Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid haemorrhage - neurological and radiological outcome

Preventive effect of aminocaproic acid combined with nimodipine on short-term rebleeding in patients with aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening and life-limiting disease with high mortality and disability rates. Herein, we aim to explore the preventive effect of aminocaproic acid combined with nimodipine on short-term rebleeding in patients with aSAH. Retrospectively, the medical data of patients with aSAH ( n  = 256) were collected. According to different treatment methods, patients were categorized into the aminocaproic acid + nimodipine group ( n  = 152) and the nimodipine group ( n  = 104), and were treated for 1 week. Baseline characteristics, incidence of rebleeding, average velocity of cerebral artery blood flow, cerebral vasospasm index, vascular endothelial function, complications, and adverse events were analyzed between the two groups. After 1-week treatment, compared to the nimodipine group, the aminocaproic acid + nimodipine group exhibited lower incidence of rebleeding, notable decreases in average velocity of cerebral artery blood flow and the cerebral vasospasm index, and downregulation of endothelin-1 and vascular endothelial growth factor ( P  < 0.05). There were no significant differences about complications and adverse events between the two groups. Aminocaproic acid combined with nimodipine is superior to nimodipine alone in preventing the short-term rebleeding in patients with aSAH, and has good safety.

Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: A Literature Review

Spontaneous non-aneurysmal subarachnoid haemorrhage (NAPMSAH) (addressing point 1) is a relatively rare occurrence in clinical settings as it is rarely misdiagnosed and usually involves a significantly better prognosis than the classical aneurysmal pattern. We hereby focused on a comprehensive analysis of this distinct pathological entity with the purpose of analysing possible pathophysiological entities, outcomes and treatment options involving this diagnosis with a focus on demographical, epidemiological and clinical data. The clinical setting includes focal neurological signs related to the anatomical structures, while computer tomography followed by tomographic angiography are the most common diagnosis tools, with a typical hyperdense lesion involving the midbrain, fourth ventricle and subthalamic areas without an angiographic correspondent, such as an aneurysmal pathology. Further investigations can also be used to highlight this diagnosis, such as interventional angiography or magnetic resonance imaging. Given the rarity of this condition and its relatively better prognosis, treatment options usually remain conservative. In the present review, the main characteristics of NAPMSAH are discussed.

Current status of perimesencephalic non-aneurysmal subarachnoid hemorrhage

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a distinctive disease, representing SAH centered in perimesencephalic cisterns, with negative angiography findings. In recent years, the number of patients with PNSAH has increased significantly; however, the knowledge of PNSAH is insufficient. Therefore, we performed a review of the literature from a PubMed search and recounted our understanding of PNSAH. In this review, we summarized that current high-resolution computed tomography angiography is an acceptable replacement for digital subtraction angiography to rule out aneurysms in PNSAH with strict criteria. The current hypothesis about the etiology of PNSAH is that there is deep vein rupture from aberrant venous anatomy and increased intracranial venous pressure. PNSAH is associated with mild symptoms and lower rates of hydrocephalus and symptomatic vasospasm. For PNSAH, conservative treatment has been the mainstream treatment. PNSAH has a benign clinical course and an excellent prognosis; in long-term follow-up, re-bleeding and death were uncommon.