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Sample records for aneurysmal subarachnoid hemorrhage

  1. Aneurysmal Subarachnoid Hemorrhage

    Science.gov (United States)

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome. PMID:25272066

  2. Circumstances surrounding aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Schievink, W. I.; Karemaker, J. M.; Hageman, L. M.; van der Werf, D. J.

    1989-01-01

    The circumstances surrounding aneurysmal subarachnoid hemorrhage were investigated in a group of 500 consecutive patients admitted to a neurosurgical center. Subarachnoid hemorrhage occurred during stressful events in 42.8% of the patients, during nonstrenuous activities in 34.4%, and during rest or

  3. Hypomagnesemia after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    van den Bergh, Walter M.; Algra, Ale; van der Sprenkel, Jan Willem Berkelbach; Tulleken, Cornelis A.F.; Rinkel, Gabriël J.E.

    OBJECTIVE: Hypomagnesemia frequently occurs in hospitalized patients, and it is associated with poor outcome. We assessed the frequency and time distribution of hypomagnesemia after aneurysmal subarachnoid hemorrhage (SAH) and its relationship to the severity of SAH, delayed cerebral ischemia (DCI),

  4. Non-aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Bashir, Asma; Mikkelsen, Ronni; Sørensen, Leif

    2017-01-01

    Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. M...... adequate with absence of hematoma and vasospasm. In contrast, a follow-up DSA should be mandatory for confirming or excluding vascular pathology in case of nPMSAH in order to prevent rebleeding....

  5. Intravascular volume after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Hoff, R.G.

    2009-01-01

    Intravascular volume after aneurysmal subarachnoid hemorrhage A subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm is a devastating disorder with an often poor prognosis. The occurrence of delayed cerebral ischemia (DCI) is one of the most important factors determining outcome in

  6. Aspirin and aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Gross, Bradley A; Rosalind Lai, Pui Man; Frerichs, Kai U; Du, Rose

    2014-12-01

    Recent evidence has suggested a potential beneficial effect of aspirin on the risk of aneurysm rupture. This benefit must be weighed against its potential adverse effects as an antiplatelet agent in the setting of acute aneurysmal subarachnoid hemorrhage (SAH). A total of 747 consecutive patients with cerebral aneurysms were reviewed, comparing demographics, aneurysm features, presenting clinical and radiographic grades, vasospasm, and outcome at 1 year between patients with aneurysmal SAH taking aspirin on presentation and those who were not. The rate of hemorrhagic presentation was significantly greater in patients not taking aspirin (40% vs. 28%; P = 0.016). Among 274 patients presenting with aneurysmal SAH, there was no significant difference in presenting clinical (Hunt and Hess) and radiographic (Fisher) grade between patients taking aspirin and those who were not. There was also no significant difference in the rate of subsequent angiographic and delayed cerebral ischemia. Multivariate analysis of outcome at 1 year found only increasing age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.04-1.12), Hunt and Hess grade (OR 3.01, 95% CI 1.81-5.03), and associated hypertension (OR 3.30, 95% CI 1.39-7.81) to be statistically significant risk factors for poor outcome (death or dependence), whereas aspirin use was not associated with poor outcome (OR 1.19, 95% CI 0.35-4.09; P = 0.78). In the present study, patients taking aspirin had a lower rate of hemorrhagic presentation. In addition, taking aspirin did not adversely impact presenting clinical grade or radiographic grade, vasospasm, and outcome in the setting of aneurysmal SAH. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. 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...

  8. 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...

  9. Magnetic resonance imaging of aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Toshihide; Shimosegawa, Eku; Inugami, Atsushi; Shishido, Fumio; Fujita, Hideaki; Ito, Hiroshi; Uemura, Kazuo; Yasui, Nobuyuki (Research Inst. of Brain and Blood Vessels, Akita (Japan))

    1991-11-01

    Magnetic resonance imaging of subarachnoid hemorrhage (SAH) due to aneurysm rupture was evaluated in relation to CT findings in nine patients. Six patients were studied within 3 days and the other three patients were studied 4 to 6 days from the ictus of SAH using a 0.5 Tesla superconducting unit. In all of the patients, hematoma in the subarachnoid space and ventricles was demonstrated by the proton density-weighted spin echo sequence, which showed that bloody cerebrospinal fluid (CSF) had a higher signal intensity than brain tissue or normal CSF. Magnetic resonance imaging was more sensitive in detecting SAH and more informative as to the site of the ruptured aneurysm than CT. Despite some limitations in applying it to patients with acute SAH, magnetic resonace imaging has clear advantages in the diagnosis of SAH. (author).

  10. Magnesium sulfate in aneurysmal subarachnoid hemorrhage: a randomized controlled trial

    NARCIS (Netherlands)

    van den Bergh, Walter M.; Algra, A.; van Kooten, F.; Dirven, C. M. F.; van Gijn, J.; Vermeulen, M.; Rinkel, G. J. E.

    2005-01-01

    BACKGROUND AND PURPOSE: Magnesium reverses cerebral vasospasm and reduces infarct volume after experimental subarachnoid hemorrhage (SAH) in rats. We aimed to assess whether magnesium reduces the frequency of delayed cerebral ischemia (DCI) in patients with aneurysmal SAH. METHODS: Patients were

  11. Bedside diagnosis of mitochondrial dysfunction in aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Jacobsen, A.; Nielsen, T. H.; Nilsson, O.

    2014-01-01

    Objectives - Aneurysmal subarachnoid hemorrhage (SAH) is frequently associated with delayed neurological deterioration (DND). Several studies have shown that DND is not always related to vasospasm and ischemia. Experimental and clinical studies have recently documented that it is possible...

  12. 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)

  13. Impaired Work Productivity After Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Crago, Elizabeth A; Price, Thomas J; Bender, Catherine M; Ren, Dianxu; Poloyac, Samuel M; Sherwood, Paula R

    2016-10-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a sudden debilitating condition affecting individuals during the most productive times of their lives. Treatment advances have reduced mortality rates but increased the number of survivors facing deficits in physical and neuropsychological function. This study examined associations between neuropsychological function and work productivity after aSAH. Fifty-two patients with aSAH, employed before hemorrhage, were recruited from an ongoing National Institutes of Health study. Work Limitations Questionnaire (WLQ), neuropsychological tests (executive function, psychomotor speed, attention and mental flexibility, memory), and Patient Assessment of Own Function were completed at 3 and 12 months after aSAH. Subjects in this analysis reported some level of difficulty in work productivity at 3 and 12 months (35% and 30%, respectively) after hemorrhage. Lower WLQ scores in time management and mental/interpersonal subscales were associated with poorer performance in psychomotor function (r = .5, p = .04 and r = .42, p = .09). Poorer mental flexibility and working memory correlated with time management difficulty at 3 months (r = -.4, p = .09 and r = .54, p = .02). Patients performing poorly on story recall tests were more likely to report difficulty with job physical performance (r = -.42, p = .09) and completing work effectively (r = .61, p = .009). Poorer working memory performance was associated with lower scores on mental/interpersonal WLQ subscales (r = .45, p = .05) and overall health-related work productivity loss (r = .47, p = .04). WLQ areas also correlated with participants' perception of their neuropsychological function after aSAH. These results suggest that neuropsychological deficits impact work quality after hemorrhage and provide strong impetus for future studies so that domain-specific interventions can be implemented to improve outcomes that affect quality of life including work productivity.

  14. Radiological analysis of subarachnoid hemorrhage from ruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    Lee, Jong Doo; Suh, Jung Ho; Kim, Dong Ik

    1988-01-01

    The CT findings of 98 patients with subarachnoid hemorrhage due to aneurysmal rupture were analyzed and compared with cerebral angiography for the purpose of preangiographic prediction of aneurysmal location as well as evaluation of the CT features corresponding to the vasospasm or ischemic neurologic dysfunctions. The results were as follows: 1.Aneurysms could be identified on initial cerebral angiography in 82 out of 98 patients with subarachnoid hemorrhage and anterior communicating artery aneurysms were most common (42 cases), followed by MCA, posterior communicating artery, ICA, basilar artery in order of frequency. 2.The CT findings of those patients were hemorrhage in subarachnoid space (69%), localized hematoma (47%), ventricular dilatation (31%), enhancing nodule (23%), cisternal enhancement (20%), cerebral infarction (15%), ventricular hemorrhage (14%), and epidural hemorrhage (3%). 3.Localized hematoma was more prevalent in anterior communicating artery aneurysm rupture (54%), and less frequently in MCA, posterior communicating artery and ICA aneurysms. 4.Most of aneurysmal sac could be identified as enhancing nodule on CT when the real size were over 1 cm. 5.The size of ruptured aneurysm could be predicted in many patients with ACA and MCA aneurysm according to the CT features such as hemorrhagic patterns, location of hematomas or enhancing nodules. 6.Localized hematoma or blood clots and cerebral infarction are considered to be the CT features corresponding to the angiographic vasospasm

  15. Radiological analysis of subarachnoid hemorrhage from ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Doo; Suh, Jung Ho; Kim, Dong Ik [Yonsei University, College of Medicine, Seoul (Korea, Republic of)

    1988-02-15

    The CT findings of 98 patients with subarachnoid hemorrhage due to aneurysmal rupture were analyzed and compared with cerebral angiography for the purpose of preangiographic prediction of aneurysmal location as well as evaluation of the CT features corresponding to the vasospasm or ischemic neurologic dysfunctions. The results were as follows: 1.Aneurysms could be identified on initial cerebral angiography in 82 out of 98 patients with subarachnoid hemorrhage and anterior communicating artery aneurysms were most common (42 cases), followed by MCA, posterior communicating artery, ICA, basilar artery in order of frequency. 2.The CT findings of those patients were hemorrhage in subarachnoid space (69%), localized hematoma (47%), ventricular dilatation (31%), enhancing nodule (23%), cisternal enhancement (20%), cerebral infarction (15%), ventricular hemorrhage (14%), and epidural hemorrhage (3%). 3.Localized hematoma was more prevalent in anterior communicating artery aneurysm rupture (54%), and less frequently in MCA, posterior communicating artery and ICA aneurysms. 4.Most of aneurysmal sac could be identified as enhancing nodule on CT when the real size were over 1 cm. 5.The size of ruptured aneurysm could be predicted in many patients with ACA and MCA aneurysm according to the CT features such as hemorrhagic patterns, location of hematomas or enhancing nodules. 6.Localized hematoma or blood clots and cerebral infarction are considered to be the CT features corresponding to the angiographic vasospasm.

  16. Subarachnoid hemorrhage: risks of aneurysm rupture and delayed cerebral ischemia

    NARCIS (Netherlands)

    de Rooij, N.K.

    2013-01-01

    Three percent of the population harbors an intracranial aneurysm. A minority of these aneurysms will rupture and cause a subarachnoid hemorrhage (SAH). SAH is a devastating disease with high case fatality and morbidity. A major contributor to the poor outcome after SAH is delayed cerebral ischemia

  17. CT findings of subarachnoid hemorrhage due to ruptured cerebral aneurysm

    International Nuclear Information System (INIS)

    Kim, Pyo Nyun; Bae, Won Kyung; Kim, Il Young; Lee, Kyung Soo; Lee, Byoung Ho; Kim, Ki Jung

    1990-01-01

    CT scans were analysed retrospectively in 130 patients with subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm to evaluate the relationship of the locations of aneurysms and the patterns of hemorrhage. Hemorrhage corresponded to the site of aneurysmal origin in a general way and in more specific ways to anterior communicating and middle cerebral artery aneurysms when there was parenchymal or cisternal hemorrhage. In anterior communicating artery aneurysm, SAH in the interhemispheric fissure, both sylvian fissures, and basal cistern was usually noted and intracerebral hemorrhage in anteroinferior frontal lobe was sometimes associated. In cases of middle cerebral artery aneurysm, hemorrhage in the ipsilateral sylvian fissure, interhemispheric fissure, and ipsilateral basal cistern was usual. Intracerebral hemorrhage in lateral temporal lobe was sometimes associated. Posterior communicating artery aneurysm demonstrated SAH in the ipsilateral basal cistern or in entire cisternal spaces specifically, so with higher incidence of involvement of the quadrigeminal and superior cerebellar cistern than anterior cerebral or middle cerebral artery aneurysm. We suggest the locations of aneurysm might be predicted with patterns of SAH and / or associated intracerebral hemorrhage with CT

  18. Subarachnoid hemorrhage

    Science.gov (United States)

    ... common injury leading to subarachnoid hemorrhage is motor vehicle crashes. Risks include: Aneurysm in other blood vessels ... goals of treatment are to: Save your life Repair the cause of bleeding Relieve symptoms Prevent complications ...

  19. Delayed Rebleeding of Cerebral Aneurysm Misdiagnosed as Traumatic Subarachnoid Hemorrhage

    OpenAIRE

    Song, Seung-Yoon; Kim, Dae-Won; Park, Jong-Tae; Kang, Sung-Don

    2016-01-01

    An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head traum...

  20. Fever after aneurysmal subarachnoid hemorrhage: relation with extent of hydrocephalus and amount of extravasated blood

    NARCIS (Netherlands)

    Dorhout Mees, Sanne M.; Luitse, Merel J. A.; van den Bergh, Walter M.; Rinkel, Gabriel J. E.

    2008-01-01

    BACKGROUND AND PURPOSE: Fever after aneurysmal subarachnoid hemorrhage is associated with poor outcome. Because hydrocephalus and extravasated blood may influence thermoregulation, we determined whether these factors increase the risk for fever after subarachnoid hemorrhage. METHODS: Fever within 14

  1. 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.

  2. CT findings of subarachnoid hemorrhage due to ruptured cerebral aneurysm with fundal hemorrhage

    International Nuclear Information System (INIS)

    Kashihara, Kengo; Yamashima, Tetsumori; Hasegawa, Takeshi; Kida, Shinya; Nitta, Hisashi; Yamamoto, Shinjiro

    1985-01-01

    CT scan and fundus oculi of subarachnoid hemorrhage due to ruptured cerebral aneurysm were investigated in 42 patients who were admitted between January, 1980, and August, 1984. Fundal hemorrhage (FH) was observed in 22 patients. The patients with FH showed a worse clinical grade (Hunt Kosnik) on admission than those without FH. The mortality rate of patients with FH was 64 %, much higher than the 5 % rate of those without FH. Moreover, the patients with FH showed more trouble in daily living than those without FH. CT scans of patients with FH usually showed severe subarachnoid hemorrhage (SAH), whereas those of patients without FH showed only mild hemorrhage. These findings suggest that fundal hemorrhage is caused by acute intracranial hypertension following subarachnoid hemorrhage due to a ruptured cerebral aneurysm. However, no significant correlation between the laterality of FH and the hemispheric dominancy of SAH could be demonstrated. (author)

  3. Treatment of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms by neurosurgeons in Colombia: A survey

    Science.gov (United States)

    Alcalá-Cerra, Gabriel; Gutiérrez Paternina, Juan J.; Buendía de Ávila, María E.; Preciado Mesa, Edgar I.; Barrios, Rubén Sabogal; Niño-Hernández, Lucía M.; Jaramillo, Keith Suárez

    2011-01-01

    Background: Trends in management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms among neurosurgeons is very variable and had not been previously described in any Latin American country. This study was conducted to determine the preferences of Colombian neurosurgeons in pharmacologic, surgical, and endovascular management of patients with aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms. Methods: A survey-based descriptive study was performed in a sample of members from the Colombian Association of Neurosurgery. Questions about pharmacologic, surgical, and endovascular management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysm were carried out. We calculated the mean and the standard deviation of the results obtained from the continuous variables. The results of the categorical variables are presented as percentages. Results: The preference of medication with poor clinical evidence, such as magnesium sulfate, aspirin, statins, and anti-fibrinolytics was lower than 10%. The use of intravenous nimodipine and systemic glucocorticoids was as high as 31%. The availability of endovascular therapy was 69%. The indication for treatment of patients with unruptured intracranial aneurysms that required intervention was less than 13.8%. In patients with ruptured or unruptured intracranial aneurysms, coiling was the preferred method for exclusion. Conclusions: Reported compliance of evidence-based clinical guidelines was similar to that described in developed countries, and even better. However, there is little agreement in treating patients with unruptured intracranial aneurysms. For other issues, the conducts reported by Colombian neurosurgeons are in accordance with the current guidelines. PMID:22059120

  4. 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.

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

    OpenAIRE

    Ibrahim, Fayaz; Viswanathan, Ramaswamy

    2012-01-01

    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...

  6. [Wegener granulomatosis and aneurysmal subarachnoid hemorrhage: an insignificant association?].

    Science.gov (United States)

    Marnet, D; Ginguené, C; Marcos, A; Cahen, R; Mac Gregor, B; Turjman, F; Vallée, B

    2010-08-01

    Wegener granulomatosis (WG) is an uncommon systemic necrotizing vasculitis that demonstrates renal and respiratory tropism. While the pathogenesis of WG remains controversial, autoimmune and inflammatory mechanisms are likely to be involved. The nervous system could be affected in up to 54% of cases. Although central nervous system involvement has been reported in 7-11% of cases, aneurysmal subarachnoid hemorrhage (SAH) occurrence is exceptional. We describe the third reported case of WG-related aneurysmal SAH and then discuss the diagnosis and pathogenesis of WG along with the physiopathology of intracranial aneurysm in light of recent data reported in the literature. A 63-year-old woman with WG was referred to our neurosurgical department for aneurysmal SAH. The vasculitis diagnosis had been established 4 years earlier when she presented with chronic sinusitis, recurrent cystitis, and renal failure. The cerebral angiography revealed an anterior communicating artery dysplastic aneurysm. The neurosurgical management of the aneurysm was scheduled but delayed because the patient was experiencing a vasculitis flare-up. Immunosuppressive therapy and intravenous corticotherapy were given, with the patient's improvement, allowing neurosurgical clipping of the aneurysm. Wegener granulomatosis-related aneurysmal SAH is an exceptional condition in neurovascular pathology. As inflammatory mechanisms are involved in the pathogenesis of aneurysm, the vasculitis flare-up could account for this SAH. The management of WG could benefit from anti-inflammatory therapy, as could the vasculitis-related SAH. SAH occurrence in patients with systemic vasculitis could indicate a vasculitis flare-up. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

  7. 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.

  8. 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 from

  9. 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

    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

  10. 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

  11. 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.)

  12. 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

    OBJECT: The calcium antagonist nimodipine has been shown to reduce the incidence of ischemic complications following aneurysmal subarachnoid hemorrhage (SAH). Although most randomized studies have been focused on the effect of the peroral administration of nimodipine, intravenous infusion...

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

    OpenAIRE

    Lo, Benjamin W. Y.; Macdonald, R. Loch; Baker, Andrew; Levine, Mitchell A. H.

    2013-01-01

    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 gene...

  14. Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage

    Science.gov (United States)

    Cho, Won-Sang; Park, Sukh Que; Ko, Jun Kyeung; Kim, Dae-Won; Park, Jung Cheol; Yeon, Je Young; Chung, Seung Young; Chung, Joonho; Joo, Sung-Pil; Hwang, Gyojun; Kim, Deog Young; Chang, Won Hyuk; Choi, Kyu-Sun; Lee, Sung Ho; Sheen, Seung Hun; Kang, Hyun-Seung; Kim, Byung Moon; Bae, Hee-Joon; Oh, Chang Wan; Park, Hyeon Seon

    2018-01-01

    Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research. PMID:29526058

  15. Statins and subarachnoid hemorrhage in Medicare patients with unruptured cerebral aneurysms.

    Science.gov (United States)

    Bekelis, Kimon; Smith, Jeremy; Zhou, Weiping; MacKenzie, Todd A; Roberts, David W; Skinner, Jonathan; Morden, Nancy E

    2015-10-01

    Statins have been shown to decrease aneurysm progression and rupture in two experimental settings: animals with cerebral aneurysm and humans with abdominal aortic aneurysms. To investigate statin use and outcomes in humans with unruptured cerebral aneurysms through Medicare administrative data. We used a 40% random sample Medicare denominator file and corresponding inpatient, outpatient (2003-2011), and prescription (2006-2011) claims to conduct a retrospective cohort study of patients diagnosed with unruptured cerebral aneurysms, between 2003 and 2011. We used propensity score-adjusted models to investigate the association between statin use and risk of subarachnoid hemorrhage. Secondary analyses repeated the main models stratified on tobacco use status and separately assessed other composite outcomes. We identified 28 931 patients with unruptured cerebral aneurysms (average age 72·0 years, 72·6% female); mean follow-up was 30·0 months; 41·3% used statins. Overall, 593 patients developed subarachnoid hemorrhage, and 703 underwent treatment before subarachnoid hemorrhage. Current or recent statin use was not associated with a difference in subarachnoid hemorrhage risk (odds ratio, 1·03; 95% conflict of interest 0·86-1·23); models stratified on tobacco use status were nearly identical. No association was observed between statin use and the composite outcome of subarachnoid hemorrhage or aneurysm treatment (odds ratio, 0·94; 95% conflict of interest, 0·84-1·06). The risk of subarachnoid hemorrhage or out-of-hospital death was lower among statin users (odds ratio, 0·69; 95% conflict of interest, 0·64-0·74). Statin use by patients with unruptured cerebral aneurysms was not associated with subarachnoid hemorrhage risk. Given the prior animal experimental studies demonstrating a protective effect, further prospective studies are needed to investigate the potential relationship. © 2015 World Stroke Organization.

  16. Circadian variation in ictus of aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Temes, Richard E; Bleck, Thomas; Dugar, Siddharth; Ouyang, Bichun; Mohammad, Yousef; John, Sayona; Patel, Pratik; Lee, Vivien; Prabhakaran, Shyam; Quigg, Mark

    2012-04-01

    Temporal patterns in aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into modulation, and therefore, prevention of hemorrhage. We investigated the time of hemorrhage and its relationship to traditional risk factors among patients admitted with aSAH. Admitted patients with aSAH were prospectively followed through outcomes and baseline demographics were abstracted through chart review. The group temporal distribution by hour of onset was summarized with cosinor nonlinear least squares. aSAH onset was gathered into night (2300-0500), morning (0500-1100), afternoon (1100-1700), and evening (0500-2300) daily phases. The odds ratio (OR) with 95% CI was calculated for having an aSAH during the morning, afternoon, and evening hours using night as a reference. Multinomial logit models were fitted using aSAH cases across time blocks to determine their associations with different risk factors. 202 patients had the hour of hemorrhage available, and 49 had phase identifiable [total 251: 38 (15%) night, 98 (39%) morning, 58 (23%) afternoon, 57 (23%) evening]. The peak hours of aSAH were between 0700 and 0800 representing 13% of the sample, with a significant cosinor-fitted phase of 7.33(95% CI 5.30, 9.36). For all aSAH cases, morning onset was significantly more common than night onset (OR = 2.58, 95% CI = 1.77-3.75). Nonsmokers were more likely to have aSAH in the morning than smokers (P = 0.043, OR = 3.10, 95% CI = 1.33-7.23). aSAH occur in a diurnal, morning prevalent pattern regardless of traditional aSAH risk factors. The association of these risk factors with existing onset patterns should be investigated in future studies.

  17. Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Rumalla, Kavelin; Reddy, Adithi Y; Mittal, Manoj K

    2016-02-01

    Our objective was to evaluate the effect of cannabis use on hospitalizations for aneurysmal subarachnoid hemorrhage (aSAH). The Nationwide Inpatient Sample (2004-2011) was used to identify all patients (age 15-54) with a primary diagnosis of aSAH (International Classification of Diseases, Ninth Edition, Clinical Modification 430). We identified patients testing positive for cannabis use using all available diagnosis fields. The incidence and characteristics of aSAH hospitalizations among cannabis users were examined. Bivariate and multivariate analyses were performed to determine the effect of cannabis use on aSAH and in-hospital outcomes. Prior to adjustment, the incidence of aSAH in the cannabis cohort was slightly increased relative to the noncannabis cohort (relative risk: 1.07, 95% confidence interval [CI]: 1.02-1.11). Cannabis use in aSAH was more frequent among younger patients (40.44 ± 10.17 versus 43.74 ± 8.68, P recreational marijuana use is independently associated with an 18% increased likelihood of aSAH. Further case-control studies may analyze inpatient outcomes and other understudied mechanisms behind cannabis-associated stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Therapeutic indications for aneurysmal subarachnoid hemorrhage in aged people

    International Nuclear Information System (INIS)

    Uehara, Hisao; Kawasoe, Takuma; Miyata, Shiro; Nakano, Shinichi; Wakisaka, Shinichiro; Fujime, Kenichi; Ohta, Hajime; Arikawa, Shoji

    2004-01-01

    We assessed the therapeutic indications for aneurysmal subarachnoid hemorrhage (SAH) in aged people. Between April 1999 and March 2002, 142 patients with aneurysmal SAH were treated and enrolled in this study. They were divided into 3 groups: 33 patients 75 years old and older (Group A, 23.2%), 37 between 65 and 74 years old (Group B, 26.1%), and 72 64 years old and younger (Group C, 47.4). Hunt and Kosnik grades, Fisher's CT classifications and clinical outcome were evaluated in each group. Clinical outcome was measured by Glasgow Outcome Scale, and good recovery and moderately disabled were defined as favorable outcome. Group A had a significantly higher incidence of serious Hunt and Kosnik grades of patients compared with the other 2 groups (p<0.05, <0.01). Fisher's CT classification was also more severe in Group A than Group C (p<0.05). Therefore the rate of radical treatments was significantly lower in Group A (45.5%) compared with Group B (73.0%) and C (86.1%). Only 4 of the 33 patients (12.1%) with favorable outcome were in Group A, whereas the rates of favorable outcome in Group B and C were 54.1 and 62.5%, respectively. Group A had a significantly poor outcome compared with the other 2 groups. Particularly, none of the patients in Group A with Hunt and Kosnik Grades 4-5 and Fisher's Classification 4 had favorable outcome. Since there were no significant differences in the rate of radical treatments and clinical outcome between Group B and C, aged people 74 years old and younger should be actively treated in the same manner as the young. In aged people 75 years old and older, however, radical treatment should be restricted to those with Hunt and Kosnik Grade 1-3 and Fisher's CT Classification 2-3. (author)

  19. 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

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

    NARCIS (Netherlands)

    Vergouwen, M.D.I.

    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

  1. Genes influencing coagulation and the risk of aneurysmal subarachnoid hemorrhage, and subsequent complications of secondary cerebral ischemia and rebleeding

    NARCIS (Netherlands)

    Ruigrok, Ynte M.; Slooter, Arjen J. C.; Rinkel, Gabriel J. E.; Wijmenga, Cisca; Rosendaal, Frits R.

    We investigated whether genes influencing coagulation are associated with the occurrence of aneurysmal subarachnoid hemorrhage (SAH) and with secondary cerebral ischemia and rebleeding in patients with aneurysmal SAH. Genotyping for factor V Leiden (G1691A), prothrombin G20210A,

  2. Influence of ABO blood type on the outcome after non-aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Dubinski, Daniel; Won, Sae-Yeon; Behmanesh, Bedjan; Kashefiolasl, Sepide; Geisen, Christof; Seifert, Volker; Senft, Christian; Konczalla, Juergen

    2018-04-01

    In patients with non-aneurysmal subarachnoid hemorrhage (NA-SAH), the etiology is unknown and the bleeding source remains unidentified. However, the ABO blood type system has a profound role in patient's hemostasis and thrombosis. To date, the aspect of ABO blood type in incidence, clinical course, and outcome after NA-SAH has not been investigated. In this retrospective analysis, 81 patients with non-traumatic and non-aneurysmal subarachnoid hemorrhage treated between 2010 and 2014 at the author's institution were included. WFNS admission status, cerebral vasospasm, delayed infarction, ventriculoperitoneal shunt necessity, the Fisher grade, and the modified Rankin Scale were analyzed for their association with ABO blood type. Four hundred seventy patients with aneurysmal subarachnoid hemorrhage served as a control group. The AB blood type is more frequent in NA-SAH compared to aneurysmal patients and the German population (OR 2.45, p ≤ 0.05). Furthermore, NA-SAH with AB blood type showed a similar sequelae compared to aneurysmal patients in terms of shunt necessity (OR 2.00, p ≥ 0.05), cerebral vasospasm (OR 1.66, p ≥ 0.05), and delayed infarctions (OR 1.07, p ≥ 0.05). The clinical course of NA-SAH AB blood type patients shows similar severity as of aneurysmal subarachnoid hemorrhage. Therefore, patients with AB blood type should be under intensified observation.

  3. Lumbosacral Subdural Hematoma and Concomitant Acute Lower Extremity Monoparesis After Intracranial Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Choi, Dae Han; Kim, Myeong Jin; Yoo, Chan Jong; Park, Cheol Wan

    2016-11-01

    Spinal subdural hematoma (SDH) secondary to intracranial aneurysmal subarachnoid hemorrhage (SAH) occurs rarely and can cause neurologic deficits. A 52-year-old man was diagnosed with SAH caused by rupture of an anterior communicating artery aneurysm. The aneurysm was treated by coil embolization on the day of admission. After embolization, the patient's left lower extremity strength had decreased and a spinal magnetic resonance imaging showed subarachnoid hematoma and SDH with severe thecal sac compression at L4-S2. On postbleed day 6, L4-S1 laminectomy was performed, and the strength in all muscle of the left leg improved. Rupture of an intracranial aneurysm may cause symptomatic SDH in the lumbosacral spine as well as subarachnoid hematoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 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

  5. 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.

    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

  6. 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, Joannes; 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

  7. Magnesium sulfate for aneurysmal subarachnoid hemorrhage: the end of the road or more trials?

    NARCIS (Netherlands)

    Vergouwen, Mervyn D. I.

    2011-01-01

    Delayed cerebral ischemia (DCI) is a feared complication and an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). In the current study, Wong and colleagues performed a systematic review and meta-analysis of randomized controlled trials that investigated the efficacy of

  8. Magnesium in aneurysmal subarachnoid hemorrhage (MASH II) phase III clinical trial MASH-II study group

    NARCIS (Netherlands)

    Dorhout Mees, Sanne M.; van den Bergh, W. M.; Rinkel, G. J. E.; Algra, M. D.; van Buuren, M.; Al-Shahi Salman, R.; Brekelmans, G. J. F.; Dirven, C. M. F.; van Gijn, J.; van Kooten, F.; Lavados, P. M.; van Oostenbrugge, R. J.; Vandertop, W. P.; van der Bom, J. G.; Mali, W. P. Th M.; Rothwell, P. M.; Kerr, R. S. C.

    2008-01-01

    RATIONALE: Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Magnesium is a neuroprotective agent that acts as an NMDA-receptor antagonist and a calcium channel blocker. In a phase II randomized clinical trial of 283 patients,

  9. 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...

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

    NARCIS (Netherlands)

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

    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

  11. Association of Automatically Quantified Total Blood Volume after Aneurysmal Subarachnoid Hemorrhage with Delayed Cerebral Ischemia

    NARCIS (Netherlands)

    Zijlstra, I. A.; Gathier, C. S.; Boers, A. M.; Marquering, H. A.; Slooter, A. J.; Velthuis, B. K.; Coert, B. A.; Verbaan, D.; van den Berg, R.; Rinkel, G. J.; Majoie, C. B.

    2016-01-01

    The total amount of extravasated blood after aneurysmal subarachnoid hemorrhage, assessed with semiquantitative methods such as the modified Fisher and Hijdra scales, is known to be a predictor of delayed cerebral ischemia. However, prediction rates of delayed cerebral ischemia are moderate, which

  12. Randomized controlled trial of acetylsalicylic acid in aneurysmal subarachnoid hemorrhage: the MASH Study

    NARCIS (Netherlands)

    van den Bergh, Walter M.; Algra, A.; Dorhout Mees, S. M.; van Kooten, F.; Dirven, C. M. F.; van Gijn, J.; Vermeulen, M.; Rinkel, G. J. E.

    2006-01-01

    BACKGROUND AND PURPOSE: A previous systematic review of randomized trials suggested a positive effect of antiplatelet therapy in patients with aneurysmal subarachnoid hemorrhage (SAH). We performed a randomized controlled trial to assess whether acetylsalicylic acid (ASA) reduces the risk of delayed

  13. Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage : A Randomized Clinical Trial

    NARCIS (Netherlands)

    Gathier, Celine S|info:eu-repo/dai/nl/345480392; Dankbaar, Jan Willem|info:eu-repo/dai/nl/314079408; van der Jagt, Mathieu; Verweij, Bon H|info:eu-repo/dai/nl/311491774; Oldenbeuving, Annemarie W; Rinkel, Gabriel J E|info:eu-repo/dai/nl/085712000; van den Bergh, Walter M|info:eu-repo/dai/nl/272886157; Slooter, Arjen J C|info:eu-repo/dai/nl/173059740; Kesecioglu, J|info:eu-repo/dai/nl/124832792

    2015-01-01

    BACKGROUND AND PURPOSE: The presumed effectiveness of induced hypertension for treating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is based on uncontrolled case-series only. We assessed the effect of induced hypertension on cerebral blood flow (CBF) in aneurysmal subarachnoid

  14. Subarachnoid Hemorrhage

    Science.gov (United States)

    ... All Cerebrovascular disease/Stroke http: / / n. neurology. org/ / cgi/ collection/ all_ cerebrovascular_ disease_ stro ke Arteriovenous malformation http: / / n. neurology. org/ / cgi/ collection/ arteriovenous_ malformation Subarachnoid hemorrhage http: / / n. neurology. ...

  15. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

    Science.gov (United States)

    Budohoski, Karol; Smith, Christopher; Hutchinson, Peter J.; Kirkpatrick, Peter J.

    2015-01-01

    BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome. METHODS: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome. RESULTS: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade. CONCLUSION: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome. ABBREVIATIONS: ALP, alkaline phosphatase ALT, alanine aminotransferase CK, creatine kinase CRP, C-reactive protein EVD, external ventricular drainage ICH GCP, International Conference on Harmonisation guidelines for good clinical practice mRS, modified Rankin Scale SAH, subarachnoid hemorrhage STASH, Simvastatin in

  16. Experience of 3D-TOF MR angiography for subarachnoid hemorrhage and non-ruptured aneurysms

    International Nuclear Information System (INIS)

    Suga, Toshihiro; Uchida, Keita; Goto, Hideo; Sano, Mitsuhiko

    1995-01-01

    Three-dimensional time-of-flight MR angiography (3D-TOF MRA) with 1.0 T MRI was performed on ten patients with subarachnoid hemorrhage or with non-ruptured cerebral aneurysms. 3D-TOF MRA was evaluated with respect to its efficiency in detecting aneurysms, circumferential vessels, vasospasms and combined vascular lesions. All seven cerebral aneurysms that were detected by cerebral angiography, were demonstrable by 3D-TOF MRA. The diameter of the smallest aneurysm was approximately 2.5 mm. A very small aneurysm that appeared suspicious by MRA, but could not be demonstrated by cerebral angiography was confirmed at surgery. The detection of circumferential arteries was satisfactory in one middle cerebral artery aneurysm, but small vessels could not be identified in other aneurysms. Vasospasms were detected in two cases. MRA was sensitive for detecting vasospasms, but the precise examination was difficult because of high intensity signal in subacute hematomas. MRA was excellent in detecting other combined vascular lesions. This study demonstrates that 3D-TOF MRA represents a valuable examination modality of detecting aneurysms, spasms and combined vascular lesions. We do believe that 3D TOF MRA should be considered as an efficient tool before cerebral angiography, even in the acute phase of subarachnoid hemorrhages. (author)

  17. Sex-related differences in patients treated surgically for aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Horiuchi, Tetsuyoshi; Tanaka, Yuichiro; Hongo, Kazuhiro

    2006-01-01

    Sex-related differences were examined in the clinical course of patients treated surgically for aneurysmal subarachnoid hemorrhage. Retrospective analyses were carried out to evaluate sex-related differences in aneurysm location, aneurysm size, preoperative neurological condition, preoperative computed tomography findings, and outcome among 2577 patients who underwent surgical repair of ruptured aneurysms. The internal carotid artery was most frequently affected in women and the anterior cerebral artery in men. Intracerebral or intraventricular hematoma was more common in men than in women. Some differences may be related to the location of the aneurysm. Sex-related differences were prominent in the 5th decade of life. These findings might be related to the menopause. Sex hormones may be involved in aneurysm formation. (author)

  18. Pre-hemorrhage statin use and the risk of vasospasm following aneurysmal subarachnoid hemorrhage

    Science.gov (United States)

    Moskowitz, Shaye I.; Ahrens, Christine; Provencio, J Javier; Chow, Michael; Rasmussen, Peter A

    2010-01-01

    Background and Purpose Aneurysmal subarachnoid hemorrhage (SAH) is often followed by delayed ischemic deficits attributable to cerebral vasospasm. Recent studies suggest a positive impact of statin therapy on the incidence of vasospasm. This study was designed to assess whether a history of prior use of statin therapy was associated with a lower risk of vasospasm in patients with SAH. Methods We performed a comprehensive retrospective review of patients with aneurysmal SAH between 1997 and 2004. Clinical demographics and imaging data for all patients were reviewed and a logistic regression analysis was performed to identify the predictors of cerebral vasospasm, defined as a combination of clinical signs with radiographic confirmation. Results 308 patients were included. Mean age was higher in the group receiving statins (64 +/- 12 versus 54+/- 12 years). Hunt and Hess scores and treatment modality were not significantly different between the groups. Vasospasm was observed in 31% of patients not taking a statin (n=282) versus 23% taking a statin (n=26), without achieving statistical significance. Discontinuation of the statin did not affect risk of vasospasm. Conclusions Use of a statin prior to an aneurysmal SAH trended to reduce the incidence of subsequent vasospasm, without achieving statistical significance. PMID:18423529

  19. Clinical outcome prediction in aneurysmal subarachnoid hemorrhage using Bayesian neural networks with fuzzy logic inferences.

    Science.gov (United States)

    Lo, Benjamin W Y; Macdonald, R Loch; Baker, Andrew; Levine, Mitchell A H

    2013-01-01

    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). 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). 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. This aSAH prognostic system makes use of existing knowledge, recognizes unknown areas, incorporates one's clinical reasoning, and compensates for uncertainty in prognostication.

  20. 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.

  1. Results of Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage in Elderly Patients Aged 90 or Older.

    Science.gov (United States)

    Suzuki, Yota; Watanabe, Atsushi; Wakui, Kenji; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2016-01-01

    The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing. Although advanced age is one of the recognized risk factors for poor outcome, conservative treatment for aneurysmal subarachnoid hemorrhage cannot provide satisfactory outcome in elderly patients. The aim of this study is to assess the outcome in patients aged 90 or older, for whom ruptured aneurysms were treated by clipping. We retrospectively reviewed the medical records of non-traumatic SAH patients who were hospitalized at the Chiba Neurosurgical Clinic between 2004 and 2013. Of the 702 patients, 8 patients (1.1 %) were aged 90 or older. Of them, four underwent clipping surgery and the other four died or were managed conservatively. Their preoperative conditions were evaluated with the World Federation of Neurosurgical Societies Grading Scale of SAH, and the Fisher classification was used to assess the bleeding severity. The location of the ruptured aneurysm was determined by three-dimensional computed tomographic angiography or cerebral angiography. The Glasgow Outcome Scale evaluation was assigned at discharge. Four patients (four female, all WFNS grade 1), aged 90 or older, underwent clipping surgery. Fisher classification was three in two patients and four in the other two. Location of the ruptured aneurysm was internal carotid artery in two, anterior communicating artery in one, and posterior inferior cerebellar artery in one patient. Two of these four patients had a favorable outcome. We propose that advanced age alone does not exclude suitable surgical clipping in patients with aneurysmal rupture in the tenth decade of life.

  2. Monthly variations in aneurysmal subarachnoid hemorrhage incidence and mortality: Correlation with weather and pollution.

    Directory of Open Access Journals (Sweden)

    Myung-Hoon Han

    Full Text Available Although the effect of weather and air pollution on the occurrence of subarachnoid hemorrhage (SAH has been investigated, results have remained inconsistent. The present study aimed to determine the seasonality of aneurysmal subarachnoid hemorrhage occurrence and mortality.We used the National Inpatient Sample database to evaluate the effect of meteorological factors and air pollutants on patients with subarachnoid hemorrhage in Korea between 2011 and 2014. Monthly variations in SAH occurrence and mortality were analyzed using locally weighted scatter plot smoothing curves. Multivariate Poisson generalized linear regression models were used to evaluate potential independent meteorological and pollutant variables associated with SAH occurrence and mortality.In total, 21,407 patients who underwent clip or coil treatment owing to aneurysmal SAH in Korea from January 1, 2011, to December 31, 2014, were included. The crude incidence rate of SAH in Korea was 10.5 per 100,000 people per year. An approximately 0.5% lower risk of SAH was observed per 1°C increase in mean monthly temperature (relative risk, 0.995; 95% confidence interval [CI], 0.992-0.997; p < 0.001, while an approximately 2.3% higher risk of SAH was observed per 1°C increase in mean monthly diurnal temperature.We showed distinct patterns of seasonal and monthly variation in the occurrence and mortality of SAH. Our findings suggest that meteorological factors may play an important role in monthly variations in the occurrence of aneurysmal SAH.

  3. 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.

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

    Science.gov (United States)

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

    2015-07-01

    Nosocomial 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 strategies can be designed to reduce infections after aneurysmal subarachnoid hemorrhage, more data are needed on time course and causative pathogens of infections. To investigate the time course of infection onset and bacterial microorganisms that cause nosocomial infections after aSAH. In consecutive patients with aneurysmal subarachnoid hemorrhage admitted to the University Medical Center Utrecht between 2009 and 2011, we analyzed the proportion of patients with infections, day of infection onset, and culture results. Of the 291 included patients, 107 (37%) patients developed 115 nosocomial infections. Fifty-six patients (19%) developed an infection within the first week. Median day of infection onset was for pneumonia (n = 49; 17%) day 4 (interquartile range 3-9), respiratory tract infection (n = 16; 6%) day 4 (interquartile range 1-7), urinary tract infection (n = 27; 9%) day 11 (interquartile range 7-14), and meningitis/ventriculitis (n = 10; 3%) day 19 (interquartile range 9-33). Cultures of infections mostly yielded Staphylococcus aureus (20%), Haemophilus influenzae (15%), and Escherichia coli (14%), Nosocomial infections after subarachnoid hemorrhage are common and mostly occur in the first week after ictus. Future studies should investigate if general hygienic measures, infection awareness, minimizing the duration of mechanical ventilation and use of catheters/drains, or prophylactic antibiotics reduce infections and improve functional outcome. © 2015 World Stroke Organization.

  5. Toward understanding non-coding RNA roles in intracranial aneurysms and subarachnoid hemorrhage

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    Huang Fengzhen

    2017-05-01

    Full Text Available Subarachnoid hemorrhage (SAH is a common and frequently life-threatening cerebrovascular disease, which is mostly related with a ruptured intracranial aneurysm. Its complications include rebleeding, early brain injury, cerebral vasospasm, delayed cerebral ischemia, chronic hydrocephalus, and also non neurological problems. Non-coding RNAs (ncRNAs, comprising of microRNAs (miRNAs, small interfering RNAs (siRNAs and long non-coding RNAs (lncRNAs, play an important role in intracranial aneurysms and SAH. Here, we review the non-coding RNAs expression profile and their related mechanisms in intracranial aneurysms and SAH. Moreover, we suggest that these non-coding RNAs function as novel molecular biomarkers to predict intracranial aneurysms and SAH, and may yield new therapies after SAH in the future.

  6. 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.

  7. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

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    Takamasa Nanba

    2016-01-01

    Full Text Available Although posterior reversible encephalopathy syndrome (PRES is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features.

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

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    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.)

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

    Science.gov (United States)

    Falter, Bernhard; Wiesmann, Martin; Freiherr, Jessica; Nikoubashman, Omid; Mull, Michael

    2015-10-01

    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.

  10. Aneurysmal subarachnoid hemorrhage in patients taking direct oral anticoagulants: A case series and discussion of management

    Directory of Open Access Journals (Sweden)

    Joseph H. McMordie, MD

    2018-03-01

    Full Text Available Direct oral anticoagulants are becoming more commonplace for the treatment of nonvalvular atrial fibrillation and deep vein thrombosis. Unfortunately, effective reversal agents are not widely available limiting options for neurosurgical intervention during active anticoagulation. We report a case series of 3 patients treated for aneurysmal subarachnoid hemorrhage while taking direct oral anticoagulants. All three underwent open surgical clipping after adequate time was allowed for drug metabolism. Decision-making must take into account timing of intervention, drug half-life, and currently available reversal agents.

  11. Type A interrupted aortic arch accompanied by intracranial aneurysms causing subarachnoid hemorrhage in an adult man.

    Science.gov (United States)

    Eren, Suat; Kantarci, Mecit; Pirimoglu, Berhan; Cakir, Murteza; Ogul, Hayri

    2014-01-01

    Interrupted aortic arch anomaly (IAA) characterized by complete luminal dissociation between the ascending and descending aorta and accounting for less than 1% of all cases of congenital heart disease. IAA is a rare condition in infants that occurs approximately three times per million births. It is usually diagnosed and repaired during the neonatal period and is extremely rare in adults. We present the case of an adult man who was diagnosed with IAA accompanied by intracranial aneurysms causing subarachnoid hemorrhage and demonstrate the imaging findings with 256-slice computed tomography angiography and digital subtraction angiography. Copyright © 2014. Published by Elsevier Inc.

  12. Endovascular Treatment for Aneurysmal Subarachnoid Hemorrhage with Neurogenic Pulmonary Edema in the Acute Stage.

    Science.gov (United States)

    Meguro, Toshinari; Tanabe, Tomoyuki; Muraoka, Kenichiro; Terada, Kinya; Hirotsune, Nobuyuki; Nishino, Shigeki

    2016-01-01

    Severe neurogenic pulmonary edema (NPE) can occur in a variety of brain insults, including subarachnoid hemorrhage (SAH), and severe case of NPE can cause devastating consequences. But the literature on the treatment strategy about aneurysmal SAH with NPE is very scant. We present that SAH patients with severe NPE, who were treated first by embolization of aneurysm followed by insertion of lumbar spinal drainage, had comparatively good outcome. We present 12 consecutive cases of aneurysmal SAH with NPE in the acute stage, which were treated by endovascular treatment between April 2002 and December 2012. We classified the patients according to the Hunt and Hess grading system as follows: grade-3 (1 patient), grade-4 (4 patients), and grade-5 (7 patients). All patients needed respiratory management, with the assistance of a ventilator, and underwent endovascular treatment for the ruptured aneurysms within 72 hours from onset. For all the patients, immediately after the endovascular treatment, we performed lumbar spinal drainage. The pulmonary edema disappeared rapidly after respiratory management and endovascular treatment. The outcomes were as follows: good recovery (GR; 3 patients), moderate disability (MD; 4 patients), severe disability (SD; 3 patients), and death (D; 2 patients). Five patients (42%) developed pneumonia, and we postponed extubation until recovery from pneumonia. The cause for severe disability and death was symptomatic vasospasm and primary brain damage. No patients had rebleeding from ruptured aneurysms. Endovascular treatment for ruptured aneurysm and placement of lumbar spinal drainage is an excellent treatment option for severe SAH with NPE.

  13. Cerebral vasospasm patterns following aneurysmal subarachnoid hemorrhage: an angiographic study comparing coils with clips.

    Science.gov (United States)

    Jones, J; Sayre, J; Chang, R; Tian, J; Szeder, V; Gonzalez, N; Jahan, R; Vinuela, F; Duckwiler, G; Tateshima, S

    2015-11-01

    Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) results in significant morbidity due to ischemia. Subarachnoid hematoma evacuation during aneurysm clipping reduces the incidence of vasospasm. However, studies comparing endovascular coiling with open clipping have reported similar rates of spasm. We addressed the question of how coiling produces similar (if not less) vasospasm without the benefit of clot evacuation by evaluating vasospasm patterns among patients with aSAH. We hypothesize that cerebrospinal fluid (CSF) circulation plays a major role in clearing blood breakdown products, and that coiling may preserve CSF flow in the subarachnoid space. A retrospective chart review identified 36 (18 coiled/18 clipped) patients with aSAH who developed angiographic vasospasm. The degree of spasm was quantified using an ordinal scale from 0 (none) to 5 (severe) for 26 anatomic vessel segments evaluated on 164 successive angiograms. Statistical analysis was performed using the Fisher exact test for proportions and the Wilcoxon and Student t tests on ordinal/continuous measures. Quadratic regression was also used as a model for spasm activity versus post-bleed days. In both the coiling and clipping groups the most severely spastic vessels were located adjacent to aneurysm rupture. Perianeurysmal spasm affected all subjects. However, whereas spasm remained largely confined in patients treated by clipping, those who underwent coiling developed stepwise progression distally over time. The distal vasospasm severity scores were higher among subjects treated by coiling, particularly in the most dependent regions of the subarachnoid space. Patients with aSAH treated by endovascular coiling and surgical clipping demonstrate distinct vasospasm patterns. While both initially exhibit perianeurysmal spasm, patients treated by coiling go on to develop stepwise progression distally over time. This finding may reflect dispersion of blood breakdown products along

  14. Attention deficits after aneurysmal subarachnoid hemorrhage measured using the test of variables of attention.

    Science.gov (United States)

    Wallmark, Svante; Lundström, Erik; Wikström, Johan; Ronne-Engström, Elisabeth

    2015-05-01

    The aim of this pilot study was to assess attention deficits in patients with aneurysmal subarachnoid hemorrhage using the test of variables of attention (TOVA). This is a computer-based continuous performance test providing objective measures of attention. We also compared the TOVA results with the attention and concentration domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment, 2 examiner-administrated neuropsychological instruments. Nineteen patients with moderate to good recovery (Glasgow outcome scale, 4-5) were assessed using the TOVA, Montgomery Åsberg Depression Rating Scale, and Montreal cognitive assessment. The measurements were done when the patients visited the hospital for a routine magnetic resonance imaging control of the aneurysm. TOVA performance was pathological in 58%. The dominating pattern was a worsening of performance in the second half of the test, commonly a failing to react to correct stimuli. We found no correlation between TOVA and the performance in concentration and attention domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment. Attention deficits, measured by the TOVA, were common after subarachnoid hemorrhage. This should be further studied to improve outcome. © 2015 American Heart Association, Inc.

  15. Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage.

    Science.gov (United States)

    Burkhardt, Jan-Karl; Neidert, Marian Christoph; Stienen, Martin Nikolaus; Schöni, Daniel; Fung, Christian; Roethlisberger, Michel; Corniola, Marco Vincenzo; Bervini, David; Maduri, Rodolfo; Valsecchi, Daniele; Tok, Sina; Schatlo, Bawarjan; Bijlenga, Philippe; Schaller, Karl; Bozinov, Oliver; Regli, Luca

    2017-07-01

    To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS). A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU. In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative a

  16. Loss of Consciousness at Onset of Aneurysmal Subarachnoid Hemorrhage is Associated with Functional Outcomes in Good-Grade Patients

    NARCIS (Netherlands)

    Wang, Justin; Alotaibi, Naif M.; Akbar, Muhammad Ali; Ayling, Oliver G S; Ibrahim, George M.; Macdonald, R. Loch; Noble, Adam; Molyneux, Andrew; Quinn, Audrey; Schatlo, Bawarjan; Lo, Benjamin; Jaja, Blessing N R; Johnston, Clay; Hanggi, Daniel; Hasan, David; Wong, George K C; Lantigua, Hector; Fukuda, Hitoshi; Torner, James; Singh, Jeff; Spears, Julian; Schaller, Karl; Stienen, Martin N.; Vergouwen, Mervyn D I|info:eu-repo/dai/nl/320630544; Cusimano, Michael D.; Todd, Michael; Tseng, Ming; Le Roux, Peter; Macdonald, R. Loch; Yamagata, Sen; Mayer, Stephan; Schenk, Thomas; Schweizer, Tom A.

    2017-01-01

    Background Transient loss of consciousness (LOC) is one of the most common presentations of aneurysmal subarachnoid hemorrhage (SAH) and may be an indicator of early brain injury. In this study, we examined the association of LOC and functional outcomes in patients with good-grade SAH. Methods We

  17. A Preliminary Observational Study of Anovulatory Uterine Bleeding After Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Brown, Suzanne M; Fifield, Susan W; Pizzi, Michael A; Alejos, David; Richie, Alexa N; Dinh, Tri A; Cheshire, William P; Meek, Shon E; Freeman, William D

    2017-12-01

    It was observed that women with aneurysmal subarachnoid hemorrhage (aSAH) tended to have earlier menses than a typical 21- to 28-day cycle. The goal was to determine whether there is an association between aSAH and early onset of menses. All cases of aSAH in women aged 18 to 55 years who were admitted to our facility's neuroscience intensive care unit from June 1, 2011, to June 30, 2012, were reviewed. The electronic healthcare record for each of these patients was examined for documentation of menses onset, computed tomography of the head, brain aneurysm characteristics, modified Fisher score and Glasgow Coma Scale on admission, presence/absence of vasospasm, medical/surgical history, and use of medications that affect the menstrual cycle. The mean onset of menses in this study population was compared with the mean of 21 to 28 days with the 1-sample t test. During the study period, 103 patients with subarachnoid hemorrhage were admitted. Sixty-one were women, and 15 were aged 18 to 55 years. Nine of the 15 (60%) had documentation of menses occurring during their initial week of hospitalization; 1 patient had documentation of menses on hospital day 12. There is a significant difference when the mean onset of menses in our patient population is compared with the approximate normal menstrual cycle of 21 to 28 days (P abnormal uterine bleeding after SAH may occur in women with aSAH and typically within the first 7 to 10 days after intracranial aneurysm rupture. The physiologic cause of early onset of menses after aSAH, whether primary or secondary, remains unknown.

  18. 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

    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). 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. 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 tree was generated, which serves as a prediction tool to guide bedside prognostication and clinical treatment 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.

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

    International Nuclear Information System (INIS)

    Wadd, I.H.; Haroon, A.; Ansari, S.

    2015-01-01

    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

  20. Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage

    Science.gov (United States)

    2012-01-01

    Background Hydrocephalus following spontaneous aneurysmal sub-arachnoid hemorrhage (SAH) is often associated with unfavorable outcome. This study aimed to determine the potential risk factors and outcomes of shunt-dependent hydrocephalus in aneurysmal SAH patients but without hydrocephalus upon arrival at the hospital. Methods One hundred and sixty-eight aneurysmal SAH patients were evaluated. Using functional scores, those without hydrocephalus upon arrival at the hospital were compared to those already with hydrocephalus on admission, those who developed it during hospitalization, and those who did not develop it throughout their hospital stay. The Glasgow Coma Score, modified Fisher SAH grade, and World Federation of Neurosurgical Societies grade were determined at the emergency room. Therapeutic outcomes immediately after discharge and 18 months after were assessed using the Glasgow Outcome Score. Results Hydrocephalus accounted for 61.9% (104/168) of all episodes, including 82 with initial hydrocephalus on admission and 22 with subsequent hydrocephalus. Both the presence of intra-ventricular hemorrhage on admission and post-operative intra-cerebral hemorrhage were independently associated with shunt-dependent hydrocephalus in patients without hydrocephalus on admission. After a minimum 1.5 years of follow-up, the mean Glasgow outcome score was 3.33 ± 1.40 for patients with shunt-dependent hydrocephalus and 4.21 ± 1.19 for those without. Conclusions The presence of intra-ventricular hemorrhage, lower mean Glasgow Coma Scale score, and higher mean scores of the modified Fisher SAH and World Federation of Neurosurgical grading on admission imply risk of shunt-dependent hydrocephalus in patients without initial hydrocephalus. These patients have worse short- and long-term outcomes and longer hospitalization. PMID:22765765

  1. Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Wang Yi-Min

    2012-07-01

    Full Text Available Abstract Background Hydrocephalus following spontaneous aneurysmal sub-arachnoid hemorrhage (SAH is often associated with unfavorable outcome. This study aimed to determine the potential risk factors and outcomes of shunt-dependent hydrocephalus in aneurysmal SAH patients but without hydrocephalus upon arrival at the hospital. Methods One hundred and sixty-eight aneurysmal SAH patients were evaluated. Using functional scores, those without hydrocephalus upon arrival at the hospital were compared to those already with hydrocephalus on admission, those who developed it during hospitalization, and those who did not develop it throughout their hospital stay. The Glasgow Coma Score, modified Fisher SAH grade, and World Federation of Neurosurgical Societies grade were determined at the emergency room. Therapeutic outcomes immediately after discharge and 18 months after were assessed using the Glasgow Outcome Score. Results Hydrocephalus accounted for 61.9% (104/168 of all episodes, including 82 with initial hydrocephalus on admission and 22 with subsequent hydrocephalus. Both the presence of intra-ventricular hemorrhage on admission and post-operative intra-cerebral hemorrhage were independently associated with shunt-dependent hydrocephalus in patients without hydrocephalus on admission. After a minimum 1.5 years of follow-up, the mean Glasgow outcome score was 3.33 ± 1.40 for patients with shunt-dependent hydrocephalus and 4.21 ± 1.19 for those without. Conclusions The presence of intra-ventricular hemorrhage, lower mean Glasgow Coma Scale score, and higher mean scores of the modified Fisher SAH and World Federation of Neurosurgical grading on admission imply risk of shunt-dependent hydrocephalus in patients without initial hydrocephalus. These patients have worse short- and long-term outcomes and longer hospitalization.

  2. Atmospheric Pressure Variation is a Delayed Trigger for Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    van Donkelaar, Carlina E; Potgieser, Adriaan R E; Groen, Henk; Foumani, Mahrouz; Abdulrahman, Herrer; Sluijter, Rob; van Dijk, J Marc C; Groen, Rob J M

    2018-04-01

    There is an ongoing search for conditions that induce spontaneous subarachnoid hemorrhage (SAH). The seasonal pattern of SAH is shown in a large meta-analysis of the literature, but its explanation remains undecided. There is a clear need for sound meteorologic data to further elucidate the seasonal influence on SAH. Because of the stable and densely monitored atmospheric situation in the north of the Netherlands, we reviewed our unique cohort on the seasonal incidence of SAH and the association between SAH and local atmospheric changes. Our observational cohort study included 1535 patients with spontaneous SAH admitted to our neurovascular center in the north of the Netherlands between 2000 and 2015. Meteorologic data could be linked to the day of the ictus. To compare SAH incidences over the year and to test the association with meteorologic conditions, incidence rate ratios (IRRs) with corresponding 95% confidence intervals (CIs) were used, calculated by Poisson regression analyses. Atmospheric pressure variations were significantly associated with aneurysmal SAH. In particular, the pressure change on the second and third day before the ictus was independently correlated to a higher incidence of aneurysmal SAH (IRR, 1.11; 95% CI, 1.00-1.23). The IRR for aneurysmal SAH in July was calculated 0.67 (95% CI, 0.49-0.92) after adjustment for temperature and atmospheric pressure changes. Atmospheric pressure variations are a delayed trigger for aneurysmal SAH. Also, a significantly decreased incidence of aneurysmal SAH was noted in July. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

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    Bonilha Leonardo

    2001-01-01

    Full Text Available OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%, while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%. Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively. Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

  4. Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment

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    Simard, J. Marc; Aldrich, E. Francois; Schreibman, David; James, Robert F.; Polifka, Adam; Beaty, Narlin

    2015-01-01

    Object Aneurysmal subarachnoid hemorrhage (aSAH) predisposes to delayed neurological deficits, including stroke and cognitive and neuropsychological abnormalities. Heparin is a pleiotropic drug that antagonizes many of the pathophysiological mechanisms implicated in secondary brain injury after aSAH. Methods The authors performed a retrospective analysis in 86 consecutive patients with Fisher Grade 3 aSAH due to rupture of a supratentorial aneurysm who presented within 36 hours and were treated by surgical clipping within 48 hours of their ictus. Forty-three patients were managed postoperatively with a low-dose intravenous heparin infusion (Maryland low-dose intravenous heparin infusion protocol: 8 U/kg/hr progressing over 36 hours to 10 U/kg/hr) beginning 12 hours after surgery and continuing until Day 14 after the ictus. Forty-three control patients received conventional subcutaneous heparin twice daily as deep vein thrombosis prophylaxis. Results Patients in the 2 groups were balanced in terms of baseline characteristics. In the heparin group, activated partial thromboplastin times were normal to mildly elevated; no clinically significant hemorrhages or instances of heparin-induced thrombocytopenia or deep vein thrombosis were encountered. In the control group, the incidence of clinical vasospasm requiring rescue therapy (induced hypertension, selective intraarterial verapamil, and angioplasty) was 20 (47%) of 43 patients, and 9 (21%) of 43 patients experienced a delayed infarct on CT scanning. In the heparin group, the incidence of clinical vasospasm requiring rescue therapy was 9% (4 of 43, p = 0.0002), and no patient suffered a delayed infarct (p = 0.003). Conclusions In patients with Fisher Grade 3 aSAH whose aneurysm is secured, postprocedure use of a low-dose intravenous heparin infusion may be safe and beneficial. PMID:24032706

  5. Cerebrospinal Fluid and Microdialysis Cytokines in Aneurysmal Subarachnoid Hemorrhage: A Scoping Systematic Review

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    Frederick A. Zeiler

    2017-08-01

    Full Text Available ObjectiveTo perform two scoping systematic reviews of the literature on cytokine measurement in cerebral microdialysis (CMD and cerebrospinal fluid (CSF in aneurysmal subarachnoid hemorrhage (SAH patients, aiming to summarize the evidence relating cytokine levels to pathophysiology, disease progression, and outcome.MethodsTwo separate systematic reviews were conducted: one for CMD cytokines and the second for CSF cytokines.Data sourcesArticles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016, reference lists of relevant articles, and gray literature were searched.Study selectionTwo reviewers independently identified all manuscripts utilizing predefined inclusion/exclusion criteria. A two-tier filter of references was conducted.Data extractionPatient demographic and study data were extracted to tables.ResultsThere were 9 studies identified describing the analysis of cytokines via CMD in 246 aneurysmal SAH patients. Similarly, 20 studies were identified describing the analysis of CSF cytokines in 630 patients. The two scoping systematic reviews demonstrated the following: (1 limited literature available on CMD cytokine measurement in aneurysmal SAH with some preliminary data supporting feasibility of measurement and potential association between interleukin (IL-6 and patient outcome. (2 Various CSF measured cytokines may be associated with patient outcome at 3–6 months, including IL-1ra, IL-6, IL-8, and tumor necrosis factor-alpha. (3 There is a small literature body supporting an association between acute/subacute CSF transforming growth factor levels and the development of chronic hydrocephalus at 2–3 months.ConclusionThe evaluation of CMD and CSF cytokines is an emerging area of the literature in aneurysmal SAH. Further large prospective multicenter studies on cytokines in CMD and CSF need to be conducted.

  6. Irreversible Total Loss of Brain Function and Organ Donation in Patients with Aneurysmal Subarachnoid Hemorrhage.

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    Mohme, Malte; Sauvigny, Thomas; Grensemann, Jörn; Söffker, Gerold; Kluge, Stefan; Westphal, Manfred; Czorlich, Patrick

    2017-09-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with an often fatal clinical course leading to irreversible loss of brain function (ILBF) (i.e., brain death). The purpose of this study was to assess the prevalence and characteristics of patients with aSAH who became organ donors after diagnosis of ILBF. Anonymized clinical data sets of 395 patients treated for aSAH at a university medical center from January 2011 to December 2016 were retrospectively analyzed. Prevalence of consent for organ donation and clinical characteristics, including parameters for diagnosis of irreversible loss of brain function, were assessed. After initial admission to the intensive care unit, 18.0% of patients (n = 71) died (Glasgow Outcome Scale score 1). Intracerebral hemorrhage occurred in 42.3% of patients who died, aneurysmal rebleeding occurred in 19.7%, and intraventricular hemorrhage occurred in 87.3%. In 50.7% of patients who died (n = 36), ILBF was diagnosed, and 32.4% (n = 23) of these patients became organ donors. In 55.6%, additional diagnostic electroencephalography was performed. Male patients significantly more often became organ donors than female patients (P = 0.008). ILBF with subsequent organ donation was predominantly seen in patients organs were explanted for donation, including 42 kidneys, 21 livers, 3 pancreas, 11 hearts and 8 lungs. ILBF in the setting of fatal aSAH is a prevalent diagnosis with complex demands for neurointensive care physicians. We demonstrated the clinical characteristics and epidemiologic factors of patients with aSAH converting to organ donors. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    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.

  8. Troponin elevation in subarachnoid hemorrhage

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    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 neur...

  9. Language, memory, and verbal fluency changes in patients with aneurysmal subarachnoid hemorrhage: results of a preoperative investigation.

    Science.gov (United States)

    Vieira, Ana Cláudia C; Azevedo-Filho, Hildo R C; Quinino, Saul; Ponte de Souza, Moysés Loyola; Câmara, Divaldo; Leitão, Laécio; Andrade, Gustavo

    2011-01-01

    To detect changes in speech, verbal fluency, and memory in patients with subarachnoid hemorrhage (SAH) caused by ruptured aneurysms and to analyze the results before surgical or embolization procedure. During the period May 2007 to November 2009, 193 patients with anterior aneurysmal SAH admitted to the Department of Neurosurgery, Hospital da Restauração, Recife, Brazil, were tested for speech, verbal fluency, and memory disturbances after the first week of bleeding and compared with a control group with similar demographics. Patients with aneurysmal SAH differed significantly from the control group in language, verbal fluency, and memory functions before clipping or coiling procedures. There were differences in cognitive performance between patients with different aneurysm sites. It was possible to characterize the cognitive impairments of each area affected early on in the preoperative period, confirming the assumptions that the aneurysm site could be a determining factor of cognitive impairment. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage

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    Dustin G. Mark

    2015-10-01

    Full Text Available Introduction: Application of a clinical decision rule for subarachnoid hemorrhage, in combination with cranial computed tomography (CT performed within six hours of ictus (early cranial CT, may be able to reasonably exclude a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH. This study’s objective was to examine the sensitivity of both early cranial CT and a previously validated clinical decision rule among emergency department (ED patients with aSAH and a normal mental status. Methods: Patients were evaluated in the 21 EDs of an integrated health delivery system between January 2007 and June 2013. We identified by chart review a retrospective cohort of patients diagnosed with aSAH in the setting of a normal mental status and performance of early cranial CT. Variables comprising the SAH clinical decision rule (age >40, presence of neck pain or stiffness, headache onset with exertion, loss of consciousness at headache onset were abstracted from the chart and assessed for inter-rater reliability. Results: One hundred fifty-five patients with aSAH met study inclusion criteria. The sensitivity of early cranial CT was 95.5% (95% CI [90.9-98.2]. The sensitivity of the SAH clinical decision rule was also 95.5% (95% CI [90.9-98.2]. Since all false negative cases for each diagnostic modality were mutually independent, the combined use of both early cranial CT and the clinical decision rule improved sensitivity to 100% (95% CI [97.6-100.0]. Conclusion: Neither early cranial CT nor the SAH clinical decision rule demonstrated ideal sensitivity for aSAH in this retrospective cohort. However, the combination of both strategies might optimize sensitivity for this life-threatening disease.

  11. Cerebral Blood Flow Changes after Shunt in Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage: Analysis by statistical Parametric Mapping

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    Hyun, I. Y.; Choi, W. S.; Pak, H. S. [College of Medicine, Univ. of Inhwa, Incheon (Korea, Republic of)

    2003-07-01

    The purpose of this study was to evaluate the changes of regional cerebral blood flow (rCBF) after shunt operation in patients with hydrocephalus after aneurysmal subarachnoid hemorrhage ba statistical parametric mapping (SPM). Seven patients (4 male, mean age 54 years) with hydrocephalus after aneurysmal subarachnoid hemorrhage underwent a shunt operation. Tc-99m HMPAO SPECT was performed within I week before, and 2 weeks after the shunt operation. All of the SPECT images were spatially transformed to standard space, smoothed, and globally normalized. After spatial and count normalization, rCBF of pre- and post- shunting Tc- 99m HMPAO SPECT was estimated at every voxel using t statistics. The voxels with a P value of less than 0.001 were considered to be significantly different. The shunt operation was effective in all patients. Pre-shunting Tc-99m HMPAO SPECT showed hypoperfusion, predominantly in the periventricular area. After shunt operation, periventricular low perfusion was disappeared. The results of this study show that periventricular CBF is impaired in hydrocephalus after aneurysmal subarachnoid hemorrhage. Significant increase of periventricular CBF after shunt operation suggests the evaluation of periventricular CBF by SPM might be of value for the prediction of shunt effectiveness in hydrocephalus.

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

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    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.

  13. Associations of renin-angiotensin system genetic polymorphisms and clinical course after aneurysmal subarachnoid hemorrhage.

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    Griessenauer, Christoph J; Tubbs, R Shane; Foreman, Paul M; Chua, Michelle H; Vyas, Nilesh A; Lipsky, Robert H; Lin, Mingkuan; Iyer, Ramaswamy; Haridas, Rishikesh; Walters, Beverly C; Chaudry, Salman; Malieva, Aisana; Wilkins, Samantha; Harrigan, Mark R; Fisher, Winfield S; Shoja, Mohammadali M

    2017-05-01

    OBJECTIVE Renin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin Angiotensin System (CARAS) study prospectively evaluated associations of common RAS polymorphisms and clinical course after aneurysmal subarachnoid hemorrhage (aSAH). METHODS The CARAS study prospectively enrolled aSAH patients at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5'exonuclease genotyping assays and pyrosequencing. Analysis of associations of RAS polymorphisms and clinical course after aSAH were performed. RESULTS A total of 166 patients were screened, and 149 aSAH patients were included for analysis. A recessive effect of allele I (insertion) of the ACE I/D (insertion/deletion) polymorphism was identified for Hunt and Hess grade in all patients (OR 2.76, 95% CI 1.17-6.50; p = 0.0206) with subsequent poor functional outcome. There was a similar effect on delayed cerebral ischemia (DCI) in patients 55 years or younger (OR 3.63, 95% CI 1.04-12.7; p = 0.0439). In patients older than 55 years, there was a recessive effect of allele A of the angiotensin II receptor Type 2 (AT2) A/C single nucleotide polymorphism (SNP) on DCI (OR 4.70, 95% CI 1.43-15.4; p = 0.0111). CONCLUSIONS Both the ACE I/D polymorphism and the AT2 A/C single nucleotide polymorphism were associated with an age-dependent risk of delayed cerebral ischemia, whereas only the ACE I/D polymorphism was associated with poor clinical grade at presentation. Further studies are required to elucidate the relevant pathophysiology and its potential implication in the treatment of patients with aSAH.

  14. Subarachnoid Hemorrhage

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    ... Susco Chair of Research North Shore University Hospital, Brain Aneurysm Center Chair of Research The Christopher C. Getch, MD Chair of Research Carol W. Harvey Memorial Chair of Research Kristen’s Legacy of Love Chair of Research TeamCindy Alcatraz Chair of Research ...

  15. Treatment Modality and Quality Benchmarks of Aneurysmal Subarachnoid Hemorrhage at a Comprehensive Stroke Center

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    Wengui Yu

    2018-03-01

    Full Text Available BackgroundAneurysmal subarachnoid hemorrhage (aSAH is the most severe type of stroke. In 2012, the Joint Commission, in collaboration with the American Heart Association/American Stroke Association (AHA/ASA, launched the Advanced Certification for Comprehensive Stroke Centers (CSCs. This new level of certification was designed to promote higher standard of care for patients with complex stroke.ObjectiveThe goal of this study was to examine the treatment modality and quality benchmarks of aSAH at one of the first five certified CSCs in the United States.MethodsConsecutive patients with aSAH at Cedars-Sinai Medical Center between April 1, 2012 and May 30, 2014 were included for this retrospective study. The ruptured aneurysm was treated with coiling or clipping within 24 h. All patients were managed per AHA guidelines. Discharge outcomes were assessed using modified Rankin Scale (mRS. The rate of aneurysm treatment, door-to-treatment time, rate of posttreatment rebleed, hospital length of stay (LOS, discharge outcome, and mortality rates were evaluated as quality indicators.ResultsThe median age (interquartile range of the 118 patients with aSAH was 55 (19. Among them, 84 (71.2% were females, 94 (79.7% were transfers from outside hospitals, and 74 (62.7% had Hunt and Hess grades 1–3. Sixty patients (50.8% were treated with coiling, 52 (44.1% with clipping, and 6 (5.1% untreated due to ictal cardiac arrest or severe comorbidities. The rate of aneurysm treatment was 95% (112/118 with median door-to-treatment time at 12.5 (8.5 h and 0.9% (1/112 posttreatment rebleed. The median ICU and hospital LOS were 12.5 (7 and 17.0 (14.5 days, respectively. Coiling was associated with significantly shorter LOS than clipping. There were 59 patients (50% with favorable outcome and 19 deaths (16.1% at hospital discharge. There was no significant difference in discharge outcome between coiling and clipping.ConclusionCare of aSAH at one of the early CSCs in the

  16. The safety of vasopressor-induced hypertension in subarachnoid hemorrhage patients with coexisting unruptured, unprotected intracranial aneurysms.

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    Reynolds, Matthew R; Buckley, Robert T; Indrakanti, Santoshi S; Turkmani, Ali H; Oh, Gerald; Crobeddu, Emanuela; Fargen, Kyle M; El Ahmadieh, Tarek Y; Naidech, Andrew M; Amin-Hanjani, Sepideh; Lanzino, Giuseppe; Hoh, Brian L; Bendok, Bernard R; Zipfel, Gregory J

    2015-10-01

    Vasopressor-induced hypertension (VIH) is an established treatment for patients with aneurysmal subarachnoid hemorrhage (SAH) who develop vasospasm and delayed cerebral ischemia (DCI). However, the safety of VIH in patients with coincident, unruptured, unprotected intracranial aneurysms is uncertain. This retrospective multiinstitutional study identified 1) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who required VIH therapy (VIH group), and 2) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who did not require VIH therapy (non-VIH group). All patients had previously undergone surgical or endovascular treatment for the presumed ruptured aneurysm. Comparisons between the VIH and non-VIH patients were made in terms of the patient characteristics, clinical and radiographic severity of SAH, total number of aneurysms, number of ruptured/unruptured aneurysms, aneurysm location/size, number of unruptured and unprotected aneurysms during VIH, severity of vasospasm, degree of hypervolemia, and degree and duration of VIH therapy. For the VIH group (n = 176), 484 aneurysms were diagnosed, 231 aneurysms were treated, and 253 unruptured aneurysms were left unprotected during 1293 total days of VIH therapy (5.12 total years of VIH therapy for unruptured, unprotected aneurysms). For the non-VIH group (n = 73), 207 aneurysms were diagnosed, 93 aneurysms were treated, and 114 unruptured aneurysms were left unprotected. For the VIH and non-VIH groups, the mean sizes of the ruptured (7.2 ± 0.3 vs 7.8 ± 0.6 mm, respectively; p = 0.27) and unruptured (3.4 ± 0.2 vs 3.2 ± 0.2 mm, respectively; p = 0.40) aneurysms did not differ. The authors observed 1 new SAH from a previously unruptured, unprotected aneurysm in each group (1 of 176 vs 1 of 73 patients; p = 0.50). Baseline patient characteristics and comorbidities were similar between groups. While the degree of hypervolemia was similar between the VIH and non-VIH patients

  17. Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke.

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    Garge, Shaileshkumar S; Vyas, Pooja D; Modi, Pranav D; Ghatge, Sharad

    2014-10-01

    Cerebral vasculitis secondary to Crohn's disease (CD) seems to be a very rare phenomenon. We report a 39-year-old male who presented with headache, vomiting, and left-sided weakness in the known case of CD. Cross-sectional imaging (computed tomography and magnetic resonance imaging,) showed right gangliocapsular acute infarct with supraclinoid cistern subarachnoid hemorrhage (SAH). Cerebral digital substraction angiography (DSA) showed dilatation and narrowing of right distal internal carotid artery (ICA). Left ICA was chronically occluded. His inflammatory markers were significantly raised. Imaging features are suggestive of cerebral vasculitis. Arterial and venous infarcts due to thrombosis are known in CD. Our case presented with acute subarachnoid hemorrhage in supraclinoid cistern due to rupture of tiny aneurysm of perforator arteries causing SAH and infarction in right basal ganglia. Patient was treated conservatively with immunosuppression along with medical management of SAH.

  18. Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke

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    Shaileshkumar S Garge

    2014-01-01

    Full Text Available Cerebral vasculitis secondary to Crohn′s disease (CD seems to be a very rare phenomenon. We report a 39-year-old male who presented with headache, vomiting, and left-sided weakness in the known case of CD. Cross-sectional imaging (computed tomography and magnetic resonance imaging, showed right gangliocapsular acute infarct with supraclinoid cistern subarachnoid hemorrhage (SAH. Cerebral digital substraction angiography (DSA showed dilatation and narrowing of right distal internal carotid artery (ICA. Left ICA was chronically occluded. His inflammatory markers were significantly raised. Imaging features are suggestive of cerebral vasculitis. Arterial and venous infarcts due to thrombosis are known in CD. Our case presented with acute subarachnoid hemorrhage in supraclinoid cistern due to rupture of tiny aneurysm of perforator arteries causing SAH and infarction in right basal ganglia. Patient was treated conservatively with immunosuppression along with medical management of SAH.

  19. Intracranial pressure after subarachnoid hemorrhage.

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    Zoerle, Tommaso; Lombardo, Alessandra; Colombo, Angelo; Longhi, Luca; Zanier, Elisa R; Rampini, Paolo; Stocchetti, Nino

    2015-01-01

    To describe mean intracranial pressure after aneurysmal subarachnoid hemorrhage, to identify clinical factors associated with increased mean intracranial pressure, and to explore the relationship between mean intracranial pressure and outcome. Analysis of a prospectively collected observational database. Neuroscience ICU of an academic hospital. One hundred sixteen patients with subarachnoid hemorrhage and intracranial pressure monitoring. None. Episodes of intracranial pressure greater than 20 mm Hg lasting at least 5 minutes and the mean intracranial pressure for every 12-hour interval were analyzed. The highest mean intracranial pressure was analyzed in relation to demographic characteristics, acute neurologic status, initial radiological findings, aneurysm treatment, clinical vasospasm, and ischemic lesion. Mortality and 6-month outcome (evaluated using a dichotomized Glasgow Outcome Scale) were also introduced in multivariable logistic models. Eighty-one percent of patients had at least one episode of high intracranial pressure and 36% had a highest mean intracranial pressure more than 20 mm Hg. The number of patients with high intracranial pressure peaked 3 days after subarachnoid hemorrhage and declined after day 7. Highest mean intracranial pressure greater than 20 mm Hg was significantly associated with initial neurologic status, aneurysmal rebleeding, amount of blood on CT scan, and ischemic lesion within 72 hours from subarachnoid hemorrhage. Patients with highest mean intracranial pressure greater than 20 mm Hg had significantly higher mortality. When death, vegetative state, and severe disability at 6 months were pooled, however, intracranial pressure was not an independent predictor of unfavorable outcome. High intracranial pressure is a common complication in the first week after subarachnoid hemorrhage in severe cases admitted to ICU. Mean intracranial pressure is associated with the severity of early brain injury and with mortality.

  20. Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Rudy, Robert F; Rosalind Lai, Pui Man; Smith, Timothy R; Frerichs, Kai U; Gormley, William B; Aziz-Sultan, M Ali; Du, Rose

    2017-10-27

    OBJECTIVE Although cigarette smoking is one of the strongest risk factors for cerebral aneurysm development and rupture, there are limited data evaluating the impact of smoking on outcomes after aneurysmal subarachnoid hemorrhage (SAH). Additionally, two recent studies suggested that nicotine replacement therapy was associated with improved neurological outcomes among smokers who had sustained an SAH compared with smokers who did not receive nicotine. METHODS Patients who underwent endovascular or microsurgical repair of a ruptured cerebral aneurysm were extracted from the Nationwide Inpatient Sample (NIS, 2009-2011) and stratified by cigarette smoking. Multivariable logistic regression analyzed in-hospital mortality, complications, tracheostomy or gastrostomy placement, and discharge to institutional care (a nursing or an extended care facility). Additionally, the composite NIS-SAH outcome measure (based on mortality, tracheostomy or gastrostomy, and discharge disposition) was evaluated, which has been shown to have excellent agreement with a modified Rankin Scale score greater than 3. Covariates included in regression constructs were patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities (including hypertension, drug and alcohol abuse), the NIS-SAH severity scale (previously validated against the Hunt and Hess grade), treatment modality used for aneurysm repair, and hospital characteristics. A sensitivity analysis was performed matching smokers to nonsmokers on age, sex, number of comorbidities, and NIS-SAH severity scale score. RESULTS Among the 5784 admissions evaluated, 37.1% (n = 2148) had a diagnosis of tobacco use, of which 31.1% (n = 1800) were current and 6.0% (n = 348) prior tobacco users. Smokers were significantly younger (mean age 51.4 vs 56.2 years) and had more comorbidities compared with nonsmokers (p < 0.001). There were no significant differences in mortality, total complications, or neurological complications by

  1. Cognitive deficits after aneurysmal and angiographically negative subarachnoid hemorrhage: Memory, attention, executive functioning, and emotion recognition.

    Science.gov (United States)

    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

    2016-11-01

    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 focused on higher-order prefrontal functions, namely executive functioning (EF) and emotion recognition. Patients and healthy controls were assessed with tests measuring memory (15 Words Test, Digit Span), attention and processing speed (Trail Making Test A and B), EF (Zoo Map, Letter Fluency, Dysexecutive Questionnaire), and emotion recognition (Facial Expressions of Emotion Stimuli and Tests). Between-groups comparisons of test performances were made. Patients with aSAH scored significantly lower than healthy controls on measures of memory, processing speed, and attention, but anSAH patients did not. In the higher-order prefrontal functions (EF and emotion recognition), aSAH patients were clearly impaired when compared to healthy controls. However, anSAH patients did not perform significantly better than aSAH patients on the majority of the tests. In the subacute phase after SAH, cognitive functions, including the higher-order prefrontal functions EF and emotion recognition, were clearly impaired in aSAH patients. Patients with anSAH did not perform better than aSAH patients, which indicates that these functions may also be affected to some extent in anSAH patients. Considering the importance of these higher-order prefrontal functions for daily life functioning, and following the results of the present study, tests that measure emotion recognition and EF should be part of the standard neuropsychological assessment after SAH. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

    Science.gov (United States)

    Cremers, Charlotte H P; Dankbaar, Jan Willem; Vergouwen, Mervyn D I; Vos, Pieter C; Bennink, Edwin; Rinkel, Gabriel J E; Velthuis, Birgitta K; van der Schaaf, Irene C

    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.

  3. Early Dynamics of Interleukin-6 in Cerebrospinal Fluid after Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Ďuriš, Kamil; Neuman, Eduard; Vybíhal, Václav; Juráň, Vilém; Gottwaldová, Jana; Kýr, Michal; Vašků, Anna; Smrčka, Martin

    2018-03-01

    Subarachnoid hemorrhage (SAH) is a severe condition associated with high mortality. Early brain injury (EBI) plays an important role in the pathophysiology of SAH, and inflammation is a major contributor to EBI. Inflammation is a widely studied topic in both experimental and clinical conditions; however, just a few clinical studies have focused primarily on the early inflammatory response after SAH, and detailed information about the association between the dynamics of early inflammatory response with main clinical characteristics is lacking. This study analyzes the early dynamics of inflammatory response after SAH and evaluates the possible associations between the markers of early inflammatory response and main clinical characteristics.  A total of 47 patients with a diagnosis of aneurysmal SAH within the last 24 hours were enrolled in the study. All treatments, including treatment of aneurysm (surgery/coiling) and implantation of a drainage system (external ventricular drainage/lumbar catheter), were conducted in the same way as in other patients with this diagnosis. Blood and cerebrospinal fluid (CSF) samples were collected three times a day for 4 days. The dynamics of proinflammatory cytokines were assessed, and associations between levels of the proinflammatory cytokines interleukin (IL)-6, IL-1β, or tumor necrosis factor (TNF)α and main clinical characteristics were evaluated using linear mixed-effect models.  The CSF levels of IL-6 were massively increased initially after SAH (up to 72 hours) with an additional increase in later phases (after 72 hours), but there was high variability in IL-6 levels. A significant association was noted between the Glasgow Outcome Scale score and both overall levels of IL-6 ( p  = 0.0095) and their dynamics ( p  = 0.0208); the effect of the Hunt and Hess scale was borderline ( p  = 0.0887). No association was found between IL-6 levels and Fisher grade, modality of treatment (surgery, coiling, no treatment

  4. Delayed diagnosis of aneurysmal subarachnoid hemorrhage in patients: a community-based study.

    Science.gov (United States)

    Inagawa, Tetsuji

    2011-10-01

    A community-based study was conducted to estimate the frequency of and evaluate the clinical features related to delayed diagnosis of aneurysmal subarachnoid hemorrhage (SAH). Between 1980 and 1998, 358 patients with aneurysmal SAH underwent treatment in Izumo, Japan. The diagnosis of SAH was delayed in 76 patients (21%) and was early in 282 (79%). Among the 76 patients whose diagnosis was delayed, the condition was misdiagnosed by clinicians in 46 cases (Subgroup A), and in the remaining 30 the patients were unaware that SAH had occurred and failed to seek prompt treatment (Subgroup B). The proportion of Subgroup A patients decreased significantly from 18% (30 of 170 patients) between 1980 and 1989 to 9% (16 of 188 patients) between 1990 and 1998 (p = 0.0098), whereas the proportion of Subgroup B patients during the same periods was 8% (13 of 170 patients) and 9% (17 of 188 patients), respectively (p = 0.6341). With regard to Subgroup A, the misdiagnosis rate in private clinics decreased from 14% (23 of 170 patients) between 1980 and 1989 to 5% (10 of 188 patients) between 1990 and 1998 (p = 0.0073), whereas the misdiagnosis rate in hospitals during the same periods was 4% (7 of 170 patients) and 3% (6 of 188 patients), respectively (p = 0.6399). Multivariate analysis revealed that World Federation of Neurosurgical Societies Grade I or II was the main risk factor for delayed diagnosis of SAH (OR 3.97 [95% CI 1.69-10.37]), and that the timing of SAH onset, that is, between 12:00 a.m. and 6:00 a.m., was an important reason for the condition in Subgroup B patients (OR 9.29 [95% CI 2.66-33.93]). Rebleeding before admission occurred in 26% of the patients in whom diagnosis was delayed, and in 3% of those who were diagnosed early (p better educated about SAH and the importance of getting prompt medical attention, even in the middle of the night.

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

    International Nuclear Information System (INIS)

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

    2014-01-01

    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. 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. Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. BSCTA is easily accessible, less time consuming, and most importantly, a non

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

    Science.gov (United States)

    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 subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Results: Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. Conclusions: BSCTA is

  7. Decision tree analysis in subarachnoid hemorrhage: prediction of outcome parameters during the course of aneurysmal subarachnoid hemorrhage using decision tree analysis.

    Science.gov (United States)

    Hostettler, Isabel Charlotte; Muroi, Carl; Richter, Johannes Konstantin; Schmid, Josef; Neidert, Marian Christoph; Seule, Martin; Boss, Oliver; Pangalu, Athina; Germans, Menno Robbert; Keller, Emanuela

    2018-01-19

    OBJECTIVE The aim of this study was to create prediction models for outcome parameters by decision tree analysis based on clinical and laboratory data in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS The database consisted of clinical and laboratory parameters of 548 patients with aSAH who were admitted to the Neurocritical Care Unit, University Hospital Zurich. To examine the model performance, the cohort was randomly divided into a derivation cohort (60% [n = 329]; training data set) and a validation cohort (40% [n = 219]; test data set). The classification and regression tree prediction algorithm was applied to predict death, functional outcome, and ventriculoperitoneal (VP) shunt dependency. Chi-square automatic interaction detection was applied to predict delayed cerebral infarction on days 1, 3, and 7. RESULTS The overall mortality was 18.4%. The accuracy of the decision tree models was good for survival on day 1 and favorable functional outcome at all time points, with a difference between the training and test data sets of decision trees enables exploration of dependent variables in the context of multiple changing influences over the course of an illness. The decision tree currently generated increases awareness of the early systemic stress response, which is seemingly pertinent for prognostication.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Cerebral Taurine Levels are Associated with Brain Edema and Delayed Cerebral Infarction in Patients with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Kofler, Mario; Schiefecker, Alois; Ferger, Boris; Beer, Ronny; Sohm, Florian; Broessner, Gregor; Hackl, Werner; Rhomberg, Paul; Lackner, Peter; Pfausler, Bettina; Thomé, Claudius; Schmutzhard, Erich; Helbok, Raimund

    2015-12-01

    Cerebral edema and delayed cerebral infarction (DCI) are common complications after aneurysmal subarachnoid hemorrhage (aSAH) and associated with poor functional outcome. Experimental data suggest that the amino acid taurine is released into the brain extracellular space secondary to cytotoxic edema and brain tissue hypoxia, and therefore may serve as a biomarker for secondary brain injury after aSAH. On the other hand, neuroprotective mechanisms of taurine treatment have been described in the experimental setting. We analyzed cerebral taurine levels using high-performance liquid chromatography in the brain extracellular fluid of 25 consecutive aSAH patients with multimodal neuromonitoring including cerebral microdialysis (CMD). Patient characteristics and clinical course were prospectively recorded. Associations with CMD-taurine levels were analyzed using generalized estimating equations with an autoregressive process to handle repeated observations within subjects. CMD-taurine levels were highest in the first days after aSAH (11.2 ± 3.2 µM/l) and significantly decreased over time (p taurine levels compared to those without (Wald = 7.3, df = 1, p taurine supplementation and brain extracellular taurine (p = 0.6). Moreover, a significant correlation with brain extracellular glutamate (r = 0.82, p taurine levels were found in patients with brain edema or DCI after aneurysmal subarachnoid hemorrhage. Its value as a potential biomarker deserves further investigation.

  10. Genetic Epidemiology of Spontaneous Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Korja, Miikka; Silventoinen, Karri; McCarron, Peter

    2010-01-01

    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...

  11. Impaired muscle strength may contribute to fatigue in patients with aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Harmsen, Wouter J; Ribbers, Gerard M; Zegers, Bart; Sneekes, Emiel M; Praet, Stephan F E; Heijenbrok-Kal, Majanka H; Khajeh, Ladbon; van Kooten, Fop; Neggers, Sebastiaan J C M M; van den Berg-Emons, Rita J

    2017-03-01

    Patients with aneurysmal subarachnoid hemorrhage (a-SAH) show long-term fatigue and face difficulties in resuming daily physical activities. Impaired muscle strength, especially of the lower extremity, impacts the performance of daily activities and may trigger the onset of fatigue complaints. The present study evaluated knee muscle strength and fatigue in patients with a-SAH. This study included 33 patients, 6 months after a-SAH, and 33 sex-matched and age-matched healthy controls. Isokinetic muscle strength of the knee extensors and flexors was measured at 60 and 180°/s. Maximal voluntary muscle strength was defined as peak torque and measured in Newton-meter. Fatigue was examined using the Fatigue Severity Scale. In patients with a-SAH, the maximal knee extension was 22% (60°/s) and 25% (180°/s) lower and maximal knee flexion was 33% (60°/s) and 36% (180°/s) lower compared with that of matched controls (P≤0.001). The Fatigue Severity Scale score was related to maximal knee extension (60°/s: r=-0.426, P=0.015; 180°/s: r=-0.376, P=0.034) and flexion (60°/s: r=-0.482, P=0.005; 180°/s: r=-0.344, P=0.083). The knee muscle strength was 28-47% lower in fatigued (n=13) and 11-32% lower in nonfatigued (n=20) patients; deficits were larger in fatigued patients (Pmuscle strength (peak torque) was measured at 60°/s. The present results indicate that patients with a-SAH have considerably impaired knee muscle strength, which is related to more severe fatigue. The present findings are exploratory, but showed that knee muscle strength may play a role in the severity of fatigue complaints, or vice versa. Interventions targeting fatigue after a-SAH seem necessary and may consider strengthening exercise training in order to treat a debilitating condition.

  12. Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Na Rae Yang

    2017-05-01

    Full Text Available Background Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH. The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC. However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. Methods We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. Results Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2% were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033 and the initial consecutive fasting time (OR, 1.325; P = 0.024. Conclusions AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this

  13. Time-dependent changes in cerebrospinal fluid metal ions following aneurysm subarachnoid hemorrhage and their association with cerebral vasospasm.

    Science.gov (United States)

    Singla, Amit; Villwock, Mark R; Riordan, Margaret A; Padalino, David J; Deshaies, Eric M

    2015-01-01

    Aneurysm subarachnoid hemorrhage affects 10 in 100,000 people annually, 40 % of whom will develop neurological deficits from ischemic stroke caused by cerebral vasospasm. Currently, the underlying mechanisms are uncertain. Metal ions are important modulators of neuronal electrophysiological conduction and smooth muscle cell activity, thereby potentially contributing to vasospasm. We hypothesized that metal ion concentrations in the cerebrospinal fluid (CSF) after aneurysm rupture would change over time and be associated with vasospasm. To test this hypothesis, for 21 days, we collected CSF from patients with aneurysmal rupture and subjected it to spectrometry to detect metals. A repeated measures analysis was performed to analyze concentration changes over time. Six of the seven patients with aneurysmal rupture experienced vasospasm, all resolving by day 14. Changes in Fe²⁺ and Zn²⁺ concentrations in the CSF paralleled the incidence of vasospasm in this study population. Na²⁺, Ca²⁺, Mg²⁺, and Cu²⁺ concentrations exhibited no statistically significant changes over time. In conclusion, Fe²⁺ concentration in the CSF was significantly elevated during days 7-10, whereas Zn²⁺ concentrations spiked shortly thereafter, during days 11-14. This suggests that Fe²⁺ may be related to the induction of vasospasm and Zn²⁺ may be a marker of early brain injury secondary to ischemic injury and inflammation.

  14. Stent-assisted coiling of wide-necked aneurysms in the setting of acute subarachnoid hemorrhage: experience in 65 patients.

    Science.gov (United States)

    Amenta, Peter S; Dalyai, Richard T; Kung, David; Toporowski, Amy; Chandela, Sid; Hasan, David; Gonzalez, L Fernando; Dumont, Aaron S; Tjoumakaris, Stavropoula I; Rosenwasser, Robert H; Maltenfort, Mitchell G; Jabbour, Pascal M

    2012-06-01

    Stent-assisted coiling in the setting of subarachnoid hemorrhage remains controversial. Currently, there is a paucity of data regarding the utility of this procedure and the risks of hemorrhagic and ischemic complications. To assess the utility of stent-assisted coil embolization and pretreatment with antiplatelet agents in the management of ruptured wide-necked aneurysms. A retrospective study of 65 patients with ruptured wide-necked aneurysms treated with stent-assisted coiling. Patients with hydrocephalus or a Hunt and Hess grade ≥ III received a ventriculostomy before endovascular intervention. Patients were treated intraoperatively with 600 mg of clopidogrel and maintained on daily doses of 75 mg of clopidogrel and 81 mg of aspirin. The Glasgow outcome scale (GOS) score was recorded at the time of discharge. We identified major bleeding complications secondary to antiplatelet therapy and cases of in-stent thrombosis that required periprocedural thrombolysis. Of the aneurysms, 66.2% arose within the anterior circulation; 69.2% of patients presented with hydrocephalus or a Hunt and Hess grade ≥ III and required a ventriculostomy. A good outcome (GOS of 4 or 5) was achieved in 63.1% of patients, and the overall mortality rate was 16.9%. There were 10 (15.38%) major complications associated with bleeding secondary to antiplatelet therapy (5 patients, 7.7%) or intraoperative in-stent thrombosis (5 patients, 7.7%). Three (4.6%) patients had a fatal hemorrhage. Our findings suggest that stent-assisted coiling and routine treatment with antiplatelet agents is a viable option in the management of ruptured wide-necked aneurysms.

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

    International Nuclear Information System (INIS)

    Lee, Jin Young; Shin, Hwa Seon; Choi, Hye Young; Chung, Sung Hoon; You, Jin Jong; Choi, Dae Seob; Son, Seung Nam; Ryu, Jae Wook

    2012-01-01

    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

  16. Intrasylvian hematoma caused by ruptured middle cerebral artery aneurysms predicts recovery from poor-grade subarachnoid hemorrhage.

    Science.gov (United States)

    Fukuda, Hitoshi; Hayashi, Kosuke; Moriya, Takafumi; Nakashita, Satoru; Lo, Benjamin W Y; Yamagata, Sen

    2015-09-01

    Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p < 0.001, Mann-Whitney U-test), which significantly resolved overtime (p < 0.001, Mann-Whitney U-test). These patients had a better chance of functional survival (modified Rankin Scale scores of 1-3; OR 5.75; 95% CI 1.36-24.3; p = 0.017) at 6 months after hospital discharge, after adjustment for potential confounders such as younger age and better initial neurological grade by multivariable analysis. ISH predicted good functional recovery from poor-grade aneurysmal SAH.

  17. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage

    NARCIS (Netherlands)

    van Gijn, J.; van Dongen, K. J.; Vermeulen, M.; Hijdra, A.

    1985-01-01

    We studied 28 patients with subarachnoid hemorrhage and normal angiograms. On early CT (within 5 days) in 13 cases, blood was seen mainly or only in the cisterns around the midbrain. This pattern of hemorrhage was found in only 1 of 92 patients with a ruptured aneurysm. None of the unexplained

  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).

    Science.gov (United States)

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

    2015-10-01

    Magnesium 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 investigated if magnesium treatment led to less delayed cerebral ischemia and if glucose levels interacted with magnesium treatment in the Magnesium in Aneurysmal Subarachnoid Haemorrhage II trial. To investigate the effect of magnesium treatment on occurrence of delayed cerebral ischemia and the interaction between glucose levels and magnesium treatment in subarachnoid hemorrhage patients. The Magnesium in Aneurysmal Subarachnoid Haemorrhage was a phase III randomized placebo-controlled trial assessing the effect of magnesium sulphate on clinical outcome in aneurysmal subarachnoid hemorrhage patients. For the current study, we included only the patients admitted to the University Medical Centre-Utrecht. We calculated hazard ratios for occurrence of delayed cerebral ischemia in patients treated with magnesium vs. placebo for the entire study population, and separately in the subgroups of patients with high and low mean fasting and mean daily glucose levels until onset of delayed cerebral ischemia. We used the cross-product of magnesium and glucose in the regression analysis to evaluate whether an interaction between magnesium and glucose existed. We included 616 patients: 307 received magnesium and 309 placebo; 156 patients had delayed cerebral ischemia. Hazard ratio for magnesium on occurrence of delayed cerebral ischemia was 1·0 (95% confidence interval: 0·7-1·4). Results were similar in patients with low or high fasting or daily glucose levels. We found no interactions between magnesium treatment and high fasting (P = 0·54) and daily glucose (P = 0·60). Magnesium treatment did not reduce the risk of delayed cerebral ischemia in patients with aneurysmal

  19. Magnesium in subarachnoid hemorrhage

    NARCIS (Netherlands)

    Bergh, W.M. (Walter Marcel) van den

    2004-01-01

    The main objective of this thesis was to determine the role of serum magnesium in the pathophysiology after subarachnoid hemorrhage (SAH) and to assess the effect of magnesium treatment in reducing cerebral ischemia in experimental SAH and in improving clinical outcome in patients with

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

    International Nuclear Information System (INIS)

    Suzuki, Satoshi; Ito, Osamu; Sayama, Tetsuro; Goto, Katsuya

    2010-01-01

    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.)

  1. Blood free Radicals Concentration Determined by Electron Paramagnetic Resonance Spectroscopy and Delayed Cerebral Ischemia Occurrence in Patients with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Ewelina, Grzywna; Krzysztof, Stachura; Marek, Moskala; Krzysztof, Kruczala

    2017-12-01

    Pathophysiology of delayed cerebral ischemia and cerebral vasospasm following aneurysmal subarachnoid hemorrhage is still poorly recognized, however free radicals are postulated as one of the crucial players. This study was designed to scrutinize whether the concentration of free radicals in the peripheral venous blood is related to the occurrence of delayed cerebral ischemia associated with cerebral vasospasm. Twenty-four aneurysmal subarachnoid hemorrhage patients and seven patients with unruptured intracranial aneurysm (control group) have been studied. Free radicals in patients' blood have been detected by the electron paramagnetic resonance (CMH.HCl spin probe, 150 K, ELEXSYS E500 spectrometer) on admission and at least 72 h from disease onset. Delayed cerebral ischemia monitoring was performed by daily neurological follow-up and transcranial color coded Doppler. Delayed cerebral ischemia observed in six aneurysmal subarachnoid hemorrhage patients was accompanied by cerebral vasospasm in all six cases. No statistically significant difference in average free radicals concentration between controls and study subgroups was noticed on admission (p = .3; Kruskal-Wallis test). After 72 h free radicals concentration in delayed cerebral ischemia patients (3.19 ± 1.52 mmol/l) differed significantly from the concentration in aneurysmal subarachnoid hemorrhage patients without delayed cerebral ischemia (0.65 ± 0.37 mmol/l) (p = .012; Mann-Whitney test). These findings are consistent with our assumptions and seem to confirm the role of free radicals in delayed cerebral ischemia development. Preliminary results presented above are promising and we need perform further investigation to establish whether blood free radicals concentration may serve as the biomarker of delayed cerebral ischemia associated with cerebral vasospasm.

  2. Predictors of Shunt-dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage? A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Xie, Zhiyi; Hu, Xin; Zan, Xin; Lin, Sen; Li, Hao; You, Chao

    2017-10-01

    Hydrocephalus is a well-recognized complication after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to identify predictors for shunt-dependent hydrocephalus (SDHC) after aSAH via a systematic review and meta-analysis. A systematic search was conducted using the Embase, MEDLINE, and Web of Science databases for studies pertaining to aSAH and SDHC. Risk factors were assessed by meta-analysis when they were reported by at least 2 studies. The results were presented as odd ratios or risk ratios according to the study design with the corresponding 95% confidence intervals (CI). Twenty-five studies were included. In primary analysis of 14 potential risk factors, 12 were identified as predictors of SDHC after aSAH including age ≥50 years, female gender, high Hunt-Hess grade, Glasgow Coma Scale ≤8, Fisher grade ≥3, acute hydrocephalus, external ventricular drainage insertion, intraventricular hemorrhage, postcirculation aneurysm, anterior communicating artery aneurysm, meningitis, and rebleeding. The meta-analysis based on cohort studies found a significantly increased risk for SDHC in patients with aSAH treated by coiling (risk ratio, 1.16; 95% CI, 1.05-1.29), while the meta-analysis based on case-controlled studies failed to replicate this finding (odds ratio, 1.27; 95% CI, 0.95-1.71). Several new predictors of SDHC after aSAH were identified that may assist with the early recognition and prevention of SDHC. The controversial evidence found in this study was insufficient to support the potential of neurosurgical clipping for reducing the risk of shunt dependency. Further well-designed studies are warranted to explore the effect of treatment modality on SDHC risk. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    Kunze, E.; Raslan, F.; Stetter, Ch.; Lee, J.Y.; Solymosi, L.; Ernestus, R.I.; Vince, G.H.; Westermaier, Th.; Pham, M.; Solymosi, L.

    2012-01-01

    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

  4. [Reangiography after perimesencephalic subarachnoid hemorrhage].

    Science.gov (United States)

    Ringelstein, A; Mueller, O; Timochenko, O; Moenninghoff, C; Sure, U; Forsting, M; Schlamann, M

    2013-06-01

    This study aimed to determine the value of digital subtraction angiography (DSA) for the detection of causative vascular lesions in patients with perimesencephalic subarachnoid hemorrhage (SAH) after initially negative noninvasive and invasive neurovascular imaging, such as computed tomography angiography (CTA), DSA and magnetic resonance angiography (MRA). We analyzed the value of repeated DSA for the detection of causative vascular lesions in 750 patients presenting to our institution with SAH and including 30 with a purely perimesencephalic pattern of subarachnoidal hemorrhage and initially negative noninvasive and invasive neurovascular imaging over a 10-year period. Repeated DSA demonstrated a causative vascular lesion in 1 patient (3.3%) but no causative vascular lesions were detected in the other patients. Repeated DSA can be used to detect a source of hemorrhage after initially negative imaging diagnostics in some rare cases. Such a finding has a therapeutic and prognostic impact especially for aneurysms in the posterior circulation which bear a higher risk of renewed hemorrhaging. Therefore, we believe that repeated DSA should be recommended in patients with perimesencephalic SAH even under consideration of the risk of complications caused by a second invasive DSA.

  5. Spreading depolarizations increase delayed brain injury in a rat model of subarachnoid hemorrhage

    NARCIS (Netherlands)

    Hamming, Arend M.; Wermer, Marieke J. H.; Rudrapatna, S. Umesh; Lanier, Christian; van Os, Hine J. A.; van den Bergh, Walter M.; Ferrari, Michel D.; van der Toorn, Annette; van den Maagdenberg, Arn M. J. M.; Stowe, Ann M.; Dijkhuizen, Rick M.

    Spreading depolarizations may contribute to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage, but the effect of spreading depolarizations on brain lesion progression after subarachnoid hemorrhage has not yet been assessed directly. Therefore, we tested the hypothesis that

  6. Loss of Consciousness at Onset of Aneurysmal Subarachnoid Hemorrhage is Associated with Functional Outcomes in Good-Grade Patients.

    Science.gov (United States)

    Wang, Justin; Alotaibi, Naif M; Akbar, Muhammad Ali; Ayling, Oliver G S; Ibrahim, George M; Macdonald, R Loch

    2017-02-01

    Transient loss of consciousness (LOC) is one of the most common presentations of aneurysmal subarachnoid hemorrhage (SAH) and may be an indicator of early brain injury. In this study, we examined the association of LOC and functional outcomes in patients with good-grade SAH. We searched the Subarachnoid Hemorrhage International Trialists Repository for patients who presented with LOC at ictus of SAH. A propensity score analysis was performed on good-grade patients (defined as World Federation of Neurosurgical Societies grade 1-3) to balance selected covariates between those with and without LOC. The primary outcome was Glasgow Outcome Score (GOS) at 3 months (with poor outcome defined as a GOS of 1-3). Secondary outcomes were delayed cerebral ischemia (DCI), rebleed, length of hospital stay, and time to death. A propensity score-matching algorithm identified 336 patients (168 with and 168 without LOC at ictus). The proportion of patients with poor functional outcome at 3 months was significantly higher in the cohort with LOC at ictus compared with the matched cohort without LOC at ictus (30% vs. 19%; P = 0.02). There was a nonsignificant trend toward greater mortality in the patients with LOC at ictus (19% vs. 13%; P = 0.14). There were no significant differences in the secondary outcomes between the 2 cohorts. LOC at ictus of SAH is associated with a higher rate of unfavorable functional outcomes but not of mortality, DCI, or rebleed in patients with good-grade SAH. Future studies should further investigate the putative mechanisms through which LOC mediates early brain injury in SAH. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Simulation of spreading depolarization trajectories in cerebral cortex: Correlation of velocity and susceptibility in patients with aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Denny Milakara

    2017-01-01

    Full Text Available In many cerebral grey matter structures including the neocortex, spreading depolarization (SD is the principal mechanism of the near-complete breakdown of the transcellular ion gradients with abrupt water influx into neurons. Accordingly, SDs are abundantly recorded in patients with traumatic brain injury, spontaneous intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage (aSAH and malignant hemispheric stroke using subdural electrode strips. SD is observed as a large slow potential change, spreading in the cortex at velocities between 2 and 9 mm/min. Velocity and SD susceptibility typically correlate positively in various animal models. In patients monitored in neurocritical care, the Co-Operative Studies on Brain Injury Depolarizations (COSBID recommends several variables to quantify SD occurrence and susceptibility, although accurate measures of SD velocity have not been possible. Therefore, we developed an algorithm to estimate SD velocities based on reconstructing SD trajectories of the wave-front's curvature center from magnetic resonance imaging scans and time-of-SD-arrival-differences between subdural electrode pairs. We then correlated variables indicating SD susceptibility with algorithm-estimated SD velocities in twelve aSAH patients. Highly significant correlations supported the algorithm's validity. The trajectory search failed significantly more often for SDs recorded directly over emerging focal brain lesions suggesting in humans similar to animals that the complexity of SD propagation paths increase in tissue undergoing injury.

  8. Cranioplasty and Duraplasty with Transcranial Color-Coded Duplex Sonography after Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Sadahiro, Hirokazu; Inamura, Akinori; Sugimoto, Kazutaka; Yamane, Akiko; Ishihara, Hideyuki; Shirao, Satoshi; Yoneda, Hiroshi; Suzuki, Michiyasu

    2015-11-01

    Transcranial color-coded duplex sonography (TCCS) is a noninvasive technique for monitoring of cerebral vasospasm after neurosurgery for aneurismal subarachnoid hemorrhage. In this surgery, surgical materials are used. The goal of the study was to identify materials that can be used with ultrasound and to propose methods for cranioplasty and duraplasty using materials that permit TCCS. The chosen neurosurgical materials were titanium mesh plate (TMP), Gore-tex, SEAMDURA, gelatinous sponge, and oxidized cellulose. B-mode imaging was recorded with the materials placed between urethane resin 10 mm in diameter and the urethane phantom model. TCCS was performed to detect middle cerebral artery flow through TMP and Gore-tex. TMP and SEAMDURA permitted penetration of ultrasound in B-mode and Doppler imaging, but the other materials did not do so. A postcraniotomy window (PCW) on a line extending from the horizontal portion of M1 using only TMP permitted flow imaging with TCCS. In external decompression, TCCS was effective only without use of Gore-tex around the postcraniotomy window. This method allows the middle cerebral artery flow to be detected easily. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Time-related changes in cerebral blood flow in subarachnoid hemorrhage due to ruptured cerebral aneurysm

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    Fukuda, Tadaharu; Hasue, Masamichi; Ko, Meishyu; Hasegawa, Kouichi; Nakamura, Tatsuya (Tokyo Medical Coll. (Japan). Hachiouji Medical Center); Miwa, Tetsurou

    1992-04-01

    Cerebral blood flow (CBF) was determined by the {sup 123}I-IMP SPECT reference sample method in 39 patients with subarachnoid hemorrahge (SAH) due to ruptured cerebral aneurysm, who were referred to a medical center within 36 hours after the onset. SAH and ruptured aneurysm were diagnosed by CT scan and angiography, respectively. By regarding the day of onset as day 0, SAH was divided into three stages: the acute stage during day 0-4, the subacute stage during day 5-20, and the chronic stage during day 21 or more. The prognosis was evaluated with the Glasgow outcome scale (GOS). Average CBFs were 33.39, 29.44, and 33.15 in the acute, subacute, and chronic stages, respectively. The values were all lower than the reference sample value, 43.39. Only a small number of cases, however, had vasospasm on angiography conducted in the acute stage. There was correlation between CT severity in the acute stage and decreased CBF. When low denisty area was seen on CT in the subacute stage, average CBFs were 28.28 and 23.95 in the acute and subacute stages, respectively, in contrast to 35.97 and 32.45 without evidence of low density in the subacute stage. CBF decreased by 0.79 in a group of cisternal drainage from the acute stage to the subacute stage, being smaller than the value (7.15) in a group without drainage. When ventricular-peritoneal shunt was conducted for hydrocepharus in the chronic stage, CBF was increased after surgery. CBF associated with an improvement of the GOS was higher in both the acute and the subacute stages than in severely disabled or death cases. Prognosis was better in a group with acute CBF of 30 or more than a group of less than 30. Serial determination of CBF in SAH was useful for evaluating the condition of SAH, selecting therapeutic methods, and estimating the prognosis. (N.K.).

  10. Early quantitative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Rodriguez-Regent, Christine; Hafsa, Monia; Ben Hassen, Wagih; Edjlali, Myriam; Trystram, Denis; Al-Shareef, Fawaz; Meder, Jean-Francois; Oppenheim, Catherine; Naggara, Olivier; Turc, Guillaume; Sermet, Alain; Laquay, Nathalie; Devaux, Bertrand

    2016-01-01

    To prospectively evaluate the predictive value of cerebral perfusion-computerized tomography (CTP) parameters variation between day0 and day4 after aneurysmal subarachnoid haemorrhage (aSAH). Mean transit time (MTT) and cerebral blood flow (CBF) values were compared between patients with delayed cerebral ischemia (DCI+ group) and patients without DCI (DCI- group) for previously published optimal cutoff values and for variations of MTT (ΔMTT) and of CBF (ΔCBF) values between day0 and day4. DCI+ was defined as a cerebral infarction on 3-months follow-up MRI. Among 47 included patients, 10 suffered DCI+. Published optimal cutoff values did not predict DCI, either at day0 or at day4. Conversely, ΔMTT and ΔCBF significantly differed between the DCI+ and DCI- groups, with optimal ΔMTT and ΔCBF values of 0.91 seconds (83.9 % sensitivity, 79.5 % specificity, AUC 0.84) and -7.6 mL/100 g/min (100 % sensitivity, 71.4 % specificity, AUC 0.86), respectively. In multivariate analysis, ΔCBF (OR = 1.91, IC95% 1.13-3.23 per each 20 % decrease of ΔCBF) and ΔMTT values (OR = 14.70, IC95% 4.85-44.52 per each 20 % increase of ΔMTT) were independent predictors of DCI. Assessment of MTT and CBF value variations between day0 and day4 may serve as an early imaging surrogate for prediction of DCI in aSAH. (orig.)

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

    2015-01-01

    Background: Magnesium 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.

  12. Marriage and Partnership Integrity After Aneurysmal Subarachnoid Hemorrhage: Small Alterations in Neurologic Status Matter Most.

    Science.gov (United States)

    Schöni, Daniel; Lauber, Lara; Fung, Christian; Goldberg, Johannes; Müri, René; Raabe, Andreas; Nyffeler, Thomas; Beck, Jürgen

    2018-02-06

    Common sequelae of subarachnoid hemorrhage (SAH) include somatic and/or cognitive impairment. This can cause emotional stress, social tensions, and difficulties in relationships. To test our hypothesis that more severe somatic and cognitive impairments increased the likelihood of disruption of a relationship after SAH, we assessed the integrity of marriage or partnership status in a well-evaluated subset of SAH patients. Our sample comprised 50 SAH patients who were discharged to a neurologic, in-house rehabilitation center between 2005 and 2010. Deficits on admission to the rehabilitation center were divided into 18 categories and grouped into minor and major somatic deficits, as well as cognitive deficits. Clinical outcome scores, marital/partnership status, and duration of partnership before ictus were recorded. A follow-up questionnaire after 4.3 (2012) and 8.8 (2017) years was used to assess changes in marital/partnership status. Possible predictor parameters were estimated and included in a stepdown regression analysis. In 2012, after a mean follow-up of 4.3 years, 8 of the 50 SAH patients were divorced or separated, whereas after 8.8 years only 1 additional relationship had ended. In our regression model analysis, a "short duration of relationship" before SAH and the presence of a "few minor somatic deficits" were associated with a higher likelihood of divorce or separation in the near future and remained unchanged at long-term follow-up. Contrary to our hypothesis, neither the presence of severe somatic or cognitive deficits nor clinical evaluation scores reliably predicted divorce or separation after SAH. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Simultaneous occurrence of subarachnoid hemorrhage and epistaxis due to ruptured petrous internal carotid artery aneurysm. Association with transsphenoidal surgery and radiation therapy. Case report

    International Nuclear Information System (INIS)

    Endo, Hidenori; Fujimura, Miki; Inoue, Takashi; Matsumoto, Yasushi; Ogawa, Yoshikazu; Kawagishi, Jun; Jokura, Hidefumi; Shimizu, Hiroaki; Tominaga, Teiji

    2011-01-01

    A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm. (author)

  14. The Worst Headache of Life: Evaluation of Nontraumatic Subarachnoid Hemorrhage

    Science.gov (United States)

    2005-09-06

    include autosomal dominant polycystic kidney disease, hypertension, aortic coarctation , alpha-1 -antitrypsin deficiency, connective tissue diseases...which is highest immediately after the initial subarachnoid hemorrhage, is through early surgical or endovascular treatment of the ruptured aneurysm...Endovascular treatment is particularly useful in posterior circulation aneurysms, such as a basilar tip aneurysm, in which the surgical approach is

  15. 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.

  16. Higher brain extracellular potassium is associated with brain metabolic distress and poor outcome after aneurysmal subarachnoid hemorrhage

    Science.gov (United States)

    2014-01-01

    Introduction Elevated brain potassium levels ([K+]) are associated with neuronal damage in experimental models. The role of brain extracellular [K+] in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) and its association with hemorrhage load, metabolic dysfunction and outcome has not been studied so far. Methods Cerebral microdialysis (CMD) samples from 28 poor grade aSAH patients were analyzed for CMD [K+] for 12 consecutive days after ictus, and time-matched to brain metabolic and hemodynamic parameters as well as corresponding plasma [K+]. Statistical analysis was performed using a generalized estimating equation with an autoregressive function to handle repeated observations of an individual patient. Results CMD [K+] did not correlate with plasma [K+] (Spearman’s ρ = 0.114, P = 0.109). Higher CMD [K+] was associated with the presence of intracerebral hematoma on admission head computed tomography, CMD lactate/pyruvate ratio >40 and CMD lactate >4 mmol/L (P < 0.05). In vitro retrodialysis data suggest that high CMD [K+] was of brain cellular origin. Higher CMD [K+] was significantly associated with poor 3-month outcome, even after adjusting for age and disease severity (P < 0.01). Conclusions The results of this pilot study suggest that brain extracellular [K+] may serve as a biomarker for brain tissue injury in poor-grade aSAH patients. Further studies are needed to elucidate the relevance of brain interstitial K+ levels in the pathophysiology of secondary brain injury after aSAH. PMID:24920041

  17. Occipital artery-anterior inferior cerebellar artery bypass with microsurgical trapping for exclusively intra-meatal anterior inferior cerebellar artery aneurysm manifesting as subarachnoid hemorrhage. Case report.

    Science.gov (United States)

    Fujimura, Miki; Inoue, Takashi; Shimizu, Hiroaki; Tominaga, Teiji

    2012-01-01

    A 77-year-old woman presented with an extremely rare exclusively intra-meatal anterior inferior cerebellar artery (AICA) aneurysm manifesting as subarachnoid hemorrhage. The aneurysm was located at a non-branching site of its meatal loop, deeply inside the internal auditory canal. The ipsilateral posterior inferior cerebellar artery was hypoplastic and the affected AICA supplied a wide vascular territory in the right cerebellum. The patient underwent microsurgical trapping of the distal AICA aneurysm in the acute stage. Collateral back flow to the parent artery was poor, so right occipital artery (OA)-AICA anastomosis was performed prior to aneurysm trapping. The postoperative course was uneventful, and magnetic resonance imaging after surgery did not demonstrate any ischemic change. Postoperative angiography showed complete disappearance of the AICA aneurysm and the apparently patent OA-AICA bypass. She did not suffer neurological deficit except for right incomplete hearing disturbance, and postoperative single photon emission computed tomography demonstrated absence of hemodynamic compromise in the cerebellum. OA-AICA anastomosis with aneurysm trapping could be the optimal surgical management of the AICA aneurysm located exclusively inside the internal auditory canal, especially if the parent artery supplies a wide vascular territory.

  18. Definition of initial grading, specific events, and overall outcome in patients with aneurysmal subarachnoid hemorrhage. A survey

    NARCIS (Netherlands)

    van Gijn, J.; Bromberg, J. E.; Lindsay, K. W.; Hasan, D.; Vermeulen, M.

    1994-01-01

    Scientific communication in medicine can be effective only if reports are based on unequivocal criteria for clinical conditions or specific diagnoses. We reviewed all articles about subarachnoid hemorrhage published in nine neurosurgical or neurological journals from 1985 through 1992 and assessed

  19. Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage

    NARCIS (Netherlands)

    Germans, M. R.; Pennings, F. A.; Sprengers, M. E. S.; Vandertop, W. P.

    2008-01-01

    OBJECTIVE: In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is found. The exact incidence of a spinal

  20. External lumbar cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis of controlled trials.

    Science.gov (United States)

    Alcalá-Cerra, G; Paternina-Caicedo, Á; Díaz-Becerra, C; Moscote-Salazar, L R; Gutiérrez-Paternina, J J; Niño-Hernández, L M

    2016-09-01

    External lumbar drainage is a promising measure for the prevention of delayed aneurysmal subarachnoid hemorrhage-related ischemic complications. Controlled studies evaluating the effects of external lumbar drainage in patients with aneurysmal subarachnoid hemorrhage were included. Primary outcomes were: new cerebral infarctions and severe disability. Secondary outcomes were: clinical deterioration due to delayed cerebral ischemia, mortality, and the need of definitive ventricular shunting. Results were presented as pooled relative risks, with their 95% confidence intervals (95% CI). A total of 6 controlled studies were included. Pooled relative risks were: new cerebral infarctions, 0.48 (95% CI: 0.32-0.72); severe disability, 0.5 (95% CI: 0.29-0.85); delayed cerebral ischemia-related clinical deterioration, 0.46 (95% CI: 0.34-0.63); mortality, 0.71 (95% CI: 0.24-2.06), and need of definitive ventricular shunting, 0.80 (95% CI: 0.51-1.24). Assessment of heterogeneity only revealed statistically significant indexes for the analysis of severe disability (I(2)=70% and P=.01). External lumbar drainage was associated with a statistically significant decrease in the risk of delayed cerebral ischemia-related complications (cerebral infarctions and clinical deterioration), as well as the risk of severe disability; however, it was not translated in a lower mortality. Nevertheless, it is not prudent to provide definitive recommendations at this time because of the qualitative and quantitative heterogeneity among included studies. More randomized controlled trials with more homogeneous outcomes and definitions are needed to clarify its impact in patients with aneurysmal subarachnoid hemorrhage. Copyright © 2013 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

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

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    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.)

  2. Effects of Radiation Exposure on the Cost-Effectiveness of CT Angiography and Perfusion Imaging in Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Ivanidze, J; Charalel, R A; Shuryak, I; Brenner, D; Pandya, A; Kallas, O N; Kesavabhotla, K; Segal, A Z; Simon, M S; Sanelli, P C

    2017-03-01

    CT angiography and perfusion imaging is an important prognostic tool in the management of patients with aneurysmal subarachnoid hemorrhage. The purpose of this study was to perform a cost-effectiveness analysis of advanced imaging in patients with SAH, incorporating the risks of radiation exposure from CT angiography and CT perfusion imaging. The risks of radiation-induced brain cancer and cataracts were incorporated into our established decision model comparing the cost-effectiveness of CT angiography and CT perfusion imaging and transcranial Doppler sonography in SAH. Cancer risk was calculated by using National Cancer Institute methodology. The remaining input probabilities were based on literature data and a cohort at our institution. Outcomes were expected quality-adjusted life years gained, costs, and incremental cost-effectiveness ratios. One-way, 2-way, and probabilistic sensitivity analyses were performed. CT angiography and CT perfusion imaging were the dominant strategies, resulting in both better health outcomes and lower costs, even when incorporating brain cancer and cataract risks. Our results remained robust in 2-way sensitivity analyses varying the prolonged latency period up to 30 years, with either brain cancer risk up to 50 times higher than the upper 95% CI limit or the probability of cataracts from 0 to 1. Results were consistent for scenarios that considered either symptomatic or asymptomatic patients with SAH. Probabilistic sensitivity analysis confirmed our findings over a broad range of selected input parameters. While risks of radiation exposure represent an important consideration, CT angiography and CT perfusion imaging remained the preferred imaging compared with transcranial Doppler sonography in both asymptomatic and symptomatic patients with SAH, with improved health outcomes and lower health care costs, even when modeling a significantly higher risk and shorter latency period for both cataract and brain cancer than that currently

  3. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Dubosh, Nicole M; Bellolio, M Fernanda; Rabinstein, Alejandro A; Edlow, Jonathan A

    2016-03-01

    Emerging evidence demonstrating the high sensitivity of early brain computed tomography (CT) brings into question the necessity of always performing lumbar puncture after a negative CT in the diagnosis of spontaneous subarachnoid hemorrhage (SAH). Our objective was to determine the sensitivity of brain CT using modern scanners (16-slice technology or greater) when performed within 6 hours of headache onset to exclude SAH in neurologically intact patients. After conducting a comprehensive literature search using Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus, we conducted a meta-analysis. We included original research studies of adults presenting with a history concerning for spontaneous SAH and who had noncontrast brain CT scan using a modern generation multidetector CT scanner within 6 hours of symptom onset. Our study adheres to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). A total of 882 titles were reviewed and 5 articles met inclusion criteria, including an estimated 8907 patients. Thirteen had a missed SAH (incidence 1.46 per 1000) on brain CTs within 6 hours. Overall sensitivity of the CT was 0.987 (95% confidence intervals, 0.971-0.994) and specificity was 0.999 (95% confidence intervals, 0.993-1.0). The pooled likelihood ratio of a negative CT was 0.010 (95% confidence intervals, 0.003-0.034). In patients presenting with thunderclap headache and normal neurological examination, normal brain CT within 6 hours of headache is extremely sensitive in ruling out aneurysmal SAH. © 2016 American Heart Association, Inc.

  4. 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.)

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

    Science.gov (United States)

    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

    2017-03-01

    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. In this study, participation restrictions and participation satisfaction experienced after aSAH were assessed. Moreover, possible predictors of participation after aSAH were examined to identify goals for rehabilitation. Participation restrictions experienced by a series of 67 patients visiting our SAH outpatient clinic were assessed as part of standard clinical care using the Participation Restrictions and Satisfaction sections of the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-Participation) 6 months after aSAH. Cognitive impairments, cognitive and emotional complaints, and symptoms of depression and anxiety, assessed 10 weeks after aSAH, were examined as possible predictors of participation by means of linear regression analysis. Although patients were ADL-independent, 64% reported one or more participation restrictions and 60% were dissatisfied in one or more participation domains. Most commonly experienced restrictions concerned housekeeping, chores in and around the house, and physical exercise. Dissatisfaction was most often reported about outdoor activities, mobility, and work/housekeeping. The main predictors of participation restrictions as well as satisfaction with participation were cognitive complaints (subjective) (β = -.30, p = .03 and β = -.40, p = .002, respectively) and anxiety (β = .32, p = .02 and β = -.34, p = .007, respectively). Almost two-thirds of the ADL-independent patients experienced problems of participation 6 months after aSAH. Cognitive complaints (subjective) and anxiety symptoms showed the strongest association with participation restrictions and satisfaction. Cognitive rehabilitation and anxiety-reducing interventions may help to optimize rehabilitation and increase

  6. Psychosocial impact of screening for intracranial aneurysms in relatives with familial subarachnoid hemorrhage

    NARCIS (Netherlands)

    Wermer, M. J. H.; van der Schaaf, I. C.; van Nunen, P.; Bossuyt, P. M. M.; Anderson, C. S.; Rinkel, G. J. E.

    2005-01-01

    Background and Purpose - In families with >= 2 relatives with intracranial aneurysms (IAs), screening for IAs in asymptomatic first-degree relatives is often recommended. We assessed the long-term psychosocial impact of such screening. Methods - We identified all persons with IA (screen-positives)

  7. MR of acute subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Spickler, E.; Lufkin, R.; Frazee, J.; Lylyk, P.; Vinuela, F.; Bentson, J.; Dion, J.

    1987-01-01

    Subarachnoid hemorrhage was produced in four Macaca nemestrina monkeys using the technique of Frazee. CT and MR imaging was performed immediately after the procedure and at frequent intervals up to 2 weeks after hemorrhage. The imaging studies were compared with clinical evaluations and pathologic specimens of all animals. Additional human clinical CT/MR studies of subarachnoid hemorrhage were also studied. Acute hemorrhage was recognized on MR images as an increase in signal in the region of clot compared with surrounding cerebrospinal fluid. This most likely reflects T1 shortening due to proton binding rather than a pure paramagnetic effect. While CT is sensitive to the hemoglobin protein in acute hemorrhage, the superior resolution of MR of the basal cisterns results in equal or better definition of acute subarachnoid hemorrhage on MR studies in many cases

  8. Troponin elevation in subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Ioannis N. Mavridis

    2015-03-01

    Full Text Available 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 >1 μg/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.

  9. Temporal evolution of vasospasm and clinical outcome after intra-arterial vasodilator therapy in patients with aneurysmal subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Laleh Daftari Besheli

    Full Text Available Intra-arterial (IA vasodilator therapy is one of the recommended treatments to minimize the impact of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm refractory to standard management. However, its usefulness and efficacy is not well established. We evaluated the effect IA vasodilator therapy on middle cerebral artery blood flow and on discharge outcome. We reviewed records for 115 adults admitted to Neurointensive Care Unit to test whether there was a difference in clinical outcome (discharge mRS in those who received IA infusions. In a subset of 19 patients (33 vessels treated using IA therapy, we tested whether therapy was effective in reversing the trends in blood flow. All measures of MCA blood flow increased from day -2 to -1 before infusion (maximum Peak Systolic Velocity (PSV 232.2±9.4 to 262.4±12.5 cm/s [p = 0.02]; average PSV 202.1±8.5 to 229.9±10.9 [p = 0.02]; highest Mean Flow Velocity (MFV 154.3±8.3 to 172.9±10.5 [p = 0.10]; average MFV 125.5±6.3 to 147.8±9.5 cm/s, [p = 0.02] but not post-infusion (maximum PSV 261.2±14.6 cm/s [p = .89]; average PSV 223.4±11.4 [p = 0.56]; highest MFV 182.9±12.4 cm/s [p = 0.38]; average MFV 153.0±10.2 cm/s [p = 0.54]. After IA therapy, flow velocities were consistently reduced (day X infusion interaction p<0.01 for all measures. However, discharge mRS was higher in IA infusion group, even after adjusting for sex, age, and admission grades. Thus, while IA vasodilator therapy was effective in reversing the vasospasm-mediated deterioration in blood flow, clinical outcomes in the treated group were worse than the untreated group. There is need for a prospective randomized controlled trial to avoid potential confounding effect of selection bias.

  10. Recovery from a Subarachnoid Hemorrhage: Patient and Spouse Perspectives

    Science.gov (United States)

    Brice, Roanne G.; Brice, Alejandro

    2017-01-01

    This second article of a two-part case study focuses on the experiences of a patient and his spouse (caregiver) when a neurological trauma occurs. It is the personal account when A.B. survived a vertebral artery aneurysm and hemorrhage resulting in a subarachnoid hemorrhage. It is also an in-depth post-trauma account from two speech-language…

  11. Diagnostic Accuracy of Simulated Low-Dose Perfusion CT to Detect Cerebral Perfusion Impairment after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Analysis.

    Science.gov (United States)

    Afat, Saif; Brockmann, Carolin; Nikoubashman, Omid; Müller, Marguerite; Thierfelder, Kolja M; Brockmann, Marc A; Nikolaou, Konstantin; Wiesmann, Martin; Kim, Jong Hyo; Othman, Ahmed E

    2018-01-08

    Purpose To evaluate diagnostic accuracy of low-dose volume perfusion (VP) computed tomography (CT) compared with original VP CT regarding the detection of cerebral perfusion impairment after aneurysmal subarachnoid hemorrhage. Materials and Methods In this retrospective study, 85 patients (mean age, 59.6 years; 62 women) with aneurysmal subarachnoid hemorrhage and who were suspected of having cerebral vasospasm at unenhanced CT and VP CT (tube voltage, 80 kVp; tube current-time product, 180 mAs) were included, 37 of whom underwent digital subtraction angiography (DSA) within 6 hours. Low-dose VP CT data sets at tube current-time product of 72 mAs were retrospectively generated by validated realistic simulation. Perfusion maps were generated from both data sets and reviewed by two neuroradiologists for overall image quality, diagnostic confidence and presence and/or severity of perfusion impairment indicating vasospasm. An interventional neuroradiologist evaluated 16 vascular segments at DSA. Diagnostic accuracy of low-dose VP CT was calculated with original VP CT as reference standard. Agreement between findings of both data sets was assessed by using weighted Cohen κ and findings were correlated with DSA by using Spearman correlation. After quantitative volumetric analysis, lesion volumes were compared on both VP CT data sets. Results Low-dose VP CT yielded good ratings of image quality and diagnostic confidence and classified all patients correctly with high diagnostic accuracy (sensitivity, 99.0%; specificity, 99.5%) without significant differences regarding presence and/or severity of perfusion impairment between original and low-dose data sets (Z = -0.447; P = .655). Findings of both data sets correlated significantly with DSA (original, r = 0.671; low dose, r = 0.667). Lesion volume was comparable for both data sets (relative difference, 5.9% ± 5.1 [range, 0.2%-25.0%; median, 4.0%]) with strong correlation (r = 0.955). Conclusion The results suggest that

  12. Continuous Acetylsalicylic Acid Treatment Does Not Influence Bleeding Pattern or Outcome of Aneurysmal Subarachnoid Hemorrhage: A Matched-Pair Analysis.

    Science.gov (United States)

    Bruder, Markus; Won, Sae-Yeon; Wagner, Marlies; Brawanski, Nina; Dinc, Nazife; Kashefiolasl, Sepide; Seifert, Volker; Konczalla, Juergen

    2018-02-03

    Demographic changes are leading to an aging society with a growing number of patients with cardiovascular diseases, relying on antiplatelet drugs like acetylsalicylic acid (ASA). Although antiplatelet agents are suspected to be protective not only in the cardiologic but in the neurovascular field, the alteration of the coagulating process could have a major impact on the course and outcome after rupture of intracranial aneurysms. Between June 1999 and December 2014, 1422 patients were treated for aneurysmal SAH in our institution, 144 (10.1%) with continuous ASA at the time of aneurysm rupture. A matched-pair analysis was performed. The rate of patients with continuous ASA treatment while rupture of the aneurysm is rising significantly (P < 0.01). Those patients were significantly older than patients without ASA (60 vs. 53 years, P < 0.001). ASA-treated patients more often had aneurysmal rebleeding (4.7% vs. 2.3%, P = 0.3) and treatment-related hemorrhagic complications (13.9% vs. 6.2%, P = 0.06). However, rates were not different in microsurgical or endovascular procedures (16.4% vs. 12.2%, P = 0.6). Favorable outcome (Modified Rankin Scale 0-2) was achieved in 49.3% of the ASA group and 52.1% of the control group (P = 0.7). Patients with continuous ASA treatment were significantly older than patients without ASA, but there was no difference in admission status or bleeding pattern. Outcome was not different in the matched-pair analysis. There was no statistical difference in treatment related-complication rates of microsurgical and endovascular procedures. Therefore, ASA use should not influence treatment decision of the ruptured aneurysm. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Respiratory arrest in subarachnoid hemorrhage

    NARCIS (Netherlands)

    Hijdra, A.; Vermeulen, M.; van Gijn, J.; van Crevel, H.

    1984-01-01

    Sudden loss of consciousness and cardiorespiratory disorders occurred in 43 of 254 patients with subarachnoid hemorrhage. Two patients had ventricular fibrillation, 37 had one or more episodes with a disturbance of respiratory rhythm that required assisted ventilation, and 4 died suddenly without

  14. Enterprise stent-assisted coiling for wide-necked intracranial aneurysms during ultra-early (48hours) subarachnoid hemorrhage: a single-center experience in 59 consecutive patients.

    Science.gov (United States)

    Liu, Aihua; Peng, Tangming; Qian, Zenghui; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Yang, Xinjian

    2015-10-01

    Accumulated experience and improvement of stents dedicated to intracranial use have significantly widened the applicability of stent-assisted coiling (SAC) to ruptured wide-necked aneurysms. This retrospective study was designed to evaluate the safety and efficacy of SAC using the Enterprise stent for ruptured wide-necked intracranial aneurysms during ultra-early subarachnoid hemorrhage. We reviewed data from 59 consecutive patients with ruptured wide-necked aneurysms who had SAC using the Enterprise stent performed within 48hours of onset. Data collected and analyzed included: patient demographics; morphologic features of the aneurysm; treatment results and follow-up results. Clinical outcomes were evaluated by modified Rankin Scale (mRS). In all 59 cases, SAC using the Enterprise stent was performed successfully, with no significant technical difficulties. Initial angiographic results were: complete occlusion in 38 cases; near occlusion in 17; and partial occlusion in four. Angiographic follow-up of 48 patients showed that 46 (95.8%) remained stable or improved, without regrowth, while regrowth was imaged in two patients. Medium-term clinical follow-up of 54 patients (mean, 26.9months) showed that 88.9% had a good outcome (mRS: 0 in 34; 1 in eight; and 2 in six), and 11.1% poor outcomes (mRS: 3 in four; and 4 in two). Enterprise SAC is a safe and viable option for treatment of ruptured wide-necked aneurysms within 48hours of ictus. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. 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.

    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

  16. 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.

  17. Isolated Subarachnoidal Hemorrhage following Carotid Endarterectomy.

    Science.gov (United States)

    Bodenant, Marie; Leys, Didier; Lucas, Christian

    2010-06-08

    Cerebral hyperperfusion syndrome is a rare but well-described complication following carotid endarterectomy or stenting. Clinical signs are ipsilateral, throbbing, unilateral headache with nausea or vomiting, seizures, and neurological deficits, with or without intracerebral abnormalities on CT scan, such as brain edema or intracerebral hemorrhage. Subarachnoidal hemorrhage is rarely described especially if it occurs isolated. We describe a 74-year-old man with a history of high blood pressure, hypercholesterolemia, atrioventricular block with pacemaker, and ischemic cardiopathy with coronary bypass. He underwent right carotid endarterectomy for a 90% NASCET asymptomatic stenosis. Four days after surgery, he complained of unusual headaches with right, throbbing hemicrania. Nine days after surgery, he presented with left hemiplegia and a partial motor seizure. He had fluctuant altered consciousness, left hemiplegia, and left visual and sensory neglect. Brain CT showed right frontal subarachnoidal hemorrhage without parenchymal bleeding. Cerebral angiography found no cerebral aneurysm, no vascular malformation, but a vasospasm of the left middle cerebral artery. Transcranial Doppler confirmed this vasospasm. Evolution was favorable with no recurrence of seizures but with an improvement of the neurological deficits and vasospasm. Physicians should bear in mind this very rare complication of endarterectomy and immediately perform neuroimaging in case of unusual headache following endarterectomy or angioplasty.

  18. 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

  19. Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    G. Logan Douds

    2012-01-01

    Full Text Available Although fever and infection have been implicated in the causation of delayed neurological deficits (DND and poor outcome after aneurysmal subarachnoid hemorrhage (SAH, the relationship between these two often related events has not been extensively studied. We reviewed these events through of our retrospective database of patients with SAH. Multivariate logistic regression was used to determine independent predictors of DND and poor outcome. A total of 186 patients were analyzed. DND was noted in 76 patients (45%. Fever was recorded in 102 patients (55%; infection was noted in 87 patients (47%. A patient with one infection was more likely to experience DND compared to a patient with no infections (adjusted OR 3.73, 95% CI 1.62, 8.59. For those with more than two infections the likelihood of DND was even greater (adjusted OR 4.24, 95% CI 1.55, 11.56. Patients with 1-2 days of fever were less likely to have a favorable outcome when compared to their counterparts with no fever (adjusted OR 0.19, 95% CI 0.06, 0.62. This trend worsened as the number of days febrile increased. These data suggest that the presence of infection is associated with DND, but that fever may have a stronger independent association with overall outcome.

  20. Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture.

    Science.gov (United States)

    Inoue, Takashi; Shimizu, Hiroaki; Fujimura, Miki; Sato, Kenichi; Endo, Hidenori; Niizuma, Kuniyasu; Sakata, Hiroyuki; Tominaga, Teiji

    2015-12-01

    Postoperative meningitis is a serious complication occurring after neurosurgical interventions. However, few investigations have focused specifically on the risk factors that predispose patients to meningitis after major craniotomy. This study identified the risk factors for postoperative meningitis after neurovascular surgery, and investigated the relationship between postoperative meningitis and clinical outcome. A total of 148 consecutive patients with subarachnoid hemorrhage (SAH) who underwent clipping surgery through a pterional approach within 72 h between January 2007 and September 2011 were retrospectively analyzed. The treatment strategy of our hospital for patients with SAH was based on the findings of digital subtraction angiography in the acute phase. Coil embolization was firstly considered, and clipping through craniotomy if indicated was performed as soon as possible. Prophylactic antibiotics were administered before beginning craniotomy and for at least 3 days after. Hydrocortisone was used to prevent hyponatremia if allowed by the medical condition of the patient. Intrathecal administration of nicardipine hydrochloride was given if required for vasospasm treatment. Meningitis was clinically diagnosed from the blood samplings and cerebrospinal fluid (CSF) examinations. Data were collected from the electronic and paper charts. The status of modified Rankin scale (mRS) 0-2 at discharge was defined as favorable outcome. A total of 14 patients (9.5%) had meningitis during this study period. Symptomatic vasospasm was detected in 33 patients (22.3%), and 12 patients (8.1%) had permanent neurological deficits caused by vasospasm. Overall, 109 patients (73.6%) had favorable outcome. The longer duration of drainage placement, presence of CSF leakage, and intrathecal administration of vasodilatory agent showed significantly higher incidence of postoperative meningitis in univariate analysis (p=0.0093, 0.0017, and 0.0090, respectively). The proportion of

  1. CT findings of fulminant subarachnoid hemorrhages

    International Nuclear Information System (INIS)

    Ikeda, Yukio; Isayama, Kazuo; Yajima, Kouzo; Nakazawa, Shozo; Yano, Masami; Otsuka, Toshibumi

    1985-01-01

    We studied the clinical features and CT findings of 20 cases with fulminant subarachonid hemorrhages in the acute stage. They were admitted to our hospital within 3 hours after the attack as DOA (dead on arrival) or near DOA. CT-visualized subarachnoid hemorrhages were located in the basal cisterns surrounding the brain stem in all cases. In 90 % of the cases, the subarachnoid hemorrhage formed a clot or a thick layer. Massive intracerebral hematomas were observed in 10 % of the cases. Acute intraventricular hemorrhages were seen in 80 % of the cases. The mechanism of intraventricular hemorrhage in 70 % of the cases was of the reflux type, which was characterized by a reflux of the severe subarachnoid hemorrhage in the basal cistern. Acute and diffuse brain swelling on CT scan was observed in several cases, which also showed initial increased intracranial pressures. The major mechanisms leading to acute death or a very severe state soon after subarachnoid hemorrhage might be caused by acute brain-stem failure due to severe subarachnoid hemorrhages in the basal cisterns surrounding the brain-stem and an acute increase in intracranial pressure by cerebral edema following subarachnoid hemorrhage and secondary cerebral ischemia due to cardiac and respiratory arrest. (author)

  2. The Course of Headache in Patients With Moderate-to-Severe Headache Due to Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cross-Sectional Study.

    Science.gov (United States)

    Hong, Chang-Ki; Joo, Jin-Yang; Kim, Yong Bae; Shim, Yu Shik; Lim, Yong Cheol; Shin, Yong Sam; Chung, Joonho

    2015-01-01

    The purpose of this study was to evaluate the course of headache in patients with moderate-to-severe headache due to aneurysmal subarachnoid hemorrhage (aSAH) and to identify its predisposing factors. Little is known about the long-term course of headache in patients with aSAH. Since September 2009, patients with aSAH have had their headaches prospectively rated using a numeric rating scale (NRS). From this database containing 838 patients, 217 were included and all included patients met the following criteria: (1) presence of ruptured intracranial aneurysms on computed tomography angiography or magnetic resonance angiography; (2) alert consciousness (Glasgow Coma Scale 15); (3) newly onset moderate-to-severe headache (NRS ≥ 4) due to ruptured intracranial aneurysms; and (4) good clinical outcome at discharge (modified Rankin Scale 0, 1, or 2). We observed the changes in NRS scores from initial to 12-month follow-up and identified the predisposing factors of NRS changes. Of the 217 patients, 182 (83.9%) experienced improvement in NRS score ≤ 3 upon discharge. The NRS scores at discharge were significantly lower than those on admission (P headache improvement included previous stroke (odds ratio [OR] = 0.141; 95% CI 0.051-0.381; P headache treated with medication (OR = 0.079; 95% CI 0.010-0.518; P = .008), and endovascular treatment (EVT; OR = 2.531; 95% CI 1.141-5.912; P = .026). The NRS scores tended to decrease continuously until the 12-month follow-up. EVT and symptomatic vasospasm were independently associated with a decrease of NRS in the follow-up periods. The course of headache in patients with aSAH continuously improved during the 12 months of follow-up. Headache improvement might be expected in patients who were treated with EVT and in those who did not have previous stroke or headache. © 2015 American Headache Society.

  3. 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.

  4. The Use of Social Media Communications in Brain Aneurysms and Subarachnoid Hemorrhage: A Mixed-Method Analysis.

    Science.gov (United States)

    Alotaibi, Naif M; Samuel, Nardin; Wang, Justin; Ahuja, Christopher S; Guha, Daipayan; Ibrahim, George M; Schweizer, Tom A; Saposnik, Gustavo; Macdonald, R Loch

    2017-02-01

    The diagnosis of a ruptured or unruptured brain aneurysm has a significant impact on patients' quality of life and their psychosocial well-being. As a result, patients and caregivers may resort to social media platforms for support and education. The aim of this report is to evaluate the use of social media and the online communications regarding brain aneurysms. Three social media platforms (Facebook, Twitter, and YouTube) were assessed for public content pertaining to brain aneurysms in March 2016. We conducted a mixed-method analysis that includes a descriptive examination of cross-sectional data and a qualitative evaluation of online communications for thematic analysis. We assessed categorized data using nonparametric tests for statistical significance. Our analyses showed that Facebook was the most highly used social media platform, with 11 relevant pages and 83 groups. Facebook accounts were all nonprofit foundations or patient support groups. Most users in Facebook groups were joining private support groups as opposed to public (P study is the first to provide insight into characteristics and patterns of social media communications regarding brain aneurysms. These findings should serve to inform the treating physicians of the needs and expectations of individuals affected by brain aneurysms. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS).

    Science.gov (United States)

    Neidert, Marian Christoph; Maldaner, Nicolai; Stienen, Martin Nikolaus; Roethlisberger, Michel; Zumofen, Daniel W; D'Alonzo, Donato; Marbacher, Serge; Maduri, Rodolfo; Hostettler, Isabel Charlotte; Schatlo, Bawarjan; Schneider, Michel M; Seule, Martin A; Schöni, Daniel; Goldberg, Johannes; Fung, Christian; Arrighi, Marta; Valsecchi, Daniele; Bijlenga, Philippe; Schaller, Karl; Bozinov, Oliver; Regli, Luca; Burkhardt, Jan-Karl

    2018-01-17

    The Barrow Neurological Institute (BNI) scale is a novel quantitative scale measuring maximal subarachnoid hemorrhage (SAH) thickness to predict delayed cerebral ischemia (DCI). This scale could replace the Fisher score, which was traditionally used for DCI prediction. To validate the BNI scale. All patient data were obtained from the prospective aneurysmal SAH multicenter registry. In 1321 patients, demographic data, BNI scale, DCI, and modified Rankin Scale (mRS) score up to the 1-yr follow-up (1FU) were available for descriptive and univariate statistics. Outcome was dichotomized in favorable (mRS 0-2) and unfavorable (mRS 3-6). Odds ratios (OR) for DCI of Fisher 3 patients (n = 1115, 84%) compared to a control cohort of Fisher grade 1, 2, and 4 patients (n = 206, 16%) were calculated for each BNI grade separately. Overall, 409 patients (31%) developed DCI with a high DCI rate in the Fisher 3 cohort (34%). With regard to the BNI scale, DCI rates went up progressively from 26% (BNI 2) to 38% (BNI 5) and corresponding OR for DCI increased from 1.9 (1.0-3.5, 95% confidence interval) to 3.4 (2.1-5.3), respectively. BNI grade 5 patients had high rates of unfavorable outcome with 75% at discharge and 58% at 1FU. Likelihood for unfavorable outcome was high in BNI grade 5 patients with OR 5.9 (3.9-8.9) at discharge and OR 6.6 (4.1-10.5) at 1FU. This multicenter external validation analysis confirms that patients with a higher BNI grade show a significantly higher risk for DCI; high BNI grade was a predictor for unfavorable outcome at discharge and 1FU. Copyright © 2018 by the Congress of Neurological Surgeons

  6. MR imaging of acute subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Spickler, E.; Lufkin, R.B.; Frazee, J.; Lylyk, P.; Vinuela, F.; Bentson, J.R.; Dion, J.E.

    1987-01-01

    Subarachnoid hemorrhage was produced in four Macaca nemestrina monkeys using the technique of Frazee. CT and MR imaging were performed immediately after the procedure and at frequent intervals up to 2 weeks after hemorrhage. The imaging studies were compared with clinical evaluations and pathologic specimens of all animals. Additional human clinical CT/MR studies of subarachnoid hemorrhage were also studied. Acute hemorrhage was recognized on MR as an increase in signal in the region of clot compared with surrounding cerebrospinal fluid. This most likely reflects T1 shortening due to proton binding rather than a pure paramagnetic effect. While CT is sensitive to the hemoglobin protein in acute hemorrhage, the superior resolution of the basal cisterns on MR images results in equal or better definition of acute subarachnoid hemorrhage on MR in many cases

  7. 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

    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...... 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 (32.1......±0.5%), and ACCTTDC (9.5±0.2%). No significant difference in distribution of alleles, genotypes, haplotypes, or haplotype pairs between the 2 populations was found. Specifically, we could not reproduce previously reported associations between the ACE I genotype and intracranial aneurysms. When subdivided into groups...

  8. Hippocampal Atrophy Following Subarachnoid Hemorrhage Correlates with Disruption of Astrocyte Morphology and Capillary Coverage by AQP4

    DEFF Research Database (Denmark)

    Anzabi, Maryam; Ardalan, Maryam; Iversen, Nina Kerting

    2018-01-01

    Despite successful management of ruptured intracranial aneurysm following subarachnoid hemorrhage (SAH), delayed cerebral ischemia (DCI) remains the main cause of high mortality and morbidity in patients who survive the initial bleeding. Astrocytes play a key role in neurovascular coupling...

  9. Subarachnoid hemorrhage as a psychological trauma.

    Science.gov (United States)

    Hütter, Bernd-Otto; Kreitschmann-Andermahr, Ilonka

    2014-04-01

    Despite the progress made in the management of subarachnoid hemorrhage (SAH), many patients complain of persistent psychosocial and cognitive problems. The present study was performed to explore the significance of psychological traumatization by the bleeding with respect to psychosocial results after SAH. A series of 45 patients were examined in a cross-sectional study an average of 49.4 months after SAH by means of a quality-of-life questionnaire, the Beck Depression Inventory, the German version of the Impact of Event Scale (IES), and a clinical interview (Structured Clinical Interview for DSM Disorders) to make the diagnosis of chronic posttraumatic stress disorder (PTSD). Twenty-nine patients underwent surgery for treatment of a ruptured aneurysm; the remaining 16 patients had SAH of unknown origin. Twelve patients (27%) exhibited PTSD, and almost two-thirds of the 45 patients in the study reported substantial fear of recurrent hemorrhage. Not only the presence of PTSD but the severity of psychological traumatization as assessed by the IES explained up to 40% of the variance of the self- and proxy-rated impairments. Multivariate analyses revealed psychological traumatization (IES) and neurological state on admission (Hunt and Hess grade) as substantial predictors of the self- and proxy-rated quality of life, explaining 31% and 42% of the variance, respectively. Even several years after SAH, the severity of psychological traumatization by the bleeding substantially determines the degree of psychosocial impairment. In the future, this issue should be addressed in the care of these patients. Furthermore, the development of psychological interventions is called for to prevent the emergence of PTSD after SAH.

  10. Proximity to the treating centre and outcomes following subarachnoid hemorrhage.

    Science.gov (United States)

    O'Kelly, Cian J; Spears, Julian; Urbach, David; Wallace, M Christopher

    2011-01-01

    In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH. Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre. The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300 km, mortality increased with increasing distance. Over 300 km, a survival benefit was observed. Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.

  11. Presentation of Significant Subarachnoid Hemorrhage without Loss of Consciousness

    Directory of Open Access Journals (Sweden)

    Nicholas Taylor

    2017-04-01

    Full Text Available History of present illness: A 68-year-old female with history of hypertension presented to the emergency department one hour after the sudden onset of 10/10 headache. The patient had a history of headaches, but described this episode as the “worst of her life” with associated vomiting, mild neck pain with movement, increased light sensitivity, and generalized weakness. The patient denied focal weakness or changes in vision. On exam, the patient was awake and alert with no slurred speech. Gait was intact and strength was 5/5 bilaterally in the upper and lower extremities. She had no facial asymmetry. Significant findings: A non-contrast head CT demonstrated extensive subarachnoid hemorrhage occupying both cerebral convexities, the anterior interhemispheric fissure, the sylvian fissures, and the basal cisterns. Later CTA would show an 8 mm by 7 mm by 8mm MCA aneurysm near the M1/M2 junction and two pericallosal artery aneurysms, 7 by 6 mm and 8 by 5 mm respectively. The patient underwent external ventricular drain (EVD placement by neurosurgery, followed by coiling of the three aneurysms by interventional radiology. Discussion: Subarachnoid hemorrhages account for 10 percent of cerebrovascular accidents, with mortality rates approaching 50 percent. Most subarachnoid hemorrhages are due to ruptured saccular aneurysms located at bifurcations of arteries within the circle of Willis. Other causes include trauma or AV malformations. Common complications of SAH include vasospasms, cerebral tissue infarction, seizure, and cardiac complications.1 In addition to the sudden severe headache seen in 97 percent of cases, 50 percent of patients experience transient loss of consciousness, and many experience vomiting, meningeal irritation, nuchal rigidity, and photosensitivity.2 One retrospective series evaluating proven non-traumatic, spontaneous subarachnoid hemorrhages found nausea or vomiting in 77 percent of patients, loss of consciousness in 53 percent

  12. Subarachnoid hemosiderin deposition after subarachnoid hemorrhage on T2*-weighted MRI correlates with the location of disturbed cerebrospinal fluid flow on computed tomography cisternography.

    Science.gov (United States)

    Horita, Yoshifumi; Imaizumi, Toshio; Hashimoto, Yuji; Niwa, Jun

    2008-01-01

    A 72-year-old male was admitted with subarachnoid hemorrhage associated with a ruptured cerebral aneurysm. The aneurysm was treated with clipping soon after radiological examination. Eight weeks after the treatment, the patient suffered from secondary hydrocephalus resulting from blockage of the subarachnoid space due to subarachnoid granulation. Previous pathological examination revealed the granulation was associated with hemosiderin deposition. We investigated subarachnoid hemosiderin deposition in this patient using T2*-weighted (T2*-w) magnetic resonance image (MRI), a sensitive method for hemosiderin detection. computed tomography (CT) cisternography demonstrated that cerebrospinal fluid (CSF) flow was disturbed adjacent to sites of subarachnoid hemosiderin deposition on T2*-w MRI. Placement of a ventriculo-peritoneal shunt contributed to neurological improvement. In this case, T2*-w MRI was an effective means of diagnosing the location of disturbed CSF flow associated with subarachnoid hemosiderin deposition.

  13. Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Sophia F. Shakur

    2013-01-01

    Full Text Available Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage (SAH triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, who was on Coumadin for atrial fibrillation, presented with chest pain radiating to the back accompanied by headache and leg paresthesias. The international normalized ratio (INR was 4.5. Ten hours after presentation, she developed loss of movement in both legs and lack of sensation below the umbilicus. Spine MRI showed intradural hemorrhage. Her coagulopathy was reversed, and she underwent T2 to T12 laminectomies. A large subarachnoid hematoma was evacuated. Given her complaint of headache preoperatively and the intraoperative finding of spinal SAH, a head CT was done postoperatively that displayed SAH in peripheral sulci. On postoperative day 5, she became obtunded. Brain MRI demonstrated focal restricted diffusion in the left frontoparietal area. Formal angiography revealed vasospasm in anterior cerebral arteries bilaterally and right middle cerebral artery. Vasospasm was treated, and she returned to baseline within 48 hours. Spontaneous spinal SAH can result in the same sequelae typically associated with aneurysmal SAH, and the clinician must have a degree of suspicion in such patients. The pathophysiological mechanisms underlying cerebral vasospasm may explain this unique case.

  14. Brain Aneurysm

    Science.gov (United States)

    ... thin tissues covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage. A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment. Most brain aneurysms, however, don't rupture, create ...

  15. 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

    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

  16. Cerebral vasospasm following traumatic subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Bahram Aminmansour

    2009-11-01

    Full Text Available

    • Background: Cerebral vasospasm is a preventable cause of death and disability in patients who experience aneurysmal subarachnoid hemorrhage (SAH. The aim of this study is to investigate the incidence of cerebral vasospasm following traumatic SAH and its relationship with different brain injuries and severity of trauma.
    • Methods: This cross-sectional study was conducted from October 2006 to March 2007 in department of Neurosurgery in Al-Zahra Hospital. Consecutive head-injured patients who had SAH on the basis of an admission CT scan were prospectively evaluated. The severity of the trauma was evaluated by determining Glasgow Coma Scale (GCS score on admission. Transcranial Doppler ultrasonography evaluations were performed at least 48 hours after admission and one week thereafter. Vasospasm in the MCA and ACA was defined by mean flow velocity (FV of more than 120 cm/sec with a Lindegaard index (MVA/ICA FV ratio higher than 3. Basilar artery vasospasm was defined by FV higher than 85 cm/sec.
    • Results: Seventy seven patients with tSAH were enrolled from whom 13 were excluded. The remaining were 52 (81.2% men and 12 (18.7% women, with a mean age of 37.89 years. Trauma was severe in 11 (17.2%, moderate in 13 (20.3%, and mild in 40 (62.5% patients. From all, 27 patients (42.1% experienced at least one vasospasm during the study period and MCA vasospasm was the most common in the first and second weeks (55.5%.
    • Conclusions: Traumatic SAH is associated with a high incidence of cerebral vasospasm with a higher probability in patients with severe TBI.
    • Keywords: Cerebral Vasospasm, Subarachnoid Hemorrhage, Trauma, Traumatic Brain Injury.
  1. Arachnoid granulation affected by subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    R.P. Chopard

    1993-11-01

    Full Text Available The purpose of this study was to investigate using light microscopy the fibro-cellular components of arachnoid granulations affected by mild and severe subarachnoid hemorrage. The erythrocytes were in the channels delimitated by collagenous and elastic bundles and arachnoid cells, showing their tortuous and intercommunicating row from the pedicle to the fibrous capsule. The core portion of the pedicle and the center represented a principal route to the bulk outflow of cerebrospinal fluid and erythrocytes. In the severe hemorrhage, the fibrocellular components are desorganized, increasing the extracellular channels. We could see arachnoid granulations without erythrocytes, which cells showed big round nucleous suggesting their transformation into phagocytic cells.

  2. 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.

  3. MicroRNA Changes in Cerebrospinal Fluid After Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Bache, Søren; Rasmussen, Rune; Rossing, Maria

    2017-01-01

    BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) accounts for a major part of the morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). MicroRNAs (miRNAs) are pathophysiologically involved in acute cerebral ischemia. This study compared miRNA profiles in cerebrospinal fluid...... from neurologically healthy patients, as well as SAH patients with and without subsequent development of DCI. METHODS: In a prospective case-control study of SAH patients treated with external ventricular drainage and neurologically healthy patients, miRNA profiles in cerebrospinal fluid were screened...... passed quality control. In the validation, 66 miRNAs showed a relative increase in cerebrospinal fluid from SAH patients compared with neurologically healthy patients (P

  4. Non-aneurysmal non-perimesencephalic subarachnoid hemorrhage: effect of rehabilitation at short-term and in a prospective study of long-term follow-up.

    Science.gov (United States)

    Konczalla, Juergen; Schmitz, Jens; Kashefiolasl, Sepide; Senft, Christian; Platz, Johannes; Seifert, Volker

    2016-08-01

    A recently published prospective study identified an impaired outcome of patients with non-perimesencephalic (NPM) subarachnoid hemorrhage (SAH). Our objective was to analyze the long-term outcome of patients with subsequent rehabilitation after NPM SAH. A comparison of patients with NPM SAH receiving subsequent in-patient rehabilitation was done at discharge (using the modified Rankin scale (mRS)), short-term outcome after 6 months (mRS), and prospectively using a questionnaire (short-form health survey with 36 questions (SF-36)), which was sent to 66 patients. Thirty-seven patients answered the SF-36, on average 6.3 years after ictus (range 1.5-14 years). After NPM SAH, the mRS is impaired. Patients with subsequent rehabilitation had a significant better improvement until short-term follow-up. Until long-term outcome, the psychological items were non-significantly reduced, whereas all physical items (physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions) were significantly decreased compared to the standard population. In patients with subsequent rehabilitation, all items were only non-significantly reduced. About 16% of the patients developed secondary neurological and/or psychiatric diseases. The quality of life (QoL) is decreased after NPM SAH. In the long-term follow-up, a significant reduction in physical items was identified. Due to subsequent in-patient rehabilitation after NPM SAH, the impairment can be improved significantly until short-term follow-up. Whereas patients with NPM SAH had a significantly decreased QoL at long-term follow-up, for patients with rehabilitation, the QoL was only slightly (non-significantly) reduced. Therefore, patients should receive subsequent rehabilitation after NPM SAH to improve the functional short-term outcome (mRS) and long-term QoL. www.clinicaltrials.gov (Identifier No. NCT02334657).

  5. Cerebral Artery Remodeling in Rodent Models of Subarachnoid Hemorrhage

    NARCIS (Netherlands)

    Guvenc Tuna, Bilge; Lachkar, Nadia; de Vos, Judith; Bakker, Erik N. T. P.; VanBavel, Ed

    2015-01-01

    Vasospasm is known to contribute to delayed cerebral ischemia following subarachnoid hemorrhage (SAH). We hypothesized that vasospasm initiates structural changes within the vessel wall, possibly aggravating ischemia and leading to resistance to vasodilator treatment. We therefore investigated the

  6. Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia

    NARCIS (Netherlands)

    Sokolov, Arseny A.; Husain, Shakir; Sztajzel, Roman; Croquelois, Alexandre; Lobrinus, Johannes A.; Thaler, David; Städler, Claudio; Hungerbühler, Hansjörg; Caso, Valeria; Rinkel, Gabriel J.; Michel, Patrik

    2016-01-01

    Vertebrobasilar dolichoectasia (VBD) is a chronic disorder with various cerebrovascular and compressive manifestations, involving subarachnoid hemorrhage (SAH). Occurrence of SAH shortly after worsening of clinical VBD symptoms has occasionally been reported. The goal of the study was to examine

  7. Myocarditis in patients with subarachnoid hemorrhage : A histopathologic study

    NARCIS (Netherlands)

    van der Bilt, Ivo A C; Vendeville, Jean Paul; van de Hoef, Tim P.; Begieneman, Mark P V; Lagrand, Wim K.; Kros, Johan M.; Wilde, Arthur A M; Rinkel, Gabriel J E; Niessen, Hans W M

    Cardiac abnormalities after subarachnoid hemorrhage (SAH) such as electrocardiographic changes, echocardiographic wall motion abnormalities, and elevated troponin levels are independently associated with a poor prognosis. They are caused by catecholaminergic stress coinciding with influx of

  8. Brain Lactate Metabolism in Humans With Subarachnoid Hemorrhage

    OpenAIRE

    Oddo M; Levine JM; Frangos S; Maloney-Wilensky E; Carrera E; Daniel RT; Levivier M; Magistretti PJ; LeRoux PD

    2012-01-01

    Abstract BACKGROUND AND PURPOSE: Lactate is central for the regulation of brain metabolism and is an alternative substrate to glucose after injury. Brain lactate metabolism in patients with subarachnoid hemorrhage has not been fully elucidated. METHODS: Thirty one subarachnoid hemorrhage patients monitored with cerebral microdialysis (CMD) and brain oxygen (PbtO(2)) were studied. Samples with elevated CMD lactate (>4 mmol/L) were matched to PbtO(2) and CMD pyruvate and categorized as hypoxi...

  9. Paradoxical undressing associated with subarachnoid hemorrhage in a non-hypothermia case?

    Science.gov (United States)

    Descloux, Emilienne; Ducrot, Kewin; Scarpelli, Maria Pia; Lobrinus, Alexander; Palmiere, Cristian

    2017-09-01

    Paradoxical undressing is a phenomenon characterizing some fatal hypothermia cases. The victims, despite low environmental temperatures, paradoxically remove their clothes due to a sudden feeling of warmth. In this report, we describe a case of suspected paradoxical undressing in a non-hypothermia case. The victim, a 51-year-old Caucasian man, was found dead wearing only sneakers and socks. All other clothing was found in his car. Postmortem investigations allowed the hypothesis of hypothermia to be ruled out and revealed the presence of a ruptured cerebral aneurysm that caused a subarachnoid hemorrhage, the latter responsible for the death. The absence of any elements suggesting a voluntary undressing or any third party's DNA profile or involvement along with the possibility that the subarachnoid hemorrhage might have determined a hypothalamic injury, somehow rendered conceivable the hypothesis of an inappropriate feeling of warmth due to hemorrhage-induced dysregulation of the hypothalamic temperature-regulating centers.

  10. Neutrophil depletion after subarachnoid hemorrhage improves memory via NMDA receptors.

    Science.gov (United States)

    Provencio, Jose Javier; Swank, Valerie; Lu, Haiyan; Brunet, Sylvain; Baltan, Selva; Khapre, Rohini V; Seerapu, Himabindu; Kokiko-Cochran, Olga N; Lamb, Bruce T; Ransohoff, Richard M

    2016-05-01

    Cognitive deficits after aneurysmal subarachnoid hemorrhage (SAH) are common and disabling. Patients who experience delayed deterioration associated with vasospasm are likely to have cognitive deficits, particularly problems with executive function, verbal and spatial memory. Here, we report neurophysiological and pathological mechanisms underlying behavioral deficits in a murine model of SAH. On tests of spatial memory, animals with SAH performed worse than sham animals in the first week and one month after SAH suggesting a prolonged injury. Between three and six days after experimental hemorrhage, mice demonstrated loss of late long-term potentiation (L-LTP) due to dysfunction of the NMDA receptor. Suppression of innate immune cell activation prevents delayed vasospasm after murine SAH. We therefore explored the role of neutrophil-mediated innate inflammation on memory deficits after SAH. Depletion of neutrophils three days after SAH mitigates tissue inflammation, reverses cerebral vasoconstriction in the middle cerebral artery, and rescues L-LTP dysfunction at day 6. Spatial memory deficits in both the short and long-term are improved and associated with a shift of NMDA receptor subunit composition toward a memory sparing phenotype. This work supports further investigating suppression of innate immunity after SAH as a target for preventative therapies in SAH. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    International Nuclear Information System (INIS)

    Gonzalez Valverde, F.M.; Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-01-01

    Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture

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

    International Nuclear Information System (INIS)

    Coolen, Teresa

    2006-01-01

    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

  13. The Importance of Early Brain Injury after Subarachnoid Hemorrhage

    Science.gov (United States)

    Sehba, Fatima A.; Hou, Jack; Pluta, Ryszard M.; Zhang, John H.

    2012-01-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency that accounts for 5% of all stroke cases. Individuals affected are typically in the prime of their lives (mean age 50 years). Approximately 12% of patients die before receiving medical attention, 33% within 48 hours and 50% within 30 days of aSAH. Of the survivors 50% suffer from permanent disability with an estimated lifetime cost more than double that of an ischemic stroke. Traditionally, spasm that develops in large cerebral arteries 3-7 days after aneurysm rupture is considered the most important determinant of brain injury and outcome after aSAH. However, recent studies show that prevention of delayed vasospasm does not improve outcome in aSAH patients. This finding has finally brought in focus the influence of early brain injury on outcome of aSAH. A substantial amount of evidence indicates that brain injury begins at the aneurysm rupture, evolves with time and plays an important role in patients’ outcome. In this manuscript we review early brain injury after aSAH. Due to the early nature, most of the information on this injury comes from animals and few only from autopsy of patients who died within days after aSAH. Consequently, we began with a review of animal models of early brain injury, next we review the mechanisms of brain injury according to the sequence of their temporal appearance and finally we discuss the failure of clinical translation of therapies successful in animal models of aSAH. PMID:22414893

  14. 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.)

  15. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage.

    NARCIS (Netherlands)

    Linn, F.H.H.; Wijdicks, E.F.M.; Graaf, Y. van der; Weerdesteyn-van Vliet, F.A.C.; Bartelds, A.I.M.; Gijn, J. van

    1994-01-01

    Retrospective surveys of patients with subarachnoid haemorrhage suggest that minor episodes with sudden headache (warning leaks) may precede rupture of an aneurysm, and that early recognition and surgery might lead to improved outcome. We studied 148 patients with sudden and severe headache

  16. Detection of hemosiderin deposition by T2*-weighted MRI after subarachnoid hemorrhage.

    Science.gov (United States)

    Imaizumi, Toshio; Chiba, Masahiko; Honma, Toshimi; Niwa, Jun

    2003-07-01

    Subarachnoid hemorrhage (SAH) is very difficult to diagnose several months after its onset. We thus investigated subarachnoid hemosiderin deposition well after SAH by T2*-weighted MRI, a sensitive method for hemosiderin detection. To investigate how hemosiderin deposition as confirmed by T2*-weighted MRI contributes to the determination of prior SAH and how the extent of hemosiderin deposition is associated with a number of clinical factors, we retrospectively analyzed 58 patients >3 months after SAH associated with ruptured aneurysms. We also investigated 209 healthy volunteers as controls. T2*-weighted MRI demonstrated subarachnoid hemosiderin deposition in 72.4% of the SAH patients, whereas no deposition was seen in the healthy volunteer group. The hemosiderin was preferentially deposited in the subarachnoid space near a ruptured aneurysm. Odds ratios (ORs) were estimated from logistic regression analyses correlating hemosiderin deposition with other factors. Age (>or=54 years) (OR, 5.1; 95% CI, 1.03 to 25.0; P=0.046), Fisher grade 3 on initial CT (OR, 8.0; 95% CI, 1.26 to 50.4; P=0.027), and Karnofsky Scale score hemosiderin deposition levels. T2*-weighted MRI is an effective means of diagnosing prior SAH and may also reveal the location of a ruptured aneurysm. The extent of hemosiderin deposition was significantly associated with several factors, including age, CT findings, and poor prognosis.

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

    Science.gov (United States)

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

    2016-11-01

    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. Unblinded pilot study testing response to drug intervention. Neuroscience ICU, John Radcliffe Hospital, Oxford, United Kingdom. Fourteen World Federation of Neurosurgeons grades 3, 4, and 5 patients (mean age, 52.8 yr [range, 41-69 yr]; 11 women). IV sodium nitrite (10 μg/kg/min) for 1 hour. 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 accounting for major confounds). 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.

  18. Calcium antagonists for aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Dorhout Mees, S. M.; Rinkel, G. J. E.; Feigin, V. L.; Algra, A.; van den Bergh, W. M.; Vermeulen, M.; van Gijn, J.

    2007-01-01

    BACKGROUND: Secondary ischaemia is a frequent cause of poor outcome in patients with subarachnoid haemorrhage (SAH). Its pathogenesis has been incompletely elucidated, but vasospasm probably is a contributing factor. Experimental studies have suggested that calcium antagonists can prevent or reverse

  19. Innovative approach for prevention and treatment of post subarachnoid hemorrhage vasospasm: A preliminary report.

    Science.gov (United States)

    Venkataramana, Neelam K; Rao, Shailesh A V; Naik, Arun L; Shetty, Kishore; Murthy, Paparaja; Bansal, Abhilash; Panotopoulos, Christos

    2012-04-01

    More than one third of patients with subarachnoid hemorrhage (SAH) develop clinically significant vasospasm, as a leading morbidity and mortality factor for these patients. It is widely accepted that a) Degradation products of blood are the causative factors of vasospasm b) The amount of subarachnoid blood seen on admission CT is correlated to the risk of vasospasm c) Reducing the subarachnoid clot burden at the time of surgery reduces the risk of vasospasm. But there is no existing method to clear the blood from subarachnoid spaces satisfactorily. We have evaluated safety and feasibility of fluid exchange catheter system in SAH, to achieve this goal. We were successful in clearing cisternal blood in three patients with aneurysmal rupture with fluid exchange catheter system. Baseline CT scan of brain was performed immediately after the surgery and then at the end of irrigation. The amount of subarachnoid blood was evaluated. This innovative, fluid exchange catheter system infuses and aspirates micro volumes of drug solution in a cyclic mode, ensuring isobaric exchange of fluids. The result is good clearance of blood in subarachnoid spaces were seen in all the patients. Also, significant improvement in neurological deficits secondary to vasospasm was seen. We conclude that the fluid exchange catheter system is safe and adoptable in neurosurgical practice.

  20. Calcium antagonists for aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Rinkel, G. J. E.; Feigin, V. L.; Algra, A.; van den Bergh, W. M.; Vermeulen, M.; van Gijn, J.

    2005-01-01

    BACKGROUND: Secondary ischaemia is a frequent cause of poor outcome in patients with subarachnoid haemorrhage (SAH). Its pathogenesis has not been elucidated yet, but may be related to vasospasm. Experimental studies have indicated that calcium antagonists can prevent or reverse vasospasm and have

  1. Impact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Mutoh, Tatsushi; Ishikawa, Tatsuya; Moroi, Junta; Suzuki, Akifumi; Yasui, Nobuyuki

    2010-01-01

    The present study aimed to evaluate the impact of early surgical evacuation of sylvian hematoma caused by ruptured middle cerebral artery (MCA) aneurysm on clinical outcome after subarachnoid hemorrhage. Hospital records and computed tomography scans for 26 patients with MCA aneurysm who underwent surgical clipping between June 2001 and January 2008 were retrospectively reviewed. All patients presented with sylvian hematoma associated with subarachnoid hemorrhage and received surgery at 7.9±3.6 (mean±standard deviation) hours of ictus. They were divided postoperatively into two groups, achievement (n=16) and non-achievement (n=10) of extensive hematoma evacuation, and their clinical course and functional outcomes were compared. The frequencies of delayed ischemic neurological deficit and vasospasm-related cerebral infarction were significantly less (p<0.05) in the achievement group. Better functional outcomes were obtained in patients with successful evacuation (p<0.05), as assessed by improvement of hemiparesis on manual muscle testing scale at postoperative 1-month follow up and by the modified Rankin scale at postoperative 3 and 6 months. Clinical outcomes were also better in the achievement group. These results suggest that better clinical course and outcome can be expected in patients who undergo early successful hematoma evacuation with surgical clipping of a ruptured MCA aneurysm. (author)

  2. Recurrent craniospinal subarachnoid hemorrhage in cerebral amyloid angiopathy

    Directory of Open Access Journals (Sweden)

    Mathew Alexander

    2013-01-01

    Full Text Available Cerebral amyloid angiopathy (CAA usually manifests as cerebral hemorrhage, especially as nontraumatic hemorrhages in normotensive elderly patients. Other manifestations are subarachnoid (SAH, subdural, intraventricular hemorrhage (IVH and superficial hemosiderosis. A 52-year-old hypertensive woman presented with recurrent neurological deficits over a period of 2 years. Her serial brain magnetic resonance imaging and computed tomography scans showed recurrent SAH hemorrhage, and also intracerebral, IVH and spinal hemorrhage, with superficial siderosis. Cerebral angiograms were normal. Right frontal lobe biopsy showed features of CAA. CAA can present with unexplained recurrent SAH hemorrhage, and may be the initial and prominent finding in the course of disease in addition to superficial cortical siderosis and intracerebal and spinal hemorrhages.

  3. Angiographic assessment of variants of basal vein of Rosenthal in idiopathic subarachnoid hemorrhage.

    Science.gov (United States)

    Karatas, Ayse; Cakir, Volkan; Sevin, Ertan; Balli, Omur; Feran, Hamit

    2015-01-01

    Previous studies have reported the possible contribution of a primitive variant of the basal vein of Rosenthal (BVR) in the cause of idiopathic subarachnoid hemorrhage (ISAH). The purpose of this study was to assess the drainage patterns of the BVR among ISAH patients. The venous phase at cerebral angiography was retrospectively analyzed in 19 patients with ISAH and then compared with patients with unruptured aneurysms as controls. A relationship was found between ISAH and the presence of a primitive variant. However, the venous configuration effect on bleeding is still unknown. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  4. Subarachnoid hemorrhage: long-term consequences & stem cell treatment

    NARCIS (Netherlands)

    Kooijman, E.

    2014-01-01

    Subarachnoid hemorrhage (SAH) represents a considerable health problem that strikes patients at a relatively young age. At present, limited options are available to treat the devastating consequences of SAH. The endovascular puncture model is a suitable animal model to study the pathophysiological

  5. 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…

  6. 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...

  7. Cerebral hemodynamics in elderly patients with subarachnoid hemorrhage. Using serial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Hideo; Fukushima, Takeo; Hirakawa, Katsuyuki; Sakamoto, Seizaburou; Tsuchimochi, Hirohito; Tomonaga, Masamichi [Fukuoka Univ. (Japan). Faculty of Medicine

    1995-05-01

    To define characteristics of cerebral vasospasm in elderly patients with subarachnoid hemorrhage, changes in cerebral hemodynamics were serially determined by single photon emission computed tomography (SPECT) with {sup 99m}Tc-hexamethylpropylene-amino-oxime (HMPAO). The subjects were 8 elderly patients with an average age of 65 years (one men and 7 women). The findings were compared with those from 28 younger patients with an average age of 49 years (9 men and 19 women). The common site of aneurysms was the internal carotid artery (37.5%) in the elderly group. The frequency of delayed ischemic neurologic dysfunction after cerebral vasospasm was 50.0% in the elderly group and 39.3% in the younger group. There was no significant difference in the frequency of cerebral infarction between the two groups (25.0% vs 28.6%); however, the rate of persistent delayed ischemic neurologic dysfunction was higher in the elderly group (50.0%) than the younger group (36.4%). The frequency of hydrocephalus was higher in the elderly group (50.0%) than the younger group (21.4%). In the elderly group, the recovery from decreased cerebral blood flow was poor even in patients with mild subarachnoid hemorrhage. All patients with severe subarachnoid hemorrhage developed delayed ischemic neurologic dysfunction. Even if the degree of subarachnoid hemorrhage was the same in both groups, the recovery from decreased blood flow was poorer in the elderly group than the younger group. There was no decrease in cerebral blood flow in the stage of vasospasm, which may be attributed to the relief of intracranial pressure due to cerebral atrophy. Even in subacute stage, blood flow was more diffusely decreased in the elderly group than the younger group. (N.K.).

  8. A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage.

    Science.gov (United States)

    Obata, Yoshiki; Takeda, Junichi; Sato, Yohei; Ishikura, Hiroyasu; Matsui, Toru; Isotani, Eiji

    2016-08-01

    OBJECT Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. METHODS A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. RESULTS Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. CONCLUSIONS Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.

  9. Spectrophotometry or visual inspection to most reliably detect xanthochromia in subarachnoid hemorrhage: systematic review.

    Science.gov (United States)

    Chu, Kevin; Hann, Angus; Greenslade, Jaimi; Williams, Julian; Brown, Anthony

    2014-09-01

    We assess the sensitivity and specificity of xanthochromia as adjudicated by visual inspection and spectrophotometry at predicting the presence of cerebral aneurysm in patients with suspected subarachnoid hemorrhage who have a normal computed tomography (CT) head scan result. A systematic review was performed. MEDLINE and EMBASE databases were searched. Relevant studies with clinical data on the diagnostic accuracy of visual inspection or spectrophotometry were considered. Patients who had a normal CT head scan result followed by a lumbar puncture were included in this review. Sensitivities, specificities, and heterogeneity (I(2)) were calculated. Subgroup analyses were performed to explore reasons for the heterogeneity. There were major methodological limitations in the studies found. Twenty-two relevant articles were heterogeneous in regard to time to lumbar puncture, spectrophotometry methods, and follow-up of patients not undergoing cerebral angiography. Twelve of the 22 studies selected patients on the basis of a cerebral aneurysm or subarachnoid hemorrhage on imaging, or a positive lumbar puncture result. These studies were excluded from our initial analysis, which included only patients with clinically suspected subarachnoid hemorrhage. In this initial analysis, pooled estimates of sensitivity and specificity for spectrophotometry were 87% (95% confidence interval [CI] 71% to 96%; I(2)=26%) and 86% (95% CI 84% to 88%; I(2)=96%), respectively. For visual inspection, pooled sensitivity and specificity were 83% (95% CI 59% to 96%; I(2)=52%) and 96% (95% CI 93% to 97%; I(2)=76%), respectively. Sensitivity estimates are difficult to interpret without knowing time to lumbar puncture. The heterogeneity in the underlying studies, combined with significant overlap in pooled confidence limits, makes it impossible to provide a definite conclusion about the diagnostic accuracy of spectrophotometry versus visual inspection. Copyright © 2014 American College of Emergency

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

    Directory of Open Access Journals (Sweden)

    Ulrich Kertzscher

    Full Text Available 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.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.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.

  11. Spontaneous Coronary Artery Dissection in a Woman with a Past Medical History of Subarachnoid Hemorrhage: A Case Report.

    Science.gov (United States)

    Bardon, Jean; Picard, Fabien; Barbou, Franck; Varenne, Olivier; Vivien, Benoît

    2017-01-01

    Spontaneous coronary artery dissection (SCAD) is an uncommon disease. We report the case of a 50 year-old woman with a past medical history of aneurysmal subarachnoid hemorrhage, presenting with acute chest pain and diffuse ST segment elevation on ECG. Coronary angiogram revealed a SCAD of the left anterior descending coronary artery. The association between cerebral aneurysms and SCAD should trigger providers concern for fibromuscular dysplasia. We hereby report on a rare and atypical case involving the relationship between fibromuscular dysplasia and SCAD.

  12. Gender influences the initial impact of subarachnoid hemorrhage: an experimental investigation.

    Directory of Open Access Journals (Sweden)

    Victor Friedrich

    Full Text Available Aneurysmal subarachnoid hemorrhage (SAH carries high early patient mortality. More women than men suffer from SAH and the average age of female SAH survivors is greater than that of male survivors; however, the overall mortality and neurological outcomes are not better in males despite their younger age. This pattern suggests the possibility of gender differences in the severity of initial impact and/or in subsequent pathophysiology. We explored gender differences in survival and pathophysiology following subarachnoid hemorrhage induced in age-matched male and female rats by endovascular puncture. Intracranial pressure (ICP, cerebral blood flow (CBF, blood pressure (BP and cerebral perfusion pressure (CPP were recorded at and after induction of SAH. Animals were sacrificed 3 hours after lesion and studied for subarachnoid hematoma size, vascular pathology (collagen and endothelium immunostaining, inflammation (platelet and neutrophil immunostaining, and cell death (TUNEL assay. In a second cohort, 24-hour survival was determined. Subarachnoid hematoma, post-hemorrhage ICP peak, BP elevation, reduction in CPP, intraluminal platelet aggregation and neutrophil accumulation, loss of vascular collagen, and neuronal and non-neuronal cell death were greater in male than in female rats. Hematoma size did not correlate with the number of apoptotic cells, platelet aggregates or neutrophil. The ICP peak correlated with hematoma size and with number of apoptotic cells but not with platelet aggregates and neutrophil number. This suggests that the intensity of ICP rise at SAH influences the severity of apoptosis but not of inflammation. Mortality was markedly greater in males than females. Our data demonstrate that in rats gender influences the initial impact of SAH causing greater bleed and early injury in males as compared to females.

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

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali [Feinberg School of Medicine of Northwestern University, Department of Radiology, Chicago, IL (United States); Bowman, Robin M. [Feinberg School of Medicine of Northwestern University, Department of Neurological Surgery, Chicago, IL (United States)

    2007-06-15

    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.)

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

    International Nuclear Information System (INIS)

    Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali; Bowman, Robin M.

    2007-01-01

    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.)

  15. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm Sindrome da doença não tiroideana em pacientes com hemorragia subaracnoidea devida a aneurisma cerebral

    Directory of Open Access Journals (Sweden)

    Luiz Augusto Casulari

    2004-03-01

    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 (pNós apresentamos previamente que a hemorragia subaracnoidea devido à ruptura de aneurisma intracraniano (SH está associada com alterações no perfil hormonal nas primeiras 24 horas após o evento. Nós propusemos que as alterações hormonais observadas são devidas ao intenso estresse ao qual os pacientes estão expostos. Contudo, o perfil hormonal tireoidiano é indicativo da presença da síndrome da doença não tireoidiana (NTIS. Neste trabalho, examinamos se as alterações no perfil dos hormônios tireoidianos são compatíveis com a NTIS. Dois grupos de pacientes foram incluídos no estudo: A 30 pacientes com SH (21 mulheres e 9 homens; 41,7±11,4 anos e B um grupo controle incluindo 25 pacientes com doenças benignas da coluna (BDS (hérnia de disco lombar ou estável trauma da coluna (8 mulheres e 17 homens; 41,3±14,2 anos. Em um subgrupo de oito pacientes de cada grupo

  16. [Comparison of extent of postoperative hydrocephalus in patients between intervertional therapy with embolism and craniotomy occlusion in Hunt-Hess III-IV level aneurysm induced subarachnoid hemorrhage and their prognosis].

    Science.gov (United States)

    Liu, Yang; Sun, Shengkai; Chen, Xuyi; Cheng, Shixiang; Qin, Zhizhen; Liu, Xiu; Chen, Xiaochu; Ning, Lili; Wang, Zhihong

    2015-02-01

    To analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with Hunt-Hess level III-IV, and acute postoperative hydrocephalus. 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. 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 significant (χ (2) = 4.350, P = 0.037). In 767 patients with aSAH, the incidence of hydrocephalus among the patients after the hematoma removal operation was significantly lower than that of patients without hematoma removal [3.07% (11/358) vs. 19.07% (78/409), χ (2) = 47.635, P = 0.000]. The incidence of hydrocephalus among the patients after ventricular drainage was significantly lower than that of patients without the drainage [2.77% (19/685) vs. 85.37% (70/82), χ (2) = 487.032, P = 0.000]. In 403 cases of vascular embolization group, the incidence of hydrocephalus in the patients after the hematoma removal operation was lower than that of patients without it [8.06% (5/62) vs. 14.96% (51/341), χ (2) = 2.082, P = 0.168]. The incidence of hydrocephalus in the patients after the ventricular drainage was lower than that of patients without drainage [2.59% (9/347) vs. 83.93% (47/56), χ (2) = 266.599, P = 0.000]. In 364 cases of craniotomy occlusion

  17. Decompressive craniectomy in aneurysmal subarachnoid haemorrhage for hematoma or oedema versus secondary infarction

    NARCIS (Netherlands)

    Goedemans, Taco; Verbaan, Dagmar; Coert, Bert A.; Sprengers, Marieke E. S.; van den Berg, René; Vandertop, W. Peter; van den Munckhof, Pepijn

    2017-01-01

    Decompressive craniectomy (DC) has been proposed as lifesaving treatment in aneurysmal subarachnoid haemorrhage (aSAH) patients with elevated intracranial pressure (ICP). However, data is sparse and controversy exists whether the underlying cause of elevated ICP influences neurological outcome. The

  18. Impaired endothelial function after aneurysmal subarachnoid haemorrhage correlates with arginine:asymmetric dimethylarginine ratio

    DEFF Research Database (Denmark)

    Bergström, A; Staalsø, J M; Romner, B

    2014-01-01

    BACKGROUND: Endothelial dysfunction might be involved in the development of cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH). METHODS: This prospective observational study of 48 SAH subjects and 23 control subjects examined associations between reactive hyperaemia index (RHI...

  19. 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.

    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

  20. Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Johansson, M.; Cesarini, K.G.; Ronne-Engstroem, E.; Enblad, P.; Norbaeck, O.; Gal, G.; Tovi, M.; Solander, S.; Contant, C.F.

    2004-01-01

    Subarachnoid hemorrhage (SAH) is not an unusual disease in an elderly population. The clinical outcome has improved over time. It has been suggested that elderly SAH patients would benefit from endovascular aneurysm treatment. The aim of this study was to evaluate technical results and clinical outcome in a series of elderly SAH-patients treated with endovascular coil embolization. Sixty-two patients (≥ 65 years) presenting with aneurysmal SAH underwent early endovascular coil embolization at Uppsala University Hospital between September 1996 and December 2000. In all 62 cases included in the study, endovascular coil embolization was considered the first line of treatment. Admission variables, specific information on technical success, degree of occlusion and procedural complications, and outcome figures were recorded. Clinical grade on admission was Hunt and Hess (H and H) I-II in 39%, H and H III in 27% and H and H IV-V in 34% of the patients. The proportion of posterior circulation aneurysms was 24%. Coil embolization was successfully completed in 94%. The degree of occlusion of the treated aneurysm was complete occlusion in 56%, neck remnant in 21%, residual filling in 11%, other remnant in 5% and not treated in 6%. The rate of procedural complications was 11%. Outcome after 6 months was favorable in 41%, severe disability in 36% and poor in 22%. Favorable outcome was achieved in 57% of the H and H I-II patients, 47% of the H and H III patients and 17% of the H and H IV-V patients. Endovascular aneurysm treatment can be performed in elderly patients with SAH with a high level of technical success, acceptable aneurysm occlusion results, an acceptable rate of procedural complications and fair outcome results. (orig.)

  1. 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...... implemented monitoring system provides answers but it also raises valuable new questions challenging our current understanding of the brain injury after SAH....... complications. Currently, several neuro-monitoring techniques are available; this review describes the most frequently used techniques and discusses indications for their use, and their value in diagnosis and prognosis. None of the techniques, when considered in isolation, has proved sufficient after SAH...... 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...

  2. 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.

  3. Brain lactate metabolism in humans with subarachnoid hemorrhage.

    Science.gov (United States)

    Oddo, Mauro; Levine, Joshua M; Frangos, Suzanne; Maloney-Wilensky, Eileen; Carrera, Emmanuel; Daniel, Roy T; Levivier, Marc; Magistretti, Pierre J; LeRoux, Peter D

    2012-05-01

    Lactate is central for the regulation of brain metabolism and is an alternative substrate to glucose after injury. Brain lactate metabolism in patients with subarachnoid hemorrhage has not been fully elucidated. Thirty-one subarachnoid hemorrhage patients monitored with cerebral microdialysis (CMD) and brain oxygen (PbtO(2)) were studied. Samples with elevated CMD lactate (>4 mmol/L) were matched to PbtO(2) and CMD pyruvate and categorized as hypoxic (PbtO(2) 119 μmol/L) versus nonhyperglycolytic. Median per patient samples with elevated CMD lactate was 54% (interquartile range, 11%-80%). Lactate elevations were more often attributable to cerebral hyperglycolysis (78%; interquartile range, 5%-98%) than brain hypoxia (11%; interquartile range, 4%-75%). Mortality was associated with increased percentage of samples with elevated lactate and brain hypoxia (28% [interquartile range 9%-95%] in nonsurvivors versus 9% [interquartile range 3%-17%] in survivors; P=0.02) and lower percentage of elevated lactate and cerebral hyperglycolysis (13% [interquartile range, 1%-87%] versus 88% [interquartile range, 27%-99%]; P=0.07). Cerebral hyperglycolytic lactate production predicted good 6-month outcome (odds ratio for modified Rankin Scale score, 0-3 1.49; CI, 1.08-2.05; P=0.016), whereas increased lactate with brain hypoxia was associated with a reduced likelihood of good outcome (OR, 0.78; CI, 0.59-1.03; P=0.08). Brain lactate is frequently elevated in subarachnoid hemorrhage patients, predominantly because of hyperglycolysis rather than hypoxia. A pattern of increased cerebral hyperglycolytic lactate was associated with good long-term recovery. Our data suggest that lactate may be used as an aerobic substrate by the injured human brain.

  4. Comparison of blood pressure-associated risk of intracerebral hemorrhage and subarachnoid hemorrhage: Korea Medical Insurance Corporation study.

    Science.gov (United States)

    Kim, Hyeon Chang; Nam, Chung Mo; Jee, Sun Ha; Suh, Il

    2005-08-01

    Intracerebral hemorrhage and subarachnoid hemorrhage have different pathogeneses and risk factor profiles. However, little information is available on the difference between intracerebral and subarachnoid hemorrhages in relation to blood pressure. We prospectively investigated the relationships between blood pressure and risks of stroke subtypes. We measured blood pressure and other cardiovascular risk factors in 100,147 men and 59,558 women 35 to 59 years of age in 1990 and 1992. Outcomes were fatal and nonfatal events of stroke and its subtypes from 1993 to 2002. Independent relationships between baseline blood pressure and stroke subtypes were assessed using Cox's proportional hazard models. During the 10 years, 1714 ischemic and 1159 hemorrhagic strokes (742 intracerebral and 308 subarachnoid hemorrhages) occurred. Blood pressure was related more closely with hemorrhagic stroke than ischemic stroke, and the difference was more prominent in women. Among the subtypes of hemorrhagic stroke, intracerebral hemorrhage was more closely related with blood pressure than subarachnoid hemorrhage. For each 20 mm Hg increase in systolic blood pressure, adjusted relative risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 1.79 (95% confidence interval, 1.68 to 1.90), 2.48 (2.30 to 2.68), and 1.65 (1.38 to 1.97) in men, and 1.64 (1.42 to 1.89), 3.15 (2.61 to 3.80), and 2.29 (1.82 to 2.89) in women, respectively. In conclusion, blood pressure is more closely related with intracerebral hemorrhage than subarachnoid hemorrhage, thus proportion of intracerebral hemorrhage in hemorrhagic stroke may affect the association between blood pressure and hemorrhagic stroke. Our data also emphasize the importance of blood pressure control for the prevention of stroke, especially in countries with a high incidence of intracerebral hemorrhage.

  5. The initial time-course of headache in patients with spontaneous subarachnoid hemorrhage.

    Science.gov (United States)

    Čomić, Hata; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-08-15

    If acute severe headache disappears early after its onset, the question arises whether subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course and minimal duration of headache in a consecutive series of neurologically intact patients with spontaneous SAH. We included patients admitted between 2012 and 2015 within 48h after spontaneous SAH with a normal level of consciousness and no focal deficits. We retrieved data on headache severity, measured with a Numeric Rating Scale (NRS), ictus. We analyzed the proportion of patients with a first NRS 0 and NRS ictus and minimal headache duration. Patients were censored in case of a decrease in level of consciousness, aneurysm treatment, or early discharge. We included 106 patients (62 aneurysmal SAH, 33 perimesencephalic hemorrhage, 11 other spontaneous SAH). All patients were treated with analgesics. Within 48h after ictus, a first NRS 0 was reported by 9 patients (8%;95%CI:3%-14%) and a first NRS ictus. In a cohort of SAH patients with a normal level of consciousness and no focal deficits who all used analgetics, headache disappeared in around 10% within 48h after ictus. Our data indicate that a diagnostic work-up for SAH is also needed in patients using analgesics in whom headache has disappeared after 10h. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. 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 (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

  7. Global cerebral edema and brain metabolism after subarachnoid hemorrhage.

    Science.gov (United States)

    Helbok, Raimund; Ko, Sang-Bae; Schmidt, J Michael; Kurtz, Pedro; Fernandez, Luis; Choi, H Alex; Connolly, E Sander; Lee, Kiwon; Badjatia, Neeraj; Mayer, Stephan A; Claassen, Jan

    2011-06-01

    Global cerebral edema is common among patients with poor-grade subarachnoid hemorrhage and is associated with poor outcome. Currently no targeted therapy exists largely due to an incomplete understanding of the underlying mechanisms. This is a prospective observational study including 39 consecutive patients with poor-grade subarachnoid hemorrhage with multimodal neuromonitoring. Levels of microdialysate lactate-pyruvate ratio, episodes of cerebral metabolic crisis (lactate-pyruvate ratio >40 and brain glucose cerebral perfusion pressure, and transcranial Doppler sonography flow velocities were analyzed. Median age was 54 years (range, 45 to 61 years) and 62% were female. Patients with global cerebral edema on admission (n=24 [62%]) had a higher incidence of metabolic crisis in the first 12 hours of monitoring (n=15 [15% versus 2%], Pcerebral edema. There was no difference in brain tissue oxygen tension or cerebral perfusion pressure between the groups; however, in patients with global cerebral edema, a higher cerebral perfusion pressure was associated with lower lactate-pyruvate ratio (Pcerebral edema is associated with early brain metabolic distress.

  8. Utility of Indocyanine Green Video Angiography for Sylvian Fissure Dissection in Subarachnoid Hemorrhage Patients - Sylvian ICG Technique.

    Science.gov (United States)

    Toi, Hiroyuki; Matsushita, Nobuhisa; Ogawa, Yukari; Kinoshita, Keita; Satoh, Kohei; Takai, Hiroki; Hirai, Satoshi; Hara, Keijiro; Matsubara, Shunji; Uno, Masaaki

    2018-02-15

    Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes. This procedure was termed "Sylvian ICG". We observed ICG fluorescence quickly in all cases. Sylvian veins that appeared unclear in the standard microscopic operative field covered with subarachnoid hemorrhage were extremely clearly depicted. These Sylvian ICG findings were helpful in identifying entry points and the dissecting course of the Sylvian fissure. At the time of clipping, no residual fluorescence from Sylvian ICG was present, and aneurysm clipping was not impeded. Sylvian ICG for SAH patients is a novel technique to facilitate dissection of the Sylvian fissure. We believe that this technique will contribute to improved safety of clipping surgery for ruptured aneurysms.

  9. Deaths from cerebrovascular diseases correlated to month of birth: elevated risk of death from subarachnoid hemorrhage among summer-born

    Science.gov (United States)

    Nonaka, K.; Imaizumi, Y.

    It has been suggested that maternal nutrition, and fetal and infant growth have an important effect on the risk of cardiovascular disease in adult life. We investigated the population-based distribution of deaths from cerebrovascular diseases (ICD9 codes 430, 431, or 434) in Japan in 1986-1994 as a function of birth month, by examining death-certificate records. For a total of 853 981 people born in the years 1900-1959, the distribution of the number of deaths according to the month of birth was compared with the distribution expected from the monthly numbers of all births for each sex and for the corresponding birth decade. For those born between 1920 and 1949, there were significant discrepancies between the actual numbers of deaths from subarachnoid hemorrhage (ICD9 430) and the numbers expected, and these differences were related to the month of birth. Those born in summer, June-September, consistently had an elevated risk of death, particularly men, where the excess risk was 8%-23%. This tendency was also observed, less distinctly but significantly, for deaths from intracerebral hemorrhage (ICD9 431), but was not observed for those dying from occlusion of the cerebral arteries (ICD9 434). The observation that the risk of dying from subarachnoid hemorrhage was more than 10% higher among those born in the summer implies that at least one in ten deaths from subarachnoid hemorrhage has its origin at a perinatal stage. Although variations in hypertension in later life, which could possibly be ''programmed'' during the intra-uterine stages, could be an explanation for this observation, the disease-specific nature of the observation suggests the involvement of aneurysm formation, which is a predominant cause of subarachnoid hemorrhage.

  10. Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

    DEFF Research Database (Denmark)

    Agyemang, Charles; van Oeffelen, Aloysia A M; Nørredam, Marie Louise

    2014-01-01

    . We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch). RESULTS: Compared...... with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.......50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0...

  11. Hydrocephalus after Subarachnoid Hemorrhage: Pathophysiology, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Sheng Chen

    2017-01-01

    Full Text Available Hydrocephalus (HCP is a common complication in patients with subarachnoid hemorrhage. In this review, we summarize the advanced research on HCP and discuss the understanding of the molecular originators of HCP and the development of diagnoses and remedies of HCP after SAH. It has been reported that inflammation, apoptosis, autophagy, and oxidative stress are the important causes of HCP, and well-known molecules including transforming growth factor, matrix metalloproteinases, and iron terminally lead to fibrosis and blockage of HCP. Potential medicines for HCP are still in preclinical status, and surgery is the most prevalent and efficient therapy, despite respective risks of different surgical methods, including lamina terminalis fenestration, ventricle-peritoneal shunting, and lumbar-peritoneal shunting. HCP remains an ailment that cannot be ignored and even with various solutions the medical community is still trying to understand and settle why and how it develops and accordingly improve the prognosis of these patients with HCP.

  12. Diagnosis of ruptured intracranial aneurysm in acute stage

    International Nuclear Information System (INIS)

    Yoshiyama, Masataka; Nakagawa, Toshifumi

    1980-01-01

    Subarachnoid hemorrhage at an acute stage within one day from the onset to the first CT scan was classified into subarachnoid hemorrhage secondary to intracranial aneurysm, subarachnoid hemorrhage of unknown origin and subarachnoid hemorrhage of which angiography could not be carried out, and the first CT findings, the severity, and the prognosis of these subarachnoid hemorrhage were compared and discussed. CT findings of subarachnoid hemorrhage secondary to intracranial aneurysm showed various changes according to progress in the severity with time, and intracranial hematoma, intraventricular clots and ventricular dilatation increased according to progress in the severity. Ruptured intracranial aneurysm in middle cerebral artery, anterior cerebral artery and anterior communicating artery could be found easily by CT, but that in internal carotid artery and vertabral basilar artery was difficult to be detected by CT. When cerebral angiography was carried out repeatedly for ruptured intracranial aneurysm of unknown origin, the time of performance must be consifered with attention to angiospasms or hematoma. (Tsunoda, M.)

  13. Report of two cases of a rare cause of subarachnoid hemorrhage including unusual presentation and an emerging and effective treatment option.

    Science.gov (United States)

    Nyberg, Eric MacKenzie; Chaudry, M Imran; Turk, Aquilla S; Spiotta, Alejandro M; Fiorella, David; Turner, Raymond D

    2013-09-01

    To report two cases of a rare cause of subarachnoid hemorrhage (SAH), including unusual presentation and an emerging and effective treatment option. Ruptured basilar perforator artery aneurysm is a rare cause of SAH. Catheter angiography in the immediate post hemorrhage period may be unrevealing. We report two cases of ruptured basilar pontine perforator aneurysms. In one of these cases the perforator aneurysm was not apparent on the initial or the 1 week follow-up angiograms. Both patients returned for follow-up angiography 2 months later by which time aneurysmal filling and conspicuity had increased. Both patients were treated solely with two overlapping Neuroform stents. Follow-up angiograms demonstrated complete resolution of the aneurysms in both patients. Rupture of aneurysms arising from basilar artery perforators is a rare cause of SAH and attention to this area should be part of an interventionist's search pattern. Aneurysms in this area may not be apparent in the immediate post rupture setting and delayed post hemorrhage angiography has a role in detecting this entity. Stent monotherapy may be effective in treating these lesions.

  14. Unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Backes, D

    2016-01-01

    Rupture of an intracranial aneurysm results in aneurysmal subarachnoid hemorrhage (SAH), a subtype of stroke with an incidence of 9 per 100,000 person-years and a case-fatality around 35%. In order to prevent SAH, patients with unruptured intracranial aneurysms can be treated by neurosurgical or

  15. 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...

  16. Effects of prostacyclin on cerebral blood flow and vasospasm after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Wetterslev, Jørn; Stavngaard, Trine

    2015-01-01

    BACKGROUND AND PURPOSE: Delayed ischemic neurological deficits (DINDs) are a major contributing factor for poor outcome in patients with subarachnoid hemorrhage. In this trial, we investigated the therapeutic potential of prostacyclin, an endogen substance with known effect on vascular tone...... was initiated day 5 after subarachnoid hemorrhage and discontinued day 10. Primary outcome was the difference in change from baseline in global cerebral blood flow. Secondary outcome measures were occurrence of DIND, angiographic vasospasm, and clinical outcome at 3 months. RESULTS: No statistically significant...... parameters or clinical outcome were found between the 3 groups. CONCLUSIONS: Administration of prostacyclin to patients with subarachnoid hemorrhage may be safe and feasible. Global cerebral blood flow after subarachnoid hemorrhage is not markedly affected by administration of prostacyclin in the tested dose...

  17. Convexity Subarachnoid Hemorrhage with PiB Positive Pet Scans: Clinical Features and Prognosis.

    Science.gov (United States)

    Ly, John V; Singhal, Shaloo; Rowe, Christopher C; Kempster, Peter; Bower, Simon; Phan, Thanh G

    2015-01-01

    Cerebral amyloid angiopathy (CAA) has been reported to present as convexity subarachnoid hemorrhage (cSAH). Lesser known is that cSAH can herald intracerebral hemorrhage (ICH) and ischemic lesions. We present seven new cases with (11) C-Pittsburgh compound B (PiB) positive positron emission tomography (PET) scans including two with biopsy, review the literature and comment on clinical and radiological findings. Patients with cSAH identified on CT, underwent MR imaging and MR angiography to exclude intracranial aneurysm. Nonaneurysmal cSAH were further prospectively evaluated for amyloid angiopathy using PiB. Clinical and radiological features of cSAH, subsequent ICH and ischemic lesions were characterized. Seven patients with nonaneurysmal cSAH fulfilled the Boston criteria for probable CAA. All had PiB PET scans consistent with CAA. Of the 4 patients who had contrast MR Imaging all had enhancement overlying the cSAH, followed by ICH in three cases. All patients presented with transient sensory symptoms. All patients had small punctate subcortical and cortical infarcts on diffusion-weighted MR imaging. Literature review revealed subsequent ICH in approximately 11/79 patients. The finding of cSAH and PiB binding in our patients suggest underlying CAA. cSAH may be associated with ischemic lesion as well as future ICH occurrence. Copyright © 2014 by the American Society of Neuroimaging.

  18. Factors Associated with Acute and Chronic Hydrocephalus in Nonaneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Kang, Peter; Raya, Amanda; Zipfel, Gregory J; Dhar, Rajat

    2016-02-01

    Hydrocephalus requiring external ventricular drain (EVD) or shunt placement commonly complicates aneurysmal subarachnoid hemorrhage (SAH), but its frequency is not as well known for nonaneurysmal SAH (NA-SAH). Those with diffuse bleeding may have greater risk of hydrocephalus compared to those with a perimesencephalic pattern. We evaluated the frequency of hydrocephalus in NA-SAH and whether imaging factors could predict the need for EVD and shunting. We collected admission clinical and imaging variables for 105 NA-SAH patients, including bicaudate index (BI), Hijdra sum score (HSS), intraventricular hemorrhage (IVH) score, modified Fisher scale (mFS), and bleeding pattern. Hydrocephalus was categorized as acute (need for EVD) or chronic (shunt). We applied logistic regression to determine whether hydrocephalus risk was independently related to bleeding pattern or mediated through blood volume or ventriculomegaly. Acute hydrocephalus was seen in 26 (25%) patients but was more common with diffuse (15/28, 54%) versus perimesencephalic (10/59, 17%, p hydrocephalus had worse clinical grade and higher BI, HSS, and IVH scores. Adjusting the relationship between hydrocephalus and diffuse bleeding for HSS (but not BI) nullified this association. Nine (35%) patients requiring EVD eventually required shunting for chronic hydrocephalus, which was associated with greater blood burden but not poor clinical grade. Acute hydrocephalus occurs in one-quarter of NA-SAH patients. The greater risk in diffuse bleeding appears to be mediated by greater cisternal blood volume but not by greater ventriculomegaly. Imaging characteristics may aid in anticipatory management of hydrocephalus in NA-SAH.

  19. The early etiological diagnosis and endovascular embolization therapy of Hunt-Hess IV-V grade subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Song Jinning; Liu Shouxun; Bao Gang; Wang Tuo; Zhang Ming; Chen Jingyu; Zhang Xiaodong; Xu Gaofeng

    2007-01-01

    Objective: To explore the methods of early etiological diagnosis and principles of endovascular embolization in Hunt-Hess IV-V grade subarachnoid hemorrhage (SAH), and to evaluate the therapeutic efficacy. Methods: Thirty-one patients underwent imaging examinations such as CT and DSA to make the early diagnosis of SAH. Meanwhile, Guglielmi detachable microcoil (GDC) was used to applying aneurysmal intracapsular embolization in the ruptured aneurysms, and efficient symptomatic treatment was adopted early postoperatively. The results were tested by χ 2 test. Results: All 31 cases were diagnosed early and operated successfully. Among them, the aneurysm lumen was 100% occluded in 26 cases, 95% occluded in 3 cases; 90% occluded in 2 cases. There were 5 cases complicating with cerebral vasospasm. One case recurrent was cured with secondary complementary GDC embolization. Nine cases (29.0%) had permanent sequelae associated with SAH. According to the Glasgow prognosis score, the therapeutic efficacy was as following: 6 patients were in grade I, 9 in grade II, 4 in grade III, 2 in grade IV, and 10 in grade V; 10 patients died, and the morality rate was 32.3%. None of them exhibited re-bleeding with follow-up period of 3 to 68 months postoperatively. Morality rates were significantly different between the group with aneurysmal diameter of 11-25 mm and the group of 5-10 mm (χ 2 =6.60, P 2 =11.24, P 2 =6.35, P<0.05). Conclusions: CT and DSA can make the early etiological diagnosis of the Hunt-Hess IV-V grade aneurysmal SAH, and GDC can be used early to perform the aneurysmal intracapsular embolization. Dealing with hemorrhage and using efficient symptomatic treatment earlier postoperatively are important methods to improve the curative rate and reduce the mortality rate and mutilation rate. (authors)

  20. 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.

  1. Subarachnoid hyperattenuation on flat panel detector-based conebeam CT immediately after uneventful coil embolization of unruptured intracranial aneurysms.

    Science.gov (United States)

    Shinohara, Y; Sakamoto, M; Takeuchi, H; Uno, T; Watanabe, T; Kaminou, T; Ogawa, T

    2013-03-01

    Flat panel detector-based CBCT can provide CT-like images of the brain without transferring patients from the angiography suite to a conventional CT facility. Conventional brain CT after uneventful endovascular treatment sometimes shows focal subarachnoid hyperattenuation with contrast leakage, mimicking SAH. Differentiating this finding from SAH is important for immediate postprocedural medical management. We investigated CBCT for detecting subarachnoid hyperattenuation immediately after coil embolization of unruptured cerebral aneurysms. Thirty-six patients with unruptured cerebral aneurysms undergoing CBCT immediately after uncomplicated coil embolization were included. The relationship between the presence of subarachnoid hyperattenuation and total volume of contrast medium injected, aneurysm size and location, and balloon and stent assistance during embolization was investigated. Statistical analyses were performed with the χ(2) test (P < .05). Nine of the 36 patients (25.0%) showed focal subarachnoid hyperattenuation within the relevant parent artery territory harboring the aneurysm. Subarachnoid hyperattenuation locations included the ipsilateral superior frontal sulcus (n = 5), the bilateral superior frontal sulcus (n = 1), and the ipsilateral superior frontal and precentral sulci (n = 3). Statistically significant differences were observed between the presence of a subarachnoid hyperattenuation and the total volume of contrast medium injected (P < .001) and aneurysm size (P < .05). Subarachnoid hyperattenuation can be detected by CBCT immediately after coil embolization for unruptured aneurysms. The increased amounts of contrast medium to be given before CBCT and the specific location of the hyperattenuation may help differentiate benign subarachnoid contrast leakage from SAH.

  2. Ruptured pericallosal aneurysm causing hemorrhage along the fornix

    International Nuclear Information System (INIS)

    Stewart, C.E.; Lurito, J.T.

    2002-01-01

    We present a 57 year-old man with a pericallosal aneurysm causing parenchymal hemorrhage in the preseptal region of the frontal lobe with extension into the fornix. We briefly discuss the literature pertaining to ruptured pericallosal aneurysms and their bleeding patterns. (orig.)

  3. Ruptured pericallosal aneurysm causing hemorrhage along the fornix

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, C.E.; Lurito, J.T. [Department of Radiology, University Hospital, 550 North University Boulevard, Room 0615, Indianapolis, IN 46202 (United States)

    2002-12-01

    We present a 57 year-old man with a pericallosal aneurysm causing parenchymal hemorrhage in the preseptal region of the frontal lobe with extension into the fornix. We briefly discuss the literature pertaining to ruptured pericallosal aneurysms and their bleeding patterns. (orig.)

  4. Prognostic Assessment of Aneurysmal Subarachnoid Patients with WFNS Grade V by CT Perfusion on Arrival.

    Science.gov (United States)

    Sasahara, Atsushi; Suzuki, Kazufumi; Takahashi, Yuichi; Koseki, Hirokazu; Hirota, Kengo; Ohbuchi, Hidenori; Kasuya, Hidetoshi

    2016-08-01

    The prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) depends on their condition on arrival at the hospital. However, a small number of patients recover from an initially poor condition. We investigated the correlation between quantitative measures of computed tomography (CT) perfusion (CTP) on arrival and the outcomes of patients with World Federation of Neurosurgical Society (WFNS) grade V aSAH. We performed plain CT, CTP, and CT angiography (CTA) in all patients with aSAH on arrival. Aneurysms were surgically obliterated in patients with stable vital signs and the presence of a brain stem response. We measured the average mean transit time (aMTT) and compared it with the modified Rankin Scale (mRS) score at 1 month. Regions of interest were identified as 24 areas in the bilateral anterior, middle, and posterior cerebral artery territories and 2 areas in the basal ganglia. A total of 57 patients were treated between 2007 and 2014. None of the 21 patients with aMTT >6.385 seconds achieved a favorable outcome, whereas 8 of the 36 patients with aMTT 7.0 seconds among the aforementioned 8 areas and mRS, favorable outcomes were not seen in 24 patients with more than 2 such areas (P = 0.009). We cannot expect a favorable outcome for patients with WFNS grade V aSAH with aMTT >6.385 seconds or more than 2 of 8 areas with MTT >7.0 seconds. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. 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

  6. 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

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

    NARCIS (Netherlands)

    ter Laan, M; Mooij, JJA

    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

  8. Analysis of unknown cause subarachnoid hemorrhage with repeated negative angiogram

    International Nuclear Information System (INIS)

    Fujii, Mutsumi; Takasato, Yoshio; Masaoka, Hiroyuki; Ohta, Yoshihisa; Hayakawa, Takanori; Honma, Masato

    2006-01-01

    Seven hundred and fifty five cases of acute non-traumatic subarachnoid hemorrhage (SAH) were admitted to the department of neurosurgery of our hospital from July, 1995 to March, 2004. In 555 patients cerebral angiography was conducted but initial angiography was negative in 30 patients. Except 10 general condition poor patients, in 20 initial angiogram-negative patients were undergone repeated angiography. The cause of SAH could not be demonstrated in 13 cases. The SAH in perimesencephalic and non-perimesencephalic cisturns was seen in 7 and 6 cases, respectively. Occipital and/or neck pain on admission was statistically more common among patients with perimesencephalic SAH than those with non-perimesencephalic SAH (p=0.029), and the prognosis of perimesencephalic SAH was good. We conclude that repeat angiography should not be recommended in patients with perimesencephalic SAH. Patients with non-perimesencephalic SAH had a higher rate of complication. In the non-perimesencephalic group, 3 patients developed hydrocephalus and 3 patients had vasospasm, which were found by repeated angiography. Therefore, repeated angiography is recommended for better clinical outcome by early detection and management of serious complications in this group of patients. (author)

  9. 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.

  10. Pre-hospital ct diagnosis of subarachnoid hemorrhage.

    Science.gov (United States)

    Hov, Maren Ranhoff; Ryen, Annette; Finsnes, Katrine; Storflor, Janne; Lindner, Thomas; Gleditsch, Jostein; Lund, Christian Georg

    2017-02-28

    Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent assessment in a neurosurgical department, and the shorter the time from symptom onset to diagnosis the better. The Norwegian Acute Stroke Pre-hospital Project (NASPP) has developed a Mobile Stroke Unit (MSU) model, which is staffed with anesthesiologists also trained in pre-hospital clinical assessment of acute stroke patients and interpretation of computerized tomography (CT). The MSU was operated on-call from the local dispatch center in a rural area 45-160 km away from a neurosurgical department. Two patients presented with clinical symptoms and signs compatible with SAH. In both cases, the CT examination confirmed the diagnosis of SAH. Both were transported directly from patient location to the regional neurosurgical department, saving at least 2-2.5 h of pre-neurosurgical time. The Norwegian MSU model staffed with anesthesiologists can rapidly establish an exact diagnosis of SAH, which in a rural area significantly reduces time to neurosurgical care. Study data are retrospectively registered in ClinicalTrail.gov. NCT03036020 Unique Protocol ID: NASPP-2 Brief Title: The Norwegian Acute Stroke Prehospital Project Overall Status: Completed Primary Completion Date: January 2016 [Actual] Verification Date: January 2017.

  11. The role of spreading depolarization in subarachnoid hemorrhage.

    Science.gov (United States)

    Sánchez-Porras, R; Zheng, Z; Santos, E; Schöll, M; Unterberg, A W; Sakowitz, O W

    2013-08-01

    Subarachnoid hemorrhage (SAH) is a devastating disease associated with death and poor functional outcome. Despite decades of intense research and improvements in clinical management, delayed cerebral ischaemia (DCI) remains the most important cause of morbidity and mortality after SAH. The key role of angiographic cerebral vasospasm, thought to be the main cause of DCI, has been questioned. Emerging evidence suggests that DCI is likely to have a multifactorial etiology. Over the last few years, spreading depolarization (SD) has been identified as a potential pathophysiological mechanism contributing to DCI. The presence of cortical spreading ischaemia, due to an inverse hemodynamic response to SD, offers a possible explanation for DCI and requires more intensive research. Understanding the role of SD as another mechanism inducing DCI and its relationship with other pathological factors could instigate the development of new approaches to the diagnosis and treatment of DCI in order to improve the clinical outcome. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  12. Controversies and Evolving New Mechanisms in Subarachnoid Hemorrhage

    Science.gov (United States)

    Chen, Sheng; Feng, Hua; Sherchan, Prativa; Klebe, Damon; Zhao, Gang; Sun, Xiaochuan; Zhang, Jianmin; Tang, Jiping; Zhang, John H.

    2013-01-01

    Despite decades of study, subarachnoid hemorrhage (SAH) continues to be a serious and significant health problem in the United States and worldwide. The mechanisms contributing to brain injury after SAH remain unclear. Traditionally, most in vivo research has heavily emphasized the basic mechanisms of SAH over the pathophysiological or morphological changes of delayed cerebral vasospasm after SAH. Unfortunately, the results of clinical trials based on this premise have mostly been disappointing, implicating some other pathophysiological factors, independent of vasospasm, as contributors to poor clinical outcomes. Delayed cerebral vasospasm is no longer the only culprit. In this review, we summarize recent data from both experimental and clinical studies of SAH and discuss the vast array of physiological dysfunctions following SAH that ultimately lead to cell death. Based on the progress in neurobiological understanding of SAH, the terms “early brain injury” and “delayed brain injury” are used according to the temporal progression of SAH-induced brain injury. Additionally, a new concept of the vasculo-neuronal-glia triad model for SAH study is highlighted and presents the challenges and opportunities of this model for future SAH applications. PMID:24076160

  13. 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.

  14. Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Kurita, Hiroki; Sato, Eishi; Shiokawa, Yoshiaki

    2010-01-01

    The medical charts of 801 consecutive patients transferred to our critical care center over a 14-year interval (1994-2007) in poor neurological condition (World Federation of Neurological Surgeons; WFNS grade IV or V) after subarachnoid hemorrhage (SAH) were retrospectively analyzed. All patients were treated following a strict protocol. After initial neurological evaluation, patients were sedated, paralyzed, and underwent strict blood pressure control. For patients with WFNS grade IV and selected patients with grade V, aggressive ultra-early repair (mainly clipping for anterior circulation aneurysm, coiling for posterior circulation aneurysm) was initiated. In grade V patients with poor brainstem function or destruction of vital brain areas on CT, only comfort measures were offered. Compared to the former period (1994-2000), coiling was more frequently indicated in elderly patients and bypass surgery was more often applied in complex aneurysm cases in the latter period (2001-2007). Compared to the former period, the number of aggressively treated patients significantly increased (37.6% versus 28.8%) in the latter period. Outcome assessments performed at 3 months revealed a significant increase of favorable outcomes (Glasgow Outcome Scale; good recovery (GR) or moderately disabled (MD)) and a decreased mortality rate in those patients (34% versus 28%, and 43% versus 47%; respectively). The ratio of favorable outcome and morbidity in all admitted patients were also improved (12% versus 8%, and 79% versus 85%; respectively). Outcome was largely determined by the initial hemorrhage and subsequent development of intractable intracranial hypertension or cerebral infraction. Age was also found to be significantly correlated with outcome. There was no significant difference in outcomes by treatment modality (clip or coil). In the latter period, aneurismal location was not the predictor, but delayed ischemic neurological deficit (DIND) remained an important factor. In

  15. Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm

    OpenAIRE

    Lee, Kook; Shin, Sun Young; Park, Shin Hae

    2013-01-01

    Anterior communicating artery aneurysm is the most common form of intracranial aneurysm and subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. In general, patients with SAH from anterior communicating artery aneurysm present with neurological deficit. We report an interesting case of a 60-year-old man who presented with acute monocular vision loss accompanied by periorbital pain without any neurological deficit, finally diagnosed with S...

  16. Possible Role of Inflammation and Galectin-3 in Brain Injury after Subarachnoid Hemorrhage.

    Science.gov (United States)

    Nishikawa, Hirofumi; Suzuki, Hidenori

    2018-02-07

    Aneurysmal subarachnoid hemorrhage (SAH) is known as one of the most devastating diseases in the central nervous system. In the past few decades, research on SAH has focused on cerebral vasospasm to prevent post-SAH delayed cerebral ischemia (DCI) and to improve outcomes. However, increasing evidence has suggested that early brain injury (EBI) is an important mechanism contributing to DCI, cerebral vasospasm as well as poor outcomes. Though the mechanism of EBI is very complex, inflammation is thought to play a pivotal role in EBI. Galectin-3 is a unique chimera type in the galectin family characterized by its β-galactoside-binding lectin, which mediates various pathologies, such as fibrosis, cell adhesion, and inflammation. Recently, two clinical studies revealed galectin-3 to be a possible prognostic biomarker in SAH patients. In addition, our recent report suggested that higher acute-stage plasma galectin-3 levels correlated with subsequent development of delayed cerebral infarction that was not associated with vasospasm in SAH patients. We review the possible role and molecular mechanisms of inflammation as well as galectin-3 in brain injuries, especially focusing on EBI after SAH, and discuss galectin-3 as a potential new therapeutic or research target in post-SAH brain injuries.

  17. Impact of Clipping versus Coiling on Postoperative Hemodynamics and Pulmonary Edema after Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Nobutaka Horie

    2014-01-01

    Full Text Available Volume management is critical for assessment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH. This multicenter prospective cohort study compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema in patients with SAH. Hemodynamic parameters were measured for 14 days using a transpulmonary thermodilution system. The study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF, cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, extravascular lung water index (EVLWI and pulmonary vascular permeability index (PVPI were significantly higher in the clipping group in the vasospasm period. Postoperative C-reactive protein (CRP level was higher in the clipping group and was significantly correlated with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema, and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the vasospasm period, suggesting noncardiogenic edema. In conclusion, clipping affects postoperative CRP level and may thereby increase noncardiogenic pulmonary edema in the vasospasm period. His trial is registered with University Hospital Medical Information Network UMIN000003794.

  18. Estimation of prognosis for severe subarachnoid hemorrhage by initial CT perfusion

    International Nuclear Information System (INIS)

    Fukumitsu, Ryu; Yoshida, Kazumichi; Yamamoto, Hiroyuki

    2009-01-01

    While poor-grade subarachnoid hemorrhage (SAH) is generally associated with high mortality and morbidity, some patients make an unexpected dramatic recovery. To estimate prognosis for severe SAH, we assessed cerebral blood circulation by computed tomography perfusion (CTP) imaging on admission. CTP studies were performed for 25 of 49 SAH patients with World Federation of Neurosurgical Societies (WFNS) Grade V between March 2006 and July 2008. Four patients were excluded due to rerupture of aneurysm after CTP images were obtained. We measured cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) in the cerebral cortex or basal ganglia. Outcomes were assessed using the modified Rankin Scale (mRS), and patients were classified into 3 groups (n=7 each): Group A, mRS 0-3; Group B, mRS 4, 5; and Group C, mRS 6. All patients of Groups A and B underwent surgery, while 6 patients in Group C with mydriasis on admission were treated conservatively. CBF of the cerebral cortex was significantly lower in Group C than in Groups A or B. No significant differences were seen in CBV among the 3 groups. MTTs of cerebral cortex were significantly longer in Group C than in Groups A or B, with a cutoff value of 6.6 s. CTP is a potential modality for poor-grade SAH, in that discrimination between 'false' and 'true' Grade V patients could be made rapidly and less invasively. (author)

  19. Subarachnoid hemorrhage: role of subtraction CT angiography in etiological diagnosis and pretreatment planning.

    Science.gov (United States)

    Li, K; Wei, X; Lv, F; Li, Q; Xie, P

    2014-12-01

    Subarachnoid hemorrhage (SAH) is a deleterious cerebrovascular disorder that requires prompt etiological diagnosis. We wished to evaluate the diagnostic performance of the latest generation 3D subtraction CT angiography (CTA) in etiological diagnosis and pretreatment planning of patients with suspected SAH. A total of 88 patients were included in our study and underwent both 3D subtraction CTA and digital subtraction angiography (DSA) examinations. The 3D subtraction CTA images were reviewed by two independent readers who were blinded to the results of DSA. Sensitivity, specificity, positive and negative predictive values of 3D subtraction CTA were calculated on a per-patient basis. The possibility for surgical treatment was also evaluated based on information provided by CTA alone. According to DSA results, 72 patients were diagnosed with ruptured intracranial aneurysms, 5 patients with arteriovenous malformations, and no lesion was detected in 11 patients. Sensitivity, specificity, positive predictive value and negative predictive values of CTA for etiological evaluation of SAH were all 100%. Correct pretreatment decision was made in 67 of 70 patients based on the CTA measurements alone. THE results of our study indicate that 3D subtraction CTA is an accurate, fast and non-invasive imaging modality that is equal to DSA in etiological evaluation and pretreatment planning of patients with suspected SAH. It may replace DSA as the first step imaging method in patients with suspected SAH, while DSA should still be reserved for case of uncertainty.

  20. Aspirin and Risk of Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Phan, Kevin; Moore, Justin M; Griessenauer, Christoph J; Ogilvy, Christopher S; Thomas, Ajith J

    2017-05-01

    Recent studies have suggested that the use of low-dose aspirin may reduce the risk of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate any association between aspirin use and risk of aSAH based on the literature, and whether this is influenced by duration or frequency of aspirin use. A search of electronic databases was done from inception to September 2016. For each study, data on risk of aSAH in aspirin versus nonaspirin users were used to generate odds ratios and 95% confidence intervals, and combined using inverse variance-weighted averages of logarithmic odds ratios in a random-effects models. From 7 included studies, no significant difference was noted between aspirin use of any duration or frequency and nonaspirin users (odds ratio, 1.00; 95% confidence interval, 0.81-1.24; P =0.99). We found a significant association between short-term use of aspirin (3 years of durations of use. No significant association was found between infrequent aspirin use (≤2× per week) or frequent use (≥3× per week) with risk of aSAH. Current evidence suggests that short-term (aspirin is associated with increased risk of aSAH. Limitations include substantial heterogenity of the included studies. The role of long-term aspirin in reducing risk of aSAH remains unclear and ideally should be addressed by an appropriately designed randomized controlled trial. © 2017 American Heart Association, Inc.

  1. Functional independence: A comparison of the changes during neurorehabilitation between patients with non-traumatic subarachnoid hemorrhage and intracerebral hemorrhage or acute ischemic stroke

    DEFF Research Database (Denmark)

    Stabel, Henriette Holm; Pedersen, Asger Roer; Johnsen, Søren Paaske

    2017-01-01

    Objective To compare the changes in functional independence measured by the FIM after specialized neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage (SAH) and patients with intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS). Design Historical cohort study...

  2. 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.)

  3. 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

    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...... receptors (NK1Rs) by administration of L-822429 blunts the decrease in CBF as well as cerebrovascular receptor upregulation in an animal model of SAH. METHODS: Subarachnoid hemorrhage was induced in rats by injection of 250 microl of blood into the prechiasmatic cistern. The NK1R inhibitor L-822429...

  4. 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...

  5. Perioperative Management of Subarachnoid Hemorrhage in a Patient with Alagille Syndrome and Unrepaired Tetralogy of Fallot: Case Report

    Directory of Open Access Journals (Sweden)

    Juan Fiorda-Diaz

    2017-12-01

    Full Text Available Alagille syndrome (ALGS is a genetic disorder associated with multisystem dysfunction involving the hepatic, cardiovascular, and neurologic systems. Tetralogy of Fallot (TOF, a congenital cardiac anomaly, is commonly found in these patients. Patients with ALGS may also have an increased risk of cerebrovascular abnormalities and bleeding. Ruptured cerebral aneurysm and subarachnoid hemorrhage (SAH may be developed, increasing the incidence of morbidity and mortality. Advances in neuroimaging and neurosurgery have allowed early identification and treatment of such vascular abnormalities, improving patients’ outcomes and reducing life-threatening complications such as intracranial bleeding. Authors describe the perioperative management of a patient with ALGS and TOF who was admitted to the emergency department due a ruptured intracranial aneurysm with concomitant SAH. Surgical treatment included diagnostic cerebral arteriography with coil embolization of a left posterior communicating artery aneurysm, and placement of right external ventricular drain (EVD. The combination of neuroprotective anesthetic techniques, fast emergence from anesthesia, and maintenance of intraoperative hemodynamic stability led to a successful perioperative management. A multidisciplinary approach in specialized centers is essential for the treatment of patients with SAH, especially in patients with ALGS and complex congenital heart disease such as TOF.

  6. Accumulation of intimal platelets in cerebral arteries following experimental subarachnoid hemorrhage in cats

    International Nuclear Information System (INIS)

    Haining, J.L.; Clower, B.R.; Honma, Y.; Smith, R.R.

    1988-01-01

    From 2 hours to 23 days following experimental subarachnoid hemorrhage, the accumulation of indium-111-labeled platelets on the intimal surface of the middle cerebral artery was studied in 23 cats. Subarachnoid hemorrhage was produced by transorbital rupture of the right middle cerebral artery. Of the 23 cats, 17 exhibited right middle cerebral artery/left middle cerebral artery radioactivity ratios of greater than 1.25. When these results were compared with those of 12 control cats, 0.001 less than p less than 0.005 (chi2 test). Thus, the results from the control and experimental groups are significantly different and indicate early (after 2 hours) preferential accumulation of intimal platelets in the ruptured right middle cerebral artery compared with the unruptured left middle cerebral artery and new platelet deposition continuing for up to 23 days. However, the experimental group did not reveal a clear pattern for platelet accumulation following subarachnoid hemorrhage. There was no simple correlation between the magnitude of the radioactivity ratios and the time after hemorrhage when the cats were killed although the ratios for 2 hours to 7 days seemed greater than those for 8 to 23 days. Assuming the pivotal role of platelets in the angiopathy of subarachnoid hemorrhage, the administration of antiplatelet agents as soon as possible following its occurrence may be of value

  7. Glycemia in conditions of hypothermia in patients with intracranial aneurysmal hemorrhage

    Directory of Open Access Journals (Sweden)

    Світлана Олександрівна Дудукіна

    2015-04-01

    Full Text Available Despite the proven effectiveness of hypothermia as a method of neuroprotection, the presence of significant side effects requires further development of detailed protocols of usage, especially glucose.Aim: Improving treatment outcomes of patients with subarachnoid aneurysmal hemorrhage by preventing the development of hyperglycemia during systemic hypothermia.Materials and Methods: The study involved 48 patients with spontaneous subarachnoid hemorrhage of aneurysmal origin. All patients were conducted intracranial surgery - clipping aneurysms of cerebral vessels during regression of arterial vascular spasm (AVS in the systemic hypothermia prevention. Therapeutic hypothermia was performed in 29 patients with complicated disease course for 48 hours. It is evaluated the effectiveness of its own method of prevention and correction of hyperglycemia - permanent short-acting insulin before the warm saline at a dose of 2 units/hour during hypothermiaResults: During the prevention of hypothermia using methods of hyperglycemia episodes of above 10 mmol / L did not observe the rejection of a group of patients using the conventional method of correction of glycemia. Episodes of hypoglycemia do not observed in both groups of the study. Up to 48 hours of therapeutic hypothermia glucose levels remained stable, after 48 hours of hypothermia it is observed a significant increase in blood glucose that was cool termination criterion.Conclusions: Holding insulin infusion at short-acting dose of 2 units/hour during prophylactic hypothermia prevents episodes of hyperglycemia and consequently helps to maintain homeostasis. Carrying insulin infusion at short-acting dose of 2 units/hour during therapeutic hypothermia promotes stable blood glucose levels to 48 hours. After 48 hours of hypothermia in 51.72% of patients experienced a significant increase in blood glucose, which is one of the criteria for termination of cooling

  8. Impact of the moon on cerebral aneurysm rupture.

    Science.gov (United States)

    Kamp, Marcel A; Dibué, Maxine; Slotty, Philipp; Steiger, Hans-Jakob; Hänggi, Daniel

    2013-08-01

    Several external and internal risk factors for cerebral aneurysm rupture have been identified to date. Recently, it has been reported that moon phases correlate with the incidence of aneurysmal subarachnoid hemorrhage (SAH), however, another author found no such association. Therefore, the present study investigates the influence of the lunar cycle on the incidence of aneurysmal rupture, the initial clinical presentation, and the amount of subarachnoid blood. Lunar phase and the particular day of the lunar cycle were correlated to the date of aneurysm rupture, aneurysm location, initial clinical presentation, and amount of subarachnoid blood assessed from CT scans of all patients treated for basal SAH in our department from 2003 to 2010. We found no correlation between incidence of aneurysmal SAH, location of the aneurysm, initial clinical presentation, or amount of subarachnoid blood and the lunar cycle. The moon influences neither the incidence of aneurysmal SAH nor the grade of initial neurological deterioration or amount of subarachnoid blood.

  9. Early Brain Injury: A Common Mechanism in Subarachnoid Hemorrhage and Global Cerebral Ischemia

    Directory of Open Access Journals (Sweden)

    Mohammed Sabri

    2013-01-01

    Full Text Available Early brain injury (EBI has become an area of extreme interest in the recent years and seems to be a common denominator in the pathophysiology of global transient ischemia and subarachnoid hemorrhage (SAH. In this paper, we highlight the importance of cerebral hypoperfusion and other mechanisms that occur in tandem in both pathologies and underline their possible roles in triggering brain injury after hemorrhagic or ischemic strokes.

  10. The initial time-course of headache in patients with spontaneous subarachnoid hemorrhage

    NARCIS (Netherlands)

    Čomić, Hata; Rinkel, Gabriel J.E.|info:eu-repo/dai/nl/085712000; Vergouwen, Mervyn D.I.|info:eu-repo/dai/nl/320630544

    2017-01-01

    Background If acute severe headache disappears early after its onset, the question arises whether subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course and minimal duration of headache in a consecutive series of neurologically intact patients with spontaneous

  11. Headache as a crucial symptom in the etiology of convexal subarachnoid hemorrhage.

    Science.gov (United States)

    Rico, María; Benavente, Lorena; Para, Marta; Santamarta, Elena; Pascual, Julio; Calleja, Sergio

    2014-03-01

    Convexal subarachnoid hemorrhage has been associated with different diseases, reversible cerebral vasoconstriction syndrome and cerebral amyloid angiopathy being the 2 main causes. To investigate whether headache at onset is determinant in identifying the underlying etiology for convexal subarachnoid hemorrhage. After searching in the database of our hospital, 24 patients were found with convexal subarachnoid hemorrhage in the last 10 years. The mean age of the sample was 69.5 years. We recorded data referring to demographics, symptoms and neuroimaging. Cerebral amyloid angiopathy patients accounted for 46% of the sample, 13% were diagnosed with reversible cerebral vasoconstriction syndrome, 16% with several other etiologies, and in 25%, the cause remained unknown. Mild headache was present only in 1 (9%) of the 11 cerebral amyloid angiopathy patients, while severe headache was the dominant feature in 86% of cases of the remaining etiologies. Headache is a key symptom allowing a presumptive etiological diagnosis of convexal subarachnoid hemorrhage. While the absence of headache suggests cerebral amyloid angiopathy as the more probable cause, severe headache obliges us to rule out other etiologies, such as reversible cerebral vasoconstriction syndrome. © 2013 American Headache Society.

  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...

  13. 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...

  14. Subarachnoid hemorrhage induces enhanced expression of thromboxane A2 receptors in rat cerebral arteries

    DEFF Research Database (Denmark)

    Ansar, Saema; Larsen, Carl; Maddahi, Aida

    2010-01-01

    Cerebral ischemia remains the key cause of morbidity and mortality after subarachnoid hemorrhage (SAH) with a pathogenesis that is still poorly understood. The aim of the present study was to examine the involvement of thromboxane A(2) receptors (TP) in the pathophysiology of cerebral ischemia...

  15. Early events triggering delayed vasoconstrictor receptor upregulation and cerebral ischemia after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Povlsen, Gro Klitgaard; Johansson, Sara Ellinor; Larsen, Carl Christian

    2013-01-01

    Upregulation of vasoconstrictor receptors in cerebral arteries, including endothelin B (ETB) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors, has been suggested to contribute to delayed cerebral ischemia, a feared complication after subarachnoid hemorrhage (SAH). This receptor upregulation has been...

  16. Risk factors and short-term outcome in patients with angiographically negative subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Dalbjerg, Sara Maria; Larsen, Carl Christian; Romner, Bertil

    2013-01-01

    The objective of this study was to identify prognostic factors for clinical outcome in patients with non-traumatic, angiographically negative subarachnoid hemorrhage. Furthermore, the aim was to investigate if patients on anticoagulant therapy may have a more unfavorable outcome than patients...

  17. Effect of delayed onset prostacyclin on markers of endothelial function and damage after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Gybel-Brask, Mikkel; Rasmussen, Rune; Stensballe, Jakob

    2017-01-01

    Background: Subarachnoid hemorrhage (SAH) is a neurological emergency. Delayed ischemic neurological deficit is one of the main causes of poor outcome after SAH and is probably caused, at least in part, by cerebral vasospasm. The pathophysiology of this is multifaceted, but endothelial damage...

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

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    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.

  19. Infarction of the entire corpus callosum as a complication in subarachnoid hemorrhage: A case report

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    Satoru Takahashi, M.D.

    2017-03-01

    Full Text Available The corpus callosum is the major commissural pathway connecting the cerebral hemispheres. This pathway receives its blood supply from anterior communicating artery, pericallosal artery, and posterior pericallosal artery. However, in some cases, the entire corpus callosum is supplied by median callosal artery; thus, occlusion of this artery can lead to infarction of the entire corpus callosum. Few reports have described this type of infarction, and no reports after subarachnoid hemorrhage (SAH exist. Here, we report on a 42-year-old female who was diagnosed with SAH after two aneurysms were discovered in bifurcation of left anterior cerebral artery (A1-A2. After successful clipping was performed, the patient was alert and had no neurological deficits; moreover, the computed tomography images that were acquired after the operation showed no evidence of infarction. Nine days after admittance to the hospital, drowsiness and weakness of the left limbs with brain swelling appeared and decompressive hemi-craniectomy was performed. Diagnostic cerebral angiography revealed vasospasms in both anterior and middle cerebral arteries, thus fasudil hydrochloride was administered intra-arterially. While blood flow in all arteries improved, diffusion-weighted magnetic resonance imaging detected infarction along the entire length of the corpus callosum and in the medial region of the right frontal lobe. We believe this infarction was due to secondary ischemia of median callosal artery. This case reminded us of the anatomical variation wherein median callosal artery is the sole blood supply line for the corpus callosum and demonstrated that infarction of the entire corpus callosum is possible.

  20. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage.

    Science.gov (United States)

    Backes, Daan; Rinkel, Gabriel J E; Kemperman, Hans; Linn, Francisca H H; Vergouwen, Mervyn D I

    2012-08-01

    A recent study suggested that in patients with acute headache suspicious of nontraumatic subarachnoid hemorrhage (SAH), cerebrospinal fluid (CSF) analysis is not needed to rule out SAH if head CT performed ≤6 hours after ictus is negative. Before implementation in daily practice, these results need replication. Therefore, we investigated test characteristics of head CT in patients with a clinical suspicion of SAH. Patients suspicious of SAH and a normal level of consciousness presenting to our tertiary care hospital between 2005 and 2012 were included. All patients had a head CT interpreted by experienced neuroradiologists and CSF spectrophotometry if head CT was negative or inconclusive. We determined test characteristics with 95% confidence intervals (CI) for nontraumatic SAH of head CT performed ≤6 or >6 hours after onset of headache. Sensitivity of head CT ≤6 hours after ictus (n=137) was 98.5% (95% CI, 92.1%-100%), diagnosing all patients with aneurysmal and perimesencephalic SAH, but not with a cervical arteriovenous malformation. Sensitivity of head CT performed >6 hours after ictus (n=113) was 90.0% (95% CI, 76.3-97.2). After exclusion of patients with an atypical presentation without headache, sensitivity, specificity, negative predictive value, and positive predictive value of head CT ≤6 hours were all 100%. In patients presenting with acute headache and a normal head CT ≤6 hours after ictus, as interpreted by experienced neuroradiologists, there is no added value of CSF analysis. In patients with an atypical presentation without headache and in patients presenting >6 hours after ictus, CSF analysis is still indicated.

  1. Clinical Trials in Cardiac Arrest and Subarachnoid Hemorrhage: Lessons from the Past and Ideas for the Future

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    Jennifer A. Frontera

    2013-01-01

    Full Text Available Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH. Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest met the review criteria (103 published, 39 ongoing. The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%, while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study.

  2. Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm.

    Science.gov (United States)

    Lee, Kook; Shin, Sun Young; Park, Shin Hae

    2013-01-01

    Anterior communicating artery aneurysm is the most common form of intracranial aneurysm and subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. In general, patients with SAH from anterior communicating artery aneurysm present with neurological deficit. We report an interesting case of a 60-year-old man who presented with acute monocular vision loss accompanied by periorbital pain without any neurological deficit, finally diagnosed with SAH from ruptured anterior communicating artery aneurysm. Five months after immediate craniotomy with aneurysm neck clipping, his visual acuity was improved to 20/63 with a pale optic disc appearance. Acute retrobulbar optic neuropathy may be the sole manifestation of SAH from ruptured anterior communicating artery aneurysm. Unilateral decrease of visual acuity with periorbital pain, in the absence of other neurological change, may be the initial and isolated sign.

  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

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    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

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    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. A Case of Microscopic Polyangiitis with Subarachnoid Hemorrhage and Cardiovascular Complications.

    Science.gov (United States)

    Aratani, Sae; Sakai, Yukinao; Tsuruoka, Shuichi

    2017-01-01

    Microscopic polyangiitis (MPA) is a primary systemic vasculitis that predominantly affects small and medium vessels. MPA is rarely complicated with central nervous system or cardiovascular disease. We report a very rare case of MPA complicated with cerebral infarction, cardiovascular disease, and fatal subarachnoid hemorrhage in a 54-year-old man. During the first six days of hospitalization the patient was diagnosed with rapid progressive glomerulonephritis (RPGN), cerebral infarction, and unstable angina. According to patient's symptoms and laboratory findings, were consisted with a diagnosis of severe MPA. Steroid pulse therapy was immediately introduced. However, the patient developed massive subarachnoid hemorrhage on the 8th day of hospitalization. The condition progressively deteriorated, and the patient died on the 33rd hospital day.

  6. Can S100B predict cerebral vasospasms in patients suffering from subarachnoid hemorrhage?

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    Moshgan eAmiri

    2013-06-01

    Full Text Available Background: Protein S100B has proven to be a useful biomarker for cerebral damages. Increased levels of serum and CSF S100B have been shown in patients suffering subarachnoid hemorrhage, severe head injury and stroke. In patients with subarachnoid hemorrhage, the course of S100B levels has been correlated with neurological deficits and outcome. Cerebral vasospasm is a major contributor to morbidity and mortality. The primary aim of this study was to investigate the potential of S100B protein as a predictor of cerebral vasospasm in patients with severe subarachnoid hemorrhage.Methods: Patients with SAH, Fisher grade 3 and 4, were included in the study. Five samples of CSF and serum S100B were collected from each patient. The first sample (baseline sample was drawn within the first three days following ictus and the following four samples, once a day on days 5 to 8, with day of ictus defined as day 1. Clinical suspicion of cerebral vasospasm confirmed by computed tomography angiography was used to diagnose cerebral vasospasm.Results: A total of 18 patients were included. Five patients (28 % developed cerebral vasospasm, two (11 % developed ventriculitis. There were no significant differences between S100B for those with and without vasospasm. Serum S100B levels in patients with vasospasm were slightly lower within the first 5 days following ictus, compared to patients without vasospasm. Two out of 5 patients had elevated and increasing serum S100B prior to vasospasm. Only one showed a peak level of S100B one day before vasospasm could be diagnosed. Due to the low number of patients in the study, statistical significance could not be reached. Conclusion: Neither serum nor CSF S100B can be used as predictor of cerebral vasospasm in patients suffering from subarachnoid hemorrhage.

  7. Bedside transcranial sonography monitoring in a patient with hydrocephalus post subarachnoid hemorrhage

    OpenAIRE

    Najjar, Ahmed; Denault, André Y.; Bojanowski, Michel W.

    2017-01-01

    Background Development of hydrocephalus can occur after subarachnoid hemorrhage (SAH). Typically, it is diagnosed with computed tomography, CT, scan. However, transcranial sonography (TCS) can be used particularly in patients with craniotomy which removes the acoustic interference of the skull and allows a closer up visualization of brain structures through the skin. Case presentation We report a 73-year-old woman who was hospitalized for SAH and developed acute hydrocephalus requiring an ext...

  8. Clinical features of patients with subarachnoid hemorrhage arriving through a referral from a local primary hospital

    International Nuclear Information System (INIS)

    Yamazaki, Takaaki; Kubota, Tsukasa; Shimazaki, Mitsunori

    2010-01-01

    We investigated the current state of and problems in patients with subarachnoid hemorrhage initially diagnosed and treated by general physicians at a local referring hospital and subsequently transferred to our hospital for neurosurgical treatment. We studied 37 consecutive patients with subarachnoid hemorrhage over a 7-year period from April 2001 to March 2008. A total of 7 men and 30 women aged 50 to 89 years (average: 71.2±9.5 years) were included in this study. Thirteen patients (35.1%) were referred to our hospital with diagnoses other than subarachnoid hemorrhage. Twenty-three of 27 patients who had CT scans were diagnosed correctly in the referring hospital, while only 1 of 10 patients was correctly diagnosed without CT. Time from the onset to admission to our hospital ranged from 85 minutes to 144 hours (average: 15.3±29 hours). The reasons of delay in patients who took more than 12 hours to reach us were patients' delay in visiting the referring hospital in 3 cases and uncertain initial diagnosis in 6. All 6 cases complained of sudden headache, but did not undergo CT. All patients were transferred by an ambulance car, and the duration of transfer ranged from 60 to 120 minutes (average: 85.4±15.7 minutes). None of the patients experienced rebleeding during transfer. Subarachnoid hemorrhage can be diagnosed correctly at the local primary hospital with CT, allowing appropriate primary treatments. Initial misdiagnosis is the major cause of delay in transferring patients to neurosurgical facilities. (author)

  9. Procedural complications of endovascular treatment in patients with aneurysmal subarachnoid haemorrhage treated at a single centre.

    Science.gov (United States)

    Alanen, Mikko; Pyysalo, Liisa; Jalava, Iiro; Snicker, Oona; Pienimäki, Juha-Pekka; Öhman, Juha; Ronkainen, Antti

    2018-03-01

    We present a single-centre experience of procedural complications suffered by patients undergoing endovascular treatment for a ruptured saccular intracranial aneurysm at Tampere University Hospital, Finland, between 2000 and 2014. From 2000 to 2014, we treated 1,253 patients with aneurysmal subarachnoid haemorrhage, 491 of whom received endovascular treatment. Clinical data were collected retrospectively from the hospital's aneurysm database. A procedural complication was defined as having occurred whenever there was a documented new event in the patient's medical records or a note of a technical complication written by an interventionist after endovascular treatment. Procedural complications could be with or without clinical symptoms. Nearly 40% (491/1253) of the patients were treated with the endovascular method. Procedural complications occurred in 11.4% (56/491) of cases. The morbidity rate was 4.5% (22/491) and the mortality rate was 0.2% (1/491). Of the 56 complications, ischaemic complications occurred in 52% (29/56), haemorrhagic complications occurred in 27% (15/56) and technical complications occurred in 21% (12/56) of cases. In 61% (34/56) of the cases, the procedural complication did not cause any clinical symptoms. The total risk for procedural complications leading to postoperative disability or death at our institute was 4.7%. The complication frequency is in accordance with previous reports. Endovascular treatment of ruptured intracranial aneurysms is a safe treatment method when patient selection is carefully performed.

  10. Cerebral Hemodynamic Changes Induced by a Lumbar Puncture in Good-Grade Subarachnoid Hemorrhage

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    Eric A. Schmidt

    2012-09-01

    Full Text Available Background: Patients with good-grade subarachnoid hemorrhage (SAH are those without initial neurological deficit. However, they can die or present severe deficit due to secondary insult leading to brain ischemia. After SAH, in a known context of energy crisis, vasospasm, hydrocephalus and intracranial hypertension contribute to unfavorable outcome. Lumbar puncture (LP is sometimes performed in an attempt to reduce intracranial pressure (ICP and release headaches. We hypothesize that in good-grade SAH patients, a 20-ml LP releases headaches, reduces ICP and improves cerebral blood flow (CBF as measured with O15 PET scan. Methods: Six good-grade (WFNS grade 1or 2 SAH patients (mean age 48 years, 2 women, 4 men were prospectively included. All aneurysms (4 anterior communicating artery and 2 right middle cerebral artery were coiled at day 1. Patients were managed according to our local protocol. LP was performed for severe headache (VAS >7 despite maximal painkiller treatment. Patients were included when the LP was clinically needed. The 20-ml LP was done in the PET scan (mean delay between SAH and LP: 3.5 days. LP allows hydrostatic measurement of ICP. Arterial blood pressure (ABP was noninvasively gauged with photoplethysmography. Every signal was monitored and analyzed off-line. Regional CBF (rCBF was measured semiquantitatively with O15 PET before and after LP. Then we calculated the difference between baseline and post-LP condition for each area: positive value means augmentation of rCBF after the LP, negative value means reduction of rCBF. Individual descriptive analysis of CBF was first performed for each patient; then a statistical group analysis was done with SPM for all voxels using t statistics converted to Z scores (p 3.2. Results: A 20-ml LP yielded a reduction in pain (–4, a drop in ICP (24.3 ± 12.5 to 6.9 ± 4.7 mm Hg, but no change in ABP. Descriptive and statistical image analysis showed a heterogeneous and biphasic change in

  11. Femoral access in 100 consecutive subarachnoid hemorrhage patients: the "craniotomy" of endovascular neurosurgery

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    Huang Judy

    2010-11-01

    Full Text Available Abstract Background Femoral access is a fundamental element of catheter-based cerebral angiography. Knowledge of location of the common femoral artery (CFA bifurcation is important as the risk of retroperitoneal bleeding is increased if the puncture is superior to the inguinal ligament and there is an increased risk of thrombosis and arteriovenous fistula formation if the puncture is distal into branch vessels. We sought to characterize the location of the CFA bifurcation along with the presence of significant atherosclerosis or iliac tortuosity in a contemporary series of subarachnoid hemorrhage (SAH patients. Findings The records of a prospective single-center aneurysm database were reviewed to identify 100 consecutive SAH patients. Using an oblique femoral arteriogram, the presence of significant atherosclerosis, iliac tortuosity, and the CFA bifurcation were assessed. The CFA bifurcation was graded according to its position with respect to the femoral head: below (grade 1, lower half (grade 2, and above the upper half (grade 3. We found a CFA bifurcation grade 1 in 50 patients (50%, mean age 51.2 years, grade 2 in 40 patients (40%, mean age 55.5 years, and grade 3 in 10 patients (10%, mean age 58.2 years. Whereas 30 of 90 patients with CFA grades I or II were male (33%, only 10% with grade 3 were male (1 of 10, p = 0.12. Mean age for significant atherosclerosis was 65.5 +/- 2.6 years versus 50.9 +/- 1.6 years (p Conclusions Although a requisite element of endovascular treatment in SAH patients, femoral access can be complicated by a high common femoral artery bifurcation and the presence of atherosclerotic disease and/or iliac artery tortuosity. In this study, we found a grade 3 (above the femoral head CFA bifurcation in 10% patients, with 90% of these patients being female. We also found the presence of atherosclerotic disease and iliac tortuosity to be significantly more likely in patients older than 65 years of age.

  12. Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit

    NARCIS (Netherlands)

    Gathier, Celine S; Oostdijk, Evelien A; Rinkel, Gabriel J E; Dorhout Mees, Sanne M; Vergouwen, Mervyn D I; de Smet, Anne Marie G A; van de Beek, Diederik; Vandertop, W Peter; Verbaan, Dagmar; Algra, Ale; Bonten, Marc J M; van den Bergh, Walter M

    INTRODUCTION: Delayed cerebral ischemia (DCI) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Development of DCI is multifactorial, and inflammation, with or without infection, is one of the factors independently associated with development of DCI and

  13. Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit

    NARCIS (Netherlands)

    Gathier, Celine S.; Oostdijk, Evelien A.; Rinkel, Gabriel J. E.; Dorhout Mees, Sanne M.; Vergouwen, Mervyn D. I.; de Smet, Anne Marie G. A.; van de Beek, Diederik; Vandertop, W. Peter; Verbaan, Dagmar; Algra, Ale; Bonten, Marc J. M.; van den Bergh, Walter M.

    2016-01-01

    Delayed cerebral ischemia (DCI) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Development of DCI is multifactorial, and inflammation, with or without infection, is one of the factors independently associated with development of DCI and poor outcome. We

  14. Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit

    NARCIS (Netherlands)

    Gathier, Celine S.|info:eu-repo/dai/nl/345480392; Oostdijk, Evelien A.; Rinkel, Gabriel J E|info:eu-repo/dai/nl/085712000; Dorhout Mees, Sanne M.|info:eu-repo/dai/nl/304818828; Vergouwen, Mervyn D I|info:eu-repo/dai/nl/320630544; de Smet, Anne Marie G A; van de Beek, Diederik; Vandertop, W. Peter; Verbaan, Dagmar; Algra, Ale|info:eu-repo/dai/nl/07483472X; Bonten, Marc J M|info:eu-repo/dai/nl/123144337; van den Bergh, Walter M.|info:eu-repo/dai/nl/272886157

    2016-01-01

    Introduction: Delayed cerebral ischemia (DCI) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Development of DCI is multifactorial, and inflammation, with or without infection, is one of the factors independently associated with development of DCI and

  15. 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...

  16. Nonaneurysmal subarachnoid hemorrhage in intramural hematoma of the basilar artery - a case report and literature review

    International Nuclear Information System (INIS)

    Nedevska, A.; Nakov, V.; Hristov, H.

    2012-01-01

    Pretruncal (perimesencephalic) nonaneurysmal subarachnoid hemorrhage (SAH) is a benign variant of SAH. Although angiography fails to show a source of the hemorrhage, mild basilar artery narrowing may be observed. The cause of pretruncal nonaneurysmal SAH has not been established. Recent imaging studies have demonstrated that the center of this type of SAH is not around the mesencephalon but is in the prepontine or interpeduncular cistern with the hemorrhage closely associated with the basilar artery. We review the possible sources of hemorrhage in these cisterns and hypothesize that pretruncal nonaneurysmal SAH is caused by a primary intramural hematoma of the basilar artery. Such an intramural hematoma would explain bleeding under low pressure, the location of the hemorrhage anterior to the brainstem, and the typical findings of hemorrhage adjacent to the basilar artery lumen on magnetic resonance imaging and mild basilar artery narrowing on angiography. Hemorrhage in such location is easily found in native computed tomography (CT) images. Crescent, hyperdense thickening of the basilar artery wall is also observed. We have presented this unusual case to highlight the possible mechanism of hematoma formation and underline the importance of MDCT examination in the diagnosis confirmation and also excluding other potentially serious underlying condition that could also lead to non traumatic SAH. (authors)

  17. Intracranial Biodegradable Silica-Based Nimodipine Drug Release Implant for Treating Vasospasm in Subarachnoid Hemorrhage in an Experimental Healthy Pig and Dog Model

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    Janne Koskimäki

    2015-01-01

    Full Text Available Nimodipine is a widely used medication for treating delayed cerebral ischemia (DCI after subarachnoid hemorrhage. When administrated orally or intravenously, systemic hypotension is an undesirable side effect. Intracranial subarachnoid delivery of nimodipine during aneurysm clipping may be more efficient way of preventing vasospasm and DCI due to higher concentration of nimodipine in cerebrospinal fluid (CSF. The risk of systemic hypotension may also be decreased with intracranial delivery. We used animal models to evaluate the feasibility of surgically implanting a silica-based nimodipine releasing implant into the subarachnoid space through a frontotemporal craniotomy. Concentrations of released nimodipine were measured from plasma samples and CSF samples. Implant degradation was followed using CT imaging. After completing the recovery period, full histological examination was performed on the brain and meninges. The in vitro characteristics of the implant were determined. Our results show that the biodegradable silica-based implant can be used for an intracranial drug delivery system and no major histopathological foreign body reactions were observed. CT imaging is a feasible method for determining the degradation of silica implants in vivo. The sustained release profiles of nimodipine in CSF were achieved. Compared to a traditional treatment, higher nimodipine CSF/plasma ratios can be obtained with the implant.

  18. Intraoperative Vascular Neuromonitoring in Patients with Subarachnoid Hemorrhage: A Pilot Study Using Combined Laser-Doppler Spectrophotometry.

    Science.gov (United States)

    Schmitz, Emilija; Bischoff, Barbara; Wolf, Dennis; Schmitt, Hubert J; Eyupoglu, Ilker Y; Roessler, Karl; Buchfelder, Michael; Sommer, Björn

    2017-11-01

    Intraoperative monitoring of cerebral microcirculation in patients with subarachnoid hemorrhage (SAH) may predict the postoperative neurologic outcome. In this pilot study, we examined the value of a novel noninvasive real-time measurement technique for detecting changes in local microcirculation. We used the O2C (Oxygen to see) laser-Doppler spectrophotometry system in 14 patients with Hunt & Hess grade 2-5 SAH who underwent microsurgical cerebral aneurysm clipping. A subdural probe recorded capillary venous oxygenation (SO 2 ), relative hemoglobin concentration, blood cell velocity, and blood flow at a tissue depth of 7 mm. Data were recorded immediately before dural closure. We also recorded somatosensory evoked potentials (SEPs) with median and tibial nerve stimulation. Results were compared with neurologic performance, as measured on the modified Rankin Scale, at the day of discharge from the hospital and 12 months thereafter. Patient functional outcomes after discharge and 12 months were correlated with pathological decreased flow and increased SO 2 values. In 6 of 8 patients, microcirculatory monitoring parameters indicated ischemia during surgery, as shown by electrophysiological SEP changes and infarction detected on the postoperative computed tomography (CT) scan. Pathological SEP results correlated closely with infarct demarcation as seen on CT. Our results indicate the potential benefit of intraoperative combined laser-Doppler flowmetry and spectrophotometry for predicting postoperative clinical outcomes in this small patient sample. Larger-cohort testing is needed to verify our findings and show the possible merits of this novel method. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Severe Dextran-Induced Anaphylactic Shock during Induction of Hypertension-Hypervolemia-Hemodilution Therapy following Subarachnoid Hemorrhage

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    Tohru Shiratori

    2015-01-01

    Full Text Available Dextran is a colloid effective for volume expansion; however, a possible side effect of its use is anaphylaxis. Dextran-induced anaphylactoid reaction (DIAR is a rare but severe complication, with a small dose of dextran solution sufficient to induce anaphylaxis. An 86-year-old female who underwent clipping for a ruptured cerebral aneurysm was admitted to the intensive care unit. Prophylactic hypertension-hypervolemia-hemodilution therapy was induced for cerebral vasospasm following a subarachnoid hemorrhage. The patient went into severe shock after administration of dextran for volume expansion, and dextran administration was immediately discontinued. The volume administered at that time was only 0.8 mL at the most. After fluid resuscitation with a crystalloid solution, circulatory status began to recover. However, cerebral vasospasm occurred and the patient’s neurological condition deteriorated. Five weeks after the shock, she was diagnosed with hypersensitivity to dextran by a skin test. When severe hypotension occurs after dextran administration, appropriate treatments for shock should be performed immediately with discontinuation of dextran solution. Although colloid administration is recommended in some guidelines and researches, it is necessary to consider concerning the indication for volume expansion as well as the risk of colloid administration.

  20. Remote acute subarachnoid hemorrhage after drainage of chronic subdural hematoma: A case report and review of the literature.

    Science.gov (United States)

    Wang, Guangming; Yu, Jinlu

    2018-03-03

    Chronic subdural hematoma(CSDH) can be treated by a relatively simple burr hole surgery. Acute subarachnoid hemorrhage (SAH) occurring after surgery for CSDH has been reported as a rare but severe complication. An 88-year-old female complained of progressive headache and dizziness for one month. A right fronto-temporo-parietal CSDH with a shift in the midline structures and lateral ventricle compression was shown by computed tomography (CT) scans. Closed-system drainage of the hematoma was performed via one burr hole under general anesthesia. Two hours after we began draining the hematoma at the patient's bedside, the patient complained of headache and exhibited impaired consciousness that progressively degenerated. The drainage bag collected 200 ml of bloody liquid overa short time. A subsequent CT scan revealed SAH and an acute subdural hematoma. A CT angiogram excluded the presence of intracranial aneurysms. The patient died of hypostatic pneumonia after 15 days despite conservative medical management. Relevant literature was reviewed, and we believe that the occurrence of a hematoma in the opposite hemisphere and the hyperperfusion resulted from the rapid drainage of the hematoma, which caused the rupture of weak bridging veins during drainage. Slow decompression with closed-system drainage is recommended to avoid rapid dynamic intracranial changes during drainage of a subdural hematoma, including brain shift or restoration of normal perfusion,to prevent devastating complications. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. 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 effects in all parameters were more pronounced for SAH than for saline injection. CONCLUSIONS: This study revealed that both the elevation of intracranial pressure and subarachnoid blood per se contribute approximately equally to the late CBF reductions and receptor upregulation following SAH....

  2. Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of ruptured cerebral aneurysm

    International Nuclear Information System (INIS)

    Karttunen, A.I.; Jartti, P.H.; Haapea, M.; Ukkola, V.A.; Sajanti, J.

    2003-01-01

    Computed tomography (CT) is the 'gold standard' for detecting subarachnoid haemorrhage (SAH) and digital subtraction angiography (DSA) for visualising the vascular pathology. We studied retrospectively 180 patients with subarachnoid haemorrhage (SAH) who underwent first non-enhanced computed tomography (CT), then digital subtraction angiography (DSA) and finally operative aneurysm clipping. Our aim was to assess if the location of the ruptured aneurysm could be predicted on the basis of the quantity and distribution of haemorrhage on the initial CT scan. 180 patients with SAH were retrospectively studied. All the CT and DSA examinations were performed at the same hospital. CT was performed within 24 hours after the initial haemorrhage. DSA was performed alter the CT, within 48 hours after the initial haemorrhage. Two neuroradiologists, blind to the DSA results, analysed and scored independently the quantity and distribution of the haemorrhage and predicted the site of the ruptured aneurysm on the basis of the non-enhanced CT. DSA provided the location of the ruptured aneurysm. All the patients were operated upon, and the location of the ruptured aneurysm was determined. The overall reliability value (r,-value) between the two neuroradiologists for locating all ruptured aneurysms was 0.780. The corresponding value for the right MCA was 0.911, that for the left MCA 0.877 and that for the AcoA 0.736. Not all of the rc-values were calculated, either because the location of the rupture was constant or because the number of ruptures in the vessel was too small. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of the ruptured aneurysm with a statistical significance of p = 0.003. The quantity and pattern of the blood clot an CT within the day of onset of SAH is a reliable and quick cool for locating a ruptured MCA or AcoA aneurysm. It is not, however, reliable for locating other ruptured aneurysms. Subarachnoid haemorrhage with a

  3. Early variations of laboratory parameters predicting shunt-dependent hydrocephalus after subarachnoid hemorrhage.

    Science.gov (United States)

    Na, Min Kyun; Won, Yu Deok; Kim, Choong Hyun; Kim, Jae Min; Cheong, Jin Hwan; Ryu, Je Il; Han, Myung-Hoon

    2017-01-01

    Hydrocephalus is a frequent complication following subarachnoid hemorrhage. Few studies investigated the association between laboratory parameters and shunt-dependent hydrocephalus. This study aimed to investigate the variations of laboratory parameters after subarachnoid hemorrhage. We also attempted to identify predictive laboratory parameters for shunt-dependent hydrocephalus. Multiple imputation was performed to fill the missing laboratory data using Bayesian methods in SPSS. We used univariate and multivariate Cox regression analyses to calculate hazard ratios for shunt-dependent hydrocephalus based on clinical and laboratory factors. The area under the receiver operating characteristic curve was used to determine the laboratory risk values predicting shunt-dependent hydrocephalus. We included 181 participants with a mean age of 54.4 years. Higher sodium (hazard ratio, 1.53; 95% confidence interval, 1.13-2.07; p = 0.005), lower potassium, and higher glucose levels were associated with higher shunt-dependent hydrocephalus. The receiver operating characteristic curve analysis showed that the areas under the curve of sodium, potassium, and glucose were 0.649 (cutoff value, 142.75 mEq/L), 0.609 (cutoff value, 3.04 mmol/L), and 0.664 (cutoff value, 140.51 mg/dL), respectively. Despite the exploratory nature of this study, we found that higher sodium, lower potassium, and higher glucose levels were predictive values for shunt-dependent hydrocephalus from postoperative day (POD) 1 to POD 12-16 after subarachnoid hemorrhage. Strict correction of electrolyte imbalance seems necessary to reduce shunt-dependent hydrocephalus. Further large studies are warranted to confirm our findings.

  4. [Comparison of Two Methods of Lidocaine Administrating for Neuroprotection in Rabbit Model of Subarachnoid Hemorrhage].

    Science.gov (United States)

    Shi, Xian-Qing; Fu, Yong-Jian; Zheng, Li-Rong

    2017-01-01

    To compare the neuroprotection effect of two methods of Lidocaine administration in rabbit model of subarachnoid hemorrhage. Forty New Zealand white rabbits were randomly divided into sham group, subarachnoid hemorrhage group (SAH), Lidocaine intravenous injection group (L1), and Lidocaine intracisternal administration group (L2). The rabbits were given general anaesthesia, then 1.5 mL autologous nonheparinized arterial blood was injected into cisterna magna to establish SAH model, while 1.5 mL saline was used in sham group. Thirty minutes later, the rabbits in L1 and L2 group respectively received 0.3 mL 2% Lidocaine administration of intravenously and intracisternally injection. All animals were sacrificed at 72 h after SAH. The samples of basilar artery and hippocampus tissue were processed for morphometric analysis. At pre-operation and 72 h after SAH, the level of interleukin-6 (IL-6) in serum was measured. HE staining and C fos immunohistochemical staining were performed in L1 and L2 groups. Artery area and artery diameter of basal arteries, normal neuron density and C-fos positive cell in hippocampus were measured at 72 h after SAH. The baseline level of IL-6 was not significant different in four groups ( P >0.05). The level of IL-6 at 72 h after SAH was significantly higher than that at pre-operation in SAH, L1 and L2 groups ( P L1 group was higher than that in L2 group ( P L2 group, the cross-section area and diameter of basal artery were smaller in SAH and L1 group, while the normal neuron density of hippocampus was less ( P <0.05). Intracisternal administration of Lidocaine could provide neuroprotection in rabbit model of subarachnoid hemorrhage.

  5. Intracerebral Hemorrhage

    Science.gov (United States)

    ... Home » Patients & Families » About Stroke » Intracerebral Hemorrhage Intracerebral Hemorrhage What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Warning Signs Stroke Statistics ...

  6. Anosmia After Perimesencephalic Nonaneurysmal Hemorrhage

    NARCIS (Netherlands)

    Greebe, Paut; Rinkel, Gabriel J. E.; Algra, Ale

    Background and Purpose-Anosmia frequently occurs after aneurysmal subarachnoid hemorrhage not only after clipping, but also after endovascular coiling. Thus, at least in part, anosmia is caused by the hemorrhage itself and not only by surgical treatment. However, it is unknown whether anosmia is

  7. 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 melatonin were less than those without melatonin treatment (p melatonin could mitigate CV after experimental SAH.

  8. Indicators of Subarachnoid Hemorrhage as a Cause of Sudden Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Joseph Zachariah

    2016-03-01

    Full Text Available Subarachnoid hemorrhage (SAH may present with cardiac arrest (SAH-CA. We report a case of SAH-CA to assist providers in distinguishing SAH as an etiology of cardiac arrest despite electrocardiogram findings that may be suggestive of a cardiac etiology. SAH-CA is associated with high rates of return of spontaneous circulation, but overall poor outcome. An initially non-shockable cardiac rhythm and the absence of brain stem reflexes are important clues in indentifying SAH-CA.

  9. 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.)

  10. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. 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.

  12. 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....

  13. 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...

  14. Predictors of work status and quality of life 9-13 years after aneurysmal subarachnoid hemorrahage.

    Science.gov (United States)

    Vilkki, Juhani; Juvela, Seppo; Malmivaara, Kirsi; Siironen, Jari; Hernesniemi, Juha

    2012-08-01

    Aneurysmal subarachnoid hemorrhage (SAH) causes long-term psychosocial impairments even in patients who regain functional independence. Little is known about predictors of these impairments. We studied how early clinical data and neuropsychological results predict work status and health-related quality of life (HRQoL) 9-13 years after SAH. One hundred one patients performed a neuropsychological test battery and returned their self-rating and partner's rating of a psychosocial impairment questionnaire approximately 1 year after SAH. These data were analyzed for association to the patients' work status and self-rated HRQoL approximately 10 years later. Age inversely, lower levels of self-rated impairments, employment and higher levels of education at the first follow-up independently predicted employment at the long-term follow-up. Although most cognitive test results were significantly associated with employment status at the long-term follow-up, they were of limited additional value as predictors of work status. The best predictor combination for long-term high HRQoL was good performance in a face recognition test and lower levels of self-rated impairments at the first follow-up as well as male sex. Problems in usual activities at the long-term follow-up were predicted by poor results in the face recognition and in a word list-learning task. Questionnaire ratings of patients' psychosocial impairments 1 year after SAH give important information for the long-term prediction of their work status and HRQoL. In the long run, patients' unemployment becomes strongly associated with higher age, while their performance of usual activities can be predicted with learning and memory results.

  15. Acute Compressive Myelopathy Caused by Spinal Subarachnoid Hemorrhage: A Combined Effect of Asymptomatic Cervical Spondylosis.

    Science.gov (United States)

    Kawasaki, Toshinari; Fukuda, Hitoshi; Kurosaki, Yoshitaka; Handa, Akira; Chin, Masaki; Yamagata, Sen

    2016-11-01

    Patients with subarachnoid hemorrhage (SAH) by hemorrhagic arteriovenous fistulas (AVFs) usually presents with meningeal signs, including headache and nausea, and focal neurologic deficit is found in rare cases. In this article, we report a case of acute compressive cervical myelopathy caused by hemorrhagic AVF at the craniocervical junction. A 73-year-old woman was transferred to our hospital for sudden headache and subsequent left hemiparesis. Head computed tomography scan showed SAH exclusively in the posterior fossa, and catheter angiography revealed a perimedullary arteriovenous fistula at the craniocervical junction as a source of the SAH. Detailed neurologic examination showed the sensory disturbance of bilateral upper extremities and bladder and rectal disturbance, suggesting concurrent cervical myelopathy. Magnetic resonance imaging of the cervical spine showed disk herniation at the C4-5 level, spinal SAH deposition above the C4-5 level, and accompanying myelomalacia. No intramedullary hemorrhage was found. Spinal SAH alone rarely causes focal neurologic deficit. However, this case suggests spinal SAH can cause acute compressive myelopathy when complicated with preexisting spinal canal stenosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Anterior communicating artery aneurysm clipping versus coiling: a comparative study of 50 cases

    Directory of Open Access Journals (Sweden)

    Kumar Pradeep

    2017-09-01

    Full Text Available Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH remains a devastating and often fatal form of stroke. The aneurysm is targeted for obliteration to prevent re-bleeding and to manage the possible complications from the event. Endovascular coiling has emerged as a less invasive alternative to conventional surgical clipping to treat aneurysms.

  17. Anosmia after endovascular and open surgical treatment of intracranial aneurysms Clinical article

    NARCIS (Netherlands)

    Moman, Maaike R.; Verweij, Bon H.; Buwalda, Joeri; Rinkel, Gabriel J. E.

    Object. Patients treated for aneurysmal subarachnoid hemorrhage (SAH) often report a loss of smell. To discriminate between the effects of aneurysmal rupture and treatment, the authors assessed the occurrence of anosmia after clipping and coiling of unruptured aneurysms as well as after the coiling

  18. The relationship between contrast enhancement on CT and cerebral vasospasm in patient with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Tazawa, Toshiaki; Mizukami, Masahiro; Kawase, Takeshi; Usami, Takashi; Togashi, Osamu

    1982-01-01

    Sixty patients with a single rupture of an aneurysm were subjected to study. Contrast enhanced CT (CECT) was performed by intravenous infusion of 100 ml of 60% meglumine iothalamate in 10 minutes. Post-contrast CT scans were repeated serially just after infusion, 15 minutes and 30 minutes later. Prominent increase in density in the region of the circle of Willis and its branches 30 minutes after infusion was considered as remarkable enhancement. In 17 (46%) out of 37 patients who underwent CECT within day 3, the contrast enhancement was remarkable. Transient or permanent symptomatic vasospasm occurred in 13 (76.5%) out of these 17 patients and the remaining 4 patients who underwent the operation with successful removal of subarachnoid clot within day 3 did not develop symptomatic vasospasm. Eight (67%) out of 12 patients operated within day 3, in whom post-operative CT showed incomplete removal of subarachnoid clot, developed transient or permanent symptomatic vasospasm. In only one (5%) out of 20 patients without remarkable enhancement, transient symptomatic vasospasm occurred. The abnormal contrast enhancement in the region of the circle of Willis and its branches within day 3 was closely related to the subsequent occurrence of vasospasm. Contrast enhanced CT was performed in 41 patients after day 3. There was no patient with remarkable enhancement on CECT. There was no relationship between the findings on CECT after day 3 and the occurrence of vasospasm. CECT within day 3 allows prediction of that patient destined for vasospasm and early removal of subarachnoid clot within day 3 may minimize the future development of vasospasm.(J.P.N.)

  19. Aneurysmal subarachnoid haemorrhage (aSAH: Five consecutive years' experience of Fars province, Iran.

    Directory of Open Access Journals (Sweden)

    Abdolkarim Rahmanian

    Full Text Available Subarachnoid haemorrhage (SAH, caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran.In this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery. Data from the last national census in 2011 were used to calculate the incidence. The data were analysed using SPSS software version 18 using independent sample t test, chi square test and ANOVA. The significance level was set at 0.05.The number of aSAH cases identified in Fars, Iran, each year varied between 78 (2011 and 98 (2015 for a total of 421 aSAH cases within the 5-year study period. The annual aSAH incidence estimates showed no differences and were 1.65 [95% confidence interval (CI: 1.58-1.72], 1.70 (95%CI: 1.68-1.72, 1.71 (95%CI: 1.63-1.78, 1.82 (95%CI: 1.74-1.9, and 2.05 (95%CI: 1.97-2.13 per 100,000 persons, respectively, for the five consecutive years from 21 March 2011 to 20 March 2016. Hypertension was the most common risk factor, and was found in 198 (48% aSAH patients. Ninety-four (22.5% patients had moderate hydrocephalus on admission. Middle cerebral artery and anterior communicating artery were the most common sites of aneurysms. On admission, 351 (83% patients had a Glasgow Coma Scale score >7, 197 (47% presented with Hunt and Hess score of 1, and 365 (87% had a Fisher score of ≤3. Multiple aneurysms were found in 59 (14% of the 421 cases and the most common risk factors in multiple aneurysms were hypertension in 30 (51% and smoking in 26 (44% cases. Survival data were available only on patients diagnosed in year 2015, and the six

  20. 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.)

  1. 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

    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...

  2. Relation of serum TNF-α and TNF-α genotype with delayed cerebral ischemia and outcome in subarachnoid hemorrhage

    NARCIS (Netherlands)

    Beeftink, Martine M. A.; Ruigrok, Ynte M.; Rinkel, Gabriel J. E.; van den Bergh, Walter M.

    2011-01-01

    The pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) remains obscure. The authors assessed the relationship of tumor necrosis factor alpha (TNF-α) and TNF-α gene polymorphisms with occurrence of DCI and poor outcome at 3 months. Serum levels of TNF-α were measured

  3. Lateral Medullary Ischemic Infarct Caused by Posterior Inferior Cerebellar Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Muhammad Taimur Malik

    2017-12-01

    Full Text Available Posterior inferior cerebellar artery (PICA aneurysms are rare. The most common complication of intracranial aneurysms is rupture causing subarachnoid hemorrhage. Ischemic infarct, although more common in giant thrombosed aneurysms, is a very rare manifestation of small intracranial aneurysms. Here we describe a patient who presented with lateral medullary acute infarction associated with an ipsilateral, small (4 × 3.5 mm, unruptured and non-thrombosed PICA aneurysm.

  4. Flat-panel detector volumetric CT for visualization of subarachnoid hemorrhage and ventricles: preliminary results compared to conventional CT

    International Nuclear Information System (INIS)

    Doelken, M.; Struffert, T.; Richter, G.; Engelhorn, T.; Doerfler, A.; Nimsky, C.; Ganslandt, O.; Hammen, T.

    2008-01-01

    The aim of this study was to compare flat-panel volumetric CT (VCT) to conventional CT (cCT) in the visualization of the extent of subarachnoid hemorrhage (SAH) and the width of the ventricles in patients with acute SAH. Included in the study were 22 patients with an acutely ruptured cerebral aneurysm who received VCT during coil embolization. VCT image quality, the extent of SAH (using a modified Fisher score and total slice number with SAH visible) and the width of the ventricles (Evans index) were evaluated by two experienced neuroradiologists (RAD1 and RAD2) and compared to the findings on cCT. Ten patients undergoing VCT for reasons other than SAH served as negative controls. Interobserver agreement in rating image quality was excellent for cCT (Kendall W value 0.94) and good for VCT (0.74). SAH was identified by RAD1 and RAD2 on VCT images in all patients. The modified Fisher scores underestimated the extent of SAH on VCT images in comparison with cCT images. Pearson's correlation coefficient (r) regarding the number of image slices with SAH visible on cCT images compared with the number on VCT images was 0.85 for RAD1 and 0.84 for RAD2. The r value for the degree of interobserver agreement for the number of slices with SAH visible was 0.99 for cCT, and 0.95 for VCT images (n 19), respectively. The width of the ventricles measured in terms of the Evans Index showed excellent concordance between the modalities (r = 0.81 vs. 0.82). Our preliminary results indicate that VCT is helpful in evaluating SAH in the angiography suite. Additionally, reliable evaluation of ventricle width is feasible. However, there are limitations with regard to the visibility of SAH on VCT images in comparison to cCT images. (orig.)

  5. 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.)

  6. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study.

    Science.gov (United States)

    Ascanio, Luis C; Gupta, Raghav; Adeeb, Nimer; Moore, Justin M; Griessenauer, Christoph J; Mayeku, Julie; Tachie-Baffour, Yaw; Thomas, Ranjit; Alturki, Abdulrahman Y; Schmalz, Philip G R; Ogilvy, Christopher S; Thomas, Ajith J

    2018-03-16

    OBJECTIVE Currently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship. METHODS A retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed. Patients with SAH who had received an EVD within the first 24 hours of hospital admission and had undergone at least 1 clamp trial prior to EVD removal were eligible for inclusion in the study. Patient demographics, clinical presentations, SAH etiologies and grades, clamp trial data, hospital lengths of stay, and functional outcomes were recorded. RESULTS One hundred fourteen patients with nontraumatic SAH complicated by posthemorrhagic hydrocephalus were included in the study. The median patient age was 57 years (range 28-90 years), with a male/female ratio of 1:1.7. A ruptured aneurysm was the underlying etiology of SAH in 79.8% of patients. A majority of patients (69.4%) had a Hunt and Hess grade III-V on admission. The median number of clamp trials performed was 2 (range 1-6). A VP shunt was required in 40.4% of patients. In those who underwent 2 and 3 clamp trials, 60% and 38.9%, respectively, did not require subsequent VP shunt placement. CONCLUSIONS Surgical placement of a VP shunt is associated with complications. Clamp trials are routinely performed before making the decision to insert a shunt. In the present study, the authors found that a significant percentage of patients passed their second and third clamp trials without requiring subsequent shunt insertion. These data support performing multiple clamp trials prior to shunt placement.

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

    International Nuclear Information System (INIS)

    Fainardi, E.; Tagliaferri, M.F.; Compagnone, C.; Tanfani, A.; Cocciolo, F.; Targa, L.; Chieregato, A.; Battaglia, R.; Frattarelli, M.; Pascarella, R.

    2006-01-01

    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 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 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 hyperemic areas. (orig.)

  8. Concentration of plasma haptoglobin and symptomatic cerebral vasospasm after subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    FAN Yi-mu

    2013-08-01

    Full Text Available The relation of plasma haptoglobin concentration to symptomatic cerebral vasospasm (SCVS after subarachnoid hemorrhage (SAH was investigated. The plasma concentration of haptoglobin was analyzed by enzyme-linked immunosorbent assay (ELISA. SCVS was determined by aggravated headache, deteriorated conscious state a few days after ictus or by new neurologic impairment and new ischemic injuries on repeated CT scans. The mean concentration of plasma haptoglobin in 19 patients with SCVS was (0.29 ± 0.14 g/L, whereas it was (0.78 ± 0.48 g/L in 24 patients without SCVS. These findings may suggest that plasma haptoglobin concentration seems to be associated with the development of SCVS after SAH.

  9. Pediatric Extracorporeal Cardiopulmonary Resuscitation Patient With Traumatic Subarachnoid Hemorrhage and Takotsubo Syndrome.

    Science.gov (United States)

    Pearson, Thomas E; Frizzola, Meg A; Priest, Marc A; Rochman, Monica F; Froehlich, Curtis D

    Takotsubo syndrome is rare in pediatric patients but must be considered in patients with subarachnoid hemorrhage with pulmonary edema and cardiomyopathy. A systematic, collaborative approach is needed to facilitate emergent transfer of patients where extracorporeal cardiopulmonary resuscitation (e-CPR) is used as a lifesaving measure. Extracorporeal membrane oxygenation (ECMO) use in transport requires preplanning, role delineation, resources, and research efforts to be successful. We present an unusual transport case of successful e-CPR/ECMO treatment of Takotsubo syndrome in a 12-year-old boy with an isolated traumatic intracranial injury, cardiomyopathy with pulmonary edema, and multiple cardiac arrests. Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    2013-01-01

    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 < 0.05). The neurological deficits of SAH rats treated with melatonin were less than those without melatonin treatment (p < 0.05). We concluded that SRA was a precise and in vivo tool to observe and evaluate CV of SAH rats; intraperitoneally administration of melatonin could mitigate CV after experimental SAH.

  11. 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.

  12. Psychosocial outcomes at 18 months after good neurological recovery from aneurysmal subarachnoid haemorrhage.

    Science.gov (United States)

    Powell, J; Kitchen, N; Heslin, J; Greenwood, R

    2004-08-01

    To evaluate functioning, 18 months after surgery, of 49 patients with good neurological recovery following aneurysmal subarachnoid haemorrhage (SAH), and to determine the extent of any improvements in disturbances of mood, cognitive functioning, and levels of activity and participation previously observed at 9 month follow up. SAH patients, matched for age, gender, and occupation with healthy control participants, completely quantitative measures of mood (HADS, FIES, BDI) and activity/participation (BICRO-39 scales), and a brief cognitive assessment battery (verbal fluency, digit span, prose recall). Controls completed the HADS and the BICRO-39. Patients showed some recovery of cognitive functioning, though impairments of prose recall persisted. Anxiety and depression symptoms were higher in patients than in controls, but fewer than 20% scored in the clinical range on any questionnaires except for RIES-Intrusive thoughts (22%); only three showed signs of full blown post-traumatic stress disorder. Almost half showed elevated dependence on others for domestic activities and organisation and abnormally low levels of employment. Very little variance in outcome was predicted by demographic variables, neurological or cognitive impairment, prior life stress, or mood. However, levels of social activity and self-organisation were related to persisting fatigue. The observed decline in intrusive thoughts and avoidance over time is consistent with that seen after life threatening illness or trauma. The persistent reductions in independence and levels of employment may in some cases reflect considered lifestyle adjustments rather than adverse and unwanted changes but in others indicate a need for focused rehabilitation.

  13. 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.)

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

    International Nuclear Information System (INIS)

    Nayak, S.; Kunz, A.B.; Kieslinger, K.; Ladurner, G.; Killer, M.

    2010-01-01

    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.

  15. 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.

  16. Clinical problems of the patients with subarachnoid hemorrhage which had not been diagnosed until they suffered ischemic neurological deficits and/or rebleeding

    International Nuclear Information System (INIS)

    Fukui, Issei; Ishikawa, Tatsuya; Moroi, Junta

    2011-01-01

    A small part of the patients with subarachnoid hemorrhage (SAH) are not properly diagnosed until they suffer ischemic neurological deficits and/or rebleeding during vasospasm. We therefore investigated the clinical profile of such patients. We retrospectively analyzed 581 patients with aneurysmal SAH experienced in our institute between 2001 and 2009. Patient's characteristics, presence and severity of headache before final diagnosis, imaging investigations they received, their World Federation of Neurological Surgeons (WFNS) grades at admission, the location of aneurysm, treatment, and outcome at discharge were investigated. Five patients were not correctly diagnosed until they presented neurological deficits due to vasospasm or experienced simultaneous rebleeding. Their mean age was 69.4, and all were female. Although all patients had a bad headache, they did not undergo any imaging examinations. Immediate coil embolization was performed for 2 patients, 1 died due to rupturing during embolization procedure. The other 3 were treated by open clipping surgery (2 delayed and 1 immediate). Four patients had some disability as a sequel, and their outcomes were significantly worse compared with 53 patients with SAH in WFNS Grade II. The patients with SAH who had not been properly diagnosed in the acute stage had a poor outcome. We should be very careful when we see patients complaining of severe headache. (author)

  17. Choque cardiogênico associado à hemorragia subaracnóidea Cardiogenic shock associated with subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Glauco Adrieno Westphal

    2010-09-01

    cardiomyopathy may occur, possibly associated with myocardial dysfunction. This manuscript aims to report a case of subarachnoid hemorrhage associated with myocardial dysfunction and cardiogenic shock. A 45 years old woman was admitted with subarachnoid hemorrhage and coma, showing Glasgow scale = 7, Hunt-Hess = 5 and Fischer computed tomography classification = 3. On the second day, the patient underwent anterior cerebral communicant artery aneurysm embolization. The clinical evaluation revealed diffuse pulmonary infiltration, dyspnea and hypotension. Additional tests showed electrocardiographic lateral wall repolarization changes and elevated creatine kinase-MB fraction (36U/L. The cardiac index was 2.03 L/minute/m², Vascular systemic resistance was 3728 dynes.sec/cm². The non-responsiveness to volume demonstrated a cardiogenic shock pattern. The ventricular ejection fraction was 39%. The coronariography was normal, showing no obstructive lesions. Six days later the patient was removed from respiratory support and after eight days the dobutamine infusion was discontinued. The ejection fraction recovered up to 65%. Serial transcranial Doppler evaluations did not show vascular spasm. After ten days the patient was discharged from the intensive care unit. Patients with subarachnoid hemorrhage may be complicated with ventricular dysfunction and cardiogenic shock, increasing the cerebral ischemia risk. Diagnosis optimization and hemodynamic stabilization are essential to minimize the risk of cerebral vasospasm and ischemia.

  18. Experimental subarachnoid hemorrhage: subarachnoid blood volume, mortality rate, neuronal death, cerebral blood flow, and perfusion pressure in three different rat models.

    Science.gov (United States)

    Prunell, Giselle Fabiana; Mathiesen, Tiit; Diemer, Nils Henrik; Svendgaard, Niels-Aage

    2003-01-01

    To investigate which of three subarachnoid hemorrhage (SAH) models is the most suitable for studies of pathological and pathophysiological processes after SAH. SAH was induced in rats via intracranial endovascular perforation (perforation model), blood injection into the cisterna magna (300 microl), or blood injection into the prechiasmatic cistern (200 microl). The subarachnoid blood volume was quantitatively measured. Cerebral blood flow (CBF) (as assessed with laser Doppler flowmetry), intracranial pressure, and mean arterial blood pressure were recorded for 90 minutes after SAH. Mortality was recorded, and neuronal death was assessed in animals that survived 7 days after SAH. The subarachnoid blood volume was close to the injected amount after prechiasmatic SAH. In the other models, the volume varied between 40 and 480 microl. The mortality rates were 44% in the perforation SAH group, 25% in the prechiasmatic SAH group, and 0% in the cisterna magna SAH group; the corresponding values for neuronal death were 11, 44, and 28%. Cerebral perfusion pressure approached baseline values within 5 minutes after SAH in all three models. CBF decreased to approximately 35% of baseline values immediately after SAH in all groups; it gradually increased to normal values 15 minutes after SAH in the cisterna magna SAH group and to 60 and 89% of baseline values 90 minutes post-SAH in the perforation and prechiasmatic SAH groups. CBF was significantly correlated with the subarachnoid blood volume. The prechiasmatic SAH model seems to be the most suitable for study of the sequelae after SAH; it produces a significant decrease in CBF, an acceptable mortality rate, and substantial pathological lesions, with high reproducibility. The CBF reduction is predominantly dependent on the amount of subarachnoid blood.

  19. The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage.

    Science.gov (United States)

    Bretz, Julia S; Von Dincklage, Falk; Woitzik, Johannes; Winkler, Maren K L; Major, Sebastian; Dreier, Jens P; Bohner, Georg; Scheel, Michael

    2017-09-01

    Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category. Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months. Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient's age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p present study indicates that it has an additional predictive value for the functional outcome within the Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.

  20. Inversion of neurovascular coupling after subarachnoid hemorrhage in vivo.

    Science.gov (United States)

    Balbi, Matilde; Koide, Masayo; Wellman, George C; Plesnila, Nikolaus

    2017-11-01

    Subarachnoid hemorrhage (SAH) induces acute changes in the cerebral microcirculation. Recent findings ex vivo suggest neurovascular coupling (NVC), the process that increases cerebral blood flow upon neuronal activity, is also impaired after SAH. The aim of the current study was to investigate whether this occurs also in vivo. C57BL/6 mice were subjected to either sham surgery or SAH by filament perforation. Twenty-four hours later NVC was tested by forepaw stimulation and CO 2 reactivity by inhalation of 10% CO 2 . Vessel diameter was assessed in vivo by two-photon microscopy. NVC was also investigated ex vivo using brain slices. Cerebral arterioles of sham-operated mice dilated to 130% of baseline upon CO 2 inhalation or forepaw stimulation and cerebral blood flow (CBF) increased. Following SAH, however, CO 2 reactivity was completely lost and the majority of cerebral arterioles showed paradoxical constriction in vivo and ex vivo resulting in a reduced CBF response. As previous results showed intact NVC 3 h after SAH, the current findings indicate that impairment of NVC after cerebral hemorrhage occurs secondarily and is progressive. Since neuronal activity-induced vasoconstriction (inverse NVC) is likely to further aggravate SAH-induced cerebral ischemia and subsequent brain damage, inverse NVC may represent a novel therapeutic target after SAH.

  1. 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.

  2. Endovascular embolization of mirror brain aneurysms

    International Nuclear Information System (INIS)

    Sirakov, S.; Penkov, M.; Sirakov, A.; Todorov, Y.; Ninov, K.; Minkin, K.; Bachvarov, Ch.

    2016-01-01

    Aneurysms of the vertebral artery are rare, constituting 0.5 to 3% of all intracranial aneurysms and less than 20% of those of the posterior brain circulation. Bilateral - mirror aneurysms on vertebral artery are extremely rare and unusual lesions, but are often seen and treated in the setting of acute subarachnoid hemorrhage or stroke in the posterior circulation. The treatment of such aneurysms of the vertebral artery with their specific anatomical location is great challenge to traditional neurosurgery. We present our experience with endovascular approach with this pathology. Key words: Mirror Brain Aneurysm. Endovascular Embolization

  3. Dissecting Aneurysm of Anterior Inferior Cerebellar Artery Initially Presenting with Nonhemorrhagic Symptom.

    Science.gov (United States)

    Sasame, Jo; Nomura, Motohiro

    2015-08-01

    We report a patient with a probable dissecting aneurysm of the anterior inferior cerebellar artery (AICA) initially presenting with a nonhemorrhagic symptom, which resulted in subarachnoid hemorrhage. A 61-year-old woman suddenly experienced nausea. Computed tomography (CT) on admission showed a high-density mass with a double lumen in the right cerebellopontine angle without subarachnoid hemorrhage. Five days after the onset, she suddenly lost consciousness. CT demonstrated subarachnoid hemorrhage. Emergency angiography revealed a probable dissecting aneurysm at the lateral pontomedullary segment of the right AICA. Although the initial symptom is not hemorrhage, an unruptured dissecting aneurysm of the AICA may have a high risk of rupture. Immediate radical treatment to prevent subsequent rupture is necessary for even an unruptured dissecting aneurysm of the AICA. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Cognitive domain deficits in patients with aneurysmal subarachnoid haemorrhage at 1 year

    Science.gov (United States)

    Wong, George Kwok Chu; Lam, Sandy Wai; Ngai, Karine; Wong, Adrian; Siu, Deyond; Poon, Wai Sang; Mok, Vincent

    2013-01-01

    Background Cognitive domain deficits can occur after aneurysmal subarachnoid haemorrhage (aSAH) though few studies systemically evaluate its impact on 1-year outcomes. Objective We aimed to evaluate the pattern and functional outcome impact of cognitive domain deficits in aSAH patients at 1 year. Methods We carried out a prospective observational study in Hong Kong, during which, 168 aSAH patients (aged 21–75 years and had been admitted within 96 h of ictus) were recruited over a 26-month period. The cognitive function was assessed by a domain-specific neuropsychological assessment battery at 1 year after ictus. The current study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193). Results Prevalence of individual domain deficits varied between 7% to 15%, and 13% had two or more domain deficits. After adjusting for abbreviated National Institute of Health Stroke Scale and Geriatric Depressive Scale scores, unfavourable outcome (Modified Rankin Scale 3–5) and dependent instrumental activity of daily living (Lawton Instrumental Activity of Daily Living<15) were significantly associated with two or more domain deficits and number of cognitive domain deficits at 1 year. Two or more domain deficits was independently associated with age (OR, 1.1; 95% CI 1.1 to 1.2; p<0.001) and delayed cerebral infarction (OR, 6.1; 95% CI 1.1 to 33.5; p=0.036), after adjustment for years of school education. Interpretation In patients with aSAH, cognitive domain deficits worsened functional outcomes at 1 year. Delayed cerebral infarction was an independent risk factor for two or more domain deficits at 1 year. PMID:23606736

  5. Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom.

    Science.gov (United States)

    Rivero-Arias, Oliver; Gray, Alastair; Wolstenholme, Jane

    2010-04-27

    To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) pound168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be pound23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be pound510 million annually. The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories.

  6. Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH in the United Kingdom

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    Gray Alastair

    2010-04-01

    Full Text Available Abstract Background To estimate life years and quality-adjusted life years (QALYs lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. Methods All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10 code I60. Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. Results A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses of a SAH in the United Kingdom was estimated to be £510 million annually. Conclusion The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories.

  7. Isolated Traumatic Subarachnoid Hemorrhage: An Evaluation of Critical Care Unit Admission Practices and Outcomes From a North American Perspective.

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    Witiw, Christopher D; Byrne, James P; Nassiri, Farshad; Badhiwala, Jetan H; Nathens, Avery B; da Costa, Leodante B

    2018-03-01

    Traumatic subarachnoid hemorrhage is a common radiographic finding associated with traumatic brain injury. The objective of this investigation is to evaluate the association between hospital-level ICU admission practices and clinically important outcomes for patients with isolated traumatic subarachnoid hemorrhage and mild clinical traumatic brain injury. Multicenter observational cohort. Trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program spanning January 2012 to March 2014. A total of 14,146 subjects, 16 years old and older, admitted to 215 trauma centers with isolated traumatic subarachnoid hemorrhage and Glasgow Coma Scale score 13 or greater. Patients with concurrent intracranial injuries, severe injury to other body regions, or tests positive for alcohol or illicit substances were excluded. ICU admission. The primary outcome was need for neurosurgical intervention, defined as insertion of an intracranial monitor/drain or craniectomy/craniotomy. Secondary outcomes describing the clinical course included hospital discharge disposition, in-hospital mortality, and length of stay. Admission to ICU was common within the cohort (44.6%), yet the need for neurosurgical intervention was rare (0.24%). Variability was high between centers and remained so after adjusting for differences in case-mix and hospital-level characteristics (median odds ratio, 4.1). No significant differences in neurosurgical interventions, mortality, or discharge disposition to home under self-care were observed between groups of the highest and lowest ICU admitting hospitals. However, those in highest admitting group "stayed" in hospital 1.13 (95% CI, 1.07-1.20; p practices may represent an opportunity for resource optimization when managing patients with mild clinical traumatic brain injury and associated isolated traumatic subarachnoid hemorrhage.

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

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    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.

  9. Pseudoaneurysm of the anterior spinal artery in a patient with Moyamoya: an unusual cause of subarachnoid hemorrhage.

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    Walz, D M; Woldenberg, R F; Setton, A

    2006-08-01

    Subarachnoid hemorrhage (SAH) is a recognized presentation of Moyamoya disease in adults. Because there are extensive collateral networks and potential complications that develop, a thorough investigation of the intracranial and extracranial circulation is necessary to exclude a treatable cause when these patients present with SAH. We present a case of SAH due to a ruptured pseudoaneurysm of the anterior spinal artery arising from the supreme intercostal artery, which was the sole source of blood supply to the intracranial circulation.

  10. Post-thrombolysis hemorrhage risk of unruptured intracranial aneurysms.

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    Chen, Fujian; Yan, Shenqiang; Jin, Xinchun; Lin, Chen; Cao, Jin

    2015-01-01

    It has been questioned whether patients with unruptured intracranial aneurysms (IAs) are at a greater risk for the development of intracerebral hemorrhage (ICH) following thrombolytic therapy. We thus performed a meta-analysis to better quantify the risk of post-thrombolysis ICH in patients with acute ischemic stroke and incidental IAs. We searched PubMed, Web of Science and EMBASE for studies assessing ICH risk in patients with acute ischemic stroke treated with thrombolysis, in relation to the presence of pretreatment IAs. A fixed-effects model meta-analysis was performed. We identified four studies totaling 707 participants receiving intravenous thrombolysis. The prevalence of unruptured IAs was 6.8%. Pooled analysis demonstrates relative risk (RR) for the presence of unruptured IAs and the development of any ICH to be 1.204 (95% CI 0.709-2.043; p = 0.492; I(2) = 0.0%). The RR for sICH is 1.645 (95% CI 0.453-5.970; p = 0.449; I(2) = 28.1%). Intravenous thrombolysis was safe among patients with acute ischemic stroke and incidental unruptured IAs. Future prospective studies with much larger sample sizes are required to clarify the significance of the association between pre-existing unruptured IAs and the development of post-thrombolysis ICH.

  11. Consciousness recovery induced by intrathecal baclofen administration after subarachnoid hemorrhage -two case reports-.

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    Oyama, Hirofumi; Kito, Akira; Maki, Hideki; Hattori, Kenichi; Tanahashi, Kuniaki

    2010-01-01

    Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 microg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. However, the patient could eat food and wash her face with minimal assistance at 3 months after the implantation, and could stand up in the parallel bars with assistance and speak several words at 8 months. Case 2 was in a completely bedridden state at 10 months after onset and could neither drink water nor follow instructions. However, the patient became oriented and could eat by herself within 3 to 4 weeks of implantation. She could walk with a cane and use the stairs with minimal assistance at 2 and 3 months after implantation. The patient could speak fluently within 6 months of implantation. Flatulence and dysuria happened during the screening test, but these symptoms were not repeated after implantation of a pump-catheter-system and continuous intrathecal baclofen infusion. Continuous intrathecal baclofen infusion caused both improvement in muscle tone and spasms and consciousness recovery from the vegetative state. This therapy is a strong candidate treatment for patients with spasticity and consciousness disturbance.

  12. Accuracy of Daily Lung Ultrasound for the Detection of Pulmonary Edema Following Subarachnoid Hemorrhage.

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    Williamson, Craig A; Co, Ivan; Pandey, Aditya S; Gregory Thompson, B; Rajajee, Venkatakrishna

    2016-04-01

    Early detection of pulmonary edema is vital to appropriate fluid management following subarachnoid hemorrhage (SAH). Lung ultrasound (LUS) has been shown to accurately identify pulmonary edema in patients with acute respiratory failure (ARF). Our objective was to determine the accuracy of daily screening LUS for the detection of pulmonary edema following SAH. Screening LUS was performed in conjunction with daily transcranial doppler for SAH patients within the delayed cerebral ischemia (DCI) risk period in our neuroICU. We reviewed records of SAH patients admitted 7/2012-5/2014 who underwent bilateral LUS on at least 5 consecutive days. Ultrasound videos were reviewed by an investigator blinded to the final diagnosis. "B+ lines" were defined as ≥3 B-lines on LUS. Two other investigators blinded to ultrasound results determined whether pulmonary edema with ARF (PE-ARF) was present during the period of evaluation on the basis of independent chart review, with a fourth investigator performing adjudication in the event of disagreement. The diagnostic accuracy of B+ lines for the detection of PE-ARF and RPE was determined. Of 59 patients meeting criteria for inclusion, 21 (36%) had PE-ARF and 26 (44%) had B+ lines. Kappa for inter-rater agreement was 0.821 (p pulmonary edema following SAH and may assist with fluid titration during the risk period for DCI.

  13. Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage: A Propensity Score-Matched Analysis

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    Panczykowski, David; Pease, Matthew; Zhao, Yin; Weiner, Gregory; Ares, William; Crago, Elizabeth; Jankowitz, Brian; Ducruet, Andrew F.

    2016-01-01

    Background and Purpose The utility of prophylactic antiepileptic drug (AED) administration following spontaneous subarachnoid hemorrhage (SAH) remains controversial. AEDs have not clearly been associated with a reduction in seizure incidence and have been associated with both neurologic worsening and delayed functional recovery in this setting. Methods We retrospectively analyzed a prospectively collected database of SAH patients admitted to our institution between 2005 and 2010. Between 2005 and 2007, all patients received prophylactic AEDs upon admission. After 2007 no patients received prophylactic AEDs or had AEDs immediately discontinued if initiated at an outside hospital. A propensity score-matched analysis was then performed to compare the development of clinical and/or electrographic seizures in these two populations. Results 353 patients with spontaneous SAH were analyzed, 43% of whom were treated with prophylactic AEDs upon admission. Overall, 10% of patients suffered clinical and/or electrographic seizures, most frequently occurring within 24-hrs of ictus (47%). The incidence of seizures did not vary significantly based on the use of prophylactic AEDs (11 vs. 8%, p=0.33). Propensity score-matched analyses suggest that patients receiving prophylactic AEDs had a similar likelihood of suffering seizures as those who did not (p=0.49). Conclusions Propensity score-matched analysis suggests that prophylactic AEDs do not significantly reduce the risk of seizure occurrence in patients with spontaneous SAH. PMID:27301932

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

    International Nuclear Information System (INIS)

    Cho, Eun; Kang, Myung Jin; Kim, Sang Hyeon

    2016-01-01

    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

  15. The Effect of Gender on Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage.

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    Shishido, Hajime; Zhang, Haining; Okubo, Shuichi; Hua, Ya; Keep, Richard F; Xi, Guohua

    2016-01-01

    Acute hydrocephalus is a common complication of subarachnoid hemorrhage (SAH). We investigated the effect of gender on acute hydrocephalus development in a rat SAH model. SAH was induced in adult male and female Sprague-Dawley rats using endovascular perforation. Sham rats underwent the same procedure without perforation. Magnetic resonance imaging (MRI) was performed 24 h after SAH to determine ventricular volume. Hydrocephalus was defined as a ventricular volume that was more than 3 standard deviations from the mean value in sham-operated animals. After MRI, animals were euthanized and the extent of SAH was assessed using a modified grading system. No sham animals died. Mortality rates after SAH induction in male and female animals were 27 and 22 %, respectively. SAH induced significant ventricular enlargement compared with sham-operated rats (p hydrocephalus 24 h after SAH was greater in female (75 %) than in male animals (47 %, p hydrocephalus occurred even though SAH severity grade and ventricular T2* hypointensity volumes were not significantly different between male and female animals. Our data demonstrate that gender influences acute hydrocephalus development in a rat SAH model. Future studies should determine the role of estrogen in SAH-induced hydrocephalus.

  16. Predicting delayed cerebral ischemia after subarachnoid hemorrhage using physiological time series data.

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    Park, Soojin; Megjhani, Murad; Frey, Hans-Peter; Grave, Edouard; Wiggins, Chris; Terilli, Kalijah L; Roh, David J; Velazquez, Angela; Agarwal, Sachin; Connolly, E Sander; Schmidt, J Michael; Claassen, Jan; Elhadad, Noemie

    2018-03-20

    To develop and validate a prediction model for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) using a temporal unsupervised feature engineering approach, demonstrating improved precision over standard features. 488 consecutive SAH admissions from 2006 to 2014 to a tertiary care hospital were included. Models were trained on 80%, while 20% were set aside for validation testing. Baseline information and standard grading scales were evaluated: age, sex, Hunt Hess grade, modified Fisher Scale (mFS), and Glasgow Coma Scale (GCS). An unsupervised approach applying random kernels was used to extract features from physiological time series (systolic and diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation). Classifiers (Partial Least Squares, linear and kernel Support Vector Machines) were trained on feature subsets of the derivation dataset. Models were applied to the validation dataset. The performances of the best classifiers on the validation dataset are reported by feature subset. Standard grading scale (mFS): AUC 0.58. Combined demographics and grading scales: AUC 0.60. Random kernel derived physiologic features: AUC 0.74. Combined baseline and physiologic features with redundant feature reduction: AUC 0.77. Current DCI prediction tools rely on admission imaging and are advantageously simple to employ. However, using an agnostic and computationally inexpensive learning approach for high-frequency physiologic time series data, we demonstrated that our models achieve higher classification accuracy.

  17. Time from onset of SIRS to antibiotic administration and outcomes after subarachnoid hemorrhage.

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    Guterman, Elan L; Kamel, Hooman; Azran, Carmil; Shah, Maulik P; Claude Hemphill, J; Smith, Wade S; Navi, Babak B

    2014-08-01

    The interval from presentation with systemic inflammatory response syndrome (SIRS) to the start of antibiotic administration affects mortality in patients with sepsis. However, patients with subarachnoid hemorrhage (SAH) often develop SIRS directly from their brain injury, making it a less useful indicator of infection. We therefore hypothesized that SIRS would not be a suitable trigger for antibiotics in this population. We examined the time from the development of SIRS until antibiotic initiation and its relationship to long-term neurological outcomes in patients with nontraumatic SAH. Patients' baseline characteristics, time of antibiotic administration, and hospital course were collected from retrospective chart review. The primary outcome, 6-month functional status, was prospectively determined using blinded, structured interviews incorporating the modified Rankin Scale (mRS). Sixty-six of 70 patients with SAH during the study period had 6-month follow-up and were included in this analysis. SIRS developed in 57 patients (86%, 95% CI 78-95%). In ordinal logistic regression models controlling for age and illness severity, the time from SIRS onset until antibiotic initiation was not associated with 6-month mRS scores (OR per hour, 0.994; 95% CI 0.987-1.001). In this cohort of patients with SAH, time from SIRS onset until antibiotic administration was not related to functional outcomes. Our results indicate that SIRS is nonspecific in patients with SAH, and support the safety of withholding antibiotics in those who lack additional evidence of infection or hemodynamic deterioration.

  18. Role of P2X purinoceptor 7 in neurogenic pulmonary edema after subarachnoid hemorrhage in rats.

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    Sheng Chen

    Full Text Available INTRODUCTION: Neurogenic pulmonary edema (NPE is an acute and serious complication after subarachnoid hemorrhage (SAH with high mortality. The present study aimed to test the therapeutic potential of brilliant blue G (BBG, a selective P2X purinoceptor 7 (P2X7R antagonist, on NPE in a rat SAH model. METHODS: SAH was induced by endovascular perforation. 86 Sprague-Dawley rats were randomly divided into sham, vehicle-, or BBG-treatment groups. Mortality, body weight, SAH grading, neurological deficits, NPE clinical symptoms, and pulmonary index were measured at 24 hours following SAH. Western blot, gelatin zymography, lung histopathology, and immunofluorescence staining were performed in the left lung lobe to explore the underlying mechanisms at 24 hours post-surgery. RESULTS: The incidence of clinical symptoms was correlated with pulmonary index. P2X7R and the marker of alveolar type I epithelial cells (the mucin-type glycoprotein T1-α immunoreactivities were generally co-localized. BBG administration decreased mature interleukin-1β, myeloperoxidase, and matrix metallopeptidase-9 activation, but increased tight junction proteins, such as ZO-1 and occludin, which ameliorated pulmonary edema via anti-inflammation and improved neurological deficits. CONCLUSION: P2X7R inhibition prevented NPE after SAH by attenuating inflammation. Thus, BBG is a potential therapeutic application for NPE after SAH and warrants further research.

  19. 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

  20. Sudden headache, lumbar puncture, and the diagnosis of subarachnoid hemorrhage in patients with a normal computed tomography scans.

    Science.gov (United States)

    Valle Alonso, Joaquín; Fonseca Del Pozo, Francisco Javier; Vaquero Álvarez, Manuel; De la Fuente Carillo, Juan José; Llamas, José Carlos; Hernández Montes, Yelda

    2018-02-01

    To assess the usefulness of computed tomography (CT) to identify subarachnoid bleeding in patients with neurologic deficits seeking emergency care for sudden headache within 6 hours of onset of symptoms. Retrospective observational study of patients presenting with sudden nontraumatic headache peaking during the previous hour in the absence of neurologic deficits. We ordered CT scans for all patients, and if the scan was normal we performed a lumbar puncture. All patients were then followed for 6 months. Eighty-five patients were included. Subarachnoid bleeding was identified in 10 (10.2%) patients by CT. Seventy- four lumbar punctures were performed in patients with negative CTs; the lumbar puncture was positive in 1 patient and inconclusive in 2 patients. In all 3 patients, bleeding was ruled out with later images; thus, no cases of subarachnoid hemorrhage were confirmed in the 74 patients who underwent lumbar puncture. Nor were any cases found in any of these patients during follow-up. A CT scan taken within 6 hours of onset of sudden headache is sufficient for confirming or ruling out subarachnoid bleeding in patients with sudden headache who have no neurologic deficits.

  1. Lifetime Effects of Small Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Aishima, Kaoru; Shimizu, Tatsuya; Aihara, Masanori; Yoshimoto, Yuhei

    2016-11-01

    Recent prospective multicenter studies have shown that the probability of rupture of unruptured aneurysms with maximal diameter <7 mm is rather low. However, the overall risks and long-term impact of unruptured aneurysms on lifetime quality of life are still unknown. A mathematical model of the natural history of intracranial aneurysms was constructed, in which the hypothetical individuals with or without unruptured aneurysm transit between discrete health states. The annual rupture rate of small aneurysms was assumed to be 0.5% in the baseline analysis, followed by the subsequent sensitivity analysis. The analyses were continued until cumulative death rate from subarachnoid hemorrhage or other causes reached 1.0. Age-specific ratios of death of subarachnoid hemorrhage in the individuals harboring unruptured aneurysm, if dying at 60 years old, were 25% in men and 43% in women. These ratios decreased rapidly with higher age. Most (more than 90%) patients with small aneurysms were expected to die of diseases other than subarachnoid hemorrhage. In the baseline analysis (60-year-old individuals), lifetime lost to small aneurysms could be estimated as 3.8% for men and 4.2% for women, but a somewhat larger impact could be identified in the young and/or female individuals compared with in the elderly and/or male individuals. Lifetime effects of small unruptured aneurysms without risk factors increasing the probability of rupture are relatively small, and most patients were expected to die of diseases other than subarachnoid hemorrhage. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography.

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    Rana, A K; Turner, H E; Deans, K A

    2013-01-01

    Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks. Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and imaging data from the electronic radiology records were reviewed. Discharge letters were consulted to relate the biochemistry and radiology results to the final diagnosis. 15 patients with CT angiography were found. Nine patients had normal CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA. The likelihood of a clinically significant aneurysm in a patient who is CT negative, lumbar puncture positive and CTA negative is low. Double reporting of negative CT angiograms may be advisable.

  3. Aneurysm of Anterior Inferior Cerebellar Artery-posterior Inferior Cerebellar Artery Variant

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    Ansari, Khursheed Ahmad; Menon, Girish; Nair, Suresh; Abraham, Mathew

    2018-01-01

    Aneurysms arising from anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) variant are extremely rare. They usually present with subarachnoid hemorrhage. This is probably the second case report of a large thrombosed AICA-PICA variant aneurysm presenting as a cerebellopontine angle mass lesion with cranial nerve palsy, managed successfully by surgical clipping. PMID:29492120

  4. Assessment and comparison of the memory profile in traumatic brain injury and subarachnoid hemorrhage patients

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    Ashima Nehra

    2014-01-01

    Full Text Available Background: Traumatic brain injury (TBI and Subarachnoid Hemorrhage (SAH are the leading cause of death and disability in both developed and developing countries. They have significant cognitive and behavioral consequences, affecting the quality of life of both patients and their families. Aim: To compare the memory functioning of TBI and SAH and study the effect of demographics on the same through a retrospective study. Materials and Methods: A sample of 210 patients clinically diagnosed as TBI (N = 165; M = 145/F = 20 and SAH (N = 45; M = 35/F = 10 were using post graduate institute of memory scale (PGI-MS which assesses 10 memory domains. Results: Odds Ratio (OR was calculated by categorizing the scores as average and impaired on PGI-MS, the percentage of impaired cases of SAH were significantly less as compared to TBI (8.9% vs. 22.4%; OR = 0.34 Moreover, only two domains were found to have significant results, i.e. delayed recall and recognition. When the scores were adjusted for age, education and gender, memory impairment was found to be statistically significant in domains of remote memory (OR = O.10 recent memory (OR = 0.32, delayed recall (OR = 0.26, immediate memory (OR = 0.30, new learning ability (OR = 0.38, and recognition (OR = 0.17. Conclusion: A primary prevention (awareness program about risk factors and tertiary prevention (holistic rehabilitation would play a crucial role in improving the quality of life of both patients as well as the population at risk.

  5. Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage

    Science.gov (United States)

    Silventoinen, Karri; Laatikainen, Tiina; Jousilahti, Pekka; Salomaa, Veikko; Kaprio, Jaakko

    2013-01-01

    Objective: To assess long-term, cause-specific mortality rates and rate ratios of the patients alive at 1 year after subarachnoid hemorrhage (SAH). Methods: The population-based, prospective, cohort study with a nested case-control design consisted of 64,349 persons (aged 25–74 years at enrollment) who participated in the National FINRISK Study between 1972 and 2007. Four hundred thirty-seven SAH cases, 233 one-year SAH survivors, and their matched intrinsic controls were identified and followed up until the end of 2009 through the nationwide Finnish Causes of Death Register. All-cause mortality rates and rate ratios of the 1-year SAH survivors and controls were the main outcome measures. Results: Eighty-eight (37.8%) of 233 one-year SAH survivors died during the total follow-up time of 2,487 person-years (median 8.6 years, range 0.1–35.8 years). The 1-year SAH survivors had a hazard ratio of 1.96 (95% confidence interval 1.57–2.47) for death compared with the matched general population with 10 controls for each SAH survivor. One-year SAH survivors had up to 31 additional deaths per 1,000 person-years compared with controls with minimal cerebrovascular risk factors. The higher long-term risk of death among SAH survivors was attributed solely to cerebrovascular diseases, and most important modifiable risk factors for death were smoking, high systolic blood pressure (≥159 mm Hg), and high cholesterol levels (≥7.07 mmol/L). Conclusion: One-year SAH survivors have excess mortality, which is attributed to an exceptional risk of deadly cerebrovascular events. Aggressive post-SAH cerebrovascular risk factor intervention strategies are highly warranted. PMID:23303843

  6. Can S100B Predict Cerebral Vasospasms in Patients Suffering from Subarachnoid Hemorrhage?

    Science.gov (United States)

    Amiri, Moshgan; Astrand, Ramona; Romner, Bertil

    2013-01-01

    Background: Protein S100B has proven to be a useful biomarker for cerebral damages. Increased levels of serum and cerebrospinal fluid (CSF) S100B have been shown in patients suffering subarachnoid hemorrhage (SAH), severe head injury and stroke. In patients with SAH, the course of S100B levels has been correlated with neurological deficits and outcome. Cerebral vasospasm is a major contributor to morbidity and mortality. The primary aim of this study was to investigate the potential of S100B protein as a predictor of cerebral vasospasm in patients with severe SAH. Materials and Methods: Patients with SAH, Fisher grade 3 and 4, were included in the study. Five samples of CSF and serum S100B were collected from each patient. The first sample (baseline sample) was drawn within the first 3 days following ictus and the following four samples, once a day on days 5–8, with day of ictus defined as day 1. Clinical suspicion of cerebral vasospasm confirmed by computed tomography angiography was used to diagnose cerebral vasospasm. Results: A total of 18 patients were included. Five patients (28%) developed cerebral vasospasm, two (11%) developed ventriculitis. There were no significant differences between S100B for those with and without vasospasm. Serum S100B levels in patients with vasospasm were slightly lower within the first 5 days following ictus, compared to patients without vasospasm. Two out of five patients had elevated and increasing serum S100B prior to vasospasm. Only one showed a peak level of S100B 1 day before vasospasm could be diagnosed. Due to the low number of patients in the study, statistical significance could not be reached. Conclusion: Neither serum nor CSF S100B can be used as predictor of cerebral vasospasm in patients suffering from SAH. PMID:23761779

  7. Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes.

    Science.gov (United States)

    Reznik, Michael E; Schmidt, J Michael; Mahta, Ali; Agarwal, Sachin; Roh, David J; Park, Soojin; Frey, Hans Peter; Claassen, Jan

    2017-06-01

    Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study. We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton IADL (Instrumental Activities of Daily Living) scores. Independent predictors were identified using logistic regression. From 309 SAH patients admitted between January 2011 and December 2015, 52 (17 %) developed agitation, frequently in the first 72 h (50 %) and in patients with Hunt-Hess grades 3-4 (12 % of grades 1-2, 28 % of grades 3-4, 8 % of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications; and in half of these patients, complications were diagnosed within 24 h of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95 % CI, 1.1-6.8) in non-comatose patients (Hunt-Hess 1-4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors. Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications and may have an independent impact on long-term outcomes.

  8. 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 drainage also reduced angiographic vasospasm (OR of 0.35, 95% CI, 0.23–0.51, P drainage group and the no CSF drainage group on shunt-dependent 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

  9. Whole brain CT perfusion combined with CT angiography in patients with subarachnoid hemorrhage and cerebral vasospasm.

    Science.gov (United States)

    Zhang, He; Zhang, Bo; Li, Shu; Liang, Chuansheng; Xu, Ke; Li, Songbai

    2013-12-01

    To assess cerebral vasospasm (CVS) and monitor cerebral microcirculatory changes in patients with acute subarachnoid hemorrhage (SAH) via CT angiography (CTA) combined with whole-brain CT perfusion (CTP) techniques. Sixty patients with SAH (SAH group) and 10 patients without SAH (control group) were selected for a prospective study. CTP combined with CTA and digital subtraction angiography (DSA) studies were performed on patients with initial onset of SAH less than three days. CTA and DSA as well as the CTP parameters such as cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) were acquired and analyzed. The relationship of CTA and CTP measurements was assessed in these acute SAH patients. CTP techniques were used to achieve the perfusion maps of the whole brain in patients with acute SAH. Compared to the control group, mean CBF value was significantly lower while both MTT and TTP values were significantly higher in SAH group (all p<0.05). Further analysis revealed that mean CBF in patients with CVS, sCVS, Fisher III-IV and Hunt-Hess III-V significantly decreased when compared to patients with nCVS, asCVS, Fisher I-II and Hunt-Hess I-II (p<0.05). Furthermore both MTT and TTP values were also significantly reduced in patient with CVS, sCVS, Fisher III-IV and Hunt-Hess III-V (p<0.05). The study demonstrated that changes of microcirculation in patients with SAH could be assessed by whole-brain CTP. CTP combined with CTA could detect both macroscopic evident vasospasm on CTA and alterations of microcirculation on CTP. Mean CBF was significantly lower in patients with SAH. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Subarachnoid hemorrhage and visuospatial and visuoperceptive impairment: disruption of the mirror neuron system.

    Science.gov (United States)

    Plata-Bello, Julio; Modroño, Cristián; Acosta-López, Silvia; Pérez-Martín, Yaiza; Marcano, Francisco; García-Marín, Víctor; González-Mora, José Luis

    2017-10-01

    Nearly 20 % of patients who suffer a subarachnoid hemorrhage (SAH) still display cognitive impairment even a year after follow-up. Visuospatial and visuoperceptive domains may be impaired in this cognitive impairment and may not have been fully studied in these patients. Furthermore, these cognitively impaired domains have been associated with activity in the so-called mirror neuron system (MNS). The aim of the study is to analyze the pattern of brain activity with an MNS task-based functional magnetic resonance imaging (fMRI) study in SAH patients. A complete neuropsychological assessment and fMRI study (with observation and execution conditions) were performed in patients with a history of SAH registered in the database of the Hospital Universitario de Canarias and a healthy control group. The patients had to meet all the following inclusion criteria for the study (less than 50 years old; SAH with a Fisher score 1-3; no vasospasm or ischemia; minimum follow-up of one year). Twelve SAH patients were studied. Three of which displayed visuospatial/visuoperceptive impairment. fMRI study showed the presence of higher activity in MNS regions in these patients than in patients with normal visuospatial/visuoperceptive functions. Furthermore, there was a negative correlation between the test scores and brain activity in premotor regions of the studied patients. SAH patients with visuospatial/visuoperceptive impairment have greater activity in the MNS regions. This finding may be associated with a subcortical dysfunction, leading to a disruption of neural activity and less efficient behavior of this brain network.

  11. Genetics of intracranial aneurysms and related diseases

    NARCIS (Netherlands)

    van 't Hof, F.N.G.

    2017-01-01

    Intracranial aneurysms (IA) are dilatations of the vessel walls of cerebral arteries. Some can rupture and result in a subarachnoid hemorrhage (SAH), a severe subtype of stroke. This thesis is set out to elucidate the pathophysiology of IA from a genetic perspective. The main conclusions are: 1.

  12. Rerupture of intracranial aneurysms: a clinicoanatomic study

    NARCIS (Netherlands)

    Hijdra, A.; Vermeulen, M.; van Gijn, J.; van Crevel, H.

    1987-01-01

    In a series of 176 prospectively studied patients who survived for at least 24 hours after aneurysmal subarachnoid hemorrhage, 39 had at least one computerized tomography (CT)-proven rebleed within 4 weeks after the first rupture. There were peaks in the incidence of rebleeding at the end of the 2nd

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

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    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.

  14. ERK1/2 inhibition attenuates cerebral blood flow reduction and abolishes ET(B) and 5-HT(1B) receptor upregulation after subarachnoid hemorrhage in rat

    DEFF Research Database (Denmark)

    Beg, Saema A S; Hansen-Schwartz, Jacob A; Vikman, Petter J

    2006-01-01

    Upregulation of endothelin B (ET(B)) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors via transcription has been found after experimental subarachnoid hemorrhage (SAH), and this is associated with enhanced phosphorylation of the mitogen-activated protein kinase (MAPK) extracellular signal-regulate......Upregulation of endothelin B (ET(B)) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors via transcription has been found after experimental subarachnoid hemorrhage (SAH), and this is associated with enhanced phosphorylation of the mitogen-activated protein kinase (MAPK) extracellular signal...

  15. Flair MR imaging in the Detection of subarachnoid hemorrhage : comparison with CT and T1-weighted MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Min, Soo Hyun; Kim, Soo Youn; Lee, Ghi Jai; Shim, Jae Chan; Oh, Tae Kyung; Kim, Ho Kyun [College of Medicine, Jnje University, Seoul (Korea, Republic of)

    2000-03-01

    To compare the findings of fluid-attenuated inversion recovery (FLAIR) MR imaging in the detection of subarachnoid hemorrhage (SAH), with those of precontrast CT and T1-weighted MR imaging. In 13 patients (14 cases) with SAH, FLAIR MR images were retrospectively analyzed and compared with CT (10 patients, 11 cases) and T1-weighted MR images (9 cases). SAH was confirmed on the basis of high density along the subarachnoid space, as seen on precontrast CT, or lumbar puncture. MR imaging was performed on a 1.0T unit. FLAIR MR and CT images were obtained during the acute stage(less than 3 days after ictus) in 10 and 9 cases, respectively, during the subacute stage (4-14 days after ictus) in two cases and one, respectively, and during the chronic stage (more than 15 days after ictus) in two cases and one, respectively. CT was performed before FLAIR MR imaging, and the interval between CT and FLAIR ranged from 24 hours (6 cases) to 2-3 (2 cases) or 4-7 days (3 cases). In each study, the conspicuity of visualization of SAH was graded as excellent, good, fair, or negative at five locations (sylvian fissure, cortical sulci, anterior basal cistern, posterior basal cistern, and perimesencephalic cistern). In all cases, subarachnoid hemorrhages were demonstrated as high signal intensity areas on FLAIR images. The detection rates for SAH on CT and T1-weighted MR images were 100% (11/11) and 89% (8/9), respectively. FLAIR was superior to T1-weighted imaging in the detection of SAH at all sites except the anterior basal cistern (p less than 0.05) and superior to CT in the detection of SAH at the cortical sulci (p less than 0.05). On FLAIR MR images, subarachnoid hemorrhages at all stages are demonstrated as high signal intensity areas; the FLAIR MR sequence is thus considered useful in the detection of SAH. In particular FLAIR is more sensitive than CT for the detection of SAH in the cortical sulci. (author)

  16. Computed tomography may demonstrate pseudosubarachnoid hemorrhage in diffuse cerebral edema after cardiorespiratory arrest.

    Science.gov (United States)

    Wong, Leonie C; Schelvan, Chris; Mitchell, L Ann; Inwald, David Philip

    2011-09-01

    To report the cases of two children who died from diffuse cerebral edema after cardiorespiratory arrest and who had radiologic findings of subarachnoid hemorrhage on computed tomography, the presence of which was excluded on subsequent postmortem examination. Case notes, clinical records, and postmortem reports of two children who became brain stem dead after cardiorespiratory arrest. Radiologic mimics of subarachnoid hemorrhage have been reported in the adult literature and are termed pseudosubarachnoid hemorrhage. A diagnosis of pseudosubarachnoid hemorrhage, rather than true subarachnoid hemorrhage, should be considered in the context of diffuse cerebral edema after cardiorespiratory arrest. Interpretation of the radiologic finding of subarachnoid hemorrhage in a child after a prolonged cardiac arrest should be cautious to avoid unnecessary and deleterious management and investigation for aneurysms.

  17. Variations in the cerebrospinal fluid proteome following traumatic brain injury and subarachnoid hemorrhage.

    Science.gov (United States)

    Connor, David E; Chaitanya, Ganta V; Chittiboina, Prashant; McCarthy, Paul; Scott, L Keith; Schrott, Lisa; Minagar, Alireza; Nanda, Anil; Alexander, J Steven

    2017-09-01

    Proteomic analysis of cerebrospinal fluid (CSF) has shown great promise in identifying potential markers of injury in neurodegenerative diseases [1-13]. Here we compared CSF proteomes in healthy individuals, with patients diagnosed with traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) in order to characterize molecular biomarkers which might identify these different clinical states and describe different molecular mechanisms active in each disease state. Patients presenting to the Neurosurgery service at the Louisiana State University Hospital-Shreveport with an admitting diagnosis of TBI or SAH were prospectively enrolled. Patients undergoing CSF sampling for diagnostic procedures were also enrolled as controls. CSF aliquots were subjected to 2-dimensional gel electrophoresis (2D GE) and spot percentage densities analyzed. Increased or decreased spot expression (compared to controls) was defined in terms of in spot percentages, with spots showing consistent expression change across TBI or SAH specimens being followed up by Matrix-Assisted Laser Desorption/Ionization mass spectrometry (MALDI-MS). Polypeptide masses generated were matched to known standards using a search of the NCBI and/or GenPept databases for protein matches. Eight hundred fifteen separately identifiable polypeptide migration spots were identified on 2D GE gels. MALDI-MS successfully identified 13 of 22 selected 2D GE spots as recognizable polypeptides. Statistically significant changes were noted in the expression of fibrinogen, carbonic anhydrase-I (CA-I), peroxiredoxin-2 (Prx-2), both α and β chains of hemoglobin, serotransferrin (Tf) and N-terminal haptoglobin (Hp) in TBI and SAH specimens, as compared to controls. The greatest mean fold change among all specimens was seen in CA-I and Hp at 30.7 and -25.7, respectively. TBI specimens trended toward greater mean increases in CA-I and Prx-2 and greater mean decreases in Hp and Tf. Consistent CSF elevation of CA-I and Prx-2 with

  18. Hypothesis on the Role of Cryptochromes in Inflammation and Subarachnoid Hemorrhage Outcome

    Directory of Open Access Journals (Sweden)

    Adriano Barreto Nogueira

    2017-11-01

    Full Text Available We have recently found that the temperature variability (TV in the day–night cycle may predict the mean intracranial pressure in the following 24 h (ICP24 in subarachnoid hemorrhage (SAH patients under multimodality monitoring, sedation, and hypothermia (<35°C. Specifically, we found that ICP24 = 6 (4 − TV mmHg. TV is the ratio between the coefficient of variation of temperature during the nocturnal and the preceding diurnal periods. This result suggests that the circadian clock reflects brain plasticity mechanisms and its malfunctioning leads to deterioration of the neurologic status. The sleep–wake cycle is absent in these patients and their circadian clock can function properly only by environment light-independent mechanisms. One mechanism involves the circadian clock proteins named cryptochromes (CRYs. CRYs are highly preserved and widespread in the evolutionary tree, are expressed in different cell types in humans [type II CRYs, in two forms: human cryptochrome 1 and 2 (hCRY1 and hCRY2], and in certain species, respond to blue light and play role in magnetoreception. Interestingly, SAH outcome seems to correlate with inflammation, and CRYs decrease inflammatory activity. Our hypothesis derived from these observations is that CRYs modulate the circadian oscillation of temperature even during therapeutic hypothermia and improve outcome in SAH through decrease in inflammation. A strategy to test this hypothesis is to measure periodically during the acute phase of high-grade SAH the level of CRYs in cerebrospinal fluid (CSF and circulating white blood cells, and to correlate these levels with outcome, TV, ICP24, and pro- and anti-inflammatory markers in CSF and blood. If this hypothesis is true, the development of therapies targeting inflammation in SAH could take advantage of cryptochrome properties. It has been shown that blue light phototherapy increases the expression of CRYs in blood mononuclear cells in jaundiced

  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. Trehalose treatment suppresses inflammation, oxidative stress, and vasospasm induced by experimental subarachnoid hemorrhage

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    Echigo Ryosuke

    2012-04-01

    Full Text Available Abstract Background Subarachnoid hemorrhage (SAH frequently results in several complications, including cerebral vasospasm, associated with high mortality. Although cerebral vasospasm is a major cause of brain damages after SAH, other factors such as inflammatory responses and oxidative stress also contribute to high mortality after SAH. Trehalose is a non-reducing disaccharide in which two glucose units are linked by α,α-1,1-glycosidic bond, and has been shown to induce tolerance to a variety of stressors in numerous organisms. In the present study, we investigated the effect of trehalose on cerebral vasospasm, inflammatory responses, and oxidative stress induced by blood in vitro and in vivo. Methods Enzyme immunoassay for eicosanoids, pro-inflammatory cytokines, and endothelin-1, and western blotting analysis for cyclooxygenase-2, inducible nitric oxide synthase, and inhibitor of NF-κB were examined in macrophage-like cells treated with hemolysate. After treatment with hemolysate and hydrogen peroxide, the levels of lipid peroxide and amounts of arachidonic acid release were also analyzed. Three hours after the onset of experimental SAH, 18 Japanese White rabbits received an injection of saline, trehalose, or maltose into the cisterna magna. Angiographic and histological analyses of the basilar arteries were performed. In a separate study, the femoral arteries from 60 rats were exposed to fresh autologous blood. At 1, 3, 5, 7, 10, and 20 days after treatment, cryosections prepared from the femoral arteries were histologically analyzed. Results When cells were treated with hemolysate, trehalose inhibited the production of several inflammatory mediators and degradation of the inhibitor of NF-κB and also suppressed the lipid peroxidation, the reactive oxygen species-induced arachidonic acid release in vitro. In the rabbit model, trehalose produced an inhibitory effect on vasospasm after the onset of experimental SAH, while maltose had only

  1. 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

    Recent years' research has revealed a specific, neuroprotective erythropoietin (EPO) system in the central nervous system (CNS) that is upregulated by hypoxia. The presence and dynamics of EPO in the cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage (SAH) has not been investigated...

  2. Platelet aggregation inhibitors, vitamin K antagonists and risk of subarachnoid hemorrhage.

    Science.gov (United States)

    Risselada, R; Straatman, H; van Kooten, F; Dippel, D W J; van der Lugt, A; Niessen, W J; Firouzian, A; Herings, R M C; Sturkenboom, M C J M

    2011-03-01

    Use of platelet aggregation inhibitors and vitamin K antagonists has been associated with an increased risk of intracranial hemorrhage (ICH). Whether the use of these antithrombotic drugs is associated with an increased risk of subarachnoid hemorrhage (SAH) remains unclear, especially as confounding by indication might play a role. The aim of the present study was to investigate whether use of platelet aggregation inhibitors or vitamin K antagonists increase the risk of SAH. We applied population-based case-control, case-crossover and case-time-control designs to estimate the risk of SAH while addressing issues both of confounding by indication and time varying exposure within the PHARMO Record Linkage System database. This system includes drug dispensing records from community pharmacies and hospital discharge records of more than 3 million community-dwelling inhabitants in the Netherlands. Patients were considered a case if they were hospitalized for a first SAH (ICD-9-CM code 430) in the period between 1st January 1998 and 31st December 2006. Controls were selected from the source population, matched on age, gender and date of hospitalization. Conditional logistic regression was used to estimate multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of SAH during use of platelet aggregation inhibitors or vitamin K antagonists. In the case-crossover and case-time-control designs we selected 11 control periods preceding the index date in successive steps of 1 month in the past. In all, 1004 cases of SAH were identified. In the case-control analysis the adjusted OR for the risk of SAH in current use of platelet aggregation inhibitors was 1.32 (95% CI: 1.02-1.70) and in current use of vitamin K antagonists 1.29 (95% CI: 0.89-1.87) compared with no use. In the case-crossover analysis the ORs for the risk of SAH in current use of platelet aggregation inhibitors and vitamin K antagonists were 1.04 (95% CI: 0.56-1.94) and 2.46 (95% CI

  3. The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Wei Ting Chiu

    Full Text Available The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT, which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.Medical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH and symptomatic ICH after r-tPA. The differences were analyzed using Fisher's exact or Mann-Whitney U tests, and p < 0.05 was defined as the statistical significance.A total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%. No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively. The bleeding risk was not significant different between aneurysm group (2 out of 11, 18% with nonaneurysm group (7 out of 133, 5.3% (p = 0.14. None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.The presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they

  4. A case of aneurysm on a persistent hypoglossal artery treated by endovascular coiling.

    Science.gov (United States)

    De Blasi, R; Medicamento, N; Chiumarullo, L; Salvati, A; Maghenzani, M; Dicuonzo, F; Carella, A

    2009-07-29

    We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.

  5. 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. Copyright © 2015 Elsevier B

  6. Social cognition impairments after aneurysmal subarachnoid haemorrhage: Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness.

    Science.gov (United States)

    Buunk, Anne M; Spikman, Jacoba M; Veenstra, Wencke S; van Laar, Peter Jan; Metzemaekers, Jan D M; van Dijk, J Marc C; Meiners, Linda C; Groen, Rob J M

    2017-08-01

    Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal-subcortical circuits underlying social cognition. Therefore, we aimed to investigate social cognition after aSAH and its associations with behavioural problems (deficits in interpersonal behaviour, apathy, and impaired self-awareness) and focal as well as diffuse brain damage. 88 aSAH patients (in the subacute phase post-aSAH) and 60 age-, sex- and education-matched healthy controls participated. Tasks for emotion recognition, Theory of Mind (ToM), and empathy as well as questionnaires were used. Cortical infarctions in frontal and non-frontal areas on MRI, aneurysm circulation and aSAH-related events were taken into account. Compared to healthy controls, aSAH patients performed significantly worse on tasks for emotion recognition, ToM and empathy. Poor performance on ToM and emotion recognition was associated with proxy-ratings indicating impaired interpersonal behaviour and apathy and with indications of impaired self-awareness. No associations were found between deficits in social cognition and frontal or non-frontal cortical lesions on MRI. Also, aneurysm circulation and aSAH-related events such as hydrocephalus, vasospasm, and treatment method did not explain why and how social cognitive deficits did occur after aSAH. In conclusion, emotion recognition, ToM and empathy were clearly impaired in aSAH patients and these deficits were related to apathy and deficits in interpersonal behaviour as reported by proxies and to impaired self-awareness. This association strengthens the assumption of impaired social cognition as an underlying construct of behavioural problems after aSAH. Consequently, social cognition tests and proxy-ratings should be used in clinical practice, irrespective of lesion location on

  7. Hemorragia subaracnoídea com tomografia de crânio sem sinais de sangramento Subarachnoidal hemorrhage with cranial tomography without bleeding signals

    Directory of Open Access Journals (Sweden)

    Silvio Francisco

    1997-09-01

    Full Text Available Foram observados 23 casos de pacientes com suspeita clínica de hemorragia subaracnoídea (HSA, com tomografia de crânio (CT sem sinais de sangramento, com diagnóstico definitivo realizado por exame de líquido cefalorraquiano(LCR. Desses, 20 casos foram submetidos a angiografia cerebral. Estabeleceu-se a classificação clínica de Hunt & Hess. Os principais achados neste estudo foram:1 um terço dos pacientes apresentou intervalo de tempo entre o ictus e a realização da CT e do LCR entre 24 e 48 horas, período de maior sensiblidade da CT; 2 dos pacientes estudados com angiografia cerebral, 55% tiveram o diagnóstico de aneurisma com predomínio no território de carótida e cerebral anterior; 3 o grau clínico dominante foi Hunt & Hess I e II. Todos os achados encontrados demonstraram a necessidade da realização de LCR em suspeita de HSA sem sinais de sangramento na CT.We observed 23 pacients with clinical hypothesis of subarachnoidal hemorrhage (SAH having cranial tomography (CT without bleeding signals. The final diagnosis of SAH was made upon the cerebrospinal fluid (CSF results. Twenty cases were submitted to brain angiography. They were focused under the clinical classification of Hunt & Hess. The main results were: 1 1/3 of patients had interval time between 24 and 48 hours after ictus and before CT and CSF making; this was the most sensitive CT time; 2 55% of patients with brain angiography had aneurysm predominantly in the carotid and anterior cerebral artery territory; 3 the dominant clinical degree was Hunt & Hess I e II. Conclusion: the results demonstrate the need of CSF test in case of SAH clinical diagnosis with CT showing no bleeding signals.

  8. Aneurysmal wall imaging in a case of cortical superficial siderosis and multiple unruptured aneurysms.

    Science.gov (United States)

    Yalo, Bertrand; Pop, Raoul; Zinchenko, Ielyzaveta; Diaconu, Mihaela; Chibbaro, Salvatore; Manisor, Monica; Wolff, Valerie; Beaujeux, Remy

    2016-11-09

    We report a case of interhemispheric and bifrontal cortical superficial siderosis in association with two intracranial aneurysms. The patient had no clinical history suggestive of aneurysm rupture, no feature of amyloid angiopathy or other apparent etiology for cortical siderosis. We performed high resolution brain MRI with dark blood T1 sequences before and after IV contrast injection. An anterior communicating aneurysm showed partial wall enhancement on the posterior wall whereas a left posterior communicating aneurysm did not. In the light of recent reports of the association of wall enhancement with unstable aneurysms, we considered wall enhancement to be a marker of inflammation and remodeling of the aneurysm wall, resulting in chronic hemorrhagic suffusion in the subarachnoid spaces. To our knowledge, this is the first report offering proof for a possible link between apparently unruptured aneurysms and cortical siderosis. 2016 BMJ Publishing Group Ltd.

  9. Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit.

    Science.gov (United States)

    Gathier, Celine S; Oostdijk, Evelien A; Rinkel, Gabriel J E; Dorhout Mees, Sanne M; Vergouwen, Mervyn D I; de Smet, Anne Marie G A; van de Beek, Diederik; Vandertop, W Peter; Verbaan, Dagmar; Algra, Ale; Bonten, Marc J M; van den Bergh, Walter M

    2016-02-01

    Delayed cerebral ischemia (DCI) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Development of DCI is multifactorial, and inflammation, with or without infection, is one of the factors independently associated with development of DCI and poor outcome. We thus postulated that preventive antibiotics might be associated with a reduced risk of DCI and subsequent poor outcome in aSAH patients. We performed a retrospective cohort-study in intensive care units (ICU) of three university hospitals in The Netherlands. We included consecutive aSAH patients with minimal ICU stay of 72 h who received either preventive antibiotics (SDD: selective digestive tract decontamination including systemic cefotaxime or SOD: selective oropharyngeal decontamination) or no preventive antibiotics. DCI was defined as a new hypodensity on CT with no other explanation than DCI. Hazard ratio's (HR) for DCI and risk ratio's (RR) for 28-day case-fatality and poor outcome at 3 months were calculated, with adjustment (aHR/aRR) for clinical condition on admission, recurrent bleeding, aneurysm treatment modality and treatment site. Of 459 included patients, 274 received preventive antibiotics (SOD or SDD) and 185 did not. With preventive antibiotics, the aHR for DCI was 1.0 (95% CI 0.6-1.8), the aRR for 28-day case-fatality was 1.1 (95% CI 0.7-1.9) and the aRR for poor functional outcome 1.2 (95% CI 1.0-1.4). Preventive antibiotics were not associated with reduced risk of DCI or poor outcome in aSAH patients in the ICU.

  10. Blood-filled cerebrospinal fluid-enhanced pericyte microvasculature contraction in rat retina: A novelin vitrostudy of subarachnoid hemorrhage.

    Science.gov (United States)

    Liu, Zhi; Li, Qiang; Cui, Gaoyu; Zhu, Gang; Tang, Weihua; Zhao, Hengli; Zhang, John H; Chen, Yujie; Feng, Hua

    2016-10-01

    Previously, it was widely accepted that the delayed ischemic injury and poor clinical outcome following subarachnoid hemorrhage (SAH) was caused by cerebral vasospasm. This classical theory was challenged by a clazosentan clinical trial, which failed to improve patient outcome, despite reversing angiographic vasospasm. One possible explanation for the results of this trial is the changes in microcirculation following SAH, particularly in pericytes, which are the primary cell type controlling microcirculation in the brain parenchyma. However, as a result of technical limitations and the lack of suitable models, there was no direct evidence of microvessel dysfunction following SAH. In the present study, whole-mount retinal microvasculature has been introduced to study microcirculation in the brain following experimental SAH in vitro . Artificial blood-filled cerebrospinal fluid (BSCF) was applied to the retinal microvasculature to test the hypothesis that the presence of subarachnoid blood affects the contractile properties of the pericytes containing cerebral microcirculation during the early phase of SAH. It was observed that BCSF induced retina microvessel contraction and that this contraction could be resolved by BCSF wash-out. Furthermore, BCSF application accelerated pericyte-populated collagen gel contraction and increased the expression of α-smooth muscle actin. In addition, BCSF induced an influx of calcium in cultured retinal pericytes. In conclusion, the present study demonstrates increased contractility of retinal microvessels and pericytes in the presence of BCSF in vitro . These findings suggest that pericyte contraction and microvascular dysfunction is induced following SAH, which could lead to greater susceptibility to SAH-induced ischemia.

  11. Effect of graded hyperventilation on cerebral metabolism in a cisterna magna blood injection model of subarachnoid hemorrhage in rats

    DEFF Research Database (Denmark)

    Ma, Xiaodong; Bay-Hansen, Rikke; Hauerberg, John

    2006-01-01

    In subarachnoid hemorrhage (SAH) with cerebrovascular instability, hyperventilation may induce a risk of inducing or aggravating cerebral ischemia. We measured cerebral blood flow (CBF) and cerebral metabolic rates of oxygen (CMRO2), glucose (CMRglc), and lactate (CMRlac) at different PaCO2 levels...... after experimental SAH in rats (injection of 0.07 mL of autologous blood into the cisterna magna). Four groups of Sprague-Dawley male rats were studied at predetermined PaCO2 levels: group A: normocapnia (5.01-5.66 kPa [38.0-42.0 mm Hg]); group B: slight hyperventilation (4.34-5.00 kPa [32.5-37.5 mm Hg...... in oxygen extraction fraction (OEF). The results show that even profound hyperventilation in this model of SAH is associated with an adequate increase in OEF so that CMRs of oxygen, glucose, and lactate remain similar to levels observed in normocapnic conditions....

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

    DEFF Research Database (Denmark)

    Lauritzen, Martin; Dreier, Jens Peter; Fabricius, Martin

    2011-01-01

    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 brain mechanisms have the potential to worsen the outcome of cerebrovascular episodes or brain trauma...... as a pathophysiological mechanism for this group of acute neurological disorders. The findings have implications for monitoring and treatment of patients with acute brain disorders in the intensive care unit. Drawing on the large body of experimental findings from animal studies of CSD obtained during decades we suggest...... treatment strategies, which may be used to prevent or attenuate secondary neuronal damage in acutely injured human brain cortex caused by depolarization waves....

  13. Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage.

    Science.gov (United States)

    Alberti, O; Becker, R; Benes, L; Wallenfang, T; Bertalanffy, H

    2000-06-01

    An association between hyperglycemia and outcome in spontaneous subarachnoid hemorrhage (SAH) has been sporadically reported. Our hypothesis was that hyperglycemia is a sign of central metabolic disturbance linked with specific appearances on computerized tomography (CT) scans reflecting different degrees of corresponding brain injury. The admission plasma glucose level, initial CT findings, and outcome after 6 months were analysed in a cohort of 99 patients with SAH in Hunt & Hess Grade IV or V. The CT scans were quantitatively assessed for subarachnoid blood, intracerebral hematoma, intraventricular hemorrhage, hydrocephalus, midline shift and compression of the perimesencephalic cisterns. These findings were combined to determine a three-point CT severity score. All patients showed elevated (>5.8 mmol/l) plasma glucose levels on admission. Mortality among 33 patients with glucose concentration below 9.0 mmol/l was 33.3%, 71.1% for the 45 patients with glucose level between 9.0 and 13.0 mmol/l, and 95.2% for the 21 patients with concentration above 13.0 mmol/l (P<0.0001). Glucose level was higher in Grade V than in Grade IV patients (mean+/-SD) (11.8+/-3.2 vs 9.8+/-2.9 mmol/l; P=0.0012). Patients with mild CT findings (n=10) had the lowest glucose level (8.9+/-1.8 mmol/l; P=0.0082), whereas patients with severe findings (n=56) had the highest glucose (11.4+/-3.5 mmol/l; P=0.011). Despite association with clinical grade and extent of CT findings, logistic multiple regression revealed the admission plasma glucose level to be an independent prognosticator of outcome. The prognostic potential of the initial plasma glucose level may be beneficial in management protocols of poor-grade SAH patients.

  14. Proteomic Expression Changes in Large Cerebral Arteries After Experimental Subarachnoid Hemorrhage in Rat Are Regulated by the MEK-ERK1/2 Pathway

    DEFF Research Database (Denmark)

    Müller, Anne H.; Edwards, Alistair V.G.; Larsen, Martin R.

    2017-01-01

    was induced in rats that were treated with the MEK1/2 inhibitor U0126 or vehicle. Neurological outcome was assessed using a battery of behavioral tests. Specific protein expression of large cerebral arteries was analyzed quantitatively with high-throughput tandem mass spectrometry. SAH resulted in a marked......Subarachnoid hemorrhage (SAH) is a serious clinical condition where leakage of blood into the subarachnoid space causes an acute rise in intracranial pressure and reduces cerebral blood flow, which may lead to delayed cerebral ischemia and poor outcome. In experimental SAH, we have previously shown...

  15. Proteomic Expression Changes in Large Cerebral Arteries After Experimental Subarachnoid Hemorrhage in Rat Are Regulated by the MEK-ERK1/2 Pathway

    DEFF Research Database (Denmark)

    Müller, Anne H; Edwards, Alistair V G; Larsen, Martin R

    2017-01-01

    Subarachnoid hemorrhage (SAH) is a serious clinical condition where leakage of blood into the subarachnoid space causes an acute rise in intracranial pressure and reduces cerebral blood flow, which may lead to delayed cerebral ischemia and poor outcome. In experimental SAH, we have previously shown...... that the outcome can be significantly improved by early inhibition of the MAPK/ERK kinase/extracellular signal-regulated kinase (MEK/ERK1/2) pathway. The aim of this study was to apply mass spectrometry to investigate the overall late effects of experimental SAH on cerebrovascular protein expression. SAH...

  16. Comparison of Montreal Cognitive Assessment and Mini-Mental State Examination in Evaluating Cognitive Domain Deficit Following Aneurysmal Subarachnoid Haemorrhage

    Science.gov (United States)

    Wong, George Kwok Chu; Lam, Sandy Wai; Wong, Adrian; Ngai, Karine; Poon, Wai Sang; Mok, Vincent

    2013-01-01

    Objective Cognitive deficits are common after aneurysmal subarachnoid haemorrhage (aSAH), and clinical evaluation is important for their management. Our hypothesis was that the Montreal Cognitive Assessment (MoCa) is superior to the Mini-Mental State Examination (MMSE) in screening for cognitive domain deficit in aSAH patients. Methods We carried out a prospective observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus. The domain-specific neuropsychological assessment battery, the MoCA and MMSE were administered 2–4 weeks and 1 year after ictus. A cognitive domain deficit was defined as a cognitive domain z score ictus, the MoCA produced higher area under the curve scores for cognitive impairment than the MMSE (MoCA, 0.92; 95% CI, 0.83 to 0.97 versus MMSE, 0.77; 95% CI, 0.66 to 0.83, p = 0.009). Interpretation Cognitive domain deficits and cognitive impairment in patients with aSAH can be screened with the MoCA in both the subacute and chronic phases. PMID:23573223

  17. Role of 123I-IMP SPET in the early diagnosis of borderline chronic hydrocephalus after aneurysmal subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    Ohkuma, Hiroki; Tanaka, Masahiko; Suzuki, Shigeharu; Kondoh, Izumi

    2000-01-01

    Chronic hydrocephalus after aneurysmal subarachnoid haemorrhage (SAH) is easily diagnosed in most cases. However, the diagnosis is sometimes difficult in borderline cases, in which (a) pathognomonic clinical deterioration due to hydrocephalus is masked by the neurological deficits caused in the acute stage of SAH and (b) ventricular enlargement is not so marked on CT scan. The purpose of this study was to investigate whether or not iodine-123 labelled N-isopropyl-p-iodoamphetamine ( 123 I-IMP) single-photon emission tomography (SPET) is of value for the early diagnosis of borderline chronic hydrocephalus after SAH. Fifteen patients who met the criteria of borderline chronic hydrocephalus were selected for the study, and underwent a shunt operation. The patients were divided into a shunt-effective group and a shunt-ineffective group according to neurological improvement after the shunt operation. 123 I-IMP SPET was performed in the acute stage of SAH, within 1 week before the shunt operation, and 2 weeks after the shunt operation. Regional cerebral blood flow was estimated by the 123 I-IMP autoradiographic method. Pre-shunting periventricular low-perfusion areas showed statistically significant differences between the two groups (P 123 I-IMP SPET can be used for both the early diagnosis of borderline chronic hydrocephalus after SAH and the prediction of shunt effectiveness. (orig.)

  18. Clinical characteristics of ruptured distal middle cerebral artery aneurysms: Review of the literature.

    Science.gov (United States)

    Tsutsumi, Keiji; Horiuchi, Tetsuyoshi; Nagm, Alhusain; Toba, Yasuyuki; Hongo, Kazuhiro

    2017-06-01

    Middle cerebral artery (MCA) aneurysms usually arise at the primary MCA bifurcation or trifurcation. Distal MCA aneurysms are rarely considered as sources of aneurysmal subarachnoid hemorrhage (SAH). It has been reported that ruptured distal MCA aneurysms are associated with head trauma, neoplastic emboli, arterial dissection, or bacterial infection. We experienced five cases of ruptured distal MCA aneurysms and evaluated their clinical characteristics. Retrospective analysis of aneurysmal SAH at Kobayashi Neurosurgical Neurological Hospital was performed from January, 2004 to December, 2014. Clinical characteristics of ruptured distal MCA aneurysms were analyzed using our database. Among 191 aneurysmal SAH patients, there were five ruptured distal MCA aneurysms. All patients did not have any specific medical problems such as infectious disease, head trauma, or cardiac disorders. The incidence of ruptured distal MCA aneurysm was higher than expected and was equivalent to 9.4% of the total ruptured MCA aneurysms. Strong male predominance (80%) and M2-3 junction aneurysm preponderance (80%) were observed. In addition, there were only two patients (40%) with intracerebral hematoma in our study. We reported five cases of ruptured distal MCA aneurysms. Although ruptured distal MCA aneurysms are thought to be rare as sources of aneurysmal SAH, the incidence of ruptured distal MCA aneurysm was 9.4% of all ruptured MCA aneurysms in our study. Ruptured distal MCA aneurysms should be considered as sources of aneurysmal SAH without intracerebral hematoma. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Ruptured intracranial aneurysm in patients with osteogenesis imperfecta: 2 familial cases and a systematic review of the literature.

    Science.gov (United States)

    Gaberel, T; Rochey, A; di Palma, C; Lucas, F; Touze, E; Emery, E

    2016-12-01

    Osteogenesis imperfecta is an inherited connective tissue disorder that causes bone fragility. Vascular complications have been described, but only few cases of ruptured intracranial aneurysm have been reported. We first described 2 familial cases of ruptured intracranial aneurysm and then conducted a systematic review of the literature. A mother and her daughter with a typical history of osteogenesis imperfecta presented with subarachnoid hemorrhage, which was related to a posterior communicating artery aneurysm in both cases. The mother had early rebleeding and died. The aneurysm was excluded by coiling in the daughter. Despite occurrence of hydrocephalus and delayed cerebral ischemia, she had an excellent functional outcome. A systematic review of the literature identified seven additional cases. None of the cases were in fact familial. All patients had a previous medical history of multiple fractures. Seven aneurysms were resolved, three by surgical clipping and four by endovascular procedure. No periprocedural complication was reported. One patient died prematurely and 6 experienced good functional outcome. We report the first familial cases of aneurysmal subarachnoid hemorrhage in osteogenesis imperfecta patients. Intracranial aneurysms are probably linked to a collagen pathology, which is at the origin of osteogenesis imperfecta. In cases of aneurysmal subarachnoid hemorrhage in an osteogenesis imperfecta family, intracranial aneurysm screenings in the relatives showing osteogenesis imperfecta should be considered. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. 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

    . We collected a total of 83 corresponding serum and CSF samples from 18 patients with aneurysmal SAH and compared the concentrations of EPO with those of blood-derived markers of blood-brain barrier function (albumin, transferrin, alpha(2)-macroglobulin) and with those of proteins with well-known CNS...... synthesis (prealbumin, apolipoprotein E). The EPO concentration in CSF was 0.93 (0.82) mU/ml (median and inter-quartile range). Nine patients presented CSF-EPO values above 1 mU/ml. CSF levels did not correlate with serum concentrations and were independent of blood-brain barrier integrity suggesting...

  1. Subarachnoid Hemorrhage in a Three-year-old-boy with Left Middle ...

    African Journals Online (AJOL)

    Left pterional craniotomy and clipping of the aneurysm was done.The postoperative period was uneventful and the patient was discharged on the eighth postoperative day without any neurological deficit. At 55 month follow-up, his Glasgow Outcome scale score was 5 and he had no functional or cognitive deficit. Pediatric ...

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

    Science.gov (United States)

    Kubota, Hisashi; Sanada, Yasuhiro; Nagatsuka, Kazuhiro; Kato, Amami

    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 revealed to be an unruptured aneurysm after surgical exploration. A small distal AICA aneurysm was detected by 3D rotational angiography (3DRA). The patient fully recovered except for left-side hearing loss four months after the second operation. Conclusion: We recommend a meticulous diagnosis by 3DRA in patients with SAH in which the distribution is not coincident with a typical aneurysmal location. PMID:26110079

  3. Clinical studies of cerebral circulation using single photon emission computed tomography, 1; Serial change of cerebral blood flow on subarachnoid hemorrhage measured by [sup 99m]Tc-d, 1-hexamethyl propylene amine oxime

    Energy Technology Data Exchange (ETDEWEB)

    Uno, Toshiro (Gifu Univ. (Japan). Faculty of Medicine)

    1993-09-01

    To clarify the significance of regional cerebral blood flow (rCBF) in subarachnoid hemorrhage (SAH), single photon computed tomography (SPECT) using [sup 99m]tc-d,1-hexamethyl propylene amine oxime ([sup 99m]Tc-HMPAO) was sequentially performed on consecutive 34 patients. All patients were admitted within 2 days after onset of SAH and underwent aneurysmal clipping or coating with craniotomy less than 24 hr after admission. As a rule, CBF studies were performed before surgery, and then repeated once a week for at least 1 month. A total of 147 CBF measurements examined included various clinical courses such as cerebral vasospasm and normal pressure hydrocephalus following SAH. The CBF in all region of interest (ROI) revealed significant decrease and somewhat increase in the early stage after operation; the postoperative rCBF in each ROI increased up to 10% in anterior cerebral artery (ACA), 16% in middle cerebral artery (MCA), 15% in posterior cerebral artery (PCA), and 18% in basal ganglia. However, there were major changes in follow-up rCBF: r-CBF with cerebral vasospasm decreased significantly until the 2nd week after onset, and then normalized by the 3rd week, while that without cerebral vasospasm showed not any significant changes. rCBF in ruptured aneurysm arising from internal carotid artery and ACA showed decrease the 2nd week after onset, but rCBF in ruptured aneurysm in MCA increased relatively. rCBF with normal pressure hydrocephalus decreased, whereas significantly increased after CSF diversion. SPECT using [sup 99m]Tc-HMPAO may be useful in evaluating clinical course in SAH in special cerebral vasospasm and normal pressure hydrocephalus. Also, [sup 99m]Tc-HMPAO for CBF study was reliable as well as [sup 123]Xe and [sup 123]I-IMP. (author) 67 refs.

  4. CT and angiography evaluation in ruptured intracranial aneurysm clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Sik; Kim, Byung Young; Kim, Hong; Woo, Seong Ku; Zeon, Seok Kil; Park, Sam Kyoon [Keimyung University School of Medicine, Taegu (Korea, Republic of)

    1984-09-15

    CT has been become one of the most important diagnostic method in the evaluation of ruptured intracranial aneurysm with direct detection of subarachnoid, intracerebral and intraventricular hemorrhage, and identification of complications such as recurrent bleeding, hydrocephalus and infarction secondary to arterial spam. Angiography gives precise information on the location, size of aneurysm and presence of arterial spasm. Authors attempted to predict the location of ruptured aneurysm in the CT by distribution of blood in subarachnoid spaces and brain parenchyme in comparison with angiographic findings, and also predict the prognosis of the patients by relationship between the extent of blood and clinical grade. Authors analysed 40 cases of ruptured intracranial aneurysm confirmed by CT and angiography at Keimyung University Hospital for last 2 year. The results were as follows: 1. The age and sex distribution; the most prevalent age group was 5th to 6th decades (70%), and female patient was slightly more than male patient (57.5% : 42.5%). 2. The location of aneurysms were; posterior communicating artery group 17 cases (42.2%), middle cerebral artery group 10 cases (25.0%), anterior communicating artery group 7 cases (17.5%), basilar artery bifurcation 1 case (2.5%), posterior inferior cerebellar artery 1 cases (2.5%), and multiple aneurysms 4 cases (10%) in order to frequency. 3. Characteristic distribution of intracranial hemorrhage in CT were as follows; 1) In 6 cases (85.7%) of anterior communicating artery aneurysm, interhemispheric fissure hemorrhage was noted. 2) The ipsilateral sylvian fissure hemorrhage was noted in all cases of middle cerebral artery aneurysm (10 cases) and 12 cases (70.6%) of posterior communicating artery aneurysm. 3) Localized hematoma in frontal lobe near interhemispheric fissure (2 cases; 28.6%), septum pellucidum (1 case; 14.3%) and corpus callosm (1 case; 14.3%) were characteristic in anterior communicating artery aneurysm. 4) Comma

  5. A 'Benign' Sphenoid Ridge Meningioma Manifesting as a Subarachnoid Hemorrhage Associated with Tumor Invasion into the Middle Cerebral Artery

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Nae Jung; Kim, Ho Sung; Kim, Sun Yong [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2008-07-15

    Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery

  6. Multiple intracranial aneurysms following radiation therapy for nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Puneet Gulati

    2014-01-01

    Full Text Available A 30-year-old male presented to the neurosurgical emergency with sudden onset severe headache, nausea, and vomiting. A computed tomography scan showed subarachnoid hemorrhage and a subsequent four vessel angiogram showed six cerebral aneurysms (predominantly fusiform involving both the anterior and posterior circulations, all on the left side. The patient had received 60 Gy external beam radiotherapy for left nasopharyngeal carcinoma 8 years back. The middle cerebral artery aneurysm was clipped, while the internal carotid artery and the two posterior cerebral artery aneurysms were wrapped. The patient was discharged uneventfully and is asymptomatic at follow-up 6 months later. The effects of radiation on cerebral vasculature are well-documented. Radiation-induced vasculopathy generally presents as occlusion/stenosis of cerebral vessels and aneurysms are rare. Only 46 cases of radiation-induced aneurysms have been reported previously. Just seven of these had multiple aneurysms and only one case had as many as six aneurysms.

  7. Plasma acrolein levels and their association with delayed ischemic neurological deficits following aneurysmal subarachnoid haemorrhage: a pilot study.

    Science.gov (United States)

    Garrett, M C; McCullough-Hicks, M E; Kim, G H; Komotar, R J; Kellner, C P; Hahn, D K; Otten, M L; Rynkowski, M A; Merkow, M B; Starke, R M; Connolly, E Sander

    2008-08-01

    The molecular mechanisms of cerebral vasospasm following aneurysmal subarachnoid haemorrhage (aSAH) remain unclear. Acrolein, a reactive metabolite produced in many models of mechanical and ischemic injury, has been shown to cause vasospasm in coronary artery and aorta models. These traits suggest it may play a role in post-aSAH cerebral vasospasm. This pilot study was designed as a preliminary investigation to determine if acrolein levels could be used as a clinical tool to predict the presence of vasospasm. Eleven patients with aSAH and Hunt and Hess admission grades of III-V were prospectively enrolled. Patients were stratified according to the presence or absence of vasospasm, defined as a delayed ischaemic neurological deficit in which all other possible causes have been excluded. Soluble acrolein levels were determined at two times points: early (day 1-3 post-SAH) and late (day 8-12 post-SAH) and the change in acrolein levels over this period was computed using a Mann-Whitney test. The change in acrolein levels over this period between the vasospasm and non-vasospasm group trended toward but did not achieve statistical significance (means: 5.68 versus -5.54; medians: 5.27 versus -3.99; range: -8.067 to 22.904 versus -13.83 to 5.199 p=0.13). Five out of six vasospasm patients showed an increase in acrolein levels over the vasospasm period. Three out of four non-vasospasm patients showed a decrease over the vasospasm period. The results of this pilot study suggest that acrolein levels increase in patients undergoing vasospasm during the vasospasm window. This suggests that acrolein may play a role in the pathways leading up to or following vasospasm. There is a need for larger more definitive studies.

  8. Comparison of montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage.

    Directory of Open Access Journals (Sweden)

    George Kwok Chu Wong

    Full Text Available Cognitive deficits are common after aneurysmal subarachnoid haemorrhage (aSAH, and clinical evaluation is important for their management. Our hypothesis was that the Montreal Cognitive Assessment (MoCa is superior to the Mini-Mental State Examination (MMSE in screening for cognitive domain deficit in aSAH patients.We carried out a prospective observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus. The domain-specific neuropsychological assessment battery, the MoCA and MMSE were administered 2-4 weeks and 1 year after ictus. A cognitive domain deficit was defined as a cognitive domain z score <-1.65 (below the fifth percentile. Cognitive impairment was defined as two or more cognitive domain deficits. The study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193.Both the MoCA and the MMSE were successful in differentiating between patients with and without cognitive domain deficits and cognitive impairment at both assessment periods. At 1 year post-ictus, the MoCA produced higher area under the curve scores for cognitive impairment than the MMSE (MoCA, 0.92; 95% CI, 0.83 to 0.97 versus MMSE, 0.77; 95% CI, 0.66 to 0.83, p = 0.009.Cognitive domain deficits and cognitive impairment in patients with aSAH can be screened with the MoCA in both the subacute and chronic phases.

  9. Computed tomographic findings of spontaneous intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Seung Sook; Kim, Young Sook; Kim, Young Chul [College of Medicine, Chosun University, Kwangju (Korea, Republic of)

    1987-10-15

    Computed tomography (CT) was a reliable technique to evaluate the exact size and location of spontaneous intracranial hemorrhage and to predict it's prognosis. Fifty-nine cases of spontaneous intracranial hemorrhage were evaluated and reviewed by CT scan. The following results were obtained. 1. The sex ratio of male to female was 1 to 1.4, The highest incidence was in 6th and 7th decades. 2. The most common cause of spontaneous intracranial hemorrhage was hypertension (74.6%), followed by the aneurysm (13.5%), arteriovenous malformation (5.1%), occlusive vascular disease (3.4%), and blood dyscrasia (3.4%). 3. The most common location was basal ganglia and thalamic hemorrhage (37.3%), followed by lobar hemorrhage (27.1%), cerebellar hemorrhage (13.5%), and subarachnoid hemorrhage (11.9%). 4. Primary intraventricular hemorrhage carried the highest mortality. 5. The larger volume of hematoma, the higher the mortality rate.

  10. Anti-TNF-alpha antibody attenuates subarachnoid hemorrhage-induced apoptosis in the hypothalamus by inhibiting the activation of Erk

    Directory of Open Access Journals (Sweden)

    Ma L

    2018-02-01

    Full Text Available Ling Ma,1 Yong Jiang,2 Yanan Dong,2 Jun Gao,2 Bin Du,2 Dianwei Liu2 1Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, Shandong, People’s Republic of China; 2Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China Background: Subarachnoid hemorrhage (SAH can induce apoptosis in many regions of the brain including the cortex and hippocampus. However, few studies have focused on apoptosis in the hypothalamus after SAH. Although some antiapoptotic strategies have been developed for SAH, such as anti-tumor necrosis factor-alpha (TNF-α antibody, the molecular mechanisms underlying this condition have yet to be elucidated. Therefore, the purpose of this study was to evaluate whether SAH could induce apoptosis in the hypothalamus and identify the potential molecular mechanisms underlying the actions of anti-TNF-α antibody, as a therapeutic regimen, upon apoptosis. Materials and methods: SAH was induced in a rat model. Thirty minutes prior to SAH, anti-TNF-α antibody or U0126, an extracellular signal-regulated kinase (Erk inhibitor, was microinjected into the left lateral cerebral ventricle. In addition, phorbol-12-myristate-13-acetate was injected intraperitoneally immediately after the anti-TNF-α antibody microinjection. Then, real-time polymerase chain reaction, Western blotting and immunohistochemistry were used to detect the expression of caspase-3, bax, bcl-2, phosphorylated Erk (p-Erk and Erk. Finally, anxiety-like behavior was identified by using open field. Results: Levels of caspase-3, bax and bcl-2, all showed a temporary rise after SAH in the hypothalamus, indicating the induction of apoptosis in this brain region. Interestingly, we found that the microinjection of anti-TNF-α antibody could selectively block the elevated levels of bax, suggesting the potential role of anti-TNF-α antibody in the inhibition of SAH

  11. Investigation of small ruptured aneurysms

    International Nuclear Information System (INIS)

    Abiko, Masaru; Ikawa, Fusao; Obayashi, Naohiko; Mitsuhara, Takafumi; Nosaka, Ryou; Inagawa, Tetsuji

    2008-01-01

    Subarachnoid hemorrhage (SAH) patients with ruptured aneurysms smaller than 5 mm in diameter are sometimes encountoied at our hospital. However, the operative indication for unruptured aneurysm is over 5 mm according to the JAPANESE SOCIETY FOR DETECTION OF ASYMPTOMATIC BRAIN DISEASES. We therefore analyzed the characteristics of ruptured aneurysms smaller than 5 mm in diameter. A retrospective review of all SAH patients using digital subtraction angiography (DSA) between April 1999 and March 2004 was conducted. We compared 201 SAH patients with DSA (group A) and 61 with aneurysms smaller than 5 mm (group B). Age, gender, familial history, hypertension, and location of the ruptured aneurysm were examined. In males younger than 40 years old, anterior communicating artery/distal anterior cerebral artery (Acom/DACA) aneurysms were significantly correlated with group B rather than group A. Familial history and hypertension were not found to be characteristic in group B in this study. Small unruptured aneurysms may have a risk of rupture especially in young males with Acom/DACA aneurysms. Further investigations on small aneurysms are needed. (author)

  12. Subarachnoid Hemorrhage in a Three-year-old-boy with Left Middle ...

    African Journals Online (AJOL)

    We report a case of three-year-old boy, who presented with a history of sudden onset of headache and vomiting. Neurologically he was conscious, oriented, and with no neurological deficits (Hunt and Hess grade-2) at the time of admission. Computed Tomography (CT) scan of the brain revealed intracerebral hemorrhage [ ...

  13. The genetics of primary haemorrhagic stroke, subarachnoid haemorrhage and ruptured intracranial aneurysms in adults.

    Directory of Open Access Journals (Sweden)

    George Peck

    Full Text Available The genetic basis of haemorrhagic stroke has proved difficult to unravel, partly hampered by the small numbers of subjects in any single study. A meta-analysis of all candidate gene association studies of haemorrhagic stroke (including ruptured subarachnoid haemorrhage and amyloid angiopathy-related haemorrhage was performed, allowing more reliable estimates of risk.A systematic review and meta-analysis of all genetic studies in haemorrhagic stroke was conducted. Electronic databases were searched until and including March 2007 for any candidate gene in haemorrhagic stroke. Odds ratio (OR and 95% confidence intervals (CI were determined for each gene disease association using fixed and random effect models.Our meta-analyses included 6,359 cases and 13,805 controls derived from 55 case-control studies, which included 12 genes (13 polymorphisms. Statistically significant associations with haemorrhagic stroke were identified for those homozygous for the ACE/I allele (OR, 1.48; 95% CI, 1.20-1.83; p = 0.0003 and for the 5G allele in the SERPINE1 4G/5G polymorphism (OR, 1.42; 95% CI, 1.03-1.96; p = 0.03. In addition, both epsilon2 and epsilon4 alleles of APOE were significantly associated with lobar haemorrhage (OR, 1.81; 95% CI, 1.26-2.62; p = 0.002 and OR, 1.49; 95% 1.08-2.05; p = 0.01 respectively. Furthermore, a significant protective association against haemorrhagic stroke was found for the factor V Leiden mutation (OR, 0.30; 95% CI, 0.10-0.87; p = 0.03.Our data suggests a genetic contribution to some types of haemorrhagic stroke, with no overall responsible single gene but rather supporting a polygenic aetiology . However, the evidence base is smaller compared to ischaemic stroke. Importantly, for several alleles previously found to be associated with protection from ischaemic stroke, there was a trend towards an increased risk of haemorrhagic stroke.

  14. Clipping and Coiling of Unruptured Cerebral Aneurysms Among Medicare Beneficiaries, 2000–2010

    Science.gov (United States)

    Jalbert, Jessica J; Isaacs, Abby J; Kamel, Hooman; Sedrakyan, Art

    2015-01-01

    Background and Purpose Endovascular coiling therapy is increasingly popular for obliteration of unruptured intracranial aneurysms but older patients face higher procedural risks and shorter periods during which an untreated aneurysm may rupture causing subarachnoid hemorrhage. We assessed trends in clipping and coiling of unruptured intracranial aneurysms, outcomes after clipping and coiling of unruptured intracranial aneurysms, and in subarachnoid hemorrhage among Medicare beneficiaries. Methods Using 2000–2010 MEDPAR data, we identified 2 cohorts of patients admitted electively for clipping or coiling of an unruptured aneurysm: 1) utilization cohort (2000–2010): patients ≥65 years enrolled ≥1 month in a given year; 2) outcomes cohort (2001–2010): patients ≥ 66 years of age enrolled in Medicare for ≥1 year. We calculated rates of clipping, coiling, and subarachnoid hemorrhage per 100,000 Medicare beneficiaries. We tested for trends in the risk of in-hospital mortality and complications, discharge destination, 30-day mortality, 30-day readmissions, and length of hospitalization. Results Characteristics of patients undergoing clipping (N=4,357) or coiling (N=7,942) did not change appreciably. Overall, 30-day mortality, in-hospital complications, and readmissions decreased, generally reaching their lowest levels in 2008–2010 (1.6%, 25.0%, and 14.5% for clipping and 1.5%, 13.8%, and 11.0% for coiling, respectively). Procedural treatment rates per 100,000 beneficiaries increased from 1.4 in 2000 to 6.0 in 2010, driven mainly by increased use of coiling but subarachnoid hemorrhage rates did not decrease. Conclusions While outcomes tended to be more favorable over time, increased preventative treatment of unruptured intracranial aneurysms among Medicare beneficiaries did not result in a population-level decrease in subarachnoid hemorrhage rates. PMID:26251248

  15. Astaxanthin Alleviates Early Brain Injury Following Subarachnoid Hemorrhage in Rats: Possible Involvement of Akt/Bad Signaling

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    Xiang-Sheng Zhang

    2014-07-01

    Full Text Available Apoptosis has been proven to play a crucial role in early brain injury pathogenesis and to represent a target for the treatment of subarachnoid hemorrhage (SAH. Previously, we demonstrated that astaxanthin (ATX administration markedly reduced neuronal apoptosis in the early period after SAH. However, the underlying molecular mechanisms remain obscure. In the present study, we tried to investigate whether ATX administration is associated with the phosphatidylinositol 3-kinase-Akt (PI3K/Akt pathway, which can play an important role in the signaling of apoptosis. Our results showed that post-SAH treatment with ATX could cause a significant increase of phosphorylated Akt and Bad levels, along with a significant decrease of cleaved caspase-3 levels in the cortex after SAH. In addition to the reduced neuronal apoptosis, treatment with ATX could also significantly reduce secondary brain injury characterized by neurological dysfunction, cerebral edema and blood-brain barrier disruption. In contrast, the PI3K/Akt inhibitor, LY294002, could partially reverse the neuroprotection of ATX in the early period after SAH by downregulating ATX-induced activation of Akt/Bad and upregulating cleaved caspase-3 levels. These results provided the evidence that ATX could attenuate apoptosis in a rat SAH model, potentially, in part, through modulating the Akt/Bad pathway.

  16. Packed red blood cell transfusion causes greater hemoglobin rise at a lower starting hemoglobin in patients with subarachnoid hemorrhage.

    Science.gov (United States)

    Naidech, Andrew M; Kahn, Marc J; Soong, Wayne; Green, David; Batjer, H Hunt; Bleck, Thomas P

    2008-01-01

    Each unit of packed red blood cells (PRBCs) is expected to raise circulating hemoglobin (HGB) by approximately 1 g/dL. There are few data on modifiers of this relationship other than gender and body mass index (BMI). We recorded HGB before and after PRBC transfusion in a retrospective cohort of 103 patients and a prospective cohort of 93 patients with subarachnoid hemorrhage (SAH). In the retrospective cohort, 48 of 103 patients were transfused, and in the prospective cohort, 56 of 93 patients were transfused. In both groups, lower pre-transfusion HGB was associated with a larger increase in HGB (P rise in HGB (P < 0.001) after correction for number of units of PRBCs given, gender, and BMI in repeated measures analysis. Pre-transfusion HGB explained an additional 12% of variance in the data (P < 0.001). In both cohorts, the magnitude of the effect was similar. In patients with SAH, transfusion at lower HGB leads to a greater increase in HGB. Transfusion at lower HGB may be relatively more cost-effective, and this should be balanced against any potential benefit from higher HGB in SAH. One rather than 2 units of PRBCs are likely to be sufficient for most HGB targets after SAH, especially in patients with more severe anemia.

  17. 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)

  18. Cannabinoid Receptor Type 2 Agonist Attenuates Acute Neurogenic Pulmonary Edema by Preventing Neutrophil Migration after Subarachnoid Hemorrhage in Rats.

    Science.gov (United States)

    Fujii, Mutsumi; Sherchan, Prativa; Soejima, Yoshiteru; Doycheva, Desislava; Zhao, Diana; Zhang, John H

    2016-01-01

    We evaluated whether JWH133, a selective cannabinoid type 2 receptor (CB2R) agonist, prevented neurogenic pulmonary edema (NPE) after subarachnoid hemorrhage (SAH) by attenuating inflammation. Adult male rats were assigned to six groups: sham-operated, SAH with vehicle, SAH with JWH133 (0.3, 1.0, or 3.0 mg/kg) treatment 1 h after surgery, and SAH with JWH133 (1.0 mg/kg) at 1 h with a selective CB2R antagonist, SR144528 (3.0 mg/kg). The perforation model of SAH was performed and pulmonary wet-to-dry weight ratio was evaluated 24 and 72 h after surgery. Western blot analyses and immunohistochemistry were evaluated 24 h after surgery. JWH133 (1.0 mg/kg) significantly and most strongly improved lung edema 24 h after SAH. SR144528 administration significantly reversed the effects of JWH133 (1.0 mg/kg). SAH-induced increasing levels of myeloperoxidase (MPO) and decreasing levels of a tight junction (TJ) protein, junctional adhesion molecule (JAM)-A, were ameliorated by JWH133 (1.0 mg/kg) administration 24 h after SAH. Immunohistochemical assessment also confirmed substantial leukocyte infiltration in the outside of vessels in SAH, which were attenuated by JWH133 (1.0 mg/kg) injection. CB2R agonist ameliorated lung permeability by inhibiting leukocyte trafficking and protecting tight junction proteins in the lung of NPE after SAH.

  19. Long-term assessment of motor and cognitive behaviours in the intraluminal perforation model of subarachnoid hemorrhage in rats.

    Science.gov (United States)

    Silasi, Gergely; Colbourne, Frederick

    2009-03-17

    The endovascular perforation model of subarachnoid hemorrhage (SAH) is a commonly used model in rats as it is performed without a craniotomy and accurately mimics the physiological effects of SAH in humans. The long-term behavioural profile of the model, however, has not been characterized. Given that humans often have cognitive deficits following SAH, we set out to characterize the behavioural profile as well as the spontaneous temperature changes of rats following intraluminal perforation. Rats were pre-trained on three motor tasks (tapered beam, limb-use asymmetry and the horizontal ladder tasks) prior to receiving a SAH. The animals were then assessed on post-surgical days 3, 7, 14 and 21 on these tasks. At the completion of motor testing, the rats were assessed on a moving platform version of the Morris water task. Despite significant mortality (33%), SAH did not result in lasting motor deficits on any of the tasks examined. However, the SAH group did show a minor cognitive impairment in the Morris water task. In addition, SAH produced a slight, but significant elevation in body temperature (vs. sham operated rats) despite an acute decrease in general home cage activity. The majority of the animals did not have any observable infarcts and the SAH did not significantly affect cortical thickness. In summary, the endovascular perforation model of SAH results in no lasting motor deficits and only minor cognitive impairment in survivors, which alone would be difficult to evaluate in neuroprotection or rehabilitation studies.

  20. High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms

    NARCIS (Netherlands)

    Kurki, M.I.; Gaal, E.I.; Kettunen, J.; Lappalainen, T.; Menelaou, A.; Anttila, V.; Hof, F.N. van 't; Fraunberg, M. von Und Zu; Helisalmi, S.; Hiltunen, M.; Lehto, H.; Laakso, A.; Kivisaari, R.; Koivisto, T.; Ronkainen, A.; Rinne, J.; Kiemeney, B.; Vermeulen, S.; Kaunisto, M.A.; Eriksson, J.G.; Aromaa, A.; Perola, M.; Lehtimaki, T.; Raitakari, O.T.; Salomaa, V.; Gunel, M.; Dermitzakis, E.T.; Ruigrok, Y.M.; Rinkel, G.J.; Niemela, M.; Hernesniemi, J.; Ripatti, S.; Bakker, P.I. de; Palotie, A.; Jaaskelainen, J.E.

    2014-01-01

    3% of the population develops saccular intracranial aneurysms (sIAs), a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH) is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder

  1. Intraoperative Rupture of Unruptured Cerebral Aneurysm during Craniotomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Kenji Yoshiki

    2017-11-01

    Full Text Available An unruptured aneurysm was incidentally found in the right middle cerebral artery in a 67-year-old woman. During an attempt to turn the temporalis muscle for surgical clipping, systolic blood pressure suddenly increased. After opening the dura mater, we found a subarachnoid hemorrhage and severe brain swelling. We promptly expanded the craniotomy area to reach the aneurysm while pulling part of the frontal lobe to apply a clip. We retrospectively analyzed the aneurysm using computational fluid dynamics. Our analysis suggests that the rupture of the aneurysm occurred at a location with very low wall shear stress.

  2. Importance of accessory outflow pathways in hydrocephalus after experimental subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Griebel, R.W.; Black, P.M.; Pile-Spellman, J.; Strauss, H.W.

    1989-01-01

    This study evaluated the changes in pathways of cerebrospinal fluid (CSF) outflow that accompanied acute and compensated hydrocephalus in the rabbit. Intraventricularly injected 99mTc antimony sulfide was used as a tracer of outflow pathways, and specified structures were counted 12 to 24 hours after injection. Fifteen rabbits were divided into three groups: 1) an acutely hydrocephalic group in which 3 cisternal injections of blood were followed by a study of CSF pressure, ventricular size, and CSF outflow pathways 1 week after the last injection; 2) a control group treated according to the same protocol, except that sterile saline was injected instead of blood; and 3) a chronic group also treated according to the same protocol but in which the animals were maintained an average of 4 weeks after the last blood injection. Ventricular size was measured by computed digitation and expressed as an area ratio of ventricle to brain (VBR). In control animals, 11.8% of the injected colloid dosage was found in cranial perineural lymphatic channels, and 4.8% appeared in the spinal cord. The mean CSF pressure was 149 +/- 20.2 mm H20 (mean +/- SE) and the mean VBR was 0.040 +/- 0.003. In animals evaluated 1 week after subarachnoid injection, accessory cranial perineural lymphatic outflow decreased significantly to 3.4%, and spinal cord activity increased to 9.8% (P less than 0.05, two-tailed t-test). These animals were hydrocephalic and had CSF pressure of 247 +/- 25.1 mm H20 (mean +/- SE) and VBR of 0.083 +/- 0.009

  3. Risk factors and their combined effects on the incidence rate of subarachnoid hemorrhage--a population-based cohort study.

    Directory of Open Access Journals (Sweden)

    Miikka Korja

    Full Text Available BACKGROUND: Prospective studies on the risk factors for subarachnoid hemorrhage (SAH are limited. Moreover, the effect of risk factors on the incidence rates of SAH is not well known about. AIMS: In this study, we aimed to identify risk factors for SAH and characterize subgroups in a population with a high incidence of SAH. METHODS: After recording multiple potential risk factors for SAH at the time of enrollment, first ever SAH events between 1972 and 2009 were recorded through the nationwide Causes of Death Register and Hospital Discharge Register for the population-based cohort of 64 349 participants, who participated in the National FINRISK Study between 1972 and 2007 in Finland. RESULTS: During the follow-up time of 1.26 million person-years (median 17.9 years, range 0 to 37.9 years, 437 persons experienced fatal or non-fatal SAH. Crude SAH incidence was 34.8 (95% confidence interval: 31.7-38.2 per 100 000 person-years among ≥ 25-year-old persons. Female sex, high blood pressure values and current smoking were confirmed as risk factors for SAH. Previous myocardial infarction, history of premature stroke (any kind in mother and elevated cholesterol levels in men were identified as new risk factors for SAH. Depending on the combination of risk factors, SAH incidence varied between 8 and 171 per 100 000 person-years. CONCLUSIONS: New and previously reported risk factors appear to have a much stronger association with the incidence of SAH than is ordinarily seen in cardiovascular diseases. Risk factor assessments may facilitate the identification of high-risk persons who should be the focus of preventive interventions.

  4. Risk Factors and Their Combined Effects on the Incidence Rate of Subarachnoid Hemorrhage – A Population-Based Cohort Study

    Science.gov (United States)

    Korja, Miikka; Silventoinen, Karri; Laatikainen, Tiina; Jousilahti, Pekka; Salomaa, Veikko; Hernesniemi, Juha; Kaprio, Jaakko

    2013-01-01

    Background Prospective studies on the risk factors for subarachnoid hemorrhage (SAH) are limited. Moreover, the effect of risk factors on the incidence rates of SAH is not well known about. Aims In this study, we aimed to identify risk factors for SAH and characterize subgroups in a population with a high incidence of SAH. Methods After recording multiple potential risk factors for SAH at the time of enrolment, first ever SAH events between 1972 and 2009 were recorded through the nationwide Causes of Death Register and Hospital Discharge Register for the population-based cohort of 64 349 participants, who participated in the National FINRISK Study between 1972 and 2007 in Finland. Results During the follow-up time of 1.26 million person-years (median 17.9 years, range 0 to 37.9 years), 437 persons experienced fatal or non-fatal SAH. Crude SAH incidence was 34.8 (95% confidence interval: 31.7–38.2) per 100 000 person-years among ≥25-year-old persons. Female sex, high blood pressure values and current smoking were confirmed as risk factors for SAH. Previous myocardial infarction, history of premature stroke (any kind) in mother and elevated cholesterol levels in men were identified as new risk factors for SAH. Depending on the combination of risk factors, SAH incidence varied between 8 and 171 per 100 000 person-years. Conclusions New and previously reported risk factors appear to have a much stronger association with the incidence of SAH than is ordinarily seen in cardiovascular diseases. Risk factor assessments may facilitate the identification of high-risk persons who should be the focus of preventive interventions. PMID:24040058

  5. 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.

  6. The efficacy and safety of acupuncture for cerebral vasospasm after subarachnoid hemorrhage: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Cho, Seung-Yeon; Lee, Dong-Hyuk; Shin, Hee Sup; Lee, Seung Hwan; Koh, Jun Seok; Jung, Woo-Sang; Moon, Sang-Kwan; Park, Jung-Mi; Ko, Chang-Nam; Kim, Ho; Park, Seong-Uk

    2015-02-28

    Subarachnoid hemorrhage (SAH) is a neurological disease with a high mortality rate. Several serious complications frequently arise after successful surgery for this condition. Cerebral vasospasm, one such complication, occurs in 50 to 70% of SAH patients. These patients suffer neurological symptoms known as delayed ischemic neurological deficit (DIND); however, the effect of treatment of vasospasm is limited. The major pathogenesis of cerebral vasospasm is the reduction of nitric oxide (NO) and activation of vasoconstrictors. Acupuncture is known to increase the production and activity of vascular endothelial cell-derived NO and improve endothelium-dependent vasodilatation. A preliminary retrospective case study to investigate the ability of acupuncture to prevent the occurrence of cerebral vasospasm has been conducted. However, no randomized, controlled clinical trials have been carried out to evaluate the efficacy of acupuncture for cerebral vasospasm. This trial will be a single-center, randomized, placebo-controlled, parallel group, patient-assessor-blinded clinical trial. A total of 80 patients with SAH will be randomized into two groups: a study group given acupuncture, electroacupuncture, and intradermal acupuncture, and a control group given mock transcutaneous electrical nerve stimulation and sham intradermal acupuncture. Intervention will start within 96 h after SAH, and a total of 12 sessions will be performed during a 2-week period. The primary outcome measure will be the occurrence of DIND, and the secondary outcomes will be vasospasm as measured by cerebral angiography, transcranial Doppler, clinical symptoms, vasospasm-related infarcts, NO and endothelin-1 plasma levels, mortality, and modified Rankin Scale scores. This trial will examine the efficacy and safety of acupuncture for cerebral vasospasm after SAH. The placebo effect will be excluded and the mechanism of action of the treatments will be evaluated through blood testing. Clinical

  7. Quantitative Computed Tomography Ventriculography for Assessment and Monitoring of Hydrocephalus: A Pilot Study and Description of Method in Subarachnoid Hemorrhage.

    Science.gov (United States)

    Multani, Jasjit Singh; Oermann, Eric Karl; Titano, Joseph; Mascitelli, Justin; Nicol, Kelly; Feng, Rui; Skovrlj, Branko; Pain, Margaret; Mocco, J D; Bederson, Joshua B; Costa, Anthony; Shrivastava, Raj

    2017-08-01

    There is no facile quantitative method for monitoring hydrocephalus (HCP). We propose quantitative computed tomography (CT) ventriculography (qCTV) as a novel computer vision tool for empirically assessing HCP in patients with subarachnoid hemorrhage (SAH). Twenty patients with SAH who were evaluated for ventriculoperitoneal shunt (VPS) placement were selected for inclusion. Ten patients with normal head computed tomography (CTH) findings were analyzed as negative controls. CTH scans were segmented both manually and automatically (by qCTV) to generate measures of ventricular volume. The median manually calculated ventricular volume was 36.1 cm 3 (interquartile range [IQR], 30-115 cm 3 ), which was similar to the median qCTV measured volume of 37.5 cm 3 (IQR, 32-118 cm 3 ) (P = 0.796). Patients undergoing VPS placement demonstrated an increase in median ventricular volume on qCTV from 21 cm 3 to 40 cm 3 on day T-2 and to 51 cm 3 by day 0, a change of 144%. This is in contrast to patients who did not require shunting, in whom median ventricular volume decreased from 16 cm 3 to 14 cm 3 on day T-2 and to 13 cm 3 by day 0, with an average overall volume decrease 19% (P = 0.001). The average change in ventricular volume predicted which patients would require VPS placement, successfully identifying 7 of 10 patients (P = 0.004). Using an optimized cutoff of a change in ventricular volume of 2.5 cm 3 identified all patients who went on to require VPS placement (10 of 10; P = 0.011). qCTV is a reliable means of quantifying ventricular volume and hydrocephalus. This technique offers a new tool for monitoring neurosurgical patients for hydrocephalus, and may be beneficial for use in future research studies, as well as in the routine care of patients with hydrocephalus. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Incidence and Characteristics of Remote Intracerebral Hemorrhage After Endovascular Treatment of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Sim, Sook Young; Song, Jihye; Oh, Se-Yang; Kim, Myeong Jin; Lim, Yong Cheol; Park, Sang Kyu; Shin, Yong Sam; Chung, Joonho

    2016-11-01

    The purpose of this study was to investigate the incidence and characteristics of remote intracerebral hemorrhage (ICH) after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). Between March 2007 and September 2015, 11 patients with remote ICH from a series of 2258 consecutive patients with 2597 UIAs treated via EVT were identified. Baseline demographic characteristics, medical history, radiologic imaging data, characteristics of remote ICH, and clinical outcomes were retrospectively reviewed. The characteristics of patients with remote ICH were compared with those of patients without remote ICH. All hematomas were single lesions located in the subcortical white matter as lobar-type in 9 patients (81.8%) and in the basal ganglia in 2 patients (18.2%). Events occurred mostly within 1 week and up to 3 weeks after EVT. Hematoma was located on the ipsilateral side in 8 patients (72.7%) and in the contralateral side in 3 patients (27.3%). Compared with patients without remote ICH, there were more aneurysms located on the internal carotid artery (ICA) (P = 0.041), more patients treated with stents (P < 0.001), more patients with hypertension (P = 0.026), and poorer clinical outcomes at discharge (P < 0.001) for patients with remote ICH. The incidence of remote ICH after EVT of UIAs was 0.46%. This event occurred mostly in patients with stents, hypertension, and UIAs on the ICA. It presented mostly as an ipsilateral lobar-type hemorrhage within 1 week after the procedure. This complication should not be neglected because of its poor clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Regulation of microRNAs miR-30a and miR-143 in cerebral vasculature after experimental subarachnoid hemorrhage in rats

    DEFF Research Database (Denmark)

    Müller, Anne Holt; Povlsen, Gro Klitgaard; Edvinsson, Lars

    2015-01-01

    BACKGROUND: microRNAs (miRNAs) are important regulators of translation and have been implicated in the pathogenesis of a number of cardiovascular diseases, including stroke, and suggested as possible prognostic biomarkers. Our aim was to identify miRNAs that are differentially regulated in cerebral...... arteries after subarachnoid hemorrhage (SAH), using a rat injection model of SAH and a qPCR-based screen of 728 rat miRNAs. Additionally, serum was analyzed for a possible spill-over to the circulation of regulated miRNAs from the vessel walls. RESULTS: We identified 482 different miRNAs expressed...

  10. Does treatment of ruptured intracranial aneurysms within 24 hours improve clinical outcome?

    Science.gov (United States)

    Phillips, Timothy J; Dowling, Richard J; Yan, Bernard; Laidlaw, John D; Mitchell, Peter J

    2011-07-01

    The purpose of this study was to analyze whether treating ruptured intracranial aneurysms within 24 hours of subarachnoid hemorrhage improves clinical outcome. An 11-year database of consecutive ruptured intracranial aneurysms treated with endovascular coiling or craniotomy and clipping was analyzed. Outcome was measured by the modified Rankin Scale at 6 months. Our policy is to treat all cases within 24 hours of subarachnoid hemorrhage. Treatment delays are due to nonclinical logistical factors. Two hundred thirty cases were coiled or clipped within 24 hours of subarachnoid hemorrhage and 229 at >24 hours. No difference in age, gender, smoking, family history of subarachnoid hemorrhage, aneurysm size, or aneurysm location was found between the groups. Poor World Federation of Neurological Surgeons clinical grade patients were overrepresented in the ultra-early group. Increasing age and higher World Federation of Neurological Surgeons clinical grade were predictors of poor outcome. Eight point zero percent (16 of 199) of cases treated within 24 hours of SAH (ultra-early) were dependent or dead at 6 months compared with 14.4% (30 of 209) of those treated at >24 hours post-SAH (delayed; (χ2, P0.044) [corrected]. A total of 3.5% of cases coiled within 24 hours were dependent or dead at 6 months compared with 12.5% of cases coiled at 1 to 3 days, an 82% relative risk reduction and a 10.2% absolute risk reduction (χ2, P=0.040). These groups did not differ in age, World Federation of Neurological Surgeons clinical grade, aneurysm size, or aneurysm location. Treatment of ruptured aneurysms within 24 hours is associated with improved clinical outcomes compared with treatment at >24 hours. The benefit is more pronounced for coiling than clipping.

  11. Anterior inferior cerebellar artery aneurysms: Segments and results of surgical and endovascular managements

    Science.gov (United States)

    Lv, Xianli; Ge, Huijian; He, Hongwei; Jiang, Chuhan

    2016-01-01

    Background Anterior inferior cerebellar artery (AICA) aneurysms are rare and published clinical experience with these aneurysms is limited. Objective The objective of this article is to report angiographic characteristics and results associated with premeatal, meatal and postmeatal segments, surgical and endovascular therapies. Methods A literature review was performed through PubMed using “anterior inferior cerebellar artery aneurysm” through January 2016. Clinical data, angiograms, management techniques, and patient outcomes were reviewed for 47 collected cases in 30 previous reports. Results Of these aneurysms, 21 (44.7%) were associated with meatal segment, 10 (21.3%) were postmeatal and 16 (34.0%) were premeatal. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy (77.8%). Patient outcomes of meatal aneurysms presented with more neuropathies (51.7%) and cerebellar symptoms (14.3%) (p = 0.049). Four cases of meatal aneurysm with preoperative cranial nerve deficits (two VII and two VIII) showed improvement after surgery. Endovascular treatment achieved outcomes similar to surgical treatment (p = 0.327). Conclusions AICA aneurysms have a predilection for meatal segment. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy. Patient outcomes of meatal aneurysms presented with more neuropathies and cerebellar symptoms. Endovascular treatment achieved outcomes similar to surgical treatment. PMID:27485045

  12. Reversible Akinetic Mutism after Aneurysmal Subarachnoid Haemorrhage in the Territory of the Anterior Cerebral Artery without Permanent Ischaemic Damage to Anterior Cingulate Gyri

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    François-Xavier Sibille

    2016-01-01

    Full Text Available We report on two cases of transient akinetic mutism after massive subarachnoid haemorrhage due to the rupture of an intracranial aneurysm of the anterior cerebral artery (ACA. In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. Both patients shared common radiological features: a hydrocephalus due to haemorrhagic contamination of the ventricular system and a mass effect of a subpial hematoma on the borders of the corpus callosum. Patients were also investigated using auditory event-related evoked potentials at acute stage. In contrast to previous observations of akinetic mutism, P300 wave could not be recorded. Both patients had good recovery and we hypothesized that this unexpectedly favourable outcome was due to the absence of permanent structural damage to the ACA territory, with only transient dysfunction due to a reversible mass effect on cingulate gyri.

  13. Endovascular management of distal anterior inferior cerebellar artery aneurysms: Report of two cases and review of the literature

    Science.gov (United States)

    Santillan, Alejandro; Gobin, Y. Pierre; Patsalides, Athos; Riina, Howard A.; Rosengart, Axel; Stieg, Philip E.

    2011-01-01

    Background: Aneurysms of the anterior inferior cerebellar artery (AICA), especially those located in the distal portion of the AICA, are rare. There are few reported cases treated with surgery or endovascular embolization. Case Description: We report two cases of fusiform distal AICA aneurysms presenting with subarachnoid hemorrhage. Parent artery occlusion with coils and n-butyl cyanoacrilate (n-BCA) resulted in complete aneurysm occlusion and prevented rebleeding. Both patients presented postprocedure neurological deficits, but have made a good recovery at 4 and 10 months, respectively. Conclusion: Occlusion of the parent artery for the treatment of ruptured fusiform distal AICA aneurysms is effective but has significant neurological risks. PMID:21748047

  14. Computed Tomographic Angiogram of an Anterior Communicating Artery Aneurysm Causing Acute Retrobulbar Optic Neuropathy: A Case Report

    OpenAIRE

    Chang, Jee Ho; Lee, Dong-Kyu; Kim, Bum Tae; Ohn, Young-Hoon

    2011-01-01

    Three-dimensional computed tomographic (3D-CT) angiography is a widespread imaging modality for intracranial vascular lesions. However, 3D-CT angiograms of an anterior communicating artery aneurysm associated with acute retrobulbar optic neuropathy have not been previously described. We present 3D-CT angiograms of an aneurysm of the anterior communicating artery that caused subarachnoid hemorrhage and vision loss in a 39-year old man. The 3D-CT angiograms were consistent with findings identif...

  15. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

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    Yi-Pei Tai

    2010-08-01

    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  16. Endovascular treatment for pediatric intracranial aneurysms

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    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    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. Outcome of intracranial aneurysm surgery: single center experience

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    Murat Ulutas

    2016-12-01

    Conclusion: Multiple aneurysms, poor grade and intracerebral hematomas are poor prognostic factors. The patients who have subarachnoid hemorrhage should be monitored by an experienced team of neurosurgery and intensive care and should be operated on as soon as possible because of rehemorrhage risk. The surgical clipping as a gold standard is still an affective and successful method. [Cukurova Med J 2016; 41(4.000: 732-743

  18. 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. Becaus...

  19. Diagnosis of unruptured and ruptured aneurysms using magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Takeshi; Houkin, Kiyohiro; Abe, Hiroshi (Hokkaido Univ., Sapporo (Japan). School of Medicine); Kashiwaba, Takeshi

    1994-05-01

    Most previous reports have explored the efficacy of magnetic resonance angiography (MRA) as a noninvasive screening method for the detection of unruptured intracranial aneurysms and occlusive vascular disease. The purpose of this study was to assess the accuracy of three-dimensional (3D) time-of-flight (TOF) MRA in the identification of ruptured aneurysms presenting subarachnoid hemorrhage (SAH) as well as unruptured aneurysms. Sixty-two consecutive patients with 36 ruptured and 32 unruptured aneurysms were examined. MR angiograms and conventional contrast angiograms were retrospectively reviewed with regard to the relation between the detectability on MRA and size of aneurysm, location, and influence of subarachnoid hematoma. The size of ruptured aneurysms was significantly larger than that of unruptured aneurysms. Twenty-seven of 29 ruptured aneurysms in acute stage (93%) was detected on MRA, whereas 29 of 36 unruptured aneurysms (81%) and none of 4 ruptured aneurysms in subacute stage (0%) were detectable. Individual vessel visualization and image quality of MRA in patients with acute SAH were satisfactory, although in patients with subacute SAH, MRA showed poor visualization of vessels due to T1-shortening of subacute surrounding hematoma and presence of delayed vasospasm. Main causes of failure to detect aneurysms on MRA included limitation of spatial resolution, limited projections obtainable with maximum-intensity-projection (MIP) techniques and subacute hematoma simulating flow signal on MIP reconstructions. Improvement of present limitation of MRA requires higher spatial resolution, higher contrast resolution and a more adequate reconstruction method. MRA was considered to be a safe and useful examination for intracranial aneurysms especially in patients with acute SAH. (author).

  20. The role of inflammation in cerebral aneurysms

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    Ali H Turkmani

    2015-06-01

    Full Text Available The natural history of unruptured intracranial aneurysms (IAs is poorly understood. At present, risk factors for aneurysm rupture are limited to demographics and rudimentary anatomic features of the aneurysm. The first sign of aneurysm destabilization and rupture may be subarachnoid hemorrhage, a potentially devastating brain injury with high morbidity and mortality. An emerging body of literature suggests a complex inflammatory cascade likely promotes aneurysm wall remodeling and progressive ballooning of the arterial wall, ultimately terminating in aneurysm rupture. These events likely begin with hemodynamic, flow-related endothelial injury; the injured endothelium stimulates inflammation, including the recruitment and transmigration of inflammatory cells, particularly macrophages. Various proteases are secreted by the inflammatory infiltrate, resulting in degradation of the extracellular matrix and the structural changes unique to IAs. Detailed understanding of these inflammatory processes may result in (1 early identification of patients at high risk for aneurysm rupture, perhaps via arterial wall imaging, and (2 targeted, noninvasive therapies to treat or even prevent cerebral aneurysms.

  1. Neonatal intracranial aneurysms: case report and review of the literature.

    Science.gov (United States)

    Mohotti, Jeewaka E; Carter, Nicole S; Zhang, Victor Jia Wei; Lai, Leon T; Xenos, Christopher; Asadi, Hamed; Chandra, Ronil V

    2018-03-02

    Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2-30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

  2. NADH fluorescence imaging and the histological impact of cortical spreading depolarization during the acute phase of subarachnoid hemorrhage in rats.

    Science.gov (United States)

    Shimizu, Tomohisa; Hishikawa, Tomohito; Nishihiro, Shingo; Shinji, Yukei; Takasugi, Yuji; Haruma, Jun; Hiramatsu, Masafumi; Kawase, Hirokazu; Sato, Sachiko; Mizoue, Ryoichi; Takeda, Yoshimasa; Sugiu, Kenji; Morimatsu, Hiroshi; Date, Isao

    2018-01-01

    OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P 50 ) was estimated to be 22.4 minutes (95% confidence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 ± 2.2 minutes after

  3. Effect of an evidence-based mobility intervention on the level of function in acute intracerebral and subarachnoid hemorrhagic stroke patients on a neurointensive care unit.

    Science.gov (United States)

    Rand, Maxine L; Darbinian, Jeanne A

    2015-07-01

    To explore the effect of an evidence-based mobility intervention on the level of function (LOF) achieved by patients with intracerebral hemorrhage (ICH) stroke and subarachnoid hemorrhage (SAH) stroke and to identify clinical characteristics and measures associated with walking distances >15.24m. Retrospective pre- and postintervention study. Regional neurointensive care unit. Adult patients with ICH and SAH (N=361). Daily mobility intervention based on patient's current LOF. Walking >15.24m (LOF 5) by neurointensive care unit discharge. Electronic health records for 361 patients (52.6% women; mean age, 62.1y; ICH stroke, 63.2%; aphasia, 35%; hemiplegia, 33%) were included. There was a 2.3-fold increase in patients with hemorrhagic stroke achieving a LOF of 5 by neurointensive care unit discharge after introduction of a mobility intervention. In the multivariable logistic regression model including neurointensive care unit length of stay (LOS) as a covariate, the intervention, LOF of 5 at admission, SAH stroke type, third (vs lowest) quartile of neurointensive care unit LOS, and absence of aphasia and/or hemiplegia were associated with higher likelihood of achieving a LOF of 5 (odds ratio [OR]=5.28; 95% confidence interval [CI], 2.52-11.06; OR=6.02; 95% CI, 1.45-24.96; OR=3.78; 95% CI, 1.83-7.80; OR=2.94; 95% CI, 1.16-7.47; OR=17.77; 95% CI, 6.59-47.92, respectively). A mobility intervention was strongly associated with increased distance walked by neurointensive care unit patients with acute hemorrhage at discharge and can be applied in any intensive care unit setting to promote stroke recovery. Future studies directed at building predictive models for walking achievement in patients with acute hemorrhagic stroke may provide insight into individualized treatment goal setting and discharge planning. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. A case of acute spinal subdural hematoma with subarachnoid hemorrhage: Rapid spontaneous remission, relapse, and complete resolution

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    Michito Namekawa

    2017-06-01

    In addition to rostrocaudal spreading of bloody components in the subdural space, rupture of the hematoma into the subarachnoid space must have released pressure, compressing the spinal cord. In this case report, we also describe the serial MRI studies and note the limitations of the resolution of spinal MRI in the acute phase.

  5. Cerebral aneurysm associated with cardiac myxoma: Case Report

    Science.gov (United States)

    Ivanović, Branislava A.; Tadić, Marijana; Vraneš, Mile; Orbović, Bojana

    2011-01-01

    Left atrial myxomas are a rare but well known cause of cerebrovascular accidents in young people. Cerebral embolism is the most common cause of cerebral ischemic stroke. The intracranial aneurysm is rarely associated with myxoma. We report the case of a patient who had an operation of PICA aneurysm due to subarachnoid hemorrhage ten months before the discovery of the large left atrial myxoma. Fortunately, the untimely diagnosis of the myxoma did not have other consequences. In order to prevent possible complications of we should keep in mind that these two apparently different entities could be associated. PMID:21342146

  6. Cerebral aneurysm associated with cardiac myxoma: Case Report

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    Branislava A. Ivanović

    2011-02-01

    Full Text Available Left atrial myxomas are a rare but well known cause of cerebrovascular accidents in young people. Cerebral embolism is the most common cause of cerebral ischemic stroke. The intracranial aneurysm is rarely associated with myxoma. We report the case of a patient who had an operation of PICA aneurysm due to subarachnoid hemorrhage ten months before the discovery of the large left atrial myxoma. Fortunately, the untimely diagnosis of the myxoma did not have other consequences. In order to prevent possible complications of we should keep in mind that these two apparently different entities could be associated.

  7. 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, S.; Edvinsson, L.

    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...... 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...... into the prechiasmatic cistern in the rat. The activation of different MAPK and PKC isotypes in large circle of Willis cerebral arteries and intracerebral microvessels was examined at 0, 1, 3, 6, 12, 24, and 48 hours after SAH and after intrathecal treatment with PKC or MAPK inhibitor by use of Western blot. RESULTS...

  8. Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging.

    Science.gov (United States)

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

    2014-08-01

    Patients without a subarachnoid haemorrhage (SAH) on brain CT scan (CT-negative), but a lumbar puncture (LP)-proven SAH, are a challenging patient category. The optimal diagnostic approach is still a matter of debate. Also, there is little knowledge on the probability of finding an underlying vascular lesion. In this observational study, a consecutive cohort of 94 patients with CT-negative, LP-positive SAH was prospectively collected between 1998 and 2013. The yield of diagnostic modalities as well as patient outcome was studied. In addition, risk factors for the presence of a vascular lesion were analysed. In 40 patients (43%), an intracranial vascular abnormality was detected: 37 aneurysms and three arterial dissections. Female gender was significantly associated with detection of a vascular lesion. Time between ictus and diagnosis of SAH was not associated with the presence of vascular pathology. Overall, 99% of patients had a modified Rankin Score of 0-2 after a median follow-up of 72 months. The yield of additional digital subtraction angiography in patients with a negative CT angiography was zero. In this study, the chance of finding a vascular lesion in a patient with CT-negative, LP-positive SAH was 43%, underlining the need for an adequate diagnostic workup. In general, the patient outcome was favourable. Female gender was found to be predictive for detecting a vascular lesion. In contrast with previous reports, the interval between ictus and LP was not associated with the presence of an aneurysm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Long-term MRI findings of patients with embolized cerebral aneurysms

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    Pyysalo, Liisa M.; Niskakangas, Tero T.; Oehman, Juha E. (Tampere Univ. Hospital, Dept. of Neurosurgery, Tampere (Finland)), email: liisa.pyysalo@uta.fi; Keski-Nisula, Leo H.; Kaehaerae, Veikko J. (Medical Imaging Center, Tampere (Finland))

    2011-02-15

    Background: Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. Parenchymal infarctions related to aneurysms have mostly been studied in patients with subarachnoidal hemorrhage (SAH) but infarction rates in patients with endovascularly treated unruptured aneurysms have been little studied. Purpose: To determine the frequency of permanent parenchymal lesions as detected in magnetic resonance imaging (MRI) in patients treated with endovascular coiling and to assess aneurysm-related infarctions after the initial treatment period. Material and Methods: A total of 64 patients (32 with primarily ruptured aneurysms) with 69 embolized aneurysms were examined neurologically and by MRI and magnetic resonance angiography (MRA) more than 9 years after the initial endovascular treatment. Results: A total of 14 out of 32 (44%) SAH patients and 11 (34%) patients with unruptured aneurysms had parenchymal lesions in MRI. Infarctions were detected in 10 (31%) SAH patients and the majority (9/10, 90%) of them were aneurysm-related. All aneurysm-related infarctions were detected at the acute hospitalization stage. A total of six (55%) out of 11 infarctions in patients with unruptured aneurysms were aneurysm-related and two of them appeared after the treatment period. Patients with infarction had poorer clinical outcome than patients with no ischemic lesions in MRI. Conclusion: Nineteen percent of patients with unruptured and 41% with ruptured aneurysms had aneurysmrelated parenchymal lesions in MRI. Most of these were detected during acute treatment period. Aneurysmrelated infarctions after treatment period are uncommon

  10. Cerebral Venous Thrombosis Presenting with Subracnoid Hemorrhage

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    Esra Eruyar

    2015-08-01

    Full Text Available Subarachnoid hemorrhage (SAH associated with cerebral venous thrombosis (CVT is rarely reported. In our case, the initial CT shows with suspected lesions that SAH. After the initial diagnosis of SVT with history and neurological examination findings MRV taken and consistend with thrombus signal change. Dural sinus thrombosis with secondary venous hypertension may lead to SAH into the subarachnoid space due to the rupture of fragile, thin-walled cortical veins. Patients with non-traumatic, non-aneurysmal and non-perimesencephalic subaracnoid hemorrhage tend to have clots circumscribed along the cortical convexity, a condition referred as acute cortical SAH. CVT is a potential cause of cortical SAH. This case; SAH may be the first sign of SVT and especially SVT must do in etiologic research without the involvement of the basal sisterna in cases of SAH.

  11. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data.

    Science.gov (United States)

    Lall, Rohan R; Eddleman, Christopher S; Bendok, Bernard R; Batjer, H Hunt

    2009-05-01

    Aneurysmal subarachnoid hemorrhage continues to have high rates of morbidity and mortality for patients despite optimal medical and surgical management. Due to the fact that aneurysmal rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Given the variability of the literature evaluating unruptured aneurysms regarding basic patient population, clinical practice, and aneurysm characteristics studied, such as size, location, aspect ratio, relationship to the surrounding vasculature, and the aneurysm hemodynamics, a meta-analysis is nearly impossible to perform. This review will instead focus on the various anatomical and morphological characteristics of aneurysms reported in the literature with an attempt to draw broad inferences and serve to highlight pressing questions for the future in our continued effort to improve clinical management of unruptured intracranial aneurysms.

  12. Epidemiology and genetics of intracranial aneurysms

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    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

  13. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Caranci, F.; Briganti, F.; Cirillo, L.; Leonardi, M.; Muto, M.

    2013-01-01

    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

  14. Hemolysis, Elevated Liver Enzymes, and Low Platelets, Severe Fetal Growth Restriction, Postpartum Subarachnoid Hemorrhage, and Craniotomy: A Rare Case Report and Systematic Review

    Directory of Open Access Journals (Sweden)

    Shadi Rezai

    2017-01-01

    Full Text Available Introduction. Hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome is a relatively uncommon but traumatic condition occurring in the later stage of pregnancy as a complication of severe preeclampsia or eclampsia. Prompt brain computed tomography (CT or magnetic resonance imaging (MRI and a multidisciplinary management approach are required to improve perinatal outcome. Case. A 37-year-old, Gravida 6, Para 1-0-4-1, Hispanic female with a history of chronic hypertension presented at 26 weeks and 6 days of gestational age. She was noted to have hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome accompanied by fetal growth restriction (FGR, during ultrasound evaluation, warranting premature delivery. The infant was delivered in stable condition suffering no permanent neurological deficit. Conclusion. HELLP syndrome is an uncommon and traumatic obstetric event which can lead to neurological deficits if not managed in a responsive and rapid manner. The central aggravating factor seems to be hypertension induced preeclamptic or eclamptic episode and complications thereof. The syndrome itself is manifested by hemolytic anemia, increased liver enzymes, and decreasing platelet counts with a majority of neurological defects resulting from hemorrhagic stroke or subarachnoid hemorrhage (SAH. To minimize adverse perinatal outcomes, obstetric management of this medical complication must include rapid clinical assessment, diagnostic examination, and neurosurgery consultation.

  15. Hemolysis, Elevated Liver Enzymes, and Low Platelets, Severe Fetal Growth Restriction, Postpartum Subarachnoid Hemorrhage, and Craniotomy: A Rare Case Report and Systematic Review.

    Science.gov (United States)

    Rezai, Shadi; Faye, Justin; Hughes, Alexander; Cheung, Mon-Lai; Cohen, Joel R; Kaia, Judy A; Fuller, Paul N; Henderson, Cassandra E

    2017-01-01

    Introduction . Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a relatively uncommon but traumatic condition occurring in the later stage of pregnancy as a complication of severe preeclampsia or eclampsia. Prompt brain computed tomography (CT) or magnetic resonance imaging (MRI) and a multidisciplinary management approach are required to improve perinatal outcome. Case . A 37-year-old, Gravida 6, Para 1-0-4-1, Hispanic female with a history of chronic hypertension presented at 26 weeks and 6 days of gestational age. She was noted to have hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome accompanied by fetal growth restriction (FGR), during ultrasound evaluation, warranting premature delivery. The infant was delivered in stable condition suffering no permanent neurological deficit. Conclusion . HELLP syndrome is an uncommon and traumatic obstetric event which can lead to neurological deficits if not managed in a responsive and rapid manner. The central aggravating factor seems to be hypertension induced preeclamptic or eclamptic episode and complications thereof. The syndrome itself is manifested by hemolytic anemia, increased liver enzymes, and decreasing platelet counts with a majority of neurological defects resulting from hemorrhagic stroke or subarachnoid hemorrhage (SAH). To minimize adverse perinatal outcomes, obstetric management of this medical complication must include rapid clinical assessment, diagnostic examination, and neurosurgery consultation.

  16. Stent assisted coil embolization of wide-necked bilobed anterior inferior cerebellar artery aneurysm with incorporated artery arising from the dome: a technical note.

    Science.gov (United States)

    Sabharwal, Paramveer Singh; Saini, Jitender; Hanumanthapura Ramalingaiah, Arvinda

    2013-09-01

    A technique for stent-assisted coil embolization of a bilobed wide-necked saccular aneurysm of the anterior inferior cerebellar artery (AICA) with the AICA arising from the dome of the aneurysm is described. A middle-aged patient was referred for treatment of a bilobed saccular aneurysm identified on a CT angiogram performed for a subarachnoid hemorrhage which occurred 20 days prior to presentation. A diagnostic angiogram showed a bilobed wide-necked saccular aneurysm at the AICA origin with the AICA arising from the dome of the aneurysm and also supplying the territory of the posterior inferior cerebellar artery. The therapeutic procedure involved trans-aneurysmal cannulation of the AICA with the microcatheter left in situ. Another microcatheter was maneuvered into the larger dome of the aneurysm. A stent was then deployed in the basilar artery, jailing the previous microcatheter in the aneurysm. Helical Guglielmi detachable coils were deployed in the aneurysm resulting in complete occlusion of the aneurysm with preservation of the AICA. It is important to preserve a normal branch arising from the dome of an aneurysm although it is technically demanding and a relative limitation. This case report describes a technique of coiling a bilobed aneurysm with a vital branch arising from the dome, with preservation of the branch and complete occlusion of the aneurysm using two microcatheters and a stent. This expands the repertoire of endovascular treatment of complex aneurysms.

  17. Hemorrhage rates of external ventricular drain (EVD), intracranial pressure gauge (ICP) or combined EVD and ICP gauge placement within 48 h of endovascular coil embolization of cerebral aneurysms.

    Science.gov (United States)

    Scholz, Christoph; Hubbe, Ulrich; Deininger, Miriam; Deininger, Martin H

    2013-08-01

    In single patients with a cerebral aneurysm an external ventricular drain (EVD), an intracranial pressure (ICP) gauge or a combined EVD and ICP gauge placement is necessary after coil embolization and initiation of postprocedural anticoagulation. The aim of this study was to examine the hemorrhage rates of drain placement within 48 h after aneurysm coiling and under anticoagulation or antiplatelet therapy. We retrospectively analyzed hemorrhage rates of EVD, ICP gauge or combined EVD and ICP gauge placement in 27 patients within 48 h after coil embolization under different anticoagulation or antiplatelet schemes (heparin, acetylsalicylic acid, clopidogrel). In patients with continuous heparin via perfusor the application was stopped periprocedurally. The results were compared to literature. Four hemorrhages (14.8%) were observed. Three hemorrhages were petechial and one was by definition a larger hemorrhage with 8 mm×10 mm in diameter. EVD, ICP gauge or combined EVD and ICP gauge placements within 48 h after cerebral aneurysm coiling and under different anticoagulation or antiplatelet regimens seem to have no increased risk of hemorrhages compared to literature. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. A Theoretical Consideration of the Surgical Treatment of Small Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Chang, Han Soo

    2016-12-01

    Surgical treatment of small, unruptured intracranial aneurysms remains a controversial topic. Recently, some authors have doubted the validity of the low rupture rates of small aneurysms reported in the literature and advocate aggressive surgical treatment of small unruptured aneurysms; however, some theoretical elucidation is necessary to determine whether such aggressive treatment is appropriate. On certain theoretical assumptions, a simulation was performed to examine whether the low rupture rates for small aneurysms could produce a reasonable size distribution of ruptured aneurysms. Second, considering a hypothetical population in which all the unruptured aneurysms over a certain cut-off size are treated, the effect of this policy on reducing the incidence of subarachnoid hemorrhage (SAH) was mathematically analyzed. Then, the contribution of each individual operation to this reduction of SAH incidence was calculated. The low rupture rates reported in the literature produced a reasonable size distribution of ruptured aneurysms (median diameter of 10 mm) in the simulated population. The analysis of the treatment cut-off size showed that, as the cut-off size was progressively lowered to the range of 3-5 mm, further reduction of the incidence of SAH became almost negligible. The contribution of each individual surgery on unruptured aneurysms decreased rapidly as the aneurysm size decreased, and this reduction was proportional to the reduction of the rupture rate of the aneurysm. These results suggest that we should be prudent in providing surgical treatment to small unruptured intracranial aneurysms. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. 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...... to be involved in this upregulation. The aim in the present study was to determine whether treatment with the MEK1/2 inhibitor U0126 can prevent cerebrovascular receptor upregulation and improve functional outcome after experimental SAH in rats....

  20. An unusual, duplicate origin of the anterior choroidal artery with aneurysm: a case report.

    Science.gov (United States)

    Chenin, Louis; Chivot, Cyril; Toussaint, Patrick; Deramond, Hervé; Peltier, Johann

    2015-12-01

    Aneurysms of the anterior choroidal artery (AChoA) are rare and often difficult to treat. Variations may be present and must be identified prior to treatment. We report a unique case of a ruptured aneurysm located at the origin of a duplicate branch of the AChoA. A 56-year-old male was admitted to our university hospital for coma. A brain CT scan showed a subarachnoid hemorrhage, and CT angiography revealed a duplication of the right AChoA, with an aneurysm located at the branch's origin. We decided to embolize this aneurysm. Four weeks later, our patient was able to transfer to the rehabilitation unit. To the best of our knowledge, this is one of the first descriptions of an aneurysm located at the origin of a duplicate branch of the AChoA.

  1. 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.

  2. Hemosiderin detected by T2*-weighted magnetic resonance imaging in patients with unruptured cerebral aneurysms: indication of previous bleeding?

    Science.gov (United States)

    Takada, Shihomi; Inoue, Takashi; Niizuma, Kuniyasu; Shimizu, Hiroaki; Tominaga, Teiji

    2011-01-01

    Previous bleeding from a cerebral aneurysm indicates a higher risk of rupture. Hemosiderin may be detected during aneurysm surgery or by preoperative imaging sensitive to hemosiderin. The detection of hemosiderin deposits by T(2)*-weighted magnetic resonance (MR) imaging was evaluated in 49 patients with unruptured cerebral aneurysms who underwent open surgery. MR imaging was performed using 3.0 tesla MR scanner. Two sequences of T(2)*-weighted imaging, and proton density images were obtained. Preliminary study in patients with old subarachnoid hemorrhage provided the definitions of likely pathological findings during surgery and on T(2)*-weighted imaging due to previous hemorrhage. Hemosiderin deposits in the subarachnoid space were observed during surgery in 9 of the 49 patients, although no obvious rupture site was detected around the aneurysm wall. Size, presence of bleb, location, and number of aneurysms showed no significant difference between patients with and without hemosiderin deposition. Hypointense areas on T(2)*-weighted imaging were recognized in four patients. The mean size of the aneurysms in these patients was 9.8 mm, significantly larger than those in other patients (p = 0.029). Hemosiderin deposits were observed during surgery in sites close to the lesions on T(2)*-weighted imaging in two of these four patients. Hemosiderin deposits are not rare in patients with unruptured aneurysms, and preoperative T(2)*-weighted imaging can detect such deposits.

  3. Paradoxical Increase in Mortality and Rupture of Intracranial Aneurysms in Microsomal Prostaglandin E2 Synthase Type 1-Deficient Mice: Attenuation by Aspirin.

    Science.gov (United States)

    Peña Silva, Ricardo A; Mitchell, Ian J; Kung, David K; Pewe, Lecia L; Granja, Manuel F; Harty, John T; Faraci, Frank M; Heistad, Donald D; Hasan, David M

    2015-10-01

    Inflammation plays an important role in formation and rupture of intracranial aneurysms. Expression of microsomal prostaglandin E2 (PGE2) synthase type 1 (mPGES-1) is increased in the wall of intracranial aneurysms in humans. PGE2, a by-product of mPGES-1, is associated with inflammation and cerebrovascular dysfunction. To test the hypothesis that deletion of mPGES-1 decreases the formation and rupture of intracranial aneurysms in a murine model. Intracranial aneurysms were induced in wild-type and mPGES-1 knockout (mPGES-1 KO) mice by using a combination of deoxycorticosterone acetate-salt-induced hypertension and intracranial injection of elastase in the basal cistern. Prevalence of aneurysms, subarachnoid hemorrhage, and mortality were assessed. We also tested the effects of administration of aspirin (6 mg/kg/d) by gavage and PGE2 (1 mg/kg/d) by subcutaneous infusion. Systolic blood pressure and prevalence of aneurysm were similar in wild-type and mPGES-1 KO mice. However, mortality and the prevalence of subarachnoid hemorrhage were markedly increased in mPGES-1 KO mice (P increase rupture of intracranial aneurysms. Aspirin, but not PGE2, attenuated the increased mortality in mPGES-1 KO mice (P increase in rupture of cerebral aneurysms and mortality, which are attenuated by low-dose aspirin.

  4. "Microbleeding" from intracranial aneurysms: Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms.

    Science.gov (United States)

    Nussbaum, Eric S; Defillo, Archie; Zelensky, Andrea; Pulivarthi, Swaroopa; Nussbaum, Leslie

    2014-01-01

    During elective surgery for unruptured aneurysms, we have identified a group of patients with hemosiderin staining of the pial surface immediately adjacent to the aneurysm dome suggesting a remote and unrecognized history of microbleeding from the aneurysm. These cases form the basis for this report. Medical records of 421 unruptured cerebral aneurysm patients treated surgically between January 2003 and September 2010 were retrospectively reviewed. Patients with a history of prior subarachnoid hemorrhage, craniotomy, or significant closed head injury were excluded from review. Records were reviewed for intraoperative descriptions of hemosiderin deposition in the vicinity of the aneurysm as well as history of headaches, time to presentation, comorbidities, aneurysm characteristics, procedures, and radiologic imaging. Local hemosiderin staining immediately adjacent to the aneurysm was identified intraoperatively in 13 cases. Each of these patients had a history of remote atypical headache prior to presentation. Eight of these patients (62%) had aneurysms described as particularly "thin-walled" at the time of surgery. Aneurysm locations included the internal carotid artery (ICA) (54%), middle cerebral artery (MCA) (23%), anterior communicating artery (ACOMMA) (15%), and the anterior cerebral artery (ACA) (8%). More than half (54%) of these patients had a history of smoking, while 31% had hypertension, and 23% had a history of alcohol abuse. Dyslipidemia and family history of aneurysms were present in 15% and hypercholesterolemia was noted in one patient (8%). We suggest this group of patients had suffered a "microbleed" resulting in local hemosiderin deposition next to the aneurysm. The origins and clinical implications of such microbleeds are unknown and warrant further investigation.

  5. The effect of deferoxamine on brain lipid peroxide levels and Na-K ATPase activity following experimental subarachnoid hemorrhage.

    Science.gov (United States)

    Bilgihan, A; Türközkan, N; Aricioğlu, A; Aykol, S; Cevik, C; Göksel, M

    1994-05-01

    1. In the present study we have studied the effects of deferoxamine treatment on lipid peroxidation and Na-K ATPase activity after experimental induction of subarachnoid haemorrhage (SAH) in guinea pigs. 2. We assessed the extent of lipid peroxidation by measuring the level of malondialdehyde and Na-K ATPase activity in 3 different groups (sham-operated, SAH, SAH + deferoxamine). 3. There was no significant difference in lipid peroxide content between sham-operated and haemorrhagic animals, but Na-K ATPase activity decreased after SAH. 4. Deferoxamine treatment reduced the malondialdehyde content and induced the recovery of Na-K ATPase activity, exerting a brain protective role against the detrimental effects of the haemorrhage.

  6. Massive primary intraventricular hemorrhage due to idiopathic Lateral Posterior Choroidal Artery Aneurysm:Case illustration.

    Science.gov (United States)

    Bozkurt, Gökhan; Yaman, Mesut Emre; Çevik, Serdar; Kırbaş, İsmail; Yağmurlu, Banu

    2017-12-19

    Peripheral aneurysms of the lateral posterior choroidal artery (LPChA) are rare and mostly in association with vascular and occlusive pathologies such as moyamoya disease.To the best of our knowledge, pure LPChA aneurysms without association of any other vascular diseases are unique and only 3 cases have been reported in the literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis.

    Science.gov (United States)

    Hill, Travis C; Tanweer, Omar; Thomas, Cheddhi; Engler, John; Shapiro, Maksim; Becske, Tibor; Huang, Paul P

    2016-03-01

    Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

  8. Apolipoprotein E-Mimetic Peptide COG1410 Promotes Autophagy by Phosphorylating GSK-3β in Early Brain Injury Following Experimental Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Xinshen Li

    2018-03-01

    Full Text Available COG1410, a mimetic peptide derived from the apolipoprotein E (apoE receptor binding region, exerts positive effect on neurological deficits in early brain injury (EBI after experimental subarachnoid hemorrhage (SAH. Currently the neuroprotective effect of COG1410 includes inhibiting BBB disruption, reducing neuronal apoptosis, and neuroinflammation. However, the effect and mechanism of COG1410 to subcellular organelles disorder have not been fully investigated. As the main pathway for recycling long-lived proteins and damaged organelles, neuronal autophagy is activated in SAH and exhibits neuroprotective effects by reducing the insults of EBI. Pharmacologically elevated autophagy usually contributes to alleviated brain injury, while few of the agents achieved clinical transformation. In this study, we explored the activation of autophagy during EBI by measuring the Beclin-1 and LC3B-II protein levels. Administration of COG1410 notably elevated the autophagic markers expression in neurons, simultaneously reversed the neurological deficits. Furthermore, the up-regulated autophagy by COG1410 was further promoted by p-GSK-3β agonist, whereas decreased by p-GSK-3β inhibitor. Taken together, these data suggest that the COG1410 might be a promising therapeutic strategy for EBI via promoting autophagy in SAH.

  9. SIRT3 Expression Decreases with Reactive Oxygen Species Generation in Rat Cortical Neurons during Early Brain Injury Induced by Experimental Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Wei Huang

    2016-01-01

    Full Text Available Sirtuin3 (SIRT3 is an important protein deacetylase which predominantly presents in mitochondria and exhibits broad bioactivities including regulating energy metabolism and counteracting inflammatory effect. Since inflammatory cascade was proved to be critical for pathological damage following subarachnoid hemorrhage (SAH, we investigated the overall expression and cell-specific distribution of SIRT3 in the cerebral cortex of Sprague-Dawley rats with experimental SAH induced by internal carotid perforation. Results suggested that SIRT3 was expressed abundantly in neurons and endothelia but rarely in gliocytes in normal cerebral cortex. After experimental SAH, mRNA and protein expressions of SIRT3 decreased significantly as early as 8 hours and dropped to the minimum value at 24 h after SAH. By contrast, SOD2 expression increased slowly as early as 12 hours after experimental SAH, rose up sharply at the following 12 hours, and then was maintained at a higher level. In conclusion, attenuated SIRT3 expression in cortical neurons was associated closely with enhanced reactive oxygen species generation and cellular apoptosis, implying that SIRT3 might play an important neuroprotective role during early brain injury following SAH.

  10. The Important Liaison Between Onuf Nucleus-Pudendal Nerve Ganglia Complex Degeneration and Urinary Retention in Spinal Subarachnoid Hemorrhage: An Experimental Study.

    Science.gov (United States)

    Yolas, Coskun; Kanat, Ayhan; Aydin, Mehmet Dumlu; Ozturk, Cengiz; Kabalar, Esref; Akca, Nezih; Eren, Huseyin; Gundogdu, Cemal; Kotan, Dilcan; Aydin, Nazan

    2016-05-01

    The Adamkiewicz artery (AKA) supplies pudendal nerve roots and conus medullaris. The aim of this study was to elucidate if there is any relationship between neurodegenerative changes of the Onuf nucleus (ON)-pudendal nerve ganglia complex secondary to vasospasm of the AKA after spinal subarachnoid hemorrhage (SAH). This study was conducted on 22 rabbits, which were randomly divided into 3 groups: control (n = 5), sham (n = 5), and spinal SAH (n = 12). Experimental spinal SAH was induced at the L2 level. After 2 weeks, the ON-pudendal nerve ganglia complex and AKA were examined histopathologically. Bladder volume values were estimated, and results were analyzed statistically. Two animals died within the first week of experiment. Histopathologically, severe vasospasm of the AKA and neuronal degeneration and neuronal apoptosis were observed in the ON-pudendal nerve ganglia complex in 5 animals of the SAH group. The mean volume of the imaginary AKA, mean bladder volumes, and degenerated neuron densities of ON and pudendal nerve ganglia were estimated. We found that vasospasm of the AKA led to numerous neuron degenerations in ON and pudendal ganglia and consequently urinary retention (P < 0.005). ON-pudendal nerve ganglia complex degeneration secondary to vasospasm of the AKA may be a cause of urinary retention after spinal SAH. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. [Curcumin improves learning and memory function through decreasing hippocampal TNF-α and iNOS levels after subarachnoid hemorrhage in rats].

    Science.gov (United States)

    Qiu, Zhenwei; Yue, Shuangzhu

    2016-03-01

    To investigate the effect of curcumin on learning and memory function of rats with subarachnoid hemorrhage (SAH) and the possible mechanism. A total of 30 male Sprague-Dawley rats were randomly divided into three groups: Sham group, SAH group and curcumin (Cur) therapy group. Experimental SAH rat models were established by injecting autologous blood into the cisterna magna. Neurological deficits of rats were examined at different time points. Spatial learning and memory abilities were tested by Morris water maze test. The hippocampal tumor necrosis factor-alpha (TNF-α) and inducible nitric oxide synthase (iNOS) were detected by ELISA. RESULTS Experimental SAH rat models were established successfully. Neurological scores of the SAH rats were significantly lower than those of the sham group. Curcumin therapy obviously improved the neurological deficits of rats compared with the SAH rats. Morris water maze test showed that SAH caused significant cognitive impairment with longer escape latency compared with the sham group. After treatment with curcumin for 4 weeks, the escape latency decreased significantly. The levels of TNF-α and iNOS in the curcumin-treated group were significantly lower than those of the SAH group. SAH can cause learning and memory impairment in rats. Curcumin can recover learning and memory function through down-regulating hippocampal TNF-α and iNOS levels.

  12. Exploring potential association between flow instability and rupture in patients with matched-pairs of ruptured-unruptured intracranial aneurysms.

    Science.gov (United States)

    Xu, Lijian; Gu, Lixu; Liu, Hao

    2016-12-28

    Patients with multiple intracranial aneurysms present a great challenge to the neurosurgeon, particularly when presenting with subarachnoid hemorrhage. Misjudgment may result in disastrous postoperative rebleeding from the untreated but true-ruptured lesion. In this study, computational fluid dynamic simulations of two matched-pairs of ruptured-unruptured cerebral aneurysms were performed to investigate the potential association between flow instability and aneurysm rupture. Two pairs of cerebral aneurysms from two patients were located in the middle cerebral artery and the anterior communicating artery respectively. Our results demonstrated highly disturbed states of the blood flows in the ruptured aneurysms of the two patients with multiple aneurysms, which are characterized by remarked velocity and wall shear stress (WSS) fluctuations at late systole. The ruptured aneurysms exhibit obviously temporal intra-cycle WSS fluctuations rather than the unruptured aneurysms of the same patient. Cycle-to-cycle fluctuations are further observed in the ruptured aneurysms when the flow turns to decelerate. The obvious differences observed between matched-pairs of ruptured-unruptured aneurysms imply that flow instability may be a potential source correlating to aneurysm rupture.

  13. Aneurysmal SubArachnoid Hemorrhage—Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled trial protocol

    Science.gov (United States)

    English, Shane W; Fergusson, D; Chassé, M; Lauzier, F; Griesdale, D; Algird, A; Kramer, A; Tinmouth, A; Lum, C; Sinclair, J; Marshall, S; Dowlatshahi, D; Boutin, A; Pagliarello, G; McIntyre, L A

    2016-01-01

    Introduction Anaemia is common in aneurysmal subarachnoid haemorrhage (aSAH) and is a potential critical modifiable factor affecting secondary injury. Despite physiological evidence and management guidelines that support maintaining a higher haemoglobin level in patients with aSAH, current practice is one of a more restrictive approach to transfusion. The goal of this multicentre pilot trial is to determine the feasibility of successfully conducting a red blood cell (RBC) transfusion trial in adult patients with acute aSAH and anaemia (Hb ≤100 g/L), comparing a liberal transfusion strategy (Hb ≤100 g/L) with a restrictive strategy (Hb ≤80 g/L) on the combined rate of death and severe disability at 12 months. Methods Design This is a multicentre open-label randomised controlled pilot trial at 5 academic tertiary care centres. Population We are targeting adult aSAH patients within 14 days of their initial bleed and with anaemia (Hb ≤110 g/L). Randomisation Central computer-generated randomisation, stratified by centre, will be undertaken from the host centre. Randomisation into 1 of the 2 treatment arms will occur when the haemoglobin levels of eligible patients fall to ≤100 g/L. Intervention Patients will be randomly assigned to either a liberal (threshold: Hb ≤100 g/L) or a restrictive transfusion strategy (threshold: Hb ≤80 g/L). Outcome Primary: Centre randomisation rate over the study period. Secondary: (1) transfusion threshold adherence; (2) study RBC transfusion protocol adherence; and (3) outcome assessment including vital status at hospital discharge, modified Rankin Score at 6 and 12 months and Functional Independence Measure and EuroQOL Quality of Life Scale scores at 12 months. Outcome measures will be reported in aggregate. Ethics and dissemination The study protocol has been approved by the host centre (OHSN-REB 20150433-01H). This study will determine the feasibility of conducting the large pragmatic RCT comparing 2

  14. Unruptured intracranial aneurysms in children with sickle cell disease: analysis of 18 aneurysms in 5 patients.

    Science.gov (United States)

    Saini, Surbhi; Speller-Brown, Barbara; Wyse, Emily; Meier, Emily R; Carpenter, Jessica; Fasano, Ross M; Pearl, Monica S

    2015-05-01

    Intracranial aneurysms (IAs) are rare in the general pediatric population and account for <2% of all cerebral aneurysms. Only 7 children with sickle hemoglobinopathy and IAs have been reported, the majority of which were discovered after rupture. To report the prevalence of unruptured IAs in a selected population of children with sickle cell disease (SCD) and to describe the aneurysm morphology, hematologic characteristics, and management in this patient population. A retrospective review of the electronic database for all children with SCD who underwent brain magnetic resonance imaging or angiography from January 2002 to August 2013 at a single institution was performed. Records were reviewed for IA, age, sex, sickle cell genotype, neurological symptoms, hematologic indexes, transcranial Doppler findings, and management. Five of 179 children (2.8%) with SCD imaged by brain magnetic resonance imaging or angiography were diagnosed with IAs. None presented with subarachnoid hemorrhage. Four patients (80%) had HbSS disease, and 1 patient had hemoglobin sickle cell HbSC disease. A total of 18 aneurysms were detected; the majority of patients had multiple aneurysms (80%) and bilateral involvement (60%). Children with SCD are at risk for developing multiple intracranial aneurysms, and a high index of suspicion must be maintained during the interpretation of routine magnetic resonance imaging or angiography of the brain.

  15. Hyperbaric Oxygen Intervention Modulates Early Brain Injury after Experimental Subarachnoid Hemorrhage in Rats: Possible Involvement of TLR4/NF-κ B-Mediated Signaling Pathway

    Directory of Open Access Journals (Sweden)

    Hao Liu

    2016-05-01

    Full Text Available Background/Aims: Previous studies have proved that the activation of TLR4/NF-κ B signaling pathway is involved in inflammatory processes in early brain injury (EBI after subarachnoid hemorrhage (SAH. Hyperbaric oxygen (HBO intervention has successfully been used to treat several animal models of tissue injury via its anti-inflammation property. This study was undertaken to investigate the