Human arachnoid villi response to subarachnoid hemorrhage: possible relationship to chronic hydrocephalus

1999 ◽  
Vol 91 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Eric M. Massicotte ◽  
Marc R. Del Bigio
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cellular Proliferation ◽  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Content Type ◽  
Arachnoid Villi ◽  
Cell Accumulation ◽  
Flow Through ◽  
The Relationship ◽  
Fine Print

Object. The origin of chronic communicating hydrocephalus following subarachnoid hemorrhage (SAH) is not well understood. Fibrosis of the arachnoid villi has been suggested as the cause for obstruction of cerebrospinal fluid (CSF) flow, but this is not well supported in the literature. The goal of this study was to determine the relationship between blood, inflammation, and cellular proliferation in arachnoid villi after SAH.Methods. Arachnoid villi from 50 adult patients were sampled at autopsy. All specimens were subjected to a variety of histochemical and immunohistochemical stains. The 23 cases of SAH consisted of patients in whom an autopsy was performed 12 hours to 34 years post-SAH. Fifteen cases were identified as moderate-to-severe SAH, with varying degrees of hydrocephalus. In comparison with 27 age-matched non-SAH controls, the authors observed blood and inflammation within the arachnoid villi during the 1st week after SAH. Greater mitotic activity was also noted among arachnoid cap cells. The patient with chronic SAH presented with ventriculomegaly 2 months post-SAH and exhibited remarkable arachnoid cap cell accumulation.Conclusions. The authors postulate that proliferation of arachnoidal cells, triggered by the inflammatory reaction or blood clotting products, could result in obstruction of CSF flow through arachnoid villi into the venous sinuses. This does not exclude the possibility that SAH causes generalized fibrosis in the subarachnoid space.

Hydrocephalus following spontaneous subarachnoid hemorrhage

1973 ◽  
Vol 39 (4) ◽  
pp. 474-479 ◽  
Author(s):  
M. Gazi Yasargil ◽  
Yasuhiro Yonekawa ◽  
Bruno Zumstein ◽  
Hans-Jürgen Stahl
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Features ◽  
Intracranial Aneurysms ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
The Relationship ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ Twenty-eight cases of communicating hydrocephalus after subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms are reported. The relationship between the incidence of this complication and the various clinical features of SAH is discussed. The findings of RISA cisternography have little relationship to the findings of pneumoencephalography or the results of shunting procedures. The availability and value of echoencephalography in treating such patients is emphasized.

Hydrocephalus in cerebral cysticercosis

1981 ◽  
Vol 55 (5) ◽  
pp. 786-793 ◽  
Author(s):  
Ramiro D. Lobato ◽  
Eduardo Lamas ◽  
Jaime M. Portillo ◽  
Ricardo Roger ◽  
Javier Esparza ◽  
...  
Keyword(s):  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Content Type ◽  
Inflammatory Reactions ◽  
Csf Shunting ◽  
Cerebral Cysticercosis ◽  
Flow Through ◽  
Basal Cisterns ◽  
Fine Print ◽  
Internal Hydrocephalus

✓ The cases of 11 patients with hydrocephalus secondary to cerebral cysticercosis are analyzed. Most of the patients had suffered from epilepsy before they developed hydrocephalic symptoms, and computerized tomography showed that infestation of the parenchyma coexisted with ventricular or cisternal colonization. In four cases, the parasitic vesicles compromised cerebrospinal fluid (CSF) flow in the ventricular system, resulting in internal hydrocephalus. Communicating hydrocephalus, caused by the presence of Cysticercus larvae in the basal cisterns (Cysticercus racemosus), or by the occurrence of a chronic basal meningitis, or both, developed in seven more patients. Changes in CSF pressure were related to the number and location of the cysts and to the leptomeningeal inflammatory reactions evoked by them. The majority of patients presented with a chronic and relatively normotensive hydrocephalus. All patients except one had identifiable ventricular or cisternal Cysticercus larvae; these patients were treated with open removal of the cysts, and did well. However, most of them had impairment of CSF flow through the basal cisterns and required permanent CSF shunting. Communicating hydrocephalus due to leptomeningeal scarring was also successfully managed with extracranial shunting. Epilepsy was controlled with anticonvulsant therapy. Although good lasting results may be obtained with aggressive treatment of neurocysticercosis, patients are liable to relapse because surgery is only palliative in most instances.

Evaluation of the central canal of the spinal cord in experimentally induced hydrocephalus

1978 ◽  
Vol 48 (6) ◽  
pp. 970-974 ◽  
Author(s):  
A. Everette James ◽  
William J. Flor ◽  
Gary R. Novak ◽  
Ernst-Peter Strecker ◽  
Barry Burns
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Experimental Model ◽  
Alternative Pathway ◽  
Central Canal ◽  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Content Type ◽  
Histological Appearance ◽  
Fine Print

✓ The central canal of the spinal cord has been proposed as a significant compensatory alternative pathway of cerebrospinal fluid (CSF) flow in hydrocephalus. Ten dogs were made hydrocephalic by a relatively atraumatic experimental model that simulates the human circumstance of chronic communicating hydrocephalus. The central canal was studied by histopathology and compared with 10 normal control dogs. In both groups the central canal of the spinal cord was normal in size, configuration, and histological appearance. In this experimental model dilatation of the canal and increased movement of CSF does not appear to be a compensatory alternative pathway.

Facial nevi associated with anomalous venous return and hydrocephalus

1976 ◽  
Vol 45 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Kenneth Shapiro ◽  
Kenneth Shulman
Keyword(s):  
Pediatric Patients ◽  
Venous Return ◽  
Venous Hypertension ◽  
Communicating Hydrocephalus ◽  
Age Group ◽  
Content Type ◽  
Weber Syndrome ◽  
Sturge Weber Syndrome ◽  
The Relationship ◽  
Fine Print

✓ The authors describe two children with anomalous intracranial venous return associated with bilateral facial nevi, macrocrania, and cephalic venous hypertension. Both children had functional absence of the jugular bulbs, forcing the intracranial venous effluent to exit through persistent emissary pathways. Both children had sustained intracranial hypertension, with one child developing symptomatic communicating hydrocephalus that responded satisfactorily to shunting. The relationship between these patients and those with Sturge-Weber syndrome is discussed. The embryologic abnormality producing the anomalous venous return is characterized. The link between venous hypertension and the development of hydrocephalus is discussed. The increased cranial compliance seen in this age group may predispose certain pediatric patients to develop hydrocephalus when stressed by venous hypertension.

Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage

1984 ◽  
Vol 61 (2) ◽  
pp. 225-230 ◽  
Author(s):  
Neal F. Kassell ◽  
James C. Torner ◽  
Harold P. Adams
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Surgery ◽  
Cooperative Study ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Rebleeding Rate ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ Antifibrinolytic therapy remains a controversial issue in the management of subarachnoid hemorrhage (SAH). The relationship of antifibrinolytic therapy with mortality, rebleeding, ischemia, hydrocephalus, and clotting abnormalities was studied in 672 patients in the International Cooperative Study on the Timing of Aneurysm Surgery. The patients with antifibrinolytic therapy had a significantly lower rebleeding rate, but higher rates of ischemic deficits and hydrocephalus. The net result was no difference in mortality in the 1st month following the initial SAH. Further clinical trials are needed to determine the overall effects of antifibrinolytic therapy.

Vasospasm in response to repeated subarachnoid hemorrhages in the monkey

1970 ◽  
Vol 33 (4) ◽  
pp. 395-406 ◽  
Author(s):  
Bryce Weir ◽  
Ramon Erasmo ◽  
Jack Miller ◽  
John McIntyre ◽  
David Secord ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Structural Damage ◽  
Fluid Pressure ◽  
Pressure Rise ◽  
Pathological Examination ◽  
Content Type ◽  
Subarachnoid Hemorrhages ◽  
The Relationship ◽  
Fine Print

✓ This study investigates the relationship between vasospasm and repeated subarachnoid hemorrhages in 18 monkeys. Sixteen received weekly 4 cc injections of autogenous blood into the subfrontal subarachnoid space. The weekly mortality rate for 4 weeks was 6%, 33%, 20%, and 37% respectively. The over-all mortality was 75%. The degree of vasospasm did not correlate with the morbidity and mortality. Vasospasm was limited to the intradural cerebral vessels and was diffuse. It never lasted longer than a few hours, late vasospasm did not occur, and the degree of vasospasm did not alter with repeated occasions of “subarachnoid hemorrhage.” Immediate electrocardiogram abnormalities were related to the height of the cerebrospinal fluid pressure rise following the subarachnoid hemorrhage (injected blood). Pathological examination of the vessels shown to be in spasm was normal. The study suggests that the increased mortality associated with repeated subarachnoid hemorrhage is due to cumulative structural damage rather than a heightened vasospastic response to repeated hemorrhages.

Adverse effects of limited hypotensive anesthesia on the outcome of patients with subarachnoid hemorrhage

2000 ◽  
Vol 92 (6) ◽  
pp. 971-975 ◽  
Author(s):  
Han Soo Chang ◽  
Kazuhiro Hongo ◽  
Hiroshi Nakagawa
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Outcome Variable ◽  
Content Type ◽  
Factors Affecting ◽  
Hypotensive Anesthesia ◽  
Intraoperative Hypotension ◽  
Brain Retraction ◽  
The Relationship ◽  
Fine Print

Object. This study was aimed at clarifying the effect of intraoperative hypotensive anesthesia on the outcome of early surgery in patients with subarachnoid hemorrhage (SAH) caused by saccular cerebral aneurysms. Other factors were also screened for possible effects on the outcome.Methods. Hospital charts in 84 consecutive patients with SAH who underwent aneurysm clipping by Day 4 were examined. Possible factors affecting the outcome were analyzed using multiple logistic regression with the dichotomous Glasgow Outcome Scale score as the outcome variable. The relationship between the intraoperative hypotension and the occurrence and severity of vasospasm was studied using both single- and multivariate analyses.Conclusions. Intraoperative hypotension had a significantly adverse effect on the outcome of SAH. Hypotension was also related to more frequent and severe manifestations of vasospasm. A long-lasting effect of brain retraction is possibly the cause of this phenomenon. The data contained in this study preclude the use of intraoperative hypo- tension even in a limited form.

Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants

2003 ◽  
Vol 99 (2) ◽  
pp. 248-253 ◽  
Author(s):  
Stephen M. Russell ◽  
Ke Lin ◽  
Sigrid A. Hahn ◽  
Jafar J. Jafar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Cerebral Aneurysms ◽  
Radiological Investigation ◽  
Content Type ◽  
Aneurysm Size ◽  
History Of ◽  
The Mean ◽  
The Relationship ◽  
Fine Print

Object. The goal of this study was to determine the relationship between aneurysm size and the volume of subarachnoid hemorrhage (SAH). Methods. One hundred consecutive patients who presented with acute SAH, which was diagnosed on the basis of a computerized tomography (CT) scan within 24 hours postictus and, subsequently, confirmed to be aneurysmal in origin by catheter angiography, were included in this study. The data were collected prospectively in 32 patients and retrospectively in 68. The volume of SAH on the admission CT scan was scored in a semiquantitative manner from 0 to 30, according to a previously published method. The mean aneurysm size was 8.3 mm (range 1–25 mm). The mean SAH volume score was 15 (range 0–30). Regression analysis revealed that a smaller aneurysm size correlated with a more extensive SAH (r2 = 0.23, p < 0.0001). Other variables including patient sex and age, intraparenchymal or intraventricular hemorrhage, multiple aneurysms, history of hypertension, and aneurysm location were not statistically associated with a larger volume of SAH. Conclusions. Smaller cerebral aneurysm size is associated with a larger volume of SAH. The pathophysiological basis for this correlation remains speculative.

Prognosis in subarachnoid hemorrhage of unknown etiology

1986 ◽  
Vol 64 (3) ◽  
pp. 359-362 ◽  
Author(s):  
Roar Juul ◽  
Torbjørn A. Fredriksen ◽  
Rolf Ringkjøb
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Tranexamic Acid ◽  
Complete Recovery ◽  
Unknown Etiology ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Repeat Angiography ◽  
Shunting Procedure ◽  
Fine Print

✓ Thirty-two patients with subarachnoid hemorrhage of unknown etiology were followed for periods from 1 to 6½ years. Two more patients had normal initial angiograms, but were excluded when repeat angiography revealed an aneurysm. The mortality rate in this series was 6%. There was one possible early and no late episode of rebleeding. One patient developed epilepsy. Five patients developed communicating hydrocephalus and underwent a shunting procedure. A complete recovery was observed in 12 patients. An additional eight had minimal disability, seven were more severely disabled, and three patients were totally disabled. Antifibrinolytic treatment (tranexamic acid) was given in a nonstandardized regimen to 14 patients who showed a poorer result than did the 18 untreated patients.

Aneurysm-induced third nerve palsy

1972 ◽  
Vol 36 (5) ◽  
pp. 548-551 ◽  
Author(s):  
Iftikhar A. Raja
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Recovery ◽  
Poor Prognosis ◽  
Nerve Palsy ◽  
Nerve Function ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Carotid Ligation ◽  
Third Nerve ◽  
Fine Print

✓ Forty-two patients with aneurysm-induced third nerve palsy are described. After carotid ligation, 58% showed satisfactory and 42% unsatisfactory functional recovery. In some patients the deficit continued to increase even after carotid ligation. Early ligation provided a better chance of recovery of third nerve function. Patients in whom third nerve palsy began after subarachnoid hemorrhage had a poor prognosis. No relationship was noted between the size of the aneurysm and the recovery of third nerve function.

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