênio (DAVO2, pelo fato de estar relacionada com o metabolismo cerebral, reflete alterações que ocorrem em determinadas situações patológicas, entre elas as causadas pela hemorragia subaracnóidea espontânea (HSAE. Com a finalidade de avaliar a relação entre alterações na DAVO2 com o quadro clínico e a evolução de pacientes com HSAE, devido à ruptura de aneurisma cerebral, este método foi utilizado em 30 pacientes portadores desta patologia, admitidos na Unidade de Neurocirurgia do HBDF. A HSAE foi confirmada por CT de crânio em 17 pacientes e por punção lombar em 13. Dezoito pacientes foram admitidos com Hunt & Hess (H&H I ou II, sete com H&H III e cinco com H&H IV ou V. A medida da DAVO2 baseou-se na equação de Fick e os resultados clínicos foram avaliados pela escala de seqüelas de Glasgow. Dezenove pacientes apresentaram DAVO2 normais (inicialmente e durante a evolução, sendo que três faleceram; cinco tiveram valores de DAVO2 sempre baixos e três faleceram; os restantes seis pacientes tiveram valores da DAVO2 sempre elevados e dois faleceram. Os pacientes com DAVO2 normais tiveram melhor evolução clínica e índice de mortalidade menor, quando comparados com os pacientes com valores anormais da DAVO2 (pThe arterious venous oxygen difference (AVDO2 due to the close relationship with cerebral metabolic rate of oxygen and cerebral blood flow shows metabolic alterations that occur in some pathological situations in the brain including subarachnoid haemorrhage. The AVDO2 was calculated by the Fick equation and the results evaluated by the Glasgow outcome scale. Measurements of arteriojugular oxygen difference were carried out in 30 patients with subarachnoid haemorrhage due to rupture of intracranial aneurysms, as an attempt to monitor the relationship between changes in AVDO2, clinical picture, and evolution of the patients. The subarachnoid haemorrhage was diagnosed by CT scan in

  11. Coil Knotting during Endovascular Coil Embolization for Ruptured MCA Aneurysm: A Case Report

    OpenAIRE

    Kwon, S.C.; Lyo, I.U.; Shin, S. H.; Park, J B; Kim, Y.

    2008-01-01

    Complications during coil embolization of cerebral aneurysms include thromboembolic events, hemorrhagic complications related to procedural aneurysmal rupture and parent vessel perforation, and coil-related complications. The present report describes a rare coil-related complication involving spontaneous coil knotting.

  12. 基层医院蛛网膜下腔出血急诊处置策略的探讨附37例报道%Countermeasures of Basic-level Hospital Emergency Treatment of Subarachnoid Hemorrhage With 37 Cases Reported

    Institute of Scientific and Technical Information of China (English)

    韩永峰; 段晋宁; 张娟

    2015-01-01

    目的:探讨基层医院院前急救及多通道合作对蛛网膜下腔出血的病因诊断及疗效的影响,初步分析预后的影响因素。方法回顾性分析2012年8月~2014年8月间,行院前急救及多通道合作救治的37例蛛网膜下腔出血患者资料。对其行院前急救,安全转送至医院后,统计患者院前急救及转运结局、发病至医院急诊时间及患者预后;统计患者年龄、高血压史、糖尿病史等一般信息,行多因素回归分析,明确患者预后的影响因素。结果院前急救期间死亡3例,余34例均安全转送入院,发病至医院急症时间平均(3.2±0.4)h。转