Management of subarachnoid haemorrhage.

Kopitnik, Thomas A.; Samson, Duke

doi:10.1136/jnnp.56.9.947

Cited by 37 publications

(14 citation statements)

References 113 publications

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“…Numerous clinical studies have pointed out that aneurysm daughter blebs may represent a risk factor for future rupture [1,6,7,9,22,23,25,33,36,37,38,42,43,44,45,56]. Although the mechanisms of daughter bleb formation and rupture are still poorly understood, evidence has suggested that hemodynamic factors may have an important contribution [9,16,17,22,56].…”

Section: Discussionmentioning

confidence: 99%

“…Intracranial aneurysmal daughter blebs [1,2,3,4,5], also known as ‘daughter aneurysm’ [1,6,7,8,9,10], ‘bleb’ [11,12,13,14,15,16,17,18,19], ‘daughter sac’ [20,21,22], ‘bubble’ [6], ‘loculation’ [23,24,25,26], ‘lobulation’ [27,28,29,30,31], ‘secondary loculus’ [24,32], ‘nipple’ [15,33,34,35,36,37,38] or ‘Murphy’s tit’ [39], are focal bulges that are commonly observed on the surface of original aneurysm walls. This type of lesion is distinguished from the pseudoaneurysm outpouching caused by bleeding [40,41].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic Analysis of Intracranial Aneurysms with Daughter Blebs

Zhang

Chen

et al. 2011

Eur Neurol

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Background and Purpose: Intracranial aneurysms with daughter blebs appear to have a higher risk of rupture. Whether hemodynamic factors are involved in this phenomenon is not clear. Methods: 54 patient-specific aneurysms harboring 69 daughter blebs were divided into ruptured and unruptured groups based on their clinical history. Realistic models were retrospectively constructed and analyzed by a computational fluid dynamic method. Results: There were no differences in the aspect ratio and morphology type of the aneurysms, the size of blebs or other common risk factors between the two groups. The wall shear stress (WSS) was significantly lower while the oscillatory shear index (OSI) was higher in the daughter blebs than in the primary aneurysms. Bleb-bearing aneurysms with a rupture history displayed significantly lower WSS in the daughter bleb. Of the daughter blebs, 73.9% were localized to the impingement region of the inflow jet. Conclusion: These observations indicate that low WSS and high OSI in the daughter blebs might be involved in increasing the risk of rupture. The localized striking force caused by inflow jets may contribute to the development of daughter blebs. However, a precise role of hemodynamics in predicting the future rupture of daughter blebs needs further study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hemodynamic Analysis of Intracranial Aneurysms with Daughter Blebs

Zhang

Chen

et al. 2011

Eur Neurol

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“…Ruptured intracranial aneurysms are the most common cause of subarachnoid hemorrhage (1). Numerous patients achieve good outcomes with embolization therapy, and exhibit no severe neurological dysfunction [Glasgow Outcome Scale (GOS) grades 4 and 5] (2).…”

Section: Introductionmentioning

confidence: 99%

Effect of thyroid hormone replacement therapy on cognition in long-term survivors of aneurysmal subarachnoid hemorrhage

Yang

Yin

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Aneurysmal subarachnoid hemorrhage (aSAH) is a recently identified risk factor for chronic hypothyroidism. Patients with hypothyroidism often exhibit cognitive dysfunction. The aim of the present study was to determine the effects of thyroid hormone replacement therapy on cognition in aSAH survivors with hypothyroidism. A study population of 135 patients was recruited and subjected to the Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory. Among the study population, 52 patients exhibited cognitive dysfunction. Thyroid hormone levels were measured in these patients using an electrochemiluminescence immunoassay in order to elucidate possible deficits in the thyrotrophic hormonal axes, and hypothyroidism was confirmed in 31 patients. Among these 31 patients, 22 patients consented to be randomized into groups and were administered levothyroxine replacement or a placebo treatment for 3 months. The MoCA and Wechsler Adult Intelligence Scale-Chinese version (WAIS-RC) testing were performed prior to and following the replacement therapy or placebo treatments. All subjects completed the study with no negative side effects. After 8-12 weeks of oral levothyroxine administration, it was observed that the serum concentration of thyroid-stimulating hormone was restored to normal levels. Furthermore, neuropsychological test results improved following the replacement therapy. A significant improvement was observed in the MoCA scores of the replacement group following therapy, with the exception of the score for abstraction. Additionally, significant improvements in the WAIS-RC were observed in the replacement group, with the exceptions of the information comprehension and letter-number sequencing scores. Thus, the present study has demonstrated the partial normalization of cognitive impairments in patients with hypothyroidism following aSAH as a result of appropriate levothyroxine replacement therapy.

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“…Incidence of aneurysmal SAH varies widely in different parts of the world: it is the leading cause of death in 16/ 100,000 people in the USA and 25/100,000 in Japan but only 3-5/100,000 in Rhodesia [3]. In Europe and Slovenia the incidence is 10-12/100,000 and is much higher in Finland and much lower in Mediterranean countries, especially in North African countries and Israel.…”

Section: Introductionmentioning

confidence: 98%