Letter to the Editor Regarding “Temporal Muscle as an Indicator of Sarcopenia Is Independently Associated with Hunt and Kosnik Grade on Admission and the Modified Rankin Scale Score at 6 Months of Patients with Subarachnoid Hemorrhage Treated by Endovascular Coiling”

2020 ◽  
Vol 139 ◽  
pp. 659
Author(s):  
Umut Safer ◽  
Ilker Tasci ◽  
Vildan Binay Safer
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Endovascular Coiling ◽  
Modified Rankin Scale ◽  
Temporal Muscle ◽  
Letter To The Editor

Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes

2014 ◽  
Vol 121 (6) ◽  
pp. 1367-1373 ◽  
Author(s):  
Alhafidz Hamdan ◽  
Jonathan Barnes ◽  
Patrick Mitchell
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Treatment Modalities ◽  
Modified Rankin Scale ◽  
Related Factors ◽  
Poor Outcome

Object The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH. Methods The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months). Results The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91–2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29–4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29–4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4–6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45–1.11, p > 0.05). Conclusions The overall outcomes after aSAH between women and men are similar.

Vasopressin-Induced Hyponatremia in Patients With Aneurysmal Subarachnoid Hemorrhage: A Case Series and Literature Review

2021 ◽  
pp. 089719002110534
Author(s):  
Hilamber Subba ◽  
Richard R. Riker ◽  
Susan Dunn ◽  
David J. Gagnon
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Serum Sodium ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Medical Center ◽  
Case Series ◽  
Fixed Dose ◽  
Endovascular Coiling ◽  
Convenience Sample ◽  
Maine Medical

Objective Vasopressin may be administered to treat vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). The objectives of this study were to describe five cases of suspected vasopressin-induced hyponatremia after aSAH and to review the literature. Design Single-center, observational case series of intensive care unit (ICU) patients Settings Ten-bed neurological ICU at Maine Medical Center in Portland, Maine Patients Convenience sample of patients with aSAH treated with a vasopressin for symptomatic, radiologically confirmed vasospasm Results A total of five patients were included in the case series with a median age of 57 (51, 65) years and all were women. The median Glasgow coma scale score was 15 (11, 15) on admission, and the Hunt and Hess scale score was 3, (3, 4). All patients were treated with endovascular coiling of their aneurysm. Vasopressin was administered to treat symptomatic, radiographically confirmed vasospasm on median post-bleed day (PBD) 10 (10, 15) at a fixed-dose of .03 units/min. Serum sodium at baseline was 140 (140, 144) mEq/L and decreased to 129 (126, 129) mEq/L within 26 (17, 83) hours of vasopressin initiation for a median change of −16 (−10, −16) mEq/L. Serum sodium returned to baseline within 18 (14, 22) hours of stopping the infusion. Conclusions Vasopressin use in vasospasm after aSAH may be associated with clinically significant hyponatremia within 24 hours of starting the infusion. Hyponatremia appears to resolve within 24 hours of stopping the infusion. Additional study in a larger sample size is needed to determine if a causal relationship exist.

Transluminal Balloon Angioplasty for Symptomatic Distal Vasospasm Refractory to Medical Therapy in Patients With Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Alejandro Santillan ◽  
Jared Knopman ◽  
Walter Zink ◽  
Athos Patsalides ◽  
Y Pierre Gobin
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Medical Therapy ◽  
Balloon Angioplasty ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Repeated Treatment ◽  
Modified Rankin Scale ◽  
Distal Vessel ◽  
Clinical Worsening

Abstract BACKGROUND: Cerebral vasospasm (VSP) is a major cause of morbidity and mortality associated with subarachnoid hemorrhage. The current endovascular paradigm for VSP refractory to medical therapy is to perform angioplasty for proximal vessel VSP and vasodilator infusion for distal vessel VSP. OBJECTIVE: To report our experience with a large series of balloon angioplasty for distal VSP refractory to medical therapy in patients with aneurysmal subarachnoid hemorrhage. METHODS: This was a retrospective series of 32 patients with subarachnoid hemorrhage and symptomatic VSP refractory to medical therapy who were treated with balloon angioplasty for distal vessel VSP. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed. RESULTS: From September 2001 to January 2010, 32 patients with symptomatic VSP refractory to medical therapy underwent angioplasty for distal arterial VSP. There were 26 women (81.3%); patients were 29 to 67 years of age. A total of 175 vessels were angioplastied (95 proximal and 80 distal). The only complication was rupture of an incompletely clipped aneurysm that was treated by immediate coiling and did not result in any clinical worsening. Repeated treatment was needed for 6 arteries (6 of 80, 7.5%). There were no procedure-related symptomatic complications. Good outcomes (modified Rankin Scale score ≤ 2) were observed in 23 of 28 patients (82.1%) with follow-up. CONCLUSION: Balloon angioplasty for distal VSP is safe and effective and decreases the need for repeated intraarterial treatments seen with infusion of vasodilator.

The Relationship Between Serum Neuron-Specific Enolase Levels and Severity of Bleeding and Functional Outcomes in Patients With Nontraumatic Subarachnoid Hemorrhage

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 487-491 ◽  
Author(s):  
Rabih G. Tawk ◽  
Sanjeet S. Grewal ◽  
Michael G. Heckman ◽  
Bhupendra Rawal ◽  
David A. Miller ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Functional Outcomes ◽  
Multivariable Analysis ◽  
Neuron Specific Enolase ◽  
World Federation ◽  
Modified Rankin Scale ◽  
Coma Scale ◽  
Fisher Grade

Abstract BACKGROUND: The value of neuron-specific enolase (NSE) in predicting clinical outcomes has been investigated in a variety of neurological disorders. OBJECTIVE: To investigate the associations of serum NSE with severity of bleeding and functional outcomes in patients with subarachnoid hemorrhage (SAH). METHODS: We retrospectively reviewed the records of patients with SAH from June 2008 to June 2012. The severity of SAH bleeding at admission was measured radiographically with the Fisher scale and clinically with the Glasgow Coma Scale, Hunt and Hess grade, and World Federation of Neurologic Surgeons scale. Outcomes were assessed with the modified Rankin Scale at discharge. RESULTS: We identified 309 patients with nontraumatic SAH, and 71 had NSE testing. Median age was 54 years (range, 23-87 years), and 44% were male. In multivariable analysis, increased NSE was associated with a poorer Hunt and Hess grade (P = .003), World Federation of Neurologic Surgeons scale score (P &lt; .001), and Glasgow Coma Scale score (P = .003) and worse outcomes (modified Rankin Scale at discharge; P = .001). There was no significant association between NSE level and Fisher grade (P = .81) in multivariable analysis. CONCLUSION: We found a significant association between higher NSE levels and poorer clinical presentations and worse outcomes. Although it is still early for any relevant clinical conclusions, our results suggest that NSE holds promise as a tool for screening patients at increased risk of poor outcomes after SAH.

Abstract 3456: Incidence of Vasospasm and Outcomes in Angiography-negative Perimesencephalic Subarachnoid Hemorrhage with and without Ventricular Extension

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Bryan J Bonder ◽  
Edwin A Vargas ◽  
Richard Jung ◽  
Jitendra Sharma ◽  
Kristine A Blackham
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Chart Review ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Modified Rankin Scale ◽  
Perimesencephalic Subarachnoid Hemorrhage ◽  
Fisher Grade ◽  
Increased Risk ◽  
Discharge Summaries

Background: Angiography negative perimesencephalic subarachnoid hemorrhage (SAH) is considered a relatively benign entity compared to aneurysmal SAH. However, some patients with angiography negative perimesencephalic subarachnoid hemorrhage with extension of hemorrhage beyond the perimesencephalic area are at increased risk for vasospasm. Here we present a series of 21 patients with angiography negative perimesencephalic pattern of SAH both with and without ventricular extension and describe their incidence of vasospasm and clinical outcomes. Methods: Retrospective chart review was performed among patients who underwent invasive angiography from 8/2007-6/2010. Inclusion criteria were presenting clinical symptoms typical of SAH, computed tomography (CT) evidence of perimesencephalic SAH with or without ventricular extension, no recent trauma or stroke, and cerebral angiography negative for aneurysm or arteriovenous malformation. 21 patients, 8 men and 13 women, with a mean age of 55.1 years met these criteria. The presenting CTs were examined and a modified Fisher Grade assigned. The patients’ clinical course was reviewed for incidence and treatment of vasospasm. The patients’ discharge summaries were evaluated and each patient given a modified Rankin Scale score. Results: The modified Fisher Scale score derived from the presenting CT was 1 for 29% (n=6), 2 for 5% (n=1), 3 for 19% (n=4), and 4 for 47% (n=10) of the patients. Amongst the 52% (n=11) of patients with intraventricular hemorrhage as defined by a modified Fisher Scale score of 2 or 4, 24% (n=5) developed angiographical evidence of vasospasm. 10% (n=2) of the patients required intra-arterial verapamil. 90% (n=9) of patients without intraventricular extension had good outcomes at discharge as defined by modified Rankin Scale score less than or equal to 2, while only 36% (n=4) of patients with angiography negative SAH with intraventricular extension had good outcomes. Conclusions: Although angiography negative perimesencephalic SAH is considered to have less associated morbidity and mortality than aneurysmal perimesencephalic SAH, patients with extension of hemorrhage into the ventricles are at increased risk for vasospasm and poor functional outcomes.

Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment

2017 ◽  
Vol 126 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Carlina E. van Donkelaar ◽  
Nicolaas A. Bakker ◽  
Nic J. G. M. Veeger ◽  
Maarten Uyttenboogaart ◽  
Jan D. M. Metzemaekers ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Clinical Assessment ◽  
Clinical Condition ◽  
Prognostic Value ◽  
Modified Rankin Scale ◽  
Prediction Of Outcome ◽  
Discriminative Performance ◽  
Final Model ◽  
Poor Outcome

OBJECTIVE Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue. The clinical condition of the patient on admission as assessed using the World Federation of Neurosurgical Societies (WFNS) grading scale is currently considered the gold standard. However, the timing of the clinical assessment is subject to debate, as is the contribution of additional predictors. The aim of this study was to identify either the conventional WFNS grade on admission or the WFNS grade after neurological resuscitation (rWFNS) as the most accurate predictor of outcome after SAH. METHODS This prospective observational cohort study included 1620 consecutive patients with SAH admitted between January 1998 and December 2014 at our university neurovascular center. The primary outcome measure was a poor modified Rankin Scale score at the 2-month follow-up. Clinical predictors were identified using multivariate logistic regression analyses. Area under the receiver operating characteristic curve (AUC) analysis was used to test discriminative performance of the final model. An AUC of > 0.8 was regarded as indicative of a model with good prognostic value. RESULTS Poor outcome (modified Rankin Scale Score 4–6) was observed in 25% of the patients. The rWFNS grade was a significantly stronger predictor of outcome than the admission WFNS grade. The rWFNS grade was significantly associated with poor outcome (p < 0.001) as well as increasing age (p < 0.001), higher modified Fisher grade (p < 0.001), larger aneurysm size (p < 0.001), and the presence of an intracerebral hematoma (OR 1.8, 95% CI 1.2–2.8; p = 0.002). The final model had an AUC of 0.87 (95% CI 0.85–0.89), which indicates excellent prognostic value regarding the discrimination between poor and good outcome after SAH. CONCLUSIONS In clinical practice and future research, neurological assessment and grading of patients should be performed using the rWFNS to obtain the best representation of their clinical condition.

scholarly journals Haptoglobin genotype and functional outcome after aneurysmal subarachnoid hemorrhage

2014 ◽  
Vol 120 (2) ◽  
pp. 386-390 ◽  
Author(s):  
Ellen Kantor ◽  
Hülya Bayır ◽  
Dianxu Ren ◽  
J. Javier Provencio ◽  
Laura Watkins ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Medical Condition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Outcome Data ◽  
The Body ◽  
Individual Risk ◽  
Modified Rankin Scale ◽  
Fisher Grade ◽  
Haptoglobin Genotype

Object Haptoglobin allele heterogeneity has been implicated in differential reactive oxidant inhibition and inflammation. Haptoglobin α2-α2 has a lower affinity for binding hemoglobin, and when bound to hemoglobin, is cleared less easily by the body. The authors hypothesized that haptoglobin α2-α2 genotype should be less protective for downstream injury after aneurysmal subarachnoid hemorrhage (aSAH) and should portend a worse outcome. Methods Patients with Fisher Grade 2 or higher aSAH were enrolled in the study. Genotyping for haptoglobin genotype was performed from blood and/or CSF. Demographic information, medical condition variables, and hospital course were abstracted from the medical record upon enrollment into the study. Outcome data (modified Rankin Scale score, Glasgow Outcome Scale score, and mortality) were collected at 3 months posthemorrhage. Results The authors enrolled 193 patients who ranged in age from 18 to 75 years. Only Caucasians were used in this analysis to minimize bias from variable haptoglobin allele frequencies in populations of different ancestral backgrounds. The sample had more women than men (overall mean age 54.45 years). Haptoglobin α2 homozygotes were older than the other individuals in the study sample (57.27 vs 53.2 years, respectively; p = 0.02) and were more likely to have Fisher Grade 3 SAH (p = 0.02). Haptoglobin α2-α2 genotype, along with Fisher grade and Hunt and Hess grade, was associated with a worse 3-month outcome compared to those with the haptoglobin α1-α1 genotype according to modified Rankin Scale score after controlling for covariates (OR 4.138, p = 0.0463). Conclusions Patients with aSAH who carry the haptoglobin α2-α2 genotype had a worse outcome. Interestingly, the presence of a single α-2 allele was associated with worse outcome, suggesting that the haptoglobin α-2 protein may play a role in the pathology of brain injury following aSAH, although the mechanism for this finding requires further research. The haptoglobin genotype may provide additional information on individual risk of secondary injury and recovery to guide care focused on improving outcomes.

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