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Subarachnoid bleed

Axel Neulen, Michael Kosterhon, Tobias Pantel, Stefanie Kirschner, Hermann Goetz, Marc A Brockmann, Sven R Kantelhardt, Serge C Thal
Subarachnoid hemorrhage (SAH) is a subtype of hemorrhagic stroke. Cerebral vasospasm that occurs in the aftermath of the bleeding is an important factor determining patient outcome and is therefore frequently taken as a study endpoint. However, in small animal studies on SAH, quantification of cerebral vasospasm is a major challenge. Here, an ex vivo method is presented that allows quantification of volumes of entire vessel segments, which can be used as an objective measure to quantify cerebral vasospasm. In a first step, endovascular casting of the cerebral vasculature is performed using a radiopaque casting agent...
July 28, 2018: Journal of Visualized Experiments: JoVE
Suliana Teoh, Monika Hofer, Richard Kerr, Nicola Warner, Wilhelm Kueker, Peter M Rothwell, Giovanna Zamboni
This article describes an unusual presentation of disseminated oligodendroglial-like leptomeningeal tumour. A previously healthy 23-year-old Caucasian woman presented with headache, photophobia and recurrent seizures. Initial investigations were suggestive of subarachnoid haemorrhage. Her symptoms deteriorated rapidly and within weeks she developed complete blindness and diffuse sensory ataxia. The aim of this article is to increase awareness of this rare disease, especially in patients who present with acute, rapidly progressive neurological symptoms with signs of acute or chronic central nervous system bleeding...
August 9, 2018: Neuroradiology Journal
Hirotaka Inoue, Makiko Miyahara, Yumi Funato, Shota Ozaki, Kensuke Kato, Ryuichi Noda, Shoji Yamaguchi, Yuta Tamai, Masato Inoue, Koichiro Okamoto, Tetsuo Hara
BACKGROUND AND PURPOSE: Gastrointestinal bleeding is an important complication in the acute phase of hemorrhagic stroke. In this study, we aimed to identify the risk factors for gastrointestinal bleeding in patients with hemorrhagic stroke despite the administration of antiulcer drugs. METHODS: We conducted a retrospective cohort study of our hemorrhagic stroke cases. We analyzed the background factors associated with gastrointestinal bleeding in the study population and their outcomes...
August 2018: Brain and Nerve, Shinkei Kenkyū No Shinpo
Alois J Schiefecker, Verena Rass, Maxime Gaasch, Mario Kofler, Claudius Thomé, Christian Humpel, Bogdan Ianosi, Werner O Hackl, Ronny Beer, Bettina Pfausler, Erich Schmutzhard, Raimund Helbok
In patients with aneurysmal subarachnoid hemorrhage (aSAH), increased brain extracellular interleukin (IL)-6 levels measured by cerebral microdialysis (CMD) were associated with disease severity, early brain injury, delayed cerebral infarction, and axonal injury. In this study, we analyzed brain extracellular IL-6 levels of aSAH patients following parenteral diclofenac. Twenty-four mechanically ventilated poor-grade aSAH patients were included. Changes in cerebral metabolism, brain/body temperature, and CMD-IL-6 levels following intravenous diclofenac infusion (DCF; 75 mg diluted in 100 cc normal saline) were retrospectively analyzed from prospectively collected bedside data (at 1 hour before DCF = baseline; and at 2, 4, and 8 hours after DCF)...
August 3, 2018: Therapeutic Hypothermia and Temperature Management
Brin Freund, John C Probasco, Eva K Ritzl
OBJECTIVE Delay in diagnosis and subsequent treatment of nonconvulsive seizures can lead to worsened outcomes. The gold standard in detecting nonconvulsive seizures is continuous video-electroencephalography (cEEG). Compared to routine, 30-minute EEG, the use of cEEG increases the likelihood of capturing intermittent nonconvulsive seizures. Studies of critically ill patients in intensive care units demonstrate a particularly high rate of nonconvulsive seizures. Some of these studies included postneurosurgical patients, but often subanalyses of specific populations were not done...
June 1, 2018: Journal of Neurosurgery
Marvin Darkwah Oppong, Daniela Pierscianek, Yahya Ahmadipour, Thiemo Florin Dinger, Philipp Dammann, Karsten Henning Wrede, Neriman Özkan, Oliver Müller, Ulrich Sure, Ramazan Jabbarli
OBJECTIVES: Intraoperative aneurysm rupture (IOAR) is a common complication during intracranial aneurysm(s) (IA) surgery. In virtue of paradigm shift regarding IA selected for clipping in the post-ISAT era, we aimed to evaluate the risk factors and impact of IOAR in an institutional series of clipped ruptured (RIA) and unruptured (UIA) IA. MATERIAL AND METHODS: All IA treated by microsurgical clipping at our institution between 2003 and 2016, were eligible for this study...
July 27, 2018: World Neurosurgery
Marvin Darkwah Oppong, Vanessa Skowronek, Daniela Pierscianek, Oliver Gembruch, Annika Herten, Dino Vitali Saban, Philipp Dammann, Michael Forsting, Ulrich Sure, Ramazan Jabbarli
OBJECTIVES: Intracerebral hematoma (ICH) complicates the course of aneurysmal subarachnoid hemorrhage (SAH). To date, there are no unique guidelines for management of aneurysmal ICH. The aim of this study was to identify risk factors for and impact of aneurysmal ICH with special attention on treatment decisions derived from ICH volume. PATIENTS AND METHODS: All patients admitted with aneurysmal SAH between 2003 and 2016 were eligible for this study. Various demographic, clinical and radiographic characteristics of patients were correlated with the occurrence and volume of ICH in univariate and multivariate manner...
July 19, 2018: Clinical Neurology and Neurosurgery
Jonghoon Kim, Chulhoon Chang, Youngjin Jung
We report a case of a ruptured fusiform aneurysm of the distal internal carotid artery (ICA) involving the anterior choroidal artery and posterior communicating artery, treated with selective coil embolization. An 86-year-old woman was admitted with subarachnoid haemorrhage (SAH). Computed tomography (CT) and CT angiography showed diffuse SAH with a fusiform aneurysm, as well as severe atherosclerotic change in the distal ICA. A transfemoral cerebral angiogram showed a fusiform aneurysm in the supraclinoid segment of the ICA with a daughter sac...
July 24, 2018: World Neurosurgery
Asami Kikuchi, Akihiko Hino, Hideki Oka, Youichi Hashimoto, Shigeomi Yokoya, Yukihiro Goto, Tadashi Echigo, Naoto Shiomi, Tetsuya Katsumori, Hidesato Takezawa, Hidetoshi Kasuya
In some patients with spontaneous subarachnoid hemorrhage(SAH), initial imaging investigations may not be able to detect a bleeding source;repeat imaging may be necessary to reveal these lesions. We reviewed a consecutive series of 45 patients with SAH and negative initial digital subtraction angiograms(DSA)during a 15-year period. The aims were to document the frequency and reason for the negative initial investigations, to determine the appropriate modality and timing of repeat examinations, and to investigate the identified bleeding sources...
July 2018: No Shinkei Geka. Neurological Surgery
Karen L Margolis, Suzanne E Mahady, Mark R Nelson, Diane G Ives, Suzanne Satterfield, Carlene Britt, Saifuddin Ekram, Jessica Lockery, Erin C Schwartz, Robyn L Woods, John J McNeil, Erica M Wood
Background: Bleeding is the major risk of aspirin treatment, especially in the elderly. A consensus definition for clinically significant bleeding (CSB) in aspirin primary prevention trials is lacking in the literature. Methods: This paper details the development, modification, application, and quality control of a definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial, a primary prevention trial of aspirin in 19,114 community-dwelling elderly men and women...
September 2018: Contemporary Clinical Trials Communications
Thibaud Crespy, Magali Heintzelmann, Celia Chiron, Marc Vinclair, Florence Tahon, Gilles Francony, Jean-François Payen
BACKGROUND: Milrinone has emerged as an option to treat delayed cerebral ischemia after subarachnoid hemorrhage. However, substantial variation exists in the administration of this drug. We retrospectively assessed the effectiveness of 2 protocols in patients with angiographically proven cerebral vasospasm. METHODS: During 2 successive periods, milrinone was administered using either a combination of intra-arterial milrinone infusion followed by intravenous administration until day 14 after initial bleeding (IA+IV protocol), or a continuous intravenous milrinone infusion for at least 7 days (IV protocol)...
July 13, 2018: Journal of Neurosurgical Anesthesiology
Shafqat Rasul Chaudhry, Ahmad Hafez, Behnam Rezai Jahromi, Thomas Mehari Kinfe, Alf Lamprecht, Mika Niemelä, Sajjad Muhammad
Aneurysmal subarachnoid hemorrhage (aSAH) represents only a small portion of all strokes, but accounts for almost half of the deaths caused by stroke worldwide. Neurosurgical clipping and endovascular coiling can successfully obliterate the bleeding aneurysms, but ensuing complications such as cerebral vasospasm, acute and chronic hydrocephalus, seizures, cortical spreading depression, delayed ischemic neurological deficits, and delayed cerebral ischemia lead to poor clinical outcomes. The mechanisms leading to these complications are complex and poorly understood...
July 13, 2018: International Journal of Molecular Sciences
Duo Chen, Zhao-Bo Nie, Zhi-Hong Chi, Zhan-You Wang, Xiang-Tai Wei, Jun-Hong Guan
Background: The pathophysiology of early brain injury (EBI) after subarachnoid hemorrhage (SAH) is poorly understood. The present study evaluates the influence of zinc transporter 3 (ZnT3) knockout and the depletion of vesicular zinc on EBI. Methodology: SAH was induced in ZnT3 KO mice by internal carotid artery perforation. The changes in behavior were recorded at 24 hours after SAH. Hematoxylin-eosin, Nissl and TUNEL staining were performed to evaluate neuronal apoptosis...
2018: Translational Neuroscience
Hidetoshi Kasuya, Yasuhiro Kuroi, Suguru Yokosako, Hirokazu Koseki, Shigeru Tani
OBJECTIVE: The surgical approach for the trigeminal nerve involves veins connected to the superior petrosal and tentorial sinus, and we should pay special attention to these veins. We investigated intraoperative and postoperative bleeding using our database. METHODS: A prospectively accumulated database of 247 microvascular decompression surgeries for trigeminal neuralgia over the past 10 years was analyzed. Intraoperative and postoperative bleeding was confirmed with surgical records, videos, and computed tomography...
June 26, 2018: World Neurosurgery
Mathias Kunz, Sebastian Siller, Carolina Nell, Roman Schniepp, Franziska Dorn, Volker Huge, Joerg-Christian Tonn, Hans-Walter Pfister, Christian Schichor
BACKGROUND: While prophylaxis with intravenous unfractionated heparin (UFH) can effectively prevent venous thromboembolism (VTE) during the neurocritical care of patients with severe aneurysmal subarachnoid hemorrhage (aSAH), the risk for intracranial bleeding complications might increase. Owing to this therapeutic dilemma, the UFH administration regimen in this critical patient population remains highly controversial. METHODS: We performed a retrospective analysis of patients with severe aSAH (Fisher grade 3-4) receiving either low-dose (activated partial thromboplastin time [aPTT] <40 seconds) or therapeutic range (aPTT 50-60 seconds) UFH during intensive care unit (ICU) treatment after complete surgical/endovascular aneurysm occlusion...
June 27, 2018: World Neurosurgery
Markus Bruder, Sepide Kashefiolasl, Fee Keil, Nina Brawanski, Sae-Yeon Won, Volker Seifert, Juergen Konczalla
Acetylsalicylic acid (ASA) is a well-known and widely used analgesic for acute pain. Patients with acute headache due to subarachnoid hemorrhage (SAH) are inclined to take ASA in this situation. Due to the antithrombotic effects, ASA intake is related to higher bleeding rates in case of hemorrhage or surgical treatment. Between January 2006 and December 2016, 941 patients without continuous antithrombotic or anticoagulant medication were treated due to SAH in our institution. Fourteen of them (1.5%) had taken ASA as a single dose because of headache within 24 h before hospital admission...
June 22, 2018: Neurosurgical Review
Sang-Yeon Lee, Dong-Han Lee, Yun Jung Bae, Jae-Jin Song, Ji Soo Kim, Ja-Won Koo
Background: Superficial siderosis (SS) is a rare condition in which hemosiderin, an iron storage complex, is deposited in neural tissues because of recurrent subarachnoid bleeding. Hemosiderin deposition in the vestibulocochlear nerve (CN VIII), brain, spinal cord and peripheral nerve can cause sensorineural hearing loss (SNHL) and postural imbalance, but much remains unknown about the vestibular manifestations of SS. Objectives: To report the clinical course, cochleovestibular status, and patterns of vestibulopathy during follow-up of a relatively large case series, and to discuss the possible pathophysiological mechanism of vestibular deterioration...
2018: Frontiers in Neurology
M'Peko Osawa F Mayele, X Bertrand
Subarachnoid hemorrhage is a neurovascular emergency affecting relatively young adults. A ruptured cerebral aneurysm is the main non-traumatic cause. Except for the non-specific symptom of headache, which frequently occurs in subarachnoid hemorrhage, the clinical presentation is atypical, making the diagnosis difficult with possible dramatic consequences. The diagnosis is based on the CT scan without contrast, which, when negative, will be followed by a lumbar puncture. The etiologic analysis is based on an urgent arteriography, revealing the characteristics of the aneurysm such as the anatomy of the intracerebral vessels, the identification of the bleeding site and the size and location of the aneurysm...
May 2018: Revue Médicale de Liège
K Duris, J Lipkova, Z Splichal, T Madaraszova, Michal Jurajda
The main objective was to evaluate, whether the subarachnoid hemorrhage (SAH)-associated early inflammatory response has focal or global character, i.e., whether areas distant to hematoma may be affected by an early inflammatory response. The second objective was to evaluate the association of anesthesia recovery time for basic reflexes/neurological functions with severity of SAH. SAH was induced in rats using an endovascular perforation model. Anesthesia recovery time was evaluated for pain reaction recovery time (spinal level), spontaneous ventilation recovery time (brain stem level), and consciousness recovery time (neocortical level)...
June 20, 2018: Translational Stroke Research
Diederik Bulters, Ben Gaastra, Ardalan Zolnourian, Sheila Alexander, Dianxu Ren, Spiros L Blackburn, Mark Borsody, Sylvain Doré, James Galea, Koji Iihara, Paul Nyquist, Ian Galea
Haemoglobin is released into the CNS during the breakdown of red blood cells after intracranial bleeding. Extracellular free haemoglobin is directly neurotoxic. Haemoglobin scavenging mechanisms clear haemoglobin and reduce toxicity; these mechanisms include erythrophagocytosis, haptoglobin binding of haemoglobin, haemopexin binding of haem and haem oxygenase breakdown of haem. However, the capacity of these mechanisms is limited in the CNS, and they easily become overwhelmed. Targeting of haemoglobin toxicity and scavenging is, therefore, a rational therapeutic strategy...
June 20, 2018: Nature Reviews. Neurology
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