Intracranial arterial aneurysm--an update.

Heros, Roberto C.; Kistler, J P

doi:10.1161/01.str.14.4.628

Cited by 57 publications

(19 citation statements)

References 19 publications

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“…The ANF concentration did not correlate with central venous pressure or pulmonary capillary wedge pressure (data not shown) and did not differ between patients treated for clinical vasospasm with hypervolemic therapy and those not treated (117±16 and 105±26 pg/ml, respectively). Clinical vasospasm was more frequent in patients with suprasellar blood than in those without (63% [12] versus 14% [1]). …”

Section: Resultsmentioning

confidence: 99%

Suprasellar and intraventricular blood predict elevated plasma atrial natriuretic factor in subarachnoid hemorrhage.

Diringer

Lim

Kirsch

et al. 1991

Stroke

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Following subarachnoid hemorrhage, the plasma concentration of atrial natriuretic factor is elevated and appears to be independent of atrial stretch. While the hypothalamus and circumventricular organs contribute to sodium and intravascular volume regulation, their influence on atrial natriuretic factor is not known. We tested the hypothesis that, following subarachnoid hemorrhage, suprasellar cisternal blood, intraventricular blood, or ventricular enlargement would be associated with elevated plasma levels of atrial natriuretic factor. Computed tomograms of 26 patients performed ^3 days after hemorrhage were analyzed to determine the presence of suprasellar or intraventricular blood and enlargement of the third or lateral ventricle. These results were correlated with the plasma atrial natriuretic factor and serum sodium concentrations. The initial atrial natriuretic factor concentration was elevated and was higher in patients with suprasellar or intraventricular blood than in those without (suprasellar: 131 ±20 and 54±10 pg/ml, respectively; intraventricular: 137±25 and 84±31 pg/ml, respectively). The atrial natriuretic factor concentration remained higher over the week following hemorrhage in patients with suprasellar blood than in those without (127 ±16 and 68±12 pg/ml, respectively). The atrial natriuretic factor concentration was not correlated with hyponatremia (125-134 meq/1) or age-corrected ventricular size. Hyponatremia did not correlate with the presence of intraventricular or suprasellar blood. Our data suggest that suprasellar and intraventricular blood disturb hypothalamic function, resulting in an elevated plasma atrial natriuretic factor concentration. The presence of a direct relation between atrial natriuretic factor and hyponatremia remains unclear. (Stroke 1991^22:577-581)

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Section: Resultsmentioning

confidence: 99%

Suprasellar and intraventricular blood predict elevated plasma atrial natriuretic factor in subarachnoid hemorrhage.

Diringer

Lim

Kirsch

et al. 1991

Stroke

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“…21 Detailed discussions on the theoretical and experimental bases of this approach have been published. 2 Values are mean ± SEM nat.O 2 /min/mg protein in groups of 5-7 rats for State 3 and State 4. RCR, respiratory control ratio (rates of oxygen consumption in States 3 and 4).…”

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confidence: 99%

Bioenergetics of different brain areas after experimental subarachnoid hemorrhage in rats.

Marzatico

Gaetani

Baena

et al. 1988

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We studied energy metabolism after experimental subarachnoid hemorrhage in rats. Four different cerebral areas were tested: frontal cortex, occipital cortex, hippocampus, and brainstem. V m of the following enzymatic activities was evaluated: in the homogenate: hexokinase, phosphofructokinase, and lactate dehydrogenase for the glycolytic pathway, and glucose-6-phosphate dehydrogenase for the hexose monophosphate shunt; in the purified nonsynaptic mitochondria: NAD + -isocitrate dehydrogenase, citrate synthase, and succinate dehydrogenase for the Krebs cycle, and cytochrome oxidase for the electron transfer chain. We also evaluated some parameters related to the respiration of nonsynaptic mitochondria (State 3, State 4, uncoupled state, respiratory control ratio, and ADP: O ratio). Subarachnoid hemorrhage did not significantly affect V m of the enzymatic activities related to anaerobic and aerobic metabolism; however, mitochondrial respiration was affected, particularly in the presence of NADH-producing substrates (glutamate + malate). (Stroke 1988; 19:378-384) I n humans, subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms may produce dramatic events, namely severe central nervous system dysfunction 1 "3 and complications such as cerebral vasospasm, rebleeding, and hydrocephalus responsible for extensive neurologic deterioration and/or irreversible neurologic deficits. SAH may cause a sequential cellular impairment and even irreversible neuronal damage similar to that occurring in ischemia. Many experimental animal models have been proposed to study the pathogenesis, prevention, and therapy of some complications (such as cerebral vasospasm) without paying marked attention to the neuronal impairment and brain metabolic derangement caused by SAH.Recently, a suitable rat SAH model was used to define the cerebral blood flow alterations 7 -8 and/or cerebral vasospasm pathogenesis.8 " 10 Using the described SAH rat model, our study was aimed at depicting the regional modification of cerebral energy metabolism. Materials and Methods Animals and Surgical ProcedureWe used male Sprague-Dawley rats (Charles River strain) weighing 325-350 g.Anesthesia was induced with 3% halothane in a 70:30 N 2 O:O 2 mixture and maintained with 0.75% From the Institute of Pharmacology, Faculty of Science (F.M., G.B.) and Department of Surgery, Section of Neurosurgery (P.G., R.R.B., V.S., P.P.), University of Pavia, Pavia, Italy.Address for reprints: Dr. Fulvio Marzatico, Istituto di Farmacologia, Facolta' di Scienze MM.FF.NN., Piazza Botta 11, 27100 Pavia, Italy.Received April 4, 1987; accepted August 18, 1987. halothane in the same gas mixture. A scalp incision was made in the dorsal midline. A burr hole was placed at the interparietal/occipital suture in the midline using a refrigerated twist-drill. A small PE-10 polyethylene catheter (0.62 mm o.d.) was inserted into the cisterna magna. Suitable placement of the catheter was assessed by testing the cerebrospinal fluid flowing through the catheter and by observing wit...

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“…While waiting for definitive results (Wiebers DO, ASUIA, Personal Communication), surgery is indicated for patients with a life expectancy of more than 5 years, but under 70 years of age, and harbouring an aneurysm of 5 mm or more [4,16,18,19]. Data in the literature suggest an annual rate of bleed- [14,15,17] and a mortality of 50% per bleeding episode [12,13]. A meta-analysis of studies regarding outcome after surgery for asymptomatic aneurysms showed an overall morbidity of 4.1% and 1% mortality [18].…”

Section: Discussionmentioning

confidence: 99%

Management of symptomatic carotid stenoses with coincidental intracranial aneurysms

et al. 1996

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There are at present strong indications for surgery in patients suffering from symptomatic extracranial carotid stenoses of > 70%. Surgery of coincidental aneurysms is a still debated problem, but there is general agreement that it is indicated in selected cases according to the patient's life-expectancy and size and site of the aneurysm. The coexistence of these two lesions raises a decision-making problem. We reviewed 389 endarterectomies and found 12 intracranial berry aneurysms in 10 (2.6%) patients. All the 10 patients were harbouring a symptomatic carotid stenosis of > 70%. Since the correction of a stenosis increases blood flow to an aneurysm, our approach was to first operate on the intracranial lesion and then the stenosis in 7 patients harbouring aneurysms > 5 mm. Two patients affected by small aneurysms < 5 mm of an A2 azygos and left internal carotid artery underwent left endarterectomy only. The last patient was submitted first to percutaneous angioplasty of a left stenosis, then to open surgery of a contralateral middle cerebral aneurysm and finally to intravascular occlusion of a small aneurysm of the left internal carotid bifurcation by menas of a coil; this policy was adopted in order to restore normal haemodynamic conditions before the intracranial procedure. There was no mortality or permanent morbidity following surgery for aneurysm or endarterectomy. Transient morbidity occurred in 2 cases after clipping of aneurysms of the anterior communicating and middle cerebral arteries. Our results suggest that surgery of coincidental aneurysms may give good results even when there is a severe symptomatic stenosis in the neck. Moreover, the presence of a small intracranial aneurysm does not seem to be an additional risk factor for endarterectomy. When the lesions are on different sides, it may be better to treat the stenosis first if it decreases the ipsilateral cerebral blood flow.

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Intracranial arterial aneurysm--an update.

Cited by 57 publications

References 19 publications

Suprasellar and intraventricular blood predict elevated plasma atrial natriuretic factor in subarachnoid hemorrhage.

Suprasellar and intraventricular blood predict elevated plasma atrial natriuretic factor in subarachnoid hemorrhage.

Bioenergetics of different brain areas after experimental subarachnoid hemorrhage in rats.

Management of symptomatic carotid stenoses with coincidental intracranial aneurysms

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