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Harada T, Uozumi Y, Fukuoka H, Miyake S, Yamamoto D, Okamura Y, Ishii T, Tatsumi S, Mizobe T, Aihara H, Tanaka K, Kohmura E, Sasayama T. The impact of hormonal dynamics and serum sodium fluctuations on symptomatic vasospasm after subarachnoid hemorrhage. J Clin Neurosci 2022; 103:131-140. [PMID: 35872447 DOI: 10.1016/j.jocn.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symptomatic vasospasm (SVS) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH), and serum sodium frequently decreases before SVS. Serum sodium changes might be regulated by sodium metabolism-related hormones. This multi-institutional prospective cohort study therefore investigated the measurement of sodium metabolism-related hormones to elucidate the pathophysiology of serum sodium changes in SAH. METHODS SAH patients were treated with clipping or coiling from September 2017 to August 2020 at five hospitals. The laboratory data of 133 SAH patients were collected over 14 days and correlations between changes in serum sodium, sodium metabolism-related hormones (plasma adrenocorticotropic hormone (ACTH), serum cortisol, plasma arginine vasopressin (AVP)), and SVS were determined. Serum sodium concentrations were measured every day and serum sodium levels >135 mEq/L were maintained until day 14. RESULTS Of the 133 patients, 18 developed SVS within 14 days of subarachnoid hemorrhage onset (SVS group) and 115 did not suffer from SVS (non-SVS group). Circulating AVP, ACTH, and cortisol concentrations were significantly higher on day 1 in the SVS group compared with the non-SVS group. Fluctuations in serum sodium in the SVS group were significantly higher than those in the non-SVS group. There were antiparallel fluctuations in serum sodium and potassium from days 2 to 14. CONCLUSIONS Elevated levels of ACTH/cortisol and AVP on day 1 may be predictive markers for the occurrence of SVS. Multiple logistic regression analysis showed that serum sodium fluctuations were associated with SVS occurrence. Serum sodium fluctuations were associated with stress-related hormonal dynamics. (249 words).
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Affiliation(s)
- Tomoaki Harada
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
| | - Yoichi Uozumi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan.
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
| | - Shigeru Miyake
- Department of Neurosurgery, Kita-Harima Medical Center, 926-250 Ichiba cho, Ono 675-1392, Japan
| | - Daisuke Yamamoto
- Department of Neurosurgery, Kita-Harima Medical Center, 926-250 Ichiba cho, Ono 675-1392, Japan
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, 1094 Tomaki, Toyooka 668-8501, Japan
| | - Taiji Ishii
- Department of Neurosurgery, Toyooka Hospital, 1094 Tomaki, Toyooka 668-8501, Japan
| | - Shotaro Tatsumi
- Department of Neurosurgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki cho, Hirohata ku, Himeji 671-1122, Japan
| | - Takashi Mizobe
- Department of Neurosurgery, Hyogo Brain and Heart Center, 520 Saisho, Himeji 670-981, Japan
| | - Hideo Aihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, 520 Saisho, Himeji 670-981, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan; Department of Neurosurgery, Kinki Central Hospital, 3-1 Kurumazuka Itami, 664-8533, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
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Influence of sex and hormonal status on initial impact and neurocognitive outcome after subarachnoid haemorrhage in rats. Behav Brain Res 2019; 363:13-22. [PMID: 30703399 DOI: 10.1016/j.bbr.2019.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 12/23/2022]
Abstract
The aim of this study was to detect differences in functional outcome after experimental subarachnoid haemorrhage (SAH) in rodents with different hormonal status. For this purpose, the endovascular perforation model was applied to four groups of Sprague-Dawley-Rats: male intact, male neutered, female intact and female neutered animals. Initial impact was measured by ICP, CPP and cerebral blood flow in the first hour after SAH. From day 4-14, the modified hole board test was applied to assess functional and neuro-cognitive outcome. Histological outcome was examined in the motor cortex and hippocampus of each hemisphere. Mortality was highest in the female intact group albeit not statistically significant. Physiologic parameters did not differ significantly between groups either. In the modified hole board test, male intact animals showed a greater impairment of declarative memory than the female intact and neutered groups. However, male intact animals showed greater avoidance behaviour and male animals revealed higher anxiety levels independent of hormonal status. No differences in histological damage of hippocampus and motor cortex between groups could be shown. We therefore speculate that the marginal deficits in cognitive performance that are shown by the male intact group in the modified hole board test are mostly caused by higher anxiety levels and cannot be interpreted as pure cognitive impairment.
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Baltar M, Costa A, Carreira LM. A Pilot Study Exploring the Plasma Potassium Variation in Dogs Undergoing Steroid Therapy and Its Clinical Importance. Top Companion Anim Med 2016; 31:73-77. [PMID: 27968757 DOI: 10.1053/j.tcam.2016.03.002] [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: 08/23/2015] [Accepted: 03/07/2016] [Indexed: 11/11/2022]
Abstract
In most situations in veterinary medicine, glucocorticoids are the drugs of choice used, that is, to reduce the inflammatory response or limit an inappropriate immune response. Their use in long-term therapy may cause side effects that may weaken the patient. The aim of the study was to evaluate possible variations in the plasma potassium concentrations and their clinical relevance in dogs undergoing steroid therapy with methylprednisolone in anti-inflammatory doses. The study used a sample of 21 dogs (n = 21) presented for consultation, with a clinical condition requiring a corticosteroid therapeutic protocol with an anti-inflammatory dose of methylprednisolone. All the individuals were submitted to a corticosteroid therapeutic protocol administered orally during 18 days. During this period, 3 time points were considered: T0 (the day the prescription was first given), T1 (3 days later), and T2 (8 days later). Blood samples were collected from a peripheral vein to measure plasma potassium concentrations in T0, T1, and T2. Corticosteroid therapy on an outpatient basis statistically significantly decreased plasma potassium levels, especially between T1 and T2 (P = .03). The plasma potassium levels decreased in 12.5% of the males, compared with a decrease of 23.1% in the females. No statistically significant relationships were observe between the decreased plasma potassium levels and age, clinical condition, and patient׳s body weight. However, we found a statistically significant association between decreased plasma potassium levels and sex. The study results may justify the need for the systematic prescription of potassium supplements in patients undergoing steroid therapy, similar to what already occurs in human medicine.
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Affiliation(s)
- Marina Baltar
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
| | - Alexandra Costa
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
| | - L Miguel Carreira
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal; Department of Clinic, Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal; Centre for Interdisciplinary Research in Animal Health (CIISA), FMV/ULisboa, Lisbon, Portugal.
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Kimura A, Kobayashi K, Yamaguchi H, Takahashi T, Harada M, Honda H, Mori Y, Hirose K, Tanaka N. New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study. BMJ Open 2016; 6:e010999. [PMID: 27612533 PMCID: PMC5020742 DOI: 10.1136/bmjopen-2015-010999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To ensure good outcomes in the management of subarachnoid haemorrhage (SAH), accurate prediction is crucial for initial assessment of patients presenting with acute headache. We conducted this study to develop a new clinical decision rule using only objectively measurable predictors to exclude SAH, offering higher specificity than the previous Ottawa SAH Rule while maintaining comparable sensitivity. DESIGN Multicentre prospective cohort study. SETTING Tertiary-care emergency departments of five general hospitals in Japan from April 2011 to March 2014. PARTICIPANTS Eligible patients comprised 1781 patients aged >15 years with acute headache, excluding trauma or toxic causes and patients who presented in an unconscious state. MAIN OUTCOME MEASURES Definitive diagnosis of SAH was based on confirmation of SAH on head CT or lumbar puncture findings of non-traumatic red blood cells or xanthochromia. RESULTS A total of 1561 patients were enrolled in this study, of whom 277 showed SAH. Using these enrolled patients, we reached a rule with mainly categorical predictors used in previous reports, called the 'Ottawa-like rule', offering 100% sensitivity when using any of age ≥40 years, neck pain or stiffness, altered level of consciousness or onset during exertion. Using the 1317 patients from whom blood samples were obtained, a new rule using any of systolic blood pressure >150 mm Hg, diastolic blood pressure >90 mm Hg, blood sugar >115 mg/dL or serum potassium <3.9 mEq/L offered 100% sensitivity (95% CI 98.6% to 100%) and 14.5% specificity (12.5% to 16.9%), while the Ottawa-like rule showed the same sensitivity with a lower specificity of 8.8% (7.2% to 10.7%). CONCLUSIONS While maintaining equal sensitivity, our new rule seemed to offer higher specificity than the previous rules proposed by the Ottawa group. Despite the need for blood sampling, this method can reduce unnecessary head CT in patients with acute headache. TRIAL REGISTRATION NUMBER UMIN 00004871.
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Affiliation(s)
- Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Kentaro Kobayashi
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Hitoshi Yamaguchi
- Department of Intensive Care Medicine, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan
| | - Takeshi Takahashi
- Department of Emergency and Critical Care, National Hospital Organization Kumamoto Medical Center, Kumamoto City, Kumamoto, Japan
| | - Masahiro Harada
- Department of Emergency and Critical Care, National Hospital Organization Kumamoto Medical Center, Kumamoto City, Kumamoto, Japan
| | - Hideki Honda
- Department of Emergency and Critical Care Medicine, Yokosuka General Hospital Uwamachi, Yokosuka City, Kanagawa, Japan
| | - Yoshio Mori
- Emergency and Critical Care Center, Gifu Prefectural General Medical Center, Gifu City, Gifu, Japan
| | - Keika Hirose
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Noriko Tanaka
- Biostatistics Section, Department of Clinical Research and Informatics, Clinical Science Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
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To look beyond vasospasm in aneurysmal subarachnoid haemorrhage. BIOMED RESEARCH INTERNATIONAL 2014; 2014:628597. [PMID: 24967389 PMCID: PMC4055362 DOI: 10.1155/2014/628597] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/07/2014] [Indexed: 12/26/2022]
Abstract
Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed.
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Chen S, Feng H, Sherchan P, Klebe D, Zhao G, Sun X, Zhang J, Tang J, Zhang JH. Controversies and evolving new mechanisms in subarachnoid hemorrhage. Prog Neurobiol 2014; 115:64-91. [PMID: 24076160 PMCID: PMC3961493 DOI: 10.1016/j.pneurobio.2013.09.002] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 09/07/2013] [Accepted: 09/12/2013] [Indexed: 12/13/2022]
Abstract
Despite decades of study, subarachnoid hemorrhage (SAH) continues to be a serious and significant health problem in the United States and worldwide. The mechanisms contributing to brain injury after SAH remain unclear. Traditionally, most in vivo research has heavily emphasized the basic mechanisms of SAH over the pathophysiological or morphological changes of delayed cerebral vasospasm after SAH. Unfortunately, the results of clinical trials based on this premise have mostly been disappointing, implicating some other pathophysiological factors, independent of vasospasm, as contributors to poor clinical outcomes. Delayed cerebral vasospasm is no longer the only culprit. In this review, we summarize recent data from both experimental and clinical studies of SAH and discuss the vast array of physiological dysfunctions following SAH that ultimately lead to cell death. Based on the progress in neurobiological understanding of SAH, the terms "early brain injury" and "delayed brain injury" are used according to the temporal progression of SAH-induced brain injury. Additionally, a new concept of the vasculo-neuronal-glia triad model for SAH study is highlighted and presents the challenges and opportunities of this model for future SAH applications.
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Affiliation(s)
- Sheng Chen
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Physiology & Pharmacology, Loma Linda University, Loma Linda, CA, USA
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Prativa Sherchan
- Department of Physiology & Pharmacology, Loma Linda University, Loma Linda, CA, USA
| | - Damon Klebe
- Department of Physiology & Pharmacology, Loma Linda University, Loma Linda, CA, USA
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Xiaochuan Sun
- Department of Neurosurgery, First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiping Tang
- Department of Physiology & Pharmacology, Loma Linda University, Loma Linda, CA, USA
| | - John H Zhang
- Department of Physiology & Pharmacology, Loma Linda University, Loma Linda, CA, USA; Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.
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Kagerbauer SM, Rothoerl RD, Brawanski A. Pituitary dysfunction after aneurysmal subarachnoid hemorrhage. Neurol Res 2013; 29:283-8. [PMID: 17509228 DOI: 10.1179/016164107x165633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Patients recovering from aneurysmal SAH often complain about weakness, fatigue and impaired cognitive skills. Pituitary dysfunction might be one possible reason for these complaints, as in patients with traumatic brain injury, hypopituitarism is known to be a common complication. There are only a few studies dealing with this problem in SAH patients, but these studies suggest that pituitary disturbances are very frequent after aneurysmal SAH. But anterior pituitary lobe disturbances might not be the only one responsible for some complaints or complications in patients suffering from aneurysmal SAH. Hyponatremia in the early state after SAH could be a hint for posterior pituitary lobe dysfunction.
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Affiliation(s)
- S M Kagerbauer
- University of Regensburg, Department of Neurosurgery, Regensburg, Germany.
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