Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury

Suwatcharangkoon, Sureerat; Meyers, Emma; Falo, Cristina; Schmidt, J. Michael; Agarwal, Sachin; Claassen, Jan; Mayer, Stephan A.

doi:10.1001/jamaneurol.2015.3188

Cited by 89 publications

(80 citation statements)

References 36 publications

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“…Aneurysmal subarachnoid hemorrhage (aSAH) is a common neurological disease (Rodríguez‐Rodríguez, Egea‐ Guerrero, Ruiz de Azúa‐López, & Murillo‐Cabezas, ; de Rooij, Linn, van der Plas, Algra, & Rinkel, ; Shen et al., ). Hemorrhagic brain injury contributes to poor outcome of aSAH (De Marchis et al., ; Fujii et al., ; Ji & Chen, ; Suwatcharangkoon et al., ). Inflammation is an important mechanism underlying hemorrhagic brain injury (Badjatia et al., ; Ma, Zhou, Yan, Qu, & Bu, ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of plasma galectin‐3 levels after aneurysmal subarachnoid hemorrhage

Liu

Zhao

et al. 2016

Brain and Behavior

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BackgroundInflammatory responses are correlated with secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Galectin‐3 (Gal‐3) is a novel biomarker reflecting inflammation status, and its elevated circulating levels are associated with poor prognosis of some inflammatory diseases. The aim of this study was to evaluate the relationship between Gal‐3 plasma levels and prognosis in a group of aSAH patients.Materials and MethodsWe assessed plasma Gal‐3 levels in 120 patients and 120 healthy individuals. 6‐month clinical outcomes included mortality and unfavorable outcome (Glasgow Outcome Scale score of 1–3). Associations of plasma Gal‐3 levels with clinical outcomes were investigated using multivariate analysis.ResultsPatients showed significantly higher Gal‐3 levels as compared to controls. Circulating Gal‐3 was significantly and independently associated with 6‐month clinical outcomes in the logistic regression analysis. Moreover, we observed a significant correlation between circulating Gal‐3 and World Federation of Neurological Surgeons scores and modified Fisher scores. Furthermore, Gal‐3 possessed high area under receiver operating characteristic curve for prognostic assessment.ConclusionOur findings indicate the associations between Gal‐3 levels and the severity and poor prognosis following aSAH. This suggests the possible role of Gal‐3 in the prognostic prediction after aSAH.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of plasma galectin‐3 levels after aneurysmal subarachnoid hemorrhage

Liu

Zhao

et al. 2016

Brain and Behavior

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“…Regardless of type of brain injury, accurate assessment of consciousness level is important because it provides a valuable indicator of injury severity and outcome and aids treatment decision‐making (Lindsay et al, ). In particular, two‐thirds of patients with spontaneous aneurysmatic SAH have impaired consciousness during the critical or acute stage and such consciousness impairments are considered crucial indicators of poor neurological outcomes (Jang & Kim, ; Suarez et al, ; Suwatcharangkoon et al, ). Spontaneous subarachnoid haemorrhage severity, like consciousness impairments, has been used to predict outcome and surgical decision‐making in spontaneous SAH (Rosen & Macdonald, ).…”

Section: Discussionmentioning

confidence: 99%

Construct validity and reliability of the Full Outline of UnResponsiveness (FOUR) score in spontaneous subarachnoid haemorrhage caused by aneurysm rupture

Shin

Kim

et al. 2019

Journal of Clinical Nursing

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Aims and objectives This study aimed at examining the construct validity and reliability of the Full Outline of UnResponsiveness score in patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture. Background The Full Outline of UnResponsiveness score is known to be a valid and reliable consciousness assessment tool and provides comprehensive information not given by the Glasgow Coma Scale. However, the validity and reliability of this tool have not been tested in patients with spontaneous subarachnoid haemorrhage. Design A nonexperimental, descriptive, correlational study design was adopted. Methods The STROBE statement was used for reporting this study. The study participants were 72 patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture, admitted to an intensive care unit in a university hospital between August 2016–July 2017. Data on demographic characteristics, Hunt–Hess clinical stage scores, Fisher CT stage scores, disease‐related characteristics, Full Outline of UnResponsiveness scores and 1‐month Glasgow Outcome Scale scores were subjected to analysis. Results Full Outline of UnResponsiveness scores were found to have significant correlations with scores on Hunt–Hess clinical or Fisher CT stage tool and adequately predict 1‐month recovery. This tool also exhibited excellent inter‐rater agreement and internal consistency. Conclusions The Full Outline of UnResponsiveness score is valid and reliable for consciousness evaluation in spontaneous subarachnoid haemorrhage. It has been believed that use of this tool may help prevent negative consequences arising from impaired consciousness and improve the outcomes of patients with spontaneous aneurysmatic subarachnoid haemorrhage. Relevance to clinical practice The Full Outline of UnResponsiveness score is a consciousness assessment tool that provides more neurological detail because it includes consideration of brainstem reflexes, visual tracking, breathing patterns and respiratory drive, and can be applied in cases of spontaneous subarachnoid haemorrhage and other types of brain injury, especially in patients with severe consciousness impairment.

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“…Different from above intracerebral hemorrhage, the blood clots of SAH distributes in subarachnoid space and produces global brain injury after the initial aneurysm rupture (Suwatcharangkoon et al, 2016) which is defined as EBI (Kusaka et al, 2004). The mechanisms of EBI mainly include rapid increasing of intracranial pressure (Bederson et al, 1995), reduction in cerebral perfusion pressure (Ayer and Zhang, 2010), and decreasing of cerebral blood flow (Bederson et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

DLK silencing attenuated neuron apoptosis through JIP3/MA2K7/JNK pathway in early brain injury after SAH in rats

Chen

Huang

Sun

et al. 2017

Neurobiology of Disease

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Objective Dual leucine zipper kinase (DLK/MA3K12) has been reported involved in apoptosis and neuronal degeneration during neural development and traumatic brain injury. This study was designed to investigate the role of DLK with its adaptor protein JNK interacting protein-3 (JIP3), and its downstream MA2K7/JNK signaling pathway in early brain injury (EBI) after subarachnoid hemorrhage (SAH) in a rat model. Design Controlled in vivo laboratory study. Setting Animal research laboratory. Subjects Two hundred and twenty-three adult male Sprague-Dawley rats weighing 280–320 g. Interventions SAH was induced by endovascular perforation in rats. The SAH grade, neurological score, and brain water content were measured at 24 and 72 hours (hrs) after SAH. Immunofluorescence staining was used to detect the cells that expressed DLK. The terminal deoxynucleotid transferase-deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) was used to detect the neuronal apoptosis. In mechanism research, the expression of DLK, JIP3, phosphorylated-JNK (p-JNK)/JNK, and cleaved caspase-3 (CC-3) were analyzed by western blot at 24 hrs after SAH. The DLK small interfering RNA (siRNA), JIP3 siRNA, MA2K7 siRNA and recombinant DLK protein which injected intracerebroventricularly were given as the interventions. Measurements and Main Results The DLK expression was increased in the left cortex neurons and peaked at 24 hrs after SAH. DLK siRNA attenuated brain edema, reduced neuronal apoptosis, and improved the neurobehavioral functions after SAH, but the recombinant DLK protein deteriorated neurobehavioral functions and brain edema. DLK siRNA decreased and recombinant DLK protein increased the expression of MA2K7/p-JNK/CC-3 at 24 hrs after SAH. The JIP3 siRNA reduced the level of JIP3/MA2K7/p-JNK/CC-3, combined DLK siRNA and JIP3 siRNA further decreased the expression of DLK/MA2K7/p-JNK/CC-3, and MA2K7 siRNA lowered the amount of MA2K7/p-JNK/CC-3 at 24 hrs after SAH. Conclusions As a negative role, DLK was involved in EBI after SAH, possibly mediated by its adaptor protein JIP3 and MA2K7/JNK signaling pathways. To reduce the level of DLK may be a new target as intervention for SAH.

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Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury

Cited by 89 publications

References 36 publications

Prognostic value of plasma galectin‐3 levels after aneurysmal subarachnoid hemorrhage

Prognostic value of plasma galectin‐3 levels after aneurysmal subarachnoid hemorrhage

Construct validity and reliability of the Full Outline of UnResponsiveness (FOUR) score in spontaneous subarachnoid haemorrhage caused by aneurysm rupture

DLK silencing attenuated neuron apoptosis through JIP3/MA2K7/JNK pathway in early brain injury after SAH in rats

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