Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

Flynn, Liam M C; Andrews, Peter

doi:10.12688/f1000research.6635.1

Cited by 25 publications

(18 citation statements)

References 152 publications

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“…DCI is a complex, multifactorial syndrome associated with vasospasm, early brain injury, cortical spreading depression, and microthrombosis [1,[5][6][7]. Additionally, extravasated blood and early activated inflammatory pathways post-SAH trigger a cascade of reactions involving the release of pro-inflammatory and vasoactive factors [5].…”

Section: Discussionmentioning

confidence: 99%

“…Survivors of SAH may manifest severe neurological deficits [1][2][3][4]. In patients with SAH, early brain injury or delayed cerebral ischemia (DCI) is associated with poor outcomes [1,5,6]. Although the pathogenesis of DCI has been poorly understood [1,[5][6][7], activated inflammation after SAH could be one of the most critical factors affecting the development of DCI [5,8].…”

Section: Introductionmentioning

confidence: 99%

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Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage

2020

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Background: The purpose of this study was to evaluate the role of C-reactive protein (CRP) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH). Methods: In this retrospective, observational study of adult patients with SAH treated between January 2012 and June 2017. Initial CRP levels collected within 24 h from the onset of SAH, the follow-up CRP levels were measured. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). Results: Among 156 patients with SAH, 145 (92.9%) survived until discharge. Of these survivors, 109 (69.9%) manifested favorable neurological outcomes (GOS of 4 or 5). Initial CRP levels on admission and maximal CRP levels within four days were significantly higher in the group with poor neurological outcome compared with those manifesting favorable neurological outcomes (P = 0.022, P < 0.001, respectively). However, the clearance of CRPs did not differ significantly between the two groups (P = 0.785). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that the performance of the maximal CRP was significantly better compared with the initial CRP or the clearance of CRP (P = 0.007, P < 0.001, respectively). In this study, the effect of CRP on neurological outcomes differed according to surgical clipping. The maximal CRP levels within four days facilitate the prediction of neurological outcomes of SAH patients without surgical clipping (C-statistic: 0.856, 95% confidence interval [CI]: 0.767-0.921). However, they were poorly associated with neurological prognoses in SAH patients who underwent surgical clipping (C-statistic: 0.562, 95% CI: 0.399-0.716). Multivariable logistic regression analysis revealed that age (adjusted odds ratio [OR]: 1.10, 95% CI: 1.052-1.158), initial Glasgow Coma Scale (adjusted OR: 0.74, 95% CI: 0.647-0.837), and maximal CRP without surgical clipping (adjusted OR: 1.27, 95% CI: 1.066-1.516) (Continued on next page) (Continued from previous page) were significantly associated with poor neurological outcomes in SAH patients. Conclusions: Early serial measurements of CRP may be used to predict neurological outcomes of SAH patients. Furthermore, maximal CRP levels within four days post-SAH are significantly correlated with poor neurological outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage

2020

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“…A strong association exists between cerebral vessel narrowing and DCI, and it has been suggested that treating vessel narrowing after SAH may improve outcomes (12). …”

Section: Introductionmentioning

confidence: 99%

Alpha Calcitonin Gene-Related Peptide Increases Cerebral Vessel Diameter in Animal Models of Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

et al. 2017

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Delayed cerebral ischemia (DCI) is a life-threatening complication after subarachnoid hemorrhage. There is a strong association between cerebral vessel narrowing and DCI. Alpha calcitonin gene-related peptide (αCGRP) is a potent vasodilator, which may be effective at reducing cerebral vessel narrowing after subarachnoid hemorrhage (SAH). Here, we report a meta-analysis of data from nine in vivo animal studies identified in a systematic review in which αCGRP was administered in SAH models. Our primary outcome was change in cerebral vessel diameter and the secondary outcome was change in neurobehavioral scores. There was a 40.8 ± 8.2% increase in cerebral vessel diameter in those animals treated with αCGRP compared with controls (p < 0.0005, 95% CI 23.7–57.9). Neurobehavioral scores were reported in four publications and showed a standardized mean difference of 1.31 in favor of αCGRP (CI −0.49 to 3.12). We conclude that αCGRP reduces cerebral vessel narrowing seen after SAH in animal studies but note that there is insufficient evidence to determine its effect on functional outcomes.

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“…Влиянию ангиоспазма (АС) на исходы микрохирургического лечения артериальных аневризм (АА) головного мозга, осложненных субарахноидальным кровоизлиянием (САК), посвящено большое количество работ как отечественных, так и зарубежных авторов [1][2][3][4][5]. Установлено, что АС является неотъемлемым звеном патогенеза аневризматических САК, определяющим тактику ведения больных [2,5,6]. Выраженность АС индивидуальна, а его течение и влияние на исход заболевания невозможно предсказать или запрограммировать, что объясняет диаметрально противоположные подходы к тактике лечения разорвавшихся АА [3,[7][8][9][10].…”

Section: вступлениеunclassified

The influence of angiospasm on the results of microsurgical treatment of cerebral arterial aneurysms in the acute period of rupture

Zorin¹,

Dzyak²,

Kazantseva³

2020

Ukr Neurosurg J

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Ц е л ь : в ы я с н и т ь в л и я н и е а н г и о с п а з м а (А С) н а р е з ул ьт а т ы микрохирургического лечения артериальных аневризм (АА) головного мозга в острый период разрыва. Материалы и методы. Проведен ретроспективный анализ 332 историй болезни пациентов с АА головного мозга, находившихся на лечении в Днепропетровской областной больнице имени И.И. Мечникова в период с 2013 по 2018 гг. Больные поступили в острый период разрыва АА-в 1-15-е сутки после начала заболевания. Больных разделили на пять групп в зависимости от срока проведения операции. В 1-й группе (n=54) операция выполнена в 1-е-3-и сутки с момента разрыва АА, во 2-й группе (n=56)-в наиболее неблагоприятные сроки (на 4-8-е сутки), в 3-й группе (n=106)-на 9-14-е сутки, в 4-й группе (n=103)-на 15-30-е сутки, в 5-й группе (n=13)-позднее 30-х суток после разрыва АА. Кроме общего и биохимического исследования крови, всем пациентам выполняли спиральную компьютерную томографию, церебральную ангиографию и транскраниальную допплерографию. Тяжесть исходного состояния оценивали по шкале Hunt-Hess, результаты лечения-по шкале исходов Глазго. Результаты. Выявлена четкая зависимость результатов лечения от выраженности и распространенности АС. В тех случаях, когда операцию выполняли на фоне АС III степени, исходы по шкале ком Глазго соответствовали 5 или 4 баллам. Лишь у 4 больных с АС II степени получен относительно неплохой результат. Хорошие результаты получены у больных, которые прооперировали на фоне АС I степени или отсутствия АС. Значительно хуже были результаты у больных с АС II и III степени (р=0,004174). Во 2-й группе летальность была ниже почти в 2 раза, чем в 1-й, не было больных в вегетативном состоянии. В 3-й группе летальность составила 10,4% и была немного ниже, чем во 2-й группе. В 4-й группе летальность составила 7,8%. В 5-й группе летальных исходов не было. Выводы. Выраженность и распространенность АС при аневризматических субарахноидальных кровоизлияниях индивидуальны. АС не всегда вызывает ишемию головного мозга, но выявление ишемии мозга по данным спиральной компьютерной томографии всегда свидетельствует о наличии АС. Результаты микрохирургического лечения АА статистически значимо хуже у больных, прооперированных на фоне АС ІІ и ІІІ степени.

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Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

Cited by 25 publications

References 152 publications

Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage

Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage

Alpha Calcitonin Gene-Related Peptide Increases Cerebral Vessel Diameter in Animal Models of Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

The influence of angiospasm on the results of microsurgical treatment of cerebral arterial aneurysms in the acute period of rupture

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