scholarly journals Beta-blocker therapy and impact on outcome after aneurysmal subarachnoid hemorrhage: a cohort study

2016 ◽  
Vol 125 (3) ◽  
pp. 730-736 ◽  
Author(s):  
Nohra Chalouhi ◽  
Badih Daou ◽  
Toshimasa Okabe ◽  
Robert M. Starke ◽  
Richard Dalyai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Cardiac Dysfunction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Left Ventricular Ejection ◽  
Mean Flow ◽  
Mean Flow Velocity

OBJECTIVE Cerebral vasospasm (cVSP) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), with a significant impact on outcome. Beta blockers (BBs) may blunt the sympathetic effect and catecholamine surge associated with ruptured cerebral aneurysms and prevent cardiac dysfunction. The purpose of this study was to investigate the association between preadmission BB therapy and cVSP, cardiac dysfunction, and in-hospital mortality following aSAH. METHODS This was a retrospective cohort study of patients with aSAH who were treated at a tertiary high-volume neurovascular referral center. The exposure was defined as any preadmission BB therapy. The primary outcome was cVSP assessed by serial transcranial Doppler with any mean flow velocity ≥ 120 cm/sec and/or need for endovascular intervention for medically refractory cVSP. Secondary outcomes were cardiac dysfunction (defined as cardiac troponin-I elevation > 0.05 μg/L, low left ventricular ejection fraction [LVEF] < 40%, or LV wall motion abnormalities [LVWMA]) and in-hospital mortality. RESULTS The cohort consisted of 210 patients treated between February 2009 and September 2010 (55% were women), with a mean age of 53.4 ± 13 years and median Hunt and Hess Grade III (interquartile range III–IV). Only 13% (27/210) of patients were exposed to preadmission BB therapy. Compared with these patients, a higher percentage of patients not exposed to preadmission BBs had transcranial Doppler-mean flow velocity ≥ 120 cm/sec (59% vs 22%; p = 0.003). In multivariate analyses, lower Hunt and Hess grade (OR 3.9; p < 0.001) and preadmission BBs (OR 4.5; p = 0.002) were negatively associated with cVSP. In multivariate analysis, LVWMA (OR 2.7; p = 0.002) and low LVEF (OR 1.1; p = 0.05) were independent predictors of in-hospital mortality. Low LVEF (OR 3.9; p = 0.05) independently predicted medically refractory cVSP. The in-hospital mortality rate was higher in patients with LVWMA (47.4% vs 14.8%; p < 0.001). CONCLUSIONS The study data suggest that preadmission therapy with BBs is associated with lower incidence of cVSP after aSAH. LV dysfunction was associated with higher medically refractory cVSP and in-hospital mortality. BB therapy may be considered after aSAH as a cardioprotective and cVSP preventive therapy.

scholarly journals Safety and Feasibility of an Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage

2013 ◽  
Vol 93 (2) ◽  
pp. 208-215 ◽  
Author(s):  
Brian F. Olkowski ◽  
Mary Ann Devine ◽  
Laurie E. Slotnick ◽  
Erol Veznedaroglu ◽  
Kenneth M. Liebman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Subarachnoid Hemorrhage ◽  
Physical Therapist ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Early Mobilization ◽  
Therapeutic Exercise ◽  
Mean Flow ◽  
Functional Training ◽  
Prolonged Monitoring ◽  
Mean Flow Velocity

BackgroundSurvivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery, which typically includes surgery, prolonged monitoring in the intensive care unit, and treatment focusing on the prevention of complications.ObjectiveThe purpose of this study was to determine the safety and feasibility of an early mobilization program for patients with aneurysmal SAH.DesignThis study was a retrospective analysis.MethodsTwenty-five patients received early mobilization by a physical therapist or an occupational therapist, or both, which focused on functional training and therapeutic exercise in more progressively upright positions. Participation criteria focused on neurologic and physiologic stability prior to the initiation of early mobilization program sessions.ResultsPatients met the criteria for participation in 86.1% of the early mobilization program sessions attempted. Patients did not meet criteria for the following reasons: Lindegaard ratio &gt;3.0 or middle cerebral artery (MCA) mean flow velocity (MFV) &gt;120 cm/s (8.1%), mean arterial pressure (MAP) &lt;80 mm Hg (1.8%), intracranial pressure (ICP) &gt;15 mm Hg (1.8%), unable to open eyes in response to voice (0.9%), respiratory rate &gt;40 breaths/min (0.6%), MAP &gt;110 mm Hg (0.3%), and heart rate &lt;40 bpm (0.3%). Adverse events occurred in 5.9% of early mobilization program sessions for the following reasons: MAP &lt;70 mm Hg (3.1%) or &gt;120 mm Hg (2.4%) and heart rate &gt;130 bpm (0.3%). The 30-day mortality rate for all patients was 0%. Participation in the early mobilization program began a mean of 3.2 days (SD=1.3) after aneurysmal SAH, and patients received an average of 11.4 sessions (SD=4.3). Patients required a mean of 5.4 days (SD=4.2) to participate in out-of-bed activity and a mean of 10.7 days (SD=6.2) to walk ≥15.24 m (50 ft).ConclusionsThe results of this study suggest that an early mobilization program for patients with aneurysmal SAH is safe and feasible.

scholarly journals Impact of Chronic Obstructive Pulmonary Disease on In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage: An Observational Cohort Study with Propensity Score Matching

2020 ◽  
Author(s):  
Yu Zhang ◽  
Linjie Li ◽  
Wei Yao ◽  
Xing Wang ◽  
Liyuan Peng ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Pulmonary Disease ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Objective: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear. Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2009 and 2019. Propensity score matching was performed to obtain the adjusted odds ratios (ORs) with 95% CI. The primary outcome was in hospital mortality.Results: Using a ten-year clinical database from a large university medical center, 5643 patients with aSAH were identified, of whom 377 (7.9%) also had COPD. After matching, 289 patients were included in COPD group and 1156 in non-COPD groups. COPD was associated with increased in-hospital mortality (OR 1.63, 95% CI 1.02-2.62) and poor functional outcome at discharge (OR 1.37, 95% CI 1.04-1.80). Similarly, patients with COPD had significantly longer length of hospital stay, higher odds of seizure (OR 2.05, 95% CI 1.04-4.04), pneumonia (OR 3.10, 95% CI 2.38-4.04), intracranial infection (OR 1.62, 95% CI 1.14-2.29), urinary tract infection (OR 1.59, 95% CI 1.16-2.20) and bloodstream infection(OR 3.27, 95% CI 1.74-6.15). Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for pneumonia and seizure.

scholarly journals Hemodynamic correlates of transient cognitive impairment after transient ischemic attack and minor stroke: A transcranial Doppler study

2016 ◽  
Vol 11 (9) ◽  
pp. 978-986 ◽  
Author(s):  
Sara Mazzucco ◽  
Linxin Li ◽  
Maria A Tuna ◽  
Sarah T Pendlebury ◽  
Rose Wharton ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Flow Velocity ◽  
Transient Ischemic Attack ◽  
Transcranial Doppler ◽  
Minor Stroke ◽  
Mean Flow ◽  
Hemodynamic Changes ◽  
Diastolic Velocity ◽  
Ischemic Attack ◽  
Mean Flow Velocity

Background and aims Transient cognitive impairment (TCI) on the Mini Mental State Evaluation score is common after transient ischemic attack/minor stroke and might identify patients at increased risk of dementia. We aimed to replicate TCI using the Montreal Cognitive Assessment (MoCA), compare it with persistent Mild Cognitive Impairment (PMCI), and to determine whether global cerebral hemodynamic changes could explain transient impairment. Methods Consecutive patients with transient ischemic attack/minor stroke (NIHSS ≤ 3) were assessed with the MoCA and transcranial Doppler ultrasound acutely and at 1 month. We compared patients with TCI (baseline MoCA < 26 with ≥ 2 points increase at 1 month), PMCI (MoCA < 26 with < 2 points increase), and no cognitive impairment (NCI; MoCA ≥ 26). Results Of 326 patients, 46 (14.1%) had PMCI, 98 (30.1%) TCI, and 182 (55.8%) NCI. At baseline, TCI patients had higher systolic blood pressure (150.95 ± 21.52 vs 144.86 ± 22.44 mmHg, p = 0.02) and lower cerebral blood flow velocities, particularly end-diastolic velocity (30.16 ± 9.63 vs 35.02 ± 9.01 cm/s, p < 0.001) and mean flow velocity (48.95 ± 12.72 vs 54 ± 12.46 cm/s, p = 0.001) than those with NCI, but similar clinical and hemodynamic profiles to those with PMCI. Systolic BP fell between baseline and 1 month (mean reduction = 14.01 ± 21.26 mmHg) and end-diastolic velocity and mean flow velocity increased (mean increase = + 2.42 ± 6.41 and 1.89 ± 8.77 cm/s, respectively), but these changes did not differ between patients with TCI, PMCI, and NCI. Conclusions TCI is detectable with the MoCA after transient ischemic attack and minor stroke and has similar clinical and hemodynamic profile to PMCI. However, TCI does not appear to be due to exaggerated acute reversible global hemodynamic changes.

37: MEAN FLOW VELOCITY OF THE MIDDLE CEREBRAL ARTERY PREDICTS POOR OUTCOME AFTER SUBARACHNOID HEMORRHAGE

2020 ◽  
Vol 48 (1) ◽  
pp. 19-19
Author(s):  
Khalil Yousef ◽  
Elizabeth Crago ◽  
Anne Fisher ◽  
Theodore Lagattuta ◽  
Marilyn Hravnak
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Mean Flow ◽  
Poor Outcome ◽  
Mean Flow Velocity

scholarly journals Transcranial Doppler Study Among Children with Sickle Cell Anaemia Vs Normal Children

2012 ◽  
Vol 32 (2) ◽  
pp. 146-149 ◽  
Author(s):  
BB Lakhkar ◽  
BN Lakhkar ◽  
P Vaswani
Keyword(s):  
Sickle Cell Disease ◽  
Flow Velocity ◽  
Sickle Cell ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Cell Disease ◽  
Mean Flow ◽  
Mean Velocity ◽  
Mean Flow Velocity ◽  
Age And Sex

Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache. J. Nepal Paediatr. Soc. 32(2) 2012 146-149 doi: http://dx.doi.org/10.3126/jnps.v32i2.5681

Myogenic Cerebrovascular Autoregulation in Migraine Measured by Stress Transcranial Doppler Sonography

Cephalalgia ◽  
1998 ◽  
Vol 18 (3) ◽  
pp. 133-137 ◽  
Author(s):  
JG Heckmann ◽  
MJ Hilz ◽  
A Katalinic ◽  
H Marthol ◽  
M Mück-Weymann ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Physical Stress ◽  
Cerebrovascular Reactivity ◽  
Mean Flow ◽  
Cerebrovascular Autoregulation ◽  
Mean Flow Velocity

Background and purpose: Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD. Patients and methods: Using transcranial Doppler ultrasound at rest and during ergometer stress (stress TCD), we studied the changes in mean flow velocities and resistance index (RI) in relation to physical stress in the middle cerebral artery. Fifteen migraine patients without aura, 15 migraine patients with aura, and 15 healthy control subjects were examined. Patients suffered from predominantly unilateral headache and were studied during an attack-free period. The Pourcelof's RI as a measure of cerebrovascular reactivity was calculated by dividing the difference between systolic and diastolic velocity by the systolic velocity. Results: None of the subgroups showed any difference during ergometer exercise with regard to blood pressure, endtidal CO2, heart rate, or mean flow velocity. In all subgroups, sufficient physical stress was achieved. With respect to RI change, migraine patients without aura and healthy controls did not differ ( p>0.05). However, the RI change of migraine patients with aura was significantly lower than the RI change of migraine patients without aura or healthy subjects ( p>0.05). The discrimination analysis showed in addition that RI change (absolute and as a percentage) and mean flow velocity change (as a percentage) could be used as diagnostic variables to detect patients with aura symptoms. Conclusion: Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.

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