1
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Nguyen TA, Mai TD, Vu LD, Dao CX, Ngo HM, Hoang HB, Tran TA, Pham TQ, Pham DT, Nguyen MH, Nguyen LQ, Dao PV, Nguyen DN, Vuong HTT, Vu HD, Nguyen DD, Vu TD, Nguyen DT, Do ALN, Pham QT, Khuat NH, Duong NV, Ngo CC, Do SN, Nguyen HT, Nguyen CV, Nguyen AD, Luong CQ. Factors related to intracerebral haematoma in patients with aneurysmal subarachnoid haemorrhage in Vietnam: a multicentre prospective cohort study. BMJ Open 2023; 13:e066186. [PMID: 37085308 PMCID: PMC10124281 DOI: 10.1136/bmjopen-2022-066186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To investigate the impact of intracerebral haematoma (ICH) on the outcomes and the factors related to an ICH in patients with aneurysmal subarachnoid haemorrhage (aSAH) in a low- and middle-income country. DESIGN A multicentre prospective cohort study. SETTING Three central hospitals in Hanoi, Vietnam. PARTICIPANTS This study included all patients (≥18 years) presenting with aSAH to the three central hospitals within 4 days of ictus, from August 2019 to June 2021, and excluded patients for whom the admission Glasgow Coma Scale was unable to be scored or patients who became lost at 90 days of follow-up during the study. OUTCOME MEASURES The primary outcome was ICH after aneurysm rupture, defined as ICH detected on an admission head CT scan. The secondary outcomes were 90-day poor outcomes and 90-day death. RESULTS Of 415 patients, 217 (52.3%) were females, and the median age was 57.0 years (IQR: 48.0-67.0). ICH was present in 20.5% (85/415) of patients with aSAH. There was a significant difference in the 90-day poor outcomes (43.5% (37/85) and 29.1% (96/330); p=0.011) and 90-day mortality (36.5% (31/85) and 20.0% (66/330); p=0.001) between patients who had ICH and patients who did not have ICH. The multivariable regression analysis showed that systolic blood pressure (SBP) ≥140 mm Hg (adjusted odds ratio (AOR): 2.674; 95% CI: 1.372 to 5.214; p=0.004), World Federation of Neurosurgical Societies (WFNS) grades II (AOR: 3.683; 95% CI: 1.250 to 10.858; p=0.018) to V (AOR: 6.912; 95% CI: 2.553 to 18.709; p<0.001) and a ruptured middle cerebral artery (MCA) aneurysm (AOR: 3.717; 95% CI: 1.848 to 7.477; p<0.001) were independently associated with ICH on admission. CONCLUSIONS In this study, ICH was present in a substantial proportion of patients with aSAH and contributed significantly to a high rate of poor outcomes and death. Higher SBP, worse WFNS grades and ruptured MCA aneurysms were independently associated with ICH on admission.
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Affiliation(s)
- Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Ton Duy Mai
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
| | - Luu Dang Vu
- Department of Radiology, Hanoi Medical University, Hanoi, Viet Nam
- Radiology Centre, Bach Mai Hospital, Hanoi, Viet Nam
| | - Co Xuan Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam
| | - Hung Manh Ngo
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
- Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Viet Nam
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | - Hai Bui Hoang
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Viet Nam
| | - Tuan Anh Tran
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
- Department of Radiology, Hanoi Medical University, Hanoi, Viet Nam
- Radiology Centre, Bach Mai Hospital, Hanoi, Viet Nam
| | - Trang Quynh Pham
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Linh Quoc Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Phuong Viet Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
| | | | - Hien Thi Thu Vuong
- Department of Emergency, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, Viet Nam
| | - Hung Dinh Vu
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Viet Nam
| | - Dong Duc Nguyen
- Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Viet Nam
| | - Thanh Dang Vu
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Department of Emergency, Agriculture General Hospital, Hanoi, Viet Nam
| | | | - Anh Le Ngoc Do
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Quynh Thi Pham
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Nhung Hong Khuat
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Department of Intensive Care and Poison Control, Duc Giang General Hospital, Hanoi, Viet Nam
| | - Ninh Van Duong
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Department of Intensive Care and Poison Control, Dien Bien Provincial General Hospital, Dien Bien Phu, Viet Nam
| | - Cong Chi Ngo
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Department of Emergency, Military Central Hospital 108, Hanoi, Viet Nam
| | - Son Ngoc Do
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam
| | - Hao The Nguyen
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
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2
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Li YC, Chen CC, Chen CT, Tu PH, Yeap MC, Wu YM, Liu ZH, Chang TW, Lin YJ, Wu TWE, Hsieh PC. Delayed Progressive Mass Effect After Secured Ruptured Middle Cerebral Artery Aneurysm: Risk Factors and Outcomes. Front Surg 2022; 9:852576. [PMID: 35586508 PMCID: PMC9108715 DOI: 10.3389/fsurg.2022.852576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Delayed progressive mass effect (DPME) after securing an aneurysm is uncommon following microsurgical or endovascular repair and leads to a poor clinical outcome. Patients with ruptured middle cerebral artery (MCA) aneurysms have a high risk of postoperative oedema and mass effect, which may require decompressive treatment. Because few studies have discussed the risk and predictive factors, we focused on ruptured MCA aneurysms and evaluated the outcomes of these patients and the necessity of salvage surgery when DPME presented. Methods Data on 891 patients with aneurysmal subarachnoid haemorrhage (aSAH) treated between January 2011 and February 2020 were extracted from the medical database of a tertiary referral centre. A total of 113 patients with aSAH resulting from at least one MCA aneurysm were identified. After excluding patients with several clinical confounders, we enrolled 80 patients with surgically treated aSAH. We examined the characteristics of aneurysms and hematomas, perioperative contrast pooling patterns, presence of distal hematomas, perisylvian low density, occlusive treatment modality, management strategies, the need for salvage surgical decompression, and postoperative 90-day outcomes to identify possible risk factors. Results DPME was observed in 27 of the 80 patients (33.7%). The DPME and non-DPME group differed significantly in some respects. The DPME group had a higher risk of salvage surgery (p < 0.001) and poorer outcomes (mRS at day 90; p = 0.0018). The univariate analysis indicated that the presence of hematoma, CTA spot signs, perisylvian low density, and distal hematoma were independent risk factors for DPME. We also noted that DPME remained an independent predictor of a poorer 90-day functional outcome (mRS ≤ 2). Conclusion DPME can lead to salvage decompression surgery and directly relates to poor outcomes for patients with a ruptured MCA aneurysm. Distal hematoma, perisylvian low density, and CTA spot signs on preoperative images can predict DPME.
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Affiliation(s)
- Ying-Ching Li
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
- Department of Neurosurgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taipei, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Yi-Ming Wu
- Department of Radiology, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Ting-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
- Department of Neurosurgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taipei, Taiwan
| | - Ya-Jui Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Tai-Wei Erich Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taoyuan, Taiwan
- Department of Neurosurgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taipei, Taiwan
- Correspondence: Po-Chuan Hsieh
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3
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Ni H, Zhao LB, Liu S, Jia ZY, Cao YZ, Shi HB. Intracranial hematoma following ruptured anterior communicating artery aneurysms: risk factors, outcome, and prognostic factors after management of coiling first. J Neurointerv Surg 2021; 14:neurintsurg-2021-017506. [PMID: 34158400 DOI: 10.1136/neurintsurg-2021-017506] [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: 03/10/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND To determine the risk factors for intracranial hematoma (ICH) development following ruptured anterior communicating artery (AcomA) aneurysms and to determine prognostic factors associated with unfavorable outcomes after coiling first. METHODS From March 2014 to February 2020, 235 patients with ruptured AcomA aneurysms underwent endovascular treatment in our department. The clinical and radiographic conditions were collected retrospectively. Modified Rankin Scale (mRS) scores of ≤ 2 were accepted as favorable outcomes. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to the incidence of ICHs and to unfavorable outcomes. RESULTS Of these 235 patients, 68 had additional ICHs. A posterior orientation of ruptured AcomA aneurysms was the independent variable associated with the incidence of ICHs (OR 3.675; p<0.001). Furthermore, having preoperative Hunt-Hess grades Ⅳ-Ⅴ was an independent variable associated with unfavorable outcomes for ICH patients (OR 80.000; p<0.001). Among the 68 patients with ICHs, 40% (27/68) had Hunt-Hess grades IV-V. Four percent of patients (3/68) underwent surgical hematoma evacuation after the coiling procedure and 15% of the patients (10/68) underwent external ventricular drainage. A favorable outcome was achieved in 72% (49/68) of patients with ruptured AcomA aneurysms. The mortality rate was 21% (14/68) at 6 months. CONCLUSION A posterior orientation of ruptured AcomA aneurysms was associated with the incidence of ICHs. Coiling first with surgical management if necessary seems to be an acceptable treatment for ruptured AcomA aneurysms with ICHs. The clinical outcome was associated with the clinical neurological status on admission.
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Affiliation(s)
- Heng Ni
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Lin-Bo Zhao
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Yue-Zhou Cao
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
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4
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Huang P, Xu M, He XY. Elevation of MicroRNA-126 Levels in Intracranial Aneurysm and Bioinformatic Analysis of Potential Molecular Mechanisms. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The study is to investigation of microRNA-126 levels in patients with intracranial aneurysm and bioinformatic analysis of the molecular mechanisms involved. A total of 166 patients with ICA who were hospitalized or examined in our hospital from September 2015 to December 2017 were used
as the experimental group (ICA group). This group included 120 patients with unruptured intracranial aneurysm (UICA; UICA group) and 46 patients with ruptured intracranial aneurysm (RICA); RICA group). The UICA group was further subdivided into 42 surgical groups (S group) and 78 nonsurgical
groups (NS group). Sixty-three normal people without intracranial aneurysms were selected as the control group. RT-PCR was used to quantitatively detect the relative expression of microRNA- 126 in peripheral blood mononuclear cells at the time of admission and immediately after surgery. The
UCSC database was used to analyze the gene locus and homology of microRNA-126. The TargetScan database and CoMeTa database were used to predict the potential target genes of microRNA-126. The DAVID database was used to enrich the function of potential target genes of microRNA-126 (GO enrichment)
and KEGG pathway enrichment for analysis. The expression level of microRNA-126 in peripheral blood was significantly higher in the ICA group than in the control group (P <0.01), significantly higher in the RICA group than in the UICA group (P <0.05). Expression was also
higher in the NS group than in the S group but the difference was nonsignificant (P >0.05). A total of 15 potential target genes including ITGA6, CRK, PCDH7, and ADAM9 were identified through the target gene prediction software and GO analysis and KEGG pathway analysis showed that
the function of the microRNA-126 target gene was mainly focused on protein binding and the FAS signaling pathway. In Conclusion the microRNA-126 is up-regulated in ICA patients and affects ICA by regulating multiple target genes in the FAS signaling pathway.
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Affiliation(s)
- Pan Huang
- Department of Neurology, People’s Hospital of Deyang City, 173 TaiShan North Road, Deyang, Sichuan, 618000, China
| | - Min Xu
- Department of Neurology, The Second People’s Hospital of Deyang City, 340 Minjiang West Road, Deyang, Sichuan, 618000, China
| | - Xiao-Ying He
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Jiangyang District, Luzhou City, Sichuan, 646000, China
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5
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Aktham A, AbdulAzeez MM, Hoz SS. Surgical Intervention of Intracerebral Hematoma Caused by Ruptured Middle Cerebral Artery Aneurysm in Neurosurgery Teaching Hospital, Baghdad, Iraq. Neurol India 2020; 68:124-131. [PMID: 32129261 DOI: 10.4103/0028-3886.279677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The incidence of intracerebral hematoma among patients with aneurysmal subarachnoid hemorrhage is up to third of the cases (12%-35%). The presence of an aneurysm with ICH negatively influences the patient's presentation, course, and outcome, and may be associated with an increased re-hemorrhage rate, vasospasm, cerebral edema, and hydrocephalus. Aneurysm obliteration and hematoma evacuation have been associated with a favourable outcome. Aim of Study To explore the effectiveness and the prognostic factors for patients with middle cerebral artery aneurysm associated with intracerebral hematoma treated by early surgical clipping of the aneurysm with hematoma evacuation. Patients and Method We analysed 21 patients with intracerebral hematoma caused by ruptured middle cerebral artery aneurysm presented to the Neurosurgery teaching hospital from January 2017 to January 2019. Parameters included five broad categories: demographic, clinical, radiological, surgical, and outcome. Results We found the following factors significantly related with unfavorable patient outcome: Preoperative cranial nerves deficit, dysphasia, severe contralateral weakness, presence of dilated ventricles in CT scan, presence of IVH in CT scan, aneurysm location in the dominant (left) hemisphere, high modified-Fisher grade, duration of surgery more than six hours, occurrence of intraoperative aneurysm rupture, poor postoperative GCS, occurrence postoperative vasospasm, more severe postoperative contralateral weakness, and the presence of postoperative seizure. While the good initial GCS and early surgery significantly related to favourable patient outcome. Conclusion Early surgical intervention of intracerebral hematoma caused by ruptured middle cerebral artery aneurysm has a favourable outcome in general and should be supported with consideration of the significant prognostic factors for each patient before the commencement of the surgery.
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Affiliation(s)
- Awfa Aktham
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Arthur AS, Abecassis IJ, Abi-Aad KR, Albuquerque FC, Almefty RO, Aoun RJN, Barrow DL, Bederson J, Bendok BR, Ducruet AF, Fanous AA, Fennell VS, Flores BC, Griessenauer CJ, Kim LJ, Levitt MR, Mack WJ, Mascitelli J, Min E, Mocco J, Morr S, Nerva JD, Richards AE, Schirmer CM, See AP, Snyder KV, Tian F, Walcott BP, Welz ME. Vascular. Oper Neurosurg (Hagerstown) 2020; 17:S76-S118. [PMID: 31099843 DOI: 10.1093/ons/opz088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - I Josh Abecassis
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rami O Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rami James N Aoun
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Department of Otolaryngology, Mayo Clinic, Phoenix Arizona.,Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Ophthalmalogy, Emory University School of Medicine, Atlanta, Georgia.,Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joshua Bederson
- Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Department of Otolaryngology, Mayo Clinic, Phoenix Arizona.,Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Andrew A Fanous
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - Vernard S Fennell
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - Bruno C Flores
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, Pennsylvania
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington.,Department of Mechanical Engineering, University of Washington School of Medicine, Seattle, Washington
| | - William J Mack
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Justin Mascitelli
- Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
| | - Elliott Min
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
| | - Simon Morr
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - John D Nerva
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | | | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, Pennsylvania
| | - Alfred P See
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - Fucheng Tian
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Brian P Walcott
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona.,Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona.,Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
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7
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Prognostic models for neurological functional outcomes in aneurysmal subarachnoid hemorrhage patients with intracranial hematoma. Clin Neurol Neurosurg 2020; 191:105691. [DOI: 10.1016/j.clineuro.2020.105691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 11/20/2022]
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8
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Kieninger M, Gruber M, Knott I, Dettmer K, Oefner PJ, Bele S, Wendl C, Tuemmler S, Graf B, Eissnert C. Incidence of Arterial Hypotension in Patients Receiving Peroral or Continuous Intra-arterial Nimodipine After Aneurysmal or Perimesencephalic Subarachnoid Hemorrhage. Neurocrit Care 2019; 31:32-39. [DOI: 10.1007/s12028-019-00676-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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9
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Darkwah Oppong M, Skowronek V, Pierscianek D, Gembruch O, Herten A, Saban DV, Dammann P, Forsting M, Sure U, Jabbarli R. Aneurysmal intracerebral hematoma: Risk factors and surgical treatment decisions. Clin Neurol Neurosurg 2018; 173:1-7. [DOI: 10.1016/j.clineuro.2018.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022]
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10
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Burkhardt JK, Neidert MC, Stienen MN, Schöni D, Fung C, Roethlisberger M, Corniola MV, Bervini D, Maduri R, Valsecchi D, Tok S, Schatlo B, Bijlenga P, Schaller K, Bozinov O, Regli L. Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage. Acta Neurochir (Wien) 2017; 159:1305-1312. [PMID: 28127657 DOI: 10.1007/s00701-016-3072-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS). RESULTS A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU. CONCLUSION In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | | | - David Bervini
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Sina Tok
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Philippe Bijlenga
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Middle cerebral artery aneurysms with intracerebral hematoma-the impact of side and volume on final outcome. Acta Neurochir (Wien) 2017; 159:543-547. [PMID: 28070645 DOI: 10.1007/s00701-016-3070-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Middle cerebral artery aneurysms (MCA aneurysms) belong to the most frequent type of intracranial aneurysms forming an intracerebral hematoma. The consequences of the hematoma-the laterality, the impact of ICH volume and size of the aneurysm with the final outcome of these patients had not been studied in detail in this location, and we focused on the analysis of these factors. METHODS Patients with MCA aneurysms and associated intracerebral hematomas with a volume ≥10 ml were studied; these were treated from January 2006 to December 2015. During this period, more than 700 patients with spontaneous subarachnoid hemorrhage were admitted to the Department of Neurosurgery, University Hospital Brno. The data were collected from the subarachnoid hemorrhage database of the unit and from the local hospital registry. All consecutive patients at the treating center were involved in this retrospective study. We collected clinical data such as age, gender, aneurysm location, preoperative hematoma size, Hunt-Hess grade and type of surgical procedures. We focused on the analysis of the final outcome [Glasgow Outcome Scale (GOS) score] in relation to ICH volume, side of bleeding and finally the relationship between aneurysm size and the volume of ICH. RESULTS Fifty-eight patients with an MCA aneurysm and ICH were included; the mean age of this series was 59.4 years. Thirty-six patients (62%) had clinical status Hunt-Hess 4-5 on admission. The mean size of the intracerebral hematoma was 47.1 ml (10-133 ml). Most frequently, in 30 patients (52%), the hematoma had bled into the temporal lobe. Fifty three patients were operated on, and 5 were treated conservatively because of their poor condition. Twenty-three patients (40%) had a favorable Glasgow Outcome Scale score, and 35 (60%) had an unfavorable outcome including 20 patients (35%) who died. Of the 53 patients operated on, 20 (38%) underwent decompressive hemicraniectomy (DHC). Patients with an unfavorable outcome had significantly larger hematomas with a median size of 54 ml, whereas those with a favorable outcome had a median size of 26 ml (p = 0.0022). Larger hematomas were found on the right side. The cutoff volume for an unfavorable outcome in ICH was 25 ml. The outcomes were not related to the side of the ICH (p = 0.42), and the aneurysm size did not predetermine the ICH volume (p = 0.3159). CONCLUSION Our study confirms the benefit of the active treatment of patients with MCA aneurysms and associated ICH. A significant proportion of these patients achieves a favorable outcome. No association between the side of bleeding and outcome was demonstrated. Hematomas larger than 25 ml have a greater tendency to lead to an unfavorable outcome. The treatment decision-making process should not differ for either side.
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12
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Hänggi D, Etminan N, Macdonald RL, Steiger HJ, Mayer SA, Aldrich F, Diringer MN, Hoh BL, Mocco J, Strange P, Faleck HJ, Miller M. NEWTON: Nimodipine Microparticles to Enhance Recovery While Reducing Toxicity After Subarachnoid Hemorrhage. Neurocrit Care 2016; 23:274-84. [PMID: 25678453 DOI: 10.1007/s12028-015-0112-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. EG-1962 is a sustained-release microparticle formulation of nimodipine that has shown preclinical efficacy when administered intraventricularly or intracisternally to dogs with SAH, without evidence of toxicity at doses in the anticipated therapeutic range. Thus, we propose to administer EG-1962 to humans in order to assess safety and tolerability and determine a dose to investigate efficacy in subsequent clinical studies. METHODS We describe a Phase 1/2a multicenter, controlled, randomized, open-label, dose escalation study to determine the maximum tolerated dose (MTD) and assess the safety and tolerability of EG-1962 in patients with aSAH. The study will comprise two parts: a dose escalation period (Part 1) to determine the MTD of EG-1962 and a treatment period (Part 2) to assess the safety and tolerability of the selected dose of EG-1962. Patients with a ruptured saccular aneurysm treated by neurosurgical clipping or endovascular coiling will be considered for enrollment. Patients will be randomized to receive either EG-1962 (study drug: nimodipine microparticles) or oral nimodipine in the approved dose regimen (active control) within 60 h of aSAH. RESULTS Primary objectives are to determine the MTD and the safety and tolerability of the selected dose of intraventricular EG-1962 as compared to enteral nimodipine. The secondary objective is to determine release and distribution by measuring plasma and CSF concentrations of nimodipine. Exploratory objectives are to determine the incidence of delayed cerebral infarction on computed tomography, clinical features of delayed cerebral ischemia, angiographic vasospasm, and incidence of rescue therapy and clinical outcome. Clinical outcome will be determined at 90 days after aSAH using the extended Glasgow outcome scale, modified Rankin scale, Montreal cognitive assessment, telephone interview of cognitive status, and Barthel index. CONCLUSION Here, we describe a Phase 1/2a multicenter, controlled, randomized, open-label, dose escalation study to determine the MTD and assess the safety and tolerability of EG-1962 in patients with aSAH.
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Affiliation(s)
- Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany,
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13
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Wan A, Jaja BNR, Schweizer TA, Macdonald RL. Clinical characteristics and outcome of aneurysmal subarachnoid hemorrhage with intracerebral hematoma. J Neurosurg 2016; 125:1344-1351. [PMID: 26918469 DOI: 10.3171/2015.10.jns151036] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Intracerebral hematoma (ICH) with subarachnoid hemorrhage (SAH) indicates a unique feature of intracranial aneurysm rupture since the aneurysm is in the subarachnoid space and separated from the brain by pia mater. Broad consensus is lacking regarding the concept that ultra-early treatment improves outcome. The aim of this study is to determine the associative factors for ICH, ascertain the prognostic value of ICH, and investigate how the timing of treatment relates to the outcome of SAH with concurrent ICH. METHODS The study data were pooled from the SAH International Trialists repository. Logistic regression was applied to study the associations of clinical and aneurysm characteristics with ICH. Proportional odds models and dominance analysis were applied to study the effect of ICH on 3-month outcome (Glasgow Outcome Scale) and investigate the effect of time from ictus to treatment on outcome. RESULTS Of the 5362 SAH patients analyzed, 1120 (21%) had concurrent ICH. In order of importance, neurological status, aneurysm location, aneurysm size, and patient ethnicity were significantly associated with ICH. Patients with ICH experienced poorer outcome than those without ICH (OR 1.58; 95% CI 1.37-1.82). Treatment within 6 hours of SAH was associated with poorer outcome than treatment thereafter (adjusted OR 1.67; 95% CI 1.04-2.69). Subgroup analysis with adjustment for ICH volume, location, and midline shift resulted in no association between time from ictus to treatment and outcome (OR 0.99; 95% CI 0.94-1.07). CONCLUSIONS The most important associative factor for ICH is neurological status on admission. The finding regarding the value of ultra-early treatment suggests the need to more robustly reevaluate the concept that hematoma evacuation of an ICH and repair of a ruptured aneurysm within 6 hours of ictus is the most optimal treatment path.
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Affiliation(s)
- Anthony Wan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto; and Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Blessing N R Jaja
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto; and Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Tom A Schweizer
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto; and Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - R Loch Macdonald
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto; and Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
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14
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Liu LP, Wong LKS, Wang DZ, Miao ZR. Current status of endovascular procedures in management of ischemic stroke in China. CNS Neurosci Ther 2014; 20:483-4. [PMID: 24836738 DOI: 10.1111/cns.12281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Li-Ping Liu
- Department of Neurology and Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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15
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[Patients with subarachnoid haemorrhage in poor grade neurological status: Study of prognostic factors]. Neurocirugia (Astur) 2014; 26:32-8. [PMID: 25455762 DOI: 10.1016/j.neucir.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/31/2014] [Accepted: 09/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and predict factors influencing prognosis and/or clinical outcome at 6 months in patients with spontaneous subarachnoid haemorrhage, World Federation of Neurosurgical Societies (WFNS) grades iv and v. MATERIAL AND METHODS This was a retrospective study of a consecutive series of 394 patients admitted to our hospital with clinical and radiological diagnosis of spontaneous subarachnoid haemorrhage, from 1 January 1999 to 30 June 2009. We selected 121 patients who met the criteria of being in WFNS grades iv or v before treatment; 3 patients were excluded due to loss of tracking. The outcome variable was assessed 6 months after the event using the Glasgow Outcome Scale. A P value<.05 was considered statistically significant. RESULTS One hundred and twenty-one patients were included in the statistical analysis. The average age of the patients in the series was 54 years (14-92). Patients who had a mean Glasgow Coma Scale lower than 7 points (P<.0001), those who were grade v (P<.0001) in the pre-treatment WFNS scale and those with pupillary disorder (P=.002) had a worse clinical outcome. Likewise, those with associated intraparenchymal hematoma (P=.020) and those not receiving any treatment (P=.020) were also associated with a poor clinical outcome. These results were statistically significant. CONCLUSIONS Patients admitted with a WFNS grade v and/or presenting pupil disorder and/or intraparenchymal hematoma were associated with worse clinical outcomes.
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Subarachnoid hemorrhage and intracerebral hematoma caused by aneurysms of the anterior circulation: influence of hematoma localization on outcome. Neurosurg Rev 2014; 37:653-9. [DOI: 10.1007/s10143-014-0560-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/03/2014] [Accepted: 05/18/2014] [Indexed: 11/25/2022]
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Lee KW, Tsai FY, Cheng CY. Venous hypertension may be a factor in aneurysmal rupture. A case report. Neuroradiol J 2013; 26:311-4. [PMID: 23859288 DOI: 10.1177/197140091302600310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 05/07/2013] [Indexed: 11/15/2022] Open
Abstract
This report describes cerebral aneurysmal rupture with asymmetry of ipsilateral dural sinus hypoplasia using quantitative color-coded I-Flow cerebral venography to identify the venous pressure gradient. We suggest the pressure gradient may be a potential factor in cerebral aneurysmal rupture. We used I-Flow quantitative cerebral venography to measure the venous pressure gradient during acute cerebral aneurysmal rupture and post embolization in a 67-year-old woman who presented with clinical symptoms of left third nerve palsy for several days with mild headache initially without subarachnoid hemorrhage. We encountered a high venous pressure gradient of severe ipsilateral dural sinus hypoplasia during acute rupture of a posterior communicating aneurysm. Venous dural sinus asymmetry has been considered a congenital benign and non-pathological condition. However, this case may present severe hypoplasia of the dural sinus with potential pressure gradient in some unusual condition. A high venous pressure gradient may be another factor in cerebral aneurysmal rupture.
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Affiliation(s)
- K-W Lee
- Imaging Research Center, Taipei Medical University, Taipei, Taiwan
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18
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Biesbroek JM, Rinkel GJ, Algra A, van der Sprenkel JWB. Risk Factors for Acute Subdural Hematoma From Intracranial Aneurysm Rupture. Neurosurgery 2012; 71:264-8; discussion 268-9. [DOI: 10.1227/neu.0b013e318256c27d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops.
OBJECTIVE:
To identify risk factors for the development of an aSDH from intracranial aneurysm rupture.
METHODS:
Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression.
RESULTS:
Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH.
CONCLUSION:
Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.
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Affiliation(s)
- J. Matthijs Biesbroek
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gabriel J.E. Rinkel
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ale Algra
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Berkelbach van der Sprenkel
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
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Progress in cerebrovascular disease research in the last year. J Neurol 2012; 259:391-4. [PMID: 22258481 DOI: 10.1007/s00415-012-6408-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 12/30/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
Herein, we review the main papers in cerebrovascular diseases published in the Journal of Neurology over the last year.
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