Abstract P453: Histamine 2 Blockers and Nimodipine in Aneurysmal Subarachnoid Hemorrhage Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Fawad Ishfaq ◽  
Nitish Kumar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Significant Interaction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Relative Bioavailability ◽  
Discharge Destination ◽  
H2 Blockers ◽  
Clinically Significant

Background: Histamine (H) 2 blockers led to a significant increase of the relative bioavailability of nimodipine and therefore may change tolerability of nimodipine in patients with aneurysmal subarachnoid hemorrhage (SAH). Objective: To determine the effect of H2 blockers on outcome of SAH patients being treated with nimodipine on outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1st, 2000 to July 1st, 2018. We identified SAH patients who underwent endovascular or surgical treatment for intracranial aneurysm and received nimodipine with or without H2 blockers. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 815 (54.8%) of 1488 SAH patients received H2 blockers in addition to nimodipine. There were no differences in rates of cerebral ischemia (8.8% versus 9.8%) or performance of angioplasty (3.8% versus 3.7%) between patients who did or did not receive H2 blockers. There were no differences in rates of intubation/mechanical ventilation (26.0% versus 29.3%) or intra-procedural cerebral infarction (3.4% versus 2.8%) between the two groups. There was no difference in in hospital mortality rates (10.9% versus 10.2%) or none to minimal disability (41.8% versus 38.2%) between patients who did or did not receive H2 blockers. Conclusions: H2 blockers are frequently used with nimodipine in SAH patients and did not appear to adversely affect rates of death or disability. The finding does not support any clinically significant interaction between H2 blockers and nimodipine in SAH patients.

scholarly journals Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil

2004 ◽  
Vol 62 (2a) ◽  
pp. 245-249 ◽  
Author(s):  
Leodante Batista da Costa Jr ◽  
Josaphat Vilela de Morais ◽  
Agustinho de Andrade ◽  
Marcelo Duarte Vilela ◽  
Renato P. Campolina Pontes ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
The United States ◽  
Anterior Circulation ◽  
Common Location ◽  
Belo Horizonte ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Anterior Circulation Aneurysms

Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1%) in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%). The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS). At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.

scholarly journals Proximity to the Treating Centre and Outcomes Following Subarachnoid Hemorrhage

2011 ◽  
Vol 38 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Cian J. O'Kelly ◽  
Julian Spears ◽  
David Urbach ◽  
M. Christopher Wallace
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Survival Benefit ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Limited Resources ◽  
Early Complications ◽  
The Impact ◽  
The Relationship

Abstract:Background:In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.Methods:Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.Results:The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300km, mortality increased with increasing distance. Over 300km, a survival benefit was observed.Conclusions:Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.

scholarly journals Intensive care of traumatic brain injury and aneurysmal subarachnoid hemorrhage in Helsinki during the Covid-19 pandemic

2020 ◽  
Vol 162 (11) ◽  
pp. 2715-2724
Author(s):  
Teemu Luostarinen ◽  
Jyri Virta ◽  
Jarno Satopää ◽  
Minna Bäcklund ◽  
Riku Kivisaari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Retrospective Review ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Case Mix

Abstract Background To ensure adequate intensive care unit (ICU) capacity for SARS-CoV-2 patients, elective neurosurgery and neurosurgical ICU capacity were reduced. Further, the Finnish government enforced strict restrictions to reduce the spread. Our objective was to assess changes in ICU admissions and prognosis of traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) during the Covid-19 pandemic. Methods Retrospective review of all consecutive patients with TBI and aneurysmal SAH admitted to the neurosurgical ICU in Helsinki from January to May of 2019 and the same months of 2020. The pre-pandemic time was defined as weeks 1–11, and the pandemic time was defined as weeks 12–22. The number of admissions and standardized mortality rates (SMRs) were compared to assess the effect of the Covid-19 pandemic on these. Standardized mortality rates were adjusted for case mix. Results Two hundred twenty-four patients were included (TBI n = 123, SAH n = 101). There were no notable differences in case mix between TBI and SAH patients admitted during the Covid-19 pandemic compared with before the pandemic. No notable difference in TBI or SAH ICU admissions during the pandemic was noted in comparison with early 2020 or 2019. SMRs were no higher during the pandemic than before. Conclusion In the area of Helsinki, Finland, there were no changes in the number of ICU admissions or in prognosis of patients with TBI or SAH during the Covid-19 pandemic.

Aneurysmal Subarachnoid Hemorrhage: Neurosurgical Frontiers and Nursing Challenges

1991 ◽  
Vol 2 (4) ◽  
pp. 665-674
Author(s):  
Helen A. Cook
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Seizure Activity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Aneurysmal Rupture ◽  
Management Of Complications ◽  
Ruptured Intracranial Aneurysms

Despite increases in survival beyond the initial hemorrhage, the devastating consequences of subarachnoid hemorrhage persist. Ruptured intracranial aneurysms are the most likely cause of subarachnoid hemorrhage, with morbidity and mortality rates approaching 75%. Complications arising from aneurysmal subarachnoid hemorrhage include rebleeding, delayed cerebral ischemia, hydrocephalus, hypothalamic dysfunction, and seizure activity. In order to positively influence outcome after subarachnoid hemorrhage, preservation of an adequate cerebral blood flow and prevention of secondary aneurysmal rupture is essential. This article reviews aneurysmal subarachnoid hemorrhage, relating the management of complications to currently accepted treatment strategies

The burden of pediatric subarachnoid hemorrhage healthcare disparities in Senegal: A retrospective cohort study

2021 ◽  
Author(s):  
Thioub Mbaye ◽  
Maguette Mbaye ◽  
Yvan Zolo ◽  
Manal Sghiouar ◽  
Sagar Diop ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Population Attributable Fraction ◽  
Surgical Care ◽  
Health Systems Strengthening ◽  
Rank Test ◽  
Signed Rank ◽  
Fisher Grade ◽  
Signed Rank Test

Introduction Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal. Methods Pediatric aSAH patients admitted at the authors’ institution from 2012 and 2020 were recruited. Spearman Rho’s correlation, McNemar’s test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care. Results Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI=10.0-14.3) years presented with aSAH. They had 1 median aneurysm (range [1, 2]) measuring 12.6 (6.1-19.0) mm. The median WFNS grade was 3 (range [1, 4]), and the mean Fisher grade was 4 (range [1, 4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR=23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08. Conclusion Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health systems strengthening policies should be implemented to address this health inequity.

Prognosis for patients with nonsurgically-treated aneurysms

1971 ◽  
Vol 35 (4) ◽  
pp. 438-443 ◽  
Author(s):  
Carl J. Graf
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Clinical Review ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Nonsurgical Treatment ◽  
Autopsy Study ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Fine Print ◽  
Better Than

✓ The clinical review of this large series of patients with aneurysmal subarachnoid hemorrhage has revealed that the prognosis, with surgical or nonsurgical treatment, is related to several factors, but most significantly to the condition of the patient 1 day after hemorrhage. Autopsy study indicates that the prognosis for patients with unsuspected or “incidental” unruptured aneurysms is better than could be expected with surgical treatment.

Endovascular and Surgical Treatment Is Predictive of Readmission Risk After Aneurysmal Subarachnoid Hemorrhage

2020 ◽  
Vol 142 ◽  
pp. e494-e501
Author(s):  
Ajay Chatrath ◽  
Sauson Soldozy ◽  
Jennifer D. Sokolowski ◽  
Rebecca M. Burke ◽  
Julianne G. Schultz ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Readmission Risk

scholarly journals Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes

2013 ◽  
Vol 04 (01) ◽  
pp. 24-28 ◽  
Author(s):  
P P Saramma ◽  
P Girish Menon ◽  
Adesh Srivastava ◽  
P Sankara Sarma
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Serum Sodium ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Glasgow Outcome Score ◽  
World Federation ◽  
Anterior Communicating Artery ◽  
Sree Chitra Tirunal Institute ◽  
Outcome Score ◽  
The Mean ◽  
Clinically Significant

ABSTRACT Background: Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods: This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1st January to 31st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results: Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion: Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.

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