Size of third and fourth ventricle in obstructive and communicating acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Object The purpose of this study was to identify predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH). Methods The authors evaluated the incidence of shunt-dependent hydrocephalus in a consecutive cohort of 580 patients with SAH who were admitted to the Neurological Intensive Care Unit of Columbia University Medical Center between July 1996 and September 2002. Patient demographics, 24-hour admission variables, initial CT scan characteristics, daily transcranial Doppler variables, and development of in-hospital complications were analyzed. Odds ratios and 95% CIs for candidate predictors were calculated using multivariate nominal logistic regression. Results Admission glucose of at least 126 mg/dl (adjusted OR 1.6; 95% CI 1.0–2.6), admission brain CT scan with a bicaudate index of at least 0.20 (adjusted OR 1.43; 95% CI 1.0–2.0), Fisher Grade 4 (adjusted OR 2.71; 95% CI 1.2–5.7), fourth ventricle hemorrhage (adjusted OR 1.78; 95% CI 1.1–2.7), and development of nosocomial meningitis (adjusted OR 2.2; 95% CI 1.4–3.7) were independently associated with shunt dependency. Conclusions These data suggest that permanent CSF diversion after aneurysmal SAH may be independently predicted by hyperglycemia at admission, findings on the admission CT scan (Fisher Grade 4, fourth ventricle intraventricular hemorrhage, and bicaudate index ≥ 0.20), and development of nosocomial meningitis. Future research is needed to assess if tight glycemic control, reduction of fourth ventricle clot burden, and prevention of nosocomial meningitis may reduce the need for permanent CSF diversion after aneurysmal SAH.

Download Full-text

Symptomatic vasospasm and outcomes following aneurysmal subarachnoid hemorrhage: a comparison between surgical repair and endovascular coil occlusion

Journal of Neurosurgery ◽

10.3171/jns.2003.98.2.0319 ◽

2003 ◽

Vol 98 (2) ◽

pp. 319-325 ◽

Cited By ~ 120

Author(s):

Alejandro A. Rabinstein ◽

Mark A. Pichelmann ◽

Jonathan A. Friedman ◽

David G. Piepgras ◽

Douglas A. Nichols ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Content Type ◽

Acute Hydrocephalus ◽

Treatment Groups ◽

Symptomatic Vasospasm ◽

Coil Occlusion ◽

Clip Application ◽

Fine Print

Object. The authors studied patients with aneurysmal subarachnoid hemorrhage (SAH) to determine whether the incidence of symptomatic vasospasm or overall clinical outcomes differed between patients treated with craniotomy and clip application and those treated by endovascular coil occlusion. Methods. The authors reviewed 415 consecutive patients with aneurysmal SAH who had been treated with either craniotomy and clip application or endovascular coil occlusion at a single institution between 1990 and 2000. Three hundred thirty-nine patients underwent surgical clip application procedures, whereas 76 patients underwent endovascular coil occlusion. Symptomatic vasospasm occurred in 39% of patients treated with clip application, 30% of patients treated with endovascular coil occlusion, and 37% of patients overall. Compared with patients treated with clip application, patients treated with endovascular coil occlusion were more likely to suffer acute hydrocephalus (50 compared with 34%, p = 0.008) and were more likely to harbor aneurysms in the posterior circulation (53 compared with 20%, p < 0.001). Logistic regression models controlling for patient age, admission World Federation of Neurosurgical Societies (WFNS) grade, acute hydrocephalus, aneurysm location, and day of treatment revealed that, among patients with an admission WFNS grade of I to III, endovascular coil occlusion carried a lower risk of symptomatic vasospasm (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.14—0.8) and death or permanent neurological deficit due to vasospasm (OR 0.28, 95% CI 0.08–1) compared with craniotomy and clip application. Similar models revealed no difference in the likelihood of a Glasgow Outcome Scale score of 3 or less at the longest follow-up review (median 6 months) between treatment groups (OR 0.58, 95% CI 0.28–1.21). Conclusions. Patients with better clinical grades (WFNS Grades I–III) at hospital admission were less likely to suffer symptomatic vasospasm when treated by endovascular coil occlusion, compared with craniotomy and clip application. Nevertheless, there was no significant difference in overall outcome at the longest follow-up examination between the two treatment groups.

Download Full-text

HMGB1 Level in Cerebrospinal Fluid as a Marker of Treatment Outcome in Patients with Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2015.05.002 ◽

2015 ◽

Vol 24 (8) ◽

pp. 1897-1904 ◽

Cited By ~ 24

Author(s):

Bartosz Sokół ◽

Anna Woźniak ◽

Roman Jankowski ◽

Stefan Jurga ◽

Norbert Wąsik ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Treatment Outcome ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hmgb1 Level ◽

Acute Hydrocephalus

Download Full-text

Acute Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

Annual Review of Hydrocephalus ◽

10.1007/978-3-662-11152-9_101 ◽

1990 ◽

pp. 141-141

Author(s):

Thomas H. Milhorat

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Acute Hydrocephalus

Download Full-text

Neurogenic Stress Cardiomyopathy Precipitated by Acute Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

Neurocritical Care ◽

10.1007/s12028-017-0437-0 ◽

2017 ◽

Vol 28 (2) ◽

pp. 239-242 ◽

Cited By ~ 1

Author(s):

Kamel Gharaibeh ◽

Jackie Scott ◽

Nicholas A. Morris

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Stress Cardiomyopathy ◽

Acute Hydrocephalus ◽

Neurogenic Stress

Download Full-text

Preoperative ventriculostomy and rebleeding after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2002.97.5.1042 ◽

2002 ◽

Vol 97 (5) ◽

pp. 1042-1044 ◽

Cited By ~ 53

Author(s):

Jon I. McIver ◽

Jonathan A. Friedman ◽

Eelco F. M. Wijdicks ◽

David G. Piepgras ◽

Mark A. Pichelmann ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Time Interval ◽

Content Type ◽

Acute Hydrocephalus ◽

Increased Risk ◽

The Mean ◽

Aneurysm Repair ◽

Mean Time ◽

Fine Print

Object. Despite the widespread use of ventriculostomy in the treatment of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH), there is no consensus regarding the risk of rebleeding associated with ventriculostomy before aneurysm repair. This present study was conducted to assess the risk of rebleeding after preoperative ventriculostomy in patients with aneurysmal SAH. Methods. The authors reviewed the records of all patients with acute SAH who were treated at a single institution between 1990 and 1997. Thus, the records of 304 consecutive patients in whom an aneurysmal SAH source was documented on angiographic studies and who had presented to the authors' institution within 7 days of ictus were analyzed. Rebleeding was confirmed by evidence of recurrent hemorrhage on computerized tomography scans in all cases. Forty-five patients underwent ventriculostomy for acute hydrocephalus after aneurysmal SAH at least 24 hours before aneurysm repair. Ventriculostomy was performed within 24 hours of SAH in 38 patients, within 24 to 48 hours in three patients, and more than 48 hours after SAH in four patients. The mean time interval between SAH and surgery in patients who did not undergo ventriculostomy was no different from the mean interval between ventriculostomy and surgery in patients who underwent preoperative ventriculostomy (3.6 compared with 3.8 days, p = 0.81). Fourteen (5.4%) of the 259 patients who did not undergo ventriculostomy suffered preoperative aneurysm rebleeding, whereas two (4.4%) of the 45 patients who underwent preoperative ventriculostomy had aneurysm rebleeding. Conclusions. No evidence was found that preoperative ventriculostomy performed after aneurysmal SAH is associated with an increased risk of aneurysm rebleeding when early aneurysm surgery is performed.

Download Full-text