On the mechanism of sudden death with subarachnoid hemorrhage

Parizel, G

doi:10.1007/bf00313946

Cited by 24 publications

(7 citation statements)

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“…[16][17][18] The mechanisms leading to CA after SAH are well described, mainly due to the sudden increase of intracranial pressure. 8,[19][20][21][22] It is not clear whether CA with a need for CPR additionally deteriorates the already poor outcome of patients with SAH H&H grade 5.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Arrest in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Single-Center Experience

Ridwan

Kristof

2019

J Neurol Surg A Cent Eur Neurosurg

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Background Poor-grade aneurysmal subarachnoid hemorrhage (SAH), in particular Hunt and Hess (H&H) grade 5 SAH, still has a high case-fatality rate. Recent studies regarding the clinical outcome of such patients and the influence of comorbidities, especially cardiac arrest (CA) requiring additional cardiopulmonary resuscitation (CPR), on the outcome of these patients are scant. Our primary objective was to assess the outcome of SAH H&H grade 5 patients and the influence of additional CA and requirement for CPR. Methods All patients with spontaneous aneurysmal SAH H&H grade 5 admitted to our hospital from 2001 to 2010 were enrolled in the study. Data were extracted from the hospital's clinical records and electronic database. The patients' clinical outcome at time of discharge was represented by the Glasgow Outcome Score and modified Rankin Scale (mRS). The influence of CA and additional CPR on patient outcome was analyzed. Results Of 80 SAH H&H grade 5 patients (median age 55 years), 21 patients (median age 50 years) experienced CA and received additional CPR. Mortality in SAH H&H grade 5 patients was 85% with CA and 68% without CA (p = 0.158). Overall, 22 of 59 patients with no CA survived, 4 with a good clinical outcome (mRS 0–3). Of the 21 with CA, only 3 survived, none with a good outcome (mRS 4–5). Due to the small subgroup surviving additional CA, a statistical difference could not be found between the groups. Aneurysm occlusion (p < 0.001) and aneurysm of the posterior circulation (p = 0.010) resulted in a more favorable clinical outcome. Conclusions Patients with SAH H&H grade 5 do survive and in 5% of cases even with a good outcome. Surviving an additional CA resulted in a less favorable outcome without statistical significance. Thus SAH H&H grade 5 patients with or without CA and additional CPR should not be excluded from appropriate neurosurgical treatment.

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Section: Discussionmentioning

confidence: 99%

Cardiac Arrest in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Single-Center Experience

Ridwan

Kristof

2019

J Neurol Surg A Cent Eur Neurosurg

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“…Although experimental evidence has, for a century, suggested that the CNS has a role in cardiac dysrhythmias 128, 1351, the relevance of these experimental data to the clinical situation was first emphasized by Parizel in 1973 [llO]. His observations of supraventricular tachycardia, ectopic ventricular contractions, multifocal ventricular tachycardias, ventricular flutter, and ventricular fibrillation in subjects with subarachnoid hemorrhage [l 101 have been confirmed [25,35,40,49,111,1591 and extended to subjects with head injuries [60], cerebral ischemia [GO], and cerebral tumors [58], as well as those who have undergone neurosurgical procedures [58J The cardiac dysrhythmias in these conditions could occur with or without electrocardiographic signs of myocardial damage. Even though neural influences may generate the cardiac dysrhythmias, it is possible that the rhythm disturbances may be secondary to incipient cardiac damage caused by the neural influences.…”

Section: Cardiac Arrhythmias With Disease Of the Cns The Clinical Phementioning

confidence: 99%

“…The importance of these complicating cardiac arrhythmias to the overall prognosis of subjects with intracranial disease is profound. They presumably are a major cause of sudden death in patients with subarachnoid hemorrhage, which alone accounts for 4 to 5% of all nonviolent sudden deaths 11 111. One experimental study in cats with unilateral ischemia in the distribution of the left middle cerebral artery demonstrated major arrhythmias in 60% of the animals 1160).…”

Section: Cardiac Arrhythmias With Disease Of the Cns The Clinical Phementioning

confidence: 99%

“…Indeed, the potential for sudden death from cardiac arrhythmias in patients with cerebral lesions in general and subarachnoid hemorrhages in particular has led some investigators to suggest that the antiarrhythmia treatment in patients with intracranial hemorrhages should be just as aggressive as the treatment of subjects with acute myocardial infarctions 1 1 1 1 1. Specifically, atropine or beta blockers, or both, have been recommended in subjects with appropriate indications (supraventricular bradyarrhythmias or tachyarrhythmias, respectively), and specific antiarrhythmia therapy should be directed promptly at any other atrial or ventricular arrhythmia 11 111.…”

Section: Cardiac Arrhythmias With Disease Of the Cns The Clinical Phementioning

confidence: 99%

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Cardiovascular regulation and lesions of the central nervous system

Talman

1985

Annals of Neurology

172

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The central nervous system has an important role in the second-to-second regulation of cardiac activity and vasomotor tone. Central lesions that lead to a disturbance in autonomic activity tend to cause electrocardiographic and pathological evidence of myocardial damage, cardiac arrhythmias, and disturbances of arterial blood pressure regulation. To a great extent such cardiovascular disturbances result from alterations in sympathetic activity. Similar alterations in sympathetic activity can occur under conditions of emotional stress and precipitate cardiac arrhythmias that can themselves lead to the syndrome of sudden death. Experimental and clinical evidence suggests that central neural mechanisms may be involved in this important human syndrome, but no central lesion has yet been identified to account for it. Recent experimental evidence, derived from hypertension research, suggests that chemical disturbances in the central nervous system, without accompanying structural lesions, may be found to explain cardiovascular disturbances such as sudden death and hypertension.

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“…Einleitung über vielfältige kardiale Rhythmusstörungen bis hin zu bedrohlichen Kammertachykardien nach Subarachnoidalblutungen (SAß) wurde berichtet (3, 8,14,16,17,18). Da aber bislang nur wenige Untersuchungen unter Anwendung einer kontinuierlichen EKG-Langzeitregistrierung erfolgten (15,17,18), mangelt es an einer detaillierten Erfassung und Analyse dieser Arrhythmien, insbesondere vor, während und nach hochakuten und unvorhersehbaren Ereignissen, wie Nachblutungen.…”

Section: Zusammenfassungunclassified

Neurogene kardiale Arrhythmien bei akutem intrakraniellem Druckanstieg (Nachblutungen bei Subarachnoidalblutungen)

Stober¹,

Sen²,

T³

et al. 1986

Fortschr Neurol Psychiatr

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Neurogenic cardiac arrhythmias during 5 cases of subarachnoid rebleeding in 4 patients were analyzed by using long-term ECG (Holter). The initial onset of rebleeding was characterized by an abrupt decrease of heart rate from 93.3 +/- 7.85 (beats/min) to 63.3 +/- 14.6 (beats/min). This was immediately followed by pronounced tachycardia of 163.0 +/- 20.9 (beats/min) and subsequently, alterations of the P wave, ST depression with an increase in T wave amplitude. Frequent premature ventricular contractions, couplets, and self-terminating episodes of ventricular tachycardia for 2-8 minutes were observed during 2 episodes of rebleeding, an idioventricular rhythm in one case. The ECG returned to normal in the 3 non-lethal cases. Pathogenetically, the initial heart rate decrease with varying P wave configuration can be explained through activation of the baroreceptor reflex. Elevated intracranial pressure causes a blood pressure increase thus stimulating the baroreceptors and consequently, the afferent and efferent tracts of the vagus nerve. The sympathicotonus appears to have a modulating effect.

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On the mechanism of sudden death with subarachnoid hemorrhage

Abstract: The mechanism of death in some patients with subarachnoid hemorrhage is cardiac arrhythmia. Prevention of cardiac arrhythmias by suitable drugs might save the life of patients whose brain is still good.

Cited by 24 publications

References 55 publications

Cardiac Arrest in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Single-Center Experience

Cardiac Arrest in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Single-Center Experience

Cardiovascular regulation and lesions of the central nervous system

Neurogene kardiale Arrhythmien bei akutem intrakraniellem Druckanstieg (Nachblutungen bei Subarachnoidalblutungen)

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