Risk Factors for Unfavorable Outcome in Aneurysmal Subarachnoid Hemorrhage Revisited; Odds and Ends

Rahmanian, Abdolkarim; Derakhshan, Nima; Sisakht, Alireza Mohsenian; Karamzade-Ziarati, Najme; Shahraki, Hadi Raeisi; Motamed, Soheil

doi:10.29252/beat-060215

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…Other recent studies also emphasize brief courses of 3 to 7 days of prophylaxis and save the extended prophylaxis for those with mentioned risk factors (14,29). From March 2016, we have switched to a 1-week course of phenytoin or levetiracetam and the results were promising so far for seizure control (13). The results of an ongoing prospective clinical trial at our center will provide further evidence for guidelines of seizure prophylaxis in SAH patients.…”

Section: Future Perspectivementioning

confidence: 80%

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Long-Versus Short-Term Seizure Prophylaxis After Craniotomy for Clipping in Aneurysmal Subarachnoid Hemorrhage; A Retrospective Cohort Study

et al. 2019

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Background: Seizures are quite common following subarachnoid hemorrhage (SAH) and due to increased mortality and morbidity in this setting, thus seizure prophylaxis is introduced as a common neurosurgical practice. Investigations are still ongoing to figure out the most efficient seizure prophylaxis guideline. Objectives: To compare the efficacy of two seizures prophylaxis protocols that have been practiced in a tertiary neurovascular center in Southern Iran through a retrospective cohort analysis Methods: A total of 426 patients who were operated due to aneurysmal SAH between September 2007 and March 2016 were included in this retrospective cohort study. From September 2007 to March 2011 the common practice was prophylaxis with phenytoin for 3 -6 months, which was switched to a shorter 1-month course since March 2011. Seizure control was evaluated in telephoned patients and outpatient records. Results: Out of 426 subjects eligible for this study, 165 (38.7%) took the 1-month (short-term) regimen and 261 (61.3%) took the 3 -6 months (long-term) regimen. Results revealed that achievement of seizure control was similar for both groups in those without perioperative seizures (P = 0.4); however, with perioperative seizures, the short-term protocol had inferior results for seizure control and higher odds (almost 109-fold) for developing post-operative seizures. Conclusions: Although short-term 1-month seizure prophylaxis with phenytoin provides adequate seizure control for most individuals after SAH, perioperative seizures necessitates a longer course of 3 -6 month seizure prophylaxis.

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Section: Future Perspectivementioning

confidence: 80%

“…A total of 474 patients with aneurysmal SAH who underwent clipping in Shiraz Namazi Hospital (the main referral neurovascular center of Southern Iran) (11)(12)(13)(14) were included in this cohort study from September 2007 to March 2016. Those with incomplete hospital and outpatient records were excluded.…”

Section: Study Populationmentioning

confidence: 99%

Long-Versus Short-Term Seizure Prophylaxis After Craniotomy for Clipping in Aneurysmal Subarachnoid Hemorrhage; A Retrospective Cohort Study

et al. 2019

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“…In this retrospective study, a total of 648 patients with anterior circulation aneurysms, who were operated between September 2010 and September 2017 at Neurovascular Unit of Namazi Hospital (main referral neurovascular center in southern Iran) [22,23], were investigated. After exclusion of those who were lost to follow up and the ones whose hospital records were incomplete and inaccessible, 617 were remained eligible as the reference population.…”

Section: Study Populationmentioning

confidence: 99%

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Rahmanian

Derakhshan

Alibai

2018

Iran. J. Neurosurg.

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In-hospital rebleeding and early aneurysm rupture are major causes of mortality and morbidity in aneurysmal subarachnoid hemorrhage. Rebleeding may occur at the referring hospital, during transfer or at the referral neurovascular center prior to surgical or endovascular treatment. However, there has been no report regarding the rate of in-hospital rebleeding and early aneurysm rupture at the referral centers. This study aims to clarify the incidence, significance, management, and outcome of individuals who suffer in-hospital aneurysmal rebleeding and early aneurysm rupture at the referral hospital due to anterior circulation cerebral aneurysm to the time when its neck is visualized for clipping. Methods and Materials/Patients: Among 617 patients with anterior circulation cerebral aneurysms, who underwent operation between September 2010 and September 2017 at Neurovascular Unit of Namazi Hospital (main referral neurovascular center in southern Iran), 22 suffered rebleeding since the time of neuroradiologic diagnosis of aneurysm to intraoperative visualization of aneurysm for neck dissection. A surgical technique for fast access and securing the aneurysm is described in this article, too. The patients' demographics were collected via hospital records in a retrospective fashion. Six-month functional outcome was obtained via OPD records as well as phone calls. Performing Independent t test, 1-way ANOVA, Kruskal-Wallis and Mann-Whitney tests in SPSS22, the effect of each study variable was evaluated during 6 months followup period. Results: Rebleeding occurred at different venues from CT angiography to frontal lobe retraction. Anterior communicating artery was the most common aneurysm to suffer in-hospital rebleeding and male gender was found as a risk factor. These patients have significantly higher bleeding amount and longer operative time (P<0.001), but still have a 68.2% chance of survival with good functional recovery. Earlier in-hospital rebleedings used to have worse outcomes (P=0.036 for GOS and 0.028 for mRS, respectively). Conclusion: Patients with in-hospital rebleeding and early aneurysm rupture at the referral hospitals will have a considerable chance for favorable outcome if they undergo aggressive surgical management emergently.

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“…As reported by Sames et al, by categorising SAH patients based on symptom onset time (less or more than 24 hours), the sensitivity of CT falls from 93.1% to 83.8% [23][24]. Furthermore, in the cases of minor bleeding and re-absorption of blood over time, CT seems unreliable and may provide false negative results [25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double Inversion Recovery

Mardanshahi¹,

Tayebi²,

Shafiee³

et al. 2020

BioMedicine

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Background and objectives: The diagnosis of subarachnoid hemorrhage (SAH) especially at the subacute stage is still a challenging issue using the conventional imaging modalities. Here we evaluated the role of double inversion recovery (DIR) sequence of MRI compared with the conventional gradient-recalled echo (GRE)-T2*-W and susceptibilityweighted imaging (SWI) sequences in the diagnosis of subacute SAH. Materials and methods: This prospective study was conducted on 21 patients with SAH, which were diagnosed using CT scan at the initial step. In the third week after the injury (14-20 days), all patients underwent a brain MRI exam that included T2*-W, SWI, and DIR imaging sequences. All images were independently read by two radiologists, who were blinded to the clinical history of the patients. The presence or absence of SAH was reviewed and assessed in 6 anatomical regions. Results: On the DIR images, 20 patients were found to have at least one subarachnoid signal abnormality, while the SWI and T2*-W images identified SAH areas on 17 and 15 patients, respectively. The highest rate of inter-observer consensus by the DIR sequence was found in the interhemispheric fissure and perimesencephalic area (k ¼ 1). Also, a highest rate of inter-observer consensus using SWI was found in the interhemispheric fissure and posterior fossa cistern area (k ¼ 1). A weak agreement was found in frontal-parietal convexity using SWI (k ¼ 0.447), and in posterior fossa cistern by the T2* sequence (k ¼ 0.447). Conclusion: In conclusion, the DIR sequence was more reliable at identifying signal abnormalities in subacute SAH patients than the T2*-W and SWI sequence, and is suggested as a promising imaging technique for detecting hemorrhagic areas without considering the anatomical distribution of SAH.

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Risk Factors for Unfavorable Outcome in Aneurysmal Subarachnoid Hemorrhage Revisited; Odds and Ends

Cited by 6 publications

References 33 publications

Long-Versus Short-Term Seizure Prophylaxis After Craniotomy for Clipping in Aneurysmal Subarachnoid Hemorrhage; A Retrospective Cohort Study

Long-Versus Short-Term Seizure Prophylaxis After Craniotomy for Clipping in Aneurysmal Subarachnoid Hemorrhage; A Retrospective Cohort Study

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double Inversion Recovery

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