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Myung Sung Joo, Dong Sun Park, Chang Taek Moon, Young Il Chun, Sang Woo Song, Hong Gee Roh
OBJECTIVE: The gyrus rectus (GR) is known as a non-functional gyrus; hence, its resection is agreed to be a safe procedure frequently practiced to achieve a better surgical view during specific surgeries. This study aimed at comparing the cognitive outcomes following GR resection in patients who underwent surgery for ruptured anterior communicating artery (ACoA) aneurysms. MATERIALS AND METHODS: From 2012 to 2015, 39 patients underwent surgical clipping for ruptured ACoA aneurysms...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
Bernd-Otto Hütter, Joachim-Michael Gilsbach
BACKGROUND: The neuropsychological effects of lumbar puncture and shunting in terms of cognitive functioning and quality of life were analyzed prospectively in four patients with malabsorptive hydrocephalus who became symptomatic in the chronic state after aneurysmal subarachnoid haemorrhage (SAH). METHODS: A comprehensive battery of neuropsychological tests was applied to four patients before and shortly after lumbar puncture and six months later. In three of them a shunt has been inserted, one patient was treated by repeated lumbar punctures...
November 12, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
R A Benson, B A Ozdemir, D Matthews, I M Loftus
OBJECTIVES Postoperative cognitive decline (POCD) is a well-recognised neurological phenomenon following major surgery. Most commonly seen in elderly patients, it has direct links to increased long-term morbidity and reduced quality of life. Its incidence following open and endovascular abdominal and thoracic aneurysm surgery is unclear. The purpose of this systematic review is to collate available evidence for POCD following abdominal and thoracic aortic surgery, and to identify continuing controversies directing future research...
November 4, 2016: Annals of the Royal College of Surgeons of England
Bo Carlberg
The J curve hypothesis propose that the relation between blood pressure and risk for cardiovascular events is non-linear. Instead of a decreased risk with lower blood pressure, the risk increases at lower blood pressures. This issue has been discussed for many years, and is still a hot topic. The debates have most often had its origin in the question about how far blood pressure should be lowered with antihypertensive drugs.One one hand, we know that many patients with hypertension is not treated to targets according to guidelines and that this contributes to the high risk for cardiovascular diseases in patients with hypertension...
September 2016: Journal of Hypertension
Christoph Scherfler, Alois Josef Schiefecker, Margarete Delazer, Ronny Beer, Thomas Bodner, Georg Spinka, Mario Kofler, Bettina Pfausler, Christian Kremser, Michael Schocke, Thomas Benke, Elke R Gizewski, Erich Schmutzhard, Raimund Helbok
OBJECTIVE: MRI parameters of iron concentration (R2*, transverse relaxation rate), microstructural integrity (mean diffusivity and fractional anisotropy), as well as gray and white matter volumes were analyzed in patients with subarachnoid hemorrhage (SAH) and uncomplicated clinical course to detect the evolution of brain tissue changes 3 weeks and 12 months after ictus. METHODS: MRI scans of 14 SAH patients (aneurysm of the anterior communicating artery, n = 5; no aneurysm n = 9) were compared with 14 age-matched healthy control subjects...
October 2016: Annals of Clinical and Translational Neurology
Nakao Ota, Felix Goehre, Takanori Miyazaki, Yu Kinoshita, Hidetoshi Matsukawa, Takeshi Yanagisawa, Humihiro Sakakibara, Norihiro Saito, Shiro Miyata, Kosumo Noda, Toshiyuki Tsuboi, Hiroyasu Kamiyama, Sadahisa Tokuda, Kyousuke Kamada, Rokuya Tanikawa
BACKGROUND: The application of bypass procedures to the posterior cerebral artery (PCA) in combination with proximal clipping or trapping is a useful option for the treatment of complex posterior circulation aneurysms, especially those of the PCA. Due to its course around the midbrain through various cisterns, different approaches are required to access the PCA. OBJECTIVE: The presented study analyzes a retrospective case series of bypass procedures to the PCA to investigate the relevant treatment strategies and their outcomes...
September 16, 2016: World Neurosurgery
Bo Carlberg
The J curve hypothesis propose that the relation between blood pressure and risk for cardiovascular events is non-linear. Instead of a decreased risk with lower blood pressure, the risk increases at lower blood pressures. This issue has been discussed for many years, and is still a hot topic. The debates have most often had its origin in the question about how far blood pressure should be lowered with antihypertensive drugs.One one hand, we know that many patients with hypertension is not treated to targets according to guidelines and that this contributes to the high risk for cardiovascular diseases in patients with hypertension...
September 2016: Journal of Hypertension
R Loch Macdonald, Tom A Schweizer
Subarachnoid haemorrhage is an uncommon and severe subtype of stroke affecting patients at a mean age of 55 years, leading to loss of many years of productive life. The rupture of an intracranial aneurysm is the underlining cause in 85% of cases. Survival from aneurysmal subarachnoid haemorrhage has increased by 17% in the past few decades, probably because of better diagnosis, early aneurysm repair, prescription of nimodipine, and advanced intensive care support. Nevertheless, survivors commonly have cognitive impairments, which in turn affect patients' daily functionality, working capacity, and quality of life...
September 13, 2016: Lancet
Tadayoshi Nakagomi, Kazuhide Furuya, Junichi Tanaka, Shigehiko Takanashi, Takehiro Watanabe, Takayuki Shinohara, Akiko Ogawa, Norio Fujii
Clipping surgeries for 139 consecutive unruptured middle cerebral aneurysms were performed between April 1991 and March 2014. Left hemiparesis occurred in one case (0.7 %). Transient symptoms arose in six patients due to perforator injury, arterial branch occlusion, damage to the venous system, or chronic subdural hematoma. Neither mortality nor decline in cognitive function was noted in this study. Clipping surgery for unruptured middle cerebral artery aneurysms can be done with minimal morbidity. However, meticulous management during the perioperative period as well as the use of modern technologies during the surgery, such as MEP monitoring and ICG videoangiography, are needed for safe and secure clipping surgery...
2016: Acta Neurochirurgica. Supplement
Andjela Milovanovic, Danica Grujicic, Vojislav Bogosavljevic, Milos Jokovic, Natasa Mujovic, Ivana Petronic Markovic
AIM: To develop a specific rehabilitation protocol for patients who have undergone surgical repair of acute aneurysmal subarachnoid hemorrhage (aSAH), and to determine the time at which verticalization should be initiated after aSAH. MATERIAL AND METHODS: Sixty-five patients who underwent acute-term surgery for aSAH and early rehabilitation were evaluated in groups: Group 1 (n=34) started verticalization on Days 2-5 post-bleeding whereas Group 2 (n=31) started verticalization approximately Day 12 post-bleeding...
June 1, 2016: Turkish Neurosurgery
Leodante da Costa, Benjamin T Dunkley, Allison Bethune, Amanda Robertson, Anne Keller, Elizabeth W Pang
BACKGROUND AND PURPOSE: Neurocognitive deficits are common among survivors of aneurysmal subarachnoid hemorrhage, even among those with good outcomes and no structural lesions. This study aims to probe the neurophysiological underpinnings of cognitive dysfunction among patients with ruptured intracranial aneurysms using magnetoencephalography (MEG). METHODS: Thirteen patients who had undergone uncomplicated coiling for aneurysmal subarachnoid hemorrhage and 13 matched controls were enrolled...
October 2016: Stroke; a Journal of Cerebral Circulation
Justin M Moore, Louis Caplan, Peter Hwang, Anoop Mandan, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND: Dementia places a large burden on the economy, with financial and emotional costs incurred by patients, caregivers and the health sector. METHODS AND RESULTS: We report the first published case series of giant basilar aneurysm leading to progressive cognitive and functional decline. We review the literature regarding giant aneurysms and their association with dementia and the possible underlying pathophysiological mechanism. CONCLUSIONS: This report highlights a number of therapeutic considerations when determining the best management strategy for these difficult lesions...
October 2016: Acta Neurochirurgica
Elisabeth Bründl, Christina Böhm, Ralf Lürding, Petra Schödel, Sylvia Bele, Andreas Hochreiter, Judith Scheitzach, Florian Zeman, Alexander Brawanski, Karl-Michael Schebesch
BACKGROUND: Few studies have addressed the effect of treatment of unruptured intracranial aneurysm (UIA) on cognitive function. OBJECTIVE: Neuropsychological assessment after UIA treatment is underreported, and prospective trials have repeatedly been demanded. In 2014, we conducted a prospective controlled study to evaluate the differences in cognitive processing caused by the treatment of anterior circulation UIA. PATIENTS AND METHODS: 30 patients were enrolled until September 2015...
July 5, 2016: World Neurosurgery
Robert F James, Daniel R Kramer, Zaid S Aljuboori, Gunjan Parikh, Shawn W Adams, Jessica C Eaton, Hussam Abou Al-Shaar, Neeraj Badjatia, William J Mack, J Marc Simard
New neuroprotective treatments aimed at preventing or minimizing "delayed brain injury" are attractive areas of investigation and hold the potential to have substantial beneficial effects on aneurysmal subarachnoid hemorrhage (aSAH) survivors. The underlying mechanisms for this "delayed brain injury" are multi-factorial and not fully understood. The most ideal treatment strategies would have the potential for a pleotropic effect positively modulating multiple implicated pathophysiological mechanisms at once...
August 2016: Current Treatment Options in Neurology
Irene M C Huenges Wajer, Johanna M A Visser-Meily, Paut Greebe, Marcel W M Post, Gabriel J E Rinkel, Martine J E van Zandvoort
BACKGROUND: Most survivors of an aneurysmal subarachnoid hemorrhage (aSAH) are ADL-independent, but they often experience restrictions in (social) activities and, therefore, cannot regain their pre-morbid level of participation. OBJECTIVE: In this study, participation restrictions and participation satisfaction experienced after aSAH were assessed. Moreover, possible predictors of participation after aSAH were examined to identify goals for rehabilitation. METHOD: Participation restrictions experienced by a series of 67 patients visiting our SAH outpatient clinic were assessed as part of standard clinical care using the Participation Restrictions and Satisfaction sections of the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-Participation) 6 months after aSAH...
June 20, 2016: Topics in Stroke Rehabilitation
Hiroyuki Sato, Takayuki Koizumi, Daisuke Sato, Shin Endo, Syunichi Kato
The patient, a 79-year-old man, experienced a Hunt & Kosnik grade IV subarachnoid hemorrhage, presenting with sudden-onset coma and severe left hemiplegia. We performed cranial clipping surgery for a ruptured aneurysm on the right middle cerebral artery the same day. Post-operative recovery proceeded smoothly, with gradual improvements in disturbed consciousness and left hemiplegia. Three weeks post-operation, CT revealed low-density areas in the right frontal and temporal lobe, believed to be due to subarachnoid hemorrhage, as well as hydrocephaly...
June 2016: No Shinkei Geka. Neurological Surgery
Wendy Boerboom, Martine J E van Zandvoort, Fop van Kooten, Ladbon Khajeh, Johanna M A Visser-Meily, Gerard M Ribbers, Majanka H Heijenbrok-Kal
PURPOSE: To study relationships between fatigue and objective and subjective cognitive functioning, mood and comorbidity in the long term after perimesencephalic subarachnoid haemorrhage (PM-SAH). METHODS: Cross-sectional study. Objective cognitive functioning was measured with: Trail Making Test; Symbol Substitution; D2; Verbal and Semantic Fluency; Tower Test; Digit Span; 15-Words Test; Rey Complex Figure. Subjective cognitive functioning: Cognitive Failure Questionnaire...
June 7, 2016: Disability and Rehabilitation
Anne M Buunk, Rob J M Groen, Wencke S Veenstra, Jan D M Metzemaekers, Johannes H van der Hoeven, J Marc C van Dijk, Jacoba M Spikman
OBJECTIVE: The authors' aim was to investigate cognitive outcome in patients with aneurysmal and angiographically negative subarachnoid hemorrhage (aSAH and anSAH), by comparing them to healthy controls and to each other. Besides investigating cognitive functions as memory and attention, they focused on higher-order prefrontal functions, namely executive functioning (EF) and emotion recognition. METHOD: Patients and healthy controls were assessed with tests measuring memory (15 Words Test, Digit Span), attention and processing speed (Trail Making Test A and B), EF (Zoo Map, Letter Fluency, Dysexecutive Questionnaire), and emotion recognition (Facial Expressions of Emotion Stimuli and Tests)...
May 19, 2016: Neuropsychology
George Kwok Chu Wong, Sandy Wai Lam, Adrian Wong, Karine Ngai, Vincent Mok, Wai Sang Poon
OBJECTIVE: Cognitive deficits commonly occur after aneurysmal subarachnoid hemorrhage (aSAH), although a few studies systemically evaluate its early impact. We hypothesized that early cognitive domain deficits in patients with aSAH correlate with functional status. METHODS: We carried out a prospective observational study in Hong Kong, for which patients with aSAH, aged 21-75 years, who had been admitted within 96 h of ictus were recruited. The cognitive assessment used was the domain-specific neuropsychological assessment battery at 2-4 weeks (n = 74) after ictus...
2016: Acta Neurochirurgica. Supplement
Jens Witsch, Hans-Peter Frey, Sweta Patel, Soojin Park, Shouri Lahiri, J Michael Schmidt, Sachin Agarwal, Maria Cristina Falo, Angela Velazquez, Blessing Jaja, R Loch Macdonald, E Sander Connolly, Jan Claassen
OBJECTIVE: To create a multidimensional tool to prognosticate long-term functional, cognitive, and quality of life outcomes after spontaneous subarachnoid hemorrhage (SAH) using data up to 48 hours after admission. METHODS: Data were prospectively collected for 1,619 consecutive patients enrolled in the SAH outcome project July 1996 to March 2014. Linear models (LMs) were applied to identify factors associated with outcome in 1,526 patients with complete data. Twelve-month functional, cognitive, and quality of life outcomes were measured using the modified Rankin scale (mRS), Telephone Interview for Cognitive Status, and Sickness Impact Profile...
July 2016: Annals of Neurology
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