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1.
Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). We studied
differences in incidence and impact of DCI as defined clinically after coiling and after clipping in the International Subarachnoid
Aneurysm Trial. We calculated odds ratios (OR) for DCI for clipping versus coiling with logistic regression analysis. With
coiled patients without DCI as the reference group, we calculated ORs for poor outcome at 2 months and 1 year for coiled patients
with DCI and for clipped patients without, and with DCI. With these ORs, we calculated relative excess risk due to Interaction
(RERI). Clipping increased the risk of DCI compared to coiling in the 2,143 patients OR 1.24, 95% confidence interval (95%
CI 1.01–1.51). Coiled patients with DCI, clipped patients without DCI, and clipped patients with DCI all had higher risks
of poor outcome than coiled patients without DCI. Clipping and DCI showed no interaction for poor outcome at 2 months: RERI
0.12 (95% CI −1.16 to 1.40) or 1 year: RERI −0.48 (95% CI −1.69 to 0.74). Only for patients treated within 4 days, coiling
and DCI was associated with a poorer outcome at 1 year than clipping and DCI (RERI −2.02, 95% CI −3.97 to −0.08). DCI was
more common after clipping than after coiling in SAH patients in ISAT. Impact of DCI on poor outcome did not differ between
clipped and coiled patients, except for patients treated within 4 days, in whom DCI resulted more often in poor outcome after
coiling than after clipping. 相似文献
2.
The development of shunt-dependent hydrocephalus is a well-recognised complication after aneurysmal subarachnoid haemorrhage, and negatively impacts on outcomes among survivors. This study aimed to identify early predictors of shunt dependency in a large administrative dataset of aneurysmal subarachnoid haemorrhage patients. We reviewed the National Hospital Morbidity Database in Australia for the years 1998 to 2008 and investigated the incidence of ventricular shunt placement following aneurysmal subarachnoid haemorrhage admissions. Putative risk factors were evaluated with univariate and multivariate logistic regression analysis to identify independent predictors of outcome. The following variables were considered: poor admission neurological grade; aneurysm location; intracerebral haemorrhage; intraventricular haemorrhage; acute hydrocephalus requiring the insertion of an external ventricular drain; surgical clipping; endovascular coiling; meningitis; and prolonged period of external ventricular drainage. A total of 10 807 patients hospitalised for aneurysmal subarachnoid haemorrhage were identified. Among them, 701 (6.5%) required a permanent cerebrospinal fluid diversion procedure during the same admission as the aneurysmal subarachnoid haemorrhage. On multivariate analysis, poor admission neurological grade, acute hydrocephalus, the presence of intraventricular haemorrhage, ruptured vertebral artery aneurysm, surgical clipping, endovascular coiling, meningitis, and a prolonged period of external ventricular drainage were significant predictors of shunt dependency. A patient with a ruptured middle cerebral artery aneurysm was unlikely to develop shunt dependency (odds ratio 0.58; 95% confidence interval 0.46–0.73; p < 0.001). 相似文献
3.
Objective
Aneurysm treatment with endovascular coiling is associated with a better outcome than neurosurgical clipping in patients with
subarachnoid haemorrhage (SAH). The better outcome after coiling may decrease the risk reduction from other treatments in
these patients, and thus may increase sample sizes for current or future neuroprotective trials. The influence of the method
of aneurysm treatment was studied in our randomised MASH trial, which assessed in a factorial design the efficacy of magnesium
and aspirin in preventing delayed cerebral ischaemia (DCI) and poor outcome.
Methods
Between November 2000 and January 2004 315 patients were enrolled in the trial; 55 of them had no aneurysm treatment and were
excluded for the current analysis, 176 underwent neurosurgical and 84 endovascular treatment. The effect of treatment on the
risk of DCI was assessed by means of Cox proportional hazards modelling and that of poor outcome by means of logistic regression
analysis.
Results
The hazard ratio of DCI with aspirin was 1.4 (95 % CI 0.3 – 1.7) after coiling and 1.9 (0.8 – 4.4) after clipping, and with
magnesium 0.4 (0.1 – 1.2) after coiling and 0.8 (0.4 – 1.7) after clipping. The odds ratio of poor outcome with aspirin was
0.7 (0.2 – 2.9) after coiling and 0.8 (0.3 – 2.3) after clipping, and with magnesium 0.3 (0.1 – 1.0) after coiling and 0.8
(0.4 – 1.6) after clipping.
Conclusion
This post hoc analysis does not suggest that medical treatments are less effective after endovascular than after neurosurgical
treatment in patients with SAH, and thus do not support a need for adjusting sample size calculations in future trials.
Magnesium and Acetylsalicylic acid in Subarachnoid Haemorrhage (MASH) Study Group:
W. M. van den Bergh,A. Algra, S. M. Dorhout Mees,J. van Gijn,G. J. E. Rinkel,Dept. of Neurology,University Medical Centre
Utrecht,Utrecht, The Netherlands
Ale Algra,Julius Centre for Health Sciences and Primary Care,University Medical Centre Utrecht,Utrecht, The Netherlands
Fop van Kooten,Dept. of Neurology,Erasmus Medical Centre,Rotterdam, The Netherlands
Clemens M.F. Dirven,Dept. of Neurology,VU University Medical Centre,Amsterdam, The Netherlands
Marinus Vermeulen,Dept. of Neurology,Academic Medical CentreUniversity of Amsterdam,Amsterdam, The Netherlands
W. M. van den Bergh, MD, PhD ✉, Dept. of Intensive Care, Room Q04.460,University Medical Centre Utrecht,P.O. Box 85500,3508
GA, Utrecht, The Netherlands,Tel.: +31-30/2508350,Fax: +31-30/2522782,E-Mail: w.m.vandenbergh@umcutrecht.nl 相似文献
4.
Massive intraventricular haemorrhage (IVH) complicating aneurysmal subarachnoid haemorrhage (SAH) is associated with a poor
prognosis. Small observational studies suggest favourable results from fibrinolysis of the intraventricular blood. We performed
an observational study on IVH in a large series of patients with SAH to assess the proportion of patients that may benefit
from fibrinolytic treatment. From our prospective database we retrieved patients with aneurysmal SAH admitted between January
2000 and January 2005. We calculated the proportion of patients with massive IVH and the proportion of patients that are eligible
for fibrinolysis on basis of clinical and CT-scan characteristics and assessed neurological outcome in a treatment strategy
without fibrinolysis. Poor neurological condition was defined as World Federation of Neurological Surgeons scale 4 and 5,
poor outcome as death or dependence 3 months after SAH. Of the 573 patients admitted with aneurysmal SAH, 59 (10%; 95% confidence
interval CI 8–13%) had massive IVH, of which 55 were in poor clinical condition. For these 55 patients, the case-fatality
rate was 78% (95% CI 66–88%) and the proportion with poor outcome 91% (95% CI 81–97%). Of the 55 patients, 31 (56%, and 5%
of all patients SAH within the study period) fulfilled our eligibility criteria and were considered suitable for intraventricular
fibrinolysis. At 3 months, 30 of these 31 eligible patients (97%; 95% CI 85–100%) had a poor outcome. Massive IVH occurs in
10% of patients with aneurysmal SAH. Half of these patients may benefit from intraventricular fibrinolysis. Without fibrinolysis
outcome is almost invariably poor in these patients. 相似文献
5.
Varelas PN Schultz L Conti M Spanaki M Genarrelli T Hacein-Bey L 《Neurocritical care》2008,9(3):293-299
Introduction Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a
full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences
Intensive Care Unit (NICU).
Methods Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month
periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral
hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate
analyses.
Results One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the period after the NI.
Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs.
54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period
(Cox proportional hazard ratios, 95% CI were 2.37, 1.4–4.1 and 1.8, 1.04–3 for IS, 1.98, 1.3–3 and 1.2, 0.8–1.9 for ICH, and
1.6, 1.1–2.3 and 1.4, 1.01–2 for SAH, respectively) or for all strokes (1.92, 1.52–2.43 and 1.7, 1.28–2.25 for the first 12 days
of hospital admission).
Conclusion The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and
improved the disposition of patients with strokes admitted to a NICU. 相似文献
6.
Intracerebral haematoma (ICH) occurs in one-third of patients with aneurysmal subarachnoid haemorrhage (SAH) and is associated
with poor prognosis. Identification of risk factors for ICH from aneurysmal rupture may help in balancing risks of treatment
of unruptured aneurysms. We assessed potential clinical and aneurysmal risk factors for ICH from aneurysmal rupture. In all
310 SAH patients admitted to our service between 2005 and 2007, we compared clinical risk factors (gender, age, smoking, hypertension,
history of SAH and family history) of patients with and without an ICH. From the latest admitted, 50 patients with and 50
without ICH, we compared the location, shape and direction of blood flow of the aneurysms on CT-angiography. Relative risks
(RRs) of ICH were 1.2 (95% confidence interval, CI):0.7–1.8) for males, 1.0 (95%CI:0.7–1.4) for age ≥55 year, 1.0 (95%CI:0.6–1.6)
for smoking, 0.9 (95%CI:0.5–1.5) for hypertension, 0.6 (95%CI:0.1–3.8) for history of SAH and 0.5 (95%CI:0.2–1.3) for family
history of SAH. RRs of ICH were 1.8 (95%CI:1.2–2.5) for MCA aneurysms, 0.5 (95%CI:0.3–1.0) for ICA aneurysms, 0.4 (95%CI:0.1–1.3)
for posterior circulation aneurysms, and 0.7 (95%CI:0.3–1.3) for multilobed aneurysms. The RRs of other aneurysmal characteristics
varied between 0.9 and 1.2. Patients with MCA aneurysms are at a higher risk of developing ICH. The other aneurysmal or clinical
factors have no or only minor influence on the risk of ICH after rupture and are, therefore, not helpful in deciding on treatment
of unruptured aneurysms. 相似文献
7.
Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage 总被引:1,自引:0,他引:1
J. Michael Frangiskakis Marilyn Hravnak Elizabeth A. Crago Masaki Tanabe Kevin E. Kip John Gorcsan III Michael B. Horowitz Amin B. Kassam Barry London 《Neurocritical care》2009,10(3):287-294
Introduction Cardiac morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH) are attributable to myocardial injury, decreased
ventricular function, and ventricular arrhythmia (VA). Our objective was to test the relationships between QTc prolongation,
VA, and survival after SAH.
Methods In 200 subjects with acute aneurysmal SAH, electrocardiograms, echocardiograms, and telemetry were evaluated. Serum electrolytes
and troponin were also evaluated.
Results Initial QTc (mean 460 ± 45 ms) was prolonged (≥470 ms) in 38% of subjects and decreased on follow-up (469 ± 49 initial vs.
435 ± 31 ms follow-up; N = 89; P < 0.0001). VA was present in 14% of subjects, 52% of subjects with VA had QTc ≥ 470 ms, and initial QTc trended toward longer
duration in subjects with VA (474 ± 61 vs. 457 ± 42 ms; P = 0.084). Multivariate analysis demonstrated significant predictors of VA after SAH were increasing age (OR 1.3/5 years;
P = 0.025), increasing stroke severity (OR 1.8; P = 0.009), decreasing heart rate (OR 0.5/10 beats/min; P= 0.006), and the absence of angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist use at SAH onset
(OR 0.10; P = 0.027). All-cause mortality was 19% (25/135) at 3 months and subjects with VA had significantly higher mortality than those
without VA (37% vs. 16%; P = 0.027).
Conclusions These data demonstrate that QTc prolongation and arrhythmias are frequently noted after SAH, but arrhythmias are often not
associated with QTc prolongation. In addition, the presence of VA identified subjects at greater risk of mortality following
their SAH. 相似文献
8.
Alan K. H. Tam Don Ilodigwe Jay Mocco Stephan Mayer Neal Kassell Daniel Ruefenacht Peter Schmiedek Stephan Weidauer Alberto Pasqualin R. Loch Macdonald 《Neurocritical care》2010,13(2):182-189
Background
Systemic inflammatory response syndrome (SIRS) may develop after aneurysmal subarachnoid hemorrhage (SAH). We investigated factors associated with SIRS after SAH, whether SIRS was associated with complications of SAH such as vasospasm, cerebral infarction, and clinical outcome, and whether SIRS could contribute to a difference in outcome between patients treated by endovascular coiling or neurosurgical clipping of the ruptured aneurysm. 相似文献9.
Kothavale A Banki NM Kopelnik A Yarlagadda S Lawton MT Ko N Smith WS Drew B Foster E Zaroff JG 《Neurocritical care》2006,4(3):199-205
Introduction Cardiac abnormalities that have been reported after subarachnoid hemorrhage (SAH) include the release of cardiac biomarkers,
electrocardiographic changes, and left ventricular (LV) systolic dysfunction. The mechanisms of cardiac dysfunction after
SAH remain controversial. The aim of this study was to determine the prevalence of LV regional wall motion abnormalities (RWMA)
after SAH and to quantify the independent effects of specific demographic and clinical variables in predicting the development
of RWMA.
Methods Three hundred patients hospitalized with SAH were prospectively studied with serial echocardiography. The primary outcome
measure was the presence of RWMA. The predictor variables included the admission Hunt & Hess grade, age, gender, cardiac risk
factors, aneurysm location, plasma catecholamine levels, cardiac troponin I (cTi) level, heart rate (HR), blood pressure,
and phenylephrine dose. Univariate and multivariate logistic regression was performed with adjustment for serial measurements,
reporting olds ratios (OR) and 95% confidence intervals (CI).
Results In this study, 817 echocardiograms were analysed. RWMA were detected in 18% of those studied. The prevalence of RWMA in patients
with Hunt & Hess grades 3–5 was 35%. Among patients with a peak cTi level grater than 1.0 μg/L, 65% had RWMA. Multivariate
analysis demonstrated that high Hunt & Hess grade (OR 4.22 for grade 3–5 versus grade 1–2, p=0.046), a cTi level greater than 1.0 μg/L (OR 10.47, p=0.001), a history of prior cocaine or amphetamine use (OR 5.50, p=0.037), and higher HR (OR 1.34 per 10 bpm increase, p=0.024) were predictive of RWMA.
Conclusions RWMA were frequent after SAH. High-grade SAH, an elevation in cTi levels, a history of prior stimulant drug use, and tachycardia
are independent predictors of RWMA. 相似文献
10.
Karsten Schöller Maike Massmann Gertraud Markl Mathias Kunz Gunther Fesl Hartmut Brückmann Thomas Pfefferkorn Jörg-Christian Tonn Christian Schichor 《Journal of neurology》2013,260(4):1052-1060
The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60–69, 70–79, and ≥80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60–69, 93 aged 70–79, 25 aged ≥80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1–154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I–III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I–III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis. 相似文献
11.
Wei-Ju Lee Shuu-Jiun Wang Li-Chi Hsu Jiing-Feng Lirng Chen-Hao Wu Jong-Ling Fuh 《Journal of neurology》2010,257(10):1675-1681
In this study, our objective was to identify the characteristic morphological features of brain MRI associated with a positive
cerebrospinal fluid (CSF) tap test in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients diagnosed with
clinical suspected iNPH were evaluated. All patients underwent a mini-mental state examination, a brain MRI, and a CSF tap
test. The severities of clinical symptoms were rated before and after the CSF tap test. Characteristic brain MRI findings
including frontal convexity narrowing, parietal convexity narrowing, upward bowing of the corpus callosum, empty sella, narrowing
of the CSF space at the high convexity, marked dilatation of the Sylvian fissure, and disproportion between narrowing of the
CSF space at the high convexity and dilatation of the Sylvian fissure (“mismatch” sign) on T1-weighted or FLAIR image were
analyzed. Forty-three patients (33 males/ten females, mean age 76.9 ± 6.9 years) with possible iNPH participated in this study.
The presence versus absence of empty sella (52.4 vs. 14.3%, OR 6.6, 95% CI 1.5–29.4, p = 0.02) and “mismatch” sign (45.5 vs. 9.5%, OR 7.9, 95% CI 1.5–42.5, p = 0.02) were associated with positive CSF tap test responses. The sensitivity, specificity, positive predictive value, and
negative predictive value of the presence of either of these two MRI features in the prediction of CSF tap response were 72.7,
81, 80, and 73.9%, respectively. Specific brain MRI features can be used as markers for the identification of potential CSF
tap test responders in iNPH patients. These features may serve as supplemental evidence in the diagnosis of iNPH patients. 相似文献
12.
Introduction: Increases in cerebral blood flow velocity (CBFV) as measured by transcranial Doppler (TCD) sonography are reflective of cerebral
vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). In serial TCD measurements, some patients exhibit CBFV
temporal profiles with two peaks (biphasic). The significance of this finding remains unclear. This retrospective case-control
study was conducted to investigate the characteristics and possible predictors of biphasic CBFV profiles.
Methods: Biphasic CBFV profiles were identified in serial TCD examinations (every 1–2 days) of 182 consecutive patients admitted for
aneurysmal SAH based on CBFV profiles of the middle cerebral artery on the side of higher maximum velocity. Patients undergoing
angioplasty were excluded. Patients meeting these criteria (study patients) were compared to control patients matched for
age and Hunt and Hess grade.
Results: Eighteen patients (9.9%) demonstrated biphasic CBFV profiles. The first CBFV (134±11 cm/second) peak occurred on post-SAH
day 6±1, and the second peak (148±12 cm/second) on day 13±1. Study patients more often exhibited focal (p<0.05) symptoms at the time of the first peak. No patient deteriorated neurologically at the time of the second peak. No correlation
was observed between CBVF and mean arterial pressure or central venous pressure trends.
Conclusion: Serial TCD assessment identifies patients with SAH and a biphasic CBFV temporal profile. Although the second peak usually
is not associated with a worsening of symptoms, these patients were more likely to exhibit clinical symptoms during the first
CBFV peak. 相似文献
13.
Kyung-Hun Nam In-Suk Hamm Dong-Hun Kang Jaechan Park Yong-Sun Kim 《Journal of Korean Neurosurgical Society》2010,48(4):313-318
Objective
The amount of hemorrhage observed on a brain computed tomography scan, or a patient''s Fisher grade (FG), is a powerful risk factor for development of shunt dependent hydrocephlaus (SDHC). However, the influence of treatment modality (clipping versus coiling) on the rate of SDHC development has not been thoroughly investigated. Therefore, we compared the risk of SDHC in both treatment groups according to the amount of subarachnoid hemorrhage (SAH).Methods
We retrospectively reviewed 839 patients with aneurysmal SAH for a 5-year-period. Incidence of chronic SDHC was analyzed using each treatment modality according to the FG system. In addition, other well known risk factors for SDHC were also evaluated.Results
According to our data, Hunt-Hess grade, FG, acute hydrocephalus, and intraventricular hemorrhage were significant risk factors for development of chronic SDHC. Coiling group showed lower incidence of SDHC in FG 2 patients, and clipping groups revealed a significantly lower rate in FG 4 patients.Conclusion
Based on our data, treatment modality might have an influence on the incidence of SDHC. In FG 4 patients, the clipping group showed lower incidence of SDHC, and the coiling group showed lower incidence in FG 2 patients. We suggest that these findings could be a considerable factor when deciding on a treatment modality for aneurysmal SAH patients, particularly when the ruptured aneurysm can be occluded by either clipping or coiling. 相似文献14.
Hana Přikrylová Vranová Jan Mareš Martin Nevrlý David Stejskal Jana Zapletalová Petr Hluštík Petr Kaňovský 《Journal of neural transmission (Vienna, Austria : 1996)》2010,117(10):1177-1181
Parkinson’s disease (PD) is a chronic, progressive, neurodegenerative disease with a multifactorial etiology. Protein accumulation
is speculated by some to play a prominent role in the pathogenesis of PD. The severity of neurodegeneration should correlate
with cerebrospinal fluid (CSF) levels of these neurodegenerative markers (NDMs). The aims of the study were to assess the
CSF levels of tau protein, beta-amyloid (1–42), cystatin C, and clusterin in patients suffering from PD and in a control group,
to compare the CSF levels between the two groups and to correlate them to PD duration. NDMs in the CSF were assessed in 32
patients suffering from PD and in a control group (CG) of 30 patients. The following statistically significant differences
in the CSF were found: higher tau protein (p = 0.045) and clusterin levels (p = 0.004) in PD patients versus CG; higher tau protein levels (p = 0.033), tau protein/beta-amyloid (1–42) ratio (p = 0.011), and clusterin (p = 0.044) in patients suffering from PD for <2 years versus patients suffering PD for more than 2 years. No differences between
beta-amyloid (1–42) and cystatin C CSF levels were found in the CG and PD patients groups. Significantly higher tau protein
and clusterin CSF levels in the group of PD patients with disease duration of <2 years probably reflect the fact that most
neurodegenerative changes in PD patients occur in the initial stage of disease. 相似文献
15.
Delayed cerebral ischemia(DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage(SAH).We studied differences in incidence and impact of DCI as defined clinically after coiling and after clipping in the International Subarachnoid Aneurysm Trial.We calculated odds ratios(OR) for DCI for clipping versus coiling with logistic regression analysis.With coiled patients without DCI as the reference group,we calculated ORs for poor outcome at 2 months and 1 year for coiled patients with DCI and for clipped patients without,and with DCI.With these ORs,we calculated relative excess risk due to Interaction(RERI).Clipping increased the risk of DCI compared to coiling in the 2,143 patients OR 1.24,95% confidence interval(95% CI 1.01-1.51).Coiled patients with DCI,clipped patients without DCI,and clipped patients with DCI all had higher risks of poor outcome than coiled patients without DCI.Clipping and DCI showed no interaction for poor outcome at 2 months: RERI 0.12(95% CI-1.16 to 1.40) or 1 year: RERI-0.48(95% CI-1.69 to 0.74).Only for patients treated within 4 days,coiling and DCI was associated with a poorer outcome at 1 year than clipping and DCI(RERI-2.02,95% CI-3.97 to-0.08).DCI was more common after clipping than after coiling in SAH patients in ISAT.Impact of DCI on poor outcome did not differ between clipped and coiled patients,except for patients treated within 4 days,in whom DCI resulted more often in poor outcome after coiling than after clipping. 相似文献
16.
Ramappa P Thatai D Coplin W Gellman S Carhuapoma JR Quah R Atkinson B Marsh JD 《Neurocritical care》2008,8(3):398-403
Background Release of cardiac biomarkers is reported in patients
with subarachnoid hemorrhage (SAH). Data addressing the impact of cardiac injury on outcome in these patients is
sparse. This study was conducted to ascertain the association of elevation of serum cardiac Troponin-I (cTnI) with
mortality and neurological outcome in patients with SAH.
Methods Medical records of all patients admitted with a diagnosis
of SAH and at least one measured cTnI were reviewed. Demographic and clinical variables including admission neurological
status were collected. Conservative and non-parametric statistics were used to assess association between cTnI and
death or neurological outcome at discharge.
Results The study group comprised of 83 patients with a mean
age of 59 years. There was a female (60%) and African-American (60%) preponderance. At admission, the median Glasgow Coma
Scale (GCS) was 9, and 47% had a severe Hunt–Hess grade (HHG) of ≥4. Elevation of cTnI was found in 31 (37%) patients and
was associated with worse baseline Fisher grade (p=0.01) and neurological status: GCS score (p=0.006) and HHG (p=0.007). Patients with abnormal cTnI were more likely to die (55% vs.27%; odds ratio 1.3–8.4, p = 0.01) and had a worse GCS score (p = 0.008) and HHG (p = 0.004) on discharge. On multivariate analysis, peak cTnI (p = 0.04) and admission GCS score of <12 (p = 0.02) were independent predictors of death at discharge.
Conclusion Patients with subarachnoid hemorrhage and elevated
cTnI are found to have worse neurological status at admission. These patients have a worse neurological outcome and in-hospital
mortality. 相似文献
17.
Anil Gopinathan Swati Jain Sein Lwin Kejia Teo Cunli Yang Vincent Nga Tseng Tsai Yeo 《Journal of stroke and cerebrovascular diseases》2021,30(8):105910
ObjectivesThe role of flow-diversion in acute sub-arachnoid haemorrhage (SAH) is controversial. Many of the published data warns of high rates of procedure-related complications and aneurysmal rebleed. This study evaluates the safety, efficacy, clinical and angiographic outcomes of acute flow-diversion at our institute.MethodsThe institutional database from June 2015 to June 2020 was retrospectively reviewed for aneurysmal SAH (aSAH) treated with flow diversion. Clinical presentation, procedural details, complications, anti-platelet usage, rebleeding and aneurysm occlusion rates and outcomes were recorded.Results22 (59% females; median age 56 years) consecutive patients were identified. None of them were on regular antiplatelets/anticoagulation in the 15-days preceding the treatment. The mean aneurysm diameter was 5.4 mm and the median delay to flow-diversion was 2 days. Almost 73% (16/22) of patients had adjunctive coiling in the same session. There was no aneurysmal rebleed at a median follow up of 8.5 months and 86.3% (19/22 patients) had good clinical outcomes (3-month MRS 0–2). Adverse events related to the flow diversion procedure were seen in 3 patients; none of them had a medium to long-term clinical consequence. Three patients died from complications of SAH, unrelated to the procedure. Vascular imaging follow-up was available for 20 patients and the complete aneurysm occlusion rate was 95%.ConclusionFlow-diversion could be a reasonably safe and effective technique for treating ruptured aneurysms in appropriately selected patients when conventional options of surgical clipping and coiling are considered challenging. 相似文献
18.
Naidech AM Bendok BR Tamul P Bassin SL Watts CM Batjer HH Bleck TP 《Neurocritical care》2009,10(1):11-19
Introduction Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may
decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid
(SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted
patients.
Methods We prospectively recorded admission characteristics, hospital complications, and LOS for 122 patients with SAH and 56 patients
with ICH from February 2006 through March 2008. A multidisciplinary Neuro-ICU team included a dedicated pharmacist and intensivist
on daily rounds. Hospital protocols set glucose control with intravenous insulin, ventilator bundles, pharmacist involvement,
and hand hygiene. Associations were explored with univariate statistics (t-tests, ANOVA, or non-parametric statistics as appropriate) and linear regression (repeated after log transformation of ICU
and hospital LOS).
Results Factors associated with longer LOS after SAH and ICH were similar. In both SAH and ICH the strongest drivers of LOS were infection,
fever, and acute lung injury. For SAH, vasospasm and Glasgow Coma Scale were also significant in some models, while in patients
with ICH the volume of the initial bleed was significant in some models.
Conclusion LOS after spontaneous brain hemorrhage is driven by medical complications even after the adoption of dedicated intensive care
medical staff, pharmacist involvement, and evidence-based protocols for ICU care. Further alterations in care will be necessary
to eliminate “preventable” complications and minimize LOS after brain hemorrhage. 相似文献
19.
Chia-Chang Hsieh Jen-Her Lu Shu-Jen Chen Cheng-Chou Lan Wen-Chi Chow Ren-Bin Tang 《Child's nervous system》2009,25(4):461-465
Purpose Certain cytokines play important roles in the pathophysiology of meningitis. The main purpose of this study was to investigate
if the levels of interleukin-6 (IL-6) and interleukin-12 (IL-12) in cerebrospinal fluid (CSF) could be diagnostic predictors
of bacterial meningitis in children.
Methods CSF was obtained from 95 patients suspected with meningitis. These cases were classified to the bacterial meningitis (n = 12), aseptic meningitis (n = 41), and nonmeningitis (n = 42) groups. The levels of IL-6 and IL-12 in CSF were measured using the enzyme-linked immmunosorbent assays test.
Results The CSF IL-6 levels in the bacterial meningitis group (45.2 ± 50.0 pg/ml) were significantly higher than those in the aseptic
meningitis group (12.9 ± 10.2 pg/ml) and the nonmeningitis group (6.5 ± 7.8 pg/ml; p < 0.05). The CSF IL-12 levels in the bacterial meningitis group (69.8 ± 67.1 pg/ml) were significantly higher than those
in the aseptic meningitis group (22.9 ± 10.8 pg/ml) and the nonmeningitis group (15.3 ± 11.2 pg/ml; p < 0.05). With regard to diagnosis, the measurement of CSF IL-6 and IL-12 levels showed sensitivities of 96% and 96%, respectively,
and specificities of 51% and 75%, respectively.
Conclusion It is suggested that the CSF IL-6 and IL-12 levels are useful markers for distinguishing bacterial meningitis from aseptic
meningitis. 相似文献
20.
Andreas H. Kramer David A. Zygun Thomas P. Bleck Aaron S. Dumont Neal F. Kassell Bart Nathan 《Neurocritical care》2009,10(2):157-165
Objective Anemia predicts poor outcome following aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that this association would
be stronger among patients with more severe SAH, since these patients are likely to be more vulnerable to secondary brain
injury in the form of reduced cerebral oxygen delivery.
Methods Daily nadir hemoglobin (Hb) concentrations over 2 weeks following SAH were retrieved in 245 consecutive patients, and compared
between those with a favorable versus unfavorable outcome. The analysis was repeated with patients dichotomized as follows:
WFNS score 4–5 vs. 1–3; modified Fisher score (MFS) 4 vs. 0–3; and vasospasm present vs. absent. Mixed effect models and multivariable
analysis using the generalized estimating equation were employed to assess correlated data with repeated measures.
Results Patients with an unfavorable outcome consistently had lower Hb concentrations, especially between days 6–11 following SAH
(P ranging from <0.001 to 0.009), as well as a greater fall in Hb over time (β = −0.07, P < 0.001). This was true regardless of WFNS score, MFS, or the presence or absence of vasospasm. However, the effect was somewhat
more pronounced among patients with higher WFNS and modified Fisher scores.
Conclusion Lower Hb levels are associated with worse outcomes regardless of SAH severity or the development of vasospasm. This finding
may imply that a lower Hb concentration is largely a marker for a greater degree of systemic illness, rather than necessarily
causing direct harm. However, the association is somewhat stronger among patients with more severe SAH. Thus, if there is
a benefit for maintaining higher Hb levels with transfusions or erythropoietin, it may be more pronounced among these patients.
Supported in part by the Louise Nerancy endowment of The University of Virginia. 相似文献