BACKGROUND:
Cerebral vasospasm can complicate aneurysmal subarachnoid hemorrhage (aSAH), contributing to cerebral ischemia. We explored the role of remote ischemic preconditioning (RIPC) in reducing cerebral vasospasm and ischemia and improving outcomes after aSAH.
MATERIALS AND METHODS:
Patients with ruptured cerebral aneurysm undergoing surgical clipping and meeting the trial criteria were randomized to true RIPC (
n
= 13) (inflating upper extremity blood pressure cuff thrice to 30 mmHg above systolic pressure for 5 min) or sham RIPC (
n
= 12) (inflating blood pressure cuff thrice to 30 mmHg for 5 min) after ethical approval. A blinded observer assessed outcome measures-cerebral vasospasm and biomarkers of cerebral ischemia. We also evaluated the feasibility and safety of RIPC in aSAH and Glasgow Outcome Scale-Extended (GOSE).
RESULTS:
Angiographic vasospasm was seen in 9/13 (69%) patients; 1/4 patients (25%) in true RIPC group, and 8/9 patients (89%) in sham RIPC group (
P
= 0.05). Vasospasm on transcranial Doppler study was diagnosed in 5/25 (20%) patients and 1/13 patients (7.7%) in true RIPC and 4/12 patients (33.3%) in sham RIPC group, (
P
= 0.16). There was no difference in S100B and neuron-specific enolase (NSE) levels over various time-points within groups (
P
= 0.32 and 0.49 for S100B,
P
= 0.66 and 0.17 for NSE in true and sham groups, respectively) and between groups (
P
= 0.56 for S100B and
P
= 0.31 for NSE). Higher GOSE scores were observed with true RIPC (
P
= 0.009) unlike sham RIPC (
P
= 0.847) over 6-month follow-up with significant between group difference (
P
= 0.003). No side effects were seen with RIPC.
CONCLUSIONS:
RIPC is feasible and safe in patients with aSAH and results in a lower incidence of vasospasm and better functional outcome.
Background The incidence of hyponatremia is high in supratentorial tumors. However, most studies of supratentorial tumors have included patients with sellar/suprasellar tumors. It is common knowledge that sellar tumors have higher incidence and severity of hyponatremia. Incidence of hyponatremia is not known if we exclude sellar/suprasellar tumors. Therefore, this study was designed to evaluate the incidence of hyponatremia in supratentorial tumors after excluding sellar/suprasellar tumors.
Methods After institutional ethics committee approval and written informed consent, adult patients with supratentorial tumors (nonsellar/suprasellar) were recruited, and data were collected prospectively. In all patients, serum electrolytes were measured every 2 to 3 days. Hyponatremia was defined as serum sodium of <135 mEq/L. All the patients were followed up till death or discharge from the hospital.
Results A total of 61 patients’ data were analyzed. There were 31 male and 30 female patients with an average age of 44 years. There were 23 meningiomas, 36 gliomas, and 2 other tumors. Forty patients (66%) developed hyponatremia during hospital stay. There were 29 mild cases (serum sodium 131–134 mEq/L), 7 were moderate (serum sodium 126–130 mEq/L), and 4 were severe (serum sodium <126 mEq/L). Three hyponatremic meningioma patients died, of which two had mild hyponatremia and one had severe hyponatremia. Duration of hospital stay was longer in hyponatremic patients.
Conclusion The incidence of hyponatremia is high in supratentorial tumor patients after excluding sellar/suprasellar lesions. In the majority of patients, the disturbance is mild. Hyponatremic patients has a longer hospital stay and higher mortality.
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