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Behrouz R, Birnbaum L, Grandhi R, Johnson J, Misra V, Palacio S, Seifi A, Topel C, Garvin R, Caron JL. Cannabis Use and Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage. Stroke 2016; 47:1371-3. [PMID: 27056985 DOI: 10.1161/strokeaha.116.013099] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/03/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of cannabis use in patients with aneurysmal subarachnoid hemorrhage (aSAH) and its impact on morbidity, mortality, and outcomes are unknown. Our objective was to evaluate the relationship between cannabis use and outcomes in patients with aSAH. METHODS Records of consecutive patients admitted with aSAH between 2010 and 2015 were reviewed. Clinical features and outcomes of aSAH patients with negative urine drug screen and cannabinoids-positive (CB+) were compared. Regression analyses were used to assess for associations. RESULTS The study group consisted of 108 patients; 25.9% with CB+. Delayed cerebral ischemia was diagnosed in 50% of CB+ and 23.8% of urine drug screen negative patients (P=0.01). CB+ was independently associated with development of delayed cerebral ischemia (odds ratio, 2.68; 95% confidence interval, 1.03-6.99; P=0.01). A significantly higher number of CB+ than urine drug screen negative patients had poor outcome (35.7% versus 13.8%; P=0.01). In univariate analysis, CB+ was associated with the composite end point of hospital mortality/severe disability (odds ratio, 2.93; 95% confidence interval, 1.07-8.01; P=0.04). However, after adjusting for other predictors, this effect was no longer significant. CONCLUSIONS We offer preliminary data that CB+ is independently associated with delayed cerebral ischemia and possibly poor outcome in patients with aSAH. Our findings add to the growing evidence on the association of cannabis with cerebrovascular risk.
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Affiliation(s)
- Réza Behrouz
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio.
| | - Lee Birnbaum
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Ramesh Grandhi
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Jeremiah Johnson
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Vivek Misra
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Santiago Palacio
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Ali Seifi
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Christopher Topel
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Rachel Garvin
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
| | - Jean-Louis Caron
- From the Departments of Neurology (R.B., L.B., V.M., S.P., C.T.), Neurosurgery (L.B., R. Grandhi, J.J., A.S., R.G., R. Garvin, J.-L.C.), School of Medicine, University of Texas Health Science Center, San Antonio
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Eide PK, Sorteberg A, Bentsen G, Marthinsen PB, Stubhaug A, Sorteberg W. Pressure-derived versus pressure wave amplitude–derived indices of cerebrovascular pressure reactivity in relation to early clinical state and 12-month outcome following aneurysmal subarachnoid hemorrhage. J Neurosurg 2012; 116:961-71. [DOI: 10.3171/2012.1.jns111313] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Indices of cerebrovascular pressure reactivity (CPR) represent surrogate markers of cerebral autoregulation. Given that intracranial pressure (ICP) wave amplitude–guided management, as compared with static ICP-guided management, improves outcome following aneurysmal subarachnoid hemorrhage (SAH), indices of CPR derived from pressure wave amplitudes should be further explored. This study was undertaken to investigate the value of CPR indices derived from static ICP–arterial blood pressure (ABP) values (pressure reactivity index [PRx]) versus ICP-ABP wave amplitudes (ICP-ABP wave amplitude correlation [IAAC]) in relation to the early clinical state and 12-month outcome in patients with aneurysmal SAH.
Methods
The authors conducted a single-center clinical trial enrolling patients with aneurysmal SAH. The CPR indices of PRx and IAAC of Week 1 after hemorrhage were related to the early clinical state (Glasgow Coma Scale [GCS] score) and 12-month outcome (modified Rankin Scale score).
Results
Ninety-four patients were included in the study. The IAAC, but not the PRx, increased with decreasing GCS score; that is, the higher the IAAC, the worse the clinical state. The PRx could differentiate between survivors and nonsurvivors only, whereas the IAAC clearly distinguished the groups “independent,” “dependent,” and “dead.” In patients with an average IAAC ≥ 0.2, mortality was approximately 3-fold higher than in those with an IAAC < 0.2.
Conclusions
The IAAC, which is based on single ICP-ABP wave identification, relates significantly to the early clinical state and 12-month outcome following aneurysmal SAH. Impaired cerebrovascular pressure regulation during the 1st week after a bleed relates to a worse outcome. Clinical trial registration no.: NCT00248690.
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Affiliation(s)
- Per Kristian Eide
- 1Departments of Neurosurgery,
- 4Faculty of Medicine, University of Oslo, Norway
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