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Mortazavi ZS, Zandifar A, Ub Kim JD, Tierradentro-García LO, Shakarami M, Zamharir FD, Hadipour M, Oustad M, Shafiei E, Tara SZ, Shirani P, Asadi H, Vossough A, Saadatnia M. Re-Evaluating Risk Factors, Incidence, and Outcome of Aneurysmal and Non-Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2023; 175:e492-e504. [PMID: 37024083 DOI: 10.1016/j.wneu.2023.03.131] [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: 03/12/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) is one of the world's most life-threatening types of stroke. SAH can be classified into two main categories, aneurysmal (aSAH) and non-aneurysmal SAH (naSAH). In the present study, we aimed to prospectively evaluate SAH and its subcategories incidences, risk factors, complications, and outcomes in central Iran. METHODS All SAH patients diagnosed between 2016 and 2020 were included in Isfahan SAH Registry. Demographic, clinical characteristics, incidence rates (based on age categories), and laboratory/imaging findings were collected and compared between aSAH and naSAH subgroups. Complications during hospital stay and outcomes were also analyzed. Binary logistic regression analysis was performed to investigate the predictors of aSAH versus naSAH. Kaplan-Meier curves and Cox regression were used to evaluate the survival probability. RESULTS A total of 461 SAH patients were included through Isfahan SAH Registry. The SAH annual incidence rate was 3.11 per 100,000 person-years. aSAH had higher incidence rate than naSAH (2.08/100,000 vs. 0.9/100,000 person-years, respectively). In-hospital mortality was 18.2%. Hypertension (P = 0.003) and smoking (P = 0.03) were significantly associated with aSAH, whereas diabetes mellitus (P < 0.001) was more associated with naSAH. After Cox regression analysis, there were higher hazard ratios for reduced in-hospital survival in conditions including altered mental status, Glasgow Coma Scale ≤13, rebleeding, and seizures. CONCLUSIONS This study provided an updated estimation of SAH and its subgroups incidences in central Iran. Risk factors for aSAH are comparable to the ones reported in the literature. It is noteworthy that diabetes mellitus was associated with a higher incidence of naSAH in our cohort.
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Affiliation(s)
- Zahra Sadat Mortazavi
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Medical Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Zandifar
- Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jorge Du Ub Kim
- Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Mehrnaz Shakarami
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Medical Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzam Dashti Zamharir
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Medical Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hadipour
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Oustad
- Department of Neurology, Bushehr University of Medical Sciences, Kangan, Iran
| | - Elham Shafiei
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyedeh Zahra Tara
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peyman Shirani
- Department of Neurology and Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Hamed Asadi
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia; Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Arastoo Vossough
- Division of Neuroradiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Al-Mistarehi AH, Elsayed MA, Ibrahim RM, Elzubair TH, Badi S, Ahmed MH, Alkhaddash R, Ali MK, Khader YS, Alomari S. Clinical Outcomes of Primary Subarachnoid Hemorrhage: An Exploratory Cohort Study from Sudan. Neurohospitalist 2022; 12:249-263. [PMID: 35419154 PMCID: PMC8995598 DOI: 10.1177/19418744211068289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Although Subarachnoid Hemorrhage (SAH) is an emergency condition, its epidemiology and prognosis remain poorly understood in Africa. We aim to explore the clinical presentations, outcomes, and potential mortality predictors of primary SAH patients within 3 weeks of hospitalization in a tertiary hospital in Sudan. Methods We prospectively studied 40 SAH patients over 5 months, with 3 weeks of follow-up for the symptomatology, signs, Glasgow coma scale (GCS), CT scan findings, and outcomes. The fatal outcome group was defined as dying within 3 weeks. Results The mean age was 53.5 years (SD, 6.9; range, 41–65), and 62.5% were women. One-third (30.0%) were smokers, 37.5% were hypertensive, two-thirds (62.5%) had elevated blood pressure on admission, 37.5% had >24 hours delayed presentation, and 15% had missed SAH diagnosis. The most common presenting symptoms were headache and neck pain/stiffness, while seizures were reported in 12.5%. Approximately one-quarter of patients (22.5%) had large-sized Computed Tomography scan hemorrhage, and 40.0% had moderate size. In-hospital mortality rate was 40.0% (16/40); and 87.5% of them passed away within the first week. Compared to survivors, fatal outcome patients had significantly higher rates of smoking (50.0%), hypertension (68.8%), elevated presenting blood pressure (93.8%), delayed diagnosis (56.2%), large hemorrhage (56.2%), lower GCS scores at presentation, and cerebral rebleeding ( P < 0.05 for each). The primary causes of death were the direct effect of the primary hemorrhage (43.8%), rebleeding (31.3%), and delayed cerebral infarction (12.5%). Conclusions SAH is associated with a high in-hospital mortality rate in this cohort of Sudanese SAH patients due to modifiable factors such as delayed diagnosis, hypertension, and smoking. Strategies toward minimizing these factors are recommended.
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Affiliation(s)
- Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muaz A. Elsayed
- Department of Neurology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman Teaching Hospital / Sudan Medical Specialization Board, Khartoum, Sudan
| | | | - Tarig Hassan Elzubair
- Department of Psychiatry, Faculty of Medicine, University of Science and Technology (UST), Khartoum, Sudan
| | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital, NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Raed Alkhaddash
- Department of Neurology, The University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA
| | - Musaab K. Ali
- Department of Emergency Medicine, King Abdullah University Hospital, Irbid, Jordan/Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Yousef S. Khader
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Al-Jehani H, Alqahtani A, Al Abbas F, Alhamid MA, Bunyan R. "Coil-and-Go" model for acute good grade subarachnoid hemorrhage: an innovative care model in the Eastern Province of Saudi Arabia. J Neurosurg Sci 2020; 65:378-380. [PMID: 32989972 DOI: 10.23736/s0390-5616.20.05067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hosam Al-Jehani
- Department of Neurosurgery and Critical Care Medicine, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia - .,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada -
| | - Alhanouv Alqahtani
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Faisal Al Abbas
- Department of Neurosurgery and Critical Care Medicine, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - May A Alhamid
- Department of Neurology, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Reem Bunyan
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Huang H, Lai LT. Incidence and Case-Fatality of Aneurysmal Subarachnoid Hemorrhage in Australia, 2008-2018. World Neurosurg 2020; 144:e438-e446. [PMID: 32889187 DOI: 10.1016/j.wneu.2020.08.186] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Contemporary aneurysmal subarachnoid hemorrhage (aSAH) and case-fatality studies have suggested a diminishing worldwide incidence. The purpose of this study was to examine whether such epidemiologic trends occur in Australia. METHODS This retrospective cross-sectional study was based on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases across hospital networks in Australia between 2008 and 2018. Information on patient characteristics, aneurysm location, procedures performed, and discharge disposition were extracted. We estimated the crude and age-adjusted incidences, trends of aSAH, and case fatality rate over time. Putative risk factors were investigated with univariate and multivariate logistic regression analysis to identify independent predictors of unfavorable discharge outcome (death and dependency). RESULTS A total of 12,915 acute hospital admissions with aSAH were identified. Annual aSAH rate remained stable (mean 5.5, range 5.3-6.0 cases per 100,000 person-years) with no decline. The overall aSAH-associated 30-day case-fatality rate was 26.7% of admissions and declined by approximately 0.7% annually (P < 0.0001). Age-adjusted incidence increased with advancing age at increments of 1.3 cases per 100,000 person-years for each 5 years after the age of 40 years. Endovascular therapy accounted for 63.1% of the overall treatment strategy. Logistic regression demonstrated older age (P < 0.0001), presence of intracerebral or intraventricular hemorrhage (P < 0.0001), and hypertension (P = 0.0007) were significant predictors of unfavorable outcome. CONCLUSIONS A decline in 30-day case-fatality rate but not aSAH incidence from 2008 to 2018 was observed.
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Affiliation(s)
- Helen Huang
- Department of Neurosurgery, Monash Health, Victoria, Australia
| | - Leon Tat Lai
- Department of Neurosurgery, Monash Health, Victoria, Australia; Department of Surgery, Monash Medical Centre, Victoria, Australia.
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Waweru P, Gatimu SM. Mortality and functional outcomes after a spontaneous subarachnoid haemorrhage: A retrospective multicentre cross-sectional study in Kenya. PLoS One 2019; 14:e0217832. [PMID: 31188844 PMCID: PMC6561561 DOI: 10.1371/journal.pone.0217832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite a reduction in poor outcomes in recent decades, spontaneous subarachnoid haemorrhage (SAH) remains associated with severe disability and high mortality rates. The exact extent of these outcomes is however unknown in Africa. This study aimed to determine the mortality and functional outcomes of patients with SAH in Kenya. METHODS We conducted a retrospective multicentre cross-sectional study involving patients admitted with SAH to three referral hospitals in Nairobi. All patients with a confirmed (primary) discharge diagnosis of first-time SAH between January 2009 and November 2017 were included (n = 158). Patients who had prior head trauma or cerebrovascular disease (n = 53) were excluded. Telephone interviews were conducted with surviving patients or their next of kin to assess out-of-hospital outcomes (including functional outcomes) based on modified Rankin Scale (mRS) scores. Chi-square and Fisher's exact tests were used to assess associations between mortality and functional outcomes and sample characteristics. RESULTS Of the 158 patients sampled, 38 (24.1%) died in hospital and 42 (26.6%) died within 1 month. In total, 87 patients were discharged home and followed-up in this study, of which 72 reported favourable functional outcomes (mRS ≤2). This represented 45.6% of all patients who presented alive, pointing to high numbers of unfavourable outcomes post SAH in Kenya. CONCLUSIONS Mortality following SAH remains high in Kenya. Patients who survive the initial ictus tend to do well after treatment, despite resource constraints. LIMITATIONS The study findings should be interpreted with caution because of unavoidable limitations in the primary data. These include its retrospective nature, the high number of patients lost to follow up, missing records and diagnoses, and/or possible miscoding of cases.
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Affiliation(s)
- Peter Waweru
- Neurosurgery Department, M.P Shah Hospital, Nairobi, Kenya
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Vasopressor Infusion After Subarachnoid Hemorrhage Does Not Increase Regional Cerebral Tissue Oxygenation. J Neurosci Nurs 2018; 50:225-230. [PMID: 29985275 DOI: 10.1097/jnn.0000000000000382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Vasopressors are commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to sustain cerebral pressure gradients. Yet, the relationship between vasopressors and the degree of cerebral microcirculatory support achieved remains unclear. This study aimed to explore the changes in cerebral and peripheral regional tissue oxygen saturation (rSO2) as well as blood pressure (BP) before and after vasopressor infusion in patients with aSAH. METHODS Continuous noninvasive cerebral and peripheral rSO2 was obtained using near-infrared spectroscopy for up to 14 days after aSAH. Within-subject differences in rSO2 before and after the commencement of vasopressor infusion were analyzed controlling for Hunt and Hess grade and vasospasm. RESULTS Of 45 patients with continuous rSO2 monitoring, 19 (42%) received vasopressor infusion (all 19 on norepinephrine, plus epinephrine in 2 patients, phenylephrine in 4 patients, and vasopressin in 2 patients). In these 19 patients, their vasopressor infusion times were associated with higher BP (systolic [b = 15.1], diastolic [b = 7.3], and mean [b = 10.1]; P = .001) but lower cerebral rSO2 (left cerebral rSO2 decreased by 4.4% [b = -4.4, P < .0001]; right cerebral rSO2 decreased by 5.5% [b = -5.5, P = .0002]). CONCLUSIONS Despite elevation in systemic BP during vasopressor infusion times, cerebral rSO2 was concurrently diminished. These findings warrant further investigation for the effect of induced hypertension on cerebral microcirculation.
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Al-Jehani H, Yamani M, Orz Y, Shiekh B. Familial Intracranial Aneurysms in Saudi Arabia: What Do We Need To Do? SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2016; 4:149-153. [PMID: 30787721 PMCID: PMC6298339 DOI: 10.4103/1658-631x.188252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a devastating event with significant morbidity and mortality. The incidence of SAH might be influenced by environmental factors but genetic predisposition is evolving as an important effector in the risk of development of intracranial aneurysms and rupture of aneurysms. This requires strategies for effective screening of family members at risk of developing such a phenotype, in order to deliver preventive treatment to these target lesions. We discuss the potential for implementing these strategies in the Saudi Arabian health system and the future implications on our care for such a vulnerable group of subjects.
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Affiliation(s)
- Hosam Al-Jehani
- Department of Neurosurgery, King Fahd University Hospital, University of Dammam, Al-Khobar, Saudi Arabia.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Canada
| | - Mahmoud Yamani
- Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Orz
- Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bassem Shiekh
- Department of Surgery, Taibah University, Al-Madina Al-Monawrrah, Saudi Arabia
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