The influence of aneurysm morphology on the volume of hemorrhage after rupture

OBJECTIVE Factors determining the risk of rupture of intracranial aneurysms have been extensively studied; however, little attention is paid to variables influencing the volume of bleeding after rupture. In this study the authors aimed to evaluate the impact of aneurysm morphological variables on the amount of hemorrhage. METHODS This was a retrospective cohort analysis of a prospectively collected data set of 116 patients presenting at a single center with subarachnoid hemorrhage due to aneurysmal rupture. A volumetric assessment of the total hemorrhage volume was performed from the initial noncontrast CT. Aneurysms were segmented and reproduced from the initial CT angiography study, and morphology indexes were calculated with a computer-assisted approach. Clinical and demographic characteristics of the patients were included in the study. Factors influencing the volume of hemorrhage were explored with univariate correlations, multiple linear regression analysis, and graphical probabilistic modeling. RESULTS The univariate analysis demonstrated that several of the morphological variables but only the patient’s age from the clinical-demographic variables correlated (p < 0.05) with the volume of bleeding. Nine morphological variables correlated positively (absolute height, perpendicular height, maximum width, sac surface area, sac volume, size ratio, bottleneck factor, neck-to-vessel ratio, and width-to-vessel ratio) and two correlated negatively (parent vessel average diameter and the aneurysm angle). After multivariate analysis, only the aneurysm size ratio (p < 0.001) and the patient’s age (p = 0.023) remained statistically significant. The graphical probabilistic model confirmed the size ratio and the patient’s age as the variables most related to the total hemorrhage volume. CONCLUSIONS A greater aneurysm size ratio and an older patient age are likely to entail a greater volume of bleeding after subarachnoid hemorrhage.

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The Impact of the Body Mass Index on Outcome After Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/01.neu.0000430322.17000.82 ◽

2013 ◽

Vol 73 (2) ◽

pp. 201-208 ◽

Cited By ~ 22

Author(s):

Johannes Platz ◽

Erdem Güresir ◽

Patrick Schuss ◽

Jürgen Konczalla ◽

Volker Seifert ◽

...

Keyword(s):

Body Mass Index ◽

Subarachnoid Hemorrhage ◽

Body Mass ◽

Glasgow Outcome Scale ◽

The Body ◽

Favorable Outcome ◽

World Federation ◽

Obese Patients ◽

Aneurysm Size ◽

The Impact

Abstract BACKGROUND: Obesity is a risk factor for cardiovascular disease and associated with a poor outcome, especially for intensive care patients. However, recent studies have described favorable outcomes of obese patients after stroke, a phenomenon called the “obesity paradox.” OBJECTIVE: To assess the impact of the body mass index (BMI) on outcome after subarachnoid hemorrhage (SAH). METHODS: We analyzed the data for 741 SAH patients. A BMI greater than 25 kg/m2 was considered overweight and greater than 30 kg/m2 obese. The outcome according to the Glasgow Outcome Scale at discharge and after 6 months was assessed using logistic regression analysis. RESULTS: According to the BMI, 268 patients (36.2%) were overweight and 113 (15.2%) were obese. A favorable outcome (Glasgow Outcome Scale score >3) was achieved in 53.0% of overweight patients. In contrast, 61.4% of the 360 patients with a normal BMI had a favorable outcome (P = .021). However, in the multivariate analysis, only age (odds ratio [OR]: 1.051, 95% confidence interval [CI]: 1.04-1.07, P < .001), World Federation of Neurological Surgeons grade (OR: 2.095, 95% CI: 1.87-2.35, P < .001), occurrence of vasospasm (OR: 2.90, 95% CI: 1.94-4.34, P < .001), and aneurysm size larger than 12 mm (OR: 2.215, 95% CI: 1.20-4.10, P = .011) were independent predictors of outcome after 6 months. Of the 321 poor grade patients (World Federation of Neurological Surgeons score >3), 171 (53.3%) were overweight. Of these, 21.6% attained a favorable outcome compared with 35.3% of normal-weight patients (P = .006). CONCLUSION: Although many physicians anticipate a worse outcome for obese patients, in our study, the BMI was not an independent predictor of outcome. Based on the BMI, obesity seems to be negligible for outcome after SAH compared with the impact of SAH itself, the patient's age, occurrence of vasospasm, or aneurysm size.

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PSA doubling time of ≤6 months as the optimal cutoff for predicting clinically relevant outcomes for men receiving salvage radiation therapy post radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.167 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 167-167

Author(s):

William C. Jackson ◽

Skyler B. Johnson ◽

Benjamin Foster ◽

Corey Foster ◽

Yeohan Song ◽

...

Keyword(s):

Radiation Therapy ◽

Radical Prostatectomy ◽

Predictive Value ◽

Doubling Time ◽

Univariate Analysis ◽

External Beam Radiation ◽

Beam Radiation ◽

Data Set ◽

Psa Doubling Time ◽

The Impact

167 Background: Short PSA doubling time (PSADT) after biochemical recurrence (BR) post radical prostatectomy (RP) is known to predict worse outcomes following salvage external beam radiation therapy (SRT). The ideal PSADT cut-off, however, in this context remains uncertain. In this study, we sought to identify the best PSADT cut-off for predicting clinical outcomes following SRT for BR after RP. Methods: 575 patients who received SRT at a single institution for BR after RP were retrospectively reviewed in an IRB approved analysis. The impact of PSADT on biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall survival (OS) was assessed using Kaplan-Meier and Cox Proportional Hazards models. Results: Median follow up was 56.7 months post SRT. PSADTs could be calculated for 277 patients. PSADT strongly predicted BF, DM, PCSM, and OS on univariate analysis regardless of cut-off point. There was no statistical difference in BF, DM, PCSM, or OS between patients with PSADT <3 (n=40) and 3-6 months (n=61) or between 6-10 (n=62) and >10 months (n=114). A difference existed in BF (p<0.01 HR: 2.2 [95%CI: 1.4-3.5]) and DM (p=0.02 HR: 2.2 [95%CI: 1.2-4.3]) between PSADT of 3-6 and 6-10 months. PSADT ≤6 had the largest positive predictive value (PPV) for BF (70%), DM (36%), and PCSM (13%) at 5 years. There was no difference in negative predictive value between a PSADT >10 vs. >6 months for BF, DM, PCSM, and OS with 5 year rates of (60% vs. 60%, 86% vs. 86%, 99% vs. 98%, and 95 vs. 94% respectively). On multivariate analysis PSADT ≤6 was a strong predictor of BF (p<0.01 HR: 2.1 [95%CI: 1.5-3.0]), DM (p=0.01 HR: 2.0 [95%CI: 1.2-3.4]), and PCSM (p=0.04 HR: 2.3 [95%CI: 1.1-5.2]), with a trend towards predicting OS (p=0.12 HR: 1.5 [95%CI: 0.9-2.6]). Conclusions: A PSADT ≤6 months was the best predictor of outcomes in our data set, particularly for DM and PCSM. Currently, the most common predictive nomogram for SRT uses PSADT <10 months as the cut-off point for BF. These results suggest that using a PSADT of ≤6 months may improve the ability to predict clinically significant outcomes and hence identify men who may benefit from additional therapy.

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Larger size ratio associated with the rupture of very small (≤3 mm) anterior communicating artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012294 ◽

2016 ◽

Vol 9 (3) ◽

pp. 278-282 ◽

Cited By ~ 12

Author(s):

Ting Xu ◽

Boli Lin ◽

Shuailiang Liu ◽

Xiaotong Shao ◽

Nengzhi Xia ◽

...

Keyword(s):

Multivariate Regression ◽

Univariate Analysis ◽

Maximum Size ◽

Aneurysm Rupture ◽

Size Ratio ◽

Anterior Communicating Artery ◽

Rupture Risk ◽

Aneurysm Size ◽

Aneurysm Morphology ◽

Small Aneurysms

BackgroundAnterior communicating artery (AcoA) aneurysms have a high rupture risk, and ruptured AcoA aneurysms tend to be smaller than other intracranial aneurysms. We aimed to determine the incidence and morphologic predictors of aneurysm rupture of very small AcoA aneurysms.MethodsWe conducted a retrospective analysis of 519 consecutive patients with single AcoA aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small aneurysms were defined as those with a maximum size ≤3 mm, and small aneurysms were defined as those with a maximum size ≤5 mm. Multivariate regression analyses were used to determine the association between aneurysm morphology and aneurysm rupture status.ResultsOf the 474 ruptured AcoA aneurysms, 134 (28.3%) aneurysms were very small and 278 (58.6%) aneurysms were small. In the univariate analysis for very small aneurysms, larger aneurysm size (p=0.037), larger size ratio (p=0.002), higher aneurysm height (p=0.038), smaller vessel size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with aneurysm rupture. Multivariate analysis revealed that a larger size ratio was independently associated with the rupture status of the very small aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger aneurysm size, larger size ratio, and dominant A1 segment configuration were associated with the rupture of small aneurysms.ConclusionsAbout one-third of ruptured AcoA aneurysms were very small. A larger size ratio, rather than other aneurysm morphologies, was independently associated with the rupture of very small AcoA aneurysms.

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Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage

Neurocritical Care ◽

10.1007/s12028-021-01305-1 ◽

2021 ◽

Author(s):

Yuxuan Lu ◽

Haiqiang Jin ◽

Yuhua Zhao ◽

Yuxian Li ◽

Jun Xu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Single Center Study ◽

Tibet Autonomous Region ◽

Basal Ganglia Hemorrhage ◽

Lobar Hemorrhage ◽

Hemorrhage Volume ◽

The Mean ◽

The Impact

Abstract Background Studies of the impact of increased hemoglobin on spontaneous intracerebral hemorrhage (ICH) are limited. The present study aimed to explore the effect of increased hemoglobin on ICH. Methods A retrospective single-center study using medical records from a database processed by univariate and multivariate analyses was performed in the People’s Hospital of Tibet Autonomous Region in Lhasa, Tibet, China. Results The mean hemoglobin level in 211 patients with ICH was 165.03 ± 34.12 g/l, and a median hematoma volume was 18.5 ml. Eighty-eight (41.7%) patients had large hematomas (supratentorial hematoma ≥ 30 ml; infratentorial hematoma ≥ 10 ml). No differences in ICH risk factors between the groups with different hemoglobin levels were detected. Increased hemoglobin was independently associated with large hematomas [odds ratio (OR) 1.013, P = 0.023]. Increased hemoglobin was independently associated with ICH with subarachnoid hemorrhage (OR 1.014, P = 0.016), which was more pronounced in men (OR 1.027, P = 0.002). Increased hemoglobin was independently associated with basal ganglia hemorrhage and lobar hemorrhage in men (OR 0.986, P = 0.022; OR 1.013, P = 0.044, respectively) but not in women (P > 0.1). Conclusions Increased hemoglobin was independently associated with large hemorrhage volume. Increased hemoglobin was independently associated with lobar hemorrhage in men and ICH with subarachnoid hemorrhage, which was more pronounced in men. Additional studies are needed to confirm our findings and explore potential mechanisms.

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A geometric scaling model for assessing the impact of aneurysm size ratio on hemodynamic characteristics

BioMedical Engineering OnLine ◽

10.1186/1475-925x-13-17 ◽

2014 ◽

Vol 13 (1) ◽

pp. 17 ◽

Cited By ~ 10

Author(s):

Yunling Long ◽

Hongyu Yu ◽

Zhizheng Zhuo ◽

Ying Zhang ◽

Yang Wang ◽

...

Keyword(s):

Size Ratio ◽

Scaling Model ◽

Aneurysm Size ◽

Geometric Scaling ◽

Hemodynamic Characteristics ◽

The Impact

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Cerebral Aneurysm Size and Distal Intracranial Hemodynamics: An Assessment of Flow and Pulsatility Index Using Quantitative Magnetic Resonance Angiography

Neurosurgery ◽

10.1093/neuros/nyx441 ◽

2017 ◽

Vol 83 (4) ◽

pp. 660-665 ◽

Cited By ~ 3

Author(s):

Ahmed E Hussein ◽

Denise Brunozzi ◽

Sophia F Shakur ◽

Rahim Ismail ◽

Fady T Charbel ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Flow Velocity ◽

Cerebral Aneurysm ◽

Pulsatility Index ◽

Quantitative Magnetic Resonance ◽

Aneurysm Size ◽

Risk Of Rupture ◽

The Impact ◽

The Relationship

Abstract BACKGROUND The relationship between cerebral aneurysm size and risk of rupture is well documented, but the impact of aneurysms on distal intracranial hemodynamics is unknown. OBJECTIVE To examine the relationship between aneurysm size and distal intracranial hemodynamics prior to treatment. METHODS Patients seen at our institution between 2006 and 2015 with cerebral aneurysms within the internal carotid artery (ICA) segments (proximal to ICA terminus) were retrospectively reviewed. Patients were included if the aneurysm was unruptured, and were excluded if a contralateral aneurysm was present. Flows within bilateral ICAs and middle cerebral arteries (MCA) were measured prior to any treatment using quantitative magnetic resonance angiography. Pulsatility index (PI = [systolic − diastolic flow velocity]/mean flow velocity) within each vessel was then calculated. Hemodynamic parameters were analyzed with respect to aneurysm size. RESULTS Forty-two patients were included. Mean aneurysm size was 13.5 mm (range 2-40 mm). There was a significant correlation between aneurysm size and ipsilateral MCA PI (P = .006; r = 0.441), MCAipsilateral/ICAipsilateral PI ratio (P = .003; r = 0.57), and MCAipsilateral/MCAcontralateral PI ratio (P = .008; r = 0.43). Mean PI in the ipsilateral ICA was 0.38 (range 0.17-0.77) and ipsilateral MCA was 0.31 (range 0.08-0.83), and mean PI in contralateral ICA was 0.35 (range 0.19-0.57) and MCA was 0.30 (range 0.07-0.89). CONCLUSION Larger aneurysm size correlates with higher ipsilateral MCA PI, demonstrating that aneurysms affect distal intracranial hemodynamics.

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Protective Effects of Obstructive Sleep Apnea on Outcomes After Subarachnoid Hemorrhage: A Nationwide Analysis

Neurosurgery ◽

10.1093/neuros/nyaa242 ◽

2020 ◽

Vol 87 (5) ◽

pp. 1008-1015

Author(s):

Christian Kaculini ◽

David J Wallace ◽

Audrey E Haywood ◽

Joel Michalek ◽

Justin Mascitelli ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Subarachnoid Hemorrhage ◽

Sleep Apnea ◽

Tobacco Use ◽

Univariate Analysis ◽

Protective Effects ◽

Obstructive Sleep ◽

Increased Risk ◽

Poor Outcomes ◽

The Impact

Abstract BACKGROUND Obstructive sleep apnea (OSA) is typically associated with an increased risk of cardiovascular and cerebrovascular disease. Recent studies, however, have suggested that hypercapnia and chronic intermittent hypoxia may potentially provide protection against ischemic events like stroke. OBJECTIVE To evaluate the impact of OSA with presentation, hospital course, and treatment outcomes of patients with subarachnoid hemorrhage (SAH). METHODS Data for patients with SAH between the years 2011 and 2015 were extracted from the Nationwide Inpatient Sample (NIS) and stratified based on diagnosis codes for OSA. Univariate analysis was used to assess the prevalence of comorbidities in OSA patients diagnosed with SAH and several covariates, including patient demographics, aneurysmal treatment, in-hospital morality rate, length of stay, and costs. Multivariate logistic regression models analyzed the relationship between several comorbidities, including OSA, tobacco use, and hypertension, and poor outcomes after SAH. RESULTS Data from 49 265 SAH patients were used in this study, of which 2408 (4.9%) also had a concomitant OSA diagnosis. Patients with OSA compared to all other SAH patients had a significantly lower in-hospital mortality rate, as well as statistically significant lower odds of vasospasm, stroke, and poor outcomes. Additionally, hypercholesterolemia, obesity, and tobacco use disorder were also associated with more favorable outcomes. CONCLUSION SAH patients with OSA are significantly less likely to have a poor outcome when compared to non-OSA patients, despite having an increased risk of several comorbidities.

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Abstract 50: Impact of Acute Cocaine use on Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.a50 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Neeraj S Naval ◽

Tiffany Chang ◽

Robert Kowalski ◽

Filissa Caserta ◽

Juan R Carhuapoma ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Mortality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Univariate Analysis ◽

Cocaine Exposure ◽

Cocaine Use ◽

History Of ◽

Cocaine Users ◽

The Impact ◽

Patient Presentation

Objective: To analyze the impact of acute cocaine use on presentation and outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Background: Acute cocaine use has been temporally associated with aSAH but there are varying reports describing how it affects patient presentation, complications and outcomes. Design/Methods: Data of aSAH patients admitted to our institution between 1991-2009 were reviewed to determine which patients had used cocaine within 72 hours of aSAH based on positive urine toxicology or a history of cocaine use within 72 hours (C). These patients were then compared with aSAH patients without recent cocaine exposure (NC) in relation to their clinical and radiological presentations, complications such as DIND (delayed ischemic neurological deficit defined by vasospasm mediated cerebral infarcts) and outcomes defined by hospital mortality. Results: Data of 1134 patients were reviewed; aSAH in142 patients (12.5%) was associated with cocaine use. Cocaine users were more likely to be younger (mean age: C:49, NC:53, p0.05), admission GCS 0.05), associated IVH (C:56%, NC:51%, p>0.05) or hydrocephalus on admission CT (C:49%; NC:52%, p> 0.05). Cocaine users were more likely to have vasospasm related infarcts when compared to non-cocaine users (C:22%; NC:16%, p<0.05) but after correcting for other factors impacting vasospasm, cocaine use was not independently associated with DIND. Cocaine users had higher rates of aneurysm re-rupture (C:7.7%, NC:2.7%, p0.004). Cocaine users were less likely to survive hospitalization compared to non-users following univariate analysis (Mortality: C:26%, NC:17%, p< 0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users following multivariate analysis (p<0.001). Conclusions: Acute cocaine use was associated with a higher risk of aneurysm re-rupture and hospital mortality following aSAH. The various mechanisms for the nearly threefold increased odds of death associated with cocaine use warrants further investigation.

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Acute kidney injury after aneurysmal subarachnoid hemorrhage and its effect on patient outcome: an exploratory analysis

Journal of Neurosurgery ◽

10.3171/2019.4.jns19103 ◽

2020 ◽

Vol 133 (3) ◽

pp. 765-772 ◽

Cited By ~ 1

Author(s):

Matthew E. Eagles ◽

Maria F. Powell ◽

Oliver G. S. Ayling ◽

Michael K. Tso ◽

R. Loch Macdonald

Keyword(s):

Acute Kidney Injury ◽

Subarachnoid Hemorrhage ◽

Functional Outcome ◽

Renal Dysfunction ◽

Independent Predictor ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Univariate Analysis ◽

Kidney Injury ◽

Stepwise Logistic Regression ◽

Data Set

OBJECTIVEAcute kidney injury (AKI) is associated with death in critically ill patients, but this complication has not been well characterized after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of this study was to determine the incidence of AKI after aSAH and to identify risk factors for renal dysfunction. Secondary objectives were to examine what effect AKI has on patient mortality and functional outcome at 12 weeks post-aSAH.METHODSThe authors performed a post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial data set (clinical trial registration no.: NCT00111085, https://clinicaltrials.gov). The primary outcome of interest was the development of AKI, which was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes of interest were death and a modified Rankin Scale score greater than 2 at 12 weeks post-aSAH. Propensity score matching was used to assess for a significant treatment effect related to clazosentan administration and AKI. Univariate analysis, locally weighted scatterplot smoothing (LOWESS) curves, and stepwise logistic regression models were used to evaluate for associations between baseline or disease-related characteristics and study outcomes.RESULTSOne hundred fifty-six (38%) of the 413 patients enrolled in the CONSCIOUS-1 trial developed AKI during their ICU stay. A history of hypertension (p < 0.001) and the number of nephrotoxic medications administered (p = 0.029) were independent predictors of AKI on multivariate analysis. AKI was an independent predictor of death (p = 0.028) but not a poor functional outcome (p = 0.21) on multivariate testing. Unresolved renal dysfunction was the strongest independent predictor of death in this cohort (p < 0.001).CONCLUSIONSAKI is a common complication following aSAH. Patients with premorbid hypertension and those treated with nephrotoxic medications may be at greater risk for renal dysfunction. AKI appears to confer an increased probability of death after aSAH.

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Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

Perspectives on Speech Science and Orofacial Disorders ◽

10.1044/ssod18.1.31 ◽

2008 ◽

Vol 18 (1) ◽

pp. 31-40 ◽

Cited By ~ 2

Author(s):

David J. Zajac

Keyword(s):

Clinical Practice ◽

Speech Intelligibility ◽

Current Practice ◽

Computer Assisted ◽

Behavioral Management ◽

Single Word ◽

Future Directions ◽

Speech Science ◽

The Impact ◽

Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

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