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Ya X, Liu C, Ma L, Ge P, Xu X, Zheng Z, Mou S, Wang R, Zhang Q, Ye X, Zhang D, Zhang Y, Wang W, Li H, Zhao J. Single-cell atlas of peripheral blood by CyTOF revealed peripheral blood immune cells metabolic alterations and neutrophil changes in intracranial aneurysm rupture. MedComm (Beijing) 2024; 5:e637. [PMID: 39015556 PMCID: PMC11247334 DOI: 10.1002/mco2.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/12/2024] [Accepted: 05/30/2024] [Indexed: 07/18/2024] Open
Abstract
Previous studies have found that the peripheral immune environment is closely related to the occurrence and development of intracranial aneurysms. However, it remains unclear how the metabolism of peripheral blood mononuclear cells (PBMCs) and the composition of polymorphonuclear leukocytes (PMNs) changes in the process of intracranial aneurysm rupture. This study utilized cytometry by time of flight technology to conduct single-cell profiling analysis of PBMCs and PMNs from 72 patients with IAs. By comparing the expression differences of key metabolic enzymes in PBMCs between patients with ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms, we found that most PBMCs subsets from RIA group showed upregulation of rate-limiting enzymes related to the glycolytic pathway. By comparing the composition of PMNs, it was found that the proinflammatory CD101+HLA DR+ subsets were increased in the RIA group, accompanied by a decrease in the anti-inflammatory polymorphonuclear myeloid-derived suppressor cells. In conclusion, this study showed the changes in the peripheral immune profile of RIAs, which is helpful for our understanding of the mechanisms underlying peripheral changes and provides a direction for future related research.
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Affiliation(s)
- Xiaolong Ya
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chenglong Liu
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Long Ma
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xiaoxue Xu
- Department of Core Facility CenterCapital Medical UniversityBeijingChina
| | - Zhiyao Zheng
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Siqi Mou
- Medical SchoolUniversity of Chinese Academy of SciencesBeijingChina
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of NeurosurgeryBeijing HospitalBeijingChina
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Wenjing Wang
- Beijing Institute of Hepatology, Beijing YouAn HospitalCapital Medical UniversityBeijingChina
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
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Sümer Coşkun A, Bülbül M, Çeker T, Özak A, Tanrıöver G, Elif Gürer İ, Tuzcu Balaban H, Göksu E, Aslan M. Protective Effects of Adropin in Experimental Subarachnoid Hemorrhage. Neuroscience 2024; 551:307-315. [PMID: 38851381 DOI: 10.1016/j.neuroscience.2024.05.037] [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] [Received: 03/21/2024] [Revised: 05/01/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE We aimed to investigate early effects of exogenously administered adropin (AD) on neurological function, endothelial nitric oxide synthase (eNOS) expression, nitrite/nitrate levels, oxidative stress, and apoptosis in subarachnoid hemorrhage (SAH). METHODS Following intracerebroventricular AD administration (10 µg/5 µl at a rate of 1 µl/min) SAH model was carried out in Sprague-Dawley rats by injection of autologous blood into the prechiasmatic cistern. The effects of AD were assessed 24 h following SAH. The modified Garcia score was employed to evaluate functional insufficiencies. Adropin and caspase-3 proteins were measured by ELISA, while nitrite/nitrate levels, total antioxidant capacity (TAC) and reactive oxygen/nitrogen species (ROS/RNS) were assayed by standard kits. eNOS expression and apoptotic neurons were detected by immunohistochemical analysis. RESULTS The SAH group performed notably lower on the modified Garcia score compared to sham and SAH + AD groups. Adropin administration increased brain eNOS expression, nitrite/nitrate and AD levels compared to SHAM and SAH groups. SAH produced enhanced ROS/RNS generation and reduced antioxidant capacity in the brain. Adropin boosted brain TAC and diminished ROS/RNS production in SAH rats and no considerable change amongst SHAM and SAH + AD groups were detected. Apoptotic cells were notably increased in intensity and number after SAH and were reduced by AD administration. CONCLUSIONS Adropin increases eNOS expression and reduces neurobehavioral deficits, oxidative stress, and apoptotic cell death in SAH model. Presented results indicate that AD provides protection in early brain injury associated with SAH.
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Affiliation(s)
- Ayşenur Sümer Coşkun
- Division of Anesthesia and Reanimation, Kepez State Hospital, 07320 Antalya, Turkey.
| | - Mehmet Bülbül
- Department of Physiology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - Tuğçe Çeker
- Department of Medical Biochemistry, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - Ahmet Özak
- Department of Neurosurgery, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - Gamze Tanrıöver
- Department of Histology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - İnanç Elif Gürer
- Department Pathology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - Hazal Tuzcu Balaban
- Department Pathology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - Ethem Göksu
- Department of Neurosurgery, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
| | - Mutay Aslan
- Department of Medical Biochemistry, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey.
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Qiu W, Li W, Xu K, Zhu G, Luo H, Deng Y, Qin Z, Zeng K, Wei Y, Lin X. Prognostic significance of fibrinogen and neutrophil/lymphocyte ratio score and D-dimer/Albumin ratio for prognosis in patients with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107338. [PMID: 37690163 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107338] [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: 04/10/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Recent research indicates that systemic inflammation significantly affects the overall prognosis of individuals with aneurysmal subarachnoid hemorrhage. To delve deeper into this issue, a retrospective study was undertaken. The study aimed to investigate the relationship between fibrinogen and neutrophil/lymphocyte ratio scores, D-dimer/Albumin ratios, and the Glasgow Outcome Scale at 6 months post-discharge for patients with aSAH. METHODS A retrospective analysis was conducted on 321 patients who experienced aneurysmal subarachnoid hemorrhage. These patients were monitored using the Glasgow Outcome Scale six months after being discharged from Huizhou Central People's Hospital. Patients with GOS scores between 1 and 3 were classified as having a poor prognosis, while those with scores ranging from 4 to 5 were considered to have a good prognosis. To create distinct sets, patients were randomly divided into both training and validation groups. The best cut-off value for the D-dimer/Albumin ratio was established through ROC curves, and the scores for fibrinogen and the neutrophil/lymphocyte ratio were calculated. Utilizing multivariate logistic regression analysis, independent risk factors linked to an unfavorable prognosis in aSAH patients were identified. A nomogram model was developed and validated based on these findings, providing an improved approach for evaluating the prognostic influence of risk factors. To gauge the model's predictive performance, several analytical tools such as ROC curves, calibration curves, and decision curve analysis were employed. This comprehensive approach ensured a thorough assessment of the prognostic prediction capabilities of the model. RESULTS Multivariate regression analysis revealed that Age (OR=3.87, 95%CI=1.54-9.73, p=0.004), Pneumonia (OR=3.54, 95%CI=1.41-8.86, p=0.007), WFNS (OR=3.24, 95%CI=1.23-8.54, p=0.017), DAR (OR=2.88, 95%CI=1.13-7.34, p=0.027), and F-NLR (OR=3.12, 95%CI=1.22-7.97, p=0.017) were identified as independent risk factors influencing the prognosis of patients with aSAH. Additionally, the area under the ROC curve was 0.866 (95%CI=0.805-0.927) for the training set and 0.924 (95%CI=0.849-0.999) for the validation set. The calibration curve analysis demonstrated a minor error of 0.02 for the training set and 0.051 for the validation set. Furthermore, both the training set and validation set displayed significant clinical benefits according to the DCA curves, underscoring the meaningful utility of the developed nomogram. CONCLUSIONS Fibrinogen and neutrophil/lymphocyte ratio scores, and the D-dimer/Albumin ratio emerged as significant independent risk factors for prognosticating the outcomes of patients with aSAH. Leveraging these factors, a robust nomogram model was meticulously developed, showcasing its impressive precision in prognostic predictions. These results underscore the promising clinical applicability of these biomarkers as effective prognostic indicators for individuals afflicted by aSAH.
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Affiliation(s)
- Wenjie Qiu
- Guangdong Medical University, Zhanjiang, China
| | - Wencai Li
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Ke Xu
- Guangdong Medical University, Zhanjiang, China
| | - Gang Zhu
- Guangdong Medical University, Zhanjiang, China; Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China.
| | - Honghai Luo
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Yifan Deng
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Zhongzong Qin
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
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A Computational Model of Blood D-Dimer, Cystatin C, and CRP Levels Predicts the Risk of Intracranial Aneurysms and their Rupture. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2216509. [DOI: 10.1155/2022/2216509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/19/2022]
Abstract
Objective. The aim of this study is to construct a computational model of blood D-dimer, cystatin C, and CRP levels and to predict the risk of intracranial aneurysms and their rupture. Methods. A total of 69 intracranial aneurysms patients were selected as the case group, including 28 cases in the ruptured group and 41 cases in the unruptured group. Another 64 non-intracranial aneurysm patients were selected as the control group. The detection results of serum D-dimer, cystatin C, and CRP were collected. The logistic regression computational model was used to analyze the occurrence and risk factors of intracranial aneurysms. The receiver operating curves (ROC) of serum D-dimer, cystatin C, and C reactive protein (CRP) levels for predicting intracranial aneurysms and their rupture were drawn, and the area under the curve (AUC), sensitivity, and specificity were calculated. Results. The serum levels of D-dimer, cystatin C, and CRP in patients with intracranial aneurysms were significantly higher than those in the control group and the differences were statistically significant
. The serum levels of D-dimer, cystatin C, and CRP in patients with ruptured intracranial aneurysms were higher than those in patients with unruptured intracranial aneurysms, and the differences were also statistically significant
. The combined detection of serum D-dimer, cystatin C, and CRP levels has a higher AUC (0.9014) for predicting intracranial aneurysms and higher AUC (0.9412) for predicting ruptured intracranial aneurysms than D-dimer (0.7118 and 0.8750, respectively), cystatin C (0.6489 and 0.6180, respectively), and CRP (0.7764 and 0.6551, respectively) independent detection; the combined detection had a sensitivity of 93.75% and 87.80 for predicting the occurrence and rupture of intracranial aneurysms, and the specificity was 68.12% and 92.86%, respectively. Conclusion. The combined detection of serum D-dimer, cystatin C, and CRP levels is a very valuable indicator for predicting the occurrence and rupture of intracranial aneurysms, and combined detection can provide scientific evidence-based guidance for clinical prediction of the occurrence and rupture of intracranial aneurysms.
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Wang Y, Sun J, Zhao P, Yi H, Yuan H, Yang M, Sun B, Che F. Rapid magnetic separation: An immunoassay platform for the SERS-based detection of subarachnoid hemorrhage biomarkers. Front Chem 2022; 10:1002351. [PMID: 36339041 PMCID: PMC9634124 DOI: 10.3389/fchem.2022.1002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
The blood–brain barrier (BBB) is of vital importance to the progression and prognosis of subarachnoid hemorrhage (SAH). The construction of a simple, sensitive, and accurate detection assay for measuring the biomarkers associated with BBB injury is still an urgent need owing to the complex pathogenesis of SAH and low expression levels of pathological molecules. Herein, we introduced surface-enhanced Raman scattering (SERS) label-embedded Fe3O4@Au core-shell nanoparticles as ideal SERS sensors for quantitative double detection of MMP-9 and occludin in SAH patients. Meanwhile, utilizing the SERS signals to dynamically estimate MMP-9 and occludin concentration in the rat SAH model is the first application in exploring the relationship of pathological MMP-9 and occludin molecular levels with neurobehavioral score. This method warrants reliable detection toward MMP-9 and occludin with a wide recognition range and a low detection limit in blood samples. Furthermore, the results monitored by the SERS assay exactly matched with those obtained through a traditional enzyme-linked immunosorbent assay (ELISA). The aforementioned results demonstrated this novel biosensor strategy has extensive application prospects in the quantitative measurement of multiple types of biomolecules in body fluid samples.
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Affiliation(s)
- Ying Wang
- Linyi People’s Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Jingyi Sun
- Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Peng Zhao
- Linyi People’s Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Hui Yi
- Linyi People’s Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Hui Yuan
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Mingfeng Yang
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Baoliang Sun
- Linyi People’s Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
- *Correspondence: Baoliang Sun, ; Fengyuan Che,
| | - Fengyuan Che
- Linyi People’s Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
- *Correspondence: Baoliang Sun, ; Fengyuan Che,
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Al-Mistarehi AH, Elsayed MA, Ibrahim RM, Elzubair TH, Badi S, Ahmed MH, Alkhaddash R, Ali MK, Khader YS, Alomari S. Clinical Outcomes of Primary Subarachnoid Hemorrhage: An Exploratory Cohort Study from Sudan. Neurohospitalist 2022; 12:249-263. [PMID: 35419154 PMCID: PMC8995598 DOI: 10.1177/19418744211068289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Although Subarachnoid Hemorrhage (SAH) is an emergency condition, its epidemiology and prognosis remain poorly understood in Africa. We aim to explore the clinical presentations, outcomes, and potential mortality predictors of primary SAH patients within 3 weeks of hospitalization in a tertiary hospital in Sudan. Methods We prospectively studied 40 SAH patients over 5 months, with 3 weeks of follow-up for the symptomatology, signs, Glasgow coma scale (GCS), CT scan findings, and outcomes. The fatal outcome group was defined as dying within 3 weeks. Results The mean age was 53.5 years (SD, 6.9; range, 41–65), and 62.5% were women. One-third (30.0%) were smokers, 37.5% were hypertensive, two-thirds (62.5%) had elevated blood pressure on admission, 37.5% had >24 hours delayed presentation, and 15% had missed SAH diagnosis. The most common presenting symptoms were headache and neck pain/stiffness, while seizures were reported in 12.5%. Approximately one-quarter of patients (22.5%) had large-sized Computed Tomography scan hemorrhage, and 40.0% had moderate size. In-hospital mortality rate was 40.0% (16/40); and 87.5% of them passed away within the first week. Compared to survivors, fatal outcome patients had significantly higher rates of smoking (50.0%), hypertension (68.8%), elevated presenting blood pressure (93.8%), delayed diagnosis (56.2%), large hemorrhage (56.2%), lower GCS scores at presentation, and cerebral rebleeding ( P < 0.05 for each). The primary causes of death were the direct effect of the primary hemorrhage (43.8%), rebleeding (31.3%), and delayed cerebral infarction (12.5%). Conclusions SAH is associated with a high in-hospital mortality rate in this cohort of Sudanese SAH patients due to modifiable factors such as delayed diagnosis, hypertension, and smoking. Strategies toward minimizing these factors are recommended.
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Affiliation(s)
- Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muaz A. Elsayed
- Department of Neurology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman Teaching Hospital / Sudan Medical Specialization Board, Khartoum, Sudan
| | | | - Tarig Hassan Elzubair
- Department of Psychiatry, Faculty of Medicine, University of Science and Technology (UST), Khartoum, Sudan
| | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital, NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Raed Alkhaddash
- Department of Neurology, The University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA
| | - Musaab K. Ali
- Department of Emergency Medicine, King Abdullah University Hospital, Irbid, Jordan/Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Yousef S. Khader
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Sun J, Song Y, Zhao S, Yang M, Yuan H, Wang Y, Liu X, Che F. Application of surface-enhanced Raman spectroscopy as a diagnostic system for the highly sensitive monitoring of the evolution of subarachnoid hemorrhage-induced complications. NEW J CHEM 2022. [DOI: 10.1039/d1nj06187a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A novel SERS biosensor to detect the development of SAH and its induced complications from cerebrospinal fluid is reported.
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Affiliation(s)
- Jingyi Sun
- Linyi People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Linyi, Shandong, 276003, China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, China
- Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Yanan Song
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
- Qingdao Medical College of Qingdao University, Qingdao, Shandong, 266021, China
| | - Shijun Zhao
- Department of Neurology, Baotou Central Hospital, Baotou 014040, China
| | - Mingfeng Yang
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Hui Yuan
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Ying Wang
- Linyi People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Linyi, Shandong, 276003, China
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Xinyu Liu
- Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Fengyuan Che
- Linyi People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Linyi, Shandong, 276003, China
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Stone L, Ryba B, Wali A, Santiago-Dieppa D, Pannell JS. Superior anastomotic vein hypoplasia as a unique predisposing factor for cerebral venous hypertension and atraumatic non-aneurysmal subarachnoid hemorrhage: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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April MD, Keim SM, Koyfman A, Meurer WJ, Schmitzberger F, Long B. Is a Lumbar Puncture Required to Rule Out Atraumatic Subarachnoid Hemorrhage in Emergency Department Patients With Headache and Normal Brain Computed Tomography More Than Six Hours After Symptom Onset? J Emerg Med 2021; 61:97-104. [PMID: 33838968 DOI: 10.1016/j.jemermed.2021.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atraumatic subarachnoid hemorrhage (SAH) is a deadly condition that most commonly presents as acute, severe headache. Controversy exists concerning evaluation of SAH based on the time from onset of symptoms, specifically if the headache occurred > 6 h prior to patient presentation. CLINICAL QUESTION Do patients undergoing evaluation for atraumatic SAH who have a negative computed tomography (CT) scan of the head obtained more than 6 h after symptom onset require a subsequent lumbar puncture to rule out the diagnosis? EVIDENCE REVIEW Studies retrieved included a retrospective cohort study, two prospective cohort studies, and a case-control study. These studies provide estimates of the diagnostic accuracy of head CT imaging obtained > 6 h from symptom onset and diagnostic test characteristics of subsequent lumbar puncture. CONCLUSION The probability of SAH above which emergency clinicians should perform a lumbar puncture is 1.0%. This threshold is essentially the same as the estimated probability of SAH in patients with a negative head CT obtained more than 6 h from symptom onset. Emergency physicians might reasonably decide to either perform or forego this procedure. Consequently, we contend that the decision whether to perform lumbar puncture in these instances is an excellent candidate for shared decision-making.
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Affiliation(s)
- Michael D April
- 2(nd) Brigade Combat Team, 4(th) Infantry Division, Fort Carson, Colorado; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Samuel M Keim
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - William J Meurer
- Departments of Emergency Medicine and Neurology, University of Michigan, Ann Arbor, Michigan
| | - Florian Schmitzberger
- Departments of Emergency Medicine and Neurology, University of Michigan, Ann Arbor, Michigan
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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Treatment of headache in aneurysmal subarachnoid hemorrhage: Multimodal approach. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2020.100857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Luo X, Li L, Zheng W, Gu L, Zhang X, Li Y, Xie Z, Cheng Y. HLY78 protects blood-brain barrier integrity through Wnt/β-catenin signaling pathway following subarachnoid hemorrhage in rats. Brain Res Bull 2020; 162:107-114. [DOI: 10.1016/j.brainresbull.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/08/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022]
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Youn DH, Kim BJ, Kim Y, Jeon JP. Extracellular Mitochondrial Dysfunction in Cerebrospinal Fluid of Patients with Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2020; 33:422-428. [PMID: 31898178 DOI: 10.1007/s12028-019-00895-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mitochondrial dysfunction is related to brain ischemic injury and neural cell death. However, little is known about the association between mitochondrial dysfunction of cerebrospinal fluid (CSF) and delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH). The objective of this study was to investigate whether extracellular CSF mitochondria might serve as a potential biomarker for DCI. METHODS CSF samples were serially collected at 1, 3, and 5 days following SAH in 33 patients (DCI, n = 12; and non-DCI, n = 21) who underwent coil embolization. To monitor mitochondrial membrane potentials, JC-1 dye was used. The ratio (red/green) of JC-1 was considered as an indicator of intact mitochondrial membrane potential. Flow cytometry was done to analyze extracellular mitochondria particles and their possible cellular origins. RESULTS DCI patients had lower JC-1 red/green ratios than non-DCI patients at 1 day (3.35 [3.20-3.75] vs. 3.70 [3.40-3.95] in non-DCI) and 3 days (4.65 [4.45-5.00] vs. 5.10 [4.65-5.30] in non-DCI) after SAH. At 5 days after SAH, JC-1 red/green ratio was significantly lower in DCI than that in non-DCI (3.05 [2.90-3.35] vs. 4.20 [4.10-4.50]; p < 0.01) patients. DCI patients had a higher percentage of vWF-positive mitochondria (40.10% [38.25%-44.90%] vs. 30.20% [25.70%-36.68%]) and a lower percentage of GLAST-positive mitochondria particles (26.85% [17.10%-30.00%] vs. 31.60% [26.70%-35.00%]) than non-DCI patients. However, there was no significant difference in CD45-positive (p = 0.369) or CD41/61-positive mitochondrial particles (p = 0.155) between the two groups of patients. CONCLUSIONS Mitochondrial membrane potential could be a marker of DCI. JC-1 ratios seemed to be able to predict future DCI onset. Further studies are needed to determine detailed mechanisms of extracellular mitochondria-mediated cell-to-cell signals in DCI.
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Affiliation(s)
- Dong Hyuk Youn
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea
| | - Bong Jun Kim
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea
| | - Youngmi Kim
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon, Korea. .,Genetic and Research Inc, Chuncheon, Korea. .,Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea.
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Liu JJ, Raskin JS, McFarlane R, Samatham R, Cetas JS. Subarachnoid Hemorrhage Pattern Predicts Acute Cerebral Blood Flow Response in the Rat. ACTA NEUROCHIRURGICA. SUPPLEMENT 2020; 127:83-89. [PMID: 31407068 DOI: 10.1007/978-3-030-04615-6_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is considerable variability in the presentation of patients with acute subarachnoid hemorrhage (aSAH). Evidence suggests that a thick, diffuse clot better predicts the development of delayed cerebral ischemia and poor outcomes. In a rodent model of acute SAH, we directly measured the effects of the volume of blood injected versus the pattern of distribution of hemorrhage in the subarachnoid space on markers of early brain injury, namely, cerebral blood flow (CBF), cerebrospinal fluid (CSF) concentrations of P450 eicosanoids and catecholamines, and cortical spreading depolarizations (CSDs). There is a significant decrease in CBF, an increase in CSF biomarkers, and a trend toward increasing frequency and severity of CSDs when grouped by severity of hemorrhage but not by volume of blood injected. In severe hemorrhage grade animals, there was a progressive decrease in CBF after successive CSD events. These results suggest that the pattern of SAH (thick diffuse clots) correlates with the "clinical" severity of SAH.
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Affiliation(s)
- Jesse J Liu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey S Raskin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | | | - Ravi Samatham
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Justin S Cetas
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.
- Portland VA Medical Center, Portland, OR, USA.
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Ortega-Gutierrez S, Samaniego EA, Reccius A, Huang A, Zheng-Lin B, Masukar A, Marshall RS, Petersen NH. Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2020; 127:149-153. [PMID: 31407076 DOI: 10.1007/978-3-030-04615-6_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV). METHODS Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07-0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT. RESULTS Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3-5 after bleed (14.22 vs 27.51; p = 0.05). CONCLUSIONS DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.
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Affiliation(s)
- S Ortega-Gutierrez
- Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA.
| | - E A Samaniego
- Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - A Reccius
- Department of Critical Care, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - A Huang
- Department of Neurology, Columbia University, New York, NY, USA
| | - B Zheng-Lin
- Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - A Masukar
- Department of Neurology, Columbia University, New York, NY, USA
| | - R S Marshall
- Department of Neurology, Columbia University, New York, NY, USA
| | - N H Petersen
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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15
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Burke T, Hughes S, Carr A, Javadpour M, Pender N. A Systematic Review of Cognitive Outcomes in Angiographically Negative Subarachnoid Haemorrhage. Neuropsychol Rev 2018; 28:453-469. [DOI: 10.1007/s11065-018-9389-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
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16
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Cognitive Evolution of a Patient Who Suffered a Subarachnoid Haemorrhage Eight Years Ago, after Being Treated with Growth Hormone, Melatonin and Neurorehabilitation. REPORTS 2018. [DOI: 10.3390/reports1010002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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17
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Anesthetic Management of Cerebral Aneurysm Surgery (Intracranial Vascular Surgeries). Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Cao Y, Tian M, Fang Q, Wen Z, Wang W, Ding H, Wang DW. Joint Effects of GWAS SNPs in Coagulation System Confer Risk to Hypertensive Intracerebral Hemorrhage. Neuromolecular Med 2017; 19:395-405. [PMID: 28718048 DOI: 10.1007/s12017-017-8453-y] [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: 05/14/2016] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
Recent genome-wide association studies (GWAS) have identified numerous single nucleotide polymorphisms (SNPs) associated with coagulation system, including hemostatic factors and hematological phenotypes. However, few articles described the relationships between these SNPs and the risk of hemorrhagic stroke. The aim of our study was to evaluate the roles of these SNPs as risk factors and survival predictors for hemorrhagic stroke. Thirteen SNPs from GWAS in coagulation system were genotyped in a Chinese Han population including 1000 patients with hemorrhagic stroke (intracerebral hemorrhage, ICH = 743; subarachnoid hemorrhage, SAH = 257) and 1044 population-based controls. The associations between the genetics risk score (GRS) and risk of hemorrhagic stroke as well as post-stroke adverse outcomes were determined. No individual SNP was associated with the risk of hemorrhagic stroke. The GRS was calculated by summing the number of risk alleles of each SNP, and a total of 13 SNPs were included. Meanwhile, the GRS cutoffs values were defined to be close to quartiles or tertiles in control subjects. For quartiles, individuals with GRS about 8-9, 10-11, ≥12 had 1.28 (OR 1.28, 95% CI 0.98-1.68, p = 0.067)-, 1.36 (OR 1.36, 95% CI 1.04-1.79, p = 0.026)-, 1.53 (OR 1.53, 95% CI 1.13-2.07, p = 0.006)-fold increase in ICH risk compared to those with GRS ≤7, respectively; for tertiles, individuals with GRS about GRS 9-10, ≥11 had 0.98 (OR 0.98, 95% CI 0.78-1.23, p = 0.067)- and 1.26 (OR 1.26, 95% CI 1.00-1.59, p = 0.048)-fold increase in ICH risk compared to those with GRS ≤8, respectively. Further stratification analyses indicated that this association was only found in hypertensive ICH subjects. However, no statistical difference was found in the volume of hematoma, activities of daily living scale as well as hospital death in the ICH patients based on GRS values. Joint effects of SNPs associated with low coagulation factor levels might confer risk to ICH patients with hypertension. However, the clinical value on risk stratification and survival prediction was limited.
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Affiliation(s)
- Yanyan Cao
- Division of Cardiology, Departments of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Min Tian
- Division of Cardiology, Departments of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qin Fang
- Division of Cardiology, Departments of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Zheng Wen
- Division of Cardiology, Departments of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Hu Ding
- Division of Cardiology, Departments of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China. .,Institute of Hypertension, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430030, People's Republic of China.
| | - Dao Wen Wang
- Division of Cardiology, Departments of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China. .,Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China. .,Institute of Hypertension, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430030, People's Republic of China.
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19
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Long B, Koyfman A. Vascular Causes of Syncope: An Emergency Medicine Review. J Emerg Med 2017; 53:322-332. [PMID: 28662832 DOI: 10.1016/j.jemermed.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. OBJECTIVE This review evaluates vascular causes of syncope and their evaluation and management in the ED. DISCUSSION Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management. CONCLUSIONS Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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20
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Ljubisavljevic S, Milosevic V, Stojanov A, Ljubisavljevic M, Dunjic O, Zivkovic M. Identification of clinical and paraclinical findings predictive for headache occurrence during spontaneous subarachnoid hemorrhage. Clin Neurol Neurosurg 2017; 158:40-45. [PMID: 28458057 DOI: 10.1016/j.clineuro.2017.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Headache is recognized as the main but unwarranted symptom of subarachnoid hemorrhage (SAH). There are no enough findings identified as predictive for headache occurrence in SAH. We evaluated the clinical and paraclinical factors predictive for headache occurrence in SAH. PATIENTS AND METHODS We retrospectively analyzed medical records of 431 consecutive non traumatic SAH patients (264 females and 167 males), ages from 19 to 91 years, presenting with headache (70.3%) and without headache (29.7%) during period of 11years. RESULTS Among all tested parameters, as negative predictors for headache occurrence were recognized: patients' ages (OR 0.97 [95%CI: 0.96-0.99], p=0.025), persistence of coagulation abnormality (OR 0.23 [95%CI: 0.08-0.67], p=0.006), atrial fibrilation (OR 0.23 [95%CI: 0.09-0.59], p=0.002), chronic renal failure (OR 0.26 [95%CI: 0.09-0.76], p=0.014) and more diseases (OR 0.11 [95%CI: 0.04-0.32], p<0.0001), as higher clinical score (OR 0.94 [95%CI: 0.90-0.99], p=0.018) including positive neurological findings (OR 0.34 [95%CI: 0.21-0.55], p<0.001) and loss of consciousness (OR 0.22 [95%CI: 0.12-0.39], p<0.001) at the SAH onset, while the complaint of neck stiffness was identified as its positive predictor (OR 1.93 [95%CI: 1.19-3.10], p=0.007). CONCLUSIONS Although diagnosis based solely on clinical presentation is not reliable and speculative, our findings could provide physicians with evidence to consider SAH not only in conditions of its headache occurrence but also in those with headache absence.
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Affiliation(s)
- Srdjan Ljubisavljevic
- Faculty of Medicine, University of Nis, Nis, Serbia; Clinic for Neurology, Clinical Center Nis, Nis, Serbia.
| | - Vuk Milosevic
- Clinic for Neurology, Clinical Center Nis, Nis, Serbia
| | | | | | | | - Miroslava Zivkovic
- Faculty of Medicine, University of Nis, Nis, Serbia; Clinic for Neurology, Clinical Center Nis, Nis, Serbia
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21
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Moisset X, Mawet J, Guegan-Massardier E, Bozzolo E, Gilard V, Tollard E, Feraud T, Noëlle B, Rondet C, Donnet A. French Guidelines For the Emergency Management of Headaches. Rev Neurol (Paris) 2016; 172:350-60. [PMID: 27377828 DOI: 10.1016/j.neurol.2016.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/08/2016] [Indexed: 01/03/2023]
Affiliation(s)
- X Moisset
- Inserm U-1107, NeuroDol, Clermont Université, Université d'Auvergne, 49, boulevard François-Mitterrand, 63000 Clermont-Ferrand, France; CHU Gabriel Montpied, Service de Neurologie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
| | - J Mawet
- Centre d'urgences céphalées, département de Neurologie, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris AP-HP, Université Paris Denis Diderot et DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | - E Guegan-Massardier
- Service de neurologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - E Bozzolo
- Service de neurologie, Pôle des Neurosciences Cliniques, CHU de Nice, Nice, France
| | - V Gilard
- Service de neurochirurgie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - E Tollard
- Service de neuroradiologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - T Feraud
- Service d'accueil des urgences, hôpital Timone, boulevard Jean-Moulin, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Noëlle
- Cabinet privé, 35, allée de Champrond, 38330 Saint-Ismier, France
| | - C Rondet
- Faculté de médecine, Service de médecine générale, Université Pierre-et-Marie-Curie Paris 06, Paris, France
| | - A Donnet
- Inserm U-1107, NeuroDol, Clermont Université, Université d'Auvergne, 49, boulevard François-Mitterrand, 63000 Clermont-Ferrand, France; Centre d'évaluation et de traitement de la douleur, hôpital Timone, boulevard Jean-Moulin, 264, rue Saint-Pierre, 13385 Marseille, France
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22
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Arati S, Sibin MK, Bhat DI, Narasingarao KVL, Chetan GK. Polymorphisms of apolipoprotein E and aneurysmal subarachnoid haemorrhage: A meta-analysis. Meta Gene 2016; 9:151-8. [PMID: 27408823 PMCID: PMC4925774 DOI: 10.1016/j.mgene.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 12/21/2022] Open
Abstract
Subarachnoid haemorrhage (SAH) is characterised by bleeding in the subarachnoid space in the brain. There are various polymorphisms in genes which are associated with this disease. We performed a systematic meta- analysis to investigate the relationship of APOE polymorphism on aSAH. A comprehensive literature search was done in the Pubmed database, Science Direct, Cochrane library and Google Scholar. The OR and 95% CI were evaluated for the gene and aSAH association using fixed and random effect models. Publication bias was assessed using Begg's funnel plot and Egger's regression test. All statistical evaluations were done using the software Review Manager 5.0 and Comprehensive Meta Analysis v2.2.023. A total of 9 studies were assessed on APOE polymorphism (1100 Cases, 2732 Control). Meta analysis results showed significant association in ε2/ ε2 versus ε3/ε3, ε2 versus ε3 genetic models and ε2 allele frequency. In subgroup analysis statistically significant association was observed in Asians in the genetic models ε2/ ε2 versus ε3/ε3, ε2/ε3 versus ε3/ε3, ε2 versus ε3 and also in ε2 allele frequency. However, in Caucasian population only ε2/ε2 versus ε3/ε3 genetic model showed significant association between APOE and risk of aSAH. In this meta-analysis study, the ε2/ε2 genotype is associated with increased risk of aSAH.
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Affiliation(s)
- S Arati
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - M K Sibin
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Dhananjaya I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - K V L Narasingarao
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - G K Chetan
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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Heit JJ, Rabinov JD. Reply. AJNR Am J Neuroradiol 2016; 37:E54. [PMID: 27056429 DOI: 10.3174/ajnr.a4802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J J Heit
- Department of Interventional Neuroradiology Stanford University Medical Center Stanford, California
| | - J D Rabinov
- Department of Interventional Neuroradiology Massachusetts General Hospital Boston, Massachusetts
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24
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Lominadze G, Lessen S, Keene A. Vasospasm Risk in Surgical ICU Patients With Grade I Subarachnoid Hemorrhage. Neurohospitalist 2016; 6:20-3. [PMID: 26740854 DOI: 10.1177/1941874415589321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. The initial hemorrhage causes death in approximately 25% of patients, with most subsequent mortality being attributable to delayed cerebral ischemia (DCI). Delayed cerebral ischemia generally occurs on post-bleed days 4 through 20, with the incidence peaking at day 8. Because of the risks of DCI, patients with SAH are usually monitored in an intensive care unit (ICU) for 14 to 21 days. Unfortunately, prolonged ICU admissions are expensive and are associated with well-documented risks to patients. We hypothesized that a subset of patients who are at low risk of DCI should be safe to transfer out of the ICU early. All patients admitted to Montefiore Medical Center from 2008 to 2013 with grade I SAH who had their aneurysms successfully protected, had an uncomplicated postoperative course, and had no clinical or ultrasonographic evidence of DCI after day 8 were retrospectively studied. The primary outcome was clinical or ultrasonographic evidence of the development of DCI after day 8. Secondary outcomes included length of ICU and hospital stay and hospital mortality. Forty patients who met the above-mentioned criteria were identified. Of these, only 1 (2.5%) developed ultrasonographic evidence of DCI after day 8 but required no intervention. The mean length of stay in the ICU was until post-bleed day 13, and the mean hospital length of stay was until post-bleed day 14. The in-hospital mortality was 0 of 40. Thus, we identified a low-risk subset of patients with grade I SAH who may be candidates for early transfer out of the ICU.
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Affiliation(s)
- George Lominadze
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Samantha Lessen
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Adam Keene
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
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25
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Gray C, Foëx BA. BET 2: does a normal CT scan within 6 h rule out subarachnoid haemorrhage?: Table 2. Arch Emerg Med 2015; 32:898-9. [DOI: 10.1136/emermed-2015-205330.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Goyale A, O'Shea J, Marsden J, Keep J, Vincent RP. Analysis of cerebrospinal fluid for xanthochromia versus modern computed tomography scanners in the diagnosis of subarachnoid haemorrhage: experience at a tertiary trauma referral centre. Ann Clin Biochem 2015; 53:150-4. [PMID: 25766384 DOI: 10.1177/0004563215579454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of subarachnoid haemorrhage, a neurosurgical emergency in patients with headache remains a logistical challenge. The rationale of the traditional pathway of cerebrospinal fluid xanthochromia analysis following negative computed tomography head scans to exclude subarachnoid haemorrhage has been challenged by the increasing accuracy of modern computed tomography scanners. AIM We set out to establish whether our xanthochromia service was adding value to the diagnostic pathway for subarachnoid haemorrhage or whether it was acting merely as a supportive test. METHOD A retrospective audit of all cerebrospinal fluid requests received since the inception of Xanthochromia service at a tertiary trauma centre. Cases interpreted as being consistent with subarachnoid haemorrhage based on cerebrospinal fluid xanthochromia analysis were selected for in-depth review from the total number of cases. RESULTS In total 660 requests were received for cerebrospinal fluid xanthochromia between August 2009 and July 2012. A total 28 of these were interpreted as being consistent with subarachnoid haemorrhage. Only 18 (64.3%) of requests were deemed appropriate as the clinical presentation in the remaining 10 (35.7%) was strongly suggestive of other causes of headache. A final clinical diagnosis of subarachnoid haemorrhage was made in 11 of the 18 patients who had cerebrospinal fluid xanthochromia requested appropriately. From these 11, five (45%) were deemed initially computed tomography negative and cerebrospinal fluid analysis led to final correct diagnosis of subarachnoid haemorrhage and appropriate surgical management. CONCLUSION Despite improved computed tomography scanning technology, cerebrospinal fluid xanthochromia interpretation aids in the definitive diagnosis of subarachnoid haemorrhage. When requested appropriately cerebrospinal fluid xanthochromia analysis remains a vital service as results impact on clinical decision making, especially when computed tomography scan results are equivocal and is also important in later presenting patients when computed tomography accuracy decreases.
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Affiliation(s)
- A Goyale
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - J O'Shea
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - J Marsden
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - J Keep
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - R P Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
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27
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Garcia LHC, Ferreira BC. An ABC for decision making. Radiol Bras 2015; 48:101-10. [PMID: 25987751 PMCID: PMC4433301 DOI: 10.1590/0100-3984.2013.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/07/2014] [Indexed: 11/22/2022] Open
Abstract
The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations.
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Affiliation(s)
- Luiz Henrique Costa Garcia
- General Surgeon, Intensive Medicine Specialist, Associação
de Medicina Intensiva Brasileira (AMIB), and Irmandade da Santa Casa de
Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Bruna Cortez Ferreira
- MD, Resident of Medical Practice at Hospital de Base de São
José do Rio Preto, São José do Rio Preto, SP, Brazil
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Hann A, Chu K, Greenslade J, Williams J, Brown A. Benefit of cerebrospinal fluid spectrophotometry in the assessment of CT scan negative suspected subarachnoid haemorrhage: a diagnostic accuracy study. J Clin Neurosci 2014; 22:173-9. [PMID: 25439758 DOI: 10.1016/j.jocn.2014.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022]
Abstract
This study aimed to determine if performing cerebrospinal fluid spectrophotometry in addition to visual inspection detects more ruptured cerebral aneurysms than performing cerebrospinal fluid visual inspection alone in patients with a normal head CT scan but suspected of suffering an aneurysmal subarachnoid haemorrhage (SAH). We performed a single-centre retrospective study of patients presenting to the emergency department of a tertiary hospital who underwent both head CT scan and lumbar puncture to exclude SAH. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of an approach utilising both spectrophotometry and visual inspection (combined approach) was compared to visual inspection alone. A total of 409 patients (mean age 37.8 years, 56.2% female) were recruited and six (1.5%) had a cerebral aneurysm on angiography. The sensitivity of visual inspection was 50% (95% confidence interval [CI]: 12.4-82.6%), specificity was 99% (95% CI: 97.5-99.7%), PPV was 42.9% (95% CI: 10.4-81.3%) and NPV was 99.2% (95% CI: 97.8-99.8%). The combined approach had a sensitivity of 100% (95% CI: 54.1-100%), specificity of 79.7% (95% CI: 75.4-83.5%), PPV of 6.8% (95% CI: 2.6-14.3%) and a NPV of 100% (95% CI: 98.8-100%). The sensitivity of the combined approach was not significantly different to that of visual inspection alone (p=0.25). Visual inspection had a significantly higher specificity than the combined approach (p<0.01). The combined approach detected more cases of aneurysmal SAH than visual inspection alone, however the difference in sensitivity was not statistically significant. Visual xanthochromia should prompt angiography because of a superior specificity and PPV. Due to its reduced sensitivity, caution should be applied when using only visual inspection of the supernatant.
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Affiliation(s)
- Angus Hann
- School of Medicine, University of Queensland, Herston, QLD, Australia; The Prince Charles Hospital, Chermside, QLD, Australia.
| | - Kevin Chu
- School of Medicine, University of Queensland, Herston, QLD, Australia; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jaimi Greenslade
- School of Medicine, University of Queensland, Herston, QLD, Australia; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Julian Williams
- School of Medicine, University of Queensland, Herston, QLD, Australia; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Anthony Brown
- School of Medicine, University of Queensland, Herston, QLD, Australia; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Kundra S, Mahendru V, Gupta V, Choudhary AK. Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage. J Anaesthesiol Clin Pharmacol 2014; 30:328-37. [PMID: 25190938 PMCID: PMC4152670 DOI: 10.4103/0970-9185.137261] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm.
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Affiliation(s)
- Sandeep Kundra
- Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vidhi Mahendru
- Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vishnu Gupta
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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The diagnosis of and emergent care for the patient with subarachnoid haemorrhage in resource-limited settings. Afr J Emerg Med 2014. [DOI: 10.1016/j.afjem.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Adamski MG, Golenia A, Turaj W, Baird AE, Moskala M, Dziedzic T, Szczudlik A, Slowik A, Pera J. The AGTR1 gene A1166C polymorphism as a risk factor and outcome predictor of primary intracerebral and aneurysmal subarachnoid hemorrhages. Neurol Neurochir Pol 2014; 48:242-7. [PMID: 25168322 DOI: 10.1016/j.pjnns.2014.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/26/2014] [Accepted: 07/14/2014] [Indexed: 11/15/2022]
Abstract
Associations between the angiotensin II type 1 receptor (AGTR1) gene A1166C polymorphism and hypertension, aortic abdominal aneurysms (as a risk factor) as well as cardiovascular disorders (as a risk factor and an outcome predictor) have been demonstrated. We aimed to investigate the role of this polymorphism as risk factors and outcome predictors in primary intracerebral hemorrhage (PICH) and aneurysmal subarachnoid hemorrhage (aSAH). We have prospectively recruited 1078 Polish participants to the study: 261 PICH patients, 392 aSAH patients, and 425 unrelated control subjects. The A1166C AGTR1 gene polymorphism was studied using the tetra-primer ARMS-PCR method. Allele and genotype frequencies were compared with other ethnically different populations. The A1166C polymorphism was not associated with the risk of PICH or aSAH. Among the aSAH patients the AA genotype was associated with a good outcome, defined by a Glasgow Outcome Scale of 4 or 5 (p<0.02). The distribution of A1166C genotypes in our cohort did not differ from other white or other populations of European descent. In conclusion, we found an association between the A1166C AGTR1 polymorphism and outcome of aSAH patients, but not with the risk of PICH or aSAH.
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Affiliation(s)
- Mateusz G Adamski
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland; Department of Neurology, SUNY Downstate Medical Center, Brooklyn, USA.
| | - Aleksandra Golenia
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Alison E Baird
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, USA
| | - Marek Moskala
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Szczudlik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.
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Ślusarz R, Beuth W, Śniegocki M. Functional Capacity Scale as a new tool for early functional assessment in patients after surgical treatment of intracranial aneurysms: a prospective study involving 128 patients. Med Sci Monit 2012; 18:CR680-6. [PMID: 23111745 PMCID: PMC3560615 DOI: 10.12659/msm.883547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Functional assessment of a patient focuses on the assessment of independence in activities of daily living. The aim of the study was to verify the usefulness of a new tool (Functional Capacity Scale – FCS) for early functional assessment of patients after surgical treatment of an intracranial aneurysm. Material/Methods The study was conducted in the Neurosurgical Department and Clinic, CM in Bydgoszcz, NCU, within a group of 128 patients after surgical treatment of an intracranial aneurysm. Direct observation and measurement were used in the study. In clinical assessment, the Hunt and Hess Scale was applied. For the final functional assessment, the Functional Capacity Scale (FCS), the Glasgow Outcome Scale, the Functional Index “Repty”, the Barthel Index, and the Rankin Scale were used. Results The study shows that on the day of discharge almost 60% of patients are independent or slightly dependent on others for functional capability, and 15% are significantly or totally dependent. FCS significantly correlates with FIR (0.93, p<0.001), GOS (0.89, p<0.01), RS (−0.88, p<0.01) and BI (0.82, p<0.001). Conclusions 1. Fifty percent of patients with intracranial aneurysm assessed at the early postoperative stage leave the ward as functionally capable of performing everyday activities. 2. There are significant correlations between FCS and the other scales used for functional assessment. 3. There is a significant relationship between functional capacity of the patient on the day of discharge and clinical condition before the surgical treatment.
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Affiliation(s)
- Robert Ślusarz
- Neurological and Neurosurgical Nursing Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland.
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Krafft PR, Bailey EL, Lekic T, Rolland WB, Altay O, Tang J, Wardlaw JM, Zhang JH, Sudlow CLM. Etiology of stroke and choice of models. Int J Stroke 2012; 7:398-406. [PMID: 22712741 DOI: 10.1111/j.1747-4949.2012.00838.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Animal models of stroke contribute to the development of better stroke prevention and treatment through studies investigating the pathophysiology of different stroke subtypes and by testing promising treatments before trials in humans. There are two broad types of animal models: those in which stroke is induced through artificial means, modeling the consequences of a vascular insult but not the vascular pathology itself; and those in which strokes occur spontaneously. Most animal models of stroke are in rodents due to cost, ethical considerations, availability of standardized neurobehavioral assessments, and ease of physiological monitoring. While there are similarities in cerebrovascular anatomy and pathophysiology between rodents and humans, there are also important differences, including brain size, length and structure of perforating arteries, and gray to white matter ratio, which is substantially lower in humans. The wide range of rodent models of stroke includes models of global and focal ischemia, and of intracerebral and sub-arachnoid hemorrhage. The most widely studied model of spontaneous stroke is the spontaneously hypertensive stroke-prone rat, in which the predominant lesions are small subcortical infarcts resulting from a vascular pathology similar to human cerebral small vessel disease. Important limitations of animal models of stroke - they generally model only certain aspects of the disease and do not reflect the heterogeneity in severity, pathology and comorbidities of human stroke - and key methodological issues (especially the need for adequate sample size, randomization, and blinding in treatment trials) must be carefully considered for the successful translation of pathophysiological concepts and therapeutics from bench to bedside.
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Affiliation(s)
- Paul R Krafft
- Department of Physiology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
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35
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Duncan CW. Neuroimaging and other investigations in patients presenting with headache. Ann Indian Acad Neurol 2012; 15:S23-32. [PMID: 23024561 PMCID: PMC3444223 DOI: 10.4103/0972-2327.99995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 04/16/2012] [Accepted: 05/17/2012] [Indexed: 11/04/2022] Open
Abstract
Headache is very common. In the United Kingdom, it accounts for 4.4% of primary care consultations, 30% of referrals to neurology services and 0.5-0.8% of alert patients presenting to emergency departments. Primary headache disorders account for the majority of patients and most patients do not require investigation. Warning features (red flags) in the history and on examination help target those who need investigation and what investigations are required. This article summarizes the typical presentations of the common secondary headaches and what neuroimaging and other investigations are appropriate for each headache type.
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Affiliation(s)
- Callum W. Duncan
- Department of Neurology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
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36
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Vieira ACC, Azevedo-Filho HR, Andrade G, Costa e Silva IE, Griz MDFL, Quinino S, Leitão L, Souza MLP, Câmara D. Cognitive Changes in Patients with Aneurysmal Subarachnoid Hemorrhage Before and Early Posttreatment: Differences Between Surgical and Endovascular. World Neurosurg 2012; 78:95-100. [DOI: 10.1016/j.wneu.2011.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/01/2011] [Accepted: 09/06/2011] [Indexed: 10/15/2022]
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37
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Turin TC, Kita Y, Rumana N, Takashima N, Ichikawa M, Sugihara H, Morita Y, Hirose K, Miura K, Okayama A, Nakamura Y, Ueshima H. Circaseptan variation in case-fatality rate for patients with acute subarachnoid hemorrhage (Takashima Stroke Registry 1988-2003). J Clin Neurosci 2010; 17:869-73. [PMID: 20395145 DOI: 10.1016/j.jocn.2009.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 10/27/2009] [Accepted: 11/03/2009] [Indexed: 11/17/2022]
Abstract
We explored the circaseptan variation in 28-day case-fatalities for patients with subarachnoid hemorrhage (SAH) across days of the week. Data were obtained from the Takashima Stroke Registry, which covers approximately 50000 residents of central Japan. There were 169 first-ever SAH cases registered during the period 1988-2003 (68 in males, 101 in females). We divided the SAH cases into two groups according to the day on which the SAH occurred: "weekend" and "weekday". The 28-day case-fatality rate and 95% confidence interval (CI) were calculated. Multiple logistic regression analysis was used to calculate the adjusted odds ratio (95% CI) for weekday fatalities by entering all relevant patient-level variables into the model. The 28-day case-fatality rate for SAH was higher on weekdays (51.7%) than on weekends (32.6%; odds ratio 2.19; 95% CI: 1.10-4.49). The differences in fatality rate persisted after adjustment for age, sex, severity, family history of stroke and patient history of hypertension, diabetes mellitus, dyslipidemia, drinking and smoking. We observed a circaseptan variation in fatalities from SAH, with higher fatality rates during weekdays in our study population.
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Affiliation(s)
- Tanvir Chowdhury Turin
- Department of Health Science, Shiga University of Medical Science, Otsu City, Shiga, Japan.
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Critical Care Management of Subarachnoid Hemorrhage. Neurocrit Care 2010. [DOI: 10.1007/978-1-84882-070-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Vascular Diseases. Neurosurgery 2010. [DOI: 10.1007/978-3-540-79565-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lu-Emerson C, Likosky D, Amin A, Tirschwell D. Management of ischemic stroke: Part 1. Emergency room management. J Hosp Med 2010; 5:33-40. [PMID: 20063394 DOI: 10.1002/jhm.518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute ischemic stroke is commonly encountered by the hospitalist. There have been dramatic changes in our ability to care for these patients acutely. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary stroke center certification has become progressively more important to institutions nationally and includes many aspects of initial evaluation and treatment. PURPOSE Acute treatment involves the rapid assimilation of patient characteristics, laboratory results, and imaging results. There are a growing number of potential acute therapies with a range of risk, benefit, necessary time windows, and specific eligibility criteria. DATA SOURCES Primary trials, current guidelines. CONCLUSIONS The hospitalist is well-positioned to play a major role in the treatment of stroke patients as well as the systems work that aids in the management of this population.
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Affiliation(s)
- Christine Lu-Emerson
- Department of Neurology, School of Medicine, University of Washington, Seattle, Washington, USA
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42
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Whiteley L, Lai K, Simpson M, Nosib V, Parris J, Wood E, Salman RAS. Fluid Balance Monitoring for Adults With Aneurysmal Subarachnoid Hemorrhage. J Neurosci Nurs 2009. [DOI: 10.1097/jnn.0b013e3181bb68eb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lumbar punctures: use and diagnostic efficiency in emergency medical departments. Int J Emerg Med 2009; 2:227-35. [PMID: 20436892 PMCID: PMC2840591 DOI: 10.1007/s12245-009-0128-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 08/30/2009] [Indexed: 12/31/2022] Open
Abstract
Background Lumbar punctures (LP) are regularly and effortlessly used in the emergency medical departments (EMD). LP use and efficiency have not been fully explored in the published literature. Aims The goal of this study was to assess in a French EMD, the frequency of use and the diagnostic efficiency of LP, the final diagnoses, and related medical practices. Methods We retrospectively studied all patients who underwent an LP after admission to our adult EMD in 2004 and 2005. Patients’ medical files were reviewed to collect clinical and paraclinical features. We defined efficient LP as abnormal LP, which confirmed a suspected diagnosis in an emergency setting. Results A total of 247 patients, representing 0.5% of all admissions, underwent an LP. LP were efficient in fewer than 15% of cases and confirmed aseptic meningitis (8.5%), bacterial meningitis (2.4%), Guillain-Barré syndromes (1.6%), subarachnoid hemorrhages (SAH, 0.4%), and carcinomatous meningitis (0.4%). The principal differential diagnoses were infections outside the central nervous system (CNS, 30%), noninfectious neurological disorders (28.7%), and benign headaches (14.2%). The main assumed LP indications were to search for CNS infection (62%) and for SAH (25%). LP efficiency decreased dramatically according to patients’ age. Brain imaging was performed in 90% of patients prior to LP. Excessive use of polymerase chain reaction to detect herpes simplex in cerebrospinal fluid was observed. The only LP complications found were postdural puncture headaches (6.1% of cases). The rate of traumatic LP was 17%. Conclusions Our results are in accordance with the few published surveys on this topic. LP efficiency is modest but must be considered in light of the seriousness of suspected diagnoses. However, the search for differential diagnoses should not be neglected.
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Guerrero López F, de la Linde Valverde CM, Pino Sánchez FI. [General management in intensive care of patient with spontaneous subarachnoid hemorrhage]. Med Intensiva 2009; 32:342-53. [PMID: 18842226 DOI: 10.1016/s0210-5691(08)76212-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a neurologic emergency and often a neurologic catastrophe. Nontraumatic subarachnoid hemorrhage is characterized by the extravasation of blood into the spaces covering the central nervous system. The leading cause of SAH is rupture of an intracranial aneurysm, which accounts for about 80-85% of cases. Mortality and morbidity can be reduced if SAH is treated urgently. Sudden, explosive headache is a cardinal but nonspecific feature in the diagnosis of SAH; computered tomography (CT) scanning is mandatory in all the patients with symp toms that are suggestive of SAH. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. Diagnosing SAH can be challenging and treatment is complex, sophisticated and multidisciplinary. Reble eding is the most imminent danger, which must be prevented by endovascular occlusion with detachable coils (coiling) or by surgical clipping of the aneurysm; the risk of delayed cerebral ischemia is reduced with nimodipine and avoiding hypovolemia; hydrocephalus can be treated by ventricular drainage. Intensive care plays a more important role in the management of SAH than in any other neurological disorder. Excellence in neurologic diagnosis, in operative neurosurgery or neuroradiologic procedures must be accompanied by excellence in Intensive Care. This review emphasizes treatment in the Intensive Care Unit, surgical and endovascular therapeutic options and the current state of treatment of major complications such as rebleeding, cerebral vasospasm and acute hydrocephalus.
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Affiliation(s)
- F Guerrero López
- Servicio de Cuidados Críticos y Urgencias. Medicina Intensiva. Hospital de Rehabilitación y Traumatología. Hospital Universitario Virgen de las Nieves. Granada. España.
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46
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SELLAR R, STEVENSON J. Out-of-hours imaging of acute neurological disease. IMAGING 2009. [DOI: 10.1259/imaging/33158075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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47
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Rama-Maceiras P, Fàbregas N, Ingelmo I, Hernández-Palazón J. [Survey of anesthesiologists' practice in treating spontaneous aneurysmal subarachnoid hemorrhage]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:9-15. [PMID: 19284122 DOI: 10.1016/s0034-9356(09)70314-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the participation of Spanish anesthesiology departments in the management of patients hospitalized for spontaneous aneurysmal subarachnoid hemorrhage. MATERIAL AND METHODS Chiefs of anesthesiology departments of hospitals listed in the Spanish National Catalog of Hospitals of the Ministry of Health and Consumer Affairs were sent a questionnaire with 30 items covering protocols for the management of patients with spontaneous aneurysmal subarachnoid hemorrhage. Items asked about the participation of anesthesiologists during both admission and the perioperative period. RESULTS The questionnaire was sent to 132 hospitals, of which 18 (13.6%) responded. Forty-six percent of anesthesiology departments do not participate in the initial resuscitation. Only 4 reported having a protocol for treating these patients. The initial diagnosis was reportedly made by cranial computed tomography in all cases. Endovascular treatment was the most common procedure reported (66%) and it was given within the first 48 hours (66%). Basic monitoring was used more than nervous system monitoring. Total intravenous anesthesia was used for craniotomy in 53% of the hospitals and for endovascular treatment in 64%. Complications reported most often were vasospasm (100%) and hydrocephalus (69%). CONCLUSIONS Even though few questionnaires were returned, the results reveal scarce use of protocols for the treatment of spontaneous aneurysmal subarachnoid hemorrhage by anesthesiologists. It was also evident that the participation of anesthesiology department staff in the treatment of this condition takes place almost exclusively in the intraoperative period and that the use of nervous system monitoring is scarce. Endovascular treatment is increasing in our practice settings.
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MESH Headings
- Anesthesia, Inhalation/statistics & numerical data
- Anesthesia, Intravenous/statistics & numerical data
- Anesthesiology/methods
- Anesthesiology/statistics & numerical data
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/surgery
- Aneurysm, Ruptured/therapy
- Craniotomy/statistics & numerical data
- Data Collection
- Embolization, Therapeutic/statistics & numerical data
- Humans
- Hydrocephalus/etiology
- Intracranial Aneurysm/complications
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/surgery
- Intracranial Aneurysm/therapy
- Monitoring, Intraoperative/methods
- Monitoring, Intraoperative/statistics & numerical data
- Patient Care Team/statistics & numerical data
- Postoperative Complications/epidemiology
- Practice Patterns, Physicians'/statistics & numerical data
- Preanesthetic Medication/statistics & numerical data
- Preoperative Care
- Spain
- Subarachnoid Hemorrhage/diagnostic imaging
- Subarachnoid Hemorrhage/surgery
- Subarachnoid Hemorrhage/therapy
- Tomography, X-Ray Computed
- Vasospasm, Intracranial/etiology
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Affiliation(s)
- P Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario A Coruña.
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48
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Surgical Management of Acute Intracranial Hemorrhage, Surgical Aneurysmal and Arteriovenous Malformation Ablation, and Other Surgical Principles. Neurol Clin 2008; 26:987-1005, ix. [DOI: 10.1016/j.ncl.2008.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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van Heyningen C, Simms DM. Acute intermittent porphyria presenting with a subarachnoid haemorrhage. Ann Clin Biochem 2008; 45:610-1. [DOI: 10.1258/acb.2008.008084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 47-year-old man presented with abdominal pain, neck stiffness, severe transient hypertension and unusually dark urine. Cerebrospinal fluid investigations and angiography confirmed the diagnosis of a subarachnoid haemorrhage. Porphyrin studies on the patient and his family demonstrated that the family has acute intermittent porphyria. This is the second case report of an acute hepatic porphyria presenting with a subarachnoid haemorrhage. Acute transient hypertension during the attack of porphyria caused the rupture of an intracranial arterial aneurysm.
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Affiliation(s)
| | - David M Simms
- Chemical Pathology Department, Kingston Hospital, Kingston upon Thames KT2 7QB, UK
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Kernick D, Stapley S, Goadsby PJ, Hamilton W. What happens to new-onset headache presented to primary care? A case-cohort study using electronic primary care records. Cephalalgia 2008; 28:1188-95. [PMID: 18771496 DOI: 10.1111/j.1468-2982.2008.01674.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the UK, 4% of general practitioner consultations are for headache, yet the natural history of these presentations is unknown. The objective of this study was to describe the outcome of new headache presentations to the general practitioner. This was a prospective case-control study in adults over a period of 1 year using data from the General Practitioner Research Database, UK. Records of patients who presented with primary headache (migraine, tension-type headache, cluster headache) or undifferentiated headache (no further descriptor) were examined for the subsequent year for subarachnoid haemorrhage, primary brain tumour, benign space-occupying lesion, temporal arteritis, stroke and transient ischaemic attack. We identified 21,758 primary headaches and 63,921 undifferentiated headaches. The likelihood ratio was 29 (9.9, 92) for a subarachnoid haemorrhage after an undifferentiated headache and increased with age. The 1-year risk of a malignant brain tumour with new undifferentiated headache was 0.15%, rising to 0.28% above the age of 50 years. For primary headache the risk was 0.045%. The risk for a benign space-occupying lesion was 0.05% for an undifferentiated and 0.009% for a primary headache. The risk of temporal arteritis was the highest of the conditions studied, 0.66% in the undifferentiated and 0.18% in the primary headache group. Accepting the limitations of this approach, our data can inform management guidelines for new presentations of headache in primary care and confirm the need for follow-up, even if a primary headache diagnosis is made.
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Affiliation(s)
- D Kernick
- St Thomas Medical Group, Exeter, UK.
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