Role of Fever in Ventriculoperitoneal Shunt Placement After Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. 1361-1368 ◽  
Author(s):  
Robert M. Starke ◽  
Ricardo J. Komotar ◽  
Brian Y. Hwang ◽  
Fred Rincon ◽  
Ivan S. Kotchetkov ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ventriculoperitoneal Shunt ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Shunt Failure ◽  
Persistent Fever ◽  
Shunt Placement ◽  
Patient Demographics ◽  
Increased Risk

Abstract BACKGROUND: Central fever is common after aneurysmal subarachnoid hemorrhage (aSAH) and may delay ventriculoperitoneal shunt (VPS) placement. OBJECTIVE: We hypothesize that drain-dependent aSAH patients with central fever or persistent fever after treatment of an identifiable cause are not at an increased risk of infectious VPS failure. METHODS: Patient demographics, radiographic characteristics, temperature, incidence of infection, and shunt failure were prospectively recorded in a consecutive cohort of aSAH patients. Central fever was defined as temperature higher than 38.3°C with no identifiable cause. RESULTS: Of 580 patients, 61 (11%) were drain dependent. Central fever developed in 18, 35 had fever of known etiology, and 8 remained afebrile. There was no shunt failure at discharge, and 2 failures (3.2%) at follow-up were attributed to infection. One patient with central fever (6%), none with fever of identifiable etiology, and 1 (13%) with no fever had infectious shunt failures at a median follow-up of 10.2 ± 3.6 months (P > .05). Nine patients with central fever (50%) and 6 (17%) who were treated for fever of known etiologies had persistent fever at shunt placement. Patients who were febrile on the day of surgery had similar infectious shunt failure rates at discharge compared with those who were afebrile (0% vs 0%; P = 1.0). Similarly, febrile and afebrile patients at VPS insertion had comparable rates of infectious shunt failure at follow-up (7% vs 2%; P = .43). CONCLUSION: aSAH patients with central fever or persistent fever after treatment of fever of identifiable etiology are not at an increased risk of infectious VPS failure.

Clinical complications and outcomes of angiographically negative subarachnoid hemorrhage

Neurology ◽  
2019 ◽  
Vol 92 (20) ◽  
pp. e2385-e2394 ◽  
Author(s):  
Cody L. Nesvick ◽  
Soliman Oushy ◽  
Lorenzo Rinaldo ◽  
Eelco F. Wijdicks ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Confidence Interval ◽  
Ventriculoperitoneal Shunt ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Tertiary Referral Center ◽  
Short And Long Term ◽  
Csf Diversion

ObjectiveTo define the in-hospital course, complications, short- and long-term functional outcomes of patients with angiographically negative subarachnoid hemorrhage (anSAH), particularly those with aneurysmal-pattern anSAH (aanSAH).MethodsRetrospective cohort study of patients with aneurysmal subarachnoid hemorrhage (aSAH), aanSAH, and perimesencephalic-pattern anSAH (panSAH) treated at a single tertiary referral center between January 2006 and April 2018. Ninety-nine patients with anSAH (33 aanSAH and 66 panSAH) and 464 patients with aSAH were included in this study. Outcomes included symptomatic hydrocephalus requiring CSF drainage, need for ventriculoperitoneal shunt, radiographic vasospasm, delayed cerebral ischemia (DCI), radiographic infarction, disability level within 1 year of ictus, and at last clinical follow-up as defined by the modified Rankin Scale.ResultsPatients with aanSAH and panSAH had similar rates of DCI and radiologic infarction, and patients with aanSAH had significantly lower rates compared to aSAH (p ≤ 0.018). Patients with aanSAH were more likely than those with panSAH to require temporary CSF diversion and ventriculoperitoneal shunt (p ≤ 0.03), with similar rates to those seen in aSAH. Only one patient with anSAH died in the hospital. Compared to those with aSAH, patients with aanSAH were significantly less likely to have a poor functional outcome within 1 year of ictus (odds ratio 0.26, 95% confidence interval 0.090–0.75) and at last follow-up (hazard ratio 0.30, 95% confidence interval 0.19–0.49, p = 0.002).ConclusionsDCI is very uncommon in anSAH, but patients with aanSAH have a similar need for short- and long-term CSF diversion to patients with aSAH. Nevertheless, patients with aanSAH have significantly better short- and long-term outcomes.

Ventriculoperitoneal Shunt Surgery Outcome in Adult Transition Patients With Pediatric-Onset Hydrocephalus

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 380-389 ◽  
Author(s):  
G. Kesava Reddy ◽  
Papireddy Bollam ◽  
Gloria Caldito ◽  
Bharat Guthikonda ◽  
Anil Nanda
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Shunt Placement ◽  
Adult Transition ◽  
Shunt Survival ◽  
Pediatric Onset

Abstract BACKGROUND: Ventriculoperitoneal shunting remains the most widely used neurosurgical procedure for the management of hydrocephalus, albeit with many complications. OBJECTIVE: To review and assess the long-term clinical outcome of ventriculoperitoneal shunt surgery in adult transition patients with pediatric-onset hydrocephalus. METHODS: Patients 17 years or older who underwent ventriculoperitoneal shunt placement for hydrocephalus during their pediatric years (younger than 17 years) were included. Medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retrospectively. RESULTS: A total of 105 adult patients with pediatric-onset hydrocephalus were included. The median age of the patients was 25.9 years. The median age at the time of the initial ventriculoperitoneal shunt placement was 1.0 year. The median follow-up time for all patients was 17.7 years. The incidence of shunt failure at 6 months was 15.2%, and the overall incidence of shunt failure was 82.9%. Single shunt revision occurred in 26.7% of the patients, and 56.2% had multiple shunt revisions. The cause of hydrocephalus was significantly associated with shunt survival for patients who had shunt failure before the age of 17 years. Being pediatric at first shunt revision, infection, proximal shunt complication, and other causes were independently associated with multiple shunt failures. CONCLUSION: The findings of this retrospective study show that the long-term ventriculoperitoneal shunt survival remains low in adult transition patients with pediatric-onset hydrocephalus.

Association of a younger age with an increased risk of angiographic and symptomatic vasospasms following subarachnoid hemorrhage

2010 ◽  
Vol 112 (6) ◽  
pp. 1208-1215 ◽  
Author(s):  
Suresh N. Magge ◽  
H. Isaac Chen ◽  
Rohan Ramakrishna ◽  
Liyi Cen ◽  
Zhen Chen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Symptomatic Vasospasm ◽  
Angiographic Vasospasm ◽  
Younger Age ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Regression Techniques ◽  
The Relationship

Object Vasospasm is a leading cause of morbidity and death following aneurysmal subarachnoid hemorrhage (SAH). It is important to predict which patients are at risk for vasospasm so that interventions can be made. There are several potential risk factors for vasospasm, one of which is age. However, the effect of age on vasospasm, particularly symptomatic vasospasm, remains controversial. Methods Three hundred ninety-one patients were retrospectively identified from a prospective observational database of patients with SAH who had been admitted to a single center. Demographic and clinical data were recorded, and cerebral angiograms obtained at admission and between 5 and 10 days later were compared. The relationship between age and angiographic and symptomatic vasospasms was examined using logistic regression techniques. Results Mild (86 patients), moderate (69 patients), severe (56 patients), and no angiographic vasospasms (180 patients) were documented by comparing admission and follow-up angiograms in each patient. Symptomatic vasospasm was identified in 69 patients (17.6%). Angiographic vasospasm was more frequent as age decreased. Except in patients < 30 years old, the frequency of symptomatic vasospasm also increased with decreasing age (p = 0.0001). After adjusting for variables known to be associated with vasospasm, an advanced age was associated with a reduced incidence of any angiographic vasospasm (OR 0.96, 95% CI 0.94–0.97), severe angiographic vasospasm (OR 0.96, 95% CI 0.95–0.98), and symptomatic vasospasm (OR 0.98, 95% CI 0.96–0.99). Conclusions Results in this study show that a younger age is associated with an increased incidence of angiographic and symptomatic vasospasm.

scholarly journals Dekompensuota arezorbcinė hidrocefalija po aneurizminės subarachnoidinės hemoragijos

2003 ◽  
Vol 1 (1) ◽  
pp. 0-0
Author(s):  
Gytis Šustickas ◽  
Saulius Širšinaitis ◽  
Gunaras Terbetas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Ruptured Intracranial Aneurysm ◽  
Keywords Hydrocephalus ◽  
Vilnius University ◽  
Development Methods ◽  
Methods Of Treatment

Gytis Šustickas, Saulius Širšinaitis, Gunaras TerbetasVilniaus greitosios pagalbos universitetinės ligoninės Neurochirurgijos skyriusVilniaus universiteto Neurologijos ir neurochirurgijos klinika Įvadas / tikslas Straipsnyje aprašomos hidrocefalijos priežastys, raidos stadijos, klinikiniai ir rentgeniniai diagnostikos metodai, gydymo būdai ir rezultatai. Analizuojami aneurizminės subarachnoidinės hemoragijos prognoziniai veiksniai, turintys didžiausią įtaką lėtinės arezorbcinės dekompensuotos hidrocefalijos raidai. Apžvelgiama likvoro cirkuliacijos patologinė anatomija ir patologinė fiziologija. Ligoniai ir metodai Vilniaus greitosios pagalbos universitetinės ligoninės (VGPUL) Neurochirurgijos skyriuje 2000–2002 metais atliktos 7 (10,6 %) ventrikuloperitoneostomijos (VPS) operacijos nuo lėtinės dekompensuotos hidrocefalijos, kurios priežastis buvo likvoro rezorbcijos sutrikimas plyšus intrakranijinei aneurizmai (IAn) ir po aneurizminės subarachnoidinės hemoragijos (AnSAH). Nė vienam ligoniui nereikėjo jungties operacijos, esant nežinomos kilmės subarachnoidinei hemoragijai (SAH). Iš viso stebėti 66 ligoniai, hospitalizuoti dėl plyšusios IAn ir išgyvenę daugiau kaip 6 mėnesius po aneurizmos klipsavimo operacijos. Rezultatai Laiku atliktas hidrocefalijos gydymas jungties operacija buvo veiksmingas 6 iš 7 ligonių (85,7 %). Išvados Lėtinė arezorbcinė dekompensuota hidrocefalija nustatyta 10,6 % ligonių, operuotų nuo plyšusių IAn, ir turi būti gydoma chirurgiškai, praėjus 1–2 mėnesiams po AnSAH. Būdingiausia aneurizmos lokalizacija, nustačius dekompensuotą arezorbcinę hidrocefaliją, – a. communicans anterior ir a.communicans posterior. Intrakranijinio kraujo kiekis plyšus aneurizmai yra blogas prognozinis veiksnys (vertinta pagal Fisherio skalę). Prasminiai žodžiai: hidrocefalija, intrakranijinė aneurizma, subarachnoidinė hemoragija, insultas, likvoro cirkuliacija, prognoziniai veiksniai. Aresorbtive hydrocephalus after aneurysmal subarachnoid hemorrhage Gytis Šustickas, Saulius Širšinaitis, Gunaras Terbetas Background / objective The origin, terms of hydrocephalus development, methods of treatment and results are reviewed. Methods Sixty-six consecutive patients, operated on for ruptured intracranial aneurysm (IAn) and surviving within 6 months were included into the study. Seven ventriculoperitoneostomies due to aresorbtive hydrocephalus after 66 aneurysmal subarachnoid hemorrhage (AnSAH) cases were performed in the Department of Neurosurgery, Vilnius University Emergency Hospital (2000–2002). The follow up period after AnSAH was 1 year. All cases of aresorbtive hydrocephalus were determined within 2 months after AnSAH. Results Surgical treatment of aresorbtive hydrocephalus was effective in 6 patients out of 7 (85.7%). Conclusions Our results suggest a significant role of predictive signs on initial computer tomography, location of IAn and patient’s age in the development of aresorbtive hydrocephalus. Keywords: hydrocephalus, intracranial aneurysm, subarachnoid hemorrhage, stroke, cerebrospinal fluid, predictive signs.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

scholarly journals Size does matter: The role of decompressive craniectomy extent for outcome after aneurysmal subarachnoid hemorrhage

2021 ◽  
Author(s):  
Ramazan Jabbarli ◽  
Shi‐Qing He ◽  
Marvin Darkwah Oppong ◽  
Annika Herten ◽  
Mehdi Chihi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Decompressive Craniectomy ◽  
Aneurysmal Subarachnoid Hemorrhage

scholarly journals Prognostic role of neoplastic markers in Takotsubo syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francesco Santoro ◽  
Tecla Zimotti ◽  
Adriana Mallardi ◽  
Alessandra Leopizzi ◽  
Enrica Vitale ◽  
...  
Keyword(s):  
Serum Levels ◽  
Takotsubo Syndrome ◽  
Ca 15.3 ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ca 19.9 ◽  
Long Term Follow Up

AbstractTakotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9–14.8, HR = 7.8 95% CI 2.4–25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6–52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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