Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization: a single-center experience

Jovanović, Ivan; Nemir, Jakob; Gardijan, Danilo; Milošević, Milan; Poljaković, Zdravka; Klarica, Marijan; Ozretić, David; Radoš, Marko

doi:10.1007/s00234-021-02747-2

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…In the present study, we applied multivariate logistic regression analysis combined with PSM to access the association between sPi levels and aHCP. The significant findings of this study were as follows: (1) A lower admission sPi level was considered as a risk factor of aHCP; (2) mFisher scale and Hunt-Hess grade were negatively correlated with sPi, respectively; (3) Patients with severe aSAH (higher mFisher score and Hunt-Hess grade) have significantly lower sPi levels; (4) The sPi level was negatively associated with SBP; (5) The model constructed by sPi levels, Hunt-Hess grade, and mFisher scale markedly improves the prediction of aHCP after aSAH. Risk factors for aHCP have been reported, including mFisher score, Hunt-Hess grade in aSAH patients, which were balanced in this study.…”

Section: Discussionmentioning

confidence: 74%

“…The onset of hydrocephalus is rapid and persistent, occurring within 6 h after aSAH and remaining for at least 72 h. Therefore, aHCP was defined as the development of cerebral ventricle enlargement within 72 h of subarachnoid hemorrhage after aneurysmal rupture ( 5 ). The bicaudate index and relative bicaudate index were used to diagnose hydrocephalus ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…A following-up CT was performed depending on the patient's clinical condition. Emergency brain CT scans were performed in the presence of clinical deterioration, new focal neurological deficits, seizures, or gradual loss of consciousness (including rebleeding or aHCP) ( 5 ). If the patient had severe aHCP or progressive deterioration of consciousness or periventricular edema, immediate external ventricular drainage was performed ( 3 ).…”

Section: Methodsmentioning

confidence: 99%

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Admission Lower Serum Phosphate Ion Levels Predict Acute Hydrocephalus of Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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Introduction: The relationship between serum phosphate ion (sPi) and the occurrence of acute hydrocephalus (aHCP) in aneurysmal subarachnoid hemorrhage (aSAH) remains largely unknown and controversial. The primary aim of this study was to investigate the association between sPi on admission and aHCP following aSAH.Methods: The study included 635 patients over the age of 19 years diagnosed with aSAH in our institution from September 2012 to June 2018. Data on clinical characteristics, laboratory parameters, treatments, and outcomes were collected and analyzed. The association between lower sPi levels and aHCP was assessed in univariate and multivariate analyses. Propensity-score matching (PSM) analysis was performed to reduce significant differences in baseline characteristics between the aHCP group and non-HCP group.Results: The overall incidence of aHCP following aSAH was 19.37% (123/512). Lower sPi levels were detected in patients with aHCP compared with those without [0.86 (0.67–1.06) vs. 1.04 (0.84–1.21) mmol/L] in the univariate analysis. In the multivariate analysis, lower sPi level, high modified Fisher (mFisher) grade, and high Hunt-Hess grade were associated with aHCP [odds ratios (OR) 1.729, 95% confidence interval (CI) 1.139–2.623, p = 0.01; mFisher OR 0.097,95% CI 0.055–0.172, p < 0.001; Hunt-Hess, OR 0.555, 95% CI 0.320–0.961, P = 0.036]. After PSM, the matched aHCP group had a significantly lower sPi level than the matched non-aHCP group [0.86 (0.67–1.06) vs. 0.94 (0.76–1.12) mmol/L, p = 0.044]. The area under the curve (AUC) of the sPi level and the logistic regression model based on these predictors (sPi, Hunt-Hess grade, and mFisher grade) was 0.667 and 0.840 (sensitivity of 88.6% and specificity of 68.4%) for predicting aHCP, respectively.Conclusions: Lower sPi levels predict the occurrence of aHCP, and the model constructed by sPi levels, Hunt-Hess grade, and mFisher grade markedly enhances the prediction of aHCP after aSAH.

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Section: Discussionmentioning

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Admission Lower Serum Phosphate Ion Levels Predict Acute Hydrocephalus of Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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“…In general, pathophysiological mechanism of hydrocephalus development is often not clear in both experimental animals and patients. This especially applies to particular forms of the disease such as unilateral communicating hydrocephalus and hydrocephalus conjoined with spinal pathology ( 7 , 8 ), as well as transitory hyrocephalus [e.g., after intracranial bleeding; ( 9 – 12 )], arrested or slow- progressing forms with normal CSF pressure and uninterrupted CSF pathways such as iNPH ( 8 , 13 , 14 ). Since these conditions cannot be explained with classical concept of CSF physiology and pathophysiology (blocked CSF system communication, imbalance between CSF secretion and absorption), etiology and pathogenesis of the mentioned forms of the disease still remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus

Kudelić,

Koprek,

Radoš

et al. 2023

Front. Neurol.

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IntroductionThe pathophysiology, diagnosis, and management of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Although some prognostic tests recommended in iNPH guidelines should have high sensitivity and high predictive value, there is often no positive clinical response to surgical treatment.Materials and methodsIn our study, 19 patients with clinical and neuroradiological signs of iNPH were selected for preoperative evaluation and possible further surgical treatment according to the guidelines. MR volumetry of the intracranial and spinal space was performed. Patients were exposed to prolonged external lumbar drainage in excess of 10 ml per hour during 3 days. Clinical response to lumbar drainage was assessed by a walk test and a mini-mental test.ResultsTwelve of 19 patients showed a positive clinical response and underwent a shunting procedure. Volumetric values of intracranial space content in responders and non-responders showed no statistically significant difference. Total CSF volume (sum of cranial and spinal CSF volumes) was higher than previously published. No correlation was found between spinal canal length, CSF pressure, and CSF spinal volume. The results show that there is a significantly higher CSF volume in the spinal space in the responder group (n = 12) (120.5 ± 14.9 ml) compared with the non-responder group (103.1 ± 27.4 ml; n = 7).DiscussionThis study demonstrates for the first time that CSF volume in the spinal space may have predictive value in the preoperative assessment of iNPH patients. The results suggest that patients with increased spinal CSF volume have decreased compliance. Additional prospective randomized clinical trials are needed to confirm our results.

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“…Aneurysmal subarachnoid hemorrhage is a fast developing, devastating, and life-threatening hemorrhagic stroke with high mortality and disability [1][2][3]. Hydrocephalus (HCP) is a common complication after aSAH, with a reported incidence ranging from 6.5% to 85% [4][5][6][7], which is classi ed as acute (0-3 days post-SAH), subacute (4-13 days post-SAH), or chronic (14 days post-SAH) [8,9]. Acute hydrocephalus (aHCP) is a potentially treatable cause of early neurological deterioration, and 20% of aSAH patients develop aHCP within 72 hours [6,8].…”

Section: Introductionmentioning

confidence: 99%

Lower Serum Phosphate Ion Level is Associated with Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage.

Kang

Zhang

Zheng

et al. 2021

Preprint

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Background: The relationship between serum phosphate ion (sPi) and the occurrence of acute hydrocephalus (aHCP) in aneurysmal subarachnoid hemorrhage (aSAH) remains largely unknown and controversial. The primary aim of this study was to evaluate the association between sPi on admission and aHCP following aSAH. Methods: A prospective study was conducted on six hundred thirty-five patients over the age of 19 years diagnosed with aSAH in our institution from January 21, 2012, to December 30, 2019. Data on clinical characteristics, laboratory parameters, treatments, and outcomes were collected and analyzed. The association between lower sPi levels and aHCP was assessed in univariate and multivariate analyses. Propensity-score matching (PSM) analyses were adopted to reduce the baseline differences between the non-HCP group and HCP group. Results: The overall incidence of aHCP following aSAH was 19.37% (123/512). Lower sPi levels were detected in patients with aHCP compared with those without [0.86(0.67-1.06) mmol/L vs. 1.04(0.84-1.21)] mmol/L in the univariate analysis. In the multivariate analysis, lower sPi, high modified Fisher (mFisher) grade, and high Hunt-Hess grade were associated with aHCP [odds ratios (OR) 1.729, 95% CI 1.139–2.623, P=0.01; mFisher OR 0.097,95%CI 0.055-0.172, p<0.001; Hunt-Hess, OR 0.555, 95% confidence interval (CI) 0.320–0.961, P=0.036]. After PSM, the matched HCP group had a significantly lower sPi level than the matched non-hydrocephalus group [(0.86(0.67-1.06) vs. 0.94(0.76-1.12) mmol/L, P= 0.020)]. The area under the curve (AUC) of the sPi level and the logistic regression model based on these predictors (sPi, Hunt-Hess grade, and mFisher score) was 0.667 and 0.840 (sensitivity of 88.6% and specificity of 68.4%) for predicting aHCP, respectively. Conclusion: Lower sPi levels at admission were observed in patients with unfavorable outcomes. Lower sPi levels were associated with aHCP and poor prognosis, and the model constructed by sPi levels, Hunt-Hess grade, and mFisher grade significantly improves the prediction of aHCP after aSAH.

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Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization: a single-center experience

Cited by 4 publications

References 26 publications

Admission Lower Serum Phosphate Ion Levels Predict Acute Hydrocephalus of Aneurysmal Subarachnoid Hemorrhage

Admission Lower Serum Phosphate Ion Levels Predict Acute Hydrocephalus of Aneurysmal Subarachnoid Hemorrhage

Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus

Lower Serum Phosphate Ion Level is Associated with Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage.

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