Apolipoprotein E ε4: A Possible Risk Factor of Intracranial Pressure and White Matter Perfusion in Good-Grade Aneurysmal Subarachnoid Hemorrhage Patients at Early Stage

Abstract BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome. METHODS: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome. RESULTS: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade. CONCLUSION: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome.

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Association of APOE Polymorphism with the Change of Brain Function in the Early Stage of Aneurysmal Subarachnoid Hemorrhage

Early Brain Injury or Cerebral Vasospasm ◽

10.1007/978-3-7091-0353-1_7 ◽

2011 ◽

pp. 39-42 ◽

Cited By ~ 2

Author(s):

Bin Lin ◽

Wei Dan ◽

Li Jiang ◽

Xiao-hong Yin ◽

Hai-tao Wu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Brain Function ◽

Early Stage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Apoe Polymorphism

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Microstructural White Matter Abnormalities and Cognitive Impairment After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/strokeaha.118.021622 ◽

2018 ◽

Vol 49 (9) ◽

pp. 2040-2045 ◽

Cited By ~ 4

Author(s):

Yael D. Reijmer ◽

Marc S. van den Heerik ◽

Rutger Heinen ◽

Alexander Leemans ◽

Jeroen Hendrikse ◽

...

Keyword(s):

Cognitive Impairment ◽

Subarachnoid Hemorrhage ◽

White Matter ◽

Aneurysmal Subarachnoid Hemorrhage ◽

White Matter Abnormalities

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Abstract 3942: Mild Controlled Hypothermia Induction is Safe and Feasible for the Treatment of Intracranial Hypertension in Patients with Aneurysmal Subarachnoid Hemorrhage.

Stroke ◽

10.1161/str.43.suppl_1.a3942 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Mohammad Ibrahim ◽

Mohammad Moussavi ◽

Elzbieta Wirkowski ◽

Adel Hanna ◽

Cecilia Carlowicz ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Subarachnoid Hemorrhage ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Electrolyte Imbalance ◽

Surface Cooling ◽

Conventional Methods ◽

Rebound Increase

Introduction Hypothermia has been increasingly used for cerebral resuscitation in comatose survivors of cardiac arrest. A large number of studies have been undertaken in patients with traumatic brain injury to asses the efficacy of hypothermia for reduction of intracranial hypertension. Hypothermia has also been shown to reduce mortality and increase functional outcome if used for longer duration in patients with severe traumatic brain injury. Due to the risk of rebound cerebral edema during re-warming, medical complications and other factors, hypothermia has not been widely utilized for other neurologic catastrophes. To determine the safety and feasibility of hypothermia to treat intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage (SAH), we performed this study. Methods Retrospective analysis was performed on 11 consecutive patients with poor grade (Hunt and Hess IV and V) SAH who had high intracranial pressure that was either non responsive or poorly responsive to conventional methods (head of bed at 30 degrees, sedation, CSF drainage and osmotherapy). All patients had intracranial pressure (ICP) monitoring via an external ventriculostomy drain (EVD) catheter. Hypothermia was induced non-invasively via surface cooling pads (Artic Sun Temperature Management System). Intravenous sedation and paralysis was used via intravenous infusion to control shivering. Hypothermia (target temperature of 32 to 34 degree C) was maintained until ICP normalized. Results Duration of hypothermia ranged from 79 hours to 190 hours. One patient required re-induction due to rebound increase in ICP during re-warming. Modified rankin scale was recorded at 3 month after the ictus. Eight patients (72%) survived with good recovery, one patient (9%) survived with severe disability and two patients (18%) died. The most common side effect was electrolyte imbalance seen in seven patients (63%), thrombocytopenia in three patients (27%), and pneumonia in four patients(36%). All complications were successfully treated and major consequences of complications (bleeding diathesis, septic shock syndrome and death) were not observed in any of these patients. Two patients had decompressive hemicraniectomy prior to hypothermia induction. Out of nine patients who did not undergo hemi-craniectomy, two died and seven did not require surgical intervention after induction of hypothermia. Conclusions Mild hypothermia induction for 72 hours or more for the treatment of intracranial hypertension refractory to other conventional methods in patients with SAH appears safe and feasible. Hypothermia may potentially be an earlier treatment option than currently recommended. This study serves as a template for future efficacy trials.

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Safety and Clinical Outcome of Good-Grade Aneurysmal Subarachnoid Hemorrhage in Non-Intensive Care Units

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105123 ◽

2020 ◽

Vol 29 (10) ◽

pp. 105123

Author(s):

Clare Angeli G. Enriquez ◽

Jose Danilo B. Diestro ◽

Abdelsimar T. Omar ◽

Romergryko G. Geocadin ◽

Gerardo D. Legaspi

Keyword(s):

Intensive Care ◽

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Intensive Care Units ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Good Grade

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Altered Cerebral Autoregulation and CO2 Reactivity after Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/00006123-198805000-00003 ◽

1988 ◽

Vol 22 (5) ◽

pp. 822-826 ◽

Cited By ~ 108

Author(s):

Paul D. Dernbach ◽

John R. Little ◽

Stephen C. Jones ◽

Zeyd Y. Ebrahim

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Early Operation ◽

Co2 Reactivity ◽

Aneurysm Clipping ◽

Arterial Blood ◽

Nearest Point ◽

Good Grade ◽

Grade Ii ◽

Pressure Autoregulation

Abstract Disruption of local cortical blood flow (CBF) autoregulation and CO2 reactivity, or vasoparalysis, has been documented in humans after aneurysmal subarachnoid hemorrhage (SAH). Generally, the degree of vasoparalysis is related to the patient's clinical grade. Using intraoperative measurement of local CBF, we evaluated pressure autoregulation and CO2 reactivity in patients after SAH. Fourteen patients with SAH and 10 patients with asymptomatic aneurysm underwent craniotomy for clipping of their aneurysms. During operation, local CBF was recorded with thermal conductivity probes placed on the middle frontal gyrus, 4 to 6 cm from the nearest point of retraction. Before retractor placement, CBF was measured with the PCO2 at 25 and 35 mm Hg and the mean arterial blood pressure (MABP) between 70 and 80 mm Hg. After aneurysm clipping, flows were again measured. With the PCO2 at 25 mm Hg, the MABP was raised from 65 to 85 mm Hg. The PCO2 was then allowed to rise to 35 mm Hg, after which the MABP was lowered from 85 to 65 mm Hg. Six patients underwent operation within the 1st week after SAH (Grade I, n = 3; Grade II, n = 3). The remainder (n = 8) were operated on 9 days to 3 months after SAH. After aneurysm clipping, significant CBF changes (P < 0.001) with PCO2 alteration occurred in control patients and those operated on more than 7 days after SAH. There was no significant change in CBF in patients operated on within 7 days after SAH. Changes in CBF reactivity to alteration of MABP were significantly larger in early operation patients than in other groups (P < 0.008). Pressure autoregulation and CO2 reactivity are significantly disturbed in good grade patients after early operation.

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