The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors

Tewari, Manoj Kumar; Aggarwal, Ashish; Mathuriya, S. N.; Gupta, Vivek

doi:10.5214/ans.0972.7531.220205

Cited by 12 publications

(6 citation statements)

References 6 publications

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“…Hypertension also had no significant predictive value of DCI (OR 0.234, p = 0.09), in agreement with a previous study [21]. This can be explained as all patients were receiving nimodipine, a calcium channel blocker, preventing vasospasm by its vasodilator effect and subsequently controlling the blood pressure [22].…”

Section: Discussionsupporting

confidence: 88%

Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study

Abdel-Tawab

Hasan

Ahmed

et al. 2020

Egypt J Radiol Nucl Med

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Background: Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds. This prospective study included 49 SAH patients. All patients were treated with the standard therapy and underwent non-contrast CT, CTP, and CTA within 3 days after SAH. Hunt and Hess and Fisher scales were assessed besides quantitative CTP parameters. The primary endpoint was DCI within 21 days after SAH, defined as clinical deterioration or infarction. Results: Out of 49 eligible patients with SAH, 9 patients developed DCI. Univariate analysis revealed that Hunt and Hess scale, Fisher scale, the presence of a cerebral aneurysm, and mean transit time (MTT) were predictive for DCI. Diagnostic threshold values by ROC curve analysis with optimal sensitivity and specificity were Hunt and Hess scale > 2, Fisher scale > 2, and MTT of 4.65 s. Conclusion: MTT is a sensitive and specific predictor of DCI. However, Hunt and Hess scale has the optimal sensitivity and specificity to distinguish between patients who developed DCI and clinically stable patients.

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Section: Discussionsupporting

confidence: 88%

Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study

Abdel-Tawab

Hasan

Ahmed

et al. 2020

Egypt J Radiol Nucl Med

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“…The variety of metabolic responses following the stress of SAH similar to traumatic brain injury is often strained further by pathophysiological challenges of compromised perfusion due to DCI. [ 3 5 6 7 8 28 ]…”

Section: Discussionmentioning

confidence: 99%

“…Subarachnoid hemorrhage (SAH) remains a serious disease with high morbidity and mortality, despite improvements in diagnostic modalities, better Intensive Care Unit (ICU) facilities, microsurgical, and endovascular advancements. [ 5 28 ] This is principally due to the occurrence of delayed cerebral ischemia (DCI) or vasospasm. [ 3 5 ] Though attempts have been made to elucidate the pathophysiology of DCI in relation to the breakdown products of blood in the subarachnoid space, imbalance between vasoconstrictor and vasodilator substances, the cause-effect relationship remains elusive because of the presence of a plethora of causative factors.…”

Section: Introductionmentioning

confidence: 99%

Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation?

et al. 2015

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Background:Serum lipid abnormalities are known to be important risk factors for vascular disorders. However, their role in delayed cerebral ischemia (DCI), the major cause of morbidity after subarachnoid hemorrhage (SAH) remains unclear. This study was an attempt to evaluate the spectrum of lipid profile changes in SAH compared to matched controls, and their relation with the occurrence of DCI.Methods:Admission serum lipid profile levels were measured in patients of SAH and prospectively studied in relation to various factors and clinical development of DCI.Results:Serum triglyceride (TG) levels were significantly lower among SAH patients compared to matched controls (mean [±standard deviation (SD)] mg/dL: 117.3 [±50.4] vs. 172.8 [±89.1], P = 0.002), probably because of energy consumption due to hypermetabolic response. Patients who developed DCI had significantly higher TG levels compared to those who did not develop DCI (mean [±SD] mg/dL: 142.1 [±56] vs. 111.9 [±54], P = 0.05). DCI was noted in 62% of patients with TG >150 mg/dL, compared to 22% among the rest (P = 0.01). Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and lipoprotein (a) neither showed a significant difference between SAH and controls and nor any significant association with DCI. Multivariate analysis using binary logistic regression adjusting for the effects of age, sex, systemic disease, World Federation of Neurosurgical Societies grade, Fisher grade, and clipping/coiling, revealed higher TG levels to have significant independent association with DCI (P = 0.01).Conclusions:Higher serum TG levels appear to be significantly associated with DCI while other lipid parameters did not show any significant association. This may be due to their association with remnant cholesterol or free fatty acid-induced lipid peroxidation.

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“…A poor WFNS grade at the time of admission is known to be an independent prognostic factor 7,8 and additionally the most important predictor of morbidity and mortality after aneurysmal SAH. 9 Our analysis confirmed initial WFNS grade as a prognostic factor irrespective of the location of the aneurysm.…”

Section: Wfns Grade and Patients' Outcomementioning

confidence: 99%

Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

Brawanski

Kashefiolasl

Won

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Objective As shown in a previous study, aneurysm location seems to influence prognosis in patients with subarachnoid hemorrhage (SAH). We compared patients with ruptured aneurysms of anterior and posterior circulation, undergoing coil embolization, concerning differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. We retrospectively identified 307 patients with aneurysms of the anterior circulation (anterior cerebral artery, carotid bifurcation, and middle cerebral artery) and 244 patients with aneurysms of the posterior circulation (aneurysms of the basilar artery, posterior inferior cerebellar artery, posterior communicating artery and posterior cerebral artery). All patients underwent coil embolization. The outcome was assessed using the modified Rankin Scale (mRS; favorable [mRS 0–2] vs. unfavorable [mRS 3–6]) 6 months after SAH. Results In interventionally treated aneurysms of the anterior and posterior circulation, statistically significant risk factors for poor outcome were worse admission status and severe cerebral vasospasm. If compared with patients with ruptured aneurysms of the anterior circulation, patients with aneurysms of the posterior circulation had a significantly poorer admission status, and suffered significantly more often from an early hydrocephalus. Nonetheless, there were no differences in outcome or mortality rate between the two patient groups. Conclusion Patients with a ruptured aneurysm of the posterior circulation suffer more often from an early hydrocephalus and have a significantly worse admission status, possibly related to the untreated hydrocephalus. Nonetheless, the outcome and the mortality rate were comparable between ruptured anterior and posterior circulation aneurysms, treated by coil embolisation. Therefore, despite the poorer admission status of patients with ruptured posterior circulation aneurysms, treatment of these patients should be considered.

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The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors

Cited by 12 publications

References 6 publications

Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study

Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study

Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation?

Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

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