scholarly journals Effect of hemorrhagic cerebrospinal fluid drainage on cognitive function after intracranial aneurysm clipping

2019 ◽  
Vol 5 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Chaoqun Lin ◽  
Lukui Chen
Keyword(s):  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Subarachnoid Hemorrhage ◽  
Cognitive Function ◽  
Lumbar Puncture ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebrospinal Fluid Drainage ◽  
Aneurysm Clipping ◽  
Significant Difference ◽  
Drainage Group

Objective: The effects of repeated lumbar puncture and continuous lumbar cistern drainage on the cognitive function of patients with aneurysmal subarachnoid hemorrhage were compared and analyzed. Methods: Retrospective analysis was performed on 59 patients with aneurysmal subarachnoid hemorrhage treated at our Neurosurgery Department between October 2017 and October 2018. According to the hemorrhagic cerebrospinal fluid drainage mode after aneurysm clipping, the patients were divided into the following two groups: the repeated lumbar puncture drainage (Group A, n = 28) and continuous lumbar cistern drainage (Group B, n = 31). Before and 1 month after surgery, the cognitive function of the patients was scored using the Montreal Cognitive Assessment Scale. Scores of 27~30 were defined as normal, and scores of < 27 as cognitive impairment. Results: The incidences of cognitive impairment were 46% (13/28) and 32% (10/31) for Groups A and B, respectively, before surgery, but the difference was not significant ( P > 0.05). The incidences of cognitive impairment were 35% (10/28) and 12% (4/31) for Groups A and B, respectively, at 1 month after surgery, with significant difference ( P < 0.05). Conclusion: Compared with repeated lumbar puncture, continuous lumbar cistern drainage for aneurysmal subarachnoid hemorrhage significantly reduced the incidence of cognitive impairment after aneurysm clipping.

scholarly journals Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Ahmed Esmael ◽  
Tamer Belal ◽  
Khaled Eltoukhy
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Subarachnoid Hemorrhage ◽  
Cognitive Function ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Biomarkers ◽  
Poor Cognitive Function ◽  
Impaired Cognition

Background and Aim. Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) stays under investigation. This study is aimed at predicting the cognitive impairment by transcranial Doppler (TCD) and detecting the associated clinical biomarkers of impaired cognition after aSAH after 3 months from the onset. Methods. Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher’s grading scales. TCD was done for all patients five times within 10 days measuring the mean flow velocities (MFVs) of cerebral arteries. At the 3-month follow-up, patients were classified into two groups according to Montreal Cognitive Assessment (MoCA) scale: the first group was 31 cases (77.5%) with intact cognitive functions and the other group was 9 cases (22.5%) with impaired cognition. Results. Patients with impaired cognitive functions showed significantly lower mean GCS ( p = 0.03 ), significantly higher mean Hunt and Hess scale grades ( p = 0.04 ), significantly higher mean diabetes mellitus (DM) ( p = 0.03 ), significantly higher mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) ( p = 0.02 and p = 0.005 , respectively), and significantly higher MFVs measured within the first 10 days. The patients with cognitive impairment were accompanied by a higher incidence of hydrocephalus ( p = 0.01 ) and a higher incidence of delayed cerebral ischemia (DCI) ( p < 0.001 ). Logistic regression analysis detected that MFV ≥ 86     cm / s in the middle cerebral artery (MCA), MFV ≥ 68     cm / s in the anterior cerebral artery (ACA), and MFV ≥ 45     cm / s in the posterior cerebral artery (PCA) were significantly associated with increased risk of cognitive impairment. Conclusion. Cognitive impairment after the 3-month follow-up phase in aSAH patients was 22.5%. Acute hydrocephalus and DCI are highly associated with poor cognitive function in aSAH. Increased MFV is a strong predictor for poor cognitive function in aSAH. This trial is registered with NCT04329208.

Effect of cerebrospinal fluid drainage on clinical outcomes following aneurysmal subarachnoid hemorrhage

2022 ◽  
Vol 97 ◽  
pp. 1-6
Author(s):  
Luis C. Ascanio ◽  
Raghav Gupta ◽  
Yaw Tachie-Baffour ◽  
Kohei Chida ◽  
Adam A. Dmytriw ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Clinical Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebrospinal Fluid Drainage

scholarly journals Sphingosine 1-phosphate levels in cerebrospinal fluid after subarachnoid hemorrhage

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Anika Männer ◽  
Dominique Thomas ◽  
Marlies Wagner ◽  
Jürgen Konczalla ◽  
Helmuth Steinmetz ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Neurological Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
High Sensitivity ◽  
Control Subjects ◽  
Symptomatic Vasospasm ◽  
Significant Difference ◽  
Hemorrhage Volume

Abstract Background and purpose Sphingosin-1-phosphate (S1P) plays a crucial role as a signaling molecule in the immune system and the vasculature. Previous studies suggested a role as a vasoconstrictor of cerebral arteries via the S1P3-Receptor. Cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of disability and poor neurological outcome. Early detection of vasospasm could facilitate the prevention of cerebral ischemia in SAH patients. The aim of this prospective case-control study was to characterize the dynamics of S1P in the cerebrospinal fluid (CSF) of patients with SAH in relation to hemorrhage volume, the occurrence of VS, and neurological outcome. Methods S1P levels in CSF of 18 control subjects and 18 SAH patients with placement of an external ventricular drainage (EVD) were determined by high sensitivity mass spectrometry from day 1 through 14 after SAH onset. Hemorrhage volume, development of asymptomatic vasospasm (aVS) and symptomatic vasospasm (sVS), and neurological outcome were correlated to day 1 S1P levels. Results The intrathecal S1P levels of SAH patients were higher than those of the control subjects, and correlated with hemorrhage volume. There was no significant difference in S1P levels between patients with aVS and those with sVS. S1P levels significantly correlated with neurological outcome on a sliding modified Rankin scale. Conclusion S1P levels were highest directly after placement of the EVD and correlated strongly with hemorrhage volume, which may be caused by the intrathecal clot and subsequent lysis of red blood cells, an important source of S1P. We did not detect a second peak of S1P release over the course of the intensive care period.

Herniation Secondary to Critical Postcraniotomy Cerebrospinal Fluid Hypovolemia

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 286-292 ◽  
Author(s):  
Ricardo J. Komotar ◽  
J Mocco ◽  
Evan R. Ransom ◽  
William J. Mack ◽  
Brad E. Zacharia ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Signs ◽  
Altered Mental Status ◽  
Response To Treatment ◽  
Trendelenburg Position ◽  
Transtentorial Herniation ◽  
Computed Tomographic ◽  
Significant Difference

ABSTRACT OBJECTIVE: Cerebrospinal fluid hypovolemia resulting in postural headaches is a well-known clinical entity, but severe forms of cerebrospinal fluid hypovolemia with altered mental status and signs of transtentorial herniation (“brain sag”) have rarely been reported. This article describes the clinical features of brain sag after craniotomy in an attempt to increase recognition of this syndrome. METHODS: Between April 2001 and January 2003, 220 consecutive patients with subarachnoid hemorrhage were prospectively enrolled in the Columbia Subarachnoid Hemorrhage Outcomes Project; 137 underwent craniotomy for aneurysm clipping. Among these patients, the diagnosis of brain sag was made when all three of the following criteria were present: clinical signs of transtentorial herniation, head computed tomographic scans revealing effacement of the basal cisterns with an oblong brainstem, and improvement of symptoms after placement of the patient in the Trendelenburg position (–15 to –30 degrees). For each patient, the symptoms, clinical course, and subsequent response to treatment were characterized. In addition, brainstem dimensions were measured on computed tomographic scans taken before, during, and after resolution of brain sag. A “sag ratio” was generated for these time points by dividing the maximum anteroposterior distance by the maximum bipeduncular distance. RESULTS: Eleven (8.0%) of 137 aneurysmal subarachnoid hemorrhage patients treated by craniotomy and an intraoperative spinal drain met the criteria for brain sag. Signs of transtentorial herniation developed most commonly between 2 and 4 days postoperatively. Pupillary asymmetry was noted in 10 (91.0%) of 11 patients, whereas the other patient demonstrated extensor posturing. The Trendelenburg position reversed the symptoms in all patients. The mean sag ratios before, during, and after resolution of brain sag were 0.91 ± 0.03 (mean ± standard error), 1.18 ± 0.03, and 0.91 ± 0.03, respectively. This represented a 30.9% elongation of the brainstem during sag (P &lt; 0.001) and a 23.6% change back to baseline after resolution of the syndrome (P &lt; 0.002). There was no significant difference between the presag and postsag ratios. CONCLUSION: Severe cerebrospinal fluid hypovolemia after craniotomy may produce a dramatic herniation syndrome that is completely reversed by the Trendelenburg position. Brain sag should be included in the differential diagnosis for acute postoperative clinical deterioration in this patient population.

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