Serum biomarkers and cerebral autoregulation as early warnings of delayed cerebral ischemia risk in patients after aneurysmal subarachnoid haemorrhage

Uryga, Agnieszka; Czyż, Marcin; Adamik, Barbara; Tabakow, Paweł; Kasprowicz, Magdalena; Burzyńska, Małgorzata

doi:10.1016/j.jocn.2021.02.009

Cited by 6 publications

(7 citation statements)

References 33 publications

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“…The advantages of brain imaging motivated our group to carry out analysis on perfusion MRI maps in a dedicated series the results of which will be shown separately. Additional information on the hemodynamic effect of HDT15 could also be obtained by testing blood levels of vasoactive molecules including adenosine (Wardas, 2002), bradykinin (Ji et al, 2017), nitric oxide (Bolaños & Almeida, 1999) and proteins shown to be associated with impaired cerebral autoregulation, like serum S100 protein B (Uryga et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Head down tilt 15° to preserve salvageable brain tissue in acute ischemic stroke: A pre‐clinical pooled analysis, with focus on cerebral hemodynamics

Diamanti

Mariani

Versace

et al. 2022

Eur J of Neuroscience

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Neurological outcome after ischemic stroke depends on residual salvageable brain tissue at the time of recanalization. Head down tilt 15 (HDT15) was proven effective in reducing infarct size and improving functional outcome in rats with transient middle cerebral artery occlusion (t-MCAO) by increasing cerebral perfusion within the ischemic penumbra. In this pooled analysis, individual animal-level data from three experimental series were combined in a study population of 104 t-MCAO rats (45 in HDT15 group and 59 in flat position group). Co-primary outcomes were infarct size and functional outcome at 24 h in both groups. The secondary outcome was hemodynamic change induced by HDT15 in ischemic and non-ischemic hemispheres in a subgroup of animals. Infarct size at 24 h was smaller in HDT15 group than in flat position group (absolute mean difference 31.69 mm 3 , 95% CI 9.1-54.2, Cohen's d 0.56, p = 0.006). Functional outcome at 24 h was better in HDT15 group than in flat position group (median [IQR]: 13[10-16] vs. 11), with a shift in the distribution of the neurobehavioural scores in favour of HDT15. Mean cerebral perfusion in the ischemic hemisphere was higher during HDT15 than before

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Section: Discussionmentioning

confidence: 99%

Head down tilt 15° to preserve salvageable brain tissue in acute ischemic stroke: A pre‐clinical pooled analysis, with focus on cerebral hemodynamics

Diamanti

Mariani

Versace

et al. 2022

Eur J of Neuroscience

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“…Using an index of | R | ≥ 0.5 on either side as a definition for impaired cerebrovascular reactivity, and the consensus definition for DCI, one group reported odds of DCI of 36 (95% CI: 6–211%) when impaired cerebrovascular reactivity was present ( 23 ). Another investigator used TOx and found that impaired cerebrovascular reactivity on the side contralateral to the aneurysm was significantly more frequent in the DCI group than in the non-DCI group (58 vs. 16%, p = 0.014) and was associated with an OR of DCI of 19 (95% CI: 1.2–320) ( 24 ). Using a threshold of 0.07 conferred TOx a sensitivity of 58% and a specificity of 91% to predict DCI.…”

Section: Clinical Data—vasospasm DCI Prognosismentioning

confidence: 99%

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

et al. 2022

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Delayed cerebral ischemia (DCI) disproportionately affects poor grade aneurysmal subarachnoid hemorrhage (aSAH) patients. An unreliable neurological exam and the lack of appropriate monitoring leads to unrecognized DCI, which in turn is associated with severe long-term deficits and higher mortality. Near Infrared Spectroscopy (NIRS) offers simple, continuous, real time, non-invasive cerebral monitoring. It provides regional cerebral oxygen saturation (c-rSO2), which reflects the balance between cerebral oxygen consumption and supply. Reports have demonstrated a good correlation with other cerebral oxygen and blood flow monitoring, and credible cerebrovascular reactivity indices were also derived from NIRS signals. Multiple critical c-rSO2 values have been reported in aSAH patients, based on various thresholds, duration, variation from baseline or cerebrovascular reactivity indices. Some were associated with vasospasm, some with DCI and others with clinical outcomes. However, the poor grade aSAH population has not been specifically studied and no randomized clinical trial has been published. The available literature does not support a specific NIRS-based intervention threshold to guide diagnostic or treatment in aSAH patients. We review herein the fundamental basic concepts behind NIRS technology, relationship of c-rSO2 to other brain monitoring values and their potential clinical interpretation. We follow with a critical evaluation of the use of NIRS in the aSAH population, more specifically its ability to diagnose vasospasm, to predict DCI and its association to outcome. In summary, NIRS might offer significant potential for poor grade aSAH in the future. However, current evidence does not support its use in clinical decision-making, and proper technology evaluation is required.

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“…An early and short course of an antifibrinolytic drug, including tranexamic acid, started as soon as the radiological diagnosis of SAH is made and stopped within 24-72 hours, has been associated with a decreased rate of ultra-early re-bleeding and a non-significant improvement in long-term functional outcome. This approach remains controversial, and short-term administration of tranexamic acid to prevent re-bleeding is being studied in a multicenter randomized trial (Dutch Trial Registry number NTR3272) [3]. The avoidance of extreme levels of blood pressure is another medical intervention applied to prevent aneurysm re-rupture.…”

Section: Introductionmentioning

confidence: 99%

“…Serum biomarkers to detect the risk of delayed cerebral ischemia (DCI) are showing promising results [3]. Changes in serum protein S100B levels interacted with DCI status (presence vs. absence): F= 3.84, p= 0.016.…”

Section: Introductionmentioning

confidence: 99%

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Conservative Versus Surgical Management for Non-Traumatic Subarachnoid Hemorrhage: A Mini Review

Benitez

2021

JHNSS

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Subarachnoid hemorrhage diagnosis is always a challenge for patients and physicians because it has different presentations. There are two main causes of subarachnoid hemorrhage: traumatic and no traumatic subarachnoid hemorrhage. Both groups share clinical characteristics, but not treatment. Therefore, it is essential to recognize the signs, symptoms, and types of presentation for proper management. The objective of this article is to inform our audience about the significant difference between conservative and surgical treatment for non-traumatic subarachnoid hemorrhage because it carries a high risk of morbidity and mortality, requiring emergency management and well-trained physicians to evaluate patients suspicious for the diagnosis. This article is a compilation of several articles that have been selected from different databases, International Journal of Emergency Medicine, and Journal of Neurosurgery. Traumatic subarachnoid-related articles were excluded from our search. There is no consensus yet about the approach of patients with non-traumatic Subarachnoid Hemorrhage(ntSAH) among experts worldwide, so SAH diagnosis is often overlooked due to the clinical manifestations and inconsistencies in individual findings, especially atypical presentation arrives at the ER. The most significant limitations of timely and aggressive management of SAH are the lack of clinical suspicion and the delay from the CT scan order until the CT scan report is ready. The most repeated cause of subarachnoid hemorrhage is aneurysm rupture. A timely aneurysm repair is considered the most critical strategy to reduce the risk of aneurysm re-rupture. Therefore, detection of the cause of bleeding and prompt management can make the difference between life and death.

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Serum biomarkers and cerebral autoregulation as early warnings of delayed cerebral ischemia risk in patients after aneurysmal subarachnoid haemorrhage

Cited by 6 publications

References 33 publications

Head down tilt 15° to preserve salvageable brain tissue in acute ischemic stroke: A pre‐clinical pooled analysis, with focus on cerebral hemodynamics

Head down tilt 15° to preserve salvageable brain tissue in acute ischemic stroke: A pre‐clinical pooled analysis, with focus on cerebral hemodynamics

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

Conservative Versus Surgical Management for Non-Traumatic Subarachnoid Hemorrhage: A Mini Review

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