scholarly journals Unlike Periodontitis, Caries Does Not Associate With Intracranial Aneurysms or Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Joona Hallikainen ◽  
Tanja Pessi ◽  
Miira Vehkalahti ◽  
Anna Liisa Suominen ◽  
Juhana Frösen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Cox Regression ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
University Hospital ◽  
Gingival Tissue ◽  
Missing Teeth ◽  
Severe Periodontitis

Abstract Background:Periodontal infections have been associated to the formation and rupture of intracranial aneurysms (IA). In this study we investigated whether also caries (tooth decay) associates to IA pathology.Methods:A total of 166 patients with either IA or aneurysmal subarachnoid hemorrhage (aSAH) underwent oral examination in Kuopio University Hospital and Tampere University Hospital. Findings were compared to age, gender and geographically matched controls acquired from cross-sectional Health 2000 Survey. This study consisted three sequential steps. First step was a comparison of the caries prevalence and number of missing teeth in IA and aSAH patients with the control population, second step was a multivariate analysis with demographic factors and third step was a prospective 13-year follow-up of participants with any caries or missing teeth.Results:In logistic regression adjusted for known risk factors and demographic data, caries (OR: 0.412 95%Cl 0.2-0.9, p=0.028) was associated with lack of IAs, while age (OR:1.029 95%Cl 1.0-1.1 p=0.039), current smoking (OR:2.7 95%Cl 1.4-5.1, p=0.003) and severe periodontitis (OR:4.3 95%Cl 2.3-12.5, p<0.001) associated with IA formation. Severe periodontitis associated also to aSAH in logistic regression (OR: 5.4, 95%Cl 1.9-15.5, p=0.002). In the cox-regression, severe periodontitis at baseline increased the risk of aSAH (HR: 11.9, 95%Cl 1.2-114.7, p=0.032) during a 13-year follow-up.Conclusion:Unlike periodontitis, caries does not increase the risk of IAs and aSAHs. However, cariogenic bacteria may participate to IA pathology by disseminating to circulation via inflamed gingival tissue.

scholarly journals Microsurgical Treatment of Pediatric Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 237-250 ◽  
Author(s):  
Udaya K. Kakarla ◽  
Elisa J. Beres ◽  
Francisco A. Ponce ◽  
Steven W. Chang ◽  
Vivek R. Deshmukh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
De Novo ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Circulatory Arrest ◽  
Morbidity Rate ◽  
Parent Vessel ◽  
Vessel Occlusion

Abstract BACKGROUND Pediatric aneurysms are rare and complex to treat. Long-term angiographic and clinical data after microsurgical or endovascular therapies are lacking. OBJECTIVE To study the clinical and radiographic outcomes in aneurysms in pediatric patients treated with microsurgery. METHODS Between 1989 and 2005, 48 patients ≤ 18 years of age (28 boys, 20 girls; mean age, 12.3 years) were treated for intracranial aneurysms. Patient charts were reviewed retrospectively for age, presentation, type and location of aneurysm(s), surgical approach, complications, and clinical and angiographic outcomes. Rates of aneurysm recurrence and de novo formation were calculated. RESULTS Seventy-two aneurysms were treated. Presentations included incidental aneurysm (35%), aneurysmal subarachnoid hemorrhage (17%), stroke (13%), and traumatic subarachnoid hemorrhage (10%). Location was anterior circulation in 76% and posterior circulation in 24%. Twenty-eight (39%) were fusiform/dissecting, and 16 (23%) were giant. Most aneurysms were clipped directly. A vascular bypass with parent-vessel occlusion was used to treat 13 aneurysms (18%). Hypothermic circulatory arrest was used to treat 10 aneurysms (14%), all involving the basilar artery. The perioperative morbidity rate was 25%. There were no deaths. The long-term morbidity rate was 14%, and the mortality rate was 3%. Clinical outcome was favorable in 92% and 94% at discharge and follow-up, respectively (mean, 59 months; median, 32 months). At angiographic follow-up (mean, 53 months; median, 32 months), the annual recurrence rate was 2.6%, and the annual rate of de novo formation or growth was 7.8%. CONCLUSION Pediatric aneurysms require complex microsurgical techniques to achieve favorable outcomes. They leave higher rates of recurrence and de novo formation or growth than their adult counterparts, which mandates lifelong follow-up.

scholarly journals Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding

1999 ◽  
Vol 6 (2) ◽  
pp. E2
Author(s):  
James V. Byrne ◽  
Min-Joo Sohn ◽  
Andrew J. Molyneux ◽  
B. Chir
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Embolization ◽  
Aneurysm Occlusion ◽  
The Stability ◽  
Ruptured Intracranial Aneurysms

Object During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed these cases to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding. Methods These cases were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual postal questionnaires. Conclusions Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography. Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.

scholarly journals Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms

2018 ◽  
Vol 7 (6) ◽  
pp. 452-456
Author(s):  
Hesham Masoud ◽  
Vijaylakshmi Nair ◽  
Adekorewale  Odulate-Williams ◽  
Sameer Sharma ◽  
Grahame Gould ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
General Anesthesia ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Small Sample Size ◽  
Aneurysm Rupture ◽  
Small Sample ◽  
Unruptured Intracranial Aneurysms

Background: The role of general anesthesia in precipitating aneurysm rupture is not clearly defined. In this study, we aimed to assess the natural history of unruptured aneurysms in patients undergoing non-aneurysm-related procedures requiring general anesthesia. Methods: Retrospective review of consecutive patients with untreated intracranial aneurysms that underwent unrelated surgery with operative note documentation of general anesthesia. Events of intraoperative and postoperative subarachnoid hemorrhage were recorded to determine the incidence of rupture. Results: A total of 110 patients harboring 134 unsecured aneurysms were studied. The mean age was 56.5 years (range, 17–92), and 68% were women (n = 75/110). Mean aneurysm size was 3.5 mm (range 1.5–17). A total of 208 procedures were performed under general anesthesia. There were no events of subarachnoid hemorrhage in 5.7 years of follow-up. Conclusion: In our study, general anesthesia did not precipitate aneurysm rupture, and there were no instances of subarachnoid hemorrhage during the follow-up period. Our results suggest a benign natural history for aneurysms undergoing unrelated general anesthesia. However, this should be interpreted with caution given limitations related to our small sample size and retrospective study design.

Effect of Blood Pressure Variability During the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes

Neurosurgery ◽  
2020 ◽  
Vol 87 (4) ◽  
pp. 779-787 ◽  
Author(s):  
Luis C Ascanio ◽  
Alejandro Enriquez-Marulanda ◽  
Georgios A Maragkos ◽  
Mohamed M Salem ◽  
Abdulrahman Y Alturki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Standard Deviation ◽  
Coefficient Of Variation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Retrospective Chart Review ◽  
Logistic Regression Models ◽  
Poor Outcomes

Abstract BACKGROUND The association of blood pressure variation with poor outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is unknown. OBJECTIVE To evaluate the association of systolic blood pressure (SBP) variation and clinical outcomes in aSAH. METHODS We conducted a retrospective chart review of all aSAH patients treated at an academic institution between 2007 and 2016. Patient demographics, aSAH characteristics, and blood pressure observations for the first 24 h of admission in 4-h intervals were obtained. SBP variability metrics assessed were mean, standard deviation, maximum, minimum, peak, trough, coefficient of variation, and successive variation. The primary outcome was a composite of the modified Rankin scale as good (0-2) or poor (3-6) at last follow-up. Comparisons between outcome groups were performed. Logistic regression models for each significant SBP metric controlling for potential confounders were constructed. RESULTS The study population was 202 patients. The mean age was 57 yr; 66% were female. The median follow-up time was 18 mo; 57 (29%) patients had a poor outcome. Patients with poor outcomes had higher standard deviation (17.1 vs 14.7 mmHg, P = .01), peak (23.5 vs 20.0 mmHg, P = .02), trough (22.6 vs 19.2 mmHg, P &lt; .01), coefficient of variation (13.9 vs 11.8 mmHg, P &lt; .01), and lower minimum SBP (101.4 vs 108.4, P &lt; .01). The logistic regression showed that every 1-mmHg increase in the minimum SBP increased the odds of good outcomes (odds ratio = 1.03; 95% CI = 1.001-1.064; P = .04). Models including other SBP metrics were not significant. CONCLUSION Hypotension was found to be independently associated with poor outcomes in patients with aSAH.

Evidence for a conditioning effect of inhalational anesthetics on angiographic vasospasm after aneurysmal subarachnoid hemorrhage

2020 ◽  
Vol 133 (1) ◽  
pp. 152-158 ◽  
Author(s):  
Umeshkumar Athiraman ◽  
Diane Aum ◽  
Ananth K. Vellimana ◽  
Joshua W. Osbun ◽  
Rajat Dhar ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
Secondary Brain Injury ◽  
Large Artery ◽  
Inhalational Anesthetics ◽  
Angiographic Vasospasm ◽  
Inhalational Anesthetic

OBJECTIVEDelayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is characterized by large-artery vasospasm, distal autoregulatory dysfunction, cortical spreading depression, and microvessel thrombi. Large-artery vasospasm has been identified as an independent predictor of poor outcome in numerous studies. Recently, several animal studies have identified a strong protective role for inhalational anesthetics against secondary brain injury after SAH including DCI—a phenomenon referred to as anesthetic conditioning. The aim of the present study was to assess the potential role of inhalational anesthetics against cerebral vasospasm and DCI in patients suffering from an SAH.METHODSAfter IRB approval, data were collected retrospectively for all SAH patients admitted to the authors’ hospital between January 1, 2010, and December 31, 2013, who received general anesthesia with either inhalational anesthetics only (sevoflurane or desflurane) or combined inhalational (sevoflurane or desflurane) and intravenous (propofol) anesthetics during aneurysm treatment. The primary outcomes were development of angiographic vasospasm and development of DCI during hospitalization. Univariate and logistic regression analyses were performed to identify independent predictors of these endpoints.RESULTSThe cohort included 157 SAH patients whose mean age was 56 ± 14 (± SD). An inhalational anesthetic–only technique was employed in 119 patients (76%), while a combination of inhalational and intravenous anesthetics was employed in 34 patients (22%). As expected, patients in the inhalational anesthetic–only group were exposed to significantly more inhalational agent than patients in the combination anesthetic group (p < 0.05). Multivariate logistic regression analysis identified inhalational anesthetic–only technique (OR 0.35, 95% CI 0.14–0.89), Hunt and Hess grade (OR 1.51, 95% CI 1.03–2.22), and diabetes (OR 0.19, 95% CI 0.06–0.55) as significant predictors of angiographic vasospasm. In contradistinction, the inhalational anesthetic–only technique had no significant impact on the incidence of DCI or functional outcome at discharge, though greater exposure to desflurane (as measured by end-tidal concentration) was associated with a lower incidence of DCI.CONCLUSIONSThese data represent the first evidence in humans that inhalational anesthetics may exert a conditioning protective effect against angiographic vasospasm in SAH patients. Future studies will be needed to determine whether optimized inhalational anesthetic paradigms produce definitive protection against angiographic vasospasm; whether they protect against other events leading to secondary brain injury after SAH, including microvascular thrombi, autoregulatory dysfunction, blood-brain barrier breakdown, neuroinflammation, and neuronal cell death; and, if so, whether this protection ultimately improves patient outcome.

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.

Management of Unruptured Intracranial Aneurysm in Japan

1998 ◽  
Vol 18 (4) ◽  
pp. 357-364 ◽  
Author(s):  
Noriaki Aoki ◽  
Takao Kitahara ◽  
Tsuguya Fukui ◽  
J. Robert Beck ◽  
Kazui Soma ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Sensitivity Analysis ◽  
Glasgow Outcome Scale ◽  
Intracranial Aneurysms ◽  
University Hospital ◽  
Health Providers ◽  
Unruptured Intracranial Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Quality Adjusted Life

The purpose of this study was to analyze the management of individual patients with unruptured intracranial aneurysms (UN-ANs) using a decision-analytic approach. Tran sition probabilities among Glasgow Outcome Scale (GOS) categories were estimated from the published literature and data from patients who had been treated at Kitasato University Hospital. Utilities were obtained from 140 health providers based principally on the GOS. Baseline analysis for a healthy 40-year-old man with an anterior UN-AN less than 10 mm in diameter showed that the quality-adjusted life expectancies for preventive operation and follow-up were 15.34 and 14.66 years, respectively. For a follow-up strategy to be preferred, the annual rupture rate had to be as low as 0.9%. These results were sustained through extensive sensitivity analysis. The results sup port preventive operation for UN-ANs, and identify problems that can be clarified with a well-designed stratified clinical trial. Key words: decision analysis; Markov model; unruptured intracranial aneurysms; Glasgow Outcome Scale; utility; preventive oper ations. (Med Decis Making 1998;18:357-364)

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 Bilateral subdural hygromas after endovascular coiling for ruptured aneurysmal subarachnoid hemorrhage: an unusual and rare complication

2021 ◽  
Vol 2021 (8) ◽  
Author(s):  
Walid O Ahmed ◽  
Shady N Mashhour ◽  
Marwa E Abdelfattah
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Rare Complication ◽  
Mass Effect ◽  
Contralateral Side ◽  
Endovascular Coiling ◽  
Neurological Assessment ◽  
Ruptured Intracranial Aneurysm ◽  
Significant Mass Effect

ABSTRACT Subarachnoid hemorrhage (SAH) with subdural hygroma (SH) was rarely reported after endovascular coiling. A 60-year-old male presented with impaired consciousness and convulsions due to SAH from a ruptured aneurysm. It was managed by endovascular coiling 20 h after the onset of symptoms. Serial brain imaging for 2 weeks revealed progressive bilateral SHs, more on contralateral side of leaking aneurysm. Management of SH was discussed in a multidisciplinary setting to be conservative as there was neither significant mass effect nor hydrocephalus. The patient recovered neurologically except for mild dysarthria. The SH persisted for 2 months and then cleared gradually. We concluded that SH may arise and become symptomatic as an unusual sequela of post-coiling of a ruptured intracranial aneurysm, in which the SH can complicate the clinical course of SAH. However, the symptomatic SH may resolve spontaneously and completely without any intervention, but needs meticulous neurological assessment and follow-up.

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