|
1
|
Sun C, Qin B, Zhang J, Liang Y, Cui M, Yang Q, Wang Y, Gong J, Xiang Y. Increased brain volume in the early phase of aneurysmal subarachnoid hemorrhage leads to delayed cerebral ischemia. Front Surg 2024; 11:1467154. [PMID: 39364373 PMCID: PMC11446905 DOI: 10.3389/fsurg.2024.1467154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 09/05/2024] [Indexed: 10/05/2024] Open
Abstract
Objective To investigate the correlation between the swelling rate of brain volume within the first 48 h after aneurysmal subarachnoid hemorrhage and the subsequent development of delayed cerebral ischemia. Methods A retrospective analysis was conducted on patients with spontaneous aneurysmal subarachnoid hemorrhage admitted to the Neurosurgery Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University between January 2020 and January 2023. The clinical data, treatment outcomes, and imaging data were analyzed. Brain volume was evaluated using 3D-Slicer software at two time points post-hemorrhage: within the first 24 h and between 24 and 48 h. The swelling rate of brain volume was defined as the ratio of the absolute difference between two measurements to the smaller of values. Patients were categorized into two groups based on established diagnostic criteria of delayed cerebral ischemia. Univariate and multivariate logistic regression analyses were performed to identify factors influencing delayed cerebral ischemia. Results A total of 140 patients were enrolled in this study. 46 patients experienced delayed cerebral ischemia after bleeding. The swelling rate of brain volume was larger in the DCI group (10.66 ± 8.45) compared to the non-DCI group (3.59 ± 2.62), which showed a statistically significant difference. Additionally, advanced age, smoking history, history of hypertension, loss of consciousness, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH were also statistically different between the two groups. Multivariate logistic regression analysis revealed that the swelling rate of brain volume was an independent risk factor for DCI with adjusting the advanced age, smoking history, history of hypertension, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH. Conclusion Brain volume significantly increased in patients with aneurysmal subarachnoid hemorrhage during the early phase (within 48 h post-onset). The larger swelling rate of brain volume is an independent risk factor for the development of delayed cerebral ischemia, and it may hold significant predictive value for the incidence of delayed cerebral ischemia.
Collapse
Affiliation(s)
- Chao Sun
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
| | - Bin Qin
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurosurgery, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jingyu Zhang
- Department of Neurosurgery, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yidan Liang
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Cui
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
| | - Qiang Yang
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
| | - Yanglingxi Wang
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
| | - Jian Gong
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
| | - Yi Xiang
- Department of Neurosurgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
| |
Collapse
|
|
2
|
Veldeman M, Rossmann T, Haeren R, Vossen LV, Weiss M, Conzen C, Siironen JO, Korja M, Schmidt TP, Höllig A, Virta JJ, Satopää J, Luostarinen T, Wiesmann M, Clusmann H, Niemela M, Raj R. Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage: Location, Distribution Patterns, Infarct Load, and Effect on Outcome. Neurology 2024; 103:e209607. [PMID: 38950352 DOI: 10.1212/wnl.0000000000209607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Delayed cerebral ischemia (DCI) is one of the main contributing factors to poor clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). Unsuccessful treatment can cause irreversible brain injury in the form of DCI-related infarction. We aimed to assess the association between the location, distribution, and size of DCI-related infarction in relation to clinical outcome. METHODS Consecutive patients with SAH treated at 2 university hospitals between 2014 and 2019 (Helsinki, Finland) and between 2006 and 2020 (Aachen, Germany) were included. Size of DCI-related infarction was quantitatively measured as absolute volume (in milliliters). In a semiquantitative fashion, infarction in 14 regions of interest (ROIs) according to a modified Alberta Stroke Program Early CT Score (ASPECTS) was noted. The association of infarction in these ROIs along predefined regions of eloquent brain, with clinical outcome, was assessed. For this purpose, 1-year outcome was measured by the Glasgow Outcome Scale (GOS) and dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3). RESULTS Of 1,190 consecutive patients with SAH, 155 (13%) developed DCI-related infarction. One-year outcome data were available for 148 (96%) patients. A median overall infarct volume of 103 mL (interquartile range 31-237) was measured. DCI-related infarction was significantly associated with 1-year unfavorable outcome (odds ratio [OR] 4.89, 95% CI 3.36-7.34, p < 0.001). In patients with 1-year unfavorable outcome, vascular territories more frequently affected were left middle cerebral artery (affected in 49% of patients with unfavorable outcome vs in 30% of patients with favorable outcome; p = 0.029), as well as left (44% vs 18%; p = 0.003) and right (52% vs 14%; p < 0.001) anterior cerebral artery supply areas. According to the ASPECTS model, the right M3 (OR 8.52, 95% CI 1.41-51.34, p = 0.013) and right A2 (OR 7.84, 95% CI 1.97-31.15, p = 0.003) regions were independently associated with unfavorable outcome. DISCUSSION DCI-related infarction was associated with a 5-fold increase in the odds of unfavorable outcome, after 1 year. Ischemic lesions in specific anatomical regions are more likely to contribute to unfavorable outcome. TRIAL REGISTRATION INFORMATION Data collection in Aachen was registered in the German Clinical Trial Register (DRKS00030505); on January 3, 2023.
Collapse
Affiliation(s)
- Michael Veldeman
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Tobias Rossmann
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Roel Haeren
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Laura V Vossen
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Miriam Weiss
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Catharina Conzen
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Jari O Siironen
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Miikka Korja
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Tobias P Schmidt
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Anke Höllig
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Jyri J Virta
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Jarno Satopää
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Teemu Luostarinen
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Martin Wiesmann
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Hans Clusmann
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Mika Niemela
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| | - Rahul Raj
- From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany
| |
Collapse
|
|
3
|
Tang WK, Wong KCG. Apathy in subarachnoid hemorrhage: study protocol for a 1-year follow-up study. Front Neurol 2024; 15:1358102. [PMID: 39144716 PMCID: PMC11322344 DOI: 10.3389/fneur.2024.1358102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Apathy is a frequent and debilitating condition among subarachnoid hemorrhage (SAH) survivors. Few studies have evaluated apathy in SAH, and none have examined the course of the condition, predictors of persistent apathy, or its impact on functional outcomes. The proposed study will examine, for the first time, the 12-month course of apathy and its impact on functional outcomes in the largest cohort of SAH survivors to date. Methods and analysis The current study is designed as a prospective cohort study with a duration of 36 months. We will recruit 240 participants. A trained research assistant will assess apathy using the Apathy Evaluation Scale 3 months after SAH. Patients' level of functioning, comorbidity, global cognitive functioning, and depressive symptoms will be assessed. All SAH patients will participate in follow-up assessments of apathy and functioning at 9 (T2) and 15 months (T3) post-SAH or at 6 and 12 months after the first assessment. Predictors of persistent apathy and the impact of apathy on functional outcomes will be examined. Discussion This will be the first large-scale 1-year follow-up study of apathy in SAH survivors. The findings will provide valuable data to advance our understanding of the clinical course of apathy in this population. Moreover, the results will have clinical relevance by providing essential information to patients, caregivers, and clinicians; promoting the evaluation of apathy; and facilitating the development of prevention strategies, rehabilitation programs, and therapeutic options. Ethics and dissemination Ethical approval for this study was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2023.339) on 3 October 2023. The findings of this study will be shared through publication in a peer-reviewed journal, presentations at relevant conferences, and dissemination through social media platforms.
Collapse
Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kwok Chu George Wong
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
|
4
|
Han Y, Zhang B, Qi X, Yuan G, Li X, Hao G, Liang G. Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis. BMC Neurol 2024; 24:153. [PMID: 38704548 PMCID: PMC11069223 DOI: 10.1186/s12883-024-03659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE Sex differences in outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. Therefore, the aim of this study was to investigate the sex differences in the prognosis of patients with aSAH. METHODS This study retrospectively analyzed the clinical data of aSAH patients admitted to the Department of Neurosurgery of General Hospital of Northern Theater Command, from April 2020 to January 2022. The modified Rankin Scale (mRS) was used to evaluate outcomes at 3-month post-discharge. Baseline characteristics, in-hospital complications and outcomes were compared after 1:1 propensity score matching (PSM). RESULTS A total of 665 patients were included and the majority (63.8%) were female. Female patients were significantly older than male patients (59.3 ± 10.9 years vs. 55.1 ± 10.9 years, P < 0.001). After PSM, 141 male and 141 female patients were compared. Comparing postoperative complications and mRS scores, the incidence of delayed cerebral ischemia (DCI) and hydrocephalus and mRS ≥ 2 at 3-month were significantly higher in female patients than in male patients. After adjustment, the analysis of risk factors for unfavorable prognosis at 3-month showed that age, sex, smoking, high Hunt Hess grade, high mFisher score, DCI, and hydrocephalus were independent risk factors. CONCLUSION Female patients with aSAH have a worse prognosis than male patients, and this difference may be because females are more vulnerable to DCI and hydrocephalus.
Collapse
Affiliation(s)
- Yuwei Han
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Bingying Zhang
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Xin Qi
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Guanqian Yuan
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Xiaoming Li
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
| | - Guangzhi Hao
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
| | - Guobiao Liang
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
| |
Collapse
|
|
5
|
Abdelgadir J, Gelman J, Dutko L, Mehta V, Friedman A, Zomorodi A. Cognitive outcomes following aneurysmal subarachnoid hemorrhage: Rehabilitation strategies. World Neurosurg X 2024; 22:100341. [PMID: 38450248 PMCID: PMC10914592 DOI: 10.1016/j.wnsx.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Despite decreases in mortality rate, the treatment of cognitive deficits following aneurysmal subarachnoid hemorrhage (aSAH) remains a serious challenge for clinicians and survivors alike. Deficits in executive function, language, and memory prevent more than half of survivors from returning to their previous level of work and put a tremendous amount of stress on the individual and their family. New therapies are needed for survivors of aSAH in order to improve cognitive outcomes and quality of life. The aim of this review is to discuss the prevalence and contributing factors of cognitive deficits following aSAH, as well as areas for therapeutic intervention. Due to the limited research on cognitive rehabilitative strategies for aSAH, a literature search of traumatic brain injury (TBI) was used to explore therapies with the potential to improve cognitive outcomes in aSAH. Across cognitive domains, existing rehabilitative and pharmacotherapeutic strategies for TBI show promise to be useful for survivors of aSAH. However, further study of these therapies in addition to consistent assessment of cognitive deficits are required to determine their efficacy in survivors of aSAH.
Collapse
Affiliation(s)
- Jihad Abdelgadir
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Justin Gelman
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Lindsay Dutko
- Duke Speech Pathology, Duke University Medical Center, Durham, NC, USA
| | - Vikram Mehta
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Allan Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
|
6
|
Krawchuk LJ, Sharrock MF. Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury. Semin Neurol 2023; 43:699-711. [PMID: 37802120 DOI: 10.1055/s-0043-1775790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Prognostic imaging biomarkers after acute brain injury inform treatment decisions, track the progression of intracranial injury, and can be used in shared decision-making processes with families. Herein, key established biomarkers and prognostic scoring systems are surveyed in the literature, and their applications in clinical practice and clinical trials are discussed. Biomarkers in acute ischemic stroke include computed tomography (CT) hypodensity scoring, diffusion-weighted lesion volume, and core infarct size on perfusion imaging. Intracerebral hemorrhage biomarkers include hemorrhage volume, expansion, and location. Aneurysmal subarachnoid biomarkers include hemorrhage grading, presence of diffusion-restricting lesions, and acute hydrocephalus. Traumatic brain injury CT scoring systems, contusion expansion, and diffuse axonal injury grading are reviewed. Emerging biomarkers including white matter disease scoring, diffusion tensor imaging, and the automated calculation of scoring systems and volumetrics are discussed.
Collapse
Affiliation(s)
- Lindsey J Krawchuk
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew F Sharrock
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
|
7
|
Stienen MN, Germans MR, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Velz J, Sebök M, Eggenberger N, May A, Haemmerli J, Bijlenga P, Schaller K, Guerra-Lopez U, Maduri R, Beaud V, Al-Taha K, Daniel RT, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Maradan-Gachet ME, Gutbrod K, Maldaner N, Neidert MC, Früh S, Schwind M, Bozinov O, Brugger P, Keller E, Marr A, Roux S, Regli L. Longitudinal neuropsychological assessment after aneurysmal subarachnoid hemorrhage and its relationship with delayed cerebral ischemia: a prospective Swiss multicenter study. J Neurosurg 2022; 137:1742-1750. [PMID: 35535839 DOI: 10.3171/2022.2.jns212595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While prior retrospective studies have suggested that delayed cerebral ischemia (DCI) is a predictor of neuropsychological deficits after aneurysmal subarachnoid hemorrhage (aSAH), all studies to date have shown a high risk of bias. This study was designed to determine the impact of DCI on the longitudinal neuropsychological outcome after aSAH, and importantly, it includes a baseline examination after aSAH but before DCI onset to reduce the risk of bias. METHODS In a prospective, multicenter study (8 Swiss centers), 112 consecutive alert patients underwent serial neuropsychological assessments (Montreal Cognitive Assessment [MoCA]) before and after the DCI period (first assessment, < 72 hours after aSAH; second, 14 days after aSAH; third, 3 months after aSAH). The authors compared standardized MoCA scores and determined the likelihood for a clinically meaningful decline of ≥ 2 points from baseline in patients with DCI versus those without. RESULTS The authors screened 519 patients, enrolled 128, and obtained complete data in 112 (87.5%; mean [± SD] age 53.9 ± 13.9 years; 66.1% female; 73% World Federation of Neurosurgical Societies [WFNS] grade I, 17% WFNS grade II, 10% WFNS grades III-V), of whom 30 (26.8%) developed DCI. MoCA z-scores were worse in the DCI group at baseline (-2.6 vs -1.4, p = 0.013) and 14 days (-3.4 vs -0.9, p < 0.001), and 3 months (-0.8 vs 0.0, p = 0.037) after aSAH. Patients with DCI were more likely to experience a decline of ≥ 2 points in MoCA score at 14 days after aSAH (adjusted OR [aOR] 3.02, 95% CI 1.07-8.54; p = 0.037), but the likelihood was similar to that in patients without DCI at 3 months after aSAH (aOR 1.58, 95% CI 0.28-8.89; p = 0.606). CONCLUSIONS Aneurysmal SAH patients experiencing DCI have worse neuropsychological function before and until 3 months after the DCI period. DCI itself is responsible for a temporary and clinically meaningful decline in neuropsychological function, but its effect on the MoCA score could not be measured at the time of the 3-month follow-up in patients with low-grade aSAH with little or no impairment of consciousness. Whether these findings can be extrapolated to patients with high-grade aSAH remains unclear. Clinical trial registration no.: NCT03032471 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | | | - Noemi Dannecker
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Julia Velz
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 4Department of Neurosurgery, University Hospital Geneva
| | | | | | - Karl Schaller
- 4Department of Neurosurgery, University Hospital Geneva
| | | | - Rodolfo Maduri
- 6Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier
| | - Valérie Beaud
- 7Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | - Khalid Al-Taha
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | - Roy Thomas Daniel
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | | | - Stefania Rossi
- 10Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Johannes Goldberg
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 11Department of Neurosurgery, University Hospital Berne, Switzerland.,12Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | | | - Klemens Gutbrod
- 13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | | | | | - Severin Früh
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Marc Schwind
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Oliver Bozinov
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,14Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Peter Brugger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich.,16Neuropsychology Unit, Rehabilitation Clinic Valens; and
| | - Emanuela Keller
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Angelina Marr
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Sébastien Roux
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | | | | |
Collapse
|
|
8
|
Comparing Protection of Remote Limb with Resveratrol Preconditioning following Rodent Subarachnoid Hemorrhage. Biomolecules 2022; 12:biom12040568. [PMID: 35454157 PMCID: PMC9026829 DOI: 10.3390/biom12040568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Preventing delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) remains an important therapeutic target. Preconditioning stimulates multiple endogenous protective mechanisms and may be a suitable treatment for DCI following SAH. We here compare remote limb conditioning with resveratrol conditioning in a clinically relevant SAH model. Methods: We produced a SAH in 39 male Sprague Dawley rats using a single injection model. Animals were randomized to four groups: repetitive limb conditioning with a blood pressure cuff, sham conditioning, intraperitoneal resveratrol (10 mg/kg) or intraperitoneal vehicle administered at 24, 48 and 72 h after SAH. On day 4 neurological and behavioral scores were obtained, and animals were euthanized. The cross-sectional area of the basilar artery was measured at the vertebrobasilar junction, and at the mid and distal segments. Hippocampal cells were counted in both hemispheres and normalized per mm length. We compared true limb preconditioning with sham conditioning and resveratrol with vehicle preconditioning. Results: The cross-sectional area of the mid-basilar artery in the true limb preconditioning group was significantly larger by 43% (p = 0.03) when compared with the sham preconditioning group. No differences in the cross-sectional area were found in the resveratrol-treated group when compared to the vehicle-treated group. We found no differences in the neuro score, behavioral score, and in mean hippocampal neuron counts between the groups. Conclusion: We found beneficial vascular effects of remote limb preconditioning on SAH-induced basilar artery vasoconstriction. Our findings support further studies of limb preconditioning as a potential treatment after SAH.
Collapse
|
|
9
|
Ma N, Feng X, Wu Z, Wang D, Liu A. Cognitive Impairments and Risk Factors After Ruptured Anterior Communicating Artery Aneurysm Treatment in Low-Grade Patients Without Severe Complications: A Multicenter Retrospective Study. Front Neurol 2021; 12:613785. [PMID: 33643199 PMCID: PMC7907430 DOI: 10.3389/fneur.2021.613785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Cognitive impairment is the main factor affecting quality of life in patients with low-grade aneurysmal subarachnoid hemorrhage. Objective: We explored cognitive impairments and risk factors after treatment for ruptured anterior communicating artery (AComA) aneurysms in low-grade (Hunt-Hess grade of 1-3) patients without severe complications. Methods: One-hundred-twenty-six patients with a Hunt-Hess grade of 1-3 who underwent microsurgical clipping or endovascular embolization for ruptured AComA aneurysm treatment at three academic institutions in China from January 2015 to December 2017 were assessed with the modified Telephone Interview for Cognitive Status (TICS-m), the modified Rankin Scale (mRS), and the instrumental activities of daily living (IADL) scale 2 or more years after microsurgical clipping or endovascular coiling. Multiple cox-regression analysis was used to identify variables independently associated with cognitive impairment. Results: Of the total of 126 patients, 115 (91.3%) achieved good clinical outcomes (mRS score 0-2) and 109 (86.5%) had excellent quality of life (IADL score 8). Twenty-eight (22.2%) patients showed cognitive impairments (TICS-m≤27). The multivariate COX regression analysis showed that the female patients and longer duration of loss of consciousness at onset of subarachnoid hemorrhage (SAH) were independently associated with cognitive impairment. Cognitive outcome at the latest follow-up was not significantly different between patients treated after surgical clipping and coiling. Conclusion: About one in five patients showed cognitive impairments after treatment for ruptured AComA aneurysms. Patients who are of the female sex, and who have a longer duration of a loss of consciousness at the onset of SAH may be at risk of cognitive impairment.
Collapse
Affiliation(s)
- Ning Ma
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Shanxi Medical University, Shanxi, China
| | - Xin Feng
- Department of Neurosurgery, Beijing Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
10
|
Lu VM, Graffeo CS, Perry A, Carlstrom LP, Rangel-Castilla L, Lanzino G, Brinjikji W, Wijdicks EFM, Rabinstein AA. Rebleeding drives poor outcome in aneurysmal subarachnoid hemorrhage independent of delayed cerebral ischemia: a propensity-score matched cohort study. J Neurosurg 2020; 133:360-368. [PMID: 31323638 DOI: 10.3171/2019.4.jns19779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Delayed cerebral ischemia (DCI) and aneurysm rebleeding contribute to morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH); however, the relationship between their impacts on overall functional outcome is incompletely understood. METHODS The authors conducted a cohort study of all aSAH during the study period from 2001 to 2016. Primary end points were overall functional outcome and ischemic aSAH sequelae, defined as delayed cerebral ischemia (DCI), DCI with infarction, symptomatic vasospasm (SV), and global cerebral edema (GCE). Outcomes were compared between the rebleed and nonrebleed cohorts overall and after propensity-score matching (PSM) for risk factors and treatment modality. Univariate and multivariate ordered logistic regression analyses for functional outcomes were performed in the PSM cohort to identify predictors of poor outcome. RESULTS Four hundred fifty-five aSAH cases admitted within 24 hours of aneurysm rupture were included, of which 411 (90%) experienced initial aneurysm ruptures only, while 44 (10%) had clinically confirmed rebleeding. In the overall cohort, rebleeding was associated with significantly worse functional outcome, longer intensive care unit length of stay (LOS), and GCE (all p < 0.01); treatment modality, overall LOS, DCI, DCI with infarction, and SV were nonsignificant. In the PSM analysis of 43 matched rebleed and 43 matched nonrebleed cases, only poor functional outcome and GCE remained significantly associated with rebleeding (p < 0.01 and p = 0.02, respectively). Multivariate regression identified that both rebleeding (HR 21.5, p < 0.01) and DCI (HR 10.1, p = 0.01) independently predicted poor functional outcome. CONCLUSIONS Rebleeding and DCI after aSAH are highly morbid and potentially deadly events after aSAH, which appear to have independent negative impacts on overall functional outcome. Early rebleeding did not significantly affect the risk of delayed ischemic complications.
Collapse
|
|
11
|
Geraghty JR, Lara-Angulo MN, Spegar M, Reeh J, Testai FD. Severe cognitive impairment in aneurysmal subarachnoid hemorrhage: Predictors and relationship to functional outcome. J Stroke Cerebrovasc Dis 2020; 29:105027. [PMID: 32807442 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105027] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cognitive impairment is common after aneurysmal subarachnoid hemorrhage (SAH). However, compared to predictors of functional outcome, meaningful predictors of cognitive impairment are lacking. OBJECTIVE Our goal was to assess which factors during hospitalization can predict severe cognitive impairment in SAH patients, especially those who might otherwise be expected to have good functional outcomes. We hypothesized that the degree of early brain injury (EBI), vasospasm, and delayed neurological deterioration (DND) would predict worse cognitive outcomes. METHODS We retrospectively reviewed SAH patient records from 2013 to 2019 to collect baseline information, clinical markers of EBI (Fisher, Hunt-Hess, and Glasgow Coma scores), vasospasm, and DND. Cognitive outcome was assessed by Montreal Cognitive Assessment (MoCA) and functional outcomes by modified Rankin Scale (mRS) at hospital discharge. SAH patients were compared to non-neurologic hospitalized controls. Among SAH patients, logistic regression analysis was used to identify predictors of severe cognitive impairment defined as a MoCA score <22. RESULTS We screened 288 SAH and 80 control patients. Cognitive outcomes assessed via MoCA at discharge were available in 105 SAH patients. Most of these patients had good functional outcome at discharge with a mean mRS of 1.8±1.3. Approximately 56.2% of SAH patients had MoCA scores <22 compared to 28.7% of controls. Among SAH patients, modified Fisher scale was an independent predictor of cognitive impairment after adjustment for baseline differences (OR 1.638, p=0.043). MoCA score correlated inversely with mRS (r=-0.3299, p=0.0006); however, among those with good functional outcome (mRS 0-2), 48.7% still exhibited cognitive impairment. CONCLUSIONS Severe cognitive impairment is highly prevalent after SAH, even among patients with good functional outcome. Higher modified Fisher scale on admission is an independent risk factor for severe cognitive impairment. Cognitive screening is warranted in all SAH patients, regardless of functional outcome.
Collapse
Affiliation(s)
- Joseph R Geraghty
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States; Medical Scientist Training Program, University of Illinois at Chicago, Chicago, IL, United States.
| | - Melissa N Lara-Angulo
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| | - Milen Spegar
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| | - Jenna Reeh
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| |
Collapse
|
|
12
|
Halalmeh DR, Klinger N, Azad S, Fadel H, Moisi MD. Delayed Cerebral Ischemia of the Corpus Callosum: A Case Report. Cureus 2019; 11:e6379. [PMID: 31938657 PMCID: PMC6957044 DOI: 10.7759/cureus.6379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ischemic infarction of the corpus callosum is a rare condition due to its rich vascular supply and therefore has been infrequently reported. Here, we present a case of a patient who developed a delayed infarct of the corpus callosum in the body. The condition was characterized by bilateral lower extremity weakness and visual disturbances following intraventricular hemorrhage managed with ventriculostomy. Understanding the anatomy and function of the corpus callosum is crucial to understanding the etiology of infarctions as well as their clinical significance. It is also essential to distinguish between relatively common post-shunting changes and true infarction and to recognize the limited consequences of corpus callosum infarction. Increased awareness of this rare infarct would help to prevent unnecessary interventions and increase the ability of the physician to provide optimal care for the patient.
Collapse
Affiliation(s)
- Dia R Halalmeh
- Neurological Surgery, Detroit Medical Center, Detroit, USA
| | - Neil Klinger
- Neurological Surgery, Wayne State University School of Medicine, Detroit, USA
| | - Sherwin Azad
- Surgery, University of California, San Francisco, USA
| | - Hassan Fadel
- Neurological Surgery, Henry Ford Health System, Detroit, USA
| | - Marc D Moisi
- Neurological Surgery, Detroit Medical Center, Detroit, USA
| |
Collapse
|
|
13
|
Roelz R, Schaefer JH, Scheiwe C, Sajonz B, Csok I, Steiert C, Buttler J, Rohr E, Grauvogel J, Shah MJ, Egger K, Niesen WD, Bardutzky J, Beck J, Coenen VA, Reinacher PC. Impact of Stereotactic Ventriculocisternostomy on Delayed Cerebral Infarction and Outcome After Subarachnoid Hemorrhage. Stroke 2019; 51:431-439. [PMID: 31795898 DOI: 10.1161/strokeaha.119.027424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Delayed cerebral infarction (DCI) is an important cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage is a new method for DCI prevention. Here, we assess the effects of implementing STX-VCS in an unselected aSAH patient population of a tertiary referral center. Methods- Retrospective cohort study of all consecutive aSAH patients admitted to a neurosurgical referral center during a 7-year period (April 2012 to April 2019). Midterm STX-VCS was introduced and offered to patients at high risk for DCI. We compared the incidence and burden of DCI, neurological outcome, and the use of induced hypertension and endovascular rescue therapy in this consecutive aSAH population 3.5 years before versus 3.5 years after STX-VCS became available. Results- Four hundred thirty-six consecutive patients were included: 222 BEFORE and 214 AFTER. Fifty-seven of 214 (27%) patients received STX-VCS. Stereotactic procedures resulted in one (2%) subdural hematoma. Favorable neurological outcome at 6 months occurred in 118 (53%) patients BEFORE and 139 (65%) patients AFTER (relative risk, 0.79 [95% CI, 0.66-0.95]). DCI occurred in 40 (18.0%) patients BEFORE and 17 (7.9%) patients AFTER (relative risk, 0.68 [95% CI, 0.57-0.86]), and total DCI volumes were 8933 (100%) and 3329 mL (36%), respectively. Induced hypertension was used in 97 (44%) and 30 (15%) patients, respectively (relative risk, 0.55 [95% CI, 0.46-0.65]). Thirty (13.5%) patients BEFORE versus 5 (2.3%) patients AFTER underwent endovascular rescue therapies (relative risk, 0.17 [95% CI, 0.07-0.42]). Conclusions- Selecting high-risk patients for STX-VCS reduced the DCI incidence, burden, and related mortality in a consecutive aSAH patient population. This was associated with an improved neurological outcome.
Collapse
Affiliation(s)
- Roland Roelz
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | - Christian Scheiwe
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bastian Sajonz
- Department of Stereotactic and Functional Neurosurgery (B.S., V.A.C., P.C.R.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Istvan Csok
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christine Steiert
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jürgen Buttler
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Eva Rohr
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jürgen Grauvogel
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Mukesch J Shah
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology (K.E.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology (W.-D.N., J. Bardutzky), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jürgen Bardutzky
- Department of Neurology (W.-D.N., J. Bardutzky), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jürgen Beck
- From the Department of Neurosurgery (R.R., C. Scheiwe, I.C., C. Steiert, J. Buttler, E.R., J.G., M.J.S., J. Beck), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery (B.S., V.A.C., P.C.R.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery (B.S., V.A.C., P.C.R.), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Fraunhofer Institute for Laser Technology, Aachen, Germany (P.C.R.)
| |
Collapse
|
|
14
|
Does aneurysm side influence the infarction side and patients´ outcome after subarachnoid hemorrhage? PLoS One 2019; 14:e0224013. [PMID: 31697715 PMCID: PMC6837438 DOI: 10.1371/journal.pone.0224013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background The prognostic factors and outcome of aneurysms appear to be dependent on its locations. Therefore, we compared left- and right- sided aneurysms in patients with aneurysmal subarachnoid hemorrhage (SAH) in terms of differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. A total of 509 patients with aneurysmal subarachnoid hemorrhage were retrospectively selected and stratified in two groups depending on side of ruptured aneurysm (right n = 284 vs. left n = 225). Midline aneurysms of the basilar and anterior communicating arteries were excluded from the analysis. Outcomes were assessed using the modified Rankin Scale (mRS; favorable (mRS 0–2) vs. unfavorable (mRS 3–6)) six months after SAH. Results We did not identify any differences in outcome depending on left- and right-sided ruptured aneurysms. In both groups, the significant negative predictive factors included clinical admission status (WFNS IV+V), Fisher 3- bleeding pattern in CT, the occurrence of delayed cerebral ischemia (DCI), early hydrocephalus and later shunt-dependence. The side of the ruptured aneurysm does not seem to influence patients´ outcome. Interestingly, the aneurysm side predicts the side of infarction, with a significant influence on patients´ outcome in case of left-sided infarctions. In addition, the in multivariate analysis side of aneurysm was an independent predictor for the side of cerebral infarctions. Conclusion The side of the ruptured aneurysms (right or left) did not influence patients’ outcome. However, the aneurysm-side predicts the side of delayed infarctions and outcome appear to be worse in patients with left-sided infarctions.
Collapse
|
|
15
|
Ding CY, Kang DZ, Wang ZL, Lin YX, Jiang CZ, Yu LH, Wang DL, Lin ZY, Gu JJ. Serum Ngb (Neuroglobin) Is Associated With Brain Metabolism and Functional Outcome of Aneurysmal Subarachnoid Hemorrhage. Stroke 2019; 50:1887-1890. [PMID: 31182001 DOI: 10.1161/strokeaha.119.025733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Purpose—
Hypoxic-ischemic brain damage is a well-recognized physiopathologic mechanism after aneurysmal subarachnoid hemorrhage (aSAH). The Ngb (neuroglobin) is a hemoprotein predominantly expressed in the brain with a high affinity for oxygen. Relationship between serum Ngb level and brain metabolism in aSAH patients has not been investigated previously.
Methods—
Thirty-six consecutive severe aSAH patients (Glasgow Coma Scale score ≤8 on admission) with multimodal neuromonitoring and 36 matched healthy subjects were included. Serum Ngb level was analyzed in combination with other time-matched cerebral microdialysis parameters, brain tissue oxygen tension, and 12-month neurological outcomes.
Results—
Serum Ngb level was correlated positively with cerebral microdialysis parameters and brain tissue oxygen tension (
P
<0.001). Poor functional outcome (modified Rankin Scale score >3) 12 months after aSAH was associated with higher Ngb level but independent of age, sex, and disease severity (
P
<0.001). A similar association was found between high Ngb level and neuropsychological test results indicative of impairments in cognition, visual conceptualization, and frontal executive functions (
P
<0.001).
Conclusions—
Ngb may be a potential biomarker for reflecting brain tissue oxygen tension, brain metabolism, and functional outcome in severe aSAH patients and merits further study in the context of aSAH.
Collapse
Affiliation(s)
- Chen-Yu Ding
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - De-Zhi Kang
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - Zi-Liang Wang
- Department of Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, People’s Republic of China (Z.-L.W., J.-J.G.)
| | - Yuan-Xiang Lin
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - Chang-Zhen Jiang
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - Liang-Hong Yu
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - Deng-Liang Wang
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - Zhang-Ya Lin
- From the Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China (C.-Y.D., D.-Z.K., Y.-X.L., C.-Z.J., L.-H.Y., D.-L.W., Z.-Y.L.)
| | - Jian-Jun Gu
- Department of Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, People’s Republic of China (Z.-L.W., J.-J.G.)
| |
Collapse
|
|
16
|
The effectiveness of lumbar cerebrospinal fluid drainage in aneurysmal subarachnoid hemorrhage with different bleeding amounts. Neurosurg Rev 2019; 43:739-747. [DOI: 10.1007/s10143-019-01116-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/07/2019] [Accepted: 05/17/2019] [Indexed: 11/27/2022]
|
|
17
|
Huenges Wajer IMC, Hendriks ME, Witkamp TD, Hendrikse J, Rinkel GJE, Visser-Meily JMA, van Zandvoort MJE, Vergouwen MDI, de Vis JB. The relationship between ischaemic brain lesions and cognitive outcome after aneurysmal subarachnoid haemorrhage. J Neurol 2019; 266:2252-2257. [PMID: 31161387 PMCID: PMC6689896 DOI: 10.1007/s00415-019-09408-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022]
Abstract
Background Cerebral ischaemia is thought to be an important determinant of cognitive outcome after aneurysmal subarachnoid haemorrhage (aSAH), but the exact relationship is unclear. We studied the effect of ischaemic brain lesions during clinical course on cognitive outcome 2 months after aSAH. Methods We studied 74 consecutive patients admitted to the University Medical Center Utrecht who had MRI post-coiling (3–21 days post-aSAH) and neuropsychological examination at 2 months. An ischaemic lesion was defined as hyperintensity on T2-FLAIR and DWI images. We measured both cognitive complaints (subjective) and cognitive functioning (objective). The relationship between ischaemic brain lesions and cognitive outcome was analysed by logistic regression analyses. Results In 40 of 74 patients (54%), 152 ischaemic lesions were found. The median number of lesions per patient was 2 (1–37) and the median total lesion volume was 0.2 (0–17.4) mL. No difference was found between the group with and the group without ischaemic lesions with respect to the frequency of cognitive complaints. In the group with ischaemic lesions, significantly more patients (55%) showed poor cognitive functioning compared to the group without ischaemic lesions (26%) (OR 3.4, 95% CI 1.3–9.1). We found no relationship between the number and volume of the ischaemic lesions and cognitive functioning. Conclusions Ischaemic brain lesions detected on MRI during clinical course after aSAH is a marker for poor cognitive functioning 2 months after aSAH, irrespective of the number or volume of the ischaemic lesions. Network or connectivity studies are needed to better understand the relationship between location of the ischaemic brain lesions and cognitive functioning.
Collapse
Affiliation(s)
- I M C Huenges Wajer
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - M E Hendriks
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G J E Rinkel
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Department of Rehabilitation, University Medical Center Utrecht and Center of Excellence in Rehabilitation Medicine, Utrecht University, Rehabilitation Center de Hoogstraat, Utrecht, The Netherlands
| | - M J E van Zandvoort
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - M D I Vergouwen
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J B de Vis
- National Institute of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| |
Collapse
|
|
18
|
Fragata I, Canhão P. Imaging predictors of outcome in acute spontaneous subarachnoid hemorrhage: a review of the literature. Acta Radiol 2019; 60:247-259. [PMID: 29792042 DOI: 10.1177/0284185118778877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spontaneous subarachnoid hemorrhage (SAH) accounts for about 5% of strokes, but has a very high morbidity and mortality. Many survivors are left with important cognitive impairment and are severely incapacitated. Prediction of complications such as vasospasm and delayed cerebral ischemia, and of clinical outcome after SAH, is challenging. Imaging studies are essential in the initial evaluation of SAH patients and are increasingly relevant in assessing for complications and prognosis. In this article, we reviewed the role of imaging studies in evaluating early brain injury and predicting complications as well as clinical and neuropsychological prognosis after acute SAH.
Collapse
Affiliation(s)
- Isabel Fragata
- Neuroradiology Department, Hospital São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Patrícia Canhão
- Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| |
Collapse
|
|
19
|
Abstract
Acute ischemic stroke represents a major cause of long-term adult disability. Accurate prognostication of post-stroke functional outcomes is invaluable in guiding patient care, targeting early rehabilitation efforts, selecting patients for clinical research, and conveying realistic expectations to families. The involvement of specific brain regions by acute ischemia can alter post-stroke recovery potential. Understanding the influences of infarct topography on neurologic outcomes holds significant promise in prognosis of functional recovery. In this review, we discuss the recent evidence of the contribution of infarct location to patient management decisions and functional outcomes after acute ischemic stroke.
Collapse
Affiliation(s)
- Mark R Etherton
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia S Rost
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ona Wu
- 1 Harvard Medical School, Boston, MA, USA.,3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| |
Collapse
|
|
20
|
Zaki Ghali MG, Srinivasan VM, Wagner K, Rao C, Chen SR, Johnson JN, Kan P. Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment. World Neurosurg 2018; 120:537-549. [PMID: 29966787 DOI: 10.1016/j.wneu.2018.06.178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive sequelae frequently follow subarachnoid hemorrhage (SAH) and include deficits across multiple domains of executive function. This factor affects overall functional outcomes negatively, especially in younger patients. Several clinical correlates predict development and severity of cognitive dysfunction after SAH. Hypothetical mechanisms of cognitive dysfunction in the absence of radiographic lesion include cerebral hypoperfusion and blood breakdown products, resulting in perturbed interneuronal communication and network synchrony, excitotoxicity, and altered microRNA expression. METHODS The PubMed database was searched for articles discussing cognitive outcomes in patients with unruptured and ruptured intracranial aneurysmal disease, sequelae of treatment, and modalities for neuropsychologic testing. RESULTS Treatment of unruptured intracranial aneurysms, although capable of preventing SAH, comes with its own set of complications and may also affect cognitive function. Neuropsychological tests such as the Montreal Cognitive Assessment, Mini-Mental Status Examination, and others have proved useful in evaluating cognitive decline. Studies using functional neurologic imaging modalities have identified regions with altered activation patterns during various cognitive tasks. The sum of research efforts in this field has provided useful insights and an initial understanding of cognitive dysfunction after aneurysm treatment and SAH that should prove useful in guiding and rendering future investigations more fruitful. CONCLUSIONS Development of finer and more sensitive neuropsychological tests in evaluating the different domains of cognitive function after aneurysm treatment and SAH in general will be useful in accurately determining outcomes after ictus and comparing efficacy of different therapeutic strategies.
Collapse
Affiliation(s)
| | | | - Kathryn Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Chethan Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen R Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
|
21
|
Heit JJ, Ball RL, Telischak NA, Do HM, Dodd RL, Steinberg GK, Chang SD, Wintermark M, Marks MP. Patient Outcomes and Cerebral Infarction after Ruptured Anterior Communicating Artery Aneurysm Treatment. AJNR Am J Neuroradiol 2017; 38:2119-2125. [PMID: 28882863 DOI: 10.3174/ajnr.a5355] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/16/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Anterior communicating artery aneurysm rupture and treatment is associated with high rates of dependency, which are more severe after clipping compared with coiling. To determine whether ischemic injury might account for these differences, we characterized cerebral infarction burden, infarction patterns, and patient outcomes after surgical or endovascular treatment of ruptured anterior communicating artery aneurysms. MATERIALS AND METHODS We performed a retrospective cohort study of consecutive patients with ruptured anterior communicating artery aneurysms. Patient data and neuroimaging studies were reviewed. A propensity score for outcome measures was calculated to account for the nonrandom assignment to treatment. Primary outcome was the frequency of frontal lobe and striatum ischemic injury. Secondary outcomes were patient mortality and clinical outcome at discharge and at 3 months. RESULTS Coiled patients were older (median, 55 versus 50 years; P = .03), presented with a worse clinical status (60% with Hunt and Hess Score >2 versus 34% in clipped patients; P = .02), had a higher modified Fisher grade (P = .01), and were more likely to present with intraventricular hemorrhage (78% versus 56%; P = .03). Ischemic frontal lobe infarction (OR, 2.9; 95% CI, 1.1-8.4; P = .03) and recurrent artery of Heubner infarction (OR, 20.9; 95% CI, 3.5-403.7; P < .001) were more common in clipped patients. Clipped patients were more likely to be functionally dependent at discharge (OR, 3.2; P = .05) compared with coiled patients. Mortality and clinical outcome at 3 months were similar between coiled and clipped patients. CONCLUSIONS Frontal lobe and recurrent artery of Heubner infarctions are more common after surgical clipping of ruptured anterior communicating artery aneurysms, and are associated with poorer clinical outcomes at discharge.
Collapse
Affiliation(s)
- J J Heit
- From the Department of Radiology, Neuroimaging and Neurointervention Division (J.J.H., N.A.T., H.M.D., M.W., M.P.M.)
| | - R L Ball
- Department of Medicine, Quantitative Sciences Unit (R.L.B.)
| | - N A Telischak
- From the Department of Radiology, Neuroimaging and Neurointervention Division (J.J.H., N.A.T., H.M.D., M.W., M.P.M.)
| | - H M Do
- From the Department of Radiology, Neuroimaging and Neurointervention Division (J.J.H., N.A.T., H.M.D., M.W., M.P.M.)
| | - R L Dodd
- Department of Neurosurgery (R.L.D., G.K.S., S.D.C.), Stanford University School of Medicine, Stanford, California
| | - G K Steinberg
- Department of Neurosurgery (R.L.D., G.K.S., S.D.C.), Stanford University School of Medicine, Stanford, California
| | - S D Chang
- Department of Neurosurgery (R.L.D., G.K.S., S.D.C.), Stanford University School of Medicine, Stanford, California
| | - M Wintermark
- From the Department of Radiology, Neuroimaging and Neurointervention Division (J.J.H., N.A.T., H.M.D., M.W., M.P.M.)
| | - M P Marks
- From the Department of Radiology, Neuroimaging and Neurointervention Division (J.J.H., N.A.T., H.M.D., M.W., M.P.M.)
| |
Collapse
|
|
22
|
Roelz R, Coenen VA, Scheiwe C, Niesen WD, Egger K, Csok I, Kraeutle R, Jabbarli R, Urbach H, Reinacher PC. Stereotactic Catheter Ventriculocisternostomy for Clearance of Subarachnoid Hemorrhage: A Matched Cohort Study. Stroke 2017; 48:2704-2709. [PMID: 28904239 DOI: 10.1161/strokeaha.117.018397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/29/2017] [Accepted: 08/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral infarction (DCI) is a major source of morbidity and mortality after aneurysmal subarachnoid hemorrhage. We report a novel intervention-stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy-for DCI prevention. Outcomes of 20 consecutive patients are compared with 60 matched controls. METHODS On the basis of individual treatment decisions, STX-VCS was performed in 20 high-risk aneurysmal subarachnoid hemorrhage patients admitted to our department between September 2015 and October 2016. Three controls matched for age, sex, aneurysm treatment method, and admission Hunt and Hess grade were assigned to each case treated by STX-VCS. DCI was the primary outcome. Mortality and mRS at rehabilitation discharge were secondary outcome parameters. The association between STX-VCS and DCI, mortality, and mRS was assessed by conditional logistic regression. RESULTS Stereotactic procedures were performed without surgical complications. Continuous cisternal lavage was feasible in 17 of 20 patients (85%). One adverse event because of cisternal lavage was without sequelae. DCI occurred in 25 of 60 (42%) controls and 3 of 20 (15%) patients with STX-VCS (odds ratio, 0.15; 95% confidence interval, 0.04-0.64). Mortality occurred in 20 of 60 (33%) controls and 1 of 20 (5%) patients with STX-VCS, respectively (odds ratio, 0.08; 95% confidence interval, 0.01 - 0.66). Favorable outcome (mRS≤3) at rehabilitation discharge was observed in 12 of 20 patients with STX-VCS (60%) versus 21 of 60 (35%) matched controls (odds ratio, 0.26; 95% confidence interval, 0.8-0.86). CONCLUSIONS STX-VCS was feasible and safe in patients with severe aneurysmal subarachnoid hemorrhage. Initial results indicate that DCI and mortality can be reduced, and neurological outcome may be improved with this method.
Collapse
Affiliation(s)
- Roland Roelz
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.).
| | - Volker A Coenen
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Christian Scheiwe
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Wolf-Dirk Niesen
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Karl Egger
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Istvan Csok
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Rainer Kraeutle
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Ramazan Jabbarli
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Horst Urbach
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Peter C Reinacher
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| |
Collapse
|
|
23
|
Wong GKC, Mak JSY, Wong A, Zheng VZY, Poon WS, Abrigo J, Mok VCT. Minimum Clinically Important Difference of Montreal Cognitive Assessment in aneurysmal subarachnoid hemorrhage patients. J Clin Neurosci 2017; 46:41-44. [PMID: 28887072 DOI: 10.1016/j.jocn.2017.08.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/15/2017] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is a major factor contributing to poor functional outcome after subarachnoid hemorrhage caused by a ruptured cerebral aneurysm (aSAH). Montreal Cognitive Assessment (MoCA) has been shown to be superior to the Mini-Mental State Examination in screening for cognitive domain deficit and correlating to functional outcome in aSAH patients. The aim of the current study was to determine the Montreal Cognitive Assessment (MoCA) score change that was associated with change of health in general in an aSAH patient cohort. We recruited aSAH patients from a regional neurosurgical center over a 3-year period. Patient assessments including MoCA and global rating of change (GRoC) were carried out at at 3 and 12months after aSAH. Anchor-based and distribution-based approaches were adopted to calculate the Minimum Clinically Important Difference (MID). One hundred and seventy-five aSAH patients completed both 3-month and 1-year assessments and consented for participation. Employing the distribution-based approach for the 3-month and 1-year MoCA scores, the MID estimates equated to a change of 2.0 and 1.1 respectively. Employing the anchor-based approach (with GRoC), the MID estimate of MoCA (median, IQR) was 2, 1-4. In conclusion, we found that the MID of MoCA score associated with change of health in general in aSAH patients was 2. The MID provides guidance for future clinical trial design targeting on cognitive dysfunction after aSAH.
Collapse
Affiliation(s)
- George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
| | - Jodhy Suk Ying Mak
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Adrian Wong
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vera Zhi Yuan Zheng
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Chung Tong Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
|
24
|
Yousef KM, Crago E, Lagattuta TF, Hravnak M. Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury. J Emerg Nurs 2017; 44:132-138. [PMID: 28712527 DOI: 10.1016/j.jen.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is frequently seen in emergency departments. Secondary injury, such as subarachnoid hemorrhage-associated myocardial injury (SAHMI), affects one third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions. The aim of this study was to determine whether patients who present to the emergency department with clinical aSAH are likely to develop SAHMI, as defined by troponin I ≥0.3 ng/mL. METHODS This was a prospective descriptive study. SAHMI was defined as troponin I ≥0.3 ng/mL. Predictors included demographics and clinical characteristics, severity of injury, admission 12-lead electrogardiogram (ECG), initial emergency department vital signs, and pre-hospital symptoms at time of aneurysm rupture. RESULTS Of 449 patients, 126 (28%) had SAHMI. Patients with SAHMI were more likely to report seizures and unresponsiveness with significantly lower Glasgow coma score and higher proportion of Hunt and Hess grades 3 to 5 and Fisher grades III and IV (all P < .05). Patients with SAHMI had higher atrial and ventricular rates and longer QTc intervals on initial ECG (P < .05). On multivariable logistic regression, poor Hunt and Hess grade, report of prehospital unresponsiveness, lower admission Glasgow coma score, and longer QTc interval were significantly and independently predictive of SAHMI (P < .05). DISCUSSION Components of the clinical presentation of subarachnoid hemorrhage to the emergency department predict SAHMI. Identifying patients with SAHMI in the emergency department can be helpful in determining surveillance and care needs and informing transfer unit care. Contribution to Emergency Nursing Practice.
Collapse
Affiliation(s)
- Khalil M Yousef
- University of Jordan, School of Nursing, Amman, Jordan; University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA.
| | - Elizabeth Crago
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | | | - Marilyn Hravnak
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| |
Collapse
|