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Gams Massi D, Pazeu MD, Motah M, Magnerou AM, Kenmegne C, Mbahé S, Mapoure NY. Spontaneous subarachnoid hemorrhage in a referral health Centre in Central Africa. eNeurologicalSci 2024; 36:100518. [PMID: 39139148 PMCID: PMC11321439 DOI: 10.1016/j.ensci.2024.100518] [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: 05/04/2024] [Revised: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
Background Spontaneous subarachnoid hemorrhage (sSAH) is a medicosurgical emergency with high morbidity and mortality. The aimed of this study was to describe the clinical features and outcome of sSAH in Cameroon. Methods We reviewed medical records of patients aged ≥15 years old, admitted for sSAH from Januray 2011 to December 2020 in the Douala General Hospital. The diagnosis of sSAH was confirmed by neuroimaging (CT scan or MRI). Clinical and radiological severities were assessed by the WFNS score and the modified Fisher score respectively. Factors associated to in-hospital mortality was identified using cross-table (RR and 95%CI). Results Among the 111 cases of sSAH reviewed in emergencies records, we included 70 patients. The mean age was of 55.6 ± 13.6 years. Female were predominant (57.1%). Altered consciousness was the main clinical feature (55.7%). The WFNS score was grade 4-5 in 54.3% of patients. And 75.7% of cases presented a modified Fisher score of 3-4. Ruptured of intracranial aneurysm was the most common etiology (46.2%). Endovascular treatment and/or surgical treatment were not avaible. Hospital-based mortality was 40% and factor associated with death were Altered consciousness (RR: 4.3, 95%CI:1.52-12.33, p = 0.004), coma (RR: 23.9, 95%CI:2.85-200.62, p = 0.004), WFNS grade 5 (RR: 18.2, 95%CI:3.7-92.3, p < 0.001), and hospital length ≤ 7 days (RR: 13.5, 95%CI:4.28-42.56, p < 0.001). Conclusion Mortality and disability of sSAH are still high in our setting. Further studies with prospective follow up of patients are needed to determine the long-term outcome of these patients.
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Affiliation(s)
- Daniel Gams Massi
- Neurology unit, Douala General Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea
| | - Mikael Doufiene Pazeu
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Mathieu Motah
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Annick Melanie Magnerou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Neurology department, Douala Laquintinie Hospital, Douala, Douala, Cameroon
| | | | - Salomon Mbahé
- Neurology unit, Douala General Hospital, Douala, Cameroon
| | - Njankouo Yacouba Mapoure
- Neurology unit, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Bhattarai HB, Bhusal A, Bhattarai G, Basnet B, Gautam S, Koirala S, Uprety M, Adhikari B, Pokhrel R, Katwal S. Subarachnoid hemorrhage mimicking an acute migraine attack: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241261012. [PMID: 38881976 PMCID: PMC11179526 DOI: 10.1177/2050313x241261012] [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: 10/06/2023] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
Subarachnoid hemorrhage is a neurological emergency in which arterial blood accumulates in the subarachnoid space with cerebral aneurysmal rupture being the most common cause. Subarachnoid hemorrhage is often misdiagnosed in the emergency department and mortality rates range from 8% to 67%. It may be the manifestation of the chronicity of the migraine. The difference in severity or quality compared to previous headaches, and other symptoms, particularly neck stiffness, but also seizure, syncope, focal neurological deficit, and vomiting are the key factors differentiating subarachnoid hemorrhage from the migraine. We report a case of a 37-year-old female with a previous history of migraines who presented with acute onset of excruciating headaches in the occiput associated with nausea, vomiting, and photophobia in whom a non-contrast computed tomography scan of the head showed hyper-densities involving the bilateral cerebral cortical sulcus and Sylvian fissure and the cerebral angiography showed a complex aneurysm in anterior communicating artery.
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Affiliation(s)
| | - Amrit Bhusal
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Ganesh Bhattarai
- Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - Bibhusan Basnet
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Swotantra Gautam
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Sabina Koirala
- Gandaki Medical College Teaching Hospital and Research Center Pvt Ltd, Pokhara, Nepal
| | - Manish Uprety
- Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Bibhuti Adhikari
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Ritu Pokhrel
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Shailendra Katwal
- Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
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3
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Qin S, Teng H, Li A, Wang L, Hu R, Fu D. Subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation: A case and literature review. Heliyon 2024; 10:e30057. [PMID: 38694106 PMCID: PMC11059115 DOI: 10.1016/j.heliyon.2024.e30057] [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: 01/07/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background Takotsubo syndrome, which is often induced by physical or psychological stress, is typically a cardiac syndrome with transient left ventricular dysfunction in the absence of obstructive coronary artery disease. Subarachnoid hemorrhage with typical symptoms and signs is frequently reported, whereas the incidence of subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation without a typical headache is rarely reported. Case description We present a rare case of a 63-year-old male patient with cough and fever as the first manifestations, accompanied by mild dizziness, headache, and mental discomfort; however, the patient was eventually diagnosed with atypical subarachnoid hemorrhage with Takotsubo syndrome. The patient underwent general anesthesia downwards stent-assisted spring coil embolization and was discharged from the hospital after postoperative treatment consisting of anti-cerebrovascular spasm, anti-platelet aggregation, and cerebrospinal fluid replacement. Conclusion This case demonstrates the association between Takotsubo syndrome and subarachnoid hemorrhage. When patients present with unexplained pulmonary edema with mild neurologic symptoms, clinicians should be alerted to subarachnoid hemorrhage and Takotsubo syndrome.
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Affiliation(s)
- Shihong Qin
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Huifang Teng
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Aiping Li
- The Fourth Department of Neurology, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fourth Department of Neurology, Hunan Provincial People's Hospital, Changsha, China
| | - Lile Wang
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Ruicheng Hu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Daiyan Fu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
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Ganti L, Veluri SC, Stead TS, Rieck R. Ominous Causes of Headache. Curr Pain Headache Rep 2024; 28:73-81. [PMID: 38091239 DOI: 10.1007/s11916-023-01202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE OF REVIEW While primary headaches like migraines or cluster headaches are prevalent and often debilitating, it's the secondary headaches-those resulting from underlying pathologies-that can be particularly ominous. This article delves into the sinister causes of headaches, underscoring the importance of a meticulous clinical approach, especially when presented with red flags. RECENT FINDINGS Headaches, one of the most common complaints in clinical practice, span a spectrum from benign tension-type episodes to harbingers of life-threatening conditions. For the seasoned physician, differentiating between these extremes is paramount. Headache etiologies covered in this article will include subarachnoid hemorrhage (SAH), cervical artery dissection, cerebral venous thrombosis, meningitis, obstructive hydrocephalus, and brain tumor.
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Affiliation(s)
- Latha Ganti
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
- University of Central Florida College of Medicine, Orlando, FL, USA.
- Envision Healthcare, Nashville, TN, USA.
| | | | - Thor S Stead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Hu J, Cheng M, Jiang C, Liu L, He Z, Liu L, Yao Y, Li Z, Wang Q. Deferoxamine Mitigates Ferroptosis and Inflammation in Hippocampal Neurons After Subarachnoid Hemorrhage by Activating the Nrf2/TXNRD1 Axis. Mol Neurobiol 2024; 61:1044-1060. [PMID: 37676391 DOI: 10.1007/s12035-023-03525-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
Ferroptosis is a distinct peroxidation-driven form of cell death tightly involved in subarachnoid hemorrhage (SAH). This study delved into the mechanism of deferoxamine (DFO, an iron chelator) in SAH-induced ferroptosis and inflammation. SAH mouse models were established by endovascular perforation method and injected intraperitoneally with DFO, or intraventricularly injected with the Nrf2 pathway inhibitor ML385 before SAH, followed by detection of neurological function, blood-brain barrier (BBB) permeability, and brain water content. Apoptotic level of hippocampal neurons, symbolic changes of ferroptosis, and levels of pro-inflammatory cytokines were assessed using TUNEL staining, Western blotting, colorimetry, and ELISA. The localization and expression of nuclear factor-erythroid 2-related factor 2 (Nrf2) were detected. HT22 cells were exposed to Hemin as in vitro SAH models and treated with FIN56 to induce ferroptosis, followed by evaluation of the effects of DFO on FIN56-treated HT22 cells. The regulation of Nrf2 in thioredoxin reductase 1 (TXNRD1) was analyzed by co-immunoprecipitation and Western blotting. Moreover, HT22 cells were treated with DFO and ML385 to identify the role of DFO in the Nrf2/TXNRD1 axis. DFO extenuated brain injury, and ferroptosis and inflammation in hippocampal neurons of SAH mice. Nrf2 localized at the CA1 region of hippocampal neurons, and DFO stimulated nuclear translocation of Nrf2 protein in hippocampal neurons of SAH mice. Additionally, DFO inhibited ferroptosis and inflammatory responses in FIN56-induced HT22 cells. Nrf2 positively regulated TXNRD1 protein expression. Indeed, DFO alleviated FIN56-induced ferroptosis and inflammation via activation of the Nrf2/TXNRD1 axis. DFO alleviated neurological deficits, BBB disruption, brain edema, and brain injury in mice after SAH by inhibiting hippocampal neuron ferroptosis via the Nrf2/TXNRD1 axis. DFO ameliorates SAH-induced ferroptosis and inflammatory responses in hippocampal neurons by activating the Nrf2/TXNRD1 axis.
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Affiliation(s)
- Junting Hu
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Meixiong Cheng
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Chonggui Jiang
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Ling Liu
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Zongze He
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Lingtong Liu
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Yuanpeng Yao
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China
| | - Zhili Li
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China.
| | - Qi Wang
- Department of Neurosurgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Section 2, West 1St Ring Road, Chengdu, 610072, Sichuan, China.
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Abstract
BACKGROUND/OBJECTIVE Primary stabbing headache is a common but under-recognized primary headache disorder. The objectives of this review were to provide practical information for better understanding and identification of the disease, suggest an algorithm for differential diagnosis, and provide an insight into the pathophysiology of primary stabbing headache hypothesized from its clinical course. METHODS This narrative review of primary stabbing headache is based on a literature search and the authors' clinical reasoning. RESULT The phenotype of each stab is typically abrupt, ultrashort-lasting (<3 s), focal or multifocal, paroxysms of pain occurring sporadically or in clusters. The diagnosis of primary stabbing headache is clinical; fixed or migrating stabs without background pain or sensory abnormalities and the absence of features suggestive of other disorders (e.g., cranial autonomic symptoms or signs) can aid in the diagnosis of primary stabbing headache. The clinical patterns include monophasic, intermittent, and chronic primary stabbing headache, of which the first two are considered typical. The pathophysiology of primary stabbing headache has not yet been elucidated. In this review, we postulated the mechanism of stabbing headache, based on the pain phenotype and clinical course, and provide a clinical algorithm for the differential diagnosis of primary stabbing headache. CONCLUSION Knowledge about the typical manifestations and clinical patterns of primary stabbing headache will aid in the proper diagnosis and differential diagnosis. Treatment should be tailored by considering the clinical patterns. Further research is needed to elucidate the pathophysiological mechanisms and optimal treatment of primary stabbing headache.
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Affiliation(s)
- Soonwook Kwon
- Department of Neurology, Inha University Hospital, Incheon, South Korea
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Zhou J, Shen R, Makale EC, Zhong W, Chen Z, Huang Q. SS31 Confers Cerebral Protection by Reversing Mitochondrial Dysfunction in Early Brain Injury Following Subarachnoid Hemorrhage, via the Nrf2- and PGC-1α-Dependent Pathways. Neurochem Res 2022; 48:1580-1595. [PMID: 36574150 DOI: 10.1007/s11064-022-03850-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
In early brain injury (EBI), oxidative stress occurs following subarachnoid hemorrhage (SAH), and mitochondria are intricately linked to this process. SS31, a mitochondria-targeting antioxidative peptide, has been demonstrated to be beneficial for multiple diseases because of its powerful antioxidant and neuroprotective properties. Although our previous study revealed that SS31 was involved in the powerful antioxidant effect following SAH, the underlying molecular mechanisms remained unclear. Thus, our study aimed to investigate the neuroprotective effects of SS31 by reversing mitochondrial dysfunction in EBI following SAH, via activating the Nrf2 signaling and PGC-1α pathways. Our findings confirmed that SS31 ameliorated SAH-triggered oxidative insult. SS31 administration decreased redundant reactive oxygen species, alleviated lipid peroxidation, and elevated the activities of antioxidant enzymes. Concomitant with the inhibited oxidative insult, SS31 dramatically attenuated neurological deficits, cerebral edema, neural apoptosis, and blood-brain barrier disruption following SAH. Moreover, SS31 remarkably promoted nuclear factor-erythroid 2 related factor 2 (Nrf2) nuclear shuttle and upregulated the expression levels of heme oxygenase-1 and NADPH: quinine oxidoreductase1. Additionally, SS31 enhanced the expression levels of PGC-1α and its target genes, and increased the mtDNA copy number, promoting mitochondrial function. However, PGC-1α-specific inhibitor SR-18292 pretreatment dramatically suppressed SS31-induced Nrf2 expression and PGC-1α activation. Furthermore, pretreatment with SR-18292 reversed the neuroprotective and antioxidant roles of SS31. These significant beneficial effects were associated with the activation of the Nrf2 signaling and PGC-1α pathways and were antagonized by SR-18292 administration. Our findings reveal that SS31 exhibits its neuroprotective activity by reversing mitochondrial dysfunction via activating the Nrf2 signaling pathway, which could be mediated through PGC-1α activation.
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Affiliation(s)
- Jian Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, 31 Longhua Road, Haikou, 570102, Hainan Province, China
| | - Ruiming Shen
- Department of Rheumatology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Emmanuel C Makale
- Department of General Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Wangwang Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, 31 Longhua Road, Haikou, 570102, Hainan Province, China
| | - Zhenggang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, 31 Longhua Road, Haikou, 570102, Hainan Province, China
| | - Qiuhu Huang
- Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, 31 Longhua Road, Haikou, 570102, Hainan Province, China.
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Luo K, Wang Z, Zhuang K, Yuan S, Liu F, Liu A. Suberoylanilide hydroxamic acid suppresses axonal damage and neurological dysfunction after subarachnoid hemorrhage via the HDAC1/HSP70/TDP-43 axis. Exp Mol Med 2022; 54:1423-1433. [PMID: 35501375 DOI: 10.1038/s12276-022-00761-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
Increased focus has been placed on the role of histone deacetylase inhibitors as crucial players in subarachnoid hemorrhage (SAH) progression. Therefore, this study was designed to expand the understanding of SAH by exploring the downstream mechanism of the histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA) in SAH. The expression of TDP-43 in patients with SAH and rat models of SAH was measured. Then, western blot analysis, immunofluorescence staining, and transmission electron microscope were used to investigate the in vitro effect of TDP-43 on a neuronal cell model of SAH established by oxyhemoglobin treatment. Immunofluorescence staining and coimmunoprecipitation assays were conducted to explore the relationship among histone deacetylase 1 (HDAC1), heat shock protein 70 (HSP70), and TDP-43. Furthermore, the in vivo effect of HDAC1 on SAH was investigated in rat models of SAH established by endovascular perforation. High expression of TDP-43 in the cerebrospinal fluid of patients with SAH and brain tissues of rat models of SAH was observed, and TDP-43 accumulation in the cytoplasm and the formation of inclusion bodies were responsible for axonal damage, abnormal nuclear membrane morphology, and apoptosis in neurons. TDP-43 degradation was promoted by the HDAC1 inhibitor SAHA via the acetylation of HSP70, alleviating SAH, and this effect was verified in vivo in rat models. In conclusion, SAHA relieved axonal damage and neurological dysfunction after SAH via the HSP70 acetylation-induced degradation of TDP-43, highlighting a novel therapeutic target for SAH.
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Affiliation(s)
- Kui Luo
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, 410013, Changsha, China
| | - Zhifei Wang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, 410013, Changsha, China
| | - Kai Zhuang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, 410013, Changsha, China
| | - Shishan Yuan
- Medical College, Hunan Normal University, 410000, Changsha, China
| | - Fei Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, 410013, Changsha, China. .,Department of Neurosurgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 519000, Zhuhai, China.
| | - Aihua Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, 410013, Changsha, China. .,Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China.
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Mahta A, Anderson MN, Azher AI, Mahmoud LN, Dakay K, Abdulrazeq H, Abud A, Moody S, Reznik ME, Yaghi S, Thompson BB, Wendell LC, Rao SS, Potter NS, Cutting S, Mac Grory B, Stretz C, Doberstein CE, Furie KL. Short- and long-term opioid use in survivors of subarachnoid hemorrhage. Clin Neurol Neurosurg 2021; 207:106770. [PMID: 34182238 DOI: 10.1016/j.clineuro.2021.106770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/03/2021] [Accepted: 06/17/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Opioids are frequently used for analgesia in patients with acute subarachnoid hemorrhage (SAH) due to a high prevalence of headache and neck pain. However, it is unclear if this practice may pose a risk for opioid dependence, as long-term opioid use in this population remains unknown. We sought to determine the prevalence of opioid use in SAH survivors, and to identify potential risk factors for opioid utilization. METHODS We analyzed a cohort of consecutive patients admitted with non-traumatic and suspected aneurysmal SAH to an academic referral center. We included patients who survived hospitalization and excluded those who were not opioid-naïve. Potential risk factors for opioid prescription at discharge, 3 and 12 months post-discharge were assessed. RESULTS Of 240 SAH patients who met our inclusion criteria (mean age 58.4 years [SD 14.8], 58% women), 233 (97%) received opioids during hospitalization and 152 (63%) received opioid prescription at discharge. Twenty-eight patients (12%) still continued to use opioids at 3 months post-discharge, and 13 patients (6%) at 12-month follow up. Although patients with poor Hunt and Hess grades (odds ratio 0.19, 95% CI 0.06-0.57) and those with intraventricular hemorrhage (odds ratio 0.38, 95% CI 0.18-0.87) were less likely to receive opioid prescriptions at discharge, we did not find significant differences between patients who had long-term opioid use and those who did not. CONCLUSION Opioids are regularly used in both the acute SAH setting and immediately after discharge. A considerable number of patients also continue to use opioids in the long-term. Opioid-sparing pain control strategies should be explored in the future.
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Affiliation(s)
- Ali Mahta
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Matthew N Anderson
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Aidan I Azher
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Leana N Mahmoud
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, United States
| | - Katarina Dakay
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Alexander Abud
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Scott Moody
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Michael E Reznik
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurology, NYU Langone, New York, NY, United States
| | - Bradford B Thompson
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Linda C Wendell
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Shyam S Rao
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Nicholas S Potter
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Shawna Cutting
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC, United States
| | - Christoph Stretz
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Curtis E Doberstein
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
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10
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Patel S, Parikh A, Okorie ON. Subarachnoid hemorrhage in the emergency department. Int J Emerg Med 2021; 14:31. [PMID: 33980142 PMCID: PMC8117305 DOI: 10.1186/s12245-021-00353-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. DISCUSSION The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. CONCLUSION Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.
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Affiliation(s)
- Sima Patel
- Division of Neurocritical Care, Department of Critical Care Medicine, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA.
| | - Amay Parikh
- Division of Neurocritical Care, Department of Critical Care Medicine, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Okorie Nduka Okorie
- Division of Neurocritical Care, Department of Critical Care Medicine, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
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Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Afamefuna Victor E, Umar NA, Kundakci B. Neurological and Musculoskeletal Features of COVID-19: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:687. [PMID: 32676052 PMCID: PMC7333777 DOI: 10.3389/fneur.2020.00687] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
Importance: Some of the symptoms of COVID-19 are fever, cough, and breathing difficulty. However, the mechanism of the disease, including some of the symptoms such as the neurological and musculoskeletal symptoms, is still poorly understood. Objective: The aim of this review is to summarize the evidence on the neurological and musculoskeletal symptoms of the disease. This may help with early diagnosis, prevention of disease spread, and treatment planning. Data Sources: MEDLINE, EMBASE, Web of Science, and Google Scholar (first 100 hits) were searched until April 17, 2020. The key search terms used were "coronavirus" and "signs and symptoms." Only studies written in English were included. Study Selection: The selection was performed by two independent reviewers using EndNote and Rayyan software. Any disagreement was resolved by consensus or by a third reviewer. Data Extraction and Synthesis: PRISMA guidelines were followed for abstracting data and assessing the quality of the studies. These were carried out by two and three independent reviewers, respectively. Any disagreement was resolved by consensus or by a third reviewer. The data were analyzed using qualitative synthesis and pooled using a random-effect model. Main Outcome(s) and Measure(s): The outcomes in the study include country, study design, participant details (sex, age, sample size), and neurological and musculoskeletal features. Result: Sixty studies (n = 11, 069) were included in the review, and 51 studies were used in the meta-analysis. The median or mean age ranged from 24 to 95 years. The prevalence of neurological and musculoskeletal manifestations was 35% for smell impairment (95% CI 0-94%; I 2 99.63%), 33% for taste impairment (95% CI 0-91%; I 2 99.58%), 19% for myalgia (95% CI 16-23; I 2 95%), 12% for headache (95% CI 9-15; I 2 93.12%), 10% for back pain (95% CI 1-23%; I 2 80.20%), 10% for dizziness (95% CI 3-19%; I 2 86.74%), 3% for acute cerebrovascular disease (95% CI 1-5%; I 2 0%), and 2% for impaired consciousness (95% CI 1-2%; I 2 0%). Conclusion and Relevance: Patients with COVID-19 present with neurological and musculoskeletal symptoms. Therefore, clinicians need to be vigilant in the diagnosis and treatment of these patients.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University, Kano, Nigeria
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
| | - Sevim Acaroz Candan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Muhammad Aliyu Abba
- Department of Physiotherapy, Bayero University, Kano, Nigeria
- Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria
| | - Auwal Hassan Bello
- Department of Medical Rehabilitation, University of Maiduguri, Maiduguri, Nigeria
| | - Mansour Abdullah Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
- NHMRC Center of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | | | | | - Burak Kundakci
- University of Nottingham, Academic Rheumatology, Nottingham, United Kingdom
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Tsai ST, Lu MK, San S, Tsai CH. The Neurologic Manifestations of Coronavirus Disease 2019 Pandemic: A Systemic Review. Front Neurol 2020; 11:498. [PMID: 32574246 PMCID: PMC7248254 DOI: 10.3389/fneur.2020.00498] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: Review and integrate the neurologic manifestations of the Coronavirus Disease 2019 (COVID-19) pandemic, to aid medical practitioners who are combating the newly derived infectious disease. Methods: We reviewed the clinical research, consisting of mainly case series, on reported neurologic manifestations of COVID-19. We also reviewed basic studies to understand the mechanism of these neurologic symptoms and signs. Results: We included 79 studies for qualitative synthesis and 63 studies for meta-analysis. The reported neurologic manifestations were olfactory/taste disorders (35.6%), myalgia (18.5%), headache (10.7%), acute cerebral vascular disease (8.1%), dizziness (7.9%), altered mental status (7.8%), seizure (1.5%), encephalitis, neuralgia, ataxia, Guillain-Barre syndrome, Miller Fisher syndrome, intracerebral hemorrhage, polyneuritis cranialis, and dystonic posture. Conclusions: Neurologic manifestations in COVID-19 may alert physicians and medical practitioners to rule in high-risk patients. The increasing incidence of olfactory/taste disorders, myalgia, headache, and acute cerebral vascular disease renders a possibility that COVID-19 could attack the nervous system. The cytokine secretion and bloodstream circulation (viremia) are among the most possible routes into the nervous system.
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Affiliation(s)
- Sheng-Ta Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- Everflourish Neuroscience and Brain Disease Center, China Medical University Hospital, Taichung, Taiwan
| | - Shao San
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Mardanshahi Z, Tayebi M, Shafiee S, Barzin M, Shafizad M, Alizadeh-Navaei R, Gholinataj A. Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double inversion recovery. Biomedicine (Taipei) 2020; 10:29-35. [PMID: 33854932 PMCID: PMC7735974 DOI: 10.37796/2211-8039.1058] [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: 09/29/2019] [Accepted: 11/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of subarachnoid hemorrhage (SAH) especially at the subacute stage is still a challenging issue using the conventional imaging modalities. Here we evaluated the role of double inversion recovery (DIR) sequence of MRI compared with the conventional gradient-recalled echo (GRE)-T2*-W and susceptibility-weighted imaging (SWI) sequences in the diagnosis of subacute SAH. MATERIALS AND METHODS This prospective study was conducted on 21 patients with SAH, which were diagnosed using CT scan at the initial step. In the third week after the injury (14-20 days), all patients underwent a brain MRI exam that included T2*-W, SWI, and DIR imaging sequences. All images were independently read by two radiologists, who were blinded to the clinical history of the patients. The presence or absence of SAH was reviewed and assessed in 6 anatomical regions. RESULTS On the DIR images, 20 patients were found to have at least one subarachnoid signal abnormality, while the SWI and T2*-W images identified SAH areas on 17 and 15 patients, respectively. The highest rate of inter-observer consensus by the DIR sequence was found in the interhemispheric fissure and perimesencephalic area (k = 1). Also, a highest rate of inter-observer consensus using SWI was found in the interhemispheric fissure and posterior fossa cistern area (k = 1). A weak agreement was found in frontal-parietal convexity using SWI (k = 0.447), and in posterior fossa cistern by the T2* sequence (k = 0.447). CONCLUSION In conclusion, the DIR sequence was more reliable at identifying signal abnormalities in subacute SAH patients than the T2*-W and SWI sequence, and is suggested as a promising imaging technique for detecting hemorrhagic areas without considering the anatomical distribution of SAH.
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Affiliation(s)
- Zahra Mardanshahi
- Department of Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Tayebi
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sajad Shafiee
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Misagh Shafizad
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdolmajid Gholinataj
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author at: E-mail address: (A. Gholinataj)
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