Delayed Neurological Deterioration in ICH Due to Cerebral Infarction

Object. The authors evaluated an alternative method to avoid postoperative posterior tethering of the spinal cord following resection of spinal ependymomas. Methods. Twenty-five patients with spinal ependymoma underwent surgery between 1978 and 2002. There were 16 male and nine female patients whose ages at the time of surgery ranged from 14 to 64 years (mean 41.8 years). The follow-up period ranged from 6 to 279 months (mean 112.4 months). In the initial 17 patients (Group A), the procedure to prevent arachnoidal adhesion consisted of the layer-to-layer closure of three meninges and laminoplasty. In the subsequently treated eight patients (Group B), the authors performed an alternative technique that included pial suturing, dural closure with Gore-Tex membrane—assisted patch grafting, and expansive laminoplasty. In Group A, postoperative adhesion was radiologically detected in eight cases (47%), and delayed neurological deterioration secondary to posterior tethering of the cord was found in five cases. In Group B, there was no evidence of adhesive posterior tethering or delayed neurological deterioration. A significant intergroup statistical difference was demonstrated for radiologically documented posterior tethering (p < 0.05, Fisher exact test). Moreover, patients with radiologically demonstrated posterior tethering suffered a significant delayed neurological functional deterioration (p < 0.01, Fisher exact test). Conclusions. This new technique for closure of the surgical wound is effective in preventing of postoperative posterior spinal cord tethering after excision of spinal ependymoma.

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The role of craniectomy in the treatment of chronic subdural hematomas

Journal of Neurosurgery ◽

10.3171/jns.1980.52.6.0776 ◽

1980 ◽

Vol 52 (6) ◽

pp. 776-781 ◽

Cited By ~ 54

Author(s):

George Tyson ◽

W. Ellis Strachan ◽

Peter Newman ◽

H. Richard Winn ◽

Albert Butler ◽

...

Keyword(s):

Cerebral Infarction ◽

Chronic Subdural Hematoma ◽

Neurological Deterioration ◽

Neurological Dysfunction ◽

Consecutive Series ◽

Content Type ◽

Significant Clinical Improvement ◽

Acute Neurological Deterioration ◽

Fine Print

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

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Determinants of Early Versus Delayed Neurological Deterioration in Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.118.024403 ◽

2019 ◽

Vol 50 (6) ◽

pp. 1409-1414 ◽

Cited By ~ 7

Author(s):

Shoujiang You ◽

Danni Zheng ◽

Candice Delcourt ◽

Shoichiro Sato ◽

Yongjun Cao ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Neurological Deterioration ◽

Delayed Neurological Deterioration

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Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2008.109.12.1052 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1052-1059 ◽

Cited By ~ 104

Author(s):

J. Michael Schmidt ◽

Katja E. Wartenberg ◽

Andres Fernandez ◽

Jan Claassen ◽

Fred Rincon ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Cerebral Infarction ◽

Clinical Symptoms ◽

External Ventricular Drain ◽

Delayed Cerebral Ischemia ◽

Neurological Deterioration ◽

Modified Rankin Scale ◽

Poor Grade

Object The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH). Methods The authors prospectively studied 580 patients with SAH admitted to their center between July 1996 and May 2002. Delayed cerebral ischemia (DCI) from vasospasm was defined as 1) a new focal neurological deficit or decrease in level of consciousness, 2) a new infarct revealed by follow-up CT imaging, or both, after excluding causes other than vasospasm. Outcome at 3 months was assessed using the modified Rankin Scale. Results Delayed cerebral ischemia occurred in 121 (21%) of 580 patients. Of those with DCI, 36% (44 patients) experienced neurological deterioration without a corresponding infarct, 42% (51 patients) developed an infarct in conjunction with neurological deterioration, and 21% (26 patients) had a new infarct on CT without concurrent neurological deterioration. In a multivariate analysis, risk factors for asymptomatic DCI included coma on admission, placement of an external ventricular drain, and smaller volumes of SAH (all p ≤ 0.03). Patients with asymptomatic DCI were less likely to be treated with vasopressor agents than those with symptomatic DCI (64 vs 86%, p = 0.01). After adjusting for clinical grade, age, and aneurysm size, the authors found that there was a higher frequency of death or moderate-to-severe disability at 3 months (modified Rankin Scale Score 4–6) in patients with asymptomatic DCI than in patients with symptomatic DCI (73 vs 40%, adjusted odds ratio 3.9, 95% confidence interval 1.3–12.0, p = 0.017). Conclusions Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.

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Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.4.peds09478 ◽

2010 ◽

Vol 6 (1) ◽

pp. 73-81 ◽

Cited By ~ 72

Author(s):

Toshiaki Hayashi ◽

Reizo Shirane ◽

Miki Fujimura ◽

Teiji Tominaga

Keyword(s):

Mr Imaging ◽

Cerebral Infarction ◽

Moyamoya Disease ◽

Postoperative Period ◽

Mr Angiography ◽

Dynamic Change ◽

Young Patients ◽

Cerebral Hemodynamics ◽

Early Postoperative Period ◽

Neurological Deterioration

Object Young patients with moyamoya disease frequently exhibit extensive cerebral infarction at the time of initial presentation, and even in the early postoperative period. To investigate clinical characteristics in the early postoperative period, the authors prospectively analyzed findings of MR imaging, MR angiography, and SPECT before and after surgery. The authors focused in particular on how postoperative neurological deterioration occurred. Methods Between August 2005 and June 2009, 22 patients younger than 18 years of age with moyamoya disease were treated at Miyagi Children's Hospital. The mean patient age (± SD) was 8.58 ± 4.55 years (range 2–17 years). Superficial temporal artery–middle cerebral artery bypass and indirect bypass of encephalosynangiosis between the brain surface and the temporal muscle, galea, and dura mater were performed in 35 hemispheres. Magnetic resonance imaging and MR angiography were performed before surgery, at 7 days postoperatively, and 3–6 months after surgery. A 123I-isopropyl iodoamphetamine SPECT scan was also obtained pre- and postoperatively. Results During the postoperative period, neurological deterioration was observed after 15 operations (10 cases of motor paresis, 1 of aphasia, and 4 of sensory disturbance) in 13 patients. All symptoms had resolved by the time of discharge, except in 2 patients who suffered cerebral infarction. All patients exhibited disappearance (94.3%) or reduction (5.7%) of transient ischemic attacks (TIAs) during the follow-up period. Perioperative studies revealed 2 different types of radiological findings, focal uptake decrease on SPECT indicative of cerebral ischemia due to dynamic change in cerebral hemodynamics caused by bypass flow, the so-called watershed shift, and perioperative edematous lesions on MR imaging due to cerebral hyperperfusion. The frequent occurrence of preoperative TIAs was significantly associated with watershed shift, whereas preoperative MR imaging findings and preoperative SPECT findings were not. Age at operation was the only factor significantly associated with postoperative hyperperfusion. Conclusions In young patients, moyamoya disease exhibits rapid progression, resulting in poor clinical outcome. The risk of postoperative neurological deterioration in very young moyamoya patients with frequent TIAs should be noted. The findings in this study showed that direct bypass is not completely safe in patients with moyamoya disease because it causes dynamic change in postoperative cerebral hemodynamics.

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Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202617666200517111802 ◽

2020 ◽

Vol 17 (4) ◽

pp. 411-419

Author(s):

Mei-Qi Wang ◽

Ying-Ying Sun ◽

Yan Wang ◽

Xiu-Li Yan ◽

Hang Jin ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Final Analysis ◽

Hemorrhagic Transformation ◽

Neurological Deterioration ◽

Receiver Operating Curve ◽

Outcome Indicators ◽

Early Neurological Deterioration ◽

Delayed Neurological Deterioration

Background and Purpose: Platelet-to-neutrophil ratio (PNR) was suggested to be an independent protective predictor for 90-days outcomes in acute ischemic stroke (AIS) patients in previous studies. This study aims to investigate the association between PNR and outcomes of AIS in intravenous thrombolysis (IVT) group. Methods: Data on acute ischemic stroke patients who received intravenous thrombolysis from April 2015 to March 2019 were collected. We defined the PNR value at admission as pre-IVT PNR and after IVT within 24 h was defined as post-IVT PNR. Clinical outcome indicators included early neurological deterioration (END), hemorrhagic transformation (HT), delayed neurological deterioration (DND), and poor 3-month outcome (3m-mRS >2). Results: A total of 581 patients were enrolled in the final analysis. The age was 61(53-69) years, and 423(72.8%) were males. Post-IVT PNR was independently associated with hemorrhagic transformation (OR = 0.974; 95%CI = 0.956-0.992; P=0.006), early neurological deterioration (OR = 0.939; 95%CI = 0.913-0.966; P = 0.01), delayed neurological deterioration (OR = 0.949; 95%CI = 0.912- 0.988; P = 0.011), and poor outcome (OR = 0.962; 95%CI = 0.948-0.976; P<0.001). PNR level was identified as high (at the cut-off value or above) or low (below the cut-off value) according to receiver operating curve (ROC) analyses on each endpoint. Comparison of early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome (3m-mRS >2) between patients at high and low levels for platelet-to-neutrophil ratio (PNR) showed statistical differences (p<0.001). Conclusions: Post-IVT PNR was independently associated with early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome. Lower PNR can predict a worse outcome.

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Delayed neurological deterioration with an unknown cause subsequent to surgery for intraspinal meningiomas

Oncology Letters ◽

10.3892/ol.2015.3024 ◽

2015 ◽

Vol 9 (5) ◽

pp. 2325-2330 ◽

Cited By ~ 1

Author(s):

TAO YANG ◽

LIANG WU ◽

XIAOFENG DENG ◽

CHENLONG YANG ◽

YAN ZHANG ◽

...

Keyword(s):

Neurological Deterioration ◽

Delayed Neurological Deterioration

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Cerebral Vasospasm after Head Injury

Neurosurgery ◽

10.1097/00006123-198412000-00015 ◽

1984 ◽

Vol 15 (6) ◽

pp. 855-858 ◽

Cited By ~ 1

Author(s):

Alberto Pasqualin ◽

Carlo Vivenza ◽

Luisa Rosta ◽

Claudio Licata ◽

Paolo Cavazzani ◽

...

Keyword(s):

Head Injury ◽

Cerebral Vasospasm ◽

Degradation Products ◽

Ct Scanning ◽

Neurological Deterioration ◽

Acute Subdural Hematoma ◽

Digital Subtraction ◽

Computed Tomographic ◽

Motorcycle Accident ◽

Delayed Neurological Deterioration

Abstract Cerebral vasospasm occurs frequently after head injury. Correlation between neurological deterioration and vasospasm has been reported previously, but delayed neurological deterioration secondary to vasospasm in head injury is a rare occurrence. We report the case of a 57-year-old man who, after a motorcycle accident, developed an acute subdural hematoma and a thick subarachnoid deposition of blood in the left sylvian-insular cistern. After surgical evacuation of the hematoma, the patient improved until the 10th postoperative day, when he developed aphasia and a right hempiparesis. Angiography demonstrated multitapering spasm, and a computed tomographic (CT) scan showed persistence of the cisternal deposition of blood. Despite therapy with hypervolemia, the patient improved only slightly. The association of head injury with substantial subarachnoid hemorrhage producing vasospasm has been considered rarely. Delayed posttraumatic vasospasm secondary to blood degradation products seems to play some role in the vasospasm after head injury. CT scanning may be useful in predicting vasospasm in such patients, and digital subtraction angiography might be useful in demonstrating it.

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