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Tang S, Xing W, Yan J, Wang L, Li Z, Wang Y, Gu N, Sun X. TREM2 alleviates long-term cognitive dysfunction after subarachnoid hemorrhage in mice by attenuating hippocampal neuroinflammation via PI3K/Akt signaling pathway. Brain Res 2024; 1846:149235. [PMID: 39270995 DOI: 10.1016/j.brainres.2024.149235] [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: 07/07/2024] [Revised: 09/03/2024] [Accepted: 09/08/2024] [Indexed: 09/15/2024]
Abstract
Subarachnoid hemorrhage (SAH) often leads to long-term cognitive deficits in patients, particularly due to injury to brain regions such as the hippocampus. This study aims to investigate the role of the triggering receptor expressed on myeloid cells 2 (TREM2) in mitigating hippocampal injury and associated cognitive impairments following SAH. To explore the protective effects of TREM2, we utilized the TREM2 agonist COG1410 to upregulate TREM2 expression and employed TREM2 knockout (KO) mice to verify the necessity of TREM2 for this protective role. The study further examined the involvement of the PI3K/Akt signaling pathway in TREM2-mediated neuroprotection. Our findings indicate that the upregulation of TREM2 significantly alleviated long-term cognitive deficits and promoted the recovery of hippocampal neural activity post-SAH. The neuroprotective effects were linked to reduced microglial activation and decreased secretion of inflammatory factors within the hippocampus. In contrast, TREM2 KO mice did not exhibit these protective effects. Furthermore, inhibition of the PI3K/Akt pathway also diminished these protective effects of TREM2 upregulation and worsened cognitive outcomes. In conclusion, TREM2 upregulation mitigates long-term cognitive dysfunction following SAH by attenuating hippocampal neuroinflammation via the PI3K/Akt signaling pathway. These findings suggest that TREM2 could be a potential therapeutic target for improving cognitive outcomes after SAH.
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Affiliation(s)
- Shuang Tang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Cerebrovascular Disease Center, Suining Central Hospital, Suining, Chongqing, China
| | - Wenli Xing
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Cerebrovascular Disease Center, Suining Central Hospital, Suining, Chongqing, China
| | - Jin Yan
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Wang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Zhao Li
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurosurgery, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu, China
| | - Yingwen Wang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nina Gu
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaochuan Sun
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Alzahrani FA, Riza YM, Eid TM, Almotairi R, Scherschinski L, Contreras J, Nadeem M, Perez SE, Raikwar SP, Jha RM, Preul MC, Ducruet AF, Lawton MT, Bhatia K, Akhter N, Ahmad S. Exosomes in Vascular/Neurological Disorders and the Road Ahead. Cells 2024; 13:670. [PMID: 38667285 PMCID: PMC11049650 DOI: 10.3390/cells13080670] [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: 03/22/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Neurodegenerative diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), Huntington's disease (HD), stroke, and aneurysms, are characterized by the abnormal accumulation and aggregation of disease-causing proteins in the brain and spinal cord. Recent research suggests that proteins linked to these conditions can be secreted and transferred among cells using exosomes. The transmission of abnormal protein buildup and the gradual degeneration in the brains of impacted individuals might be supported by these exosomes. Furthermore, it has been reported that neuroprotective functions can also be attributed to exosomes in neurodegenerative diseases. The potential neuroprotective functions may play a role in preventing the formation of aggregates and abnormal accumulation of proteins associated with the disease. The present review summarizes the roles of exosomes in neurodegenerative diseases as well as elucidating their therapeutic potential in AD, PD, ALS, HD, stroke, and aneurysms. By elucidating these two aspects of exosomes, valuable insights into potential therapeutic targets for treating neurodegenerative diseases may be provided.
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Affiliation(s)
- Faisal A. Alzahrani
- Department of Biochemistry, King Fahad Center for Medical Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Yasir M. Riza
- Department of Biochemistry, King Fahad Center for Medical Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Thamir M. Eid
- Department of Biochemistry, King Fahad Center for Medical Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Reema Almotairi
- Department of Medical Laboratory Technology, Prince Fahad bin Sultan Chair for Biomedical Research, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Lea Scherschinski
- Department of Translational Neuroscience, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA (J.C.)
| | - Jessica Contreras
- Department of Translational Neuroscience, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA (J.C.)
| | - Muhammed Nadeem
- Department of Translational Neuroscience, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA (J.C.)
| | - Sylvia E. Perez
- Department of Translational Neuroscience, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA (J.C.)
| | - Sudhanshu P. Raikwar
- Department of Translational Neuroscience, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA (J.C.)
| | - Ruchira M. Jha
- Department of Neurology, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Andrew F. Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Kanchan Bhatia
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA
| | - Naseem Akhter
- Department of Biology, Arizona State University, Lake Havasu City, AZ 86403, USA
| | - Saif Ahmad
- Department of Translational Neuroscience, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA (J.C.)
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
- Phoenix Veterans Affairs (VA) Health Care System, Phoenix, AZ 85012, USA
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Abdelgadir J, Gelman J, Dutko L, Mehta V, Friedman A, Zomorodi A. Cognitive outcomes following aneurysmal subarachnoid hemorrhage: Rehabilitation strategies. World Neurosurg X 2024; 22:100341. [PMID: 38450248 PMCID: PMC10914592 DOI: 10.1016/j.wnsx.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Despite decreases in mortality rate, the treatment of cognitive deficits following aneurysmal subarachnoid hemorrhage (aSAH) remains a serious challenge for clinicians and survivors alike. Deficits in executive function, language, and memory prevent more than half of survivors from returning to their previous level of work and put a tremendous amount of stress on the individual and their family. New therapies are needed for survivors of aSAH in order to improve cognitive outcomes and quality of life. The aim of this review is to discuss the prevalence and contributing factors of cognitive deficits following aSAH, as well as areas for therapeutic intervention. Due to the limited research on cognitive rehabilitative strategies for aSAH, a literature search of traumatic brain injury (TBI) was used to explore therapies with the potential to improve cognitive outcomes in aSAH. Across cognitive domains, existing rehabilitative and pharmacotherapeutic strategies for TBI show promise to be useful for survivors of aSAH. However, further study of these therapies in addition to consistent assessment of cognitive deficits are required to determine their efficacy in survivors of aSAH.
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Affiliation(s)
- Jihad Abdelgadir
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Justin Gelman
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Lindsay Dutko
- Duke Speech Pathology, Duke University Medical Center, Durham, NC, USA
| | - Vikram Mehta
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Allan Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Khosdelazad S, Jorna LS, Rakers SE, Koffijberg R, Groen RJM, Spikman JM, Buunk AM. Long-term Course of Cognitive Functioning After Aneurysmal and Angiographically Negative Subarachnoid Hemorrhage. Neurosurgery 2023; 93:1235-1243. [PMID: 37272715 DOI: 10.1227/neu.0000000000002559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is a common consequence of subarachnoid hemorrhage (SAH), negatively affecting everyday functioning. This study is the first to investigate the long-term course of cognitive functioning after SAH and its associations with long-term well-being (ie, anxiety and depression), cognitive complaints, and return to work, separately for patients with aneurysmal SAH (aSAH) and angiographically negative SAH (anSAH) in a longitudinal design. METHODS Cognitive functioning was measured at 2 time points (T1: 3-6 months post-SAH; T2: 2-4 years post-SAH) in 58 patients with aSAH and 22 patients with anSAH with neuropsychological tests for (working) memory, psychomotor speed, and attention/executive functioning. Questionnaires were used to measure cognitive complaints and well-being at T1 and T2 and return to work at T2. RESULTS At T2, patients with aSAH only showed improvements in memory and on an executive functioning and psychomotor speed subtest, whereas in contrast, patients with anSAH had significantly poorer scores on tests for psychomotor speed. A significant amount of patients with aSAH and anSAH still reported cognitive complaints, anxiety, and depression in the chronic stage. Cognitive functioning was not significantly associated with cognitive complaints in both SAH groups. On the other hand, cognitive complaints were related to well-being at the long-term in both SAH groups. More cognitive complaints were also associated with more difficulties in return to work in patients with aSAH. CONCLUSION Patients with aSAH and anSAH have cognitive impairments at the subacute stage post-SAH, and these impairments persist into the chronic stage. Moreover, both SAH groups still reported decreased well-being in the chronic stage post-SAH, related to cognitive complaints but not to cognitive impairment. For clinical practice, an early neuropsychological assessment will already provide relevant information to estimate long-term cognitive impairment, but in addition, it is important to pay attention to psychological distress at the long-term.
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Affiliation(s)
- Sara Khosdelazad
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Lieke S Jorna
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Sandra E Rakers
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Ralf Koffijberg
- Department of Medical Psychology, Medical Center Leeuwarden, Leeuwarden , The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Anne M Buunk
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
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Khosdelazad S, Jorna LS, Groen RJM, Rakers SE, Timmerman ME, Borra RJH, van der Hoorn A, Spikman JM, Buunk AM. Investigating Recovery After Subarachnoid Hemorrhage With the Imaging, Cognition and Outcome of Neuropsychological Functioning After Subarachnoid Hemorrhage (ICONS) Study: Protocol for a Longitudinal, Prospective Cohort Study. JMIR Res Protoc 2022; 11:e38190. [PMID: 36173673 PMCID: PMC9562051 DOI: 10.2196/38190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background A subarachnoid hemorrhage is a hemorrhage in the subarachnoid space that is often caused by the rupture of an aneurysm. Patients who survive a subarachnoid hemorrhage have a high risk of complications and a negative long-term outcome. Objective The aim of the Imaging, Cognition and Outcome of Neuropsychological functioning after Subarachnoid hemorrhage (ICONS) study is to investigate whether and to what extent deficits exist in multiple domains after subarachnoid hemorrhage, including cognition, emotion and behavior, and to investigate whether brain damage can be detected in patients with subarachnoid hemorrhage. We aim to determine which early measures of cognition, emotion and behavior, and brain damage in the subacute stage play a role in long-term recovery after subarachnoid hemorrhage. Recovery is defined as functioning at a societal participation level, with a focus on resuming and maintaining work, leisure activities, and social relationships over the long term. Methods The ICONS study is an observational, prospective, single-center cohort study. The study includes patients with subarachnoid hemorrhage admitted to the Neurosurgery Unit of the University Medical Centre Groningen in the Netherlands. The inclusion criteria include diagnosis of an aneurysmal subarachnoid hemorrhage or an angiographically negative subarachnoid hemorrhage, sufficient ability in the Dutch language, and age older than 18 years. Patients will undergo neuropsychological assessment and magnetic resonance imaging 6 months after the subarachnoid hemorrhage. Furthermore, patients will be asked to fill in questionnaires on multiple psychosocial measures and undergo a structured interview at 6 months, 1 year, and 2 years after the subarachnoid hemorrhage. The primary outcome measure of the ICONS study is societal participation 1 year after the subarachnoid hemorrhage, measured with the Dutch version of the Impact on Participation and Autonomy questionnaire. Results The study was launched in December 2019 and recruitment is expected to continue until June 2023. At the time of the acceptance of this paper, 76 patients and 69 healthy controls have been included. The first results are expected in early 2023. Conclusions The ICONS study is the first to collect and combine data after subarachnoid hemorrhage in a variety of domains, including cognition, emotion and behavior, and brain damage. The results will contribute to a more comprehensive understanding of the consequences of both aneurysmal subarachnoid hemorrhage and angiographically negative subarachnoid hemorrhage, which may ultimately optimize timely treatment for this patient group by setting realistic and attainable goals to improve daily functioning. Trial Registration Netherlands Trial Register NL7803; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7803 International Registered Report Identifier (IRRID) DERR1-10.2196/38190
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Affiliation(s)
- Sara Khosdelazad
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Lieke S Jorna
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Sandra E Rakers
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke E Timmerman
- Department of Psychometrics and Statistics, University of Groningen, Groningen, Netherlands
| | - Ronald J H Borra
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Jacoba M Spikman
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anne M Buunk
- Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Gaastra B, Alexander S, Bakker MK, Bhagat H, Bijlenga P, Blackburn S, Collins MK, Doré S, Griessenauer C, Hendrix P, Hong EP, Hostettler IC, Houlden H, IIhara K, Jeon JP, Kim BJ, Kumar M, Morel S, Nyquist P, Ren D, Ruigrok YM, Werring D, Galea I, Bulters D, Tapper W. Genome-Wide Association Study of Clinical Outcome After Aneurysmal Subarachnoid Haemorrhage: Protocol. Transl Stroke Res 2022; 13:565-576. [PMID: 34988871 PMCID: PMC9232474 DOI: 10.1007/s12975-021-00978-2] [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: 08/16/2021] [Revised: 11/26/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) results in persistent clinical deficits which prevent survivors from returning to normal daily functioning. Only a small fraction of the variation in clinical outcome following aSAH is explained by known clinical, demographic and imaging variables; meaning additional unknown factors must play a key role in clinical outcome. There is a growing body of evidence that genetic variation is important in determining outcome following aSAH. Understanding genetic determinants of outcome will help to improve prognostic modelling, stratify patients in clinical trials and target novel strategies to treat this devastating disease. This protocol details a two-stage genome-wide association study to identify susceptibility loci for clinical outcome after aSAH using individual patient-level data from multiple international cohorts. Clinical outcome will be assessed using the modified Rankin Scale or Glasgow Outcome Scale at 1–24 months. The stage 1 discovery will involve meta-analysis of individual-level genotypes from different cohorts, controlling for key covariates. Based on statistical significance, supplemented by biological relevance, top single nucleotide polymorphisms will be selected for replication at stage 2. The study has national and local ethical approval. The results of this study will be rapidly communicated to clinicians, researchers and patients through open-access publication(s), presentation(s) at international conferences and via our patient and public network.
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Affiliation(s)
- Ben Gaastra
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.,Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Sheila Alexander
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Mark K Bakker
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Heidelberlaan 100, 3584, CX, Utrecht, the Netherlands
| | - Hemant Bhagat
- Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Spiros Blackburn
- University of Texas Houston Health Science Center, Houston, TX, USA
| | - Malie K Collins
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Sylvain Doré
- Departments of Anesthesiology, Neurology, Psychiatry, Pharmaceutics, and Neuroscience, College of Medicine, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Christoph Griessenauer
- Department of Neurosurgery, Geisinger, Danville, PA, USA.,Department of Neurosurgery, Christian-Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Philipp Hendrix
- Department of Neurosurgery, Geisinger, Danville, PA, USA.,Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany
| | - Eun Pyo Hong
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Isabel C Hostettler
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Henry Houlden
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Koji IIhara
- National Cerebral and Cardiovascular Center Hospital, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Jin Pyeong Jeon
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea.,Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Bong Jun Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Munish Kumar
- Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandrine Morel
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Paul Nyquist
- Departments of Neurology, Anesthesia/Critical Care Medicine, Neurosurgery and General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Heidelberlaan 100, 3584, CX, Utrecht, the Netherlands
| | - David Werring
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Will Tapper
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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Auditory outcome following aneurysmal subarachnoid haemorrhage. J Neurol Sci 2021; 434:120125. [PMID: 34995980 DOI: 10.1016/j.jns.2021.120125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/02/2023]
Abstract
Auditory deficits are increasingly recognised following aneurysmal subarachnoid haemorrhage (aSAH) and are thought to be of central rather than peripheral origin. Central hearing impairment, also known as auditory processing disorder (APD), often coexists with cognitive deficits and it is thought that APD has both auditory and cognitive elements. The aim of this study was to assess auditory outcome following aSAH and its relationship with cognition. A retrospective case-controlled study design was employed with aSAH cases and matched controls identified from the UK Biobank. Auditory and cognitive outcomes were assessed using the digit triplet test (DTT) and a test of psychomotor reaction time, respectively. Best DTT score was compared between cases and controls using the t-test. A regression-based mediation analysis was performed to assess whether cognition mediated auditory outcome. 270 aSAH patients with auditory outcomes were identified with an average follow-up of 106 months. A matched control cohort of 1080 individuals was also identified. The aSAH cohort had significantly impaired best DTT scores compared to matched controls (p = 0.002). Cognition significantly mediated auditory outcome following aSAH, accounting for 9.8% of the hearing impairment after aSAH. In conclusion significant hearing impairment follows aSAH. The deficit is bilateral and non-progressive. There is a link with cognitive deficit, pointing to a central rather than peripheral source, in keeping with an auditory processing disorder. All aSAH patients should be asked about hearing difficulty at follow-up and when present it should be investigated with peripheral and central auditory assessments, as well as cognitive tests.
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8
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Long-Term Cognitive Outcome following Aneurysmal Subarachnoid Haemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106184. [PMID: 34773754 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Survivors of aneurysmal subarachnoid haemorrhage (aSAH) frequently suffer from cognitive dysfunction. The aim of this study was to assess, in a large sample size with long term follow-up, the characteristics of cognitive dysfunction following aSAH and explore whether cognitive deficits mediate employment outcome. MATERIALS AND METHODS In this retrospective case-controlled study, aSAH survivors (n = 884) were identified from the UK Biobank and compared to matched controls (n = 3536). Controls were propensity score matched according to age, sex, Townsend deprivation score, educational status and relevant medications known to influence cognition. Cognitive outcomes and employment status were compared between cases and controls using group comparison and cross-tabulation tests. A regression-based mediation analysis was performed to assess whether cognitive deficits mediate employment status following aSAH. RESULTS Psychomotor reaction time and employment status significantly differed between aSAH cases and controls with slower reaction times (p < 0.001) and more unemployment or inability to work due to illness (p < 0.001) in the aSAH cohort at a mean follow-up of 125 months. Psychomotor slowing was estimated to mediate a significant proportion (6.59%) of the effect of aSAH on employment status. CONCLUSIONS Psychomotor reaction time and employment status differed significantly between aSAH cases and control matched individuals in the UK Biobank. Psychomotor slowing following aSAH had a discernible impact on employment status. Psychomotor reaction time and employment status are practical to acquire and can be used as surrogate measures of outcome in future studies of aSAH survivors.
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9
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Sun J, Zhao N, Liu J, Wang ZY, Su P, Li JY. Dynamic causal modeling of the working memory system of aneurysmal subarachnoid hemorrhage patients: Searching for targets for cortical intervention. Brain Behav 2021; 11:e2307. [PMID: 34520621 PMCID: PMC8553334 DOI: 10.1002/brb3.2307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH), caused by rupture of an intracranial aneurysm and bleeding into the subarachnoid space, is a life-threatening cerebrovascular disease. Because of improvements in clinical interventions, the mortality rate of aSAH is gradually decreasing. Thus, many survivors recover from aSAH but still have sequelae. Working memory (WM) deficit is one of the most common and severe sequelae after aSAH. Interestingly, the severity of WM deficit is not identical to the extent or localization of brain damage, which implies an underlying mechanism of WM deficit other than direct hemorrhagic brain damage. Previous studies have revealed altered neural activity of several brain regions during stimulus tasks. However, the behaviors and functional organization of these corresponding areas in the resting state remain unclear. Insights into the organization of the WM network could reveal novel information about the mechanism of WM deficits, which will be of great value in developing new therapeutic strategies. METHODS In this study, we recruited 50 aSAH patients consisting of survivors with either impaired or intact WM (two groups). Independent component analysis was performed on resting state data to extract the WM network. Dynamic causal modeling was then performed to assess the intrinsic coupling between key regions of the WM network. A model describing the neural activity and functional organization of the WM network was established, although some connections were not consistent in the resting state. RESULTS We found that effective connectivity of the precuneus (PCUN)-middle temporal gyrus (MTG), MTG-PCUN, and middle frontal gyrus-inferior parietal lobule was significantly decreased in the impaired WM group, which suggests a vital and central role of affected regions or connections and provides new targets for brain stimulation. CONCLUSIONS The results of this study may contribute to new therapeutic or rehabilitation strategies for aSAH patients with WM deficits.
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Affiliation(s)
- Jie Sun
- Department of Neurosurgery, The first Hospital of Kunming, Kunming, China.,Center of Cerebrovascular Disease Treatment Technology, Kunming, China
| | - Nan Zhao
- Department of Neurosurgery, The first Hospital of Kunming, Kunming, China
| | - Jun Liu
- Department of Neurosurgery, The first Hospital of Kunming, Kunming, China
| | - Ze-Yi Wang
- Department of Neurosurgery, The first Hospital of Kunming, Kunming, China
| | - Ping Su
- Department of Neurosurgery, The first Hospital of Kunming, Kunming, China.,Center of Cerebrovascular Disease Treatment Technology, Kunming, China
| | - Jun-Yan Li
- Department of Neurosurgery, The first Hospital of Kunming, Kunming, China.,Center of Cerebrovascular Disease Treatment Technology, Kunming, China
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10
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Ascanio LC, Dmytriw AA, Chida K, Enriquez-Marulanda A, Mayeku J, Gupta R, Maragkos G, Alturki AY, Darbaz B, Thomas AJ, Ogilvy CS, Moore JM. Evaluation of the utility of early routine computed tomography angiography in subarachnoid hemorrhage patient outcomes. J Clin Neurosci 2021; 89:133-138. [PMID: 34119256 DOI: 10.1016/j.jocn.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The role of an early CTA approach in neurologically stable patients with nontraumatic SAH has not been assessed. This study explored the use of CTA in clinically stable SAH patients to pre-emptively identify cerebral vasospasm, to evaluate whether this approach is associated with improved clinical outcomes. METHODS We conducted a retrospective chart review of SAH patients presenting between July 2007 and December 2016 in a single academic center. Patients were divided into two groups: (1) Early CTA (stable patients who underwent a CTA between days 5-8 post-SAH), and (2) Standard Protocol. The co-primary outcomes were a composite of the mRS at discharge and last clinical follow-up (good = 0-2; poor = 3-6). A multivariable binary logistic regression was conducted to compare both groups against outcomes, controlling for potential confounders. RESULTS A total of 415 patients were included, 103 (24.8%) with early CTA, and 312 (75.2%) undergoing the standard protocol; the mean age was 57 years and 248 (59.8%) patients were female. Patients in the early CTA group had a higher modified Fisher grade (3-4) (87.4% vs 63.1%; p < 0.02). The multivariable analysis showed that early CTA was independently associated with lower poor outcomes at discharge (OR = 0.21, 95% CI 0.07-0.61, p = 0.004). Plus, vasospasm detection was associated with an increased risk of poor outcomes (OR = 4.77, 95% CI 1.41 - 16.10, p = 0.01). Early CTA was not associated with outcomes at clinical follow-up. CONCLUSION The early CTA surveillance approach was associated with better functional outcomes at discharge when compared to the current imaging standard practice.
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Affiliation(s)
- Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adam A Dmytriw
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kohei Chida
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Julie Mayeku
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raghav Gupta
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Georgios Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Berkan Darbaz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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11
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Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers. Stroke Res Treat 2020; 2020:8874605. [PMID: 33299539 PMCID: PMC7704183 DOI: 10.1155/2020/8874605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
Methods Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher's grading scales. TCD was done for all patients five times within 10 days measuring the mean flow velocities (MFVs) of cerebral arteries. At the 3-month follow-up, patients were classified into two groups according to Montreal Cognitive Assessment (MoCA) scale: the first group was 31 cases (77.5%) with intact cognitive functions and the other group was 9 cases (22.5%) with impaired cognition. Results Patients with impaired cognitive functions showed significantly lower mean GCS (p = 0.03), significantly higher mean Hunt and Hess scale grades (p = 0.04), significantly higher mean diabetes mellitus (DM) (p = 0.03), significantly higher mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p = 0.02 and p = 0.005, respectively), and significantly higher MFVs measured within the first 10 days. The patients with cognitive impairment were accompanied by a higher incidence of hydrocephalus (p = 0.01) and a higher incidence of delayed cerebral ischemia (DCI) (p < 0.001). Logistic regression analysis detected that MFV ≥ 86 cm/s in the middle cerebral artery (MCA), MFV ≥ 68 cm/s in the anterior cerebral artery (ACA), and MFV ≥ 45 cm/s in the posterior cerebral artery (PCA) were significantly associated with increased risk of cognitive impairment. Conclusion Cognitive impairment after the 3-month follow-up phase in aSAH patients was 22.5%. Acute hydrocephalus and DCI are highly associated with poor cognitive function in aSAH. Increased MFV is a strong predictor for poor cognitive function in aSAH. This trial is registered with NCT04329208.
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12
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Burke MK, Colin Wilson F, Curran DB, Dempster M. A meta-analysis of executive functions among survivors of subarachnoid haemorrhage. Neuropsychol Rehabil 2020; 31:1607-1628. [PMID: 32698664 DOI: 10.1080/09602011.2020.1788954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Subarachnoid Haemorrhage (SAH) is a type of stroke which is suggested to result in Executive Functioning (EF) deficits. Within the SAH research, EF is typically assessed as a unitary cognitive construct. Therefore, the nature and extent to which the different components of EF are impacted post SAH remain unclear. In this meta-analysis, 10 studies met selection criteria including 248 SAH participants, treated by endovascular coiling. Participants were assessed by EF measures and compared with 230 controls. Searches were conducted in November 2018 including Medline, PsychINFO, Web of Science, Scopus and CINAHL databases. EF measures were assigned to categories including Cognitive Flexibility, Working Memory, Inhibitory Control and Planning/Problem Solving [Diamond, 2013. Executive functions. Annual Review of Psychology, 64(1), 135-168. https://doi.org/10.1146/annurev-psych-113011-143750]. A statistically significant effect was found for overall EF. Cognitive Flexibility (G = -0.76) and Inhibitory Control (G = -0.51) generated moderate effect sizes, while Working Memory and Planning/Problem Solving found a small effect size (G = -0.45 and G = -0.49, respectively). The I2 statistic suggested small to moderate heterogeneity between studies, hypothesized to relate to different cognitive tools. Underlying components of EF appear to be differentially impacted post SAH, with Cognitive flexibility demonstrating the largest degree of deficit. Recommendations for a standardized and uniform assessment of EF post SAH are outlined.
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Affiliation(s)
- Mary-Kate Burke
- Clinical Psychology Department, Queen's University Belfast, Belfast, Co. Antrim, Northern Ireland
| | - F Colin Wilson
- Clinical Neuropsychologist, Regional Acquired Brain Injury Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - David B Curran
- Clinical Psychology Department, Queen's University Belfast, Belfast, Co. Antrim, Northern Ireland
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
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13
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Aneurysmal subarachnoid hemorrhage: A pilot study for using longitudinal cognitive and neuropsychological testing for functional outcomes. Clin Neurol Neurosurg 2020; 194:105941. [PMID: 32480295 DOI: 10.1016/j.clineuro.2020.105941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Patients with aneurysmal subarachnoid hemorrhage (aSAH) often sustain substantial cognitive and functional impairment. Traditional outcome measures have emphasized radiographic and gross clinical outcomes, but cognitive and functional outcomes are less frequently documented. This pilot study assessed the feasibility of administering longitudinal cognitive and neuropsychological testing and tracked patterns of functional improvement in aSAH patients. PATIENTS AND METHODS Standardized cognitive and neuropsychological testing were administered to a prospective cohort of aSAH patients admitted for treatment to our tertiary care center. Thirty consecutive aSAH patients (Hunt and Hess score 1-3) were enrolled over 23-months and baseline evaluations were completed within 24-h after admission. Patients were followed prospectively after treatment (coiling or clipping) at 1-, 3-, 6-, and 12-months. Functional outcome measures included the Montreal Cognitive Assessment, the Neuropsychiatric Inventory-Questionnaire, and the Functional Activities Questionnaire. RESULTS Of the 30 patients, 23 (77%) followed-up at 3-months, 21 (70%) at 6-months, and 19 (63%) at 12-months. Improvement from baseline to follow-up at 12-months was noted for general cognitive function (p = .004), memory (p = .025), and executive function (p = .039), with the greatest improvement occurring within 6-months. Daily function also improved mostly within 6-months (p = .022) while changes in neuropsychological disturbances were insignificant from baseline to follow-up at 12-months (p = .216). CONCLUSION Standardized cognitive and neuropsychological testing provides metrics for evaluating functional outcomes following treatment of aSAH. The addition of a brief battery of tests to routine clinical and radiographic evaluations is feasible. The main limitations are related to practice and referral patterns, and future studies are needed to evaluate the impact of treatment modalities on functional outcomes.
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14
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Extracellular vesicle-mediated transfer of miR-21-5p from mesenchymal stromal cells to neurons alleviates early brain injury to improve cognitive function via the PTEN/Akt pathway after subarachnoid hemorrhage. Cell Death Dis 2020; 11:363. [PMID: 32404916 PMCID: PMC7220929 DOI: 10.1038/s41419-020-2530-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
Patients with subarachnoid hemorrhage (SAH) often suffer from cognitive function impairments even when they have received proper treatment, such as the clipping or coiling of aneurysms, and this causes problems with returning to work and burdens the family. Increasing attention has been paid to mesenchymal stem cell (MSC)-derived extracellular vesicle (MSC-EV) as promising therapeutic vesicles for stroke management. In this study, we explored the potential role of MSC-EV in a rat model of SAH. We observed that MSC-EV ameliorated early brain injury (EBI) after SAH by reducing the apoptosis of neurons and that SAH induced an increase in the expression level of miR-21 in the prefrontal cortex and hippocampus. In addition, using miRNA profiling and CSF sequencing data from the exRNA Atlas, we demonstrated that EV-derived miR-21 protected neurons from apoptosis and alleviated SAH-induced cognitive dysfunction. The neuroprotective role of MSC-EV was abrogated by miR-21 knockdown or the administration of MK2206, a PTEN/Akt inhibitor. Overall, our results suggest that MSC-EV promotes neuronal survival and alleviates EBI after SAH through transferring miR-21 to recipient neurons.
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15
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Haug Nordenmark T, Karic T, Røe C, Sorteberg W, Sorteberg A. The post-aSAH syndrome: a self-reported cluster of symptoms in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2020; 132:1556-1565. [PMID: 31003212 DOI: 10.3171/2019.1.jns183168] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although many patients recover to a good functional outcome after aneurysmal subarachnoid hemorrhage (aSAH), residual symptoms are very common and may have a large impact on the patient's daily life. The particular cluster of residual symptoms after aSAH has not previously been described in detail and there is no validated questionnaire that covers the typical problems reported after aSAH. Many of the symptoms are similar to post-concussion syndrome, which often is evaluated with the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In the present study, the authors therefore performed an exploratory use of the RPQ as a template to describe post-aSAH syndrome. METHODS The RPQ was administered to 128 patients in the chronic phase after aSAH along with a battery of quality-of-life questionnaires. The patients also underwent a medical examination besides cognitive and physical testing. Based on their RPQ scores, patients were dichotomized into a "syndrome" group or "recovery" group. RESULTS A post-aSAH syndrome was seen in 33% of the patients and their symptom burden on all RPQ subscales was significantly higher than that of patients who had recovered on all RPQ subscales. The symptom cluster consisted mainly of fatigue, cognitive problems, and emotional problems. Physical problems were less frequently reported. Patients with post-aSAH syndrome scored significantly worse on mobility and pain scores, as well as on quality-of-life questionnaires. They also had significantly poorer scores on neuropsychological tests of verbal learning, verbal short- and long-term memory, psychomotor speed, and executive functions. Whereas 36% of the patients in the recovery group were able to return to their premorbid occupational status, this was true for only 1 patient in the syndrome group. CONCLUSIONS Approximately one-third of aSAH patients develop a post-aSAH syndrome. These patients struggle with fatigue and cognitive and emotional problems. Patients with post-aSAH syndrome report more pain and reduced quality of life compared to patients without this cluster of residual symptoms and have larger cognitive deficits. In this sample, patients with post-aSAH syndrome were almost invariably excluded from return to work. The RPQ is a simple questionnaire covering the specter of residual symptoms after aSAH. Being able to acknowledge these patients' complaints as a defined syndrome using the RPQ should help patients to accept and cope, thereby alleviating possible secondary distress produced.
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Affiliation(s)
| | - Tanja Karic
- Departments of1Physical Medicine and Rehabilitation and
| | - Cecilie Røe
- Departments of1Physical Medicine and Rehabilitation and
- 3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Angelika Sorteberg
- 2Neurosurgery, Oslo University Hospital; and
- 3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Hammer A, Ranaie G, Yakubov E, Erbguth F, Holtmannspoetter M, Steiner HH, Janssen H. Dynamics of outcome after aneurysmal subarachnoid hemorrhage. Aging (Albany NY) 2020; 12:7207-7217. [PMID: 32312942 PMCID: PMC7202490 DOI: 10.18632/aging.103069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
In this observational study, we analyzed and described the dynamics of the outcome after aneurysmal subarachnoid hemorrhage (SAH) in a collective of 203 cases. We detected a significant improvement of the mean aggregate modified Rankin Score (mRS) in every time interval from discharge to 6 months and up to 1 year. Every forth to fifth patient with potential of recovery (mRS 1-5) at discharge improved by 1 mRS point in the time interval from 6 month to 1 year (22.6%). Patients with mRS 3 at discharge had a remarkable late recovery rate (73.3%, p = 0.000085). Multivariate analysis revealed age ≤ 65 years (odds ratio 4.93; p = 0.0045) and "World Federation of Neurological Surgeons" (WFNS) grades I and II (odds ratio 4.77; p = 0.0077) as significant predictors of early improvement (discharge to 6 months). Absence of a shunting procedure (odds ratio 8.32; p = 0.0049) was a significant predictor of late improvement (6 months to 1 year), but not age ≤ 65 years (p = 0.54) and WFNS grades I and II (p = 0.92). Thus, late recovery (6 month to 1 year) is significant and independent from age and WFNS grade.
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Affiliation(s)
- Alexander Hammer
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Gholamreza Ranaie
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Eduard Yakubov
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Frank Erbguth
- Department of Neurology, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | | | - Hans-Herbert Steiner
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Ingolstadt General Hospital, Ingolstadt 85049, Bavaria, Germany
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17
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Reijmer YD, van den Heerik MS, Heinen R, Leemans A, Hendrikse J, de Vis JB, van der Kleij LA, Lucci C, Hendriks ME, van Zandvoort MJE, Huenges Wajer IMC, Visser-Meily JMA, Rinkel GJE, Biessels GJ, Vergouwen MDI. Microstructural White Matter Abnormalities and Cognitive Impairment After Aneurysmal Subarachnoid Hemorrhage. Stroke 2019; 49:2040-2045. [PMID: 30354997 DOI: 10.1161/strokeaha.118.021622] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Aneurysmal subarachnoid hemorrhage (aSAH) may have detrimental effects on white matter microstructure, which may in turn explain the cognitive impairments that occur often after aSAH. We investigated (1) whether the white matter microstructure is altered in patients with aSAH compared with patients with an unruptured intracranial aneurysm and (2) whether these abnormalities are associated with cognitive impairment 3 months after ictus. Methods- Forty-nine patients with aSAH and 22 patients with an unruptured intracranial aneurysm underwent 3T brain magnetic resonance imaging, including a high-resolution diffusion tensor imaging sequence. Patients with aSAH were scanned 2 weeks and 6 months after ictus. Microstructural white matter alterations were quantified by the fractional anisotropy and mean diffusivity (MD). Cognition was evaluated 3 months after ictus. Results- Patients with aSAH had higher white matter MD 2 weeks after ictus than patients with an unruptured intracranial aneurysm (mean difference±SEM, 0.3±0.01×10-3 mm2/s; P≤0.01), reflecting an abnormal microstructure. After 6 months, the MD had returned to the level of the unruptured intracranial aneurysm group. No between-group differences in fractional anisotropy were found (-0.01±0.01; P=0.16). Higher MD at 2 weeks was associated with cognitive impairment after 3 months (odds ratio per SD increase in MD, 2.6; 95% CI, 1.1-6.7). The association between MD and cognitive impairment was independent of conventional imaging markers of aSAH-related brain injury (ie, cerebral infarction, hydrocephalus, total amount of subarachnoid blood, total brain volume, or white matter hyperintensity severity). Conclusions- Patients with aSAH have temporary white matter abnormalities in the subacute phase that are associated with cognitive impairment at 3 months after ictus.
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Affiliation(s)
- Yael D Reijmer
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | - Marc S van den Heerik
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | - Rutger Heinen
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | - Alexander Leemans
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands; and Image Sciences Institute, University Medical Center Utrecht, the Netherlands (A.L.)
| | - Jeroen Hendrikse
- Department of Radiology (J.H., J.B.d.V., L.A.v.d.K., C.L., M.E.H.)
| | - Jill B de Vis
- Department of Radiology (J.H., J.B.d.V., L.A.v.d.K., C.L., M.E.H.)
| | | | - Carlo Lucci
- Department of Radiology (J.H., J.B.d.V., L.A.v.d.K., C.L., M.E.H.)
| | | | - Martine J E van Zandvoort
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | - Irene M C Huenges Wajer
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | | | - Gabriel J E Rinkel
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | - Geert Jan Biessels
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
| | - Mervyn D I Vergouwen
- From the Department of Neurology and Neurosurgery (Y.D.R., M.S.v.d.H., R.H., M.J.E.v.Z., I.M.C.H.W., G.J.E.R., G.J.B., M.D.I.V.)
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Pačić-Turk L, Jandrijević P, Havelka-Meštrović A. RECOVERY OF MEMORY AFTER CEREBRAL ARTERY ANEURYSM SURGERY. Acta Clin Croat 2019; 58:229-239. [PMID: 31819318 PMCID: PMC6884375 DOI: 10.20471/acc.2019.58.02.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The principal study objective was to define whether memory deficits (numerical, working, verbal-mechanical, verbal-logical and visual memory) occurred in patients submitted to surgery for brain artery aneurysm and whether significant recovery of memory took place with time. The study sample included 92 patients, i.e. 35 (38%) male and 57 (62%) female patients aged 27 to 76 years. Neuropsychological testing was conducted at Zagreb University Hospital Centre, Department of Neurosurgery, from 1998 to 2012, in two time intervals: first within 11 months following surgery, and then 12 to 48 months after surgery. The obtained results showed that verbal-mechanical, verbal-logical, and visual memory deficits were present in the first testing interval. In the second testing, the verbal-logical and visual memory deficits were still present, while the tests of verbal-mechanical memory showed deficits in capacity and learning curve, but the results for short- and long-term memory were within the normal ranges. Neither the first nor the second testing showed deficits of numerical and working memory. Based on our results, we can conclude that long-term verbal-mechanical and visual short- and long-term memory had recovered to a statistically significant level, whereas other types of memory showed no significant recovery.
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Affiliation(s)
| | - Petra Jandrijević
- 1Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 2Cvjetno naselje Elementary School, Zagreb, Croatia; 3Rochester Institute of Technology Croatia, Zagreb, Croatia
| | - Ana Havelka-Meštrović
- 1Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 2Cvjetno naselje Elementary School, Zagreb, Croatia; 3Rochester Institute of Technology Croatia, Zagreb, Croatia
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20
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Haug Nordenmark T, Karic T, Sorteberg W, Sorteberg A. Predictors of cognitive function in the acute phase after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2019; 161:177-184. [PMID: 30535853 DOI: 10.1007/s00701-018-3760-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cognitive dysfunction is the most common form of neurological impairment after aneurysmal subarachnoid hemorrhage (aSAH) in the chronic phase. Cognitive deficits in the acute phase after aSAH, however, remain scarcely investigated. The aim of the present study was to test cognitive function and to identify medical predictors of cognitive deficits in the acute phase of aSAH. METHODS Prospective study including 51 patients treated for aSAH. Patients were treated in accordance with a standardized institutional protocol and subjected to neuropsychological evaluation around discharge from neurosurgical care. The neuropsychological test results were transformed into a global cognitive impairment index where an index value of 0.00 is considered normal and 1.00 is considered maximally pathological. Patients with an index score of less than 0.75 were considered having good global cognitive function while those with an index score equal to or above 0.75 were considered having poor global cognitive function. Univariate and multiple regression analysis were used to identify medical predictors of cognitive function. RESULTS Fifty-seven percent of the patients had poor cognitive function. They showed severe cognitive deficits, with most tests falling well below two standard deviations from the expected normal mean. Poor cognitive function was not reflected in a poor modified Rankin score in almost half of the cases. Patients with good cognitive function showed only mild cognitive deficits with most tests falling only slightly below the normal mean. Delayed memory was the most affected function in both groups. Univariate analysis identified acute hydrocephalus and aSAH-acquired cerebral infarction to be predictors of poor cognitive function. Cerebrospinal fluid drainage in excess of 2000 ml six-folded the risk of poor cognitive function, whereas a new cerebral infarction 11-folded the respective risk of poor cognitive function. CONCLUSION More than half of aSAH patients have severe cognitive deficits in the acute phase. The modified Rankin Score should be combined with neuropsychological screening in the acute phase after aSAH to get a more accurate description of the patients' disabilities. Acute hydrocephalus and aSAH-acquired cerebral infarction are the strongest predictors of poor cognitive function in the acute phase.
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21
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Tölli A, Höybye C, Bellander BM, Johansson F, Borg J. The effect of time on cognitive impairments after non-traumatic subarachnoid haemorrhage and after traumatic brain injury. Brain Inj 2018; 32:1465-1476. [DOI: 10.1080/02699052.2018.1497203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Anna Tölli
- Dep. of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Höybye
- Dep. of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden
| | - Bo-Michael Bellander
- Dep. of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Jörgen Borg
- Dep. of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Zaki Ghali MG, Srinivasan VM, Wagner K, Rao C, Chen SR, Johnson JN, Kan P. Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment. World Neurosurg 2018; 120:537-549. [PMID: 29966787 DOI: 10.1016/j.wneu.2018.06.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive sequelae frequently follow subarachnoid hemorrhage (SAH) and include deficits across multiple domains of executive function. This factor affects overall functional outcomes negatively, especially in younger patients. Several clinical correlates predict development and severity of cognitive dysfunction after SAH. Hypothetical mechanisms of cognitive dysfunction in the absence of radiographic lesion include cerebral hypoperfusion and blood breakdown products, resulting in perturbed interneuronal communication and network synchrony, excitotoxicity, and altered microRNA expression. METHODS The PubMed database was searched for articles discussing cognitive outcomes in patients with unruptured and ruptured intracranial aneurysmal disease, sequelae of treatment, and modalities for neuropsychologic testing. RESULTS Treatment of unruptured intracranial aneurysms, although capable of preventing SAH, comes with its own set of complications and may also affect cognitive function. Neuropsychological tests such as the Montreal Cognitive Assessment, Mini-Mental Status Examination, and others have proved useful in evaluating cognitive decline. Studies using functional neurologic imaging modalities have identified regions with altered activation patterns during various cognitive tasks. The sum of research efforts in this field has provided useful insights and an initial understanding of cognitive dysfunction after aneurysm treatment and SAH that should prove useful in guiding and rendering future investigations more fruitful. CONCLUSIONS Development of finer and more sensitive neuropsychological tests in evaluating the different domains of cognitive function after aneurysm treatment and SAH in general will be useful in accurately determining outcomes after ictus and comparing efficacy of different therapeutic strategies.
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Affiliation(s)
| | | | - Kathryn Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Chethan Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen R Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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23
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da Costa L, Shah-Basak PP, Dunkley BT, Robertson AD, Pang EW. Visual Working Memory Encoding and Recognition in Good Outcome Aneurysmal Subarachnoid Patients. Front Neurol 2018; 9:494. [PMID: 29997567 PMCID: PMC6028596 DOI: 10.3389/fneur.2018.00494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/06/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for less than 5% of strokes but is associated with significant morbidity and mortality. Amongst survivors, neurocognitive complaints are common, often despite normal imaging. We used magnetoencephalography (MEG) to investigate neurophysiological function during a visual working memory task in aSAH survivors with good recovery and normal structural imaging. Methods: Patients with aSAH treated with coiling and exhibiting good outcome measured by Glasgow Outcome Scale (GOS) and without related parenchymal structural lesions in post-treatment MRI, were recruited and compared to age- and sex-matched controls. All participants underwent intelligence and cognitive screening, structural MRI, and MEG testing in conjunction with a 1-back visual working memory task. Sensor-level global field power and virtual electrode source analysis of neuronal activity and connectivity in aSAH were assessed. Results: Thirteen patients and 13 matched controls were enrolled (age: 56 ± 11 years, 19 female). The 1-back task was completed with similar accuracy despite a trend for a longer reaction time in aSAH patients (p = 0.054). During encoding and recognition phases, aSAH patients showed significantly increased neuronal activation and hyperconnectivity in periventricular areas, specifically the anterior and posterior cingulate gyri. Conclusions: Increased posterior and anterior cingulate gyri neuronal activity is demonstrated in aSAH patients during visual working memory tasks, in the absence of structural lesions. These areas work mainly as a hub to “organize” memory storage and retrieval. Increased activity in these areas might be compensatory due to injury and consequently loss of neuronal response in connected areas in the working memory networks.
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Affiliation(s)
- Leodante da Costa
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Priyanka P Shah-Basak
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Centre, Toronto, ON, Canada
| | - Benjamin T Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, Sick Kids Research Institute, Toronto, ON, Canada
| | - Andrew D Robertson
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Elizabeth W Pang
- Neurosciences and Mental Health, Sick Kids Research Institute, Toronto, ON, Canada.,Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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24
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Watson E, Ding D, Khattar NK, Everhart DE, James RF. Neurocognitive outcomes after aneurysmal subarachnoid hemorrhage: Identifying inflammatory biomarkers. J Neurol Sci 2018; 394:84-93. [PMID: 30240942 DOI: 10.1016/j.jns.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/21/2018] [Accepted: 06/24/2018] [Indexed: 12/19/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of stroke which carries a high case-fatality rate. Those who survive the ictus of aneurysm rupture harbor substantial risks of neurological morbidity, functional disability, and cognitive dysfunction. Although the pervasiveness of cognitive impairment is widely acknowledged as a long-term sequela of aSAH, the mechanisms underlying its development are poorly understood. The onset of aSAH elicits activation of the inflammatory cascade, and ongoing neuroinflammation is suspected to contribute to secondary complications, such as vasospasm and delayed cerebral ischemia. In this review, we analyze the extant literature regarding the relationship between neuroinflammation and cognitive dysfunction after aSAH. Pro-inflammatory cytokines appear to play a role in maintaining normal cognitive function in adults unaffected by aSAH. However, in the setting of aSAH, elevated cytokine levels may correlate with worse neuropsychological outcomes. This seemingly dichotomous relationship between neuroinflammation and cognition suggests that the action of cytokines varies, depending on their physiologic environment. Experimental therapies which suppress the immune response to aSAH appear to have a beneficial effect on cognitive outcomes. However, further studies are necessary to determine the utility of inflammatory mediators as biomarkers of neurocognitive outcomes, as well as their role in the management of aSAH.
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Affiliation(s)
- Eric Watson
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, 220 Abraham Flexner Way, Suite 1500, Louisville, KY 40202, United States
| | - Nicolas K Khattar
- Department of Neurosurgery, University of Louisville School of Medicine, 220 Abraham Flexner Way, Suite 1500, Louisville, KY 40202, United States
| | - D Erik Everhart
- Department of Psychology, East Carolina University, 104 Rawl Building, Greenville, NC 27858, United States
| | - Robert F James
- Department of Neurosurgery, University of Louisville School of Medicine, 220 Abraham Flexner Way, Suite 1500, Louisville, KY 40202, United States.
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25
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Functional Independence: A Comparison of the Changes During Neurorehabilitation Between Patients With Nontraumatic Subarachnoid Hemorrhage and Patients With Intracerebral Hemorrhage or Acute Ischemic Stroke. Arch Phys Med Rehabil 2017; 98:759-765. [DOI: 10.1016/j.apmr.2016.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/07/2016] [Accepted: 11/12/2016] [Indexed: 11/21/2022]
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26
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da Costa L, Dunkley BT, Bethune A, Robertson A, Keller A, Pang EW. Increased Frontal Lobe Activation After Aneurysmal Subarachnoid Hemorrhage. Stroke 2016; 47:2503-10. [PMID: 27531345 DOI: 10.1161/strokeaha.116.013786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurocognitive deficits are common among survivors of aneurysmal subarachnoid hemorrhage, even among those with good outcomes and no structural lesions. This study aims to probe the neurophysiological underpinnings of cognitive dysfunction among patients with ruptured intracranial aneurysms using magnetoencephalography (MEG). METHODS Thirteen patients who had undergone uncomplicated coiling for aneurysmal subarachnoid hemorrhage and 13 matched controls were enrolled. Neuropsychological tests were done before magnetoencephalography scans. Magnetoencephalography data were acquired in a 151-channel, whole-head magnetoencephalography system for resting state and 2 cognitive tasks (go-no-go and set-shifting). Mean time from treatment to test was 18.8 months. RESULTS Cognitive tasks of inhibition (go-no-go) indicated greater activation in the right anterior cingulate and inferior frontal gyrus, and cognitive set-shifting tasks (mental flexibility) indicated greater activity in the bilateral anterior cingulate cortex and right medial frontal gyrus among aneurysmal subarachnoid hemorrhage patients, with significantly different timing of activation between groups. Resting-state, beta-band connectivity of the anterior cingulate correlated negatively with Montreal Cognitive Assessment scores (left: r=-0.56; P<0.01 and right: r=-0.55; P<0.01): higher connectivity of this region was linked to poorer cognitive test performance. CONCLUSIONS We have shown increased activation in areas of the anterior cingulate gyrus and frontobasal regions during the execution of more demanding tasks in good grade. The degree of activation in the anterior cingulate gyrus has a negative correlation with cognitive (Montreal Cognitive Assessment) scores. These subtle differences may be related to the common neurocognitive and behavioral complaints seen in this patient population.
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Affiliation(s)
- Leodante da Costa
- From the Department of Surgery, Division of Neurosurgery, Sunnybrook Health Sciences Centre (L.d.C., A.B.), Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), Department of Diagnostic Imaging, The Hospital for Sick Children (B.T.D., A.R.), and Division of Neurology, The Hospital for Sick Children (A.K., E.W.P.), University of Toronto, Ontario, Canada.
| | - Benjamin T Dunkley
- From the Department of Surgery, Division of Neurosurgery, Sunnybrook Health Sciences Centre (L.d.C., A.B.), Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), Department of Diagnostic Imaging, The Hospital for Sick Children (B.T.D., A.R.), and Division of Neurology, The Hospital for Sick Children (A.K., E.W.P.), University of Toronto, Ontario, Canada
| | - Allison Bethune
- From the Department of Surgery, Division of Neurosurgery, Sunnybrook Health Sciences Centre (L.d.C., A.B.), Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), Department of Diagnostic Imaging, The Hospital for Sick Children (B.T.D., A.R.), and Division of Neurology, The Hospital for Sick Children (A.K., E.W.P.), University of Toronto, Ontario, Canada
| | - Amanda Robertson
- From the Department of Surgery, Division of Neurosurgery, Sunnybrook Health Sciences Centre (L.d.C., A.B.), Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), Department of Diagnostic Imaging, The Hospital for Sick Children (B.T.D., A.R.), and Division of Neurology, The Hospital for Sick Children (A.K., E.W.P.), University of Toronto, Ontario, Canada
| | - Anne Keller
- From the Department of Surgery, Division of Neurosurgery, Sunnybrook Health Sciences Centre (L.d.C., A.B.), Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), Department of Diagnostic Imaging, The Hospital for Sick Children (B.T.D., A.R.), and Division of Neurology, The Hospital for Sick Children (A.K., E.W.P.), University of Toronto, Ontario, Canada
| | - Elizabeth W Pang
- From the Department of Surgery, Division of Neurosurgery, Sunnybrook Health Sciences Centre (L.d.C., A.B.), Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), Department of Diagnostic Imaging, The Hospital for Sick Children (B.T.D., A.R.), and Division of Neurology, The Hospital for Sick Children (A.K., E.W.P.), University of Toronto, Ontario, Canada
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27
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Thomas C, Vercouillie J, Doméné A, Tauber C, Kassiou M, Guilloteau D, Destrieux C, Sérrière S, Chalon S. Detection of Neuroinflammation in a Rat Model of Subarachnoid Hemorrhage Using [18F]DPA-714 PET Imaging. Mol Imaging 2016; 15:15/0/1536012116639189. [PMID: 27118758 PMCID: PMC5470081 DOI: 10.1177/1536012116639189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 01/30/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) can lead to delayed cerebral ischemia, which increases the rate of morbidity and mortality. The detection of microglial activation may serve as a biomarker for the identification of patients at risk of this deleterious consequence. We assessed this hypothesis in a rat model of SAH in which the exploration of neuroinflammation related to microglial activation was correlated with the degree of bleeding. We used the rat filament model and evaluated (at 48 hours postsurgery) the intensity of neuroinflammation using positron emission tomography (PET) imaging with the 18-kDa translocator protein (TSPO) tracer [18F]DPA-714, quantitative autoradiography with [3H]PK-11195, and SAH grade by postmortem brain picture. High SAH grades were strongly and positively correlated with in vivo PET imaging of TSPO in the cortex and striatum. In addition, a positive correlation was found in the cortex in TSPO, with densities determined by imaging and autoradiographic approaches. Qualitative immunofluorescence studies indicated that overexpression of TSPO was linked to astrocytic/microglial activation. In this model, PET imaging of TSPO using [18F]DPA-714 appeared to be a relevant index of the degree of bleeding, indicating that this imaging method could be used in human patients to improve the management of patients with SAH.
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Affiliation(s)
- Clément Thomas
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France CHRU de Tours, Tours, France
| | | | - Aurélie Doméné
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France
| | - Clovis Tauber
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France
| | - Michael Kassiou
- Faculty of Health Sciences, School of Chemistry, University of Sydney, Sydney, Australia
| | - Denis Guilloteau
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France CHRU de Tours, Tours, France
| | - Christophe Destrieux
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France CHRU de Tours, Tours, France
| | - Sophie Sérrière
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France
| | - Sylvie Chalon
- UMR Inserm U930, Université François-Rabelais de Tours, Tours, France
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28
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Bretz JS, Von Dincklage F, Woitzik J, Winkler MKL, Major S, Dreier JP, Bohner G, Scheel M. The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage. Clin Neuroradiol 2016; 27:361-369. [PMID: 27113903 DOI: 10.1007/s00062-016-0509-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/29/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category. METHODS Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months. RESULTS Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient's age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p < 0.01). CONCLUSION The cisternal Hijdra score is fairly easy to perform and the present study indicates that it has an additional predictive value for the functional outcome within the Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.
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Affiliation(s)
- Julia S Bretz
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Falk Von Dincklage
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maren K L Winkler
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Departments of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Departments of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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29
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Glial cell response after aneurysmal subarachnoid hemorrhage — Functional consequences and clinical implications. Biochim Biophys Acta Mol Basis Dis 2016; 1862:492-505. [DOI: 10.1016/j.bbadis.2015.10.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/12/2015] [Accepted: 10/15/2015] [Indexed: 12/17/2022]
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30
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Azurmendi L, Degos V, Tiberti N, Kapandji N, Sanchez-Peña P, Sarrafzadeh A, Puybasset L, Turck N, Sanchez JC. Neopterin plasma concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with infection and long-term outcome. J Neurosurg 2015; 124:1287-99. [PMID: 26406798 DOI: 10.3171/2015.3.jns142212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of mortality and morbidity. The main predictor for the poor outcome is the World Federation of Neurosurgical Societies (WFNS) scale. However, this scale does not take into account proinflammatory events, such as infection occurring after the aSAH, which could modify the long-term status of patients. The aim of this study was to evaluate neopterin as an inflammatory biomarker for outcome and infection prediction in aSAH patients. METHODS Plasma concentrations of neopterin were measured in 61 aSAH patients (22 male and 39 female; mean age [± SD] 52.8 ± 11.8 years) using a commercial ELISA kit. Samples were collected daily for 10 days. Outcome at 12 months was determined using the Glasgow Outcome Scale (GOS) and dichotomized as poor (GOS score 1, 2, or 3) or good (GOS score 4 or 5). Infection was determined by the presence of a positive bacterial culture. RESULTS Patients with poor outcome at 12 months had higher concentrations of neopterin than patients with good outcome. In the same way, patients who had an infection during the hospitalization had significantly higher concentrations of neopterin than patients without infection (p = 0.001). Moreover, neopterin concentrations were significantly (p < 0.008) elevated in infected patients 2 days before infection detection and antibiotic therapy. CONCLUSIONS Neopterin is an efficient outcome predictor after aSAH. Furthermore, it is able to differentiate between infected and uninfected patients as early as 2 days before clinical signs of infection, facilitating earlier antibiotic therapy and better management.
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Affiliation(s)
- Leire Azurmendi
- Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
| | - Vincent Degos
- Department of Anaesthesiology, Pitié-Salpêtrière University Hospital, Paris, France; and
| | - Natalia Tiberti
- Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
| | - Natacha Kapandji
- Department of Anaesthesiology, Pitié-Salpêtrière University Hospital, Paris, France; and
| | - Paola Sanchez-Peña
- Department of Anaesthesiology, Pitié-Salpêtrière University Hospital, Paris, France; and
| | - Asita Sarrafzadeh
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Germany
| | - Louis Puybasset
- Department of Anaesthesiology, Pitié-Salpêtrière University Hospital, Paris, France; and
| | - Natacha Turck
- Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
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31
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Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir (Wien) 2015; 157:1449-58. [PMID: 26179382 DOI: 10.1007/s00701-015-2480-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines. METHODS To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized. RESULTS We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed. CONCLUSIONS This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.
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Affiliation(s)
- Antoinette E Zweifel-Zehnder
- Division of Neuropaediatrics, Development, and Rehabilitation, Department of Paediatrics, Inselspital Bern, Bern, Switzerland
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32
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Shen H, Chen Z, Wang Y, Gao A, Li H, Cui Y, Zhang L, Xu X, Wang Z, Chen G. Role of Neurexin-1β and Neuroligin-1 in Cognitive Dysfunction After Subarachnoid Hemorrhage in Rats. Stroke 2015. [PMID: 26219651 PMCID: PMC4542569 DOI: 10.1161/strokeaha.115.009729] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Neurexin-1β and neuroligin-1 play an important role in the formation, maintenance, and regulation of synaptic structures. This study is to estimate the potential role of neurexin-1β and neuroligin-1 in subarachnoid hemorrhage (SAH)-induced cognitive dysfunction.
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Affiliation(s)
- Haitao Shen
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Zhouqing Chen
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Yang Wang
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Anju Gao
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Haiying Li
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Yonghua Cui
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Li Zhang
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Xiang Xu
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Zhong Wang
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.)
| | - Gang Chen
- From the Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China (H.S., Z.C., Y.W., A.G., H.L., Y.C., L.Z., X.X., Z.W., G.C.); and Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, China (Y.W.).
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Huenges Wajer IMC, Cremers CHP, van Zandvoort MJE, Vergouwen MDI, van der Schaaf IC, Velthuis BK, Dankbaar JW, Vos PC, Visser-Meily JMA, Rinkel GJE. CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage. J Neurol 2014; 262:623-8. [DOI: 10.1007/s00415-014-7601-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/26/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
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Stienen MN, Smoll NR, Weisshaupt R, Fandino J, Hildebrandt G, Studerus-Germann A, Schatlo B. Delayed Cerebral Ischemia Predicts Neurocognitive Impairment Following Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2014; 82:e599-605. [DOI: 10.1016/j.wneu.2014.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Karic T, Sorteberg A, Haug Nordenmark T, Becker F, Roe C. Early rehabilitation in patients with acute aneurysmal subarachnoid hemorrhage. Disabil Rehabil 2014; 37:1446-54. [DOI: 10.3109/09638288.2014.966162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chen G, Hu T, Li Q, Li J, Jia Y, Wang Z. Expression of synaptosomal-associated protein-25 in the rat brain after subarachnoid hemorrhage. Neural Regen Res 2014; 8:2693-702. [PMID: 25206580 PMCID: PMC4145993 DOI: 10.3969/j.issn.1673-5374.2013.29.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/09/2013] [Indexed: 11/18/2022] Open
Abstract
Synaptosomal-associated protein-25 is an important factor for synaptic functions and cognition. In this study, subarachnoid hemorrhage models with spatial learning disorder were established through a blood injection into the chiasmatic cistern. Immunohistochemical staining and western blot analysis results showed that synaptosomal-associated protein-25 expression in the temporal lobe, hippocampus, and cerebellum significantly lower at days 1 and 3 following subarachnoid morrhage. Our findings indicate that synaptosomal-associated protein-25 expression was down-regulated in the rat brain after subarachnoid hemorrhage.
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Affiliation(s)
- Gang Chen
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Tong Hu
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China ; Department of Neurosurgery, Yixing People's Hospital, Yixing 214200, Jiangsu Province, China
| | - Qi Li
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jianke Li
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Yang Jia
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Zhong Wang
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Wang Z, Ji C, Wu L, Qiu J, Li Q, Shao Z, Chen G. Tert-butylhydroquinone alleviates early brain injury and cognitive dysfunction after experimental subarachnoid hemorrhage: role of Keap1/Nrf2/ARE pathway. PLoS One 2014; 9:e97685. [PMID: 24848277 PMCID: PMC4029824 DOI: 10.1371/journal.pone.0097685] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/23/2014] [Indexed: 11/18/2022] Open
Abstract
Tert-butylhydroquinone (tBHQ), an Nrf2 activator, has demonstrated neuroprotection against brain trauma and ischemic stroke in vivo. However, little work has been done with respect to its effect on early brain injury (EBI) after subarachnoid hemorrhage (SAH). At the same time, as an oral medication, it may have extensive clinical applications for the treatment of SAH-induced cognitive dysfunction. This study was undertaken to evaluate the influence of tBHQ on EBI, secondary deficits of learning and memory, and the Keap1/Nrf2/ARE pathway in a rat SAH model. SD rats were divided into four groups: (1) Control group (n=40); (2) SAH group (n=40); (3) SAH+vehicle group (n=40); and (4) SAH+tBHQ group (n=40). All SAH animals were subjected to injection of autologous blood into the prechiasmatic cistern once in 20 s. In SAH+tBHQ group, tBHQ was administered via oral gavage at a dose of 12.5 mg/kg at 2 h, 12 h, 24 h, and 36 h after SAH. In the first set of experiments, brain samples were extracted and evaluated 48 h after SAH. In the second set of experiments, changes in cognition and memory were investigated in a Morris water maze. Results shows that administration of tBHQ after SAH significantly ameliorated EBI-related problems, such as brain edema, blood-brain barrier (BBB) impairment, clinical behavior deficits, cortical apoptosis, and neurodegeneration. Learning deficits induced by SAH was markedly alleviated after tBHQ therapy. Treatment with tBHQ markedly up-regulated the expression of Keap1, Nrf2, HO-1, NQO1, and GSTα1 after SAH. In conclusion, the administration of tBHQ abated the development of EBI and cognitive dysfunction in this SAH model. Its action was probably mediated by activation of the Keap1/Nrf2/ARE pathway.
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Affiliation(s)
- Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Chengyuan Ji
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lingyun Wu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jiaoxue Qiu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qi Li
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhong Shao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Gang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Sorteberg A, Dahlberg D. Intracranial Non-traumatic Aneurysms in Children and Adolescents. Curr Pediatr Rev 2013; 9:343-352. [PMID: 24696670 PMCID: PMC3970571 DOI: 10.2174/221155281120100005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 07/19/2013] [Accepted: 09/12/2013] [Indexed: 11/22/2022]
Abstract
An intracranial aneurysm in a child or adolescent is a rare, but potentially devastating condition. As little as approximately 1200 cases are reported between 1939 and 2011, with many of the reports presenting diverting results. There is consensus, though, in that pediatric aneurysms represent a pathophysiological entity different from their adult counterparts. In children, there is a male predominance. About two-thirds of pediatric intracranial aneurysms become symptomatic with hemorrhage and the rate of re-hemorrhage is higher than in adults. The rate of hemorrhage from an intracranial aneurysm peaks in girls around menarche. The most common aneurysm site in children is the internal carotid artery, in particular at its terminal ending. Aneurysms in the posterior circulation are more common in children than adults. Children more often develop giant aneurysms, and may become symptomatic from the mass effect of the aneurysm (tumorlike symptoms). The more complex nature of pediatric aneurysms poses a larger challenge to treatment alongside with higher demands to the durability of treatment. Outcome and mortality are similar in children and adults, but long-term outcome in the pediatric population is influenced by the high rate of aneurysm recurrences and de novo formation of intracranial aneurysms. This urges the need for life-long follow-up and screening protocols.
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Affiliation(s)
- Angelika Sorteberg
- Dept of Neurosurgery, Oslo University Hospital - Rikshsospitalet, The National Hospital, Oslo, Norway
| | - Daniel Dahlberg
- Dept of Neurosurgery, Oslo University Hospital - Rikshsospitalet, The National Hospital, Oslo, Norway
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Uchikawa K, Inaba M, Kagami H, Ichimura S, Fujiwara T, Tsuji T, Otaka Y, Liu M. Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage. Brain Inj 2013; 28:15-9. [DOI: 10.3109/02699052.2013.847209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brand C, Alber B, Fladung AK, Knauer K, König R, Oechsner A, Schneider IL, Tumani H, Widder B, Wirtz CR, Woischneck D, Kapapa T. Cognitive performance following spontaneous subarachnoid haemorrhage versus other forms of intracranial haemorrhage. Br J Neurosurg 2013; 28:68-80. [DOI: 10.3109/02688697.2013.815314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wilson DA, Nakaji P, Albuquerque FC, McDougall CG, Zabramski JM, Spetzler RF. Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design. J Neurosurg 2013; 119:606-12. [PMID: 23724983 DOI: 10.3171/2013.4.jns121287] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Data regarding the time course of recovery after poor-grade subarachnoid hemorrhage (SAH) is lacking. Most SAH studies assess outcome at a single time point, often as early as 3 or 6 months following SAH. The authors hypothesized that recovery following poor-grade SAH is a dynamic process and that early outcomes may not always approximate long-term outcomes. To test this hypothesis, they analyzed long-term outcome data from a cohort of patients with poor-grade aneurysmal SAH to determine the incidence and predictors of early and delayed neurological improvement. METHODS The authors reviewed outcome data from 88 poor-grade SAH patients enrolled in a prospective SAH treatment trial (the Barrow Ruptured Aneurysm Trial). They assessed modified Rankin Scale (mRS) scores at discharge, 6 months, 12 months, and 36 months after treatment to determine the incidence and predictors of neurological improvement during each interval. RESULTS The mean aggregate mRS scores at 6 months (3.31 ± 2.1), 12 months (3.28 ± 2.2), and 36 months (3.17 ± 2.3) improved significantly compared with the mean score at hospital discharge (4.33 ± 1.3, p < 0.001), but they did not differ significantly among themselves. Between discharge and 6 months, 61% of patients improved on the mRS. The incidence of improvement between 6-12 months and 12-36 months was 18% and 19%, respectively. Hunt and Hess Grade IV versus V (OR 6.20, 95% CI 2.11-18.25, p < 0.001) and the absence of large (> 4 cm) (OR 2.76, 95% CI 1.02-7.55, p = 0.05) or eloquent (OR 5.17, 95% CI 1.89-14.10, p < 0.01) stroke were associated with improvement up to 6 months. Age ≤ 65 years (OR 5.56, 95% CI 1.17-26.42, p = 0.02), Hunt and Hess Grade IV versus V (OR 4.17, 95% CI 1.10-15.85, p = 0.03), and absence of a large (OR 8.97, 95% CI 2.65-30.40, p < 0.001) or eloquent (OR 4.54, 95% CI 1.46-14.08, p = 0.01) stroke were associated with improvement beyond 6 months. Improvement beyond 1 year was most strongly predicted by the absence of a large stroke (OR 7.62, 95% CI 1.55-37.30, p < 0.01). CONCLUSIONS A substantial minority of poor-grade SAH patients will experience delayed recovery beyond the point at which most studies assess outcome. Younger patients, those presenting in better clinical condition, and those without CT evidence of large or eloquent stroke demonstrated the highest capacity for delayed recovery.
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Affiliation(s)
- David A Wilson
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Navi BB, Kamel H, Hemphill JC, Smith WS. Trajectory of functional recovery after hospital discharge for subarachnoid hemorrhage. Neurocrit Care 2013; 17:343-7. [PMID: 22932992 DOI: 10.1007/s12028-012-9772-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although there are extensive data on long-term disability after subarachnoid hemorrhage (SAH), there are few data on the trajectory of functional recovery after hospital discharge. METHODS From October 2009 to April 2010, we prospectively followed consecutive patients with non-traumatic SAH discharged from a university hospital. Modified Rankin Scale (mRS) scores were calculated at discharge from chart review and at 6 months by standardized telephone interview. Good functional status was defined as a mRS score of 0-2, and poor status as an mRS score of 3-6. Descriptive statistics were used to assess the trajectory of functional recovery and determine the proportion of patients whose functional status improved from poor to good. RESULTS Among 52 patients with non-traumatic SAH (79 % aneurysmal) who were discharged alive, most (71 %) were discharged home. Median (IQR) mRS score was 3 (2-4) at discharge and 2 (1-2) at 6 months. Some functional recovery (any improvement in mRS score) was seen in most patients (83 %; 95 % CI, 72-93 %). Of the 28 patients with poor functional status at discharge, 16 (57 %) improved to good functional status at 6 months. All patients with Hunt-Hess grade 4 or 5 hemorrhages (n = 14) had poor functional status at discharge, but half (95 % CI, 20-80 %) recovered to a good functional status at 6 months. CONCLUSIONS Although our sample size is small, our findings suggest that a substantial proportion of patients with SAH who are disabled at discharge go on to regain functional independence within 6 months.
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Affiliation(s)
- Babak B Navi
- Department of Neurology and Neuroscience, Weill Cornell Medical College, 525 East 68th Street, New York, NY, USA.
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Tjahjadi M, Heinen C, König R, Rickels E, Wirtz CR, Woischneck D, Kapapa T. Health-Related Quality of Life After Spontaneous Subarachnoid Hemorrhage Measured in a Recent Patient Population. World Neurosurg 2013; 79:296-307. [DOI: 10.1016/j.wneu.2012.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 01/29/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
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Ross S, Bhargava D, Al-Tamimi Y, Goddard T, Tennant A, Quinn A. Identifying patient report outcomes relevant to aneurysmal subarachnoid hemorrhage follow-up. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 115:13-16. [PMID: 22890636 DOI: 10.1007/978-3-7091-1192-5_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patients recovered from subarachnoid hemorrhage can be assessed for neuropsychological dysfunction using postal questionnaires. We assessed 214 patients using various tests of memory, mood and strategic thinking. Patients in good outcome categories (modified Rankin Scale [mRS] 0-1) nevertheless exhibited mood disorder (28%), memory deficit and executive dysfunction (20%). Return to work (49%) was most influenced by previous employment status, Rankin scale and mood.
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Affiliation(s)
- Stuart Ross
- Department of Neurosurgery, University of Leeds, Leeds, UK.
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Chen G, Li Q, Feng D, Hu T, Fang Q, Wang Z. Expression of NR2B in different brain regions and effect of NR2B antagonism on learning deficits after experimental subarachnoid hemorrhage. Neuroscience 2012; 231:136-44. [PMID: 23219940 DOI: 10.1016/j.neuroscience.2012.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/04/2012] [Accepted: 11/06/2012] [Indexed: 01/02/2023]
Abstract
Approximately 50% of patients who survived after aneurysmal subarachnoid hemorrhage (SAH) have cognitive or neurobehavioral dysfunction. The mechanisms are not known. NR2B, one of the subunits of N-methyl-d-aspartate (NMDA) receptors, has been proved to be an important factor for synapse function and behavior cognition. Experiment 1 aimed to investigate the timecourse of the NR2B expression in the cortex, hippocampus, and cerebellum after SAH in rats. In experiment 2, we assessed the effect of Ro 25-6981 (a specific NR2B antagonist) on regulation of learning deficits and behavioral activity following SAH. All SAH animals were subjected to injection of autologous blood into the prechiasmatic cistern once on day 0. NR2B was assessed by Western blot analysis and immunohistochemistry. Cognitive and memory changes were investigated in the Morris water maze. As a result, the expression of NR2B was decreased remarkably in SAH groups compared with the control group and the low ebb was on days 1-3. The immunohistochemical staining demonstrated expression of NR2B was present mainly in the neurons in all of the three different regions, such as the cortex, hippocampus, and cerebellum. After Ro 25-6981 intraperitoneal administration, learning deficits induced by SAH was markedly aggravated and clinical behavior scale was also significantly decreased. Our results suggest that NR2B expression is down-regulated in the brain after experimental SAH and NR2B antagonism resulted in augmentation of the development of cognitive dysfunction after SAH.
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Affiliation(s)
- G Chen
- Department of Neurosurgery and Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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47
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Expression of synaptic cell adhesion molecule 1 (SynCAM 1) in different brain regions in a rat subarachnoid hemorrhage model. Neurol Sci 2012. [DOI: 10.1007/s10072-012-1240-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M, Poreh A, Ruzicka E. Czech Version of the Trail Making Test: Normative Data and Clinical Utility. Arch Clin Neuropsychol 2012; 27:906-14. [DOI: 10.1093/arclin/acs084] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Preiss M, Koblihová J, Netuka D, Bernardová L, Charvát F, Beneš V. Verbal memory capacity after treatment for ruptured intracranial aneurysm--the outcomes of three psychological tests: within a month, 1 year after and 5-7 years after treatment. Acta Neurochir (Wien) 2012; 154:417-22. [PMID: 22210561 DOI: 10.1007/s00701-011-1256-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/14/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Verbal memory is an essential cognitive ability with scope for adequate treatment of information and for orientation in everyday life. Our study is centered on memory performance in the wake of treatment for ruptured intracranial aneurysm. METHODS Three psychological tests were performed: (1) within a month of the neurosurgical intervention, (2) 1 year and (3) 5-7 years after the ruptured aneurysm treatment. Under comparison are the overall results of tests for verbal memory capacity in a cohort of patients (N = 59) and in the control group. RESULTS Three post-treatment measurements revealed a persistent deficit of verbal memory. The cohort's average performance improved from -1.3 SD (standard deviation) below the average of the norm to -0.5 SD below the norm at the second test 1 year after treatment, while at the third test the deficit had worsened to -0.68 SD. Similarly, testing for long-term recovery at 5-7 years postoperatively showed the patients' performances to be 2/3 SD below the average of the general population. CONCLUSIONS The results of the study imply the need for long-term rehabilitation of memory in this particular group of patients.
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Affiliation(s)
- Marek Preiss
- Prague Psychiatric Center, University of New York in Prague, Prague, Czech Republic
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