Shunt performance in 349 patients with hydrocephalus after aneurysmal subarachnoid hemorrhage

Abstract Background Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequelae leading to poorer neurological outcomes and predisposing to various complications. Methods A total of 2191 consecutive patients with aSAH were acutely admitted to the Neurointensive Care at the Kuopio University Hospital between 1990 and 2018 from a defined population. A total of 349 (16%) aSAH patients received a ventriculoperitoneal shunt, 101 with an adjustable valve (2012–2018), 232 with a fixed pressure valve (1990–2011), and 16 a valveless shunt (2010–2013). Clinical timelines were reconstructed from the hospital records and nationwide registries until death (n = 120) or June 2019. Results Comparing the adjustable valves vs. the fixed pressure valves vs. the valveless shunts, intraventricular hemorrhage was present in 61%, 44% and 100%, respectively. The median times to the shunt were 7 days vs. 38 days vs. 10 days. The rates of the first revision were 25% vs. 32% vs. 69%. The causes included infection in 11% vs. 7% vs. 25% and overdrainage in 1% vs. 4% vs. 31%. The valveless shunt was the only independent risk factor (HR 2.9) for revision. After the first revision, more revisions were required in 48% vs. 52% vs. 45%. Conclusions The protocol to shunt evolved over time to favor earlier shunt. In post-aSAH hydrocephalus, adjustable valve shunts, without anti-siphon device, can be installed at an early phase after aSAH, in spite of intraventricular blood, with a modest risk (25%) of revision. Valveless shunts are not recommendable due to high risk of revisions.

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Cocaine Use Is an Independent Risk Factor for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/hs1001.097041 ◽

2001 ◽

Vol 32 (10) ◽

pp. 2338-2343 ◽

Cited By ~ 64

Author(s):

James E. Conway ◽

Rafael J. Tamargo

Keyword(s):

Risk Factor ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Independent Risk Factor ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cocaine Use

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Isolated Intraventricular Hemorrhage Associated with Cerebral Vasospasm and Delayed Cerebral Ischemia following Arteriovenous Malformation Rupture

Interventional Neurology ◽

10.1159/000490583 ◽

2018 ◽

Vol 7 (6) ◽

pp. 479-489 ◽

Cited By ~ 1

Author(s):

Krishna Amuluru ◽

Fawaz Al-Mufti ◽

Charles E. Romero ◽

Chirag D. Gandhi

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Arteriovenous Malformation ◽

Cerebral Angiography ◽

Intraventricular Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Statistical Significance ◽

Delayed Cerebral Ischemia ◽

Ruptured Avm ◽

Level Of Significance

Background: Although it is well characterized in aneurysmal subarachnoid hemorrhage, vasospasm is exceedingly rare following cerebral arteriovenous malformation (AVM) rupture. Subsequently, this complication is poorly characterized with regard to delayed cerebral ischemia (DCI). We review cases of ruptured AVM to assess the frequency and severity of vasospasm on cerebral angiography, and DCI. Summary: We reviewed our institutional database of acute intracranial hemorrhages between 2005 and 2014. We identified patients with cerebral AVM rupture and evidence of vasospasm, which was confirmed with digital subtraction angiography (DSA). Cerebral angiograms were evaluated by 2 blinded neurointerventionalists for vasospasm. Statistical analyses were conducted on the angiographic results and variables of interest to determine predictors and associations of vasospasm and DCI. Thirty-six patients with acute intracranial hemorrhage due to ruptured cerebral AVM subsequently underwent cerebral angiography. The interrater reliability for vasospasm was 0.81. The incidence of vasospasm was 13.9% and the incidence of subsequent DCI was 11.1%. A significant relationship existed between isolated intraventricular hemorrhage and vasospasm (p = 0.001) and subsequent DCI (p = 0.006). Radiographic vasospasm was associated with DCI in 80% of the patients (p < 0.0001). No statistical significance existed between subarachnoid hemorrhage and the development of vasospasm or DCI (p = 1.000 and p = 0.626, respectively). All differences were significant at a 99% level of significance. Key Message: In cases of ruptured AVM, isolated intraventricular hemorrhage appears to be an independent risk factor for vasospasm and DCI. Vasospasm must be considered during late neurological deterioration following AVM hemorrhage, especially in the setting of isolated intraventricular hemorrhage.

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Predictors of the development of takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage and outcomes in patients with intra-aortic balloon pumps

Journal of Neurosurgery ◽

10.3171/2020.5.jns20536 ◽

2020 ◽

pp. 1-6

Author(s):

Joshua S. Catapano ◽

Andrew F. Ducruet ◽

Fabio A. Frisoli ◽

Candice L. Nguyen ◽

Christopher E. Louie ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Takotsubo Cardiomyopathy ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Multivariate Logistic Regression Analysis ◽

High Morbidity ◽

Female Patients ◽

Neurological Outcomes ◽

Poor Outcomes

OBJECTIVETakotsubo cardiomyopathy (TC) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Previous studies have shown that female patients presenting with a poor clinical grade are at the greatest risk for developing TC. Intra-aortic balloon pumps (IABPs) are known to support cardiac function in severe cases of TC, and they may aid in the treatment of vasospasm in these patients. In this study, the authors investigated risk factors for developing TC in the setting of aSAH and outcomes among patients requiring IABPs.METHODSThe authors retrospectively reviewed the records of 1096 patients who had presented to their institution with aSAH. Four hundred five of these patients were originally enrolled in the Barrow Ruptured Aneurysm Trial, and an additional 691 patients from a subsequent prospectively maintained aSAH database were analyzed. Medical records were reviewed for the presence of TC according to the modified Mayo Clinic criteria. Outcomes were determined at the last follow-up, with a poor outcome defined as a modified Rankin Scale (mRS) score > 2.RESULTSTC was identified in 26 patients with aSAH. Stepwise multivariate logistic regression analysis identified female sex (OR 8.2, p = 0.005), Hunt and Hess grade > III (OR 7.6, p < 0.001), aneurysm size > 7 mm (OR 3, p = 0.011), and clinical vasospasm (OR 2.9, p = 0.037) as risk factors for developing TC in the setting of aSAH. TC patients, even with IABP placement, had higher rates of poor outcomes (77% vs 47% with an mRS score > 2, p = 0.004) and mortality at the last follow-up (27% vs 11%, p = 0.018) than the non-TC patients. However, aggressive intra-arterial endovascular treatment for vasospasm was associated with good outcomes in the TC patients versus nonaggressive treatment (100% with mRS ≤ 2 at last follow-up vs 53% with mRS > 2, p = 0.040).CONCLUSIONSTC after aSAH tends to occur in female patients with large aneurysms, poor clinical grades, and clinical vasospasm. These patients have significantly higher rates of poor neurological outcomes, even with the placement of an IABP. However, aggressive intra-arterial endovascular therapy in select patients with vasospasm may improve outcome.

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Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Journal of Neurosurgery ◽

10.3171/2016.11.jns152839 ◽

2018 ◽

Vol 128 (4) ◽

pp. 1032-1036 ◽

Cited By ~ 1

Author(s):

Ha Son Nguyen ◽

Luyuan Li ◽

Mohit Patel ◽

Shekar Kurpad ◽

Wade Mueller

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Intraventricular Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Characteristic Curve ◽

Univariate Analysis ◽

Area Under The Curve ◽

Ventricular System ◽

Fisher Grade ◽

Gcs Score

OBJECTIVEThe presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores.METHODSThe authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1–3 and 4–5 subgroups for analysis.RESULTSOn univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895–0.979), GCS score (OR 3.422, 95% CI 1.9–6.164), and ventricular density (OR 0.937, 95% CI 0.878–0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1–3 and 4–5.CONCLUSIONSThis study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

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Impact of Hyperoxia and Hypocapnia on Neurological Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study

Critical Care Research and Practice ◽

10.1155/2019/7584573 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Kin Chio Li ◽

Catherine Wing Yan Tam ◽

Hoi-Ping Shum ◽

Wing Wa Yan

Keyword(s):

Subarachnoid Hemorrhage ◽

Critically Ill ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Classification Tree ◽

Tertiary Hospital ◽

Classification Tree Analysis ◽

Radiological Findings ◽

Neurological Outcomes ◽

Poor Outcomes ◽

The Impact

In recent decades, there is increasing evidence suggesting that hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with cardiac arrest or traumatic brain injury. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been well studied. In the present study, we evaluated the impact of hyperoxia and hypocapnia on neurological outcomes in patients with aneurysmal SAH (aSAH). Patients with aSAH who were admitted to the intensive care unit (ICU) of a tertiary hospital in Hong Kong between January 2011 and December 2016 were retrospectively recruited. Patients’ demographics, comorbidities, radiological findings, clinical grades of SAH, PO2, and PCO2 within 24 hours of ICU admission, and Glasgow Outcome Scale (GOS) at 3 months after admission were recorded. Patients with a GOS score of 3 or less were considered having poor neurological outcomes. Among the 244 patients with aSAH, 122 of them (50%) had poor neurological outcomes at 3 months. Early hyperoxia (PO2 > 200 mmHg) and hypercapnia (PCO2 > 45 mmHg) were more common among patients with poor neurological outcomes. Logistic regression analysis indicated that hyperoxia independently predicted poor neurological outcomes (OR 3.788, 95% CI 1.131–12.690, P=0.031). Classification tree analysis revealed that hypocapnia was associated with poor neurological outcomes in patients who were less critically ill (APACHE < 50) and without concomitant intracranial hemorrhage (ICH) or intraventricular hemorrhage (IVH) (adjusted P=0.006, χ2 = 7.452). These findings suggested that hyperoxia and hypocapnia may be associated with poor neurological outcomes in patients with aSAH.

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It is not the ride: inter-hospital transport is not an independent risk factor for intraventricular hemorrhage among very low birth weight infants

Journal of Perinatology ◽

10.1038/jp.2012.126 ◽

2012 ◽

Vol 33 (5) ◽

pp. 366-370 ◽

Cited By ~ 17

Author(s):

A Watson ◽

B Saville ◽

Z Lu ◽

W Walsh

Keyword(s):

Risk Factor ◽

Birth Weight ◽

Low Birth Weight ◽

Intraventricular Hemorrhage ◽

Independent Risk Factor ◽

Very Low Birth Weight ◽

Low Birth Weight Infants ◽

Hospital Transport

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Extent of Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage as a Risk Factor for Delayed Cerebral Infarction

Stroke ◽

10.1161/strokeaha.107.484220 ◽

2007 ◽

Vol 38 (9) ◽

pp. 2496-2499 ◽

Cited By ~ 14

Author(s):

Annelies M. Bakker ◽

Sanne M. Dorhout Mees ◽

Ale Algra ◽

Gabriël J.E. Rinkel

Keyword(s):

Risk Factor ◽

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Acute Hydrocephalus

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Is Vitamin D Insufficiency Associated with Mortality of Critically Ill Patients?

Critical Care Research and Practice ◽

10.1155/2013/856747 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Gulbin Aygencel ◽

Melda Turkoglu ◽

Ayse Fitnat Tuncel ◽

Burcu Arslan Candır ◽

Yelda Deligoz Bildacı ◽

...

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Risk Factor ◽

Vitamin D Insufficiency ◽

University Hospital ◽

Median Serum ◽

Vitamin D Levels ◽

Sufficient Vitamin

Objective. To evaluate the vitamin D status of our critically ill patients and its relevance to mortality.Patients and Methods. We performed a prospective observational study in the medical intensive care unit of a university hospital between October 2009 and March 2011. Vitamin D levels were measured and insufficiency was defined as <20 ng/mL.Results. Two hundred and one patients were included in the study. The median age was 66 (56–77) and the majority of patients were male (56%). The median serum level of vitamin D was 14,9 ng/mL and 139 (69%) patients were vitamin D insufficient on admission. While we grouped the ICU patients as vitamin D insufficient and sufficient, vitamin D insufficient patients had more severe acute diseases and worse laboratory values on admission. These patients had more morbidities and were exposed to more invasive therapies during stay. The mortality rate was significantly higher in the vitamin D insufficient group compared to the vitamin D sufficient group (43% versus 26%,P=0,027). However, logistic regression analysis demonstrated that vitamin D insufficiency was not an independent risk factor for mortality.Conclusion. Vitamin D insufficiency is common in our critically ill patients (69%), but it is not an independent risk factor for mortality.

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