Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Mehta, Vivek; Holness, Renn O.; Connolly, Kieran M.; Walling, Simon; Hall, Richard

doi:10.1017/s0317167100039160

Cited by 89 publications

(50 citation statements)

References 26 publications

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“…12,15,22 Early-onset seizures might be an underestimated factor that interferes with WFNS grading. Hence, our data support the current opinion that grading of patients with SAH should be performed after neurological resuscitation.…”

Section: Seizures and Timing Of Grading In Patients With Sahmentioning

confidence: 99%

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Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Fung¹,

Balmer²,

Murek³

et al. 2015

JNS

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O n presentation at a neurosurgical-neurovascular center, patients suffering from aneurysmal subarachnoid hemorrhage (SAH) may exhibit a reduced level of consciousness due to initial bleeding, rebleeding, hydrocephalus, sedation, or seizure 1,9,15,20,22 as well as other conditions. Subarachnoid hemorrhage causes seizures in up to 26% of patients, which occur most commonly within the first 24 hours. 3,9,20,23 Most seizures occur before hospital presentation. 20 The severity of SAH, as graded on scales like the World Federation of Neurosurgical Societies (WFNS) scale, as well as intracerebral hemorrhage (ICH), localization of the aneurysm, and the amount of subarachnoid blood are important risk factors for the development of early seizures. obJect After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome. methods This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I-III) and poor (WFNS IV-V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0-3 was considered a good outcome and an mRS score of 4-6 was considered a poor outcome. results Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14-7.46; p = 0.03) and good outcome (OR 4.01, 97.5% CI 1.63-10.53; p = 0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p < 0.001), and poor WFNS grade (p < 0.001) were associated with poor outcome. coNclusioNs Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution.

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Section: Seizures and Timing Of Grading In Patients With Sahmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Fung¹,

Balmer²,

Murek³

et al. 2015

JNS

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“…1,[4][5][6][7]12,15,16,22 However, this relationship is controversial, because SAH caused by a posterior circulation aneurysm frequently occurs with severe initial symptoms and acute hydrocephalus, compared to SAH caused by a ruptured anterior circulation aneurysm, which is known to occur with mild symptoms and/or no acute hydrocephalus. 14 In addition, most ruptured posterior circulation aneurysms have been treated with endovascular coil embolization. 3,5 This selection bias in previous hospital-based studies might have influenced the risk for development of sNPH after coil embolization among patients with a ruptured posterior circulation aneurysm.…”

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confidence: 99%

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank

Yamada¹,

Ishikawa²,

Yamamoto³

et al. 2015

JNS

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abbreviatioNs ACA = anterior cerebral artery; ICA = internal carotid artery; MCA = middle cerebral artery; NPH = normal-pressure hydrocephalus; SAH = subarachnoid hemorrhage; sNPH = secondary NPH; WFNS = World Federation of Neurological Societies. submitted December 5, 2014. accepted January 21, 2015. iNclude wheN citiNg Published online July 31, 2015; DOI: 10.3171/2015.1.JNS142761. disclosure Dr. Ishikawa has received honoraria from Medtronic Japan Co., Ltd. (Japan). Dr. Yamada declares no disclosures and no conflicts of interest. Drs. Yamamoto, Ino, Kimura, and Kobayashi report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. All authors have made substantial contributions to the intellectual content of the paper, have approved the final manuscript, and agree with submission to this journal. Dr. Yamada is the corresponding author for this study and the principal investigator. He takes responsibility for data management, accuracy of statistical analysis, conduct of the research, and drafting of the manuscript. The following grants funded this study: " obJect The present study aimed to investigate aneurysm locations and treatments for ruptured cerebral aneurysms associated with secondary normal-pressure hydrocephalus (sNPH) after subarachnoid hemorrhage (SAH) by using comprehensive data from the Japanese Stroke DataBank. methods Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients (1482 men, 3211 women) were registered as having had an SAH caused by a ruptured saccular aneurysm. Of them, 1448 patients (438 men and 1010 women; mean age 61.9 ± 13.4 years) who were confirmed to have or not have coexisting acute hydrocephalus and sNPH were included for statistical analyses. Locations of the ruptured aneurysms were subcategorized into 1 of the following 4 groups: middle cerebral artery (MCA; n = 354), anterior communicating artery and anterior cerebral artery (ACA; n = 496), internal carotid artery (ICA; n = 402), and posterior circulation (n = 130). Locations of 66 of the ruptured aneurysms were unknown/unrecorded. Treatments included craniotomy and clipping alone in 1073 patients, endovascular coil embolization alone in 285 patients, and a combination of coiling and clipping in 17 patients. The age-adjusted and multivariate odds ratios from logistic regression analyses were calculated after stratification using the Fisher CT scale to investigate the effects of the hematoma volume of SAH. results Acute hydrocephalus was confirmed in 593 patients, and 521 patients developed sNPH. Patients with a ruptured ACA aneurysm had twice the risk for sNPH over those with a ruptured MCA aneurysm. Those with an ACA aneurysm with Fisher Grade 3 SAH had a 9-fold-higher risk for sNPH than those with an MCA aneurysm with Fisher Grade 1 or 2 SAH. Patients with a ruptured posterior circulation aneurysm did not have any significant risk for sNPH. Clipping of the ruptured aneurysm resulted in twice the risk for sNPH over coil emboli...

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“…This result was also reported by Jiao et al 14 . Some authors have reported that the extent of meningeal fibrosis can increase in older patients, which impairs CSF circulation and decreases CSF absorption 40 . Moreover, the wider subarachnoid space in older patients can contain larger volumes of subarachnoid blood after TBI; thus, increasing their risks for developing a CSF circulation disturbance 41 .…”

Section: Mechanisms Of Hydrocephalus After DCmentioning

confidence: 99%

The influence of decompressive craniectomy on the development of hydrocephalus: a review

Ding

Guo

Huang

2014

Arq. Neuro-Psiquiatr.

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Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following traumatic brain injury (TBI) or cerebral vascular disease. Many studies have discussed complications of this procedure, and hydrocephalus is a common complication of DC. To further evaluate the relationship between DC and hydrocephalus, a review of the literature was performed. Numerous complications may arise after DC, including contusion or hematoma expansion, epilepsy, herniation of the cortex through a bone defect, CSF leakage through the scalp incision, infection, subdural effusion, hydrocephalus and "syndrome of the trephined". Several hydrocephalus predictors were identified; these included DC, distance from the midline, hygroma, age, injury severity, subarachnoid or intraventricular hemorrhage, delayed time to craniotomy, repeated operation, and duraplasity. However, results differed among studies. The impact of DC on hydrocephalus remains controversial.Keywords: traumatic brain injury, hydrocephalus, decompressive craniectomy. RESUMOA craniectomia descompressiva (CD) é amplamente utilizada para tratar a hipertensão intracraniana após trauma craniencefálico (TC) ou doença cerebrovascular. Vários estudos discutem as complicações deste procedimento, sendo a hidrocefalia uma das complicações mais frequentes. Fizemos uma revisão da literatura para avaliar a relação entre a CD e a hidrocefalia. Podem ocorrer numerosas complicações após a CD, incluindo aumento de volume por contusão ou hematoma, epilepsia e herniação do cortex cerebral através do acesso ósseo. Fístulas liquóricas através a incisão no couro cabeludo, infecções, hematomas subdurais, hidrocefalia e a "síndrome pós-trepanação". Foram identificados vários fatores preditivos de hidrocefalia: a distância da CD em relação à linha média, a ocorrência de higroma, a idade, a gravidade da lesão, a hemorragia subaracnóidea ou intraventricular, o tempo decorrido até a craniectomia, as reoperações e o uso de plástica com dura-máter. Entretanto, há divergências entre os autores e o impacto da CD na hidrocefalia continua controvertido.Palavras-chave: trauma cranencefálico, hidrocefalia, craniectomia descompressiva.

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Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Cited by 89 publications

References 26 publications

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank

The influence of decompressive craniectomy on the development of hydrocephalus: a review

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