Seizures after Aneurysmal Subarachnoid Hemorrhage Treated with Coil Embolization

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 545-552 ◽  
Author(s):  
James V. Byrne ◽  
Philip Boardman ◽  
Ioannis Ioannidis ◽  
Jane Adcock ◽  
Zoe Traill
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
De Novo ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Motor Vehicles ◽  
Single Operator ◽  
Surgical Data ◽  
History Of ◽  
Low Incidence

Abstract OBJECTIVE We sought to determine the incidence of seizures among patients treated with endovascular coil embolization for ruptured intracranial aneurysms because data on which to base antiepileptic drug (AED) prescriptions and advice to patients regarding driving motor vehicles and other high-risk activities are currently lacking. METHODS We conducted a single-institute, single-operator observational study of 243 patients referred for endovascular treatment after aneurysmal subarachnoid hemorrhage. Prospective data collection was performed, and all successfully treated patients were followed. The incidence of seizures was compared with published surgical data, and logistic regression analysis of potential clinical associations was performed. Patients were followed for up to 7.7 years (mean follow-up period, 21.9 mo). RESULTS Ictal seizures occurred at the time of subarachnoid hemorrhage in 26 (11%) of 243 patients and correlated with middle cerebral artery aneurysm location, loss of consciousness at ictus, and AED prescription. No patients experienced periprocedural seizures during their hospitalization. Seven of 233 successfully treated patients (3%) experienced seizures more than 30 days after treatment: late seizures occurred de novo in four patients (1.7%) and in three patients (1.4%) were caused by preexisting epilepsy. Two patients (0.85%) who had de novo seizures developed epilepsy. Late seizures correlated with a history of previous seizures, the presence of a cerebrospinal fluid shunt, and the use of AEDs. CONCLUSION The low incidence of seizures does not justify the use of prophylactic AED therapy after aneurysmal subarachnoid hemorrhage in patients treated solely with coil embolization, nor does it justify subsequent restrictions on the driving of motor vehicles if the patient is otherwise fit to drive.

scholarly journals Contrast-Induced Acute Kidney Injury after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage

2018 ◽  
Vol 59 (1) ◽  
pp. 107 ◽  
Author(s):  
Hyun Goo Lee ◽  
Won ki Kim ◽  
Je Young Yeon ◽  
Jong Soo Kim ◽  
Keon Ha Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Kidney Injury

scholarly journals Clinical Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage Using Bayesian Neural Networks with Fuzzy Logic Inferences

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Benjamin W. Y. Lo ◽  
R. Loch Macdonald ◽  
Andrew Baker ◽  
Mitchell A. H. Levine
Keyword(s):  
Neural Networks ◽  
Fuzzy Logic ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hidden Variables ◽  
Decision Rules ◽  
Bayesian Neural Networks ◽  
Prognostic System ◽  
History Of ◽  
Prediction Approach

Objective. The novel clinical prediction approach of Bayesian neural networks with fuzzy logic inferences is created and applied to derive prognostic decision rules in cerebral aneurysmal subarachnoid hemorrhage (aSAH).Methods. The approach of Bayesian neural networks with fuzzy logic inferences was applied to data from five trials of Tirilazad for aneurysmal subarachnoid hemorrhage (3551 patients).Results. Bayesian meta-analyses of observational studies on aSAH prognostic factors gave generalizable posterior distributions of population mean log odd ratios (ORs). Similar trends were noted in Bayesian and linear regression ORs. Significant outcome predictors include normal motor response, cerebral infarction, history of myocardial infarction, cerebral edema, history of diabetes mellitus, fever on day 8, prior subarachnoid hemorrhage, admission angiographic vasospasm, neurological grade, intraventricular hemorrhage, ruptured aneurysm size, history of hypertension, vasospasm day, age and mean arterial pressure. Heteroscedasticity was present in the nontransformed dataset. Artificial neural networks found nonlinear relationships with 11 hidden variables in 1 layer, using the multilayer perceptron model. Fuzzy logic decision rules (centroid defuzzification technique) denoted cut-off points for poor prognosis at greater than 2.5 clusters.Discussion. This aSAH prognostic system makes use of existing knowledge, recognizes unknown areas, incorporates one's clinical reasoning, and compensates for uncertainty in prognostication.

Development of a questionnaire to identify persons with a family history of aneurysmal subarachnoid hemorrhage

2022 ◽  
pp. 174749302110690
Author(s):  
Charlotte CM Zuurbier ◽  
Jacoba P Greving ◽  
Gabriel JE Rinkel ◽  
Ynte M Ruigrok
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Positive Family History ◽  
Stroke Patients ◽  
Degree Relative ◽  
First Degree Relatives ◽  
Family History Questionnaire ◽  
Affected Relative ◽  
History Of

Background: Preventive screening for intracranial aneurysms is effective in persons with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH), but for many relatives of aSAH patients, it can be difficult to assess whether their relative had an aSAH or another type of stroke. Aim: We aimed to develop a family history questionnaire for people in the population who believe they have a first-degree relative who had a stroke and to assess its accuracy to identify relatives of aSAH patients. Methods: A questionnaire to distinguish between aSAH and other stroke types (ischemic stroke and intracerebral hemorrhage) was developed by a team of clinicians and consumers. The level of agreement between the questionnaire outcome and medical diagnosis was pilot tested in 30 previously admitted aSAH patients. Next, the sensitivity and specificity of the questionnaire were assessed in 91 first-degree relatives (siblings/children) of previously admitted stroke patients. Results: All 30 aSAH patients were identified by the questionnaire in the pilot study; 29 of 30 first-degree relatives of aSAH patients were correctly identified. The questionnaire had a sensitivity of 97% (95% confidence interval (CI) = 83–100%) and a specificity of 93% (95% CI = 84–98%) when tested in the first-degree relatives of stroke patients. Conclusion: Our questionnaire can help persons to discriminate an aSAH from other types of stroke in their affected relative. This family history questionnaire is developed in the Netherlands but could also be used in other countries after validation.

Abstract W P307: Novel Application of Reversible Parental Anti-platelets in Patients with Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Siddhart Mehta ◽  
Mohammed Hussain ◽  
Jaskiran Brar ◽  
Daniel Korya ◽  
Harina Chahal ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Antiplatelet Agents ◽  
Endovascular Coiling ◽  
International Subarachnoid Aneurysm Trial ◽  
Procedural Complications ◽  
Acute Subarachnoid Hemorrhage ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background and Objective: The International Subarachnoid Aneurysm Trial (ISAT) showed a greater likelihood of survival free 1 year disability in patients undergoing endovascular coiling who were started on antiplatelet agents after SAH compared to ones undergoing neurosurgical clipping. However, data on safety of acute parental antiplatelet agents after aneurysmal coiling is lacking. We report on the safety of IV Eptifibatide (rapidly reversible Glyprotein IIbIIIa inhibitor) on patients presenting with acute subarachnoid hemorrhage undergoing endovascular coiling for aneurysmal embolization. Methods: All the patients from 2009-13 who presented to our university affiliated comprehensive stroke center with aneurysmal subarachnoid hemorrhage and underwent endovascular coiling were included for the study. Patients that received IV Eptifibatide for various reasons including acute need for stent assist coiling after securing the ruptured aneurysm with endovascular coiling were reviewed. Eptifibatide was administered intra-arterially as a 135-μg/kg single-dose bolus, and then continued on intravenous infusion of 0.5-μg/kg/min post-procedurally. Charts were reviewed for all patients to assess for medical/procedural complications including symptomatic and asymptomatic intra- and extra-cranial hemorrhages, groin hematomas, epistaxis and gross hematuria. Results: Of the total of 93 patients treated with coil embolization during this period, 5 patients (mean age 56 years, 20% male [n=1]) received acute intra-procedural Eptifibatide followed by IV infusion for a mean duration of 77 hours (range 20-130 hours). Various reasons for use of Eptifibatide included: stent assist coiling [n=2], multiple stents for flow diversion [n=1], partial coil prolapse [n=1] and vascular lumen flow compromise [n=1]. None of the patients demonstrated symptomatic/asymptomatic hemorrhage, groin hematoma, epistaxis or hematuria. Conclusion: Our results may highlight safety of administering IV Eptifibatide to prevent thrombotic complications after endovascular coil embolization in select patients with aneurysmal subarachnoid hemorrhage. Multicenter prospective trials are warranted to corroborate our findings.

Subarachnoid hemorrhage due to de novo dissecting vertebral artery aneurysm in a patient with Guillain‐Barré syndrome

2019 ◽  
Vol 7 (6) ◽  
pp. 341-343
Author(s):  
Takamichi Hijikata ◽  
Eiichi Baba ◽  
Kazutaka Shirokane ◽  
Atsushi Tsuchiya ◽  
Motohiro Nomura
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
De Novo ◽  
Artery Aneurysm ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage

2005 ◽  
Vol 102 (6) ◽  
pp. 998-1003 ◽  
Author(s):  
Seppo Juvela ◽  
Jari Siironen ◽  
Johanna Kuhmonen
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Patient Outcomes ◽  
Plasma Glucose ◽  
Clinical Condition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Content Type ◽  
Poor Outcome ◽  
History Of ◽  
Fine Print

Object. Stress-induced hyperglycemia has been shown to be associated with poor outcome after aneurysmal subarachnoid hemorrhage (SAH). The authors prospectively tested whether hyperglycemia, independent of other factors, affects patient outcomes and the occurrence of cerebral infarction after SAH. Methods. Previous diseases, health habits, medications, clinical condition, and neuroimaging variables were recorded for 175 patients with SAH who were admitted to the hospital within 48 hours after bleeding. The plasma level of glucose was measured at admission and the fasting value of glucose was measured in the morning after aneurysm occlusion. Factors found to be independently predictive of patient outcomes at 3 months after SAH onset and the appearance of cerebral infarction were tested by performing multiple logistic regression. Plasma glucose values at admission were found to be associated with patient age, body mass index (BMI), history of hypertension, clinical condition, amount of subarachnoid or intraventricular blood, shunt-dependent hydrocephalus, outcome variables, and the appearance of cerebral infarction. When considered independently of age, clinical condition, or amount of subarachnoid, intraventricular, or intracerebral blood, the plasma glucose values at admission predicted poor outcome (per millimole/liter the odds ratio [OR] was 1.24 with a 95% confidence interval [CI] of 1.02–1.51). After an adjustment was made for the amount of subarachnoid blood, the clinical condition, and the duration of temporary artery occlusion during surgery, the BMI was found to be a significant predictor (per kilogram/square meter the OR was 1.15 with a 95% CI of 1.02–1.29) for the finding of cerebral infarction on the follow-up computerized tomography scan. Hypertension (OR 3.11, 95% CI 1.11–8.73)—but not plasma glucose (OR 1.06, 95% CI 0.87–1.29)—also predicted the occurrence of infarction when tested instead of the BMI. Conclusions. Independent of the severity of bleeding, hyperglycemia at admission seems to impair outcome, and excess weight and hypertension appear to elevate the risk of cerebral infarction after SAH.

Low Incidence of Complete Remission but Comparable Event-Free Survival(EFS) and Overall Survival (OS) with a History of Prior Monoclonal Gammopathy of Undetermined Significance (MGUS) or Smoldering Myeloma (SMM) among Patients Receiving Total Therapy 2 (TT 2).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 932-932 ◽  
Author(s):  
Athanasios Fassas ◽  
Bart Barlogie ◽  
Erik Rasmussen ◽  
Teresa Milner ◽  
Julian Terry ◽  
...  
Keyword(s):  
De Novo ◽  
Residual Disease ◽  
Remission Induction ◽  
Solitary Plasmacytoma ◽  
Kaplan Meier ◽  
History Of ◽  
Low Incidence ◽  
Initiation Of Therapy ◽  
Smoldering Myeloma ◽  
High Level

Abstract Symptomatic/progressive MM sometimes develops on the background of MGUS or progresses through a smoldering MM phase (SMM); other patients may have initially a solitary plasmacytoma of bone (SPC). This study examines the survival implications of pre-existing conditions such as MGUS (n=22), SMM (n=22) or SPC (n=20) among 668 enrolled in TT 2. TT 2 consists of intensive remission induction, melphalan-based tandem autotransplants; consolidation chemotherapy and interferon maintenance. 2 yr estimates of CR/near-CR (only IFE-positive) were similar in de novo MM (44%/67%) and in those with preceding SPC (46%/67%); both were higher than in case of preceeding SMM (24%/38%) or MGUS (17%/49%) (p=.009/p=.007). According to multivariate analysis, the time to CR was shorter in the presence of LDH > 190 U/L (HR 1.33, p=.003) and IgA isotype (HR 1.3, p=.08) but longer in the case of preceeding MGUS or SMM (HR 0.44, p=.02). Kaplan Meier plots of EFS and OS were similar for de novo MM and patients with the 3 precursor conditions. We conclude: (1) the low incidence of stringently defined CR among patients with preceeding MGUS or SMM does not negatively impact EFS or OS after initiation of therapy for symptomatic/progressive MM; (2) this lower incidence of CR may reflect the re-establishment of a stable precursor state due to the high level of drug resistance of these low proliferative activity conditions; (3) patients with de novo MM not achieving CR but having a prolonged EFS/OS may be those with a clinically unrecognized precursor condition; (4) measurements other than M protein-reduction must be identified to better assess minimal residual disease. Figure Figure

Evolution of the treatment of cerebral vasospasm

2006 ◽  
Vol 20 (6) ◽  
pp. 1-4 ◽  
Author(s):  
Scott Y. Rahimi ◽  
John H. Brown ◽  
Samuel D. Macomson ◽  
Michael A. Jensen ◽  
Cargill H. Alleyne
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Cerebral Vasospasm ◽  
Successful Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Disease Process ◽  
Acute Setting ◽  
The Past ◽  
History Of ◽  
Insight Into

✓ Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a disease process for which the lack of effective treatments has plagued neurosurgeons for decades. Historically, successful treatment after SAH in the acute setting was often followed by a rapid, uncontrollable deterioration in the subacute interval. Little was known regarding the nature and progression of this condition until the mid-1800s, when the disease was first described by Gull. Insight into the origin and natural history of cerebral vasospasm came slowly over the next 100 years, until the 1950s. Over the past five decades our understanding of cerebral vasospasm has expanded exponentially. This newly discovered information has been used by neurosurgeons worldwide for successful treatment of complications associated with vasospasm. Nevertheless, although great strides have been made toward elucidating the causes of cerebral vasospasm, a lasting cure continues to elude experts and the disease continues to wreak havoc on patients after aneurysmal SAH.

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