Multimodality Monitoring, Inflammation, and Neuroregeneration in Subarachnoid Hemorrhage

Nogueira, Adriano Barreto; Nogueira, Afonso César Rodrigues; Veiga, José Carlos Esteves; Teixeira, Manoel J.

doi:10.1227/neu.0000000000000512

Cited by 20 publications

(13 citation statements)

References 43 publications

(62 reference statements)

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“…19,[41][42][43] Schultheiss et al concluded that hypothermia could protect retina ganglion cells against ischemia and increase the ischemic tolerance time for optic cells. 41 Moreover, research evidences show that hypothermia has a neuroprotective role for patients suffering from subarachnoid hemorrhages, 44 encephalopathy, 10 and cerebral edema due to stroke, 45 which supports this study results.…”

Section: Discussionsupporting

confidence: 87%

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

Rouzbahani

Khodadadi

Fooladi³

2020

Indian Journal of Neurotrauma

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Background and Aim Stroke is a sudden neurological disorder caused by disturbances in the brain blood flow and loss of normal brain function. Stroke is also the second leading cause of death worldwide. In the last two decades, among the various treatment options for stroke, hypothermia has shown the promise of improving the final outcome. This study aimed to investigate the effect of noninvasive hypothermia on the final outcome of patients with an acute stroke in Iran. Methods In a randomized clinical trial, 60 Iranian patients diagnosed with acute stroke were enrolled in 2018. Patients were selected by convenience sampling method and then randomized in two groups as experimental (n = 30) and control (n = 30). Mild hypothermia was applied using a cooling device for 72 hours on the patients’ heads and intervention results were compared with the control group. Data were collected by using Acute Physiology and Chronic Health Evaluation III (APACHE III), Full Outline of Un-Responsiveness (FOUR), and National Institutes of Health Stroke Scale (NIHSS), and later analyzed by Statistical Package for the Social Sciences (SPSS) software version 22. Results No significant difference was found in the mean scores of all three scales before and after the intervention in control group (p > 0.05) but statistically significant difference was found in the mean scores of all three scales for the intervention group (p < 0.05). The intervention group had an increased mean score in FOUR, while APACHE and NIHSS values dropped. Researchers found statistically significant difference between the mean scores after the intervention in the experimental group compared with the control group in all three scales (p < 0.05). Conclusion The findings of this study indicate that hypothermia has a significant statistical and clinical effect on the acute stroke outcome and it can be argued that hypothermia therapy can increase the level of consciousness and reduce the risk of death in stroke patients.

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Section: Discussionsupporting

confidence: 87%

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

Rouzbahani

Khodadadi

Fooladi³

2020

Indian Journal of Neurotrauma

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“…The discovery of adult mammalian neurogenesis opened a novel perspective on brain plasticity and neuroregeneration therapies ( 4 – 6 ). The current prevailing concept that the adult mammalian brain harbors two primary neurogenic niches in the subgranular zone of the dentate gyrus and in the subventricular zone replaced the long-lasting dogma of no-new neurons after birth ( 4 – 6 ). Adult human neurogenesis is controversial, but we have previously shown that the adult human brain harbors what we referred to as potential neurogenic system ( 4 – 6 ).…”

Section: Rationale Of the Hypothesismentioning

confidence: 99%

“…The current prevailing concept that the adult mammalian brain harbors two primary neurogenic niches in the subgranular zone of the dentate gyrus and in the subventricular zone replaced the long-lasting dogma of no-new neurons after birth ( 4 – 6 ). Adult human neurogenesis is controversial, but we have previously shown that the adult human brain harbors what we referred to as potential neurogenic system ( 4 – 6 ). The potential neurogenic system was revealed by the detection of expression of neural stem cell markers in the circumventricular organs ( 4 – 6 ).…”

Section: Rationale Of the Hypothesismentioning

confidence: 99%

Hypothesis on the Role of Cryptochromes in Inflammation and Subarachnoid Hemorrhage Outcome

Nogueira

Veiga

et al. 2017

Front. Neurol.

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We have recently found that the temperature variability (TV) in the day–night cycle may predict the mean intracranial pressure in the following 24 h (ICP24) in subarachnoid hemorrhage (SAH) patients under multimodality monitoring, sedation, and hypothermia (<35°C). Specifically, we found that ICP24 = 6 (4 − TV) mmHg. TV is the ratio between the coefficient of variation of temperature during the nocturnal and the preceding diurnal periods. This result suggests that the circadian clock reflects brain plasticity mechanisms and its malfunctioning leads to deterioration of the neurologic status. The sleep–wake cycle is absent in these patients and their circadian clock can function properly only by environment light-independent mechanisms. One mechanism involves the circadian clock proteins named cryptochromes (CRYs). CRYs are highly preserved and widespread in the evolutionary tree, are expressed in different cell types in humans [type II CRYs, in two forms: human cryptochrome 1 and 2 (hCRY1 and hCRY2)], and in certain species, respond to blue light and play role in magnetoreception. Interestingly, SAH outcome seems to correlate with inflammation, and CRYs decrease inflammatory activity. Our hypothesis derived from these observations is that CRYs modulate the circadian oscillation of temperature even during therapeutic hypothermia and improve outcome in SAH through decrease in inflammation. A strategy to test this hypothesis is to measure periodically during the acute phase of high-grade SAH the level of CRYs in cerebrospinal fluid (CSF) and circulating white blood cells, and to correlate these levels with outcome, TV, ICP24, and pro- and anti-inflammatory markers in CSF and blood. If this hypothesis is true, the development of therapies targeting inflammation in SAH could take advantage of cryptochrome properties. It has been shown that blue light phototherapy increases the expression of CRYs in blood mononuclear cells in jaundiced neonates. Likewise, visual stimulus with flashing light improves Alzheimer’s disease features in experimental model and there is a prominent expression of CRYs in the retina. Remarkably, recent evidence showed that hCRY2 responds to electromagnetic fields, which could be one elusive mechanism of action of transcranial magnetic stimulation and a reason for its use in SAH.

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“…Such poor outcome occurs in part because an effective neuroprotective therapy is missing and the currently available therapies may lead to significant side effects. Therefore, the treatment of patients with severe brain injury could be improved by the development of new methods to predict neurological status worsening [ 1 – 3 ], which could guide bedside decisions in a tailored manner.…”

Section: Introductionmentioning

confidence: 99%

Temperature variability in the day–night cycle is associated with further intracranial pressure during therapeutic hypothermia

et al. 2017

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BackgroundTo assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia.MethodsWe retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP24).ResultsWe analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm. ICP24 ranged from 11.5 ± 3.1 to 24.2 ± 6.2 mmHg. The ratio between the coefficient of variation of temperature during the nocturnal period (18:00–6:00) and the preceding diurnal period (6:00–18:00) [temperature variability (TV)] ranged from 0.274 to 1.97. Regression analysis showed that TV correlated with ICP24 (Pearson correlation = −0.861, adjusted R square = 0.725, p < 0.001), and that ICP24 = 6 (4–TV) mmHg or, for 80% prediction interval, mmHg. The results indicate that the occurrence of ICP24 higher than 20 mmHg is unlikely after a day with TV ≥1.0.ConclusionsTV correlates with further ICP during hypothermia regardless the strict range that temperature is maintained. Further studies with larger series could clarify whether intracranial hypertension in severe brain injury can be predicted by analysis of oscillation patterns of autonomic parameters across a period of 24 h or its harmonics.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-017-1272-y) contains supplementary material, which is available to authorized users.

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Multimodality Monitoring, Inflammation, and Neuroregeneration in Subarachnoid Hemorrhage

Cited by 20 publications

References 43 publications

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

Hypothesis on the Role of Cryptochromes in Inflammation and Subarachnoid Hemorrhage Outcome

Temperature variability in the day–night cycle is associated with further intracranial pressure during therapeutic hypothermia

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