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1.
Introduction
Patients with non-aneurysmal subarachnoid hemorrhage (SAH) are considered to have an overall benign course of disease compared to patients suffering from aneurysmal SAH. Nevertheless, a small but significant number of such patients might only achieve unfavorable outcome. Therefore, the purpose of the present study was to determine if routine laboratory markers of acute phase response are associated with unfavorable outcome in patients with non-aneurysmal SAH.Methods
From 2006 to 2017, 154 patients suffering from non-aneurysmal SAH were admitted to our institution. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (pSAH) versus non-perimesencephalic SAH (npSAH). C-reactive protein (CRP) and white blood cells (WBC) assessments were performed within 24 h of admission as part of routine laboratory workup. Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favorable (mRS 0–2) vs. unfavorable (mRS 3–6).Results
The multivariate regression analysis revealed “CRP?>?5 mg/l” (p?=?0.004, OR 143.7), “WBC count?>?12.1 G/l” (p?=?0.006, OR 47.8), “presence of IVH” (p?=?0.02, OR 13.5), “poor-grade SAH” (p?=?0.01, OR 45.2) and “presence of CVS” (p?=?0.003, OR 149.9) as independently associated with unfavorable outcome in patients with non-aneurysmal SAH.Conclusion
Elevated C-reactive protein and WBC count at admission were associated with unfavorable outcome after non-aneurysmal SAH.2.
Oskar P. Aspegren Ramona ÅstrandMaria I. Lundgren Bertil Romner 《Clinical neurology and neurosurgery》2013
Objective
Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy.Methods
We conducted a retrospective review of 239 patients undergoing surgery for CSDH over a period of six years (2006–2011). Risk factors such as age, head trauma, anticoagulant and/or antiplatelet agent therapy and co-morbidity were investigated along with gender, coagulation status, laterality, surgical method and recurrence.Results
Seventy-two percent of the patients were male and the mean age was 71.8 years (range 28–97 years). Previous fall with head trauma was reported in 60% of the patients while 16% were certain of no previous head trauma. The majority of patients (63%) in the non-trauma group were receiving anticoagulants and/or antiplatelet agent therapy prior to CSDH presentation, compared to 42% in the trauma group. Twenty-four percent experienced recurrence of the CSDH. There was no association between recurrence and anticoagulant and/or antiplatelet agent therapy.Conclusion
Anticoagulant and/or antiplatelet aggregation agent therapy is more prevalent among non-traumatic CSDH patients but does not seem to influence the rate of CSDH recurrence. 相似文献3.
Ji Won Kim Pyoung Jeon Gyeong-Moon Kim Oh Young Bang Hong Sik Byun Keon Ha Kim 《Clinical neurology and neurosurgery》2012
Objective
Despite the risk of intracranial hemorrhage, combination therapy with intravenous recombinant tissue plasminogen activator and intraarterial mechanical thrombolysis can be effective for treatment of acute ischemic stroke. We investigated the feasibility and safety of intraarterial tirofiban following formation of anterograde flow after mechanical thrombolysis in acute ischemic stroke.Methods
We analyzed data from consecutive patients with acute ischemic stroke, who underwent treatment with intraarterial thrombolysis. All patients were evaluated immediately and 7 days later by computed tomography scanning and magnetic resonance imaging scanning with magnetic resonance angiography. For clinical outcome analysis, we followed up the NIHSS score and modified Rankin Scale score during a period of 3 months.Results
Sixteen patients underwent treatment. The mean baseline NIHSS score was 16.1 ± 4.4 points. 75.1% of patients showed angiographic improvement; 43.8% and 31.3% had complete and partial recanalization, respectively. 53.3% and 56.3% showed clinical improvement and favorable outcome at 24 h and 3 months, respectively. One patient had symptomatic intracranial hemorrhage.Conclusions
Our results suggest that administration of local intraarterial tirofiban after anterograde flow formation is a viable treatment strategy for patients of acute ischemic stroke for reducing the risk of reocclusion after intraarterial thrombolysis. 相似文献4.
J.C. Portilla-Cuenca J.M. Ramírez-Moreno F. López-Espuela R.M. Romero-Sevilla P.E. Jiménez-Caballero J.A. Fermín-Marrero A. Falcón-García G. Gámez-Leyva F. Castellano-Fernández M.L. Calle-Escobar T. Gavilán-Iglesias M. Gómez-Gutiérrez A. Serrano-Cabrera I. Casado-Naranjo 《Neurología (Barcelona, Spain)》2014
Objective
Patients with acute stroke are more likely to survive and achieve independence if they are treated in a stroke unit. Available information in our setting is scarce. We analyse the outcomes of our patients on the basis of cumulative experience in a stroke unit.Patients and methods
A retrospective cohort study of patients admitted to a stroke unit. We differentiate between two groups according to the year of admission: group A (July 2007-December 2009) and group B (January 2010-December 2011), analysing early outcome based on the score on the National Institute of Health stroke scale and mortality at discharge, and medium-term outcome in terms of mortality and functional status according to the modified Rankin scale at three months.Results
A total 1070 patients were included. There were no differences between groups with respect to favourable outcome (68.3% vs 63.9), hospital mortality (5.1% vs 6.6%), or 90-day mortality (12.8% vs 13.1%). The percentage of patients who were independent at 90 days was greater in group B (56.3% vs 65.5%, P=.03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy, the association between patient independence and admission period remained present.Conclusions
The probability of functional independence in our patients increased alongside accumulated experience in our stroke unit with no differences in mortality. 相似文献5.
Yi-Bin Fang Qiang Li Peng-Fei Yang Qing-Hai HuangWen-Yuan Zhao Yi XuBo Hong Jian-Min Liu 《Clinical neurology and neurosurgery》2013
Objectives
Blood blister-like aneurysms (BBAs) are aneurysms arising from the nonbranching arterial trunk, which are usually small and located at the anterior wall of supraclinoid internal carotid artery. These aneurysms are quite dangerous due to their fragile neck. This paper aims to evaluate the application of stent-assisted coil embolization in the treatment of BBAs.Methods
A retrospective review of the aneurysm database in our institution identified 8 patients carrying BBAs planned to be treated by stent-assisted coil embolization. The clinical characteristics, angiographic outcome, and follow-up results were reviewed.Results
Stent-assisted coil embolization was successfully performed in 5 cases (62.5%). Two procedures were treated with sole stent deployment (25%). One patient suffered intra-operative rupture (12.5%) and endovascular trapping was performed. The modified Rankin scale (mRs) score in living patients at discharge was 1 in four cases, 2 in one case, and 3 in one case. Two patients died of post-operative hemorrhage (25%). The mRs score at 9–36 months’ follow-up was 0 in four cases, 1 in one case, and 2 in one case. All patients were followed up angiographically, and regrowth was observed in three patients, who accepted further endovascular treatments.Conclusion
Stent-assisted coil embolization may probably reduce the mortality, but may not be a cure for all BBAs. 相似文献6.
Veit Rohde Naureen Uzma Ina Rohde Eric St. Clair Uzma Samadani 《Clinical neurology and neurosurgery》2009
Object
Anticoagulant-associated intracerebral hemorrhages (AAICH) have a high morbidity and mortality, necessitating urgent treatment. We examined outcomes after conventional craniotomy and stereotactic fibrinolytic therapy in a series of patients with anticoagulant-associated hemorrhages.Methods
Among 129 consecutive surgically treated patients with supratentorial intracerebral hemorrhage, 27 patients with AAICH were identified (mean age 62; range 36–79). Thirteen patients underwent craniotomy for surgical hematoma evacuation, and 14 patients hematoma puncture and catheter placement for clot lysis. The groups had comparable major prognostic factors such as hematoma volume, age, and Glasgow coma scale (GCS) score at admission.Results
Nine patients died despite treatment (mortality = 33%). Mortality in the craniotomy group was comparable to that of the lysis group (46% versus 21%; p = 0.13). Good outcomes (Glasgow outcome score of 4 or 5) were seen in 3 craniotomy patients (23%) and 2 fibrinolysis patients (14%). Half the patients survived with major neurological deficits (GOS 2 or 3) (n = 13; 48%). One rebleed was observed two days after uneventful craniotomy and hematoma removal, while no patient who underwent fibrinolysis had rebleeding.Conclusions
Approximately one-fifth of patients with AAICH managed surgically may have good outcomes. Mortality and favourable outcome rates are comparable between craniotomy and fibrinolytic therapy. Fibrinolytic therapy appears to be a reasonable less invasive alternative treatment modality for intracerebral hemorrhage in the anticoagulated patient. 相似文献7.
Xiong L Leung H Chen XY Han JH Leung T Soo Y Wong E Chan A Lau A Wong KS 《Clinical neurology and neurosurgery》2012,114(4):316-320
Background and purpose
Impaired autonomic function is common in the acute poststroke phase but little is known about its effects on functional outcome after acute ischemic stroke. This study sought to investigate the impact of autonomic dysfunction by Ewing's classification on functional outcome 2 months after acute ischemic stroke.Methods
34 consecutive acute ischemic stroke patients within 7 days after onset were enrolled. On admission, autonomic function was assessed by Ewing's battery tests. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS), autonomy in activities of daily living by the Barthel Index (BI), and global disability by the modified Rankin Scale (mRS). BI and mRS were also evaluated 2 months after ischemic stroke onset.Results
On admission, eight patients were diagnosed as minor autonomic dysfunction and 26 patients as relatively severe autonomic dysfunction. The prevalence of relatively severe autonomic dysfunction in ischemic stroke patients was 76.5%. There were no significant differences in baseline characteristics between the minor and severe autonomic dysfunction groups. 2 months after stroke onset, the mean BI score of patients with minor autonomic dysfunction and severe autonomic dysfunction increased from 76.3 ± 15.3 on admission to 95.0 ± 7.1, 66.5 ± 15.2 on admission to 74.8 ± 15.9 respectively. The mean BI score after 2-month stroke onset and the change in BI from admission to 2-month outcome (delta BI) in patients with severe autonomic dysfunction were lower than those in patients with minor autonomic dysfunction (all P < 0.05).Conclusions
Autonomic dysfunction occurs in acute stroke patients. Relatively severe autonomic dysfunction is related to an unfavorable functional outcome in patients with acute ischemic stroke. 相似文献8.
Daniel M. Witt Thomas Delate Elaine M. Hylek Nathan P. Clark Mark A. Crowther Francesco Dentali Walter Ageno Kerri D. Martinez David A. Garcia 《Thrombosis research》2013
Introduction
Avoiding intracranial hemorrhage (ICH) during warfarin therapy is critical but little is known about factors that affect warfarin-related ICH outcomes. We aimed to define the impact of warfarin on ICH incidence rates and to identify baseline clinical characteristics of patients who experienced ICH and factors associated with fatal ICH.Materials and Methods
The primary outcome of this retrospective cohort study was the incident ICH rate per 10,000 person-years for patients receiving and not receiving warfarin therapy. Cox proportional hazards modeling was used to adjust for potential confounding factors in assessment of the association of warfarin with fatal ICH.Results
A total of 1348 patients with incident ICH, 259 (19%) who were receiving warfarin therapy, were included. The incident ICH rates were 74/10,000 (warfarin) and 5/10,000 (non-warfarin) person-years (p < 0.001). Warfarin patients were older and carried a higher burden of chronic disease. The unadjusted hazard ratio (HR) for fatal ICH was 1.64 (95% confidence interval [CI] 1.31-2.05) for warfarin patients compared to non-warfarin patients. However, the HR was no longer significant after adjustment for confounding variables (1.10; 95% CI 0.84-1.42). An INR greater than 3.5 at presentation doubled the adjusted risk for fatal ICH with warfarin therapy. Subarachnoid and subdural ICHs were less likely to be fatal than other ICH types, and each year increase in age was associated with 4% increased risk of fatal ICH.Conclusions
Although warfarin use increases the rate of incident ICH, other factors impact the risk of fatal ICH, even among anticoagulated patients. 相似文献9.
Signe Voigt Lauridsen Anne-Mette Hvas Emilie Sandgaard Tua Gyldenholm Christian Rahbek Niels Hjort Else Kirstine Tønnesen Christine Lodberg Hvas 《Journal of stroke and cerebrovascular diseases》2018,27(11):2951-2961
Background
Intracerebral hemorrhage (ICH) causes death or disability and the incidence increases with age. Knowledge of acute hemostatic function in patients with ICH without anticoagulant and antiplatelet therapy is sparse. Increased knowledge of the coagulation profile in the acute phase of ICH could improve acute treatment and recovery. We investigated coagulation at admission and changes in coagulation during the first 24hours after symptom onset.Methods
Enrolled were 41 ICH patients without anticoagulant or antiplatelet therapy admitted to Aarhus University Hospital, Denmark. Blood samples were collected at admission, 6, and 24hours after symptom onset. Thromboelastometry (ROTEM), thrombin generation, and thrombin-antithrombin (TAT) complex were analyzed. Clinical outcome was evaluated using the National Institute of Health Stroke Scale, the Modified Rankin Score, and mortality.Results
At admission, compared with healthy individuals, ICH patients had increased maximum clot firmness (EXTEM P < .0001; INTEM P < .0001; FIBTEM P < .0001), increased platelet maximum clot elasticity (P < .0001) in ROTEM, higher peak thrombin (P < .0001) and endogenous thrombin potential (P?=?.01) in thrombin generation, and elevated TAT complex levels. During 24hours after significantly, while thrombin generation showed decreased peak thrombin (P < .0001) and endogenous thrombin potential (P < .0001). Coagulation test results did not differ between patients when stratified according to clinical outcome.Conclusions
ICH patients without anticoagulant or antiplatelet therapy demonstrated activated coagulation at admission and within 24hours after symptom onset. 相似文献10.
Objective
Intraventricular tissue plasminogen activator (alteplase) has been advocated for prevention of vasospasm in aneurysmal subarachnoid hemorrhage and treatment of traumatic or spontaneous intraventricular hemorrhage. External ventricular drain (EVD) insertion is often performed to manage increased intracranial pressure and hydrocephalus associated with these disease states. EVD-related ventriculitis is a serious infection with an up to 50% mortality rate.Methods
We assessed the EVD infection rate in patients receiving intraventricular alteplase over a 12-month period. Patients were divided into intraventricular alteplase and non-intraventricular alteplase groups; ventriculitis rates were compared.Results
EVDs were placed in 93 patients. Six of 7 (86%) patients who received intraventricular alteplase developed ventriculitis versus 4 of 86 (5%) patients in the non-intraventricular alteplase group (p < 0.0001).Conclusion
Intraventricular alteplase use may increase ventriculitis risk. Currently, we reserve intraventricular alteplase for patients with EVDs obstructed by hematoma accompanied by increased intracranial pressure. 相似文献11.
Ichiro Deguchi Norio Tanahashi Masaki Takao 《Journal of stroke and cerebrovascular diseases》2018,27(10):2627-2631
Background
Anticoagulant therapy is indicated for management of ischemic stroke patients with nonvalvular atrial fibrillation. We retrospectively investigated how oral anticoagulants were selected for ischemic stroke patients with nonvalvular atrial fibrillation.Methods
This study included 297 stroke patients with nonvalvular atrial fibrillation admitted to our hospital between September 2014 and December 2017, and who were subsequently transferred to other institutions or discharged home. Baseline clinical characteristics were compared between patients prescribed warfarin and those prescribed direct-acting oral anticoagulants.Results
In total, 280 of 297 (94.3%) patients received oral anticoagulant therapy, including 36 with warfarin, while 244 received direct oral anticoagulants. Age, percentage of heart failure, CHADS2 score before stroke onset, percentage of treatment with warfarin on admission, percentage of feeding tube at hospital discharge, and modified Rankin Scale at hospital discharge were significantly higher in the warfarin group versus the direct oral anticoagulants group, while creatinine clearance was significantly higher in the direct oral anticoagulant group. By multiple logistic regression, taking warfarin at admission and higher modified Rankin Scale at hospital discharge were associated with warfarin selection, while higher creatinine clearance was associated with direct oral anticoagulant selection (warfarin: odds ratio [OR] 7.10 [95% confidence interval {CI} 2.83-17.81]; modified Rankin Scale at hospital discharge: [OR] 1.47 [95% {CI} 1.06-2.04]; creatinine clearance: [OR] .97 [95% {CI} .95-.99]).Conclusions
Selection of oral anticoagulants in acute ischemic stroke patients with nonvalvular atrial fibrillation was influenced by warfarin use at admission, clinical severity at hospital discharge, and renal function. 相似文献12.
Kyu-Sun Choi Yu-Deok Won Hyeong-Joong Yi Tae Ho Lim Young-Jun Lee Hyoung-Joon Chun 《Clinical neurology and neurosurgery》2013
Objective
Aneurysmal subarachnoid hemorrhage (SAH) is a well-known cause of sudden cardio-pulmonary arrest (CPA). Even after successful cardio-pulmonary resuscitation (CPR), the prognosis of patients following an aneurysmal SAH presenting with CPA remains dismal. However, there have been anecdotal reports of good outcomes with appropriate interventions. Pseudo-SAH resulting from marked elevation of intracranial pressure (ICP) after CPR, can mimic SAH in head computed tomographic (CT) scan. Such manifestations hamper resuscitation or delay appropriate neurosurgical management. This study assessed incidence and clinical characteristics of SAH–CPR or pseudo-SAH–CPR patients among non-traumatic CPA–CPR patients, and investigated their therapeutic and prognostic implication.Methods
During the 5-year observation period, 63 non-traumatic coma patients with CT evidence of high attenuation areas in the basal cistern who suffered arrest and underwent CPR during initial resuscitation in the emergency room, were reviewed retrospectively. They were divided into two groups according to the imaging pattern: true-SAH vs. pseudo-SAH, and then true-SAH group were further divided into two groups according to the CT acquisition time: brain CT before arrest vs. brain CT after arrest. Demographic, clinical, and CT data were assessed, and the primary outcome was measured using the 30-day Glasgow Outcome Scale (GOS) score, and the final outcome was evaluated at the end of 3 months post-ictus.Results
When compared with pseudo-SAH (n = 28) patients, true-SAH (n = 35) patients showed a higher Hounsfield unit values in the affected area, earlier CT acquisition time before CPR, more survivors beyond 3 months (all p < 0.05); however, the 30-day survival rate was not significantly different. Of the true-SAH patients, ruptured intracranial aneurysms were found in eight patients, and definite intervention was administered in four patients. When SAH patients were categorized according to the temporal relationship with CPR, the group of 24 patients undergoing CT scan before CPR showed a lower frequency of intraventricular hemorrhage, but showed a higher chance of surgical treatment and survival at 30 days and 3 months compared to the group undergoing CT scan after CPR.Conclusion
The overall survival between true-SAH and pseudo-SAH group was different significantly. Administering definite treatment for a ruptured aneurysm in instances of true SAH could save patients, albeit infrequently. A Prompt CT scan could guarantee recognition of high-density area, blood in the ventricle, and subsequent identification of the ruptured aneurysm, altogether preventing re-bleeding and warranting further systemic resuscitation. 相似文献13.
Nohra Chalouhi Sonia Teufack Sid Chandela Richard Dalyai Stavropoula Tjoumakaris David M. Hasan Aaron S. Dumont L. Fernando Gonzalez Robert H. Rosenwasser Pascal M. Jabbour 《Clinical neurology and neurosurgery》2013
Objective
Aneurysmal subarachnoid hemorrhage (SAH) is relatively uncommon in young adults. There is a paucity of data pertaining to the management of aneurysmal SAH in young patients, especially with endovascular therapy.Methods
We reviewed all SAH patients under the age of 35 years treated at Jefferson Hospital for Neuroscience, Philadelphia, USA, from 2004 to 2009.Results
A total of 40 patients (15 males and 25 females) under the age of 35 were treated for aneurysmal SAH. The average patient age was 30 years (17–35 yo); 25 (62.5%) were smokers. Seventeen patients presented with a Hunt and Hess Grade I or II (42.5%), 20 with a Grade III (50%), and 3 with a Grade IV (7.5%). Thirty-two aneurysms (80%) were located in the anterior circulation and 8 (20%) in the posterior circulation. Thirty-five patients (87.5%) were treated with coil embolization versus 5 with craniotomy and clipping. The endovascular and microsurgical occlusion rates were 90.6% and 100%, respectively. There were no procedural complications with endovascular therapy. Of 35 patients undergoing endovascular treatment, 24 (68.6%) had excellent outcomes at time of discharge with a Glasgow outcome scale of 5. There were no deaths in the series. No patient experienced a rehemorrhage after endovascular treatment.Conclusion
Smoking, female sex, and anterior circulation aneurysms are highly prevalent in young adults with SAH. Endovascular treatment resulted in an overall favorable outcome with no rehemorrhages in patients under the age of 35 years. Our results suggest that endovascular therapy is a reasonable treatment for young patients with SAH. 相似文献14.
Objective and importance
Subarachnoid haemorrhage in pregnancy has traditionally been treated by surgical clipping however lately cases of successful coiling have been reported. Nevertheless, the long-term outcome of coiling is not well known in pregnant women. Mortality due to rebleeding of an incompletely treated aneurysm remains high. Only 15 cases of successful endovascular coiling during pregnancy have been reported so far.Clinical presentation
We report the case of a pregnant woman who presented with aneurysmal subarachnoid hemorrhage (WFNS Grade III) due to rupture of a right posterior communicating artery aneurysm.Intervention
The patient underwent endovascular coiling successfully followed by an elective caesarian section and delivery of a healthy baby. However, during the course of a 2-year follow up the patient had suffered two relapses of the coiled aneurysm which required additional treatment. These events have affected her choice of extending her family.Conclusion
The small risk of recurrence and the potential impact on future pregnancies should be explicitly communicated to patients in cases of endovascular coiling. 相似文献15.
Background
To analyze the management and outcome of patients presenting with atypical causes of intracranial subarachnoid hemorrhage (SAH).Methods
We performed a review of our last 820 nontraumatic-SAH patients and analyzed the management and outcome of patients where the SAH origin was not a ruptured aneurysm. The Glasgow Outcome Scale (GOS) was used to assess outcome 3 months after event.Results
Thirty-two patients had atypical causes of SAH. In 15 patients with Hunt and Hess (H&H) scores from 1 to 3 without focal neurological deficit (FND), 8 perimesencephalic nonaneurysmatic SAH, 4 blood coagulation disorders, 1 sinus thrombosis, 1 vasculitis, and 1 unknown-origin-SAH (UOS) were diagnosed. Fourteen (93%) of these 15 patients were conservatively treated. In 17 patients with H&H scores from 3 to 5 and FND, 8 tumors, 1 cavernoma, 1 sinus thrombosis, 1 arteriovenous malformation, 1 blood coagulation disorders, 2 UOS, and 3 dural fistulas were diagnosed. Fifteen (88%) of these 17 patients were interventionally treated. The neurological condition 3 months later was good (GOS 4 and 5) in 12 of the 15 cases (80%) admitted with low-H&H scores, as well as in 13 of the 17 cases (76%) admitted with high-H&H scores. Three patients died and four developed a severe disability.Conclusions
Patients presenting with atypical causes of SAH and high-H&H scores at admission are likely to harbor an intracranial organic process producing the bleeding. Despite this poor initial condition, their 3-month outcome can be similar to those of patients with low-H&H scores if the origin of the bleeding is properly treated. 相似文献16.
Georgios Tsermoulas Lisa FlettBarbara Gregson Patrick Mitchell 《Clinical neurology and neurosurgery》2013
Objective
Subarachnoid haemorrhage (SAH) may present with coma and this is known to be associated with aneurysmal origin and blood load. Aneurysmal origin is associated with increased blood load and existing data do not allow us to determine if the association between coma and aneurysmal SAH is wholly due to blood load or if aneurysmal origin has an additional independent effect. The objective of our study is to find if an aneurysmal origin is a predictor of acute onset of coma independent of blood load.Methods
A series of consecutive patients with spontaneous SAH were divided into two groups: aneurysmal (aSAH) and non-aneurysmal – angiographically negative SAH (naSAH). Blood load was quantified so that the effect of aneurysmal origin could be resolved from the effect of the amount of blood spilled. Non-parametric regression was used to relate blood load to coma and poor outcome rates for aneurysmal bleeds.Results
We analysed a total of 421 patients presenting during the period 2009–2011. Ninety aneurysmal cases presented with coma, seventy immediately in the early phase and seven shortly after rebleeding. None of the naSAH cases presented with immediate coma and 1 developed delayed coma. Delayed coma was associated with acute hydrocephalus in both groups. Aneurysmal origin was found to be an independent determinant of immediate coma (p = 0.02) and poor outcome (p < 0.001).Conclusion
Immediate coma and poor outcome in SAH are associated with an aneurysmal origin and do not characterize naSAH. 相似文献17.
Bourcier R Papagiannaki C Bibi R Cottier JP Herbreteau D 《Clinical neurology and neurosurgery》2012,114(9):1248-1253
Objective
The objective of this communication was to study the incidence and course of ICD and the long term outcome of this severe disease. The second goal was to analyze the different endovascular treatment modalities according to their long term results.Methods
It is a retrospective analysis of 14 patients with ICD admitted in a single center in two consecutive years, treated with endovascular procedures. Patients harbouring blister-like ruptured intracranial aneurysms were excluded from this study.Results
In this case series, 12 patients presented with subarachnoid hemorrhage (SAH) and 2 with brain stem symptoms. Mean age was 51 years and 13 patients were female. Six patients (43%) died and 8 (57%) survived with a mRS at 0–1. Mean follow up was 21 months.Conclusions
ICD as a cause of SAH seems to be more frequent than previously thought and usually has a severe course. It requires a high level of suspicion to diagnosis and specific endovascular treatment modalities are required for each location to ensure long term stability and change the poor prognosis. 相似文献18.
J. Michael Schmidt Michael Crimmins Hector Lantigua Andres Fernandez Chris Zammit Cristina Falo Sachin Agarwal Jan Claassen Stephan A. Mayer 《Neurocritical care》2014,20(3):390-398
Introduction
Sympathetic nervous system hyperactivity is common after subarachnoid hemorrhage (SAH). We sought to determine whether uncontrolled prolonged heart rate elevation is a risk factor for adverse cardiopulmonary events and poor outcome after SAH.Methods
We prospectively studied 447 SAH patients between March 2006 and April 2012. Prior studies define prolonged elevated heart rate (PEHR) as heart rate >95 beats/min for >12 h. Major adverse cardiopulmonary events were documented according to the predefined criteria. Global outcome at 3 months was assessed with the modified Rankin Scale (mRS).Results
175 (39 %) patients experienced PEHR. Nonwhite race/ethnicity, admission Hunt–Hess grade ≥4, elevated APACHE-2 physiological subscore, and modified Fisher score were significant admission predictors of PEHR, whereas documented pre-hospital beta-blocker use was protective. After controlling for admission Hunt–Hess grade, Cox regression using time-lagged covariates revealed that PEHR onset in the previous 48 h was associated with an increased hazard for delayed cerebral ischemia, myocardial injury, and pulmonary edema. PEHR was associated with 3-month poor outcome (mRS 4–6) after controlling for known predictors.Conclusions
PEHR is associated with major adverse cardiopulmonary events and poor outcome after SAH. Further study is warranted to determine if early sympatholytic therapy targeted at sustained heart rate control can improve outcome after SAH. 相似文献19.
Brouns R Heylen E Sheorajpanday R Willemse JL Kunnen J De Surgeloose D Hendriks DF De Deyn PP 《Clinical neurology and neurosurgery》2009,111(2):165-170
Introduction
Thrombolytic therapy improves clinical outcome in patients with acute ischemic stroke but is compromised by symptomatic intracranial hemorrhage and an unpredictable therapeutic response. In vitro and in vivo data suggest that activation of procarboxypeptidase U (proCPU) inhibits fibrinolysis.Aims
To investigate whether the extent of proCPU activation is related to efficacy and safety of thrombolytic therapy in ischemic stroke patients.Methods
In twelve patients with ischemic stroke who were treated with intravenous (n = 7) or intra-arterial (n = 5) thrombolysis, venous blood samples were taken at different time points before, during and after thrombolytic therapy. ProCPU and carboxypeptidase U (CPU, TAFIa) plasma concentrations were determined by HPLC. The maximal CPU activity (CPUmax) and the percentage of proCPU consumption during thrombolytic therapy were calculated. The efficacy and safety of the thrombolytic therapy were assessed by evolution of the clinical deficit, recanalisation, final infarct volume, thrombolysis-induced intracranial hemorrhage and mortality.Results
No correlations between CPUmax or proCPU consumption and patient or stroke characteristics were found. However, CPUmax is associated with evolution of the clinical deficit and achieved recanalisation. ProCPU consumption is related to the risk of intracranial hemorrhage, mortality and final infarct volume.Conclusions
Irrespective of patient and stroke characteristics, CPUmax and proCPU consumption during thrombolytic treatment for ischemic stroke are parameters for therapeutic efficacy and safety. Further evaluation of the clinical applicability of these parameters and further investigation of the potential role for CPU inhibitors as adjunctive therapeutics during thrombolytic treatment may be of value. 相似文献20.
Joseph Zachariah Kendall A. Snyder Christopher S. Graffeo Deependra R. Khanal Giuseppe Lanzino Eelco F. M. Wijdicks Alejandro A. Rabinstein 《Neurocritical care》2016,25(2):224-229