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Rotim A, Raguž M, Gajski D, Vrban F, Jurilj M, Orešković D, Hrabar J, Kalousek V, Sajko T, Rotim K. METEOROLOGICAL VARIABLES ASSOCIATED WITH SUBARACHNOID HEMORRHAGE: A SINGLE CENTER STUDY. Acta Clin Croat 2022; 61:673-680. [PMID: 37868170 PMCID: PMC10588386 DOI: 10.20471/acc.2022.61.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 10/24/2023] Open
Abstract
Spontaneous subarachnoid hemorrhage (SAH) can occur unexpectedly and independently of the classic risk factors. Several different factors could affect intracranial aneurysm (IA) rupture, such as morphological and hemodynamic factors. The aim of this study was to establish the potential association of meteorological data such as temperature, atmospheric pressure, and humidity, and the onset of clinical symptoms preceding hospital admission of patients with acute SAH due to IA rupture. This retrospective study included 130 consecutive patients admitted for non-traumatic SAH with a determinable onset of SAH symptoms. The effects of meteorological parameters of atmospheric pressure, ambient temperature, and relative air humidity on the day of acute SAH onset and 24 hours prior to the onset of symptoms were recorded and analyzed in each patient. Spearman rank correlation analysis was used to assess the risks of incident SAH on the basis of daily meteorological data. Seasonal incidence of acute SAH showed the peak incidence in winter and a trough in summer, with monthly incidence peak in January and December. The circadian rhythm analysis showed the peak incidence of SAH in the forenoon, followed by the evening. Acute SAH incidence showed moderate positive association with daily atmospheric pressure (p<0.05), while no association was found with ambient temperature and relative air humidity. Our results suggested no significant association of changes in ambient temperature and relative humidity with the risk of SAH. Increases in atmospheric pressure were weakly associated with a higher SAH risk. Additional studies are needed to establish in detail both meteorological and morphological factors important to predict IA rupture and SAH.
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Affiliation(s)
- Ante Rotim
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Velika Gorica University of Applied Sciences, Velika Gorica, Croatia
- Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- Catholic University of Croatia, School of Medicine, Zagreb, Croatia
| | - Domagoj Gajski
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- University of Applied Health Sciences, Zagreb, Croatia
| | - Filip Vrban
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mia Jurilj
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Josip Hrabar
- Department of Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vladimir Kalousek
- Department of Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Tomislav Sajko
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Krešimir Rotim
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
- University of Applied Health Sciences, Zagreb, Croatia
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Maciel CB, Barlow B, Lucke-Wold B, Gobinathan A, Abu-Mowis Z, Peethala MM, Merck LH, Aspide R, Dickinson K, Miao G, Shan G, Bilotta F, Morris NA, Citerio G, Busl KM. Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers. Neurocrit Care 2022; 38:395-406. [PMID: 35915347 DOI: 10.1007/s12028-022-01571-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe headaches are common after subarachnoid hemorrhage. Guidelines recommend treatment with acetaminophen and opioids, but patient data show that headaches often persist despite multimodal treatment approaches. Considering an overall slim body of data for a common complaint affecting patients with SAH during their intensive care stay, we set out to assess practice patterns in headache management among clinicians who treat patients with SAH. METHODS We conducted an international cross-sectional study through a 37-question Web-based survey distributed to members of five professional societies relevant to intensive and neurocritical care from November 2021 to January 2022. Responses were characterized through descriptive analyses. Fisher's exact test was used to test associations. RESULTS Of 516 respondents, 329 of 497 (66%) were from North America and 121 of 497 (24%) from Europe. Of 435 respondents, 379 (87%) reported headache as a major management concern for patients with SAH. Intensive care teams were primarily responsible for analgesia during hospitalization (249 of 435, 57%), whereas responsibility shifted to neurosurgery at discharge (233 of 501, 47%). Most used medications were acetaminophen (90%), opioids (66%), corticosteroids (28%), and antiseizure medications (28%). Opioids or medication combinations including opioids were most frequently perceived as most effective by 169 of 433 respondents (39%, predominantly intensivists), followed by corticosteroids or combinations with corticosteroids (96 of 433, 22%, predominantly neurologists). Of medications prescribed at discharge, acetaminophen was most common (303 of 381, 80%), followed by opioids (175 of 381, 46%) and antiseizure medications (173 of 381, 45%). Opioids during hospitalization were significantly more prescribed by intensivists, by providers managing higher numbers of patients with SAH, and in Europe. At discharge, opioids were more frequently prescribed in North America. Of 435 respondents, 299 (69%) indicated no change in prescription practice of opioids with the opioid crisis. Additional differences in prescription patterns between continents and providers and while inpatient versus at discharge were found. CONCLUSIONS Post-SAH headache in the intensive care setting is a major clinical concern. Analgesia heavily relies on opioids both in use and in perception of efficacy, with no reported change in prescription patterns for opioids for most providers despite the significant drawbacks of opioids. Responsibility for analgesia shifts between hospitalization and discharge. International and provider-related differences are evident. Novel treatment strategies and alignment of prescription between providers are urgently needed.
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Affiliation(s)
- Carolina B Maciel
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA.,Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brooke Barlow
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Arravintha Gobinathan
- Departments of Microbiology and Anthropology, University of Florida, Gainesville, FL, USA
| | - Zaid Abu-Mowis
- Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Mounika Mukherjee Peethala
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA
| | - Lisa H Merck
- Department of Emergency Medicine College of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, Istituto delle Scienze Neurologiche di Bologna, Istituto di Ricovero e Cura a Carattere Scientifico, Bologna, Italy
| | - Katie Dickinson
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA
| | - Guanhong Miao
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, FL, USA.,Research Design and Data Coordinating Center, Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Federico Bilotta
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Nicholas A Morris
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Katharina M Busl
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA. .,Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA.
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Brown CS, Oliveira J E Silva L, Mattson AE, Cabrera D, Farrell K, Gerberi DJ, Rabinstein AA. Comparison of Intravenous Antihypertensives on Blood Pressure Control in Acute Neurovascular Emergencies: A Systematic Review. Neurocrit Care 2022; 37:435-446. [PMID: 34993849 DOI: 10.1007/s12028-021-01417-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acute blood pressure (BP) management in neurologic patients is paramount. Different neurologic emergencies dictate various BP goals. There remains a lack of literature determining the optimal BP regimen regarding safety and efficacy. The objective of this study was to identify which intravenous antihypertensive is the most effective and safest for acute BP management in neurologic emergencies. METHODS Ovid EBM (Evidence Based Medicine) Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection were searched from inception to August 2020. Randomized controlled trials or comparative observational studies that evaluated clevidipine, nicardipine, labetalol, esmolol, or nitroprusside for acute neurologic emergencies were included. Outcomes of interest included mortality, functional outcome, BP variability, time to goal BP, time within goal BP, incidence of hypotension, and need for rescue antihypertensives. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the degree of certainty in the evidence available. RESULTS A total of 3878 titles and abstracts were screened, and 183 articles were selected for full-text review. Ten studies met the inclusion criteria; however, the significant heterogeneity and very low quality of studies precluded a meta-analysis. All studies included nicardipine. Five studies compared nicardipine with labetalol, three studies compared nicardipine with clevidipine, and two studies compared nicardipine with nitroprusside. Compared with labetalol, nicardipine appears to reach goal BP faster, have less BP variability, and need less rescue antihypertensives. Compared with clevidipine, nicardipine appears to reach goal BP goal slower. Lastly, nicardipine appears to be similar for BP-related outcomes when compared with nitroprusside; however, nitroprusside may be associated with increased mortality. The confidence in the evidence available for all the outcomes was deemed very low. CONCLUSIONS Because of the very low quality of evidence, an optimal BP agent for the treatment of patients with neurologic emergencies was unable to be determined. Future randomized controlled trials are needed to compare the most promising agents.
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Affiliation(s)
- Caitlin S Brown
- Department of Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Alicia E Mattson
- Department of Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle Farrell
- Creighton University School of Medicine, Creighton University, Omaha, NE, USA
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Geraldini F, De Cassai A, Correale C, Andreatta G, Grandis M, Navalesi P, Munari M. Predictors of deep-vein thrombosis in subarachnoid hemorrhage: a retrospective analysis. Acta Neurochir (Wien) 2020; 162:2295-2301. [PMID: 32577893 PMCID: PMC7311113 DOI: 10.1007/s00701-020-04455-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage is a severe subtype of hemorrhagic stroke, and deep-vein thrombosis is a frequent complication detected in these patients. In addition to other well-established risk factors, the early activation of coagulation systems present in patients with subarachnoid hemorrhage could potentially play a role in the incidence of deep-vein thrombosis. This study aims to identify possible predictors for deep-vein thrombosis related to subarachnoid hemorrhage. METHODS We conducted a retrospective cohort study on patients with a diagnosis of subarachnoid hemorrhage who presented to our institution between 1 January 2014 and 1 August 2018. We reviewed electronic medical records and analyzed several parameters such as Fisher scale, World Federation of Neurosurgical Surgeons scale, aneurysm site, surgical or endovascular treatment, decompressive craniectomy, vasospasm, infection (meningitis and pneumonia), presence of motor deficit, length of stay in the ICU, length of hospital stay, number of days under ventilator support, d-dimer at hospitalization, and the time to thromboprophylaxis (days). RESULTS The univariate analysis showed that intraparenchymal cerebral hemorrhage, d-dimer at hospitalization, the time to thromboprophylaxis, motor deficit, and aneurysm located at the internal carotid artery were statistically significant factors. Intraparenchymal cerebral hemorrhage (OR 2,78 95%CI 1.07-7.12), motor deficit (OR 3.46; 95%CI 1.37-9.31), and d-dimer at hospitalization (OR 1.002 95% CI 1.001-1.003) were demonstrated as independent risk factors for deep-vein thrombosis. Length of hospital stay was also found to be significantly longer in patients who developed deep-vein thrombosis (p value 0.018). CONCLUSION Elevated d-dimer level at the time of hospitalization, motor deficit, and the presence of an intraparenchymal hemorrhage are independent risk factors for deep-vein thrombosis. Patients with DVT also had a significantly longer hospital stay. Even though further studies are needed, patients with elevated d-dimer at hospitalization and intraparenchymal cerebral hemorrhage may benefit from a more aggressive screening strategy for deep-vein thrombosis.
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Affiliation(s)
- Federico Geraldini
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy.
| | - Alessandro De Cassai
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Christelle Correale
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Giulio Andreatta
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Marzia Grandis
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Paolo Navalesi
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
| | - Marina Munari
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy
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Nag DS, Sahu S, Swain A, Kant S. Intracranial pressure monitoring: Gold standard and recent innovations. World J Clin Cases 2019; 7:1535-1553. [PMID: 31367614 PMCID: PMC6658373 DOI: 10.12998/wjcc.v7.i13.1535] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/11/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate non-invasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortion-product oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Seelora Sahu
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Amlan Swain
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Shashi Kant
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
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Wong H, Banfield J, Hughes N, Shankar JJS. Are Anterior Communicating Aneurysms Truly Anterior Communicating Aneurysms? An Observational Study. World Neurosurg 2019; 125:e1089-e1092. [PMID: 30790745 DOI: 10.1016/j.wneu.2019.01.249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The term anterior communicating (ACom) aneurysm is often broadly used to classify any aneurysm formed on the A1-A2 junction, A1, A2, or ACom arteries. Aneurysm location has been associated with rupture risk, so whether an aneurysm is truly formed on the ACom artery can critically affect treatment decisions. The aim of this study was to reclassify broadly termed ACom aneurysms into 4 subgroups (A1, A2, true ACom, and A1-A2 junction) based on their location. METHODS A retrospective, pilot study was conducted to identify all consecutive patients with ACom aneurysm managed over the past 4 years in a single center. Using computed tomography angiography, aneurysms were classified into 1 of the 4 subgroups. Additional information was collected on patient demographics, subarachnoid hemorrhages, projections of aneurysm dome, and aneurysm diameter. RESULTS A total of 48 aneurysms with available computed tomography angiography imaging were included in the final analysis. The reclassification of ACom aneurysms into subgroups resulted in 40 A1-A2 junction, 6 true ACom, 2 A2, and zero A1 aneurysms. A total of 100% versus 80% of true ACom and A1-A2 junction aneurysms ruptured, respectively. All elective coiling procedures were performed on unruptured A1-A2 junction aneurysms. CONCLUSIONS We found only 13% of the aneurysms initially referred to as ACom to be true ACom aneurysms. A more nuanced approach to ACom aneurysm classification may better guide management strategies.
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Affiliation(s)
- Helen Wong
- Department of Diagnostic Radiology, Dalhousie University, Nova Scotia, Canada
| | - Jillian Banfield
- Department of Diagnostic Radiology, Dalhousie University, Nova Scotia, Canada
| | - Nicole Hughes
- Department of Diagnostic Radiology, Dalhousie University, Nova Scotia, Canada
| | - Jai Jai Shiva Shankar
- Department of Diagnostic Radiology, Dalhousie University, Nova Scotia, Canada; Department of Radiology, The University of Manitoba, Winnipeg, Manitoba, Canada.
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Baeesa SS, Bakhaidar M, Ahamed NAB, Madani TA. Invasive Orbital Apex Aspergillosis with Mycotic Aneurysm Formation and Subarachnoid Hemorrhage in Immunocompetent Patients. World Neurosurg 2017; 102:42-48. [PMID: 28254599 DOI: 10.1016/j.wneu.2017.02.096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Invasive orbital apex aspergillosis (IOAA) is an aggressive form of aspergillus infection that usually affects immunocompromised patients. It can cause orbital apex syndrome and, if not treated promptly, may progress rapidly causing fatal complications. Subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysms is a very rare complication of invasive aspergillosis. We aim to describe our management and the outcome of six immunocompetent patients with IOAA with subsequent SAH secondary to ruptured mycotic aneurysms. PATIENTS AND METHODS A retrospective review was undertaken of charts of patients treated for orbital involvement with aspergillosis between January 2003 and December 2015 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. We identified all immunocompetent patients with IOAA who developed vascular complications. RESULTS Six immunocompetent patients with IOAA complicated by SAH secondary to ruptured mycotic aneurysms were identified in the study period. Four patients were female, and patients' age ranged between 14 and 53 years (mean, 33.7 ± 13.4 years). All patients presented with progressive retro-orbital headache, visual impairment, and ophthalmoplegia; four had proptosis. Two patients had vasospasm and brain infarction. Antifungal therapy was used in all patients, and 4 underwent emergency craniotomy and clipping of an aneurysm. Five patients died as a consequence of SAH and infarction. CONCLUSIONS IOAA is a serious disease that commonly causes catastrophic and fatal vascular complications.
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Affiliation(s)
- Saleh S Baeesa
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamad Bakhaidar
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naushad A B Ahamed
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tariq A Madani
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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