Prognostic Value of a Structural Brain MRI Score in the Acute Phase of Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

2021 ◽  
Author(s):  
Sarah E. Nelson ◽  
Pirouz Piran ◽  
Jun Hua ◽  
Alexander Sigmon ◽  
Casey Weiner ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pilot Study ◽  
Acute Phase ◽  
Prognostic Value ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Brain Mri ◽  
Mri Score ◽  
Structural Brain

Characteristics and prognostic value of acute catecholamine surge in patients with aneurysmal subarachnoid hemorrhage

2012 ◽  
Vol 34 (5) ◽  
pp. 484-490 ◽  
Author(s):  
Takeshi Ogura ◽  
Akira Satoh ◽  
Hidetoshi Ooigawa ◽  
Tatsuya Sugiyama ◽  
Ririko Takeda ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Prognostic Value ◽  
Aneurysmal Subarachnoid Hemorrhage

Abstract TP454: Immunological Responses in Patients With Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jorge A Roa ◽  
Deepon Sarkar ◽  
Mario Zanaty ◽  
David Hasan ◽  
Edgar Samaniego ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Acute Phase ◽  
Immune Cells ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Intracellular Cytokine Staining ◽  
Delayed Cerebral Ischemia ◽  
Effector Proteins ◽  
Time Points ◽  
Adaptive Immune ◽  
Adaptive Immune Cells

Introduction: Cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) are frequently observed after aneurysmal subarachnoid hemorrhage (aSAH) and contribute to neurocognitive decline and worse outcomes. We hypothesize that aSAH initiates a cascade of neuroinflammatory events which contributes to the development of DCI. Methods: Patients who presented with aSAH requiring external ventricular drainage (EVD) for concomitant hydrocephalus were prospectively enrolled. Cerebrospinal fluid (CSF) samples were collected at different time-points relative to index aSAH injury: acute (days 0-1); pre-vasospasm (days 2-5); vasospasm peak (days 6-9) and post-vasospasm (days 10+). Presence and severity of CVS were assessed using CTA/CTP scans and clinical exam. VEGF and MMP9 (immune affectors) protein levels in the CSF were quantified using ELISA. Mobilization of the immune system was characterized by quantification of innate and adaptive immune cells in the CSF using flow cytometry. Production of inflammatory effector proteins was evaluated using intracellular cytokine staining. Results: Of 13 patients analyzed, 6 (46.2%) experienced CVS. Levels of VEGF and MMP9 were consistently higher in aSAH patients who developed CVS, with the highest difference occurring at the acute phase. Similarly, cellularity analysis revealed elevated counts of monocytes (CD11b + ) in the CSF during the acute phase, with progressive decline at later phases. Microglia (CD45 dim CD11b + ) cells were found to be significantly increased at the post-vasospasm phase. A higher percentage of IFN-γ production cytotoxic T helper cells were found at the acute phase, while the later time points revealed an elevated leveled of CD45RA - CD27 + cytotoxic T cells. Conclusion: Our preliminary data shows an active production of proteins with known immunological functions, mobilization of innate cells, production of inflammatory mediators by adaptive immune cells and altered differentiation status. Our overall goal is to determine if there are potential targets of immunomodulatory therapies which can be used to prevent or treat vasospasms and its related deleterious outcomes.

scholarly journals Daily systemic energy expenditure in the acute phase of aneurysmal subarachnoid hemorrhage

2019 ◽  
Vol 124 (4) ◽  
pp. 254-259 ◽  
Author(s):  
Christoffer Nyberg ◽  
Elisabeth Ronne Engström ◽  
Lars Hillered ◽  
Torbjörn Karlsson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Energy Expenditure ◽  
Acute Phase ◽  
Aneurysmal Subarachnoid Hemorrhage

scholarly journals Safety, Tolerability, and Efficacy of Pain Reduction by Gabapentin for Acute Headache and Meningismus After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Laxmi P. Dhakal ◽  
Marion T. Turnbull ◽  
Daniel A. Jackson ◽  
Emily Edwards ◽  
David O. Hodge ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pilot Study ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Pain Reduction ◽  
Acute Headache

scholarly journals Prevalence and predictors of fatigue after aneurysmal subarachnoid hemorrhage

2020 ◽  
Vol 162 (12) ◽  
pp. 3107-3116
Author(s):  
Elin Western ◽  
Angelika Sorteberg ◽  
Cathrine Brunborg ◽  
Tonje Haug Nordenmark
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Acute Phase ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariable Analysis ◽  
Chronic Phase ◽  
Common Denominator ◽  
Fatigue Severity ◽  
Multivariable Regression ◽  
Subarachnoid Blood ◽  
Aneurysm Repair

Abstract Background Fatigue is a common and disabling sequel after aneurysmal subarachnoid hemorrhage (aSAH). At present, prevalence estimates of post-aSAH fatigue in the chronic phase are scarce and vary greatly. Factors from the acute phase of aSAH have hitherto barely been associated with post-aSAH fatigue in the chronic phase. Methods Prospective study assessing prevalence of fatigue using the Fatigue Severity Scale (FSS) in patients who were living independently 1 to 7 years after aSAH. We compared demographic, medical, and radiological variables from the acute phase of aSAH between patients with and without fatigue (FSS ≥ 4 versus < 4) and searched for predictors of fatigue among these variables applying univariable and multivariable regression analyses. Results Of 726 patients treated for aSAH in the period between January 2012 and December 2017, 356 patients completed the assessment. The mean FSS score was 4.7 ± 1.7, and fatigue was present in 69.7%. The frequency of patients with fatigue did not decline significantly over time. Univariable analysis identified nicotine use, loss of consciousness at ictus (LOCi), rebleed prior to aneurysm repair, reduced consciousness to Glasgow Coma Scale (GCS) < 14, large amounts of subarachnoid blood, the presence of acute hydrocephalus, and severe vasospasm as factors that were significantly associated with fatigue. In multivariable analysis, nicotine use, reduced GCS, and severe vasospasm were independent predictors that all more than doubled the risk to develop post-aSAH fatigue. Conclusions Fatigue is a frequent sequel persisting several years after aSAH. Nicotine use, reduced consciousness at admission, and severe vasospasm are independent predictors of fatigue from the acute phase of aSAH. We propose inflammatory cytokines causing dopamine imbalance to be a common denominator for post-aSAH fatigue and the presently identified predictors.

scholarly journals Jugular Bulb Oximetry for Prediction of Vasospasm Following Subarachnoid Hemorrhage

2004 ◽  
Vol 31 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Navraj S. Heran ◽  
Stephen J. Hentschel ◽  
Brian D. Toyota
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pilot Study ◽  
Observational Study ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cost Effective ◽  
Jugular Bulb ◽  
Significant Rise ◽  
Cerebral Oxygen ◽  
Blood Samples ◽  
Jugular Bulb Catheter

Background:Cerebral vasospasm adversely impacts the outcome of those suffering aneurysmal subarachnoid hemorrhage (SAH). Prediction of vasospasm could improve outcomes. We hypothesized that preclinical vasospasm would be heralded by an increase in cerebral oxygen extractions (AVDO2) which could be detected by jugular bulb oximetry. A pilot study was conducted to address this hypothesis.Methods:Fourteen consenting patients with aneurysmal SAH, undergoing early surgery, were entered into the study. Four patients were withdrawn from the study secondary to failure of catheters or religious belief. At the time of craniotomy, a jugular bulb catheter was placed. Post-operatively, arterial and jugular bulb blood samples were taken every 12 hours to calculate AVDO2. As this was an observational study, no change in management occurred based on measurements.Results:Four of 10 patients had clinical vasospasm. These patients had a significant rise in AVDO2 approximately one day prior to the onset of neurologic deficits (P<0.001). Symptoms resolved along with a significant improvement in AVDO2 on instituting hypertensive, hemo-dilutional, and hypervolemic therapy in these patients. The six patients who did not exhibit clinical vasospasm did not demonstrate significant rise in AVDO2.Conclusion:Jugular bulb oximetry is simple and cost effective. Increases in AVDO2 using this technique were predictive of clinically evident vasospasm in the subsequent hours to days. This investigation supports a larger study to assess the utility of jugular bulb oximetry in predicting vasospasm in aneurysmal SAH.

scholarly journals Hyperacute versus Subacute Coiling of Aneurysmal Subarachnoid Hemorrhage a Short-term Outcome and Single-Center Experience, Pilot Study

2016 ◽  
Vol 7 ◽  
Author(s):  
Abdulrahman Mostafa Ibrahim Ali ◽  
Ghada Abdel Hady Ossman Ashmawy ◽  
Ayman Youssef Ezeddin Eassa ◽  
Osama Yassin Mansour
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pilot Study ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Single Center ◽  
Short Term ◽  
Term Outcome ◽  
Single Center Experience ◽  
Short Term Outcome

Prognostic value of histopathological findings in aneurysmal subarachnoid hemorrhage

2009 ◽  
Vol 110 (3) ◽  
pp. 487-491 ◽  
Author(s):  
Markus Holling ◽  
Astrid Jeibmann ◽  
Joachim Gerss ◽  
Bernhard R. Fischer ◽  
Hansdetlef Wassmann ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Prognostic Value ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Histopathological Findings ◽  
Aneurysm Size ◽  
Aneurysm Wall ◽  
Fisher Grade ◽  
Lymphocytic Infiltrates

Object Aneurysmal subarachnoid hemorrhage (SAH) carries a severe prognosis, which is often related to the development of cerebral vasospasm. Even though several clinical and radiological predictors of vasospasm and functional outcome have been established, the prognostic value of histopathological findings remains unclear. Methods Histopathological findings in resected distal aneurysm walls were examined, as were the clinical and radiological factors in a series of 91 patients who had been neurosurgically treated for aneurysmal SAH. The impact of the histological, clinical, and radiological factors on the occurrence of vasospasm and functional outcome at discharge was analyzed. Results Histopathological findings frequently included lymphocytic infiltrates (60%), fibrosis (60%), and necrosis (50%) of the resected aneurysm wall. On univariate analysis, clinical (Hunt and Hess grade) and radiological (aneurysm size) factors as well as histopathological features—namely, lymphocytic infiltrates and necrosis of the aneurysm wall—were significantly associated with the occurrence of vasospasm. On multivariate analysis, lymphocytic infiltrates (OR 6.35, 95% CI 2.32–17.36, p = 0.0001) and aneurysm size (OR 1.22, 95% CI 1.05–1.42, p = 0.009) remained the only factors predicting the development of vasospasm. A poor functional outcome at discharge was significantly associated with vasospasm, other clinical factors (Hunt and Hess grade, alcohol consumption, hyperglycemia, and elevated white blood cell count [WBC] at admission), and radiological factors (Fisher grade and aneurysm size), as well as with histopathological features (lymphocytic infiltrates [p = 0.0001] and necrosis of the aneurysm wall [p = 0.0015]). On multivariate analysis taking into account all clinical, radiological, and histological factors; vasospasm (OR 9.82, 95% CI 1.83–52.82, p = 0.008), Hunt and Hess grade (OR 5.61, 95% CI 2.29–13.74, p = 0.0001), patient age (OR 1.09, 95% CI 1.02–1.16, p = 0.0013), elevated WBC (OR 1.29, 95% CI 1.01–1.64, p = 0.04), and Fisher grade (OR 4.35, 95% CI 1.25–15.07, p = 0.015) best predicted functional outcome at discharge. Conclusions The demonstration of lymphocytic infiltrates in the resected aneurysm wall is of independent prognostic value for the development of vasospasm in patients with neurosurgically treated aneurysmal SAH. Thus, histopathology might complement other clinical and radiological factors in the identification of patients at risk.

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