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Alsbrook DL, Di Napoli M, Bhatia K, Desai M, Hinduja A, Rubinos CA, Mansueto G, Singh P, Domeniconi GG, Ikram A, Sabbagh SY, Divani AA. Pathophysiology of Early Brain Injury and Its Association with Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Review of Current Literature. J Clin Med 2023; 12:jcm12031015. [PMID: 36769660 PMCID: PMC9918117 DOI: 10.3390/jcm12031015] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
Background: Delayed cerebral ischemia (DCI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Though many clinical trials have looked at therapies for DCI and vasospasm in aSAH, along with reducing rebleeding risks, none have led to improving outcomes in this patient population. We present an up-to-date review of the pathophysiology of DCI and its association with early brain injury (EBI). Recent Findings: Recent studies have demonstrated that EBI, as opposed to delayed brain injury, is the main contributor to downstream pathophysiological mechanisms that play a role in the development of DCI. New predictive models, including advanced monitoring and neuroimaging techniques, can help detect EBI and improve the clinical management of aSAH patients. Summary: EBI, the severity of subarachnoid hemorrhage, and physiological/imaging markers can serve as indicators for potential early therapeutics in aSAH. The microcellular milieu and hemodynamic pathomechanisms should remain a focus of researchers and clinicians. With the advancement in understanding the pathophysiology of DCI, we are hopeful that we will make strides toward better outcomes for this unique patient population.
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Affiliation(s)
- Diana L Alsbrook
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Sulmona, 67039 L'Aquila, Italy
| | - Kunal Bhatia
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Masoom Desai
- Department of Neurology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Archana Hinduja
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Clio A Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences, University of Campania, 80138 Naples, Italy
| | - Puneetpal Singh
- Department of Human Genetics, Punjabi University, Patiala 147002, India
| | - Gustavo G Domeniconi
- Unidad de Cuidados Intensivos, Sanatorio de la Trinidad San Isidro, Buenos Aires 1640, Argentina
| | - Asad Ikram
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Sara Y Sabbagh
- Department of Neurology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, Albuquerque, NM 87131, USA
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Emonds JJ, Arlt F, Gaudl A, Reinicke M, Heinemann M, Lindner D, Laudi S, Ceglarek U, Meixensberger J. Trimethylamine N-oxide (TMAO) in patients with subarachnoid hemorrhage: a prospective observational study. Acta Neurochir (Wien) 2023; 165:1277-1287. [PMID: 36695932 PMCID: PMC10140079 DOI: 10.1007/s00701-022-05485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND It is suspected that microbiome-derived trimethylamine N-oxide (TMAO) may enhance platelet responsiveness and accordingly be thrombophilic. The purpose of this prospective observational study is to evaluate TMAO in patients with subarachnoid hemorrhage (SAH) and compare it with a control group. A secondary aim was to investigate TMAO in the cerebrospinal fluid (CSF) from SAH patients. This should provide a better understanding of the role of TMAO in the pathogenesis of SAH and its thrombotic complications. METHODS The study included patients with diagnosed spontaneous SAH recruited after initial treatment on admission and patients with nerve, nerve root, or plexus disorders serving as controls. Blood samples were gathered from all patients at recruitment. Additionally, sampling of SAH patients in the intensive care unit continued daily for 14 days. The CSF was collected out of existing external ventricular drains whenever possible. RESULTS Thirty-four patients diagnosed with SAH, and 108 control patients participated in this study. Plasma TMAO levels at baseline were significantly lower in the SAH group (1.7 μmol/L) compared to the control group (2.9 μmol/L). TMAO was detectable in the CSF (0.4 μmol/L) and significantly lower than in plasma samples of the SAH group at baseline. Plasma and CSF TMAO levels correlated positively. The TMAO levels did not differ significantly during the observation period of 15 days. CONCLUSIONS Although we assumed that patients with higher TMAO levels were at higher risk for SAH a priori, plasma TMAO levels were lower in patients with SAH compared with control subjects with nerve, nerve root, or plexus disorders on admission to the hospital. A characteristic pattern of plasma TMAO levels in patients with SAH was not found.
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Affiliation(s)
- Julian Josef Emonds
- Department of Neurosurgery, University of Leipzig Medical Center, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Felix Arlt
- Department of Neurosurgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Alexander Gaudl
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Madlen Reinicke
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Mitja Heinemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Dirk Lindner
- Department of Neurosurgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Laudi
- Department of Anaesthesia and Intensive Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Jürgen Meixensberger
- Department of Neurosurgery, University of Leipzig Medical Center, Leipzig, Germany.
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203
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Xia C, Hoffman H, Anikpezie N, Philip K, Wee C, Choudhry R, Albright KC, Masoud H, Beutler T, Schmidt E, Gould G, Patel SD, Akano EO, Morris N, Chaturvedi S, Aneni E, Lamikanra O, Chin L, Latorre JG, Otite FO. Trends in the Incidence of Spontaneous Subarachnoid Hemorrhages in the United States, 2007-2017. Neurology 2023; 100:e123-e132. [PMID: 36289004 PMCID: PMC10499430 DOI: 10.1212/wnl.0000000000201340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To test the hypothesis that age-specific, sex-specific, and race-specific and ethnicity-specific incidence of nontraumatic subarachnoid hemorrhage (SAH) increased in the United States over the last decade. METHODS In this retrospective cohort study, validated International Classification of Diseases codes were used to identify all new cases of SAH (n = 39,475) in the State Inpatients Databases of New York and Florida (2007-2017). SAH counts were combined with Census data to calculate incidence. Joinpoint regression was used to compute the annual percentage change (APC) in incidence and to compare trends over time between demographic subgroups. RESULTS Across the study period, the average annual age-standardized/sex-standardized incidence of SAH in cases per 100,000 population was 11.4, but incidence was significantly higher in women (13.1) compared with that in men (9.6), p < 0.001. Incidence also increased with age in both sexes (men aged 20-44 years: 3.6; men aged 65 years or older: 22.0). Age-standardized and sex-standardized incidence was greater in Black patients (15.4) compared with that in non-Hispanic White (NHW) patients (9.9) and other races and ethnicities, p < 0.001. On joinpoint regression, incidence increased over time (APC 0.7%, p < 0.001), but most of this increase occurred in men aged 45-64 years (APC 1.1%, p = 0.006), men aged 65 years or older (APC 2.3%, p < 0.001), and women aged 65 years or older (APC 0.7%, p = 0.009). Incidence in women aged 20-44 years declined (APC -0.7%, p = 0.017), while those in other age/sex groups remained unchanged over time. Incidence increased in Black patients (APC 1.8%, p = 0.014), whereas that in Asian, Hispanic, and NHW patients did not change significantly over time. DISCUSSION Nontraumatic SAH incidence in the United States increased over the last decade predominantly in middle-aged men and elderly men and women. Incidence is disproportionately higher and increasing in Black patients, whereas that in other races and ethnicities did not change significantly over time.
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Affiliation(s)
- Christina Xia
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Haydn Hoffman
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Nnabuchi Anikpezie
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Karan Philip
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Claribel Wee
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Reema Choudhry
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Karen C Albright
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Hesham Masoud
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Timothy Beutler
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Elena Schmidt
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Grahame Gould
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Smit D Patel
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Emmanuel Oladele Akano
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Nicholas Morris
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Seemant Chaturvedi
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Ehimen Aneni
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Oluwatomi Lamikanra
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Lawrence Chin
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Julius G Latorre
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL
| | - Fadar Oliver Otite
- From the Departments of Neurology (C.X., K.P., C.W., R.C., K.C.A., H.M., E.S., J.G.L., F.O.O.M.), and Neurosurgery (H.H., T.B., G.G., L.C.), SUNY Upstate Medical University, Syracuse, NY; Department of Population Health Science (N.A.), University of Mississippi Medical Center, Jackson; Department of Neurology (S.D.P.), University of California Los Angeles; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (N.M., S.C.), University of Maryland, Baltimore; Department of Cardiology (E.A.), Yale University, New Haven, CT; andDepartment of Critical Care (O.L.), Springfield Clinic, IL.
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Ek AS, Holmström C, Elmerstig E. Sexuality >1 year after brain injury rehabilitation: A cross-sectional study in Sweden. Brain Inj 2023; 37:34-46. [PMID: 36408962 DOI: 10.1080/02699052.2022.2145358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE This study investigates whether Acquired Brain Injury (ABI) is associated with changes in sexual function and satisfaction and how such changes are experienced, focusing on invisible impairments after ABI. MATERIALS AND METHODS A study-specific questionnaire was distributed in 2018-2019. The sample included individuals aged 20-90 years diagnosed with ABI due to subarachnoid hemorrhage (SAH), trauma, infection, or anoxia (ischemic stroke and intracerebral hemorrhage excluded), who participated in brain injury rehabilitation in Sweden, 2014-2016. Chi-square and Logistic regression analyses were used. RESULTS The study consists of 250 participants (response rate was 40%). Among participants 78% (194/250) had resumed sexual life. Participants reporting sexual changes also experienced more consequences related to ABI. Those with decreased sexual desire (63%, 148/234) reported more ABI consequences, including decreased memory (86% vs 65%, p = 0.000), decreased concentration ability (82% vs 65%, p = 0.003), and increased tiredness (91% vs 70%, p = 0.000) compared to those with intact desire. Such consequences can be invisible to others. CONCLUSION Visible impairments are known to impact sexual functions and satisfaction after ABI. Our results show how invisible impairments also have a great impact. From a biopsychosocial perspective, these results imply that individuals should receive sexual rehabilitation, irrespective of ABI impairment.
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Affiliation(s)
- Ann-Sofie Ek
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics, Skåne University Hospital, Malmö-Lund, Sweden
| | - Charlotta Holmström
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Salih M, Salem MM, Moore JM, Ogilvy CS. Optimal Cost-Effective Screening Strategy for Unruptured Intracranial Aneurysms in Female Smokers. Neurosurgery 2023; 92:150-158. [PMID: 36222540 DOI: 10.1227/neu.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prevalence of intracranial aneurysms among female cigarette smokers was shown to be high in previous studies, yet the cost-effectiveness of screening them has never been explored. OBJECTIVE To explore the most cost-effective screening strategy for female smokers. METHODS A decision analytical study was performed with a Markov model to compare different screening strategies with no screening and to explore the most optimal screening strategy for female smokers. Input data for the model were extracted from literature. A single screening at different ages and multiple screening every 15 years, 10 years, 5 years, and 2 years were performed for female smokers in different age ranges. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the model. Finally, value of information analysis was performed to investigate the value of collecting additional data. RESULTS Screening female smokers for unruptured intracranial aneurysm is cost-effective. All screening strategies yield extra quality-adjusted life years. Screening at younger age brings more health benefit at lower cost. Frequent screening strategies decrease rupture rate of aneurysms more with higher costs per quality-adjusted life year. Screening after age 70 years and frequent screening (every 2 years) after age 60 years is not optimal. Among all the parameters in the model, collecting additional data on utility of the unscreened population would be most valuable. CONCLUSION Screening female smokers for intracranial aneurysms once at younger age is most optimal. However, in clinical practice, the duration and intensity of exposure to cigarettes should be taken into consideration.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA
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Semin KS, Zakharova NE, Eliava SS, Konovalov AN, Kheireddin AS, Kalaeva DB, Batalov AI, Pronin IN. [Magnetic resonance imaging of saccular intracranial aneurysm wall]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:55-62. [PMID: 37830469 DOI: 10.17116/neiro20238705155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Hemorrhage from intracranial aneurysms is associated with high risk of adverse outcomes. In this regard, surgical treatment of unruptured asymptomatic aneurysms has been actively developed in recent decades. One of the objectives is searching for predictors of aneurysm rupture to clarify the indications for surgery. Non-invasive analysis of vascular wall is actively discussed in last years. OBJECTIVE To evaluate the possibilities of MRI of ruptured and unruptured intracranial aneurysm walls and determine clinical significance of certain morphological patterns. MATERIAL AND METHODS The study included 111 patients with 158 ruptured and unruptured saccular aneurysms who underwent MRI according to a special protocol between November 2020 and September 2023. We analyzed each aneurysm regarding features of contrast enhancement and changes in SWAN images. After that, we compared these data with ruptures. RESULTS Wall of ruptured and unruptured aneurysms can accumulate contrast agent. We found 5 types of contrast enhancement. Thick-layer contrast enhancement was accompanied by 9.6-fold higher risk of aneurysm rupture compared to aneurysms without contrast enhancement. Dark MR signal from intracranial aneurysm wall in SWAN imaging is a significant sign of rupture. CONCLUSION MRI of the vascular wall is valuable to verify ruptured aneurysms. Unruptured aneurysms can accumulate contrast agent inside the wall, and pattern of accumulation differs from ruptured aneurysms. Morphological analysis is needed to confirm contrast enhancement as a marker of aneurysm rupture.
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Affiliation(s)
- K S Semin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | | | - D B Kalaeva
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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207
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Garvayo M, Messerer M, Starnoni D, Puccinelli F, Vandenbulcke A, Daniel RT, Cossu G. The positive impact of cisternostomy with cisternal drainage on delayed hydrocephalus after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:187-195. [PMID: 36504078 PMCID: PMC9840569 DOI: 10.1007/s00701-022-05445-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hydrocephalus is one of the major complications of aneurysmal subarachnoid haemorrhage (aSAH). In the acute setting, an external ventricular drain (EVD) is used for early management. A cisternal drain (CD) coupled with the micro-surgical opening of basal cisterns can be an alternative when the aneurysm is clipped. Chronic hydrocephalus after aSAH is managed with ventriculo-peritoneal (VP) shunt, a procedure associated with a wide range of complications. The aim of this study is to analyse the impact of micro-surgical opening of basal cisterns coupled with CD on the incidence of VP shunt, compared to patients treated with EVD. METHODS The authors conducted a retrospective review of 89 consecutive cases of patients with aSAH treated surgically and endovascularly with either EVD or CD between January 2009 and September 2021. Patients were stratified into two groups: Group 1 included patients with EVD, Group 2 included patients with CD. Subgroup analysis with only patients treated surgically was also performed. We compared their baseline characteristics, clinical outcomes and shunting rates. RESULTS There were no statistically significant differences between the two groups in terms of epidemiological characteristics, WFNS score, Fisher scale, presence of intraventricular hemorrhage (IVH), acute hydrocephalus, postoperative meningitis or of clinical outcomes at last follow-up. Cisternostomy with CD (Group 2) was associated with a statistically significant reduction in VP-shunt compared with the use of an EVD (Group 1) (9.09% vs 53.78%; p < 0.001). This finding was confirmed in our subgroup analysis, as among patients with a surgical clipping, the rate of VP shunt was 43.7% for the EVD group and 9.5% for the CD group (p = 0.02). CONCLUSIONS Cisternostomy with CD may reduce the rate of shunt-dependent hydrocephalus. Cisternostomy allows the removal of subarachnoid blood, thereby reducing arachnoid inflammation and fibrosis. CD may enhance this effect, thus resulting in lower rates of chronic hydrocephalus.
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Affiliation(s)
- Marta Garvayo
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Department of Radiology, Section of Neuroradiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alberto Vandenbulcke
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Roy T Daniel
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
| | - Giulia Cossu
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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208
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Zeng C, Huang Z, Tao W, Yan L, Tang D, Chen F, Li S. Genetically predicted tobacco consumption and risk of intracranial aneurysm: a Mendelian randomization study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:12979-12987. [PMID: 36117221 DOI: 10.1007/s11356-022-23074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/13/2022] [Indexed: 06/15/2023]
Abstract
Several observational studies have suggested that tobacco consumption is a risk factor for intracranial aneurysms (IAs). We here genetically predict the causal association between specific smoking features and biomarkers for smokers and IA risk. The Mendelian randomization (MR) analysis considered summary statistics from the largest current genome-wide association studies of smoking and IA. The inverse-variance weighted (IVW) method, weighted median method, MR-RAPS, and multiple variants Mendelian randomization (MVMR) were performed to estimate the effect of different smoking features and drinking in IA. We observed significant causal effects of smoking on the risk of both aneurysmal subarachnoid hemorrhage (aSAH) and unruptured IA (uIA). The ORs of IAs based on the IVW method were 1.890 (95% CI 1.486-2.405) of ever smoking regularly. MVMR analysis afforded odds ratios of 1.685 (95% CI 1.136-2.501). In the further subgroup analysis, a similar causal relationship was observed in aSAH. Moreover, our analyses suggested that higher blood cotinine level and cadmium increases aSAH risk, and ORs were 1.235 (95%CI 1.009-1.186) and 1.235 (95%CI 1.046-1.458), respectively. Our study suggests that ever smoking regularly is associated with the IA risk, which includes both uIA and aSAH. Besides, higher blood cadmium and cotinine level may increases IA and aSAH risk. Thus, tobacco control should be promoted as primordial prevention for IAs, and screening for patients with a smoking history is emphasized.
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Affiliation(s)
- Chudai Zeng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wengui Tao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Langchao Yan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Dong Tang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
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209
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Wang J, Li R, Li S, Ma T, Zhang X, Ren Y, Chen X, Peng Y. Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study. Front Neurosci 2023; 17:1064987. [PMID: 36875639 PMCID: PMC9982002 DOI: 10.3389/fnins.2023.1064987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Background Delayed cerebral ischemia (DCI) is the major predictor of poor outcomes in patients with aSAH. Previous studies have attempted to assess the relationship between controlling blood pressure and DCI. However, the management of intraoperative blood pressure in reducing the occurrence of DCI still remains inconclusive. Methods All patients with aSAH who received general anesthesia for surgical clipping between January 2015 and December 2020 were prospectively reviewed. Patients were divided in the DCI group or the non-DCI group depending on whether DCI occurred or not. Intraoperative arterial pressure was measured every minute and recorded in an electronic anesthesia recording system along with intraoperative medication and other vital signs. The initial neurological function score, aneurysm characteristics, surgical and anesthetic information, and outcomes were compared between the DCI and the non-DCI groups. Results Among 534 patients who were enrolled, a total of 164 (30.71%) patients experienced DCI. The baseline characteristics of patients were similar between the groups. The World Federation of Neurosurgical Societies (WFNS) Scale > 3, age ≥ 70 years, and the modified Fisher Scale > 2 were significantly higher in patients with DCI than those without. Though it was the second derivative of the regression analysis, 105 mmHg was adopted as the threshold for intraoperative hypotension and was not associated with DCI. Conclusions The threshold of 105 mmHg was adopted as intraoperative hypotension even though it was the second derivative of the regression analysis and could not be proved to be associated with delayed cerebral ischemia adjusted by the baseline severity of aSAH and age.
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Affiliation(s)
- Jie Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Runting Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingyue Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Ren
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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210
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Zhu G, Luo X, Yang T, Cai L, Yeo JH, Yan G, Yang J. Deep learning-based recognition and segmentation of intracranial aneurysms under small sample size. Front Physiol 2022; 13:1084202. [PMID: 36601346 PMCID: PMC9806214 DOI: 10.3389/fphys.2022.1084202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The manual identification and segmentation of intracranial aneurysms (IAs) involved in the 3D reconstruction procedure are labor-intensive and prone to human errors. To meet the demands for routine clinical management and large cohort studies of IAs, fast and accurate patient-specific IA reconstruction becomes a research Frontier. In this study, a deep-learning-based framework for IA identification and segmentation was developed, and the impacts of image pre-processing and convolutional neural network (CNN) architectures on the framework's performance were investigated. Three-dimensional (3D) segmentation-dedicated architectures, including 3D UNet, VNet, and 3D Res-UNet were evaluated. The dataset used in this study included 101 sets of anonymized cranial computed tomography angiography (CTA) images with 140 IA cases. After the labeling and image pre-processing, a training set and test set containing 112 and 28 IA lesions were used to train and evaluate the convolutional neural network mentioned above. The performances of three convolutional neural networks were compared in terms of training performance, segmentation performance, and segmentation efficiency using multiple quantitative metrics. All the convolutional neural networks showed a non-zero voxel-wise recall (V-Recall) at the case level. Among them, 3D UNet exhibited a better overall segmentation performance under the relatively small sample size. The automatic segmentation results based on 3D UNet reached an average V-Recall of 0.797 ± 0.140 (3.5% and 17.3% higher than that of VNet and 3D Res-UNet), as well as an average dice similarity coefficient (DSC) of 0.818 ± 0.100, which was 4.1%, and 11.7% higher than VNet and 3D Res-UNet. Moreover, the average Hausdorff distance (HD) of the 3D UNet was 3.323 ± 3.212 voxels, which was 8.3% and 17.3% lower than that of VNet and 3D Res-UNet. The three-dimensional deviation analysis results also showed that the segmentations of 3D UNet had the smallest deviation with a max distance of +1.4760/-2.3854 mm, an average distance of 0.3480 mm, a standard deviation (STD) of 0.5978 mm, a root mean square (RMS) of 0.7269 mm. In addition, the average segmentation time (AST) of the 3D UNet was 0.053s, equal to that of 3D Res-UNet and 8.62% shorter than VNet. The results from this study suggested that the proposed deep learning framework integrated with 3D UNet can provide fast and accurate IA identification and segmentation.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China,*Correspondence: Guangyu Zhu, ; Jian Yang,
| | - Xueqi Luo
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Tingting Yang
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Li Cai
- Xi’an Key Laboratory of Scientific Computation and Applied Statistics, Xi’an, China,School of Mathematics and Statistics, Northwestern Polytechnical University, Xi’an, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Ge Yan
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Guangyu Zhu, ; Jian Yang,
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211
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Yamada H, Kase Y, Okano Y, Kim D, Goto M, Takahashi S, Okano H, Toda M. Subarachnoid hemorrhage triggers neuroinflammation of the entire cerebral cortex, leading to neuronal cell death. Inflamm Regen 2022; 42:61. [PMID: 36514181 DOI: 10.1186/s41232-022-00236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is a fatal disease, with early brain injury (EBI) occurring within 72 h of SAH injury contributes to its poor prognosis. EBI is a complicated phenomenon involving multiple mechanisms. Although neuroinflammation has been shown to be important prognosis factor of EBI, whether neuroinflammation spreads throughout the cerebrum and the extent of its depth in the cerebral cortex remain unknown. Knowing how inflammation spreads throughout the cerebrum is also important to determine if anti-inflammatory agents are a future therapeutic strategy for EBI. METHODS In this study, we induced SAH in mice by injecting hematoma into prechiasmatic cistern and created models of mild to severe SAH. In sections of the mouse cerebrum, we investigated neuroinflammation and neuronal cell death in the cortex distal to the hematoma injection site, from anterior to posterior region 24 h after SAH injury. RESULTS Neuroinflammation caused by SAH spread to all layers of the cerebral cortex from the anterior to the posterior part of the cerebrum via the invasion of activated microglia, and neuronal cell death increased in correlation with neuroinflammation. This trend increased with the severity of the disease. CONCLUSIONS Neuroinflammation caused by SAH had spread throughout the cerebrum, causing neuronal cell death. Considering that the cerebral cortex is responsible for long-term memory and movement, suppressing neuroinflammation in all layers of the cerebral cortex may improve the prognosis of patients with SAH.
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Affiliation(s)
- Hiroki Yamada
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshitaka Kase
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuji Okano
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Doyoon Kim
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Maraku Goto
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Takahashi
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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212
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Puri S, Mahajan S, Jangra K, Chauhan R, Kumar S, Aggarwal A, Vyas S, Bhagat H. Effect of Comorbidities on the Outcome of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1756431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background The pathophysiological changes following aneurysmal subarachnoid hemorrhage (aSAH) lead to a varied degree of neurological deficit and cognitive decline. The presence of comorbidities can contribute to the progression and course of the disease resulting in high morbidity and mortality.
Methods A total of 140 patients with aSAH, scheduled for surgical clipping or endovascular coiling were included. The patients' comorbidities were recorded. The postoperative outcome was evaluated using Glasgow Outcome Scale at 1 month following discharge. Multiple logistic regression analysis was performed to identify variables predicting poor outcome, taking into consideration those variables which were significant in univariate analysis.
Results Sixty-six percent of these patients with aSAH had associated comorbidities. In our patient cohort, we found that smoking and hypertension were associated with worse outcome (odds ratio [OR] = 4.63 [confidence interval [CI] = 1.83–11.7] and OR = 2.92 [CI = 1.41–6.01], respectively). Hypothyroidism, diabetes mellitus, coronary artery disease, and asthma did not influence the neurological outcome because of their small number.
Conclusion Presence of comorbidities like smoking and hypertension significantly worsen the outcome of these patients with aSAH.
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Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalvi Mahajan
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Jangra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Intervention Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hemant Bhagat
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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213
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Solar P, Joukal M, Silar C, Jancalek R. Impact of analgesic regimen on patient outcome following subarachnoid hemorrhage: positive adjuvant effects of metamizole. Br J Neurosurg 2022:1-8. [PMID: 36469604 DOI: 10.1080/02688697.2022.2151563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Various analgesics are used to control intense headaches in patients following subarachnoid hemorrhage. In addition to pain control, it has been shown that some analgesics can affect various pathophysiological cascades. Therefore, we devised a study to assess whether the use of metamizole has a significant impact on the development of ischemic complications, hydrocephalus, and the overall outcome in patients following aneurysmal subarachnoid hemorrhage in the context of the other non-opioids and opioids effects. METHODS In our retrospective, single-center cohort study, we enrolled 192 patients diagnosed with subarachnoid hemorrhage. We recorded their initial clinical status, comorbidities, and the daily dosage of analgesics over 14 days of hospitalization after the onset of subarachnoid hemorrhage. Using univariate and subsequent multivariate logistic regression analysis, we assessed the influence of various factors, including analgesics, on the development of delayed cerebral ischemia and hydrocephalus, as well as on 2-week and 6-month outcomes. RESULTS Although the administration of non-opioids, in general, had no effect on the development of delayed cerebral ischemia or hydrocephalus, the use of metamizole as the main analgesic was associated with a significantly lower chance of poor outcome at both 2-weeks and 6-months, as well as the development of delayed cerebral ischemia. As opioids were indicated primarily for analgosedation in mechanically ventilated patients with poor clinical status, their usage was associated with a significantly higher chance of poor outcome, delayed cerebral ischemia, and hydrocephalus. CONCLUSION Our results suggest that the prescription of metamizole may be associated with better outcomes and a lower chance of delayed cerebral ischemia development in patients after subarachnoid hemorrhage. Considering the retrospective nature of our study and the limited worldwide availability of metamizole due to its prohibition in some countries, our results do not demonstrate a clear benefit but rather justify the need for subsequent prospective studies.
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Affiliation(s)
- Peter Solar
- Department of Neurosurgery, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Marek Joukal
- Department of Anatomy, Faculty of Medicine, Cellular and Molecular Neurobiology Research Group, Masaryk University, Brno, Czech Republic
| | - Cenek Silar
- Department of Neurosurgery, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital Brno, Masaryk University, Brno, Czech Republic
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214
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Tao T, Chen X, Zhou Y, Zheng Q, Gao S, Wang J, Ding P, Li X, Peng Z, Lu Y, Gao Y, Zhuang Z, Hang C, Li W. Continued P2X7 activation leads to mitochondrial fission and compromising microglial phagocytosis after subarachnoid haemorrhage. J Neurochem 2022; 163:419-437. [PMID: 36269673 PMCID: PMC9828135 DOI: 10.1111/jnc.15712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 01/12/2023]
Abstract
Subarachnoid haemorrhage (SAH) has a high rate of disability and mortality. Extremely damaging molecules, including adenosine triphosphate (ATP), are released from extravasated red blood cells and nerve cells, which activate microglia and induce sterile tissue injury and organ dysfunction. P2X purinoceptor 7 (P2X7) is one of the most important purine receptors on the microglial surface and is involved in the proinflammatory activation of microglia. While P2X7 can also affect microglial phagocytosis, the mechanism is not clear. Here, we demonstrated that microglial phagocytosis is progressively impaired under continued BzATP exposure and P2X7 activation. Furthermore, we found that P2X7 activation leads to increased intracellular Ca2+ levels and activates Calcineurin, which dephosphorylates dynamin-related protein 1 (DRP1) S637. The dephosphorylation of DRP1 at S637 leads to increased mitochondrial fission and decreased mitochondrial function, which may be responsible for the decreased microglial phagocytosis. Finally, we pharmacologically inhibited P2X7 activation in mice, which resulted in rescue of mitochondrial function and decreased microglial proliferation, but improved phagocytosis after SAH. Our study confirmed that P2X7 activation after SAH leads to the impairment of microglial phagocytosis through mitochondrial fission and verified that P2X7 inhibition restores microglial phagocytosis both in vitro and in vivo.
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Affiliation(s)
- Tao Tao
- Department of NeurosurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingJiangsu ProvinceChina
| | - Xiangxin Chen
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Yan Zhou
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Qiang Zheng
- Department of NeurosurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingJiangsu ProvinceChina
| | - Sen Gao
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Jinwei Wang
- Department of NeurosurgeryNanjing Drum Tower Hospital Clinical College of Jiangsu UniversityNanjingJiangsu ProvinceChina
| | - Pengfei Ding
- Department of NeurosurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingJiangsu ProvinceChina
| | - Xiaojian Li
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Zheng Peng
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Yue Lu
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Yongyue Gao
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Zong Zhuang
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Chun‐hua Hang
- Department of NeurosurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingJiangsu ProvinceChina,Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
| | - Wei Li
- Department of NeurosurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingJiangsu ProvinceChina,Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsu ProvinceChina
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215
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Li Y, Liu J, Hu C, Luo C, Zhou J, Li B, Liao X, Liu S, Yuan D, Jiang W, Li Y, Yan J. Association of rare RNF213 variants and intracranial aneurysm risk in a Chinese population. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1336. [PMID: 36660619 PMCID: PMC9843384 DOI: 10.21037/atm-22-5166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Abstract
Background Genetic factors play important roles in the development of intracranial aneurysm (IA). Rare RNF213 variants have been identified as being susceptible to Moyamoya disease (MMD), non-MMD intracranial artery stenosis/occlusion disease, and other vascular disorders. This study aimed to investigate the association between rare RNF213 variants and the risk of IA in a Chinese population. Methods We recruited 174 patients with IA for RNF213 target exome sequencing. Information on the control subjects was obtained from the 1,000 Genome Project and GeneSky in-house database. After prioritizing rare RNF213 variants, the filtered variants were confirmed by Sanger sequencing. Gene-based association analyses were performed to identify the association between variants and the disease using burden and variance component methods; that is, the weighted-sum statistic (WSS) and the sequence kernel association test (SKAT), respectively. The Student's t-test, Chi-squared test, and Fisher's exact test were used to compare the clinical characteristics between carriers and non-carriers of the RNF213 variants. Results After filtering, there were 14 RNF213 variants in 18 patients with IA, which were significantly associated with the disease after the gene-based association tests [minor allele frequency (MAF) <0.01, WSS P value 5.08×10-9; SKAT P value 2.96×10-6; SKAT-O P value 3.56×10-8]. Significant difference was not obtained between the carriers and non-carriers of the RNF213 variants in terms of the clinical characteristics. Conclusions Rare RNF213 variants were associated with sporadic IA in a Chinese population. Our findings suggest that these rare RNF213 variants might have potentially important roles in IA. However, more comprehensive studies need to be conducted to confirm this association and causality.
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Affiliation(s)
- Yaqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Junyu Liu
- Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto, Japan;,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chongyu Hu
- Department of Neurology, Hunan People’s Hospital, Changsha, China
| | - Chun Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jilin Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Bingyang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China;,Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital), Changsha, China
| | - Xin Liao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China;,The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Songlin Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Dun Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Weixi Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yifeng Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Junxia Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China;,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
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Cutler CB, Lucke-Wold B. Commentary: Serum Levels of Myo-inositol Predicts Clinical Outcome 1 Year After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2022; 91:e170-e171. [PMID: 36269571 DOI: 10.1227/neu.0000000000002195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Christopher B Cutler
- Chicago Medical School, Rosalind Franklin University of Science and Medicine, North Chicago, Illinois, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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217
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Wang L, Geng G, Zhu T, Chen W, Li X, Gu J, Jiang E. Progress in Research on TLR4-Mediated Inflammatory Response Mechanisms in Brain Injury after Subarachnoid Hemorrhage. Cells 2022; 11:cells11233781. [PMID: 36497041 PMCID: PMC9740134 DOI: 10.3390/cells11233781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is one of the common clinical neurological emergencies. Its incidence accounts for about 5-9% of cerebral stroke patients. Even surviving patients often suffer from severe adverse prognoses such as hemiplegia, aphasia, cognitive dysfunction and even death. Inflammatory response plays an important role during early nerve injury in SAH. Toll-like receptors (TLRs), pattern recognition receptors, are important components of the body's innate immune system, and they are usually activated by damage-associated molecular pattern molecules. Studies have shown that with TLR 4 as an essential member of the TLRs family, the inflammatory transduction pathway mediated by it plays a vital role in brain injury after SAH. After SAH occurrence, large amounts of blood enter the subarachnoid space. This can produce massive damage-associated molecular pattern molecules that bind to TLR4, which activates inflammatory response and causes early brain injury, thus resulting in serious adverse prognoses. In this paper, the process in research on TLR4-mediated inflammatory response mechanism in brain injury after SAH was reviewed to provide a new thought for clinical treatment.
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Affiliation(s)
- Lintao Wang
- Institute of Nursing and Health, Henan University, Kaifeng 475004, China
- School of Clinical Medicine, Henan University, Kaifeng 475004, China
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
| | - Guangping Geng
- Henan Technician College of Medicine and Health, Kaifeng 475000, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng 475001, China
| | - Wenwu Chen
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
| | - Xiaohui Li
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
| | - Jianjun Gu
- Department of Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng 475004, China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng 475004, China
- Correspondence:
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218
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Huang HY, Yuan B, Chen SJ, Han YL, Zhang X, Yu Q, Wu Q. A novel nomogram model for clinical outcomes of severe subarachnoid hemorrhage patients. Front Neurosci 2022; 16:1041548. [PMID: 36507324 PMCID: PMC9729550 DOI: 10.3389/fnins.2022.1041548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Systemic responses, especially inflammatory responses, after aneurysmal subarachnoid hemorrhage (SAH) are closely related to clinical outcomes. Our study aimed to explore the correlation between the systemic responses in the acute stage and the mid-term outcomes of severe SAH patients (Hunt-Hess grade III-V). Materials and methods Severe SAH patients admitted to Jinling Hospital from January 2015 to December 2019 were retrospectively analyzed in the study. The univariate and multivariate logistic regression analyses were used to explore the risk factors of 6-month clinical outcomes in severe SAH patients. A predictive model was established based on those risk factors and was visualized by a nomogram. Then, the predictive nomogram model was validated in another severe SAH patient cohort from January 2020 to January 2022. Results A total of 194 patients were enrolled in this study. 123 (63.4%, 123 of 194) patients achieved good clinical outcomes at the 6-month follow-up. Univariate and multivariate logistic regression analysis revealed that age, Hunt-Hess grade, neutrophil-to-lymphocyte ratio (NLR), and complications not related to operations were independent risk factors for unfavorable outcomes at 6-month follow-up. The areas under the curve (AUC) analysis showed that the predictive model based on the above four variables was significantly better than the Hunt-Hess grade (0.812 vs. 0.685, P = 0.013). In the validation cohort with 44 severe SAH patients from three different clinical centers, the AUC of the prognostic nomogram model was 0.893. Conclusion The predictive nomogram model could be a reliable predictive tool for the outcome of severe SAH patients. Systemic inflammatory responses after SAH and complications not related to operations, especially hydrocephalus, delayed cerebral ischemia, and pneumonia, might be the important risk factors that lead to poor outcomes in severe SAH patients.
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Affiliation(s)
- Han-Yu Huang
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China,Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Bin Yuan
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China,Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Shu-Juan Chen
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China,Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Yan-ling Han
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China,Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Qing Yu
- Department of Clinical Laboratory, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Qing Yu,
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China,Qi Wu,
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219
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Liu C, He P, Guo Y, Tian Q, Wang J, Wang G, Zhang Z, Li M. Taurine attenuates neuronal ferroptosis by regulating GABA B/AKT/GSK3β/β-catenin pathway after subarachnoid hemorrhage. Free Radic Biol Med 2022; 193:795-807. [PMID: 36402441 DOI: 10.1016/j.freeradbiomed.2022.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
Ferroptosis, characterized by lipid peroxidation and intracellular iron accumulation, has been reported to be involving in the pathophysiological of early brain injury (EBI) after subarachnoid hemorrhage (SAH). Although taurine reportedly yields neuroprotective effects in multiple central neurological diseases and can attenuated neuron damage after stroke, its role in EBI after SAH remains unclear. The present study indicated that taurine levels in cerebrospinal fluid were significantly reduced in SAH patients, which suggested that taurine treatment after SAH could improve neurological impairment, oxidative stress, iron accumulation, BBB integrity and neuronal ferroptosis in the SAH model in vivo. Taurine could attenuate MDA levels and ROS accumulation and regulate the expression of SLC7A11 and GPX4 and the AKT/GSK3β pathway in vitro. GABAB receptor inhibition and Ly294002 could reverse the therapeutic effects of taurine and significantly downregulate the levels of p-AKT, p-GSK3β, β-catenin, SLC7A11 and GPX4. The protective effects of taurine on SLC7A11 and GPX4 expression were reversed by ICG001 treatment in vitro. Taken together, our findings revealed that taurine could improve neurological function and alleviate cerebral edema, oxidative stress and BBB disruption after SAH, which reduced neuronal ferroptosis by regulating the GABAB/AKT/GSK3β/β-catenin signaling pathway.
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Affiliation(s)
- Chengli Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China
| | - Peibang He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China
| | - Yujia Guo
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China
| | - Qi Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China
| | - Jianfeng Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China
| | - Guijun Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China
| | - Zhan Zhang
- Department of Rehabilitation, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China.
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, PR China.
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Hassan MS, Bakir A, Adam BA, Sidow NO, Ibrahim AA, Abdi IA, Waberi MM. Warfarin-induced isolated spontaneous subarachnoid hemorrhage: Rare case report. Ann Med Surg (Lond) 2022; 84:104946. [PMID: 36582886 PMCID: PMC9793204 DOI: 10.1016/j.amsu.2022.104946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from arteriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Case presentation Here, we report the case of a 45-year-old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). His pupils were anisocoric. Brain CT showed extensive subarachnoid hemorrhage without intraparenchymal involvement. Cerebral magnetic resonance angiography ruled out aneurysmal rupture. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Clinical discussion Non-traumatic SAH is mostly caused by aneurysmal rupture. Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event. Here we present a young male patient with an isolated warfarin-induced SAH. Conclusion Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made.
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Affiliation(s)
- Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia,Corresponding author. Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia.
| | - Ahmet Bakir
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia
| | - Bakar Ali Adam
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia
| | - Nor Osman Sidow
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia
| | | | - Ishak Ahmed Abdi
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Somalia
| | - Mohamud Mire Waberi
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Somalia
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221
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Aneurysmal subarachnoid haemorrhage in Māori and European New Zealanders – A comparative study. J Clin Neurosci 2022; 106:194-198. [DOI: 10.1016/j.jocn.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
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222
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Wenneberg SB, Block L, Sörbo A, Naredi S, Oras J, Hendén PL, Ljungqvist J, Liljencrantz J, Hergès HO. Long-term outcomes after aneurysmal subarachnoid hemorrhage: A prospective observational cohort study. Acta Neurol Scand 2022; 146:525-536. [PMID: 35852005 PMCID: PMC9796482 DOI: 10.1111/ane.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The survival rates for patients affected by aneurysmal subarachnoid hemorrhage (aSAH) have increased in recent years; however, many patients continue to develop cognitive dysfunctions that affect their quality of life. The commonly used outcome measures often fail to identify these cognitive dysfunctions. This study aimed to evaluate the long-term outcomes at 1 and 3 years after aSAH to assess changes over time and relate outcomes to patient characteristics and events during the acute phase. MATERIALS AND METHODS This prospective observational study included patients that experienced aSAH. Patients were assessed according to the extended Glasgow Outcome Scale, Life Satisfaction Questionnaire, Mayo-Portland Adaptability inventory-4, and Mental Fatigue scale. RESULTS Patients were assessed after 1 year (n = 62) and 3 years (n = 54). At 3 years, the extended Glasgow Outcome Scale score improved in 15% and worsened in 12% of the patients. Mental fatigue was observed in 57% of the patients at 1 year. Patients <60 years of age at the time of aSAH had more self-assessed problems, including pain/headache (p < .01), than patients >60 years of age. Patients with delayed cerebral ischemia during the acute phase reported more dissatisfaction at 3 years, whereas no significant result was seen at 1 year. CONCLUSIONS Cognitive dysfunction, especially mental fatigue, is common in patients with aSAH, which affects quality of life and recovery. Patient outcome is a dynamic process developing throughout years after aSAH, involving both improvement and deterioration. This study indicates the importance of longer follow-up periods with broad outcome assessments.
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Affiliation(s)
- Sandra Bjerkne Wenneberg
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Linda Block
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Ann Sörbo
- Department of Neurology and Rehabilitation and Department of Research, Education and InnovationSödra Älvsborg HospitalBoråsSweden,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Silvana Naredi
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Pia Löwhagen Hendén
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Johan Ljungqvist
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of NeurosurgerySahlgrenska University HospitalGothenburgSweden
| | - Jaquette Liljencrantz
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Helena Odenstedt Hergès
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anaesthesiology and Intensive Care, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
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223
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Zhang H, Zhou S, Sun M, Hua M, Liu Z, Mu G, Wang Z, Xiang Q, Cui Y. Ferroptosis of Endothelial Cells in Vascular Diseases. Nutrients 2022; 14:4506. [PMID: 36364768 PMCID: PMC9656460 DOI: 10.3390/nu14214506] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 08/13/2023] Open
Abstract
Endothelial cells (ECs) line the inner surface of blood vessels and play a substantial role in vascular biology. Endothelial dysfunction (ED) is strongly correlated with the initiation and progression of many vascular diseases. Regulated cell death, such as ferroptosis, is one of the multiple mechanisms that lead to ED. Ferroptosis is an iron-dependent programmed cell death associated with various vascular diseases, such as cardiovascular, cerebrovascular, and pulmonary vascular diseases. This review summarized ferroptosis of ECs in vascular diseases and discussed potential therapeutic strategies for treating ferroptosis of ECs. In addition to lipid peroxidation inhibitors and iron chelators, a growing body of evidence showed that clinical drugs, natural products, and intervention of noncoding RNAs may also inhibit ferroptosis of ECs.
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Affiliation(s)
- Hanxu Zhang
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Shuang Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
| | - Minxue Sun
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Manqi Hua
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Zhiyan Liu
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
| | - Guangyan Mu
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
| | - Zhe Wang
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
- Institute of Clinical Pharmacology, Peking University, Beijing 100191, China
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224
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Wang L, Zhang Q, Zhang G, Zhang W, Chen W, Hou F, Zheng Z, Guo Y, Chen Z, Wang Y, Hernesniemi J, Andrade-Barazarte H, Li X, Li T, Feng G, Gu J. Risk factors and predictive models of poor prognosis and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage complicated with hydrocephalus. Front Neurol 2022; 13:1014501. [PMID: 36353134 PMCID: PMC9638116 DOI: 10.3389/fneur.2022.1014501] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the correlation of serum biological markers and related scales to the occurrence of delayed cerebral ischemia and clinical prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH) complicated with acute hydrocephalus before admission. Methods The clinical data of 227 patients with pre-admission aSAH complicated with acute hydrocephalus admitted to Henan Provincial People's Hospital from April 2017 to December 2020 were retrospectively analyzed. Patients were grouped according to the presence or absence of delayed cerebral ischemia (DCI) after surgery and the prognosis at 6 months after discharge. Univariate and multivariable logistic regression analysis were performed to analyze the relationship between serum biological indicators combined with aneurysm related clinical score scale and the occurrence and prognosis of delayed cerebral ischemia. ROC curves and nomogram were drawn. Results Multivariable Logistic regression analysis showed that high Hunt-Hess grade and surgical clipping were independent risk factors for postoperative DCI (P < 0.05). Older age, higher Hunt-Hess grade, higher CRP and neutrophil levels were independent risk factors for poor prognosis at 6 months after surgery (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of Hunt-Hess grade and surgical method for predicting DCI in patients with aSAH combined with hydrocephalus after surgery were 0.665 and 0.593. The combined AUC of Hunt-Hess grade and surgical method was 0.685, the sensitivity was 64.9%, and the specificity was 64.7%. The AUC of CRP, neutrophil, age and Hunt-Hess grade for predicting poor prognosis in patients with aSAH combined with hydrocephalus at 6 months after surgery were 0.804, 0.735, 0.596, 0.757, respectively. The combined AUC of CRP, neutrophil, age, Hunt-Hess grade was 0.879, the sensitivity was 79%, and the specificity was 84.5%. According to the correction curve, the predicted probability of the nomogram is basically consistent with the actual probability. Conclusion Hunt-Hess grade and surgical method are independent predictors of postoperative DCI in patients with aSAH complicated with hydrocephalus. “CRP,” “neutrophil,” “age” and “Hunt-Hess grade” at admission are independent predictors of clinical prognosis in patients with aSAH complicated with hydrocephalus. The combination of the above indicators has high predictive value.
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Affiliation(s)
- Lintao Wang
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Qingqing Zhang
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Gaoqi Zhang
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wanwan Zhang
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wenwu Chen
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Fandi Hou
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhanqiang Zheng
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yong Guo
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhongcan Chen
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yanxia Wang
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Juha Hernesniemi
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hugo Andrade-Barazarte
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaohui Li
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Tianxiao Li
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Guang Feng
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Guang Feng
| | - Jianjun Gu
- School of Clinical Medicine, Henan University, Kaifeng, China
- Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- *Correspondence: Jianjun Gu
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225
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Activation of Nrf2 to Optimise Immune Responses to Intracerebral Haemorrhage. Biomolecules 2022; 12:biom12101438. [PMID: 36291647 PMCID: PMC9599325 DOI: 10.3390/biom12101438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Haemorrhage into the brain parenchyma can be devastating. This manifests as spontaneous intracerebral haemorrhage (ICH) after head trauma, and in the context of vascular dementia. Randomised controlled trials have not reliably shown that haemostatic treatments aimed at limiting ICH haematoma expansion and surgical approaches to reducing haematoma volume are effective. Consequently, treatments to modulate the pathophysiological responses to ICH, which may cause secondary brain injury, are appealing. Following ICH, microglia and monocyte derived cells are recruited to the peri-haematomal environment where they phagocytose haematoma breakdown products and secrete inflammatory cytokines, which may trigger both protective and harmful responses. The transcription factor Nrf2, is activated by oxidative stress, is highly expressed by central nervous system microglia and macroglia. When active, Nrf2 induces a transcriptional programme characterised by increased expression of antioxidant, haem and heavy metal detoxification and proteostasis genes, as well as suppression of proinflammatory factors. Therefore, Nrf2 activation may facilitate adaptive-protective immune cell responses to ICH by boosting resistance to oxidative stress and heavy metal toxicity, whilst limiting harmful inflammatory signalling, which can contribute to further blood brain barrier dysfunction and cerebral oedema. In this review, we consider the responses of immune cells to ICH and how these might be modulated by Nrf2 activation. Finally, we propose potential therapeutic strategies to harness Nrf2 to improve the outcomes of patients with ICH.
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226
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Jabbarli R, Darkwah Oppong M, Chihi M, Dinger TF, Said M, Rodemerk J, Dammann P, Schmidt B, Deuschl C, Guberina N, Wrede KH, Sure U. Regular medication as a risk factor for intracranial aneurysms: A comparative case–control study. Eur Stroke J 2022; 8:251-258. [PMID: 37021158 PMCID: PMC10069188 DOI: 10.1177/23969873221129080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Previous medical history strongly contributes to the genesis of intracranial aneurysms (IA). A possible impact of regular medication on the occurrence of abdominal aortic aneurysms has been reported. Aim: To evaluate the value of regular medication on the risk of development and rupture of IA. Methods: Data on medication use and related comorbidities were obtained from the institutional IA registry. A 1:1 age- and sex-matched patient sample was collected from the population-based Heinz Nixdorf Recall Study with individuals from the same area. Results: In the analysis comparing IA cohort ( n = 1960) with the matched normal population ( n = 1960), the use of statins (adjusted odds ratio, 1.34 [95% confidence interval 1.02–1.78]), antidiabetics (1.46 [1.08–1.99]), and calcium channel blockers (1.49 [1.11–2.00]) was independently associated with higher risk of IA, whereas uricostatics (0.23 [0.14–0.38]), aspirin (0.23 [0.13–0.43]), beta-blockers (0.51 [0.40–0.66]), and angiotensin-converting enzyme inhibitors (0.38 [0.27–0.53]) were related to lower risk of IA. In the multivariable analysis within the IA cohort ( n = 2446), SAH patients showed higher drug exposure with thiazide diuretics (2.11 [1.59–2.80]), but lower prevalence of remaining antihypertensive medication—beta-blockers (0.38 [0.30–0.48]), calcium channel blockers (0.63 [0.48–0.83]), angiotensin-converting enzyme inhibitors (0.56 [0.44–0.72]), and angiotensin-1 receptor blockers (0.33 [0.24–0.45]). Patients with ruptured IA were less likely to be treated with statins (0.62 [0.47–0.81]), thyroid hormones (0.62 [0.48–0.79]), and aspirin (0.55 [0.41–0.75]). Conclusions: Regular medication might impact the risks related to the development and rupture of IA. Further clinical trials are required to clarify the effect of regular medication on IA genesis.
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Affiliation(s)
- Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Maryam Said
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Jan Rodemerk
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology, Department of Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
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227
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Salih M, Salem M, Moore J, Thomas AJ, Ogilvy CS. Cost-effectiveness analysis on small (< 5 mm) unruptured intracranial aneurysm follow-up strategies. J Neurosurg 2022; 138:1366-1373. [PMID: 36208436 DOI: 10.3171/2022.8.jns221053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Unruptured intracranial aneurysms are frequently detected during routine clinical diagnostic processes. A significant portion are small aneurysms less than 5 mm in diameter. While follow-up of patients with small aneurysms has been advocated, the cost-effectiveness of such care and the optimal follow-up interval remain unknown. This study aimed to explore the most cost-effective follow-up interval for small (< 5 mm) unruptured intracranial aneurysms.
METHODS
A decision analysis study was performed using a Markov model with Monte Carlo simulations to simulate patients undergoing follow-up by MRA at different time intervals (1-, 2-, 3-, 5-, and 7-year intervals) for small (< 5 mm) unruptured intracranial aneurysms. Input data for the model were extracted from the current literature, primarily meta-analyses. Probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of the model.
RESULTS
Given the current literature and the model in this study, following up every 2 years with noninvasive imaging is the most cost-effective strategy (cost $126,996, effectiveness 21.9 quality-adjusted life-years), showing the highest net monetary benefit. The conclusion remains robust in probabilistic and deterministic sensitivity analyses. As the annual growth risk of small aneurysms and annual rupture risk of growing aneurysms increase, following up every year is optimal. When the cost for follow-up with MRA is less than $2223, following up every year is cost-effective.
CONCLUSIONS
The most cost-effective follow-up strategy for small (< 5 mm) unruptured aneurysms using MRA is following up every 2 years. More frequent follow-up strategies or prompt preventive treatment would be more appropriate in patients with higher risk factors for growth and aneurysm rupture.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Ajith J. Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Christopher S. Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
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228
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Ahmed A, Ahmed Y, Duah-Asante K, Lawal A, Mohiaddin Z, Nawab H, Tang A, Wang B, Miller G, Malawana J. A cost-utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage. Neurosurg Rev 2022; 45:3259-3269. [PMID: 36056977 PMCID: PMC9492573 DOI: 10.1007/s10143-022-01854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 02/03/2023]
Abstract
Endovascular coiling (EC) has been identified in systematic reviews and meta-analyses to produce more favourable clinical outcomes in comparison to neurosurgical clipping (NC) when surgically treating a subarachnoid haemorrhage from a ruptured aneurysm. Cost-effectiveness analyses between both interventions have been done, but no cost-utility analysis has yet been published. This systematic review aims to perform an economic analysis of the relative utility outcomes and costs from both treatments in the UK. A cost-utility analysis was performed from the perspective of the National Health Service (NHS), over a 1-year analytic horizon. Outcomes were obtained from the randomised International Subarachnoid Aneurysm Trial (ISAT) and measured in terms of the patient's modified Rankin scale (mRS) grade, a 6-point disability scale that aims to quantify a patient's functional outcome following a stroke. The mRS score was weighted against the Euro-QoL 5-dimension (EQ-5D), with each state assigned a weighted utility value which was then converted into quality-adjusted life years (QALYs). A sensitivity analysis using different utility dimensions was performed to identify any variation in incremental cost-effectiveness ratio (ICER) if different input variables were used. Costs were measured in pounds sterling (£) and discounted by 3.5% to 2020/2021 prices. The cost-utility analysis showed an ICER of - £144,004 incurred for every QALY gained when EC was utilised over NC. At NICE's upper willingness-to-pay (WTP) threshold of £30,000, EC offered a monetary net benefit (MNB) of £7934.63 and health net benefit (HNB) of 0.264 higher than NC. At NICE's lower WTP threshold of £20,000, EC offered an MNB of £7478.63 and HNB of 0.374 higher than NC. EC was found to be more 'cost-effective' than NC, with an ICER in the bottom right quadrant of the cost-effectiveness plane-indicating that it offers greater benefits at lower costs. This is supported by the ICER being below the NICE's threshold of £20,000-£30,000 per QALY, and both MNB and HNB having positive values (> 0).
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Affiliation(s)
- Ayla Ahmed
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Yonis Ahmed
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Kwaku Duah-Asante
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Abayomi Lawal
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Zain Mohiaddin
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Hasan Nawab
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Alexis Tang
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Brian Wang
- Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare Trust, London, UK.
- Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK.
| | - George Miller
- Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK
| | - Johann Malawana
- Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK
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229
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Won SY, Kim MK, Song J, Lim YC. Therapeutic hypothermia in patients with poor-grade aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 2022; 221:107369. [DOI: 10.1016/j.clineuro.2022.107369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
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230
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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & IMPORTANCE This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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231
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Gloeckler S, Ferrario A, Biller-Andorno N. An Ethical Framework for Incorporating Digital Technology into Advance Directives: Promoting Informed Advance Decision Making in Healthcare. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:349-353. [PMID: 36187419 PMCID: PMC9511942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Despite the presumed value of advance directives, research to demonstrate impact has shown mixed results. For advance directives to serve their role promoting patient autonomy, it is important that patients be informed decision makers. The capacity to make decisions depends upon understanding, appreciation, reasoning, and communication. Advance directives are in part faulty because these elements are often limited. The present paper explores how the application of digital technology could be organized around a framework promoting these four elements. Given the state of digital advancements, there is great potential for advance directives to be meaningfully enhanced. The beneficial effects of incorporating digital technology would be maximized if they were organized around the aim of making advance directives not only documents for declaring preferences but also ethics-driven tools with decision aid functionality. Such advance directives would aid users in making decisions that involve complex factors with potentially far-reaching impact and would also elucidate the users' thought processes to aid those tasked with interpreting and implementing decisions based on an advance directive. Such advance directives might have embedded interactive features for learning; access to content that furthers one's ability to project oneself into possible, future scenarios; review of the logical consistency of stated preferences; and modes for effective electronic sharing. Important considerations include mitigating the introduction of bias depending on the presentation of information; optimizing interfacing with surrogate decision makers and treating clinicians; and prioritizing essential components to respect time constraints.
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Affiliation(s)
- Sophie Gloeckler
- Institute of Biomedical Ethics and History of Medicine,
University of Zurich, Zurich, Switzerland,Columbia University School of Nursing, New York, NY,
USA
| | - Andrea Ferrario
- The Mobiliar Lab for Analytics at ETH, Swiss Federal
Institute of Technology, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine,
University of Zurich, Zurich, Switzerland,To whom all correspondence should be addressed:
Nikola Biller-Andorno, Institute of Biomedical Ethics and History of Medicine,
University of Zurich, Zurich, Switzerland;
; ORCID:
https://www.orcid.org/0000-0001-7661-1324
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232
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Matsuda S, Ikawa F, Hidaka T, Yamaguchi S, Inagawa T, Horie N, Kurisu K, Akiyama Y, Goto Y, Nakayama T, Fukuda H, Ueba T, Sasaki M, Ishikawa T, Shimamura N, Ohkuma H. Recent Declining Trend of Incidence Rate of Subarachnoid Hemorrhage in Shimane, Japan: The Japan Incidence of Subarachnoid Hemorrhage (JIS) Study. Neurol Med Chir (Tokyo) 2022; 62:458-464. [PMID: 36130903 PMCID: PMC9637398 DOI: 10.2176/jns-nmc.2022-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The “Izumo Study” revealed the incidence rate of subarachnoid hemorrhage (SAH) in Izumo City, Shimane Prefecture, Japan, from 1980 to 1998. However, no study has been published regarding the incidence of SAH in Shimane Prefecture after 1998. Most studies reporting the incidence of SAH in Japan have been conducted before 2000, although a few have been reported after 2000. This study aimed to assess the estimated age-adjusted incidence rate (AAIR) of SAH in Shimane Prefecture after 1998, following the Izumo Study. A retrospective study was conducted to identify the estimated AAIR of SAH in Shimane Prefecture, using the age-adjusted SAH mortality rate for this population from 1999 to 2017 and assuming that the case-fatality rate of SAH decreased by 0.7% annually from 45% in 1999 to 32.4% in 2017. We used linear regression analysis for trend to the estimated AAIR of SAH. Sensitivity analyses were also conducted by various case-fatality rates of SAH using assuming case-fatality rate based on previous reports. The estimated AAIR of SAH in Shimane Prefecture declined from 33.6 (95% confidence interval [CI]: 29.7-37.9) per 100,000 person-years in 1999, by 26.5%, to 24.7 (95% CI: 21.4-28.5) in 2017 (p < 0.01, r = 0.58). Declining trend of incidence rate of SAH in Shimane Prefecture from 1999 to 2017 was confirmed in this study.
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Affiliation(s)
- Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | | | | | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Neurosurgery, Chugoku Rosai Hospital
| | - Yasuhiko Akiyama
- Department of Neurosurgery, Shimane University Faculty of Medicine
| | - Yoshihito Goto
- Department of Clinical Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Masahiro Sasaki
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center
| | - Tatsuya Ishikawa
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University Graduate School
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233
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Rhim JK, Park JJ, Kim H, Jeon JP. Early and Prolonged Mild Hypothermia in Patients with Poor-Grade Subarachnoid Hemorrhage: A Pilot Study. Ther Hypothermia Temp Manag 2022; 12:229-234. [PMID: 36130134 DOI: 10.1089/ther.2022.0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We assessed the feasibility of therapeutic early and prolonged mild hypothermia (MH) in patients with poor-grade subarachnoid hemorrhage (SAH). A retrospective pilot study was conducted for poor-grade SAH patients at two university hospitals from March 2015 to December 2018 who had received MH immediately after coil embolization and maintained a target temperature of 34-35°C for 5 days. A matched controlled design at a 1:2 ratio was used to compare MH therapy outcomes. The primary goal was to assess the two groups' severe functional outcomes at discharge defined as a modified Rankin Scale score of 4-6. The secondary aim was to assess mortality and severe vasospasm depending upon MH. A binary logistic regression analysis was performed to identify relevant risk factors for the outcomes. A total of 54 patients (18 with MH treatment and 36 without MH treatment) were included. Severe functional outcome was significantly decreased in poor-grade SAH patients with MH (n = 7, 38.9%) than those without MH (n = 25, 69.4%; p = 0.031). In patients treated with MH, mortality and severe vasospasm tended to be less common, although the difference was not statistically significant. A binary logistic regression analysis revealed that early and prolonged MH (odds ratio [OR] = 0.156, 95% confidence intervals [CI]: 0.037-0.644) and severe vasospasm (OR = 5.593, 95% CI: 1.372-22.812) were risk factors for severe functional outcomes. This study shows potential therapeutic effect of early and prolonged MH treatment in poor-grade SAH patients. A randomized controlled study with a large number of patients is warranted in the future.
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Affiliation(s)
- Jong-Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Heungcheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
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234
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Hvas CL, Hvas AM. Viscoelastic Testing in the Clinical Management of Subarachnoid Hemorrhage and Intracerebral Hemorrhage. Semin Thromb Hemost 2022; 48:828-841. [PMID: 36100233 DOI: 10.1055/s-0042-1756191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are both debilitating and life-threatening incidents calling for immediate action and treatment. This review focuses on the applicability of viscoelastic testing (rotational thromboelastometry or thromboelastography [TEG]) in the management of SAH and ICH. A systematic literature search was performed in PubMed and EMBASE. Studies including patients with SAH or ICH, in which viscoelastic testing was performed, were identified. In total, 24 studies were included for analysis, and further subdivided into studies on SAH patients investigated prior to stenting or coiling (n = 12), ICH patients (n = 8) and studies testing patients undergoing stenting or coiling, or ischemic stroke patients undergoing thrombolysis or thrombectomy and developing ICH as a complication (n = 5). SAH patients had increased clot firmness, and this was associated with a higher degree of early brain injury and higher Hunt-Hess score. SAH patients with delayed cerebral ischemia had higher clot firmness than patients not developing delayed cerebral ischemia. ICH patients showed accelerated clot formation and increased clot firmness in comparison to healthy controls. Patients with hematoma expansion had longer clot initiation and lower platelet aggregation than patients with no hematoma expansion. During stent procedures for SAH, adjustment of antiplatelet therapy according to TEG platelet mapping did not change prevalence of major bleeding, thromboembolic events, or functional outcome. Viscoelastic testing prior to thrombolysis showed conflicting results in predicting ICH as complication. In conclusion, viscoelastic testing suggests hypercoagulation following SAH and ICH. Further investigation of the predictive value of increased clot firmness in SAH seems relevant. In ICH, the prediction of hematoma expansion and ICH as a complication to thrombolysis might be clinically relevant.
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Affiliation(s)
- Christine Lodberg Hvas
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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235
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Abstract
Subarachnoid haemorrhage (SAH) is the third most common subtype of stroke. Incidence has decreased over past decades, possibly in part related to lifestyle changes such as smoking cessation and management of hypertension. Approximately a quarter of patients with SAH die before hospital admission; overall outcomes are improved in those admitted to hospital, but with elevated risk of long-term neuropsychiatric sequelae such as depression. The disease continues to have a major public health impact as the mean age of onset is in the mid-fifties, leading to many years of reduced quality of life. The clinical presentation varies, but severe, sudden onset of headache is the most common symptom, variably associated with meningismus, transient or prolonged unconsciousness, and focal neurological deficits including cranial nerve palsies and paresis. Diagnosis is made by CT scan of the head possibly followed by lumbar puncture. Aneurysms are commonly the underlying vascular cause of spontaneous SAH and are diagnosed by angiography. Emergent therapeutic interventions are focused on decreasing the risk of rebleeding (ie, preventing hypertension and correcting coagulopathies) and, most crucially, early aneurysm treatment using coil embolisation or clipping. Management of the disease is best delivered in specialised intensive care units and high-volume centres by a multidisciplinary team. Increasingly, early brain injury presenting as global cerebral oedema is recognised as a potential treatment target but, currently, disease management is largely focused on addressing secondary complications such as hydrocephalus, delayed cerebral ischaemia related to microvascular dysfunction and large vessel vasospasm, and medical complications such as stunned myocardium and hospital acquired infections.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA.
| | - Soojin Park
- Department of Neurology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Etminan N, de Sousa DA, Tiseo C, Bourcier R, Desal H, Lindgren A, Koivisto T, Netuka D, Peschillo S, Lémeret S, Lal A, Vergouwen MDI, Rinkel GJE. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022; 7:V. [PMID: 36082246 PMCID: PMC9446328 DOI: 10.1177/23969873221099736] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 07/30/2023] Open
Abstract
Unruptured intracranial aneurysms (UIA) occur in around 3% of the population. Important management questions concern if and how to perform preventive UIA occlusion; if, how and when to perform follow up imaging and non-interventional means to reduce the risk of rupture. Using the Standard Operational Procedure of ESO we prepared guidelines according to GRADE methodology. Since no completed randomised trials exist, we used interim analyses of trials, and meta-analyses of observational and case-control studies to provide recommendations to guide UIA management. All recommendations were based on very low evidence. We suggest preventive occlusion if the estimated 5-year rupture risk exceeds the risk of preventive treatment. In general, we cannot recommend endovascular over microsurgical treatment, but suggest flow diverting stents as option only when there are no other low-risk options for UIA repair. To detect UIA recurrence we suggest radiological follow up after occlusion. In patients who are initially observed, we suggest radiological monitoring to detect future UIA growth, smoking cessation, treatment of hypertension, but not treatment with statins or acetylsalicylic acid with the indication to reduce the risk of aneurysm rupture. Additionally, we formulated 15 expert-consensus statements. All experts suggest to assess UIA patients within a multidisciplinary setting (neurosurgery, neuroradiology and neurology) at centres consulting >100 UIA patients per year, to use a shared decision-making process based on the team recommendation and patient preferences, and to repair UIA only in centres performing the proposed treatment in >30 patients with (ruptured or unruptured) aneurysms per year per neurosurgeon or neurointerventionalist. These UIA guidelines provide contemporary recommendations and consensus statement on important aspects of UIA management until more robust data come available.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Diana Aguiar de Sousa
- Stroke Centre, Centro Hospitalar
Universitário Lisboa Central, Lisbon, Portugal
- CEEM and Institute of Anatomy,
Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cindy Tiseo
- Department of Neurology and Stroke
Unit, SS Filippo e Nicola Hospital, Avezzano, Italy
| | - Romain Bourcier
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Hubert Desal
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Anttii Lindgren
- Department of Clinical Radiology,
Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - David Netuka
- Department of Neurosurgery and
Neurooncology, 1st Medical Faculty, Charles University, Praha, Czech Republic
| | - Simone Peschillo
- Department of Surgical Medical
Sciences and Advanced Technologies ‘G.F. Ingrassia’ - Endovascular Neurosurgery,
University of Catania, Catania, Italy
- Endovascular Neurosurgery, Pia
Fondazione Cardinale Giovanni Panico Hospital, Tricase, LE, Italy
| | | | - Avtar Lal
- European Stroke Organisation, Basel,
Switzerland
| | - Mervyn DI Vergouwen
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
| | - Gabriel JE Rinkel
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
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237
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Matsuura C, Fuchinoue Y, Terazono S, Kondo K, Harada N, Sugo N. Intraperitoneal hemorrhage due to segmental arterial mediolysis associated with cerebral vasospasm after subarachnoid hemorrhage. Clin Case Rep 2022; 10:e6371. [PMID: 36188053 PMCID: PMC9487451 DOI: 10.1002/ccr3.6371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
A man in his 50s with no significant past medical history developed subarachnoid hemorrhage due to ruptured left middle cerebral artery aneurysm. On the ninth hospital day, he had a ruptured visceral aneurysm with segmental arterial mediolysis, and we successfully treated with transarterial embolization using metallic coils.
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Affiliation(s)
- Chie Matsuura
- Department of NeurosurgeryToho University Omori Medical CenterTokyoJapan
| | - Yutaka Fuchinoue
- Department of NeurosurgeryToho University Omori Medical CenterTokyoJapan
| | - Sayaka Terazono
- Department of NeurosurgeryToho University Omori Medical CenterTokyoJapan
| | - Kosuke Kondo
- Department of NeurosurgeryToho University Omori Medical CenterTokyoJapan
| | - Naoyuki Harada
- Department of NeurosurgeryToho University Omori Medical CenterTokyoJapan
| | - Nobuo Sugo
- Department of NeurosurgeryToho University Omori Medical CenterTokyoJapan
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238
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Park H, Son YJ, Hong N, Kim SB. The relationship between non-aneurysmal spontaneous subarachnoid hemorrhage and basilar tip anatomy. J Cerebrovasc Endovasc Neurosurg 2022; 24:232-240. [PMID: 35934810 PMCID: PMC9537650 DOI: 10.7461/jcen.2022.e2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Non-aneurysmal spontaneous subarachnoid hemorrhage (NASAH) has a good prognosis, but its cause has not been clearly identified. In this study, we assessed the clinical and radiological features of NASAH and suggested an anatomical relationship between the basilar tip anatomy and NASAH. METHODS From August 2013 to May 2020, 21 patients were diagnosed with NASAH at our institution. We evaluated the clinical features of NASAH. NASAH was classified into a perimesencephalic pattern and aneurysmal pattern according to the distribution of hemorrhage based on initial brain computed tomography. Digital subtraction angiography was used to classify the basilar tip anatomy into symmetric cranial fusion, symmetric caudal fusion, or asymmetric fusion types. RESULTS Of the 21 patients, twenty patients had a good clinical outcome (modified Rankin Scale (mRS) 1-2; Glasgow Outcome Scale (GOS) 4-5). These patients showed improvement in mRS and Glasgow Coma Scale (GCS) at the last follow-up (P=.003 and P=.016, respectively). Eighteen patients with NASAH (85.7%) had the caudal fusion type, and only three patients with NASAH (14.3%) had the cranial fusion type. Seven patients with the perimesencephalic pattern (77.8%) had the caudal fusion type, and eleven patients with the aneurysmal pattern (91.7%) had the caudal fusion type. CONCLUSIONS In NASAH patients, the caudal fusion tends to occur frequently among patients with basilar tip anatomy. In the case of the caudal fusion, the perforators around the basilar tip would be more susceptible to hemodynamic stress, which could contribute to the occurrence of NASAH.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young-Je Son
- Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Noah Hong
- Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung Bin Kim
- Intensive Care Units, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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239
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Advances in Intracranial Hemorrhage. Crit Care Clin 2022; 39:71-85. [DOI: 10.1016/j.ccc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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240
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Wu B, Huang Z, Liu H, He J, Ju Y, Chen Z, Zhang T, Yi F. Ultra-early endovascular treatment improves prognosis in High grade aneurysmal subarachnoid hemorrhage: A single-center retrospective study. Front Neurol 2022; 13:963624. [PMID: 36034293 PMCID: PMC9413045 DOI: 10.3389/fneur.2022.963624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The long-term survival prognosis of patients with high-grade (Hunt-Hess grade IV–V or World Federation of Neurosurgical Societies grade IV–V) aneurysmal subarachnoid hemorrhage (aSAH) is generally poor, and the association between endovascular treatment timing and the prognosis of high-grade aSAH has not been explored in depth. This retrospective cohort study aimed to determine whether endovascular treatment within 24 h of high-grade aSAH is associated with a better prognosis. Methods We retrospectively analyzed the clinical data of patients with high-grade aSAH who were admitted to our institution between January 2018 and January 2021. The Modified Rankin Scale score was used to assess the 6-month prognosis of patients. Univariate and multivariate logistic regression analyses were used to identify the factors associated with prognosis. The area under the receiver operating characteristic (ROC) curve was used to assess the model's discriminatory ability. Results Eighty-six patients were included in the study. In the multivariate analysis, the timing of endovascular treatment (odds ratio = 7.003 [1.800–27.242], P = 0.005) was an independent risk factor for prognosis. The ROC curve showed that the predictive power of the timing of endovascular treatment was 0.744, the best cut-off value was 12.5 h, and the corresponding sensitivity and specificity were 71.4 and 70.5%, respectively. Hydrocephalus (P = 0.005) and pulmonary infection (P = 0.029) were also associated with prognosis. In addition, cerebrospinal fluid drainage immediately after endovascular treatment had a significant effect on reducing hydrocephalus formation. Conclusions Endovascular therapy within 24 h is feasible and improves the prognosis of patients with high-grade aSAH.
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Affiliation(s)
- Botao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Zhe Huang
- Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Huan Liu
- Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Zhongshan, China
| | - Jiayao He
- Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Yan Ju
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Ziwei Chen
- Department of Neurosurgery, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Taiwei Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Fuxin Yi
- Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- *Correspondence: Fuxin Yi
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241
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Li R, Lin F, Chen Y, Lu J, Han H, Yan D, Li R, Yang J, Li Z, Zhang H, Yuan K, Jin Y, Hao Q, Li H, Zhang L, Shi G, Zhou J, Zhao Y, Zhang Y, Li Y, Wang S, Chen X, Zhao Y. In-hospital complication-related risk factors for discharge and 90-day outcomes in patients with aneurysmal subarachnoid hemorrhage after surgical clipping and endovascular coiling: a propensity score-matched analysis. J Neurosurg 2022; 137:381-392. [PMID: 34972088 DOI: 10.3171/2021.10.jns211484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE More than 10 years have passed since the two best-known clinical trials of ruptured aneurysms (International Subarachnoid Aneurysm Trial [ISAT] and Barrow Ruptured Aneurysm Trial [BRAT]) indicated that endovascular coiling (EC) was superior to surgical clipping (SC). However, in recent years, the development of surgical techniques has greatly improved; thus, it is necessary to reanalyze the impact of the differences in treatment modalities on the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS The authors retrospectively reviewed all aSAH patients admitted to their institution between January 2015 and December 2020. The functional outcomes at discharge and 90 days after discharge were assessed using the modified Rankin Scale (mRS). In-hospital complications, hospital charges, and risk factors derived from multivariate logistic regression were analyzed in the SC and EC groups after 1:1 propensity score matching (PSM). The area under the receiver operating characteristic curve was used to calculate each independent predictor's prediction ability between treatment groups. RESULTS A total of 844 aSAH patients were included. After PSM to control for sex, aneurysm location, Hunt and Hess grade, World Federation of Neurosurgical Societies (WFNS) grade, modified Fisher Scale grade, and current smoking and alcohol abuse status, 329 patients who underwent SC were compared with 329 patients who underwent EC. Patients who underwent SC had higher incidences of unfavorable discharge and 90-day outcomes (46.5% vs 33.1%, p < 0.001; and 19.6% vs 13.8%, p = 0.046, respectively), delayed cerebral ischemia (DCI) (31.3% vs 20.1%, p = 0.001), intracranial infection (20.1% vs 1.2%, p < 0.001), anemia (42.2% vs 17.6%, p < 0.001), hypoproteinemia (46.2% vs 21.6%, p < 0.001), and pneumonia (33.4% vs 24.9%, p = 0.016); but a lower incidence of urinary tract infection (1.2% vs 5.2%, p = 0.004) and lower median hospital charges ($12,285 [IQR $10,399-$15,569] vs $23,656 [IQR $18,816-$30,025], p < 0.001). A positive correlation between the number of in-hospital complications and total hospital charges was indicated in the SC (r = 0.498, p < 0.001) and EC (r = 0.411, p < 0.001) groups. The occurrence of pneumonia and DCI, WFNS grade IV or V, and age were common independent risk factors for unfavorable outcomes at discharge and 90 days after discharge in both treatment modalities. CONCLUSIONS EC shows advantages in discharge and 90-day outcomes, in-hospital complications, and the number of risk factors but increases the economic cost on patients during their hospital stay. Severe in-hospital complications such as pneumonia and DCI may have a long-lasting impact on the prognosis of patients.
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Affiliation(s)
- Runting Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fa Lin
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junlin Lu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heze Han
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Debin Yan
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruinan Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhipeng Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haibin Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kexin Yuan
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongchen Jin
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Hao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongliang Li
- 2Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linlin Zhang
- 2Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guangzhi Shi
- 2Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhou
- 2Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- 3Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Yukun Zhang
- 3Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Youxiang Li
- 4Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and
| | - Shuo Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 5China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaolin Chen
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanli Zhao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 3Department of Neurosurgery, Peking University International Hospital, Beijing, China
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242
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Han H, Chen Y, Li R, Lin F, Lu J, Chen X, Wang S. The value of early CT perfusion parameters for predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:2517-2531. [PMID: 35377027 DOI: 10.1007/s10143-022-01779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
Delayed cerebral ischemia (DCI) is a devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). We aim to investigate the efficacy of early CT perfusion (CTP) parameters for predicting DCI in patients with aSAH. The search was conducted in five databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and China Biology Medicine database). Studies were reviewed by two independent authors, and the included studies were assessed for methodological quality. Fifteen studies with 882 participants were included for the final analysis. The meta-analysis of quantitative parameters showed that mean transit time represented the most valuable predictor when the calculation of the mean value was uniformed (MD 0.30 s, 95% CI: 0.10 to 0.49 s, P = 0.003). Semi-quantitative parameters using relative values or index scores were also widely used to minimize undue variations derived from patients, operators, machines, and software. Studies also demonstrated that these relative parameters had better predictive accuracy than corresponding absolute parameters. Perfusion thresholds in each study were incomparable, and the results warranted further validation. The best threshold for the prediction was 0.9 using the relative cerebral blood flow parameter (sensitivity 97% and specificity 89%). We conclude that CTP in the early phase is a promising tool for predicting DCI in aSAH patients. However, the parameters require standardization. Future studies with prospective, multi-centered design and large sample size are needed to validate the thresholds and optimize the parameters.
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Affiliation(s)
- Heze Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Runting Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fa Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Junlin Lu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
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High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3252718. [PMID: 35880108 PMCID: PMC9308550 DOI: 10.1155/2022/3252718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study is to study the influence of whole-course responsibility nursing combined with high-quality nursing intervention on the level of life and complications of severe aneurysmal subarachnoid hemorrhage patients with postoperative coma. Methods From December 2018 to December 2020, 90 severe aneurysmal subarachnoid hemorrhage patients with postoperative coma were selected and were divided into two groups, the experimental group and the control group, with 45 cases in each group. The control group adopted conventional nursing care, and the experimental group received whole-course responsibility nursing combined with high-quality nursing intervention. The nursing effect, degree of coma, coma recovery, and incidence of complications between all groups were compared. Results Compared with the control group, the experimental group yielded more favorable achievement in terms of the nursing effect (P < 0.05). Superior levels of the Glasgow Coma Scale (GCS) score, Coma Recovery Scale-Revised (CRS-R) score, GQOLI-74 score, and BI score of the experimental group were obtained and compared with the control group (all P < 0.05). The experimental group witnessed a lower complication rate, as compared to the other group (P < 0.05). Conclusion The whole-course responsibility nursing combined with high-quality nursing intervention is applied to severe aneurysmal subarachnoid hemorrhage patients with postoperative coma, which can substantially optimize the nursing efficiency, improve the degree of coma, help recover consciousness, ameliorate the mental state and the quality of life, and reduce the incidence of complications, which is worthy of clinical application.
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Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department. Ir J Med Sci 2022:10.1007/s11845-022-03106-7. [PMID: 35877015 DOI: 10.1007/s11845-022-03106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) clinical decision rules can provide successful results in the differential diagnosis of non-traumatic headache. AIM The aim of this study is to investigate whether a laboratory parameter that can be added to clinical decision-making rules can better predict subarachnoid haemorrhages in patients presenting to the emergency department with headache. METHODS We conducted a retrospective cohort study between March 2017 and March 2019. Patients over the age of 18 who admitted to the emergency department with non-traumatic, acute headache last 14 days before admission and evaluated by imaging and laboratory studies were included in the study. RESULTS A total of 867 patients were included and 141 of them had SAH. In detecting the SAH, Ottawa SAH rule sensitivity (85.1%), specificity (47.1%), positive predictive value (PPV) (23.8%) and negative predictive value (NPV) (94.2%), and for EMERALD SAH, rule sensitivity (96.4%), specificity (43.2%), PPV (24.8%) and NPV (98.4%). In the regression analysis, statistically significant result was obtained to exclude the diagnosis of SAH with the decrease in the eosinophil value (cutoff < 0.085 10^3/µL, OR: 0.011, 95% CI: 0.001-0.213, p = 0.003). When eosinophil value was added to EMERALD SAH rule, it provided a 100% of sensitivity, a 38.4% of specificity, a 24% of PPV and a 100% of NPV in detecting the SAH. CONCLUSIONS EMERALD SAH rule plus eosinophil, which offers 100% sensitivity and NPV for predicting SAH in adult non-traumatic headaches, may be recommended as a successful and practical decision rule for clinical use according to the Ottawa and EMERALD SAH rule.
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245
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Subarachnoid Haemorrhage-Incidence of Hospitalization, Management and Case Fatality Rate-In the Silesian Province, Poland, in the Years 2009-2019. J Clin Med 2022; 11:jcm11144242. [PMID: 35888009 PMCID: PMC9324058 DOI: 10.3390/jcm11144242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/29/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the data on SAH in the Silesian Province, Poland. The study was based on the data obtained from the administrative databases of the only public health insurer in Poland (the National Health Fund, NHF) from 2009 to 2019. The SAH cases were selected based on primary diagnosis coded in ICD-10 as I60. The total number of SAH cases was 2014 (41.8% men, 58.2% women). The number of SAH hospitalizations decreased from 199 in 2009 to 166 cases in 2019; p < 0.05. The median age increased from 58 in 2009 to 62 years in 2019; p < 0.001. Endovascular treatment or clipping of the aneurysm was performed in 866 cases (43%). An increase in in-hospital mortality was observed from 31% in 2009 to 38% in 2019 (p = 0.013). Despite the number of stroke units increasing, in-hospital mortality in SAH patients is high, and the number of vascular interventions seems insufficient. Better organization for care of SAH patients is needed in Poland.
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246
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Wang H, Wang L, Wang J, Zhang L, Li C. The Biological Effects of Smoking on the Formation and Rupture of Intracranial Aneurysms: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:862916. [PMID: 35903120 PMCID: PMC9315281 DOI: 10.3389/fneur.2022.862916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Aneurysms of the cerebral vasculature are relatively common, which grow unpredictably, and even small aneurysms carry a risk of rupture. Rupture of intracranial aneurysms (IA) is a catastrophic event with a high mortality rate. Pieces of evidence have demonstrated that smoking is closely related to the formation and rupture of IA. However, the biological effect of smoking cigarettes on the formation and rupture of IA is still underrepresented. Methods The study protocol was prospectively registered in PROSPERO, registration number CRD42020203634. We performed a systematic search in PubMed and CNKI for studies exploring the biological effects of smoking on intracranial aneurysms published up to December 2021, and all studies were included in the analysis. The RevMan software was used for data analysis. Results A total of 6,196 patients were included in 14 original articles in this meta-analysis. The risk of ruptured IA in the current smoking group was significantly higher than that in the non-smoking group, with statistical significance (RRtotal = 1.23, 95% CI: 1.11–1.37). After heterogeneity among cohorts was removed by the sensitivity analysis, there was still a statistically significant difference in the risk of ruptured IA between the smoking and non-smoking groups (RR total = 1.26, 95% CI: 1.18–1.34). There was no statistically significant difference in the risk of ruptured IA between the former smoking (smoking cessation) group and the non-smoking group (RRtotal = 1.09, 95% CI: 0.50–2.38). After heterogeneity among cohorts was removed by sensitivity analysis, there was still no statistically significant difference in the risk of ruptured IA between the former smoking (smoking cessation) group and the non-smoking group (RRtotal = 0.75, 95% CI: 0.47–1.19). The risk of the ruptured IA in the current smoking group was significantly higher than that in the former smoking (smoking cessation) group, with a statistically significant difference (RRtotal=1.42, 95%CI: 1.27–1.59). Conclusion Although the biological effects of smoking on the formation and rupture of IA are unknown, this study suggests that current smoking is a risk factor for ruptured IA. Quitting smoking is very important for patients with IA.
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Affiliation(s)
- Hanbin Wang
- School of Clinical Medicine, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Luxuan Wang
- Department of Neurology, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Jiyue Wang
- Department of Gastroenterology, Baoding No. 1 Central Hospital, Baoding, China
| | - Lijian Zhang
- Postdoctoral Research Station of Neurosurgery, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
- Key Laboratory of Precise Diagnosis and Treatment of Glioma in Hebei Province, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
- Department of Neurosurgery, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
- Lijian Zhang
| | - Chunhui Li
- Department of Neurosurgery, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
- *Correspondence: Chunhui Li
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Díaz-García E, Nanwani-Nanwani K, García-Tovar S, Alfaro E, López-Collazo E, Quintana-Díaz M, García-Rio F, Cubillos-Zapata C. NLRP3 Inflammasome Overactivation in Patients with Aneurysmal Subarachnoid Hemorrhage. Transl Stroke Res 2022; 14:334-346. [PMID: 35819747 PMCID: PMC10160181 DOI: 10.1007/s12975-022-01064-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is an uncommon and severe subtype of stroke leading to the loss of many years of productive life. We analyzed NLRP3 activity as well as key components of the inflammasome cascade in monocytes and plasma from 28 patients with aSAH and 14 normal controls using flow cytometry, western blot, ELISA, and qPCR technologies. Our data reveal that monocytes from patients with aSAH present an overactivation of the NLRP3 inflammasome, which results in the presence of high plasma levels of interleukin (IL)-1β, IL-18, gasdermin D, and tissue factor. Although further research is needed, we propose that serum tissue factor concentration might be a useful prognosis biomarker for clinical outcome, and for Tako-Tsubo cardiomyopathy and cerebral vasospasm prediction. Remarkably, MCC-950 inhibitor effectively blocks NLRP3 activation in aSAH monocyte culture and supresses tissue factor release to the extracellular space. Finally, our findings suggest that NLRP3 activation could be due to the release of erythrocyte breakdown products to the subarachnoid space during aSAH event. These data define NLRP3 activation in monocytes from aSAH patients, indicating systemic inflammation that results in serum TF upregulation which in turns correlates with aSAH severity and might serve as a prognosis biomarker for aSAH clinical outcome and for cerebral vasospasm and Tako-Tsubo cardiomyopathy prediction.
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Affiliation(s)
- Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain.
| | | | - Sara García-Tovar
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Manuel Quintana-Díaz
- Department of Intensive Care Medicine, La Paz University Hospital, Madrid, Spain.,Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Francisco García-Rio
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.,Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain.,Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain.
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248
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Wen D, Chen R, Zhang T, Li H, Zheng J, Fu W, You C, Ma L. “Atypical” Mild Clinical Presentation in Elderly Patients With Ruptured Intracranial Aneurysm: Causes and Clinical Characteristics. Front Surg 2022; 9:927351. [PMID: 35874135 PMCID: PMC9304704 DOI: 10.3389/fsurg.2022.927351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThunderclap-like severe headache or consciousness disturbance is the common “typical” clinical presentation after aneurysmal subarachnoid hemorrhage (aSAH); however, a slowly developing “atypical” clinical pattern, with mild headache, vomiting, or dizziness, is frequently noted in elderly patients. The aim of this study was to evaluate the clinical characteristics of this “atypical” subgroup, as well as related factors associated with the presence of these mild symptoms.MethodsThe data of 176 elderly patients (≥70 years old) with ruptured intracranial aneurysms (IAs) treated at our center from January 2016 to January 2020 were retrospectively collected and analyzed. The patients were divided into “typical” and “atypical” groups based on their initial and development of clinical symptoms after the diagnosis of aSAH. Intergroup differences were analyzed, and factors related to the presence of these two clinical patterns were explored through multiple logistic regression analyses.ResultsDespite significant admission delay (P < 0.001) caused by mild initial symptoms with slow development, patients in the “atypical” group achieved better clinical prognosis, as indicated by a significantly higher favourable outcome ratio and lower death rate upon discharge and at different time points during the 1-year follow-up, than the “typical” group (P < 0.05). Multiple logistic regression analysis revealed that modified Fisher grade III-IV (OR = 11.182, P = 0.003), brain atrophy (OR = 10.010, P = 0.001), a larger lesion diameter (OR = 1.287, P < 0.001) and current smoking (OR = 5.728, P < 0.001) were independently associated with the presence of “typical” symptoms. Aneurysms with wide necks (OR = 0.013, P < 0.001) were independently associated with the presence of “atypical” symptoms.Conclusions“Atypical” presentations, with mild clinical symptoms and slow development, were commonly recorded in elderly patients after the onset of aSAH. Despite the prolonged admission delay, these “atypical” patients achieved better clinical outcomes than those with “typical” symptoms. Modified Fisher grade (III-IV), current smoking, brain atrophy and larger lesion diameter were factors predictive of “typical” symptoms, while aneurysms with wide necks were independently associated with “atypical” symptoms.
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Naamansen AB, Larsen CC, Johannsson B, Munthe S, Nielsen TH. Small ruptured intracranial aneurysms are overrepresented at the anterior and posterior communicating artery: Results of a multiple regression analysis. Surg Neurol Int 2022; 13:288. [PMID: 35855129 PMCID: PMC9282757 DOI: 10.25259/sni_1119_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Anterior communicating artery (AcomA) represents the most common location for ruptured intracranial aneurysms (rIAs). Approximately 50% of all rIAs are smaller than 7 mm, but factors that lead to rupture are multifactorial. The study investigates whether AcomA location represents an independent risk factor for small size at time of rupture (<7 mm) in a cohort of aneurysmal subarachnoid hemorrhage (aSAH) when controlling for known risk factors. Methods: The aSAH cohort was retrospectively searched from our institution charts. The cohort was dichotomized into small aneurysms (<7 mm) or large aneurysms (≥7 mm). Risk factors for rupture were identified according to the unruptured intracranial aneurysm treatment score (UIATS). These were sex, age, location, smoking, hypertension, alcohol abuse, aneurysm morphology, multiplicity, previous SAH, and family history. With size as independent variable, a multiple regression analysis was performed including UIATS risk factors. Results: One-hundred and seventy-six patients were included in the study. About 49.4% of the aneurysms were <7 mm. Multiple regression analysis demonstrated that aneurysms located at AcomA and posterior communicating artery (PcomA) was significantly more frequent smaller than 7 mm, compared to middle cerebral artery (P = 0.006), internal carotid artery (other than PcomA) (P = 0.013), and posterior circulation (P = 0.017), when controlling for risk factors. Conclusion: Ruptured AcomA and PcomA aneurysms are more frequent smaller than 7 mm compared to other locations. Patients with unruptured UIA at either AcomA or PcomA may be at increased risk of rupture even if the size of the aneurysm is small. Further studies are needed to confirm this finding.
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Affiliation(s)
| | | | | | - Sune Munthe
- Department of Neurosurgery, Odense University Hospital, Odense,
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Donaldson L, Edington A, Vlok R, Astono I, Iredale T, Flower O, Ma A, Davidson K, Delaney A. The incidence of cerebral arterial vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Neuroradiology 2022; 64:2381-2389. [PMID: 35794390 PMCID: PMC9643195 DOI: 10.1007/s00234-022-03004-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022]
Abstract
Purpose
To describe a pooled estimated incidence of cerebral arterial vasospasm (aVSP) following aneurysmal subarachnoid haemorrhage (aSAH) and to describe sources of variation in the reported incidence. Methods We performed a systematic review and meta-analysis of randomised clinical trials (RCTs) and cohort studies. The primary outcome was the proportion of study participants diagnosed with aVSP. We assessed for heterogeneity based on mode of imaging, indication for imaging, study design and clinical characteristics at a study level. Results We identified 120 studies, including 19,171 participants. More than 40 different criteria were used to diagnose aVSP. The pooled estimate of the proportion of patients diagnosed with aVSP was 0.42 (95% CI 0.39 to 0.46, I2 = 96.5%). There was no evidence that the incidence aVSP was different, nor that heterogeneity was reduced, when the estimate was assessed by study type, imaging modalities, the proportion of participants with high grade CT scores or poor grade clinical scores. The pooled estimate of the proportion of study participants diagnosed with aVSP was higher in studies with routine imaging (0.47, 95% CI 0.43 to 0.52, I2 = 96.5%) compared to those when imaging was performed when indicated (0.30, 95% CI 0.25 to 0.36, I2 = 94.0%, p for between-group difference < 0.0005). Conclusion The incidence of cerebral arterial vasospasm following aSAH varies widely from 9 to 93% of study participants. Heterogeneity in the reported incidence may be due to variation in the criteria used to diagnose aVSP. A standard set of diagnostic criteria is necessary to resolve the role that aVSP plays in delayed neurological deterioration following aSAH. PROSPERO registration CRD42020191895 Supplementary Information The online version contains supplementary material available at 10.1007/s00234-022-03004-w.
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Affiliation(s)
- Lachlan Donaldson
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, NSW, 2065, Australia. .,Division of Critical Care, The George Institute for Global Health, Faculty of Medicine UNSW, Sydney, Australia.
| | - Ashleigh Edington
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ruan Vlok
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, NSW, 2065, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Inez Astono
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, NSW, 2065, Australia
| | - Tom Iredale
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, NSW, 2065, Australia
| | - Oliver Flower
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, NSW, 2065, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Keryn Davidson
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, NSW, 2065, Australia.,Division of Critical Care, The George Institute for Global Health, Faculty of Medicine UNSW, Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
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