Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Bederson, Joshua B.; Connolly, E. Sander; Batjer, H. Hunt; Dacey, Ralph G.; Dion, Jacques E.; Diringer, Michael N.; Duldner, John E.; Harbaugh, Robert E.; Patel, Aman B.; Rosenwasser, Robert H.

doi:10.1161/strokeaha.108.191395

Cited by 1,141 publications

(509 citation statements)

References 511 publications

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“…26 Initial management included prompt cardiopulmonary support, maintenance of euvolemia, oral nimodipine 60 mg every 4 hours, and treatment of acute hydrocephalus with external ventricular drainage. The decision to treat by surgical clipping or endovascular embolization was performed on the basis of consensus between a team of neurosurgeons and interventional radiologists.…”

Section: Patients and Managementmentioning

confidence: 99%

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

Budohoski

Czosnyka

Smielewski

et al. 2012

J Cereb Blood Flow Metab

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In patients after subarachnoid hemorrhage (SAH) failure of cerebral autoregulation is associated with delayed cerebral ischemia (DCI). Various methods of assessing autoregulation are available, but their predictive values remain unknown. We characterize the relationship between different indices of autoregulation. Patients with SAH within 5 days were included in a prospective study. The relationship between three indices of autoregulation was analyzed: two indices calculated using spontaneous blood pressure fluctuations, Sxa (based on transcranial Doppler) and TOxa (based on near-infrared spectroscopy); and transient hyperemic response test (THRT) where a brief compression of the common carotid artery is used. The predictive value of indices was assessed using data from the first 5 days. Overall there was only moderate correlation between indices. However, both Sxa and TOxa showed good accuracy in predicting impaired autoregulation evidenced by a negative THRT (area under the curve (AUC): 0.788, 95% CI: 0.723 to 0.854 and AUC: 0.827, 95% CI: 0.769 to 0.885, respectively). All indices proved accurate in predicting DCI when 0-to 5-day data were used (AUC: 0.801, 95% CI: 0.660 to 0.942; AUC: 0.857, 95% CI: 0.731 to 0.984, AUC: 0.796, 95% CI: 0.658 to 0.934 for THRT, Sxa, and TOxa, respectively). Combining all three indices had 100% specificity for predicting DCI. While multiple colinearities exist between the assessed methods, multimodal monitoring of cerebral autoregulation can aid in predicting DCI.

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Section: Patients and Managementmentioning

confidence: 99%

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

Budohoski

Czosnyka

Smielewski

et al. 2012

J Cereb Blood Flow Metab

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“…This hemorrhage leads to thrombus formation on the adventitial side of the ruptured vessel and produces local ischemia in the surrounding neural tissue (Kassell et al, 1985). In addition, in 30% to 70% of cases, SAH also results in an intense and prolonged constriction of the affected cerebral vasculature (Bederson et al, 2009). This cerebral vasospasm typically occurs after a delay of 3 to 5 days after hemorrhage reaching a maximum around 7 days.…”

Section: Introductionmentioning

confidence: 99%

“…This cerebral vasospasm typically occurs after a delay of 3 to 5 days after hemorrhage reaching a maximum around 7 days. There are no efficient treatments for cerebral vasospasm and B50% of SAH patients will develop a subsequent infarction (Bederson et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Sphingosylphosphorylcholine is a Proinflammatory Mediator in Cerebral Arteries

Wirrig

Hunter

Mathieson

et al. 2010

J Cereb Blood Flow Metab

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Inflammation has an important function in the development of cerebral vasospasm after subarachnoid hemorrhage (SAH); however, the mediators of this inflammatory response have not been clearly identified. In this study, we have investigated the potential function of two sphingolipids, which occur naturally in plasma and serum, sphingosylphosphorylcholine (SPC) and sphingosine 1-phosphate (S1P), to act as proinflammatory mediators in cerebral artery vascular smooth muscle (VSM) cells. In rat cerebral arteries, SPC but not S1P activated p38 mitogen-activated protein kinase (MAPK). Using transcription factor arrays, two proinflammatory transcription factors activated by SPC in cerebral arteries were identified-nuclear factor-jB and CCAAT-enhancerbinding protein. Both these transcription factors were activated by SPC in a p38MAPK-dependent manner. To determine whether this contributed to vascular inflammation, an inflammatory protein array was performed, which showed that SPC increased release of the chemokine monocyte chemoattractant protein-1 (MCP-1) in cultured rat VSM cells. This increase in MCP-1 expression was confirmed in cerebral arteries. The S1P did not increase MCP-1 release. Taken together, our results suggest that SPC, but not S1P, can act as a proinflammatory mediator in cerebral arteries. This may contribute to inflammation observed after SAH and may be part of the initiating event in vasospasm.

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“…Hemorrhagic stroke can occur in several spaces: brain, brain stem (intraparenchymal hemorrhagic stroke), or meninges, and can reach the arachnoid membrane, resulting in a subarachnoid hemorrhage (SAH), which accounts for 5-10% of all cases of stroke (2) . For some authors, there is no relation between localization of brain aneurysm and cognitive impairment; however, others specify and associate cognitive deficits with this localization (3) .…”

Section: Introductionmentioning

confidence: 99%

Caracterização das afasias na hemorragia subaracnóidea aneurismática

Maranhão

Souza

Costa

et al. 2018

CoDAS

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RESUMO Objetivo Caracterizar o perfil dos quadros afásicos determinados pela hemorragia subaracnóidea aneurismática (HSA) da artéria cerebral média esquerda. Método Estudo analítico, retrospectivo, transversal, tendo como banco de dados as avaliações cognitivas de 193 pacientes do Hospital da Restauração com HSA aneurismática no período de março de 2007 a novembro de 2009. Destes, foram selecionados 26 pacientes com HSA em território da ACM-E, confirmada por angiografia digital. Os quadros afásicos foram classificados através do desempenho da linguagem dos pacientes através do Protocolo Montreal Toulose - Versão Alpha e a tarefa de fluência verbal da bateria CERAD. A pesquisa foi realizada no período de junho a agosto de 2015. Resultados Foi identificado comprometimento da linguagem e fluência verbal nos pacientes com HSA em território de ACM–E quando comparados com a população controle (50 indivíduos). Dos 26 pacientes com HSA, 11 apresentaram quadros afásicos ainda no período pré-operatório. Conclusão Os resultados da pesquisa corroboram com a literatura, mostrando que o quadro da HSA promove comprometimentos cognitivos ainda na fase pré-operatória para oclusão de aneurisma. Tendo em vista os aspectos observados, os quadros afásicos predominantes caracterizam afasia de compreensão por sequelas nas áreas cerebrais posteriores.

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Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Cited by 1,141 publications

References 511 publications

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

Sphingosylphosphorylcholine is a Proinflammatory Mediator in Cerebral Arteries

Caracterização das afasias na hemorragia subaracnóidea aneurismática

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