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https://www.readbyqxmd.com/read/28187800/management-of-aneurysmal-subarachnoid-hemorrhage
#1
N Etminan, R L Macdonald
Spontaneous subarachnoid hemorrhage (SAH) affects people with a mean age of 55 years. Although there are about 9/100 000 cases per year worldwide, the young age and high morbidity and mortality lead to loss of many years of productive life. Intracranial aneurysms account for 85% of cases. Despite this, the majority of survivors of aneurysmal SAH have cognitive deficits, mood disorders, fatigue, inability to return to work, and executive dysfunction and are often unable to return to their premorbid level of functioning...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28119832/characteristics-of-patients-with-aneurysmal-subarachnoid-hemorrhage-and-risk-factors-related-to-dysphagia
#2
Seung Hwa Rhie, Ji Won Choi, Se Jeong Jeon, Sung Don Kang, Min Cheol Joo, Min Su Kim
OBJECTIVE: To investigate the characteristics and risk factors of dysphagia with the Videofluoroscopic Dysphagia Scale (VDS) using a videofluoroscopic swallowing study (VFSS) in patients with ruptured aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Data of 64 patients presenting with first-ever ruptured aSAH were analyzed. Characteristics of dysphagia were evaluated using VFSS and all subjects were divided into a high (>47) and low risk group (≤47) by the VDS score...
December 2016: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28059648/validation-of-effectiveness-of-keyhole-clipping-in-nonfrail-elderly-patients-with-unruptured-intracranial-aneurysms
#3
Kentaro Mori, Kojiro Wada, Naoki Otani, Arata Tomiyama, Terushige Toyooka, Kazuya Fujii, Kosuke Kumagai, Satoru Takeuchi, Satoshi Tomura, Takuji Yamamoto, Yasuaki Nakao, Hajime Arai
OBJECTIVE Advanced age is known to be associated with a poor prognosis after surgical clipping of unruptured intracranial aneurysms (UIAs). Keyhole clipping techniques have been introduced for less invasive treatment of UIAs. In this study, the authors compared the complications and clinical and radiological outcomes after keyhole clipping between nonfrail elderly patients (≥ 70 years) and nonelderly patients. METHODS Keyhole clipping (either supraorbital or pterional) was performed to treat 260 cases of relatively small (≤ 10 mm) anterior circulation UIAs...
January 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28017208/subjective-hearing-impairment-after-subarachnoid-haemorrhage-prevalence-and-risk-factors
#4
Erik M Vos, Paut Greebe, J M Anne Visser-Meily, Gabriel J E Rinkel, Mervyn D I Vergouwen
BACKGROUND: Sensorineural hearing impairment is a key symptom in patients with superficial siderosis of the central nervous system, a disease caused by chronic or intermittent haemorrhage into the subarachnoid space. We investigated the prevalence and risk factors of subjective hearing impairment after SAH. METHODS: We systematically interviewed all SAH patients admitted between June 2011 and December 2014, who were able to visit the SAH outpatient clinic six to eight weeks after hospital discharge...
January 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27995510/mechanisms-of-global-cerebral-edema-formation-in-aneurysmal-subarachnoid-hemorrhage
#5
Erik G Hayman, Aaron Wessell, Volodymyr Gerzanich, Kevin N Sheth, J Marc Simard
A growing body of clinical literature emphasizes the impact of cerebral edema in early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Aneurysm rupture itself initiates global cerebral edema in up to two thirds of cases. Although cerebral edema is not a universal feature of aSAH, it portends a poor clinical course, with quantitative analysis revealing a direct correlation between cerebral edema and poor outcome, including mortality and cognitive deficits. Mechanistically, global cerebral edema has been linked to global ischemia at the time of aneurysm rupture, dysfunction of autoregulation, blood breakdown products, neuroinflammation, and hyponatremia/endocrine abnormalities...
December 19, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27977657/delayed-recovery-of-adipsic-diabetes-insipidus-adi-caused-by-elective-clipping-of-anterior-communicating-artery-and-left-middle-cerebral-artery-aneurysms
#6
Jeffrey Tan, Samuel Ndoro, Uchenna Okafo, Aoife Garrahy, Amar Agha, Danny Rawluk
Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications...
December 16, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27847765/relationship-between-gyrus-rectus-resection-and-cognitive-impairment-after-surgery-for-ruptured-anterior-communicating-artery-aneurysms
#7
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
https://www.readbyqxmd.com/read/27847145/short-and-long-term-neurobehavioral-effects-of-lumbar-puncture-and-shunting-in-patients-with-malabsorptive-hydrocephalus-after-subarachnoid-haemorrhage-an-explorative-case-study
#8
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...
February 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27809575/a-systematic-review-of-postoperative-cognitive-decline-following-open-and-endovascular-aortic-aneurysm-surgery
#9
REVIEW
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...
February 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27754012/me-02-1-is-lower-really-better-issue-of-the-j-curve-hypothesis-in-hypertension
#10
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
https://www.readbyqxmd.com/read/27752513/longitudinal-profile-of-iron-accumulation-in-good-grade-subarachnoid-hemorrhage
#11
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
https://www.readbyqxmd.com/read/27647023/bypass-revascularization-applied-to-the-posterior-cerebral-artery
#12
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
https://www.readbyqxmd.com/read/27642923/me-02-1-is-lower-really-better-issue-of-the-j-curve-hypothesis-in-hypertension
#13
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
https://www.readbyqxmd.com/read/27637674/spontaneous-subarachnoid-haemorrhage
#14
REVIEW
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...
February 11, 2017: Lancet
https://www.readbyqxmd.com/read/27637633/clipping-surgery-for-unruptured-middle-cerebral-artery-aneurysms
#15
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
https://www.readbyqxmd.com/read/27593842/efficacy-of-early-rehabilitation-after-surgical-repair-of-acute-aneurysmal-subarachnoid-hemorrhage-outcomes-after-verticalization-on-day-2-5-versus-day-12-post-bleeding
#16
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
https://www.readbyqxmd.com/read/27531345/increased-frontal-lobe-activation-after-aneurysmal-subarachnoid-hemorrhage
#17
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
https://www.readbyqxmd.com/read/27531175/dementia-resulting-from-expansion-of-basilar-artery-aneurysm-two-case-reports-and-a-review-of-the-literature
#18
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
https://www.readbyqxmd.com/read/27392894/treatment-of-unruptured-intracranial-aneurysms-and-cognitive-performance-preliminary-results-of-a-prospective-clinical-trial
#19
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
https://www.readbyqxmd.com/read/27325362/novel-treatments-in-neuroprotection-for-aneurysmal-subarachnoid-hemorrhage
#20
REVIEW
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
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