Background Arterial hypertension, cigarette smoking, excessive alcohol abuse and drug addiction such as cocaine all are known risk factors for aneurysmal subarachnoid hemorrhage (SAH). However, there is little information on whether tramadol addiction should also be considered as a risk factor for SAH. The purpose of this study was to investigate the prevalence and the impact of tramadol addiction on the symptomatology of intracranial aneurysmal SAH. We recruited 237 cases with acute aneurysmal ASH with a mean age of 52.3 ± 11.8 ranging from 17 to 86 years old. Results There were 124 males and 113 females; 43 cases had a history of tramadol addiction (18.1%). Tramadol addicts were significantly younger, more likely to be male (97.7%), and more commonly associated with seizure onset compared with non-addicts. Multiple aneurysms, wide neck, and sizable aneurysms were significantly more common in tramadol than non-tramadol addicts as were dissecting aneurysms. There is a high association of acute aneurysmal SAH with tramadol addiction, especially in young patients. Conclusions Tramadol addiction might be regarded as modifiable risk factor of aneurysmal ASH and tramadol addicts had a worse presentation than non-tramadol addicts. If this finding is proved, it will be of great importance in managing patients with ruptured and un-ruptured intracranial aneurysms. Tramadol is available over-counter in some countries, more studies are needed.
Background: according to the International Subarachnoid Trial (ISAT), patients with subarachnoid hemorrhage (SAH) fared better with endovascular coiling than those with surgical clipping (Molyneux et al., 2005). With the emergence of flow diversion as a useful technique in management of cerebral aneurysm, endovascular techniques now have many varieties that enable the interventionalist to achieve best outcome. Objective: This study aimed to compare the outcome and complications between balloon assisted coiling and the use of Flow diverter stent, also studying the theoretical effect of antiplatelet use in flow diverter group and whether there is an added risk for development of bleeding. Patients and Methods: Thirty two patients were included in this study between February/2016 and June/2017. Age range was 25-69 (54± 10.5) for balloon group (Group B =17), 30-68 years old (50.7±10.1) for the Flow diverter group (Group F=15). The females were 10 (58%) in the balloon group and 6 (40%) in the Flow diverter group. No statistically significant difference was found between two groups. Those patient were found to have wide neck aneurysm by either CT cerebral angiography of 4 vessel angiography. Patient undergo preoperative assessment using NIHS stroke scale, modified Rankin scale, Hunt and Hess scale and modified fisher scale. Post-operative assessment included, modified Rankin scale for clinical outcome and Raymond Roy scale for the degree of obliteration of aneurysm. Follow up study was done after 6 month of the procedure including the same sale to detect the clinical improvement as well as recanalization rate. Results: Regarding follow up assessment in clinical outcome, significant improvement occurred in both groups with minimal or no symptoms in 15 out of 17 (88.23%) in the balloon group and 14 out of 15 (93%) in the flow diverter group. Findings show that total obliteration was achieved immediately in most of cases (11 out of 17 in the balloon group, 13 out of 15 in the Flow diverter group). No significant difference between angiographic outcome of immediate and follow up imaging in the case of flow diverter. There is a significant difference between the immediate and follow up score of the balloon group but eventually most of the cases achieve complete obliteration (15 out of 17). Regarding complications, the operation went uneventful for more than 2 thirds of cases in each group. Although thrombotic complication is higher in Flow diverter group (20% for FD Vs 11.8% for B), manifest infarction is paradoxically higher in Balloon group (6.7% for FD Vs 17.6% for B). Hemorrhagic event occurred only once in balloon group (5.9%). For correlation, clinical outcome correlates with radiological outcome (P=0.007 significant level is P<0.001). Conclusion: both techniques are safe and effective in management of wide neck cerebral aneurysm with no significant difference between both techniques. Selection of either method is upon the experience of the interventional neurologist's experience and preference.
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