Delayed Cerebral Infarction is Systematically Associated with a Cerebral Vasospasm of Large Intracranial Arteries

Neurosurgery ◽  
2019 ◽  
Author(s):  
Jonathan Brami ◽  
Benjamin Chousterman ◽  
Grégoire Boulouis ◽  
Matthieu Le Dorze ◽  
Melinda Majlath ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Infarction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Large Artery ◽  
Dependent Manner ◽  
Imaging Data ◽  
Intracranial Arteries ◽  
Dose Dependent ◽  
Distal Artery

Abstract BACKGROUND Whether delayed cerebral infarction (DCIn) after aneurysmal subarachnoid hemorrhage (aSAH) is driven by large artery vasospasm is still controversial. OBJECTIVE To study the association between DCIn and vasospasm by using quantitative assessment of vasospasm up to distal arteries with time and territorial-based correlation. METHODS Clinical and imaging data of 392 patients with aSAH treated at our center between 2012 and 2017 were reviewed. DCIn was defined as any cerebral infarction occurring within 3 to 21 d after ictus and not related to other specific cause. In patients with DCIn, vasospasm was assessed within 24 h around DCIn for each cerebral artery up to the end of the 2nd segments. DCIn and vasospasm analyses were blinded. RESULTS DCIn was found in 11% of patients (inter-rater k = 0.90, computed tomography (CT)-scan = 100%, follow-up MRI = 91%). Vasospasm was quantified in 258 artery territories including 66 with and 192 without DCIn (DSA = 93%, computed tomography angiography = 7%). Vasospasm was more severe in DCIn than in non-DCIn territories (60% [55-69] vs 20% [0-50], P < .001). Vasospasm was associated with DCIn in a “dose-dependent” manner (P for trend = .022). Every DCIn territory had a vasospasm ≥ 50%, including 39% only of distal artery segments. Only 9% of non-DCIn territories had vasospasm ≥ vasospasm in DCIn territories. CONCLUSION The necessary association between severe vasospasm and DCIn in our study brings additional arguments in favor of large artery vasospasm (especially of distal segments) as a major determinant of DCIn and a potential therapeutic target.

Dose-Dependent Inhibitory Effects of Cilostazol on Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

2018 ◽  
Vol 10 (4) ◽  
pp. 381-388 ◽  
Author(s):  
Hidenori Suzuki ◽  
Yoshinari Nakatsuka ◽  
Ryuta Yasuda ◽  
Masato Shiba ◽  
Yoichi Miura ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Inhibitory Effects ◽  
Dose Dependent

scholarly journals Decompressive craniectomy in patients with cerebral infarction due to malignant vasospasm after aneurysmal subarachnoid hemorrhage

2012 ◽  
Vol 03 (03) ◽  
pp. 251-255 ◽  
Author(s):  
Saffet Tuzgen ◽  
Baris Kucukyuruk ◽  
Seckin Aydin ◽  
Fatma Ozlen ◽  
Osman Kizilkilic ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Decompressive Craniectomy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Results ◽  
Cerebral Infarct ◽  
World Federation ◽  
Life Saving

ABSTRACT Aim: The authors present their experience and the clinical results in decompressive craniectomy (DC) in patients with vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods: Between 2002 and 2010, six patients underwent DC due to cerebral infarct and edema secondary to vasospasm after aneurysmal SAH. Four patients were male, and two were female. The age of patients ranged between 33 and 60 (mean: 47,6 ± 11,4). The follow up period ranged between 12 to 104 months (mean: 47,6 ± 36,6). The SAH grading according World Federation of Neurosurgeons (WFNS) score ranged between 3 to 5. Results: Last documented modified Rankin Score (mRS) ranged between 2 to 6. One patient died in the following year after decompression due to pneumonia and sepsis. Two patients had moderate disability (mRS of 4) and three patients continue their life with minimal deficit and no major dependency (mRS score 2 and 3). Conclusion: DC can be a life-saving procedure which provides a better outcome in patients with cerebral infarction secondary to vasospasm and SAH. However, the small number of the patients in this study is the main limitation of the accuracy of the results, and more studies with larger numbers are required to evaluate the efficiency of DC in this group of patients.

Early ischemic lesion on computed tomography: predictor of poor outcome among survivors of aneurysmal subarachnoid hemorrhage

2007 ◽  
Vol 107 (6) ◽  
pp. 1074-1079 ◽  
Author(s):  
Jari Siironen ◽  
Matti Porras ◽  
Joona Varis ◽  
Kristiina Poussa ◽  
Juha Hernesniemi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Ct Scans ◽  
Ischemic Lesion ◽  
Poor Outcome ◽  
Serial Ct ◽  
Early Lesion

Object Identifying ischemic lesions after subarachnoid hemorrhage (SAH) is important because the appearance of these lesions on follow-up imaging correlates with a poor outcome. The effect of ischemic lesions seen on computed tomography (CT) scans during the first days of treatment remains unknown, however. Methods In 156 patients with SAH, clinical course and outcome, as well as the appearance of ischemic lesions on serial CT scans, were prospectively monitored for 3 months. At 3 months after SAH, magnetic resonance imaging was performed to detect permanent lesions that had not been visible on CT. Results Of the 53 patients with no lesions on any of the follow-up CT scans, four (8%) had a poor outcome. Of the 52 patients with a new hypodense lesion on the first postoperative day CT, 23 (44%) had a poor outcome. Among the remaining 51 patients with a lesion appearing later than the first postoperative morning, 10 (20%) had a poor outcome (p < 0.001). After adjusting for patient age; clinical condition on admission; amounts of subarachnoid, intracerebral, and intraventricular blood; and plasma glucose and D-dimer levels, a hypodense lesion on CT on the first postoperative morning was an independent predictor of poor outcome after SAH (odds ratio 7.27, 95% confidence interval 1.54–34.37, p < 0.05). Conclusions A new hypodense lesion on early postoperative CT seems to be an independent risk factor for poor outcome after SAH, and this early lesion development may be more detrimental to clinical outcome than a later lesion occurrence.

scholarly journals Incidence and characteristics of left atrial appendage stumps after device-enabled epicardial closure

2019 ◽  
Vol 29 (5) ◽  
pp. 663-669 ◽  
Author(s):  
Etem Caliskan ◽  
Matthias Eberhard ◽  
Volkmar Falk ◽  
Hatem Alkadhi ◽  
Maximilian Y Emmert
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Success Rates ◽  
Imaging Data ◽  
Long Term Follow Up ◽  
Short And Long Term

Abstract OBJECTIVES High success rates for left atrial appendage (LAA) exclusion with the AtriClip (Atricure, USA) device have been reported in the literature. This study evaluated the presence and characteristics of residual LAA stumps after AtriClip LAA exclusion using postoperative short- and long-term computed tomography angiography (CTA). METHODS In this retrospective analysis, 43 of 291 consecutive patients undergoing cardiac surgery with concomitant LAA occlusion using the AtriClip device were identified with available postoperative short- and long-term follow-up by CTA. LAA patency and the absence or the size of a present residual LAA stump were assessed on 2-dimensional multiplanar reconstructions, on maximum intensity projection images and on volume-rendered 3-dimensional computed tomography reconstructions. Based on current recommendations, the threshold for a significant LAA stump length was defined <10 mm. RESULTS The LAA was successfully occluded in all 43 patients (100%) as confirmed by intraoperative transoesophageal echocardiography and CTA imaging with a mean follow-up duration of 7.1 ± 0.8 years post-implant. The absence of blood flow in the excluded LAA was confirmed in all cases. In 31 of 43 patients (72%), no residual stump (0 mm) was observed creating a smooth endocardial surface, CTA revealed residual LAA stumps in 11/43 patients (26%) with a length <10 mm and a significant residual stump with a depth of >10 mm (12 mm) in 1 patient (2%). The mean length, width and depth of the residual stumps were 5.8 ± 2.1, 4.4 ± 1.2 and 7.3 ± 2.3 mm, respectively. CONCLUSIONS This study investigated the incidence of residual stump formation (>10 mm) after LAA closure with the AtriClip device based on CTA imaging data obtained during short- and long-term follow-up. While no LAA stump was detectable in the majority of patients, a non-significant LAA stump (<10 mm) was present in 26% of cases, indicating a favourable LAA occlusion profile for the AtriClip device. However, although a LAA stump length <10 mm is currently considered clinically safe, this definition needs further attention in future studies with regards to its potential clinical implications.

73Hemoglobin a1c levels and the risk of ischemic stroke and mortality in individuals with diabetes mellitus and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Kezerle ◽  
M A Tsadok ◽  
A Akriv ◽  
B Feldman ◽  
M Leventer-Roberts ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Dependent Manner ◽  
Historical Cohort ◽  
Increased Risk ◽  
Dose Dependent ◽  
Hba1c Levels

Abstract Funding Acknowledgements Pfizer Israel Background Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Whether the risk of stroke in AF patients remains the same among the wide spectrum of disease is yet to be determined. Aim Among individuals with AF and DM, to assess the incidence rates and risk of ischemic stroke and mortality by baseline HbA1C levels. Methods We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to HBA1C levels at the time of AF diagnosis: &lt;7.0%, between 7-9% and ≥ 9%. Results A total of 44,451 cases were identified. The median age was 75 years (IQR 65-83) and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.9 in patients with HBA1C &lt;7%, 2.37 in the intermediary group and 2.72 in those with HBA1C &gt;9%. In both univariate and multivariate analyses, higher levels of HBA1C were associated with an increased risk of stroke compared with a dose-dependent response when compared to individuals with HBA1C &lt;7% (Adjusted Hazard Ratio (AHR) = 1.32 {95% CI 1.12-1.55}for levels between 7-9% and AHR 1.64 {95% CI 1.28-2.09}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants. The risk for overall mortality did not differ significantly between groups, with a slight elevation in the HBA1C &gt;9% group after adjusted analysis {aHR = 1.17 (1.07- 1.28)} Conclusion: In this observational cohort of patients with incident newly diagnosed nonvalvular atrial fibrillation, HBA1C levels were associated with an increased risk of stroke in a dose-dependent manner even after accounting for other recognized risk factors for stroke in this population. Abstract Figure. Kaplan-Meier for stroke-free survival

The Association Between Symptomatic Delayed Cerebral Infarction and Serum Adhesion Molecules in Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1611-1617 ◽  
Author(s):  
Hung-Chen Wang ◽  
Wei-Che Lin ◽  
Tzu-Ming Yang ◽  
Yu-Jun Lin ◽  
Nai-Wen Tsai ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Cerebral Infarction ◽  
Adhesion Molecules ◽  
High Frequency ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Resonance Imaging ◽  
Circulating Markers

Abstract BACKGROUND: Serum concentrations of adhesion molecules may be connected to the pathogenesis of delayed cerebral infarction (DCI) after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE: To test the hypothesis that levels of adhesion molecules are substantially increased after DCI and decreased thereafter and that these levels can predict treatment outcomes. METHODS: Serial circulating markers of adhesion molecules were examined in 21 consecutive SAH patients and 2 risk control subjects. All underwent cerebral angiography and magnetic resonance imaging to confirm the DCI. The timing of magnetic resonance imaging was fixed in the acute phase and before hospital discharge. RESULTS: Symptomatic DCI developed in 33% of the patients (7 of 21). Statistical analysis of levels of adhesion molecules between patients with and those without DCI revealed that soluble (s) L-selectin, sP-selectin, and sE-selectin concentrations significantly increased after symptomatic DCI (P = .003, .013, and .043, respectively). Only higher sL-selectin level on presentation (cutoff value &gt; 636 ng/mL) was significantly associated with poor outcome after 6 months of follow-up. CONCLUSION: Increased sL-selectin, sP-selectin, and sE-selectin levels imply risks of symptomatic DCI after aneurysmal SAH. The high frequency of symptomatic DCI and higher sL-selectin level on presentation may be associated with worse outcomes.

scholarly journals Osthole prevents cerebral ischemia–reperfusion injury via the Notch signaling pathway

2017 ◽  
Vol 95 (4) ◽  
pp. 459-467 ◽  
Author(s):  
Junhong Guan ◽  
Xiangtai Wei ◽  
Shengtao Qu ◽  
Tao Lv ◽  
Qiang Fu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Signaling Pathway ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Dependent Manner ◽  
Notch 1 ◽  
Dose Dependent

Stroke is a common cerebrovascular disease in aging populations, and constitutes the second highest principle cause of mortality and the principle cause of permanent disability, and ischemic stroke is the primary form. Osthole is a coumarin derivative extracted from the fruits of Cnidium monnieri (L.) Cusson. In this study, we established a rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) in vivo and found that MCAO/R caused cerebral infarction, hippocampus neuronal injury and apoptosis, and also activated the Notch 1 signaling pathway. However, treatment with osthole further enhanced the activity of Notch 1 signaling and reduced the cerebral infarction as well as the hippocampus neuronal injury and apoptosis induced by MCAO/R in a dose-dependent manner. The same results were observed in a primary neuronal oxygen glucose deficiency/reperfusion (OGD/R) model in vitro, and the effect of osthole could be blocked by an inhibitor of Notch 1 signaling, N-[N-(3,5-difluorophenacetyl)-l-alanyl]-S-phenylglycine tert-butyl ester (DAPT). Therefore, we demonstrated that osthole injection prevented rat ischemia–reperfusion injury via activating the Notch 1 signaling pathway in vivo and in vitro in a dose-dependent manner, which may be significant for clinical treatment of ischemic stroke.

scholarly journals Dose-Dependent Variation of Synchronous Metabolites and Modules in a Yin/Yang Transformation Model of Appointed Ischemia Metabolic Networks

2021 ◽  
Vol 15 ◽  
Author(s):  
Yifei Qi ◽  
Niwen Zhou ◽  
Qing Jiang ◽  
Zhi Wang ◽  
Yingying Zhang ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Metabolic Network ◽  
Metabolic Networks ◽  
Pharmaceutical Preparation ◽  
Transformation Model ◽  
High Dose ◽  
Dependent Manner ◽  
Glutamate Metabolism ◽  
Yin Yang ◽  
Dose Dependent

AimChinese medicine Danhong injection (DHI) is an effective pharmaceutical preparation for treating cerebral infarction. Our previous study shows that DHI can remarkably reduce the ischemic stroke-induced infarct volume in a dose-dependent manner, but the pharmacological mechanism of the DHI dose-dependent relationship is not clear. Therefore, the dose-dependent efficacy of DHI on cerebral ischemia and the underlying mechanisms were further investigated in this study.MethodsA middle cerebral artery occlusion (MCAO) model was established and the rats were randomly divided into six groups: sham, vehicle, DHI dose-1, DHI dose-2, DHI dose-3, and DHI dose-4. Forty-one metabolites in serum were selected as candidate biomarkers of efficacy phenotypes by the Agilent 1290 rapid-resolution liquid chromatography system coupled with the Agilent 6550 Q-TOF MS system. Then, the metabolic networks in each group were constructed using the Weighted Correlation Network analysis (WGCNA). Moreover, the Yang and Yin transformation of six patterns (which are defined by up- and downregulation of metabolites) and synchronous modules divided from a synchronous network were used to dynamically analyze the mechanism of the drug’s effectiveness.ResultsThe neuroprotective effect of DHI has shown a dose-dependent manner, and the high-dose group (DH3 and DH4) effect is better. The entropy of the metabolic network and the Yin/Yang index both showed a consistent dose–response relationship. Seven dose-sensitive metabolites maintained constant inverse upregulation or downregulation in the four dose groups. Three synchronous modules for the DH1–DH4 full-course network were identified. Glycine, N-acetyl-L-glutamate, and tetrahydrofolate as a new emerging module appeared in DH2/DH3 and enriched in glutamine and glutamate metabolism-related pathways.ConclusionThis study takes the DHI metabolic network as an example to provide a new method for the discovery of multiple targets related to pharmacological effects. Our results show that the three conservative allosteric module nodes, taurine, L-tyrosine, and L-leucine, may be one of the basic mechanisms of DHI in the treatment of cerebral infarction, and the other three new emerging module nodes glyoxylate, L-glutamate, and L-valine may participate in the glutamine and glutamate metabolism pathway to improve the efficacy of DHI.

Anti-Inflammatory Effect of Dohongsamultang through Inhibition of Nuclear Factor-κB Activation in Peripheral Blood Mononuclear Cells of Patients with Cerebral Infarction

2007 ◽  
Vol 35 (03) ◽  
pp. 415-426 ◽  
Author(s):  
Su-Jin Kim ◽  
Hyun-Ja Jeong ◽  
Sei-Uk Park ◽  
Byung-Soon Moon ◽  
Phil-Dong Moon ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Mononuclear Cells ◽  
Dependent Manner ◽  
Nuclear Factor ◽  
Peripheral Blood Mononuclear ◽  
Inflammatory Reactions ◽  
Tnf Α ◽  
Anti Inflammatory ◽  
Dose Dependent ◽  
Inflammatory Effect

The Korean indigenous medicine "Dohongsamultang (DHSMT)" has long been used for various cerebrovascular diseases. However, the exact mechanism for the anti-inflammatory effect of DHSMT is not completely understood. The aim of the present study is to elucidate how DHSMT modulates the inflammatory reaction in lipopolysaccaride (LPS)-stimulated peripheral mononuclear cells from cerebral infarction (CI) patients. Production and expression of cytokine was measured via the ELISA and RT-PCR methods. The level of nuclear factor-kappa B (NF-κB)/Rel A protein and NF-κB DNA binding activity were determined via the Western blot analysis and transcription factor enzyme-linked immunoassay. It showed that DHSMT inhibited the production of TNF-α, IL-1β, and IL-6 induced by LPS in a dose-dependent manner ( p < 0.05). The maximal inhibition rates for TNF-α, IL-1β, and IL-6 production by DHSMT were about 50.18%, 32.13%, and 38.03%, respectively. DHSMT inhibited the TNF-α mRNA expression in a dose-dependent manner. We also showed that the inhibitory effect of DHSMT is through the suppression of the NF-κB pathway. The study suggests an important molecular mechanism by GMGHT to reduce inflammation, which might explain its beneficial effect in the regulation of inflammatory reactions.

scholarly journals Hemorrhagic Transformation in Patients with Cerebral Infarction Referred to a Rehabilitation Hospital

2015 ◽  
Vol 4 (3-4) ◽  
pp. 69-74 ◽  
Author(s):  
Shinichiro Maeshima ◽  
Sayaka Okamoto ◽  
Hideto Okazaki ◽  
Shiho Mizuno ◽  
Naoki Asano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Infarction ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Length Of Hospital Stay ◽  
Neurological Status ◽  
Hemorrhagic Transformation ◽  
Imaging Data ◽  
Rehabilitation Hospital ◽  
Physical Conditions

Purpose: The aim of our study was to investigate the presenting conditions of patients with hemorrhagic transformation (HT), the frequency of HT and its treatments at a rehabilitation hospital. Subjects and Methods: 165 patients with cerebral infarctions transferred to our rehabilitation hospital during the study period were enrolled. HT was diagnosed by two stroke specialists using computed tomography (CT) at the time of transfer to our rehabilitation hospital and other imaging data from previous consultations. Neurological status, activities of daily living, administered agents, patient age, duration from stroke onset to transfer and length of hospital stay were examined. Results: 30 of the 165 patients (18.2%) were diagnosed with HT. Decreased activities of daily living at admission and discharge as well as longer hospitalization stays were more prevalent in HT patients than in those without HT. We did not change antiplatelet or anticoagulant agents, but continued rehabilitation over a defined period while monitoring blood pressure; we confirmed with CT that the patients' physical conditions did not deteriorate. Conclusion: With careful symptom and CT monitoring over a defined period, rehabilitation can be continued in patients who develop HT at the time of transfer to a rehabilitation hospital in the acute phase of cerebral infarction.

Sign in / Sign up

Export Citation Format

Share Document