BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage....BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.展开更多
Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP p...Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.展开更多
BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hem...BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.展开更多
Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatm...Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.展开更多
Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 ane...Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ≥ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. Results The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of 〈 30 U/L, 30-50 U/L and ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively （P 〈 0.01）. The age-sex and multivariable adjusted odds ratios （95% confidence intervals） of poor prognosis comparing the top group （≥ 50 U/L） with the lowest group （〈 30 U/L） were 5.76 （2.74-12.13）, 6.64 （2.05-21.52）, and 6.36 （1.92-21.02）. A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. Conclusion Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage.展开更多
The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and p...The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.展开更多
Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and ...Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission（within 48 hours after initial hemorrhage） and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.展开更多
●AIM:To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage(SAH).●METHODS:This retrospective,interventional study included...●AIM:To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage(SAH).●METHODS:This retrospective,interventional study included 31 patients with aneurysmal SAH,and the medical records were reviewed.In addition to baseline characteristics of the study population such as age,sex,and underlying medical history,multi-modal imaging analysis,including fluorescein angiography(FA),spectral domain optical coherence tomography(SD-OCT),were also reviewed.Glasgow Coma Scale(GCS),Hunt-Hess(HH)grade,and Fisher scale at the time of admission,and functional outcome by using modified Rankin Scale(mRS)at 6 mo were compared.●RESULTS:Of the 31 patients,10 patients(32.3%)were diagnosed with Terson syndrome.All the patients with Terson syndrome did not report visual symptoms at the time of ophthalmologic screening.FA showed microvascular changes of retinal capillaries and varying degrees of disc leakage.SD-OCT allowed intuitive anatomical localization of multi-layered retinal hemorrhages and assessment of ellipsoid zone integrity.The patients with Terson syndrome showed significantly worse GCS(P=0.047)and HH grade(P=0.025)than those without,except Ficher scale(P=0.385).There was no significant difference in the mRS(P=0.250)at 6 mo.Among baseline factors,the HH grade was the only significant factor associated with Terson syndrome(B=1.079,P=0.016).●CONCLUSION:In our study,32.3%of the patients have Terson syndrome without visual symptoms.The baseline HH grade is significantly correlated with Terson syndrome,and there is no significant difference in the functional outcome between the patients with and without Terson syndrome.Terson syndrome may develop without any visual symptoms as shown in our study,and ophthalmologic screening may be recommended to prevent further visual deterioration especially in the patients with poor HH grade at the time of aneurysmal SAH.展开更多
Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, T...Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, TLR4 is expressed in various cell types in the central nervous system, and is unique in that it can signal through both the myeloid differentiation primary-response protein 88-dependent and the toll receptor associated activator of interferon-dependent cascades to coordinate the maximal inflammatory response. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of an intracranial aneurysm, and the resultant inflammatory reaction and thereby tissue damages may furthermore activate TLR4. It is widely accepted that the excreted products of TLR4 signaling alter neuronal functions. Previous studies have focused on the pathway through nuclear factor（NF）-κΒ signaling among TLR4 signaling pathways as to the development of early brain injury（EBI） such as neuronal apoptosis and blood-brain barrier disruption, and cerebral vasospasm. However, many findings suggest that both pathways via NF-κΒ and mitogen-activated protein kinases may be involved in EBI and cerebral vasospasm development. To overcome EBI and cerebral vasospasm is important to improve outcomes after SAH, because both EBI and vasopasm are responsible for delayed brain injuries or delayed cerebral ischemia, the most important preventable cause of poor outcomes after SAH. Increasing evidence has shown that TLR4 signaling plays an important role in SAH-induced brain injuries. Better understanding of the roles of TLR4 signaling in SAH will facilitate development of new treatments.展开更多
Subarachnoid hemorrhage（SAH）caused by the rupture of a cerebral aneurysm is a well-known devastating cerebrovascular disease.Post-SAH brain is vulnerable,associated with early brain injury（EBI;Suzuki,2015）.
This study aimed to determine the effectiveness of comprehensive rehabilitation for patients with aneurysmal subarachnoid hemorrhage (aSAH) and to explore the factors influencing the prognosis of rehabilitation. This ...This study aimed to determine the effectiveness of comprehensive rehabilitation for patients with aneurysmal subarachnoid hemorrhage (aSAH) and to explore the factors influencing the prognosis of rehabilitation. This was a retrospective study. Twenty-five patients with aSAH were treated with physical therapy, occupational therapy, speech therapy, cognitive therapy, music therapy, Chinese acupuncture, hyperbaric oxygen, and transcranial magnetic stimulation. The general data of all patients were collected, and the functional scores at admission were compared with those at discharge. The Mini Mental State Examination, Fugl-Meyer Assessment Scale (FMAS) for motor and balance assessment, Holden Functional Ambulation Classification (FAC), modified Rankin Scale, National Institute of Health Stroke Scale, Modified Barthel Index for activities of daily living (ADL), and Glasgow Outcome Scale were significantly improved among 25 patients with aSAH after 1 month of comprehensive rehabilitation training. Hydrocephalus was an independent factor of the ability to perform ADLs (odds ratio, 0.29;95% confidence interval, 2.03. 3.15;p = 0.000). The improvement of ADLs in aSAH patients was not related to sex, surgical method, aneurysm location, age, or smoking status. Comprehensive and professional rehabilitation is effective for the cognition, movement, walking, ADLs, and functional prognosis of patients with aSAH, while early hydrocephalus may be a risk factor for poor ADLs.展开更多
Background: Intracranial vasospasm is a common complication following subarachnoid hemorrhage (SAH). The radiographic vasospasm can reach up to 90% of aneurysmal SAH. Materials and Methods: 139 consecutive patients ad...Background: Intracranial vasospasm is a common complication following subarachnoid hemorrhage (SAH). The radiographic vasospasm can reach up to 90% of aneurysmal SAH. Materials and Methods: 139 consecutive patients admitted to Cairo University Hospitals from June 2013 to September 2014 with SAH who had been enrolled in a retrospective controlled study were analyzed retrospectively for the occurrence of vasospasm. The data collected from the charts of Cairo University Hospitals were the patient’s demographics, clinical presentation, aneurysm location, treatment modality, and Glasgow Outcome Scale (GOS) scores. We excluded 24 patients with nonaneurysmal SAH, 3 internal carotid artery (ICA) aneurysms, 7 with multiple aneurysms and 4 patients died before treatment. Results: 72 males and 29 females were included in the study, mean age 53.5 ± 11.5 years. Twelve patients had aneurysms located in the vertebral artery group, 24 had middle cerebral artery aneurysms, 11 had pericallosal aneurysms, and 54 patients had anterior communicating artery (ACoA) complex aneurysms. Radiographic vasospasm occurred in 62.4% with the highest incidence (75.9%) at the ACoA complex group. Symptomatic vasospasm occurred in 48.5% with the highest incidence (63%) at the anterior communicating artery complex aneurysm location. The mean GOS at 6 months follow-up was 4.2. The worse GOS was found in the vertebral artery (VA) aneurysm group with a mean of 3.75. Conclusion: Aneurysms of the anterior communicating artery complex group have a greater risk of both radiographic and clinical vasospasm. Also, the worse 6 months follow-up GOS when an aneurysm was located in the VA group.展开更多
Objective:to evaluate the clinical efficacy and safety of ultra-early lumbar puncture drainage of cerebrospinal fluid(CSF)in patients with aneurysmal subarachnoid hemorrhage(SAH).Methods:patients(n=140)with aneurysmal...Objective:to evaluate the clinical efficacy and safety of ultra-early lumbar puncture drainage of cerebrospinal fluid(CSF)in patients with aneurysmal subarachnoid hemorrhage(SAH).Methods:patients(n=140)with aneurysmal SAH were randomly divided into observation group(n=70)and control group(n=70).After admission,CSF was drained by ultra-early lumbar puncture in the observation group and intermittent lumbar puncture after aneurysm operation in the control group.The incidences of early aneurysm rupture,acute hydrocephalus and delayed hydrocephalus were compared between the two groups.Results:there was no significant diflerence in the incidence of early-ruptured aneurysm and acute hydrocephalus between the two groups,but the incidence of delayed hydrocephalus in the observation group was significantly lower than that in the control group.Conclusion:ultra-early lumbar puncture drainage of CSF in anexirysmal SAH can effectively reduce the incidence of long-term delayed hydrocephalus and it is a safe and effective treatment.展开更多
We describe hyperacute generalized EEG slowing and then attenuation captured at the moment of subarachnoid hemorrhage in a monitored patient. This is the first reported cEEG capture of aneurysmal subarachnoid hemorrha...We describe hyperacute generalized EEG slowing and then attenuation captured at the moment of subarachnoid hemorrhage in a monitored patient. This is the first reported cEEG capture of aneurysmal subarachnoid hemorrhage in the literature.展开更多
Objective To explore the therapeutic effect of preoperative external lumbar drainage in Hunt and Hess grade Ⅰ～Ⅲ patients with subarachnoid hemorrhage (SAH) undergoing early surgery for intracranial aneurysms. Metho...Objective To explore the therapeutic effect of preoperative external lumbar drainage in Hunt and Hess grade Ⅰ～Ⅲ patients with subarachnoid hemorrhage (SAH) undergoing early surgery for intracranial aneurysms. Methods 101 cases of gradeⅠ～Ⅲ patients according to the classification of Hunt and Hess展开更多
AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocep...AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocephalus after an-eurysm treatment. Data were divided by type of study （randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study）. They were also divided by type of aneurysm treatment （microvascular - clipping, or endo-vascular - coiling）. Additional predictive variables collected for each publication were average age, gender distribu-tion, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treat-ment, duration of follow-up and date of publication. Weemployed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.RESULTS： Because indications for the two treatments are different, there is little clinical equipoise for treat-ing most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Nei-ther this nor pooled values from other studies which compared the two treatments had the power to dem-onstrate signifcant differences between the two treat-ments. Nor was there an apparent difference when observational data were meta-analytically pooled. How-ever, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference ap-peared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocepha-lus was found to be significantly lower in coiled vsclipped cases （P = 0.014）.CONCLUSION： Pooled observational data were nec-essary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.展开更多
“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological ...“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological sequelae”. It is one among the neurological emergencies which is a very distressing cerebrovascular disease with complicated mechanisms that risks brain perfusion and its function, having higher morbidity and mortality rates. Its mortality rate is still ranged between 8.3% and 66.7%, with noticeable regional variations, beside recent advances in treatment approaches. The incidence of SAH among the population of 2 - 22.5/100,000 was reported with a minimum of 60% of aneurysm ruptures occurring amid ages of 40 and 60 years with 3:2 male:female ratio. The rupture risks for unruptured aneurysms are increased by the issues like present smokers, larger size of aneurysm, and amid young population. The surgical treatment decision should be contemplated upon factors such as aneurysm’s size, aneurysm’s location, patient’s illness history, and surgeon’s operative experiences. Latest technical progresses in imaging techniques, increased consideration of illness history, more awareness of incidences of aneurysms and use of micro neurosurgery, have raised the chance for detection of subarachnoid hemorrhage (SAH) and possible better outcomes with surgical management. Factors that may affect outcome include age, size and site of aneurysm, interval between ictus and surgery, CT Fisher Grade & Hunt and Hess Grading earlier to surgery, & Glasgow Coma Scale at the while of discharge. The studies here support the wide spread concept that surgical clipping of SAH for Hunt and Hess Grade 4, 5 SAH, which is also considered as poor Grade SAH stipulates an effective treatment if done earlier provides better outcome.展开更多
A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the ri...A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated the absence of retinal arterial filling and choroidal perfusion in the right eye even 20 minutes after injecting the dye. The patient was diagnosed with right ophthalmic artery occlusion. Computed tomography (CT) showed diffuse mucosal thickening in the right ethmoidal sinus. Based on the clinical findings and endoscopic biopsy result, mucormycosis was confirmed. Amphotericin B (40 mg/day) and ceftriaxone (2 g/day) were intravenously administered. Despite the improvement of the right ethmoidal sinusitis and the right proptosis, the patient deteriorated into a comatose state after 19 days of systemic amphotericin B therapy. Although the previous CT showed no cerebral aneurysm, a repeated CT showed newly developed posterior communicating artery aneurysm and the subarachnoid hemorrhage. Despite the amphotericin B treatment and the improvement of the sinusitis, mucormycosis could cause sudden cerebral aneurysm rupture and subarachnoid hemorrhage resulting in coma.展开更多
A key topic for aneurysmal subarachnoid hemorrhage is neuroinflammation.Neuroinflammation can predispose to aneurysm formation and rupture.Neuroinflammation can also result from the blood breakdown products after aneu...A key topic for aneurysmal subarachnoid hemorrhage is neuroinflammation.Neuroinflammation can predispose to aneurysm formation and rupture.Neuroinflammation can also result from the blood breakdown products after aneurysm rupture.Recent evidence has shown that perpetual neuroinflammation can contribute to vasospasm and hydrocephalus.Targeting neuroinflammation is a novel mechanism for preventing subsequent neurologic sequalae.In this review,we highlight the pathophysiology of aneurysm formation,the neuroinflammatory surge after rupture including the involved cytokines,and ultimately tie in the contributory clinical relevance.In the last sections,we look at the pre-clinical data and novel avenues for further discovery.This paper will be a useful resource to both the clinician and scientific investigator.展开更多
Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical c...Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical clipping, and endovascular coiling. Patients who have aSAH are also susceptible to delayed cerebral ischemia and cerebral vasospasm. The aim of this study is to compare the outcome of endovascular coiling with surgical clipping in patients with SAH, specifically in relation to prevalence of vasospasm, in the country of Georgia. Method: In this study, we present a retrospective review of the outcomes of 217 patients with acute subarachnoid hemorrhage who underwent endovascular coiling or surgical clipping. The data were gathered from patients who are admitted to New Vision University Hospital and Caucasus Medical Center in Tbilisi, Georgia, between 2017 and 2022. Results: Vasospasm was prevalent in 217 of the patients who had aneurysmal rupture when they first appeared. Endovascular coiling or surgical clipping was used to treat aneurysmal rupture. In our sample, 24.81 percent of patients who underwent coiling experienced vasospasm after 14 days, compared to 31.25 percent of patients who underwent clipping. After endovascular coiling and surgical clipping, the severity of vasospasm was only slightly different, according to Lindegaard ratios. Finally, 32 patients (23.35 percent) died after coiling whereas 55 patients (68.75 percent) died within three decades of clipping. Conclusion: After 5 years of data collection, this study has demonstrated the most favorable option for treatment is endovascular coiling. However, the treatment choice takes multiple factors into account, and clipping is not ideal for some ruptured aneurysms. Despite the fact that endovascular coiling is usually successful and minimally invasive, complications can occur and additional monitoring and potential surgical intervention are indicated.展开更多
文摘BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.
基金supported by the National Natural Science Foundation of China,Research on Brain Magnetic Resonance Image Segmentation Based on Particle Computation(No.61672386).
文摘Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.
基金financially supported by grants from Key Research and Development Projects of Zhejiang Province (2020C03071)the Construction Fund of Medical Key Disciplines of Hangzhou (OO20200485, OO20200055)。
文摘BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95% confidence interval [95% CI] 2.481-17.227,P=0.009) and modified Fisher scores(β 10.349,95% CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio [OR] 1.015,95%CI 1.000-1.031,P=0.047) and DCI(OR 1.018,95% CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95% CI 0.682-0.845) and 0.777(95% CI 0.688-0.850),respectively.Serum A20 levels ≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9% and specificity of 74.2%,and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with65.5% sensitivity and 89.2% specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.
文摘Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.
基金supported by the Jiangsu Provincial Medical Youth Talent of the Project of Invigorating Health Care through Science,Technology and Education(Grant No.QNRC2016694)the Six Talents Peak Project of Jiangsu Province(Grant No.2015-WSN-061)+2 种基金the fifth‘226’High Level Talent Training Project of Nantong Citythe National Natural Science Foundation of China(Grant No.81502867)the Technology Innovation Programme of Nantong University(Grant No.YKS14017)
文摘Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ≥ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. Results The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of 〈 30 U/L, 30-50 U/L and ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively （P 〈 0.01）. The age-sex and multivariable adjusted odds ratios （95% confidence intervals） of poor prognosis comparing the top group （≥ 50 U/L） with the lowest group （〈 30 U/L） were 5.76 （2.74-12.13）, 6.64 （2.05-21.52）, and 6.36 （1.92-21.02）. A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. Conclusion Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage.
文摘The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.
文摘Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission（within 48 hours after initial hemorrhage） and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.
基金Supported by the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT)(No.2018R1C1B5085620).
文摘●AIM:To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage(SAH).●METHODS:This retrospective,interventional study included 31 patients with aneurysmal SAH,and the medical records were reviewed.In addition to baseline characteristics of the study population such as age,sex,and underlying medical history,multi-modal imaging analysis,including fluorescein angiography(FA),spectral domain optical coherence tomography(SD-OCT),were also reviewed.Glasgow Coma Scale(GCS),Hunt-Hess(HH)grade,and Fisher scale at the time of admission,and functional outcome by using modified Rankin Scale(mRS)at 6 mo were compared.●RESULTS:Of the 31 patients,10 patients(32.3%)were diagnosed with Terson syndrome.All the patients with Terson syndrome did not report visual symptoms at the time of ophthalmologic screening.FA showed microvascular changes of retinal capillaries and varying degrees of disc leakage.SD-OCT allowed intuitive anatomical localization of multi-layered retinal hemorrhages and assessment of ellipsoid zone integrity.The patients with Terson syndrome showed significantly worse GCS(P=0.047)and HH grade(P=0.025)than those without,except Ficher scale(P=0.385).There was no significant difference in the mRS(P=0.250)at 6 mo.Among baseline factors,the HH grade was the only significant factor associated with Terson syndrome(B=1.079,P=0.016).●CONCLUSION:In our study,32.3%of the patients have Terson syndrome without visual symptoms.The baseline HH grade is significantly correlated with Terson syndrome,and there is no significant difference in the functional outcome between the patients with and without Terson syndrome.Terson syndrome may develop without any visual symptoms as shown in our study,and ophthalmologic screening may be recommended to prevent further visual deterioration especially in the patients with poor HH grade at the time of aneurysmal SAH.
基金supported by a Grant-in-Aid for Scientific Research from Mie Medical Research Foundation to Dr.Suzuki
文摘Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, TLR4 is expressed in various cell types in the central nervous system, and is unique in that it can signal through both the myeloid differentiation primary-response protein 88-dependent and the toll receptor associated activator of interferon-dependent cascades to coordinate the maximal inflammatory response. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of an intracranial aneurysm, and the resultant inflammatory reaction and thereby tissue damages may furthermore activate TLR4. It is widely accepted that the excreted products of TLR4 signaling alter neuronal functions. Previous studies have focused on the pathway through nuclear factor（NF）-κΒ signaling among TLR4 signaling pathways as to the development of early brain injury（EBI） such as neuronal apoptosis and blood-brain barrier disruption, and cerebral vasospasm. However, many findings suggest that both pathways via NF-κΒ and mitogen-activated protein kinases may be involved in EBI and cerebral vasospasm development. To overcome EBI and cerebral vasospasm is important to improve outcomes after SAH, because both EBI and vasopasm are responsible for delayed brain injuries or delayed cerebral ischemia, the most important preventable cause of poor outcomes after SAH. Increasing evidence has shown that TLR4 signaling plays an important role in SAH-induced brain injuries. Better understanding of the roles of TLR4 signaling in SAH will facilitate development of new treatments.
文摘Subarachnoid hemorrhage（SAH）caused by the rupture of a cerebral aneurysm is a well-known devastating cerebrovascular disease.Post-SAH brain is vulnerable,associated with early brain injury（EBI;Suzuki,2015）.
文摘This study aimed to determine the effectiveness of comprehensive rehabilitation for patients with aneurysmal subarachnoid hemorrhage (aSAH) and to explore the factors influencing the prognosis of rehabilitation. This was a retrospective study. Twenty-five patients with aSAH were treated with physical therapy, occupational therapy, speech therapy, cognitive therapy, music therapy, Chinese acupuncture, hyperbaric oxygen, and transcranial magnetic stimulation. The general data of all patients were collected, and the functional scores at admission were compared with those at discharge. The Mini Mental State Examination, Fugl-Meyer Assessment Scale (FMAS) for motor and balance assessment, Holden Functional Ambulation Classification (FAC), modified Rankin Scale, National Institute of Health Stroke Scale, Modified Barthel Index for activities of daily living (ADL), and Glasgow Outcome Scale were significantly improved among 25 patients with aSAH after 1 month of comprehensive rehabilitation training. Hydrocephalus was an independent factor of the ability to perform ADLs (odds ratio, 0.29;95% confidence interval, 2.03. 3.15;p = 0.000). The improvement of ADLs in aSAH patients was not related to sex, surgical method, aneurysm location, age, or smoking status. Comprehensive and professional rehabilitation is effective for the cognition, movement, walking, ADLs, and functional prognosis of patients with aSAH, while early hydrocephalus may be a risk factor for poor ADLs.
文摘Background: Intracranial vasospasm is a common complication following subarachnoid hemorrhage (SAH). The radiographic vasospasm can reach up to 90% of aneurysmal SAH. Materials and Methods: 139 consecutive patients admitted to Cairo University Hospitals from June 2013 to September 2014 with SAH who had been enrolled in a retrospective controlled study were analyzed retrospectively for the occurrence of vasospasm. The data collected from the charts of Cairo University Hospitals were the patient’s demographics, clinical presentation, aneurysm location, treatment modality, and Glasgow Outcome Scale (GOS) scores. We excluded 24 patients with nonaneurysmal SAH, 3 internal carotid artery (ICA) aneurysms, 7 with multiple aneurysms and 4 patients died before treatment. Results: 72 males and 29 females were included in the study, mean age 53.5 ± 11.5 years. Twelve patients had aneurysms located in the vertebral artery group, 24 had middle cerebral artery aneurysms, 11 had pericallosal aneurysms, and 54 patients had anterior communicating artery (ACoA) complex aneurysms. Radiographic vasospasm occurred in 62.4% with the highest incidence (75.9%) at the ACoA complex group. Symptomatic vasospasm occurred in 48.5% with the highest incidence (63%) at the anterior communicating artery complex aneurysm location. The mean GOS at 6 months follow-up was 4.2. The worse GOS was found in the vertebral artery (VA) aneurysm group with a mean of 3.75. Conclusion: Aneurysms of the anterior communicating artery complex group have a greater risk of both radiographic and clinical vasospasm. Also, the worse 6 months follow-up GOS when an aneurysm was located in the VA group.
文摘Objective:to evaluate the clinical efficacy and safety of ultra-early lumbar puncture drainage of cerebrospinal fluid(CSF)in patients with aneurysmal subarachnoid hemorrhage(SAH).Methods:patients(n=140)with aneurysmal SAH were randomly divided into observation group(n=70)and control group(n=70).After admission,CSF was drained by ultra-early lumbar puncture in the observation group and intermittent lumbar puncture after aneurysm operation in the control group.The incidences of early aneurysm rupture,acute hydrocephalus and delayed hydrocephalus were compared between the two groups.Results:there was no significant diflerence in the incidence of early-ruptured aneurysm and acute hydrocephalus between the two groups,but the incidence of delayed hydrocephalus in the observation group was significantly lower than that in the control group.Conclusion:ultra-early lumbar puncture drainage of CSF in anexirysmal SAH can effectively reduce the incidence of long-term delayed hydrocephalus and it is a safe and effective treatment.
文摘We describe hyperacute generalized EEG slowing and then attenuation captured at the moment of subarachnoid hemorrhage in a monitored patient. This is the first reported cEEG capture of aneurysmal subarachnoid hemorrhage in the literature.
文摘Objective To explore the therapeutic effect of preoperative external lumbar drainage in Hunt and Hess grade Ⅰ～Ⅲ patients with subarachnoid hemorrhage (SAH) undergoing early surgery for intracranial aneurysms. Methods 101 cases of gradeⅠ～Ⅲ patients according to the classification of Hunt and Hess
文摘AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocephalus after an-eurysm treatment. Data were divided by type of study （randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study）. They were also divided by type of aneurysm treatment （microvascular - clipping, or endo-vascular - coiling）. Additional predictive variables collected for each publication were average age, gender distribu-tion, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treat-ment, duration of follow-up and date of publication. Weemployed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.RESULTS： Because indications for the two treatments are different, there is little clinical equipoise for treat-ing most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Nei-ther this nor pooled values from other studies which compared the two treatments had the power to dem-onstrate signifcant differences between the two treat-ments. Nor was there an apparent difference when observational data were meta-analytically pooled. How-ever, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference ap-peared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocepha-lus was found to be significantly lower in coiled vsclipped cases （P = 0.014）.CONCLUSION： Pooled observational data were nec-essary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.
文摘“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological sequelae”. It is one among the neurological emergencies which is a very distressing cerebrovascular disease with complicated mechanisms that risks brain perfusion and its function, having higher morbidity and mortality rates. Its mortality rate is still ranged between 8.3% and 66.7%, with noticeable regional variations, beside recent advances in treatment approaches. The incidence of SAH among the population of 2 - 22.5/100,000 was reported with a minimum of 60% of aneurysm ruptures occurring amid ages of 40 and 60 years with 3:2 male:female ratio. The rupture risks for unruptured aneurysms are increased by the issues like present smokers, larger size of aneurysm, and amid young population. The surgical treatment decision should be contemplated upon factors such as aneurysm’s size, aneurysm’s location, patient’s illness history, and surgeon’s operative experiences. Latest technical progresses in imaging techniques, increased consideration of illness history, more awareness of incidences of aneurysms and use of micro neurosurgery, have raised the chance for detection of subarachnoid hemorrhage (SAH) and possible better outcomes with surgical management. Factors that may affect outcome include age, size and site of aneurysm, interval between ictus and surgery, CT Fisher Grade & Hunt and Hess Grading earlier to surgery, & Glasgow Coma Scale at the while of discharge. The studies here support the wide spread concept that surgical clipping of SAH for Hunt and Hess Grade 4, 5 SAH, which is also considered as poor Grade SAH stipulates an effective treatment if done earlier provides better outcome.
文摘A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated the absence of retinal arterial filling and choroidal perfusion in the right eye even 20 minutes after injecting the dye. The patient was diagnosed with right ophthalmic artery occlusion. Computed tomography (CT) showed diffuse mucosal thickening in the right ethmoidal sinus. Based on the clinical findings and endoscopic biopsy result, mucormycosis was confirmed. Amphotericin B (40 mg/day) and ceftriaxone (2 g/day) were intravenously administered. Despite the improvement of the right ethmoidal sinusitis and the right proptosis, the patient deteriorated into a comatose state after 19 days of systemic amphotericin B therapy. Although the previous CT showed no cerebral aneurysm, a repeated CT showed newly developed posterior communicating artery aneurysm and the subarachnoid hemorrhage. Despite the amphotericin B treatment and the improvement of the sinusitis, mucormycosis could cause sudden cerebral aneurysm rupture and subarachnoid hemorrhage resulting in coma.
文摘A key topic for aneurysmal subarachnoid hemorrhage is neuroinflammation.Neuroinflammation can predispose to aneurysm formation and rupture.Neuroinflammation can also result from the blood breakdown products after aneurysm rupture.Recent evidence has shown that perpetual neuroinflammation can contribute to vasospasm and hydrocephalus.Targeting neuroinflammation is a novel mechanism for preventing subsequent neurologic sequalae.In this review,we highlight the pathophysiology of aneurysm formation,the neuroinflammatory surge after rupture including the involved cytokines,and ultimately tie in the contributory clinical relevance.In the last sections,we look at the pre-clinical data and novel avenues for further discovery.This paper will be a useful resource to both the clinician and scientific investigator.
文摘Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical clipping, and endovascular coiling. Patients who have aSAH are also susceptible to delayed cerebral ischemia and cerebral vasospasm. The aim of this study is to compare the outcome of endovascular coiling with surgical clipping in patients with SAH, specifically in relation to prevalence of vasospasm, in the country of Georgia. Method: In this study, we present a retrospective review of the outcomes of 217 patients with acute subarachnoid hemorrhage who underwent endovascular coiling or surgical clipping. The data were gathered from patients who are admitted to New Vision University Hospital and Caucasus Medical Center in Tbilisi, Georgia, between 2017 and 2022. Results: Vasospasm was prevalent in 217 of the patients who had aneurysmal rupture when they first appeared. Endovascular coiling or surgical clipping was used to treat aneurysmal rupture. In our sample, 24.81 percent of patients who underwent coiling experienced vasospasm after 14 days, compared to 31.25 percent of patients who underwent clipping. After endovascular coiling and surgical clipping, the severity of vasospasm was only slightly different, according to Lindegaard ratios. Finally, 32 patients (23.35 percent) died after coiling whereas 55 patients (68.75 percent) died within three decades of clipping. Conclusion: After 5 years of data collection, this study has demonstrated the most favorable option for treatment is endovascular coiling. However, the treatment choice takes multiple factors into account, and clipping is not ideal for some ruptured aneurysms. Despite the fact that endovascular coiling is usually successful and minimally invasive, complications can occur and additional monitoring and potential surgical intervention are indicated.
