The physiopathology of spontaneous hemorrhagic stroke: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alcivan Batista de Morais Filho ◽  
Thiago Luis de Holanda Rego ◽  
Letícia de Lima Mendonça ◽  
Sulyanne Saraiva de Almeida ◽  
Mariana Lima da Nóbrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Hemorrhagic Stroke ◽  
Recent Literature ◽  
Clinical Manifestations ◽  
The Road ◽  
History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

The case for family screening for intracranial aneurysms

2011 ◽  
Vol 31 (6) ◽  
pp. E8 ◽  
Author(s):  
Nohra Chalouhi ◽  
Rohan Chitale ◽  
Pascal Jabbour ◽  
Stavropoula Tjoumakaris ◽  
Aaron S. Dumont ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Intracranial Aneurysms ◽  
Family Screening ◽  
Multiple Factors ◽  
History Of ◽  
The Cost ◽  
Familial Aneurysms ◽  
Risk Of Treatment

Given that relatives of patients with intracranial aneurysms (IAs) or subarachnoid hemorrhage have a greater risk of harboring an aneurysm, family screening has become a common practice in neurosurgery. Unclear data exist regarding who should be screened and at what age and interval screening should occur. Multiple factors including the natural history of IAs, the risk of treatment, the cost of screening, and the psychosocial impact of finding an aneurysm should be taken into account when family screening is considered. In this paper, the authors review the current literature regarding risk factors and natural history of sporadic and familial aneurysms. Based on these data the authors assess current recommendations for screening and propose their own recommendations.

scholarly journals FAKTOR RISIKO STROKE PADA USIA PRODUKTIF DI RUMAH SAKIT STROKE NASIONAL (RSSN) BUKIT TINGGI

2020 ◽  
Vol 3 (3) ◽  
pp. 129
Author(s):  
Hendri Budi ◽  
Indrawati Bahar ◽  
Heppi Sasmita
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Discharge Planning ◽  
Influential Factor ◽  
P Value ◽  
Chi Square ◽  
Stroke Risk Factors ◽  
History Of ◽  
Lack Of Exercise

ABSTRAKTujuan: mengetahui faktor risiko yang menyebabkan stroke hemoragik dan iskemik pada pasien usia produktif di RSSN Bukittinggi. Metode: Jenis penelitian ini deskriptif observasional dengan desain cross sectional. Penelitian dilaksanakan di RSSN Bukittinggi pada April sampai Oktober 2015. Populasinya seluruh pasien stroke yang dirawat di ruangan saraf berjumlah 2.132 pasien. Sampel berjumlah 77 orang yang memenuhi kriteria inklusi, dipilih dengan cara purposive sampling. Pengumpulan data menggunakan studi dokumentasi. Instrumen menggunakan daftar checklist tentang faktor risiko stroke yang dapat dimiliki pasien. Analisis data menggunakan statistik deskriptif, uji t independent, chi square dan multivariate regresi logistik. Hasil penelitian: 58,4% pasien stroke berjenis kelamin laki-laki; 97,4% berumur dewasa tua (36-59 tahun), 28,6% pekerjaan ibu rumah tangga; 68,8% stroke iskemik, 13,2% diantaranya berusia 21-45 tahun; 39,6% berusia 56-59 tahun; 31,2% stroke hemoragik, 29,2% diantaranya berusia 21-45 tahun, 37,5% berusia 51-55 tahun. Faktor risiko yang berhubungan dengan stroke iskemik yaitu hipertensi (p value=0,012), kurang olah raga (p value=0,008), dan pola makan banyak lemak (p value=0,029). Faktor yang paling berpengaruh adalah hipertensi (p value=0,052). Faktor risiko yang berhubungan dengan stroke hemoragik yaitu hipertensi (p value=0,016). Kesimpulan: Pada pasien usia produktif, stroke iskemik disebabkan oleh riwayat hipertensi, kurang olah raga dan pola makan banyak lemak, dan faktor yang paling berpengaruh yaitu riwayat kurang olah raga, sedangkan stroke hemoragik disebabkan oleh adanya riwayat hipertensi. Disarankan kepada manajemen perawatan dan perawat agar melaksanakan pendidikan kesehatan yang berfokus pada penatalaksanaan pasien hipertensi, modifiasi gaya hidup dan discharge planning terkait faktor risiko stroke kepada pasien dan keluarga.Kata Kunci: Faktor risiko, stroke iskemik, stroke hemoragikRisk Factors of Stroke in Productive Age at National Stroke Hospital (Rssn) Bukit Tinggi ABSTRACT Objective: to determine the risk factors that cause hemorrhagic and ischemic strokes in productive age patients at RSSN Bukittinggi. Method: Type of research was observational descriptive with crosssectional design. The study was conducted at RSSN Bukittinggi on April to October 2015. The population was all stroke patients treated in the nerve ward totaling 2,132 patients. Samples were 77 people who met the inclusion criteria obtained by purposive sampling. Data collection used documentation study. The instrument is a checklist of stroke risk factors that a patient could have. Data analysis using descriptive statistics, independent t test and chi square test and multivariate logistic regression. Results: 58.4% of stroke patients were male, 97.4% were elderly adults (36-59 years), 28.6% were housewives, 68.8% of ischemic strokes 13.2% were aged 21 -45 years, 39.6% were 56 -59 years. 31.2% of hemorrhagic strokes 29.2% of them aged 21-45 years, 37.5% aged 51-55 years. Risk factors associated with ischemic stroke are hypertension (p value:0.012), lack of exercise (p value:0.008), and eating a lot of fat (p value:0.029). The most influential factor is hypertension (p value:0.052). Risk factors associated with hemorrhagic stroke are hypertension (p value:0.016). Conclusion: In patients of productive age, ischemic stroke is caused by a history of hypertension, lack of exercise and eating a lot of fat, and the most influential factor is a history of lack of exercise, whereas hemorrhagic stroke is caused by a history of hypertension. It is recommended to care management and nurses to carry out health education that focuses on the management of hypertensive patients, lifestyle modification and discharge planning related to stroke risk factors to patients and families. Keywords: Risk factors, ischemic stroke, hemorrhagic stroke

Natural History of Vertebrobasilar Dolichoectatic and Fusiform Aneurysms: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 45 (1-2) ◽  
pp. 68-77 ◽  
Author(s):  
Deena M. Nasr ◽  
Kelly D. Flemming ◽  
Giuseppe Lanzino ◽  
Harry J. Cloft ◽  
David F. Kallmes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Mortality Rate ◽  
Natural History ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Rare Type ◽  
Aneurysm Morphology ◽  
History Of ◽  
Rates Of Growth

Background and Purpose: Vertebrobasilar non-saccular and dolichoectatic aneurysms (VBDA) are a rare type of aneurysm and are generally associated with poor prognosis. In order to better characterize the natural history of VBDAs, we performed a systematic review and meta-analysis of the literature to determine rates of mortality, growth, rupture, ischemia, and intraparenchymal hemorrhage. Materials and Methods: We searched the literature for longitudinal natural history studies of VBDA patients reporting clinical and imaging outcomes. Studied outcomes included annualized rates of growth, rupture, ischemic stroke, intracerebral hemorrhage (ICH), and mortality. We also studied the association between aneurysm morphology (dolichoectatic versus fusiform) and natural history. Meta-analysis was performed using a random-effects model using summary statistics from included studies. Results: Fifteen studies with 827 patients and 5,093 patient-years were included. The overall annual mortality rate among patients with VBDAs was 13%/year (95% CI 8–19). Patients with fusiform aneurysms had a higher mortality rate than those with dolichoectatic aneurysms, but this did not reach statistical significance (12 vs. 8%, p = 0.11). The overall growth rate was 6%/year (95% CI 4–13). Patients with fusiform aneurysms had higher growth rates than those with dolichoectatic aneurysms (12 vs. 3%, p < 0.0001). The overall rupture rate was 3%/year (95% CI 1–5). Patients with fusiform aneurysms had higher rupture rates than those with dolichoectatic aneurysms (3 vs. 0%, p < 0.0001). The overall rate of ischemic stroke was 6%/year (95% CI 4–9). Patients with dolichoectatic aneurysms had higher ischemic stroke rates than those with fusiform aneurysms, but this did not reach statistical significance (8 vs. 4%, p = 0.13). The overall rate of ICH was 2%/year (95% CI 0–8) with no difference in rates between dolichoectatic and fusiform aneurysms (2 vs. 2%, p = 0.65). Conclusion: In general, the natural history of ­VBDAs is poor. However, dolichoectatic and fusiform ­VBDAs appear to have distinct natural histories with substantially higher growth and rupture associated with fusiform aneurysms. These findings suggest that these aneurysms should be considered separate entities. Further studies on the natural history of vertebrobasilar dolichoectatic and fusiform aneurysms with more complete follow-up are needed to better understand the risk factors for progression of these aneurysms.

scholarly journals The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2–Related Multisystem Inflammatory Syndrome in Children: A Systematic Review

2020 ◽  
Author(s):  
Stephen C Aronoff ◽  
Ashleigh Hall ◽  
Michael T Del Vecchio
Keyword(s):  
Systematic Review ◽  
Natural History ◽  
Severe Acute Respiratory Syndrome ◽  
Myocardial Dysfunction ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
History Of ◽  
Inflammatory Syndrome

Abstract Background The clinical manifestations and natural history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related multisystem inflammatory syndrome in children (MIS-C) are poorly defined. Using a systematic review of individual cases and case series and collating elements of the clinical course, the objective of this study was to provide a detailed clinical description and natural history of MIS-C. Methods Case reports and series of MIS-C were recovered from repeated MEDLINE searches, a single EMBASE search, and table of contents reviews of major general medicine and pediatric journals performed between June 3 and July 23, 2020. Fever, evidence of inflammation, and evidence of organ dysfunction were required for inclusion. Results MEDLINE and EMBASE searches produced 129 articles, and 10 articles were identified from journal contents or article bibliographies; 16 reports describing 505 children with MIS-C comprise this review. Thirty-two children (14.7%) had negative results for SARS-CoV-2 by nucleic acid and/or antibody testing. The weighted median age was 9 years (6 months to 20 years). Clinical findings included fever (100%), gastrointestinal symptoms (88.0%), rash (59.2%), conjunctivitis (50.0%), cheilitis/ “strawberry tongue” (55.7%), or extremity edema/erythema (47.5%). Median serum C-reactive protein, ferritin, fibrinogen, and D-dimer concentrations were above the normal range. Intravenous gammaglobulin (78.1%) and methylprednisolone/prednisone (57.6%) were the most common therapeutic interventions; immunomodulation was used in 24.3% of cases. Myocardial dysfunction requiring ionotropic support (57.4%) plus extracorporeal membrane oxygenation (5.3%), respiratory distress requiring mechanical ventilation (26.1%), and acute kidney injury (11.9%) were the major complications; anticoagulation was used commonly (54.4%), but thrombotic events occurred rarely (3.5%). Seven (1.4%) children died. Conclusions MIS-C following SARS-CoV-2 infection frequently presents with gastrointestinal complaints and/or rash; conjunctivitis, cheilitis, and/or extremity changes also occur frequently. Serious complications occur frequently and respond to aggressive supportive therapy.

Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess; a systematic review and meta-analysis

2018 ◽  
Author(s):  
Yasir Elhassan ◽  
Fares Alahdab ◽  
Alessandro Prete ◽  
Danae Delivanis ◽  
Aakanksha Khanna ◽  
...  
Keyword(s):  
Systematic Review ◽  
Natural History ◽  
Meta Analysis ◽  
Adrenal Incidentalomas ◽  
History Of

The burden of cardiovascular disease risk factors in the Middle East: A systematic review and meta-analysis focusing on primary prevention

2020 ◽  
Vol 18 ◽  
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Abdullah Shehab ◽  
Anhar Ullah ◽  
Jamal Rahmani
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Family History ◽  
Primary Prevention ◽  
Middle East ◽  
Disease Risk ◽  
Meta Analysis ◽  
Middle Eastern ◽  
History Of

Background: The increasing incidence of cardiovascular disease (CVD) threatens the Middle Eastern population. Several epidemiological studies have assessed CVD and its risk factors in terms of the primary prevention of CVD in the Middle East. Therefore, summarizing the information from these studies is essential. Aim: We conducted a systematic review to assess the prevalence of CVD and its major risk factors among Middle Eastern adults based on the literature published between January 1, 2012 and December 31, 2018 and carried out a meta-analysis. Methods: We searched electronic databases such as PubMed/Medline, ScienceDirect, Embase and Google Scholar to identify literature published from January 1, 2012 to December 31, 2018. All the original articles that investigated the prevalence of CVD and reported at least one of the following factors were included: hypertension, diabetes, dyslipidaemia, smoking and family history of CVD. To summarize CVD prevalence, we performed a random-effects meta-analysis. Results: A total of 41 potentially relevant articles were included, and 32 were included in the meta-analysis (n=191,979). The overall prevalence of CVD was 10.1% (95% confidence interval (CI): 7.1-14.3%, p<0.001) in the Middle East. A high prevalence of CVD risk factors, such as dyslipidaemia (43.3%; 95% CI: 21.5-68%), hypertension (26.2%; 95% CI: 19.6-34%) and diabetes (16%; 95% CI: 9.9-24.8%), was observed. The prevalence rates of other risk factors, such as smoking (12.4%; 95% CI: 7.7-19.4%) and family history of CVD (18.7%; 95% CI: 15.4-22.5%), were also high. Conclusion: The prevalence of CVD is high (10.1%) in the Middle East. The burden of dyslipidaemia (43.3%) in this region is twice as high as that of hypertension (26.2%) and diabetes mellitus (16%). Multifaceted interventions are urgently needed for the primary prevention of CVD in this region.

scholarly journals Rupture Risk of Intracranial Aneurysm and Prediction of Hemorrhagic Stroke after Liver Transplant

2021 ◽  
Vol 11 (4) ◽  
pp. 445
Author(s):  
Hye-Mee Kwon ◽  
In-Gu Jun ◽  
Kyoung-Sun Kim ◽  
Young-Jin Moon ◽  
In Young Huh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysm ◽  
Hemorrhagic Stroke ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hazard Analysis ◽  
Related Data ◽  
Incidence And Mortality ◽  
Before And After ◽  
History Of ◽  
Cirrhotic Patients

Postoperative hemorrhagic stroke (HS) is a rare yet devastating complication after liver transplantation (LT). Unruptured intracranial aneurysm (UIA) may contribute to HS; however, related data are limited. We investigated UIA prevalence and aneurysmal subarachnoid hemorrhage (SAH) and HS incidence post-LT. We identified risk factors for 1-year HS and constructed a prediction model. This study included 3544 patients who underwent LT from January 2008 to February 2019. Primary outcomes were incidence of SAH, HS, and mortality within 1-year post-LT. Propensity score matching (PSM) analysis and Cox proportional hazard analysis were performed. The prevalence of UIAs was 4.63% (n = 164; 95% confidence interval (CI), 3.95–5.39%). The 1-year SAH incidence was 0.68% (95% CI, 0.02–3.79%) in patients with UIA. SAH and HS incidence and mortality were not different between those with and without UIA before and after PSM. Cirrhosis severity, thrombocytopenia, inflammation, and history of SAH were identified as risk factors for 1-year HS. UIA presence was not a risk factor for SAH, HS, or mortality in cirrhotic patients post-LT. Given the fatal impact of HS, a simple scoring system was constructed to predict 1-year HS risk. These results enable clinical risk stratification of LT recipients with UIA and help assess perioperative HS risk before LT.

Risk Factors for Nonunion Following Ankle Arthrodesis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 193864002199849
Author(s):  
Sumit Patel ◽  
Lauren Baker ◽  
Jose Perez ◽  
Ettore Vulcano ◽  
Jonathan Kaplan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Avascular Necrosis ◽  
Strong Evidence ◽  
Meta Analysis ◽  
Ankle Arthrodesis ◽  
Male Gender ◽  
Site Infection ◽  
Open Injury ◽  
History Of

Background Nonunion is a postoperative complication after ankle arthrodesis (AA), which leads to increased morbidity and revision rates. Previous studies have identified risk factors for nonunion following AA, but no meta-analysis has been performed to stratify risk factors based on strength of evidence. Methods Abstracts and full-text articles were screened by 2 independent reviewers. Relevant data were extracted from the included studies. Random effects meta-analyses were summarized as forest plots of individual study and pooled random effect results. Results Database search yielded 13 studies involving 987 patients were included, and 37 potential risk factors for nonunion. Meta-analysis found 5 significant risk factors for nonunion post-AA. Strong evidence supports male gender (OR: 1.96; 95% CI: 1.13-3.41), smoking (OR: 2.89; 95% CI: 1.23-6.76), and history of operative site infection prior to arthrodesis (OR: 2.40; 95% CI: 1.13-5.09) as predictors for nonunion following AA. There was moderate evidence supporting history of open injury (OR: 5.95; 95% CI: 2.31-15.38) and limited evidence for preoperative avascular necrosis (OR: 13.16; 95% CI: 2.17-79.61) as possible risk factors for nonunion. Conclusion The results of our meta-analysis suggest that male gender, smoking, and history of operative site infection have strong evidence and that history of open injury and avascular necrosis also have evidence as risk factors for nonunion. Surgeons should be cognizant of these risks when performing AA and closely follow up with patients with the aforementioned risk factors to ensure postoperative success. Levels of Evidence: Level V: Systematic review of cohort and case-control studies

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