Cerebral Aneurism Research Articles

HMGCR as a promising molecular target for therapeutic intervention in aortic aneurisms: a mendelian randomization study

BackgroundDespite the exploration of the connections between serum low-density lipoprotein cholesterol (LDL-C) levels and aneurisms in epidemiological studies, causality remains unclear. Therefore, this study aimed to assess the causal impact of LDL-C-lowering targets (HMGCR, PCSK9, NPC1L1, CETP, APOB, and LDLR) on various forms of aneurisms using Mendelian Randomization (MR) analysis.MethodsTwo genetic instruments acted as proxies for exposure to LDL-C-lowering drugs: expression quantitative trait loci of drug target genes and genetic variants linked to LDL-C near drug target genes. Summary-data-based MR (SMR), inverse-variance-weighted MR (IVW-MR), and multivariable MR (MVMR) methods were employed to compute the effect estimates.ResultsThe SMR analysis revealed substantial associations between increased HMGCR expression and a heightened risk of aortic aneurism (odds ratio [OR] = 1.603, 95% confidence interval [CI] = 1.209–2.124), thoracic aortic aneurism (OR = 1.666, 95% CI = 1.122–2.475), and abdominal aortic aneurism (OR = 1.910, 95% CI = 1.278–2.856). Likewise, IVW-MR analysis demonstrated positive correlations between HMGCR-mediated LDL-C and aortic aneurism (OR = 2.228, 95% CI = 1.702–2.918), thoracic aortic aneurism (OR = 1.751, 95% CI = 1.191–2.575), abdominal aortic aneurism (OR = 4.784, 95% CI = 3.257–7.028), and cerebral aneurism (OR = 1.993, 95% CI = 1.277–3.110). Furthermore, in the MVMR analysis, accounting for body mass index, smoking, and hypertension, a significant positive relationship was established between HMGCR-mediated LDL-C levels and the development of aortic aneurisms, encompassing both thoracic and abdominal subtypes. Similarly, consistent positive associations were observed for PCSK9 and CETP genes, as well as PCSK9-mediated and CETP-mediated LDL-C levels, with the occurrence of aortic aneurism and abdominal aortic aneurism. Nonetheless, the evidence for potential associations between APOB, NPC1L1 and LDLR with specific subtypes of aortic aneurisms lacked consistent support from both SMR and IVW-MR analyses.ConclusionsOur MR analysis offered compelling evidence of a plausible causal link between HMGCR and an increased risk of aortic aneurism, encompassing both thoracic and abdominal types. These groundbreaking findings further bolster the case for the deployment of HMGCR inhibitors in the treatment of aortic aneurisms, including both thoracic and abdominal variants.

#2095 Genetic kidney disease in pregnancy – experience of tertiary referral hospital

Abstract Background and Aims Genetic kidney diseases (GKD) are rarely seen in pregnancy and some diagnosis will only be made during gestation, due to a high proportion of chronic kidney diseases (CKD) of unknown etiology and recent advances in genetic testing. Genetic counseling and, when possible, preimplantation genetic testing (PGT) should be offered pre-pregnancy to this specific CKD population. Method Retrospective analysis of maternal, obstetric and perinatal outcomes of pregnant women with GKD surveilled at Hospital Santa Maria, at the nephro-obstetric clinic from 2011 to 2023. Results We evaluated 34 pregnancies in 28 women, mean maternal age 30±6 years-old [21-37], 89% Caucasian. Molecular genetic testing was performed pre-pregnancy, during and post-pregnancy in 12/19, 2/19 and 5/19 patients, respectively. At baseline, mean serum creatinine (SCr) and proteinuria (Pr) was 1.0±0.9 mg/dL and 222±516 mg/g, with CKD stage 1/2/3/4/5 in 27/2/2/1/2 gestations and chronic hypertension (HTN) in 11/34 pregnancies. Only 1/28 patients performed PGT, while 1/28 patient declined it. De novo or increased Pr occurred in 10/34 gestations and de novo or worsening HTN in 5/34 gestations. Deterioration of renal function occurred in one patient (CKD3) without recovery and one patient (CKD5) induced dialysis 4 months post-pregnancy. Nephrotic Pr developed in 4/34 gestations. One patient (FSGS APOL1) was treated with tacrolimus and low dose steroids. The patient with TSC re-started sirolimus on week 22 to treat severe fetal ventricular rhabdomyoma. Miscarriage occurred in 2 pregnancies. The C section rate was 21,8%. There were 7 preterm deliveries of which 3 before 32 weeks of pregnancy, mainly due to severe preeclampsia. Mean gestational age at delivery was 37,6 ± 4 weeks (26-41), mean birth weight 2756 ± 831 g (560-3835). Eight newborns were admitted to neonatal ICU due prematurity, fetal TSC, and feeding difficulties. Pulmonary hemorrhage and sepsis caused the death of 2 newborns. We found 1 maternal death, due to rupture of a cerebral aneurism 1 month postpartum (PKD patient). Conclusion Our cohort was very heterogenous regarding CKD etiologies, but generally with good kidney function, which allowed overall good obstetric outcomes. Still, maternal, obstetric and fetal complications, namely HTN, Pr, PE and prematurity had an increased incidence compared to pregnancy in healthy patients. This particular population should be approached by an experienced multidisciplinary team in CKD pregnancy care to optimize outcome.

Assessment of Risks for Gastrointestinal Bleeding in Patients with Brain Injury

The aim of the study was to develop a risk model for upper gastrointestinal tract (GIT) bleeding in patients with brain injury of various etiologies.Material and methods. Case histories of 33 patients were included into a retrospective descriptive study: 22 patients had severe brain injury of various etiologies, and 11 patients after elective surgery for cerebral aneurisms with uneventful postop period were taken for comparison. The patients were grouped in two arms: Group 1 included patients with obvious signs of GIT bleeding (N=11) and Group 2 had no obvious signs of bleeding (N=22). Complaints, life and medical history, comorbidities, specialists’ exams data, results of laboratory and instrumental examinations, therapeutic regimens were analyzed. Presence of disproportionate pathologic sympathetic overreaction to acute brain injury, i.e., paroxysmal sympathetic hyperactivity (PSH), was assessed on admission and on Days 1, 3 and 5 after brain injury. Results. A model for upper GIT bleeding risk assessment was designed using logistic regression. The resulting model gains high quality rating: χ²=33,78, 3; p<0,001; OR=315. The risk of upper GIT bleeding exceeded 95% in patients having combination of 4 symptoms in their medical history (presence of PSH on Day 1 after acute brain injury; Karnofsky performance scale index 75; lack of neurovegetative stabilization in the acute period of brain injury; gastric and/or duodenal ulcer).Conclusion. Determining the risk factors thresholds enables stratification of patients by the risk for upper GIT bleeding. Modification of the identified four risk factors (presence of PSH on Day 1after acute brain injury; Karnofsky performance scale index 75; lack of neurovegetative stabilization in the acute period of brain injury; gastric and/or duodenal ulcer) will probably reduce the occurrence of upper GIT bleeding in patients with acute brane injury of various etiology.

Anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage. Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis. Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001). Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms.

Elizabeth Bishop and the Art of Losing

Elizabeth Bishop and the Art of Losing

MULTIPLE CEREBRAL ANEURYSMS ORIGINATING FROM PREVIOUSLY RESECTED CARDIAC MYXOMA

Primary cardiac tumors are very rare, accounting for 0,001 – 0,03% in autopsy series, cardiac myxoma (CM) account for approximately 50% of them. Association between CM and cerebral aneurism is well documented in this condition but the occurrence of cerebral aneurism after resection of CM is very rare there is only 40 reports in medical literature. We present a case of 45 years old female patient with multiple cerebral aneurysms 2 years after a successful resection of cardiac myxoma, submitted to radiosurgery for 2 bigger aneurisms with good result. This report ads to literature new clinical findings and a hypothesis of radiosurgery as an effective option of treatment for cerebral aneurisms with origin in CM.

Evaluation of the Efficiency of Ultra-Early Endovascular Embolization of Cerebral Aneurisms in Subarachnoid Hemorrage

The review discusses the effectiveness of endovascular embolization of intracranial aneurysms in subarachnoid hemorrhage (SAH) in the first 24 hours after rupture. The need for this study is dictated by the medical and social significance of the disease, in particular, the high degree of mortality and disability in SAH of aneurysmal origin, including in young patients. The choice of embolization timing for SAH remains a subject of discussion in the professional community since the introduction of the technique into clinical practice. Performing embolization on the first day after the onset of the disease, the so-called “ultra-early embolization” has a potentially positive effect on the outcomes of SAH, reducing the number of deaths and increasing the number of favorable outcomes. The main advantage of this tactic is to prevent repeated rupture of the aneurysm, the probability of which is highest in the first day of the disease, as well as the possibility of starting intensive therapy for SAH at the earliest possible time.

Antiplatelet Loading Effects Prior to Endovascular Treatment: Carotid Artery Stenosis versus Unruptured Cerebral Aneurysms.

Carotid artery stenosis and cerebral aneurism may have different platelet functions and antiplatelet responses because these diseases have different etiologies. In this study, we compared the antiplatelet loading effects prior to endovascular treatment between carotid artery stenosis and unruptured cerebral aneurysm (UCA) patients. Nine patients with asymptomatic carotid artery stenosis (ACS), 14 with symptomatic carotid artery stenosis (SCS), and 20 with unruptured cerebral aneurysms were enrolled in this study. Antiplatelet (aspirin + clopidogrel) loading effects prior to endovascular treatment were evaluated using light transmission aggregometry and platelet aggregate detection methods. Although there are differences in the prevalence of atherosclerosis risk factors, maximum aggregation rates in light transmission aggregometry and platelet aggregation-prone properties were not different in the three disease groups. Preoperative dual antiplatelet therapy with aspirin and clopidogrel may be appropriate for both carotid artery stenosis and cerebral aneurism patients even though their conditions and background factors differ.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study.

Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Transcranial doppler in patients with ruptured brain aneurysms in cerebral hemodynamics evaluation and outcomes predicting

The purpose: to develop Doppler criteria in the evaluation of cerebral hemodynamics in predicting the outcome of the disease in patients with cerebral aneurysm rupture.Materials and methods. 172 patients (76 male, 96 female) with cerebral aneurism rupture were participated in the research. All patients were continuously monitored by Doppler studies (a total of 803 studies) in the period from 1 to 20 days after the rupture of the arterial aneurysm. TCD was performed on the apparatus DWL MULTI-DOP T (Germany) with sensors 2 and 4 MHz. All patients were divided into 5 groups depending on the Glasgow outcome Scale (GOS) assessment. Group 1 (n = 87; 50.6%): with an excellent outcome of the disease (GOS 1); group 2 (n = 27; 15.7%): with an good outcome of the disease (GOS 2); group 3 (n = 8; 4.65%): with an acceptable outcome of the disease (GOS 3); group 4 (n = 6; 3.48%): with an acceptable outcome of the disease (GOS 4); group 5 (n = 8; 4.65%): with a lethal outcome of the disease (GOS 5) Systolic blood flow velocity (BFV), Lindegaard index and pulsatility index were estimatedResults. Doppler prognostic criterion of disease outcome were developed: early and progressive increase in blood flow velocity (development of spasm on the 1 day delay after hemorrhage); the development of critical spasm (blood flow velocity over 300 cm/s) by 7–8 days after subarachnoid hemorrhage, the rise of the blood flow velocity per day more than 36 cm/s; the duration of the spasm more than 16 days; increase in pulsatility index (more than 1.0) and Lindegaard index (more than 4.8), the presence of diffuse spasm.Conclusion. The transcranial Doppler can be an additional screening non-invasive diagnostic method for cerebral hemodynamic evaluation and for determination complications in ruptured cerebral aneurysm.

Хірургічне лікування ускладненого аневризматичного субарахноїдального крововиливу

Мета. Покращення результатів хірургічного лікування ускладненого аневризматичного внутрішньочерепного крововиливу. Матеріали і методи. Із 213 хворих з субарахноїдальним крововиливом внаслідок розриву церебральних аневризм у 121 (56,8%) хворого констатовано ускладнений перебіг. Усім цим хворим проведено хірургічне лікування, яке передбачало оклюзію аневризми. Результати. У 68 (56%) хворих застосовано мікрохірургічне кліпування, у 53 - ендоваскулярну емболізацію. Хірургічні втручання у 84,3% хворих виконані протягом перших двох тижнів. У ряді спостережень застосовано комбіноване та багатоетапне хірургічне лікування. Позитивну динаміку отримано у 75 (61,9%) хворих, у тому числі у 59 (48,8%) хворих - хороший функціональний результат (1 - 2 ступінь інвалідизації за модифікованою шкалою Ренкіна). У 23 (19%) хворих результат був несприятливий (4 - 5 ступінь інвалідизації). Померли 23 (19%) пацієнти. Висновки. Назріла потреба в нагальному напрацюванні уніфікованої класифікації ускладнень аневризматичного внутрішньочерепного крововиливу, вивченні ефективності різноманітних хірургічних методів лікування та визначенні критеріїв вибору методу та термінів виконання втручання у залежності від типу внутрішньочерепного крововиливу.

Aneurysmal Subarachnoid Hemorrhage and Cognitive Deficits

Objective: Discuss cognitive deficits caused by subarachnoid hemorrhage (SAH) after rupture of cerebral aneurisms, since about half of the patients have severe or at least striking declines in one or more functions of the cognitive domain. Methods: This paper presents a literature review on cognitive deficits secondary to aneurysmal SAH. There was no delimitation of periods of publications or the locality where it was applied. The bibliographic references were accessed through the database PubMed (http://www.ncbi.nlm.nih.gov/pubmed/). Results: There are three main etiologies for the development of cognitive worsening: the effect of the initial bleeding, the consequences of vasospasm and delayed ischemia and the secondary ones to the treatment. Aneurysms located in the anterior communicating artery and in the middle cerebral artery seem to be related to worse evaluations. As surgical treatment seems to contribute to cognitive worsening, at least when evaluated early. Conclusion: Defining theinvolved factors in this pathology is a great challenge, since the papers of literature use different tests (Glasgow outcome scale or neuropsychological assessments), evaluate the patients in several stages (before or after treatment, being early or late) and compare the SAH patients with different groups (population without pathology or patients with unruptured aneurysms).

Correction to: Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]).

HomeStrokeVol. 49, No. 3Correction to: Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]) Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]) Originally published1 Mar 2018https://doi.org/10.1161/STR.0000000000000169Stroke. 2018;49:e144This article corrects the followingPredictors of In-Hospital Death After Aneurysmal Subarachnoid HemorrhageIn the article by Stienen et al, “Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]),” which published online on January 15, 2018, and appeared in the February 2018 issue of the journal (Stroke. 2018;49:333–340. DOI: 10.1161/STROKEAHA.117.019328), a correction is needed.On page 333, in the author byline, “Michel Röthlisberger” should read “Michel Roethlisberger.”The correction has been made to the current online version of the article, which is available at http://stroke.ahajournals.org/content/49/2/333. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Cai L, Zeng H, Tan X, Wu X, Qian C and Chen G (2021) The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage, Frontiers in Neurology, 10.3389/fneur.2021.671098, 12 Shalygin K, Gorbunov N, Dergilev A, Lyashenko A and Sudarkina A (2021) Evaluation of the Efficiency of Ultra-Early Endovascular Embolization of Cerebral Aneurisms in Subarachnoid Hemorrage, Journal of radiology and nuclear medicine, 10.20862/0042-4676-2021-102-2-116-123, 102:2, (116-123) Related articlesPredictors of In-Hospital Death After Aneurysmal Subarachnoid HemorrhageMartin Nikolaus Stienen, et al. Stroke. 2018;49:333-340 March 2018Vol 49, Issue 3 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/STR.0000000000000169PMID: 29483368 Originally publishedMarch 1, 2018 PDF download Advertisement

Tendencies in cerebral aneurism treatment: Analysis of a hospital series

Introduction and objectiveTo discover if there have been changes in the treatment time for SAH in our hospital environment. Material and methodsComparative analysis of 571 patients treated at Hospital Universitari la Fe during 2 different time periods. The SAH-OLD group consisted of 462 patients attended consecutively between April 1997 and March 2005, while SAH-NEW comprised 109 patients attended consecutively between March 2007 and April 2010. We analysed demographic factors, risk factors, severity at time of admission, time to arteriography, diagnosis of aneurysm, use of surgical or endovascular treatment and time to treatment, frequency of neurological complications, in-hospital deaths, and modified Rankin Scale (mRS) at discharge. ResultsMean time to arteriography was 2.18±2.5 days for the SAH-OLD group and 2.37±2.23 days, for the SAH-NEW group (P=.49). Mortality rates for SAH-OLD patients were calculated at 30%, compared to 18.3% in SAH-NEW patients (P=.01).Among patients surviving the hospital stay in the SAH-OLD group, 13.3% had an mRS>3, compared to 21.3% of survivors in the SAH-NEW group (P=.06). Two hundred forty-five patients in the SAH-OLD group had cerebral aneurysms and 208 were treated (45% of the patient total). Sixty-five of the SAH-NEW patients received treatment (60% of the patient total, P=.007). In the SAH-OLD group, 62.9% of the patients underwent embolisation vs 74.6% in the SAH-NEW group (P=.08). Time to embolisation was 4.7±8.2 days for SAH-OLD patients and 2.12±2.2 days for SAH-NEW patients (P=.01). Twenty-two percent of SAH-OLD patients underwent surgery, compared to 25.4% in the SAH-NEW group (P=.62). ConclusionsCare for SAH patients has improved in this hospital: results include fewer mortalities, a higher number of treatments with a smaller proportion of endovascular treatments, and shorter times to treatment. Elapsed time to arteriography remains stable.

Фузиформні аневризми в структурі церебральних артеріальних аневризм

Мета роботи – вивчити поширеність фузиформних аневризм (ФА) серед артеріальних аневризм судин головного мозку та їх структуру. Матеріали та методи. Проаналізовано дані 1650 хворих з артеріальними аневризмами судин головного мозку за період із січня 2007р. до грудня 2017р. У 79 хворих були ФА, з них у одного – 2 ФА. Серед хворих було 43 (54,4 %) чоловіки та 36 (45,6 %) жінок віком від 14 до 74 років. Більше половини (53 %) пацієнтів були молодше 50 років. Аневризми первинно виявлено за даними методів нейровізуалізації (спіральної комп’ютерної та магнітно-резонансної томографії). Усім хворим проводили селективну церебральну ангіографію. Результати. Встановлено, що ФА трапляються рідше, ніж інші артеріальні аневризми. У нашому дослідженні – у 4,78 % випадків. Фузиформні аневризми частіше локалізувались у вертебробазилярному басейні – 41 випадок (51,25 %), ніж у каротидному – 39 (48,75 %). Найчастіше ФА локалізувалася в сегментах основної (п = 30), внутрішньої сонної (п = 17) та середньої мозкової (п = 14) артерій, рідше – в сегментах хребтової (п = 6), задньої мозкової (п = 5), передньої мозкової (п = 7), задньої сполучної (п = 1) артерій. У 65 (82,4 %) випадках ФА виявлено як самостійну патологію, у 10 (12,6 %) – разом з мішкоподібними аневризмами. У 4 (5 %) хворих виявлено екстракраніальні стенози судин в інших басейнах. Висновки. Фузиформні аневризми – рідкісне захворювання судин головного мозку. Частіше бувають самостійними, рідше поєднуються з мішкоподібними аневризмами та стенозами судин головного мозку. ФА частіше виявляються у осіб середнього віку (48-65 років), переважають в особи чоловічої статі. Найбільш частою їх локалізацією є основна артерія (37,5 %) та внутрішня сонна артерія (21,25 %).

Prognostic significance of leukocyte count in the venous blood in the acute stage of cerebral aneurism rupture

To determine a prognostic role of leukocyte count in the venous blood in the acute stage of cerebral aneurysm (CA) rupture. Fifty-one patients with CA rupture, aged from 20 to 65 years, hospitalized in the first 72 h over the period from 01.10.12 to 01.02.16 were examined. The severity of disease and anatomical form of hemorrhage was corresponded to III-IV degree on the W. Hunt - R. Hess scale and Fisher scale. All patients underwent surgery. Outcomes after open and endovascular surgeries were similar. Normal leukocyte number in the venous blood at admission was identified in 12 (24%) of patients (on average 7.3±1.4·109/L), leukocytosis in 39 (76%) (14.3±3.1·109/L) (p<0.0001). Leukocyte number in the acute stage of CA rupture was correlated with the frequency and severity of the vessel spasm. In 28 (55%) of patients with ischemic lesions of the brain matter, mean leukocyte number in the first 72 h after hemorrhage was higher by 2-24% (3±4.8·109/L) compared to patients without ischemia (11.9±2.5·109/L) (p=0.06). The level of leukocytes in survivors was lower by 3 - 28% (122±3.4·109/L) compared to patients with fatal outcome and patients with severe neurological deficit after the surgery (14.5±3.9·109/L) (p>0.05). The increase in leukocyte number in the venous blood in the first 72 h after CA rupture ≥10,1·109/L is a reliable risk factor of marked vessel spasm. The level of leukocytes in patients with cerebral ischemia and poor prognosis in the first 72h after aneurysmal hemorrhage was higher by 2-28% compared to survivors without neurological impairment or mild neurological deficit.

Atrial natriuretic factor: is it responsible for hyponatremia and natriuresis in neurosurgery?

ObjectiveTo evaluate the presence of hyponatremia and natriuresis and their association with atrial natriuretic factor in neurosurgery patients.MethodsThe study included 30 patients who had been submitted to intracranial tumor resection and cerebral aneurism clipping. Both plasma and urinary sodium and plasma atrial natriuretic factor were measured during the preoperative and postoperative time periods.ResultsHyponatremia was present in 63.33% of the patients, particularly on the first postoperative day. Natriuresis was present in 93.33% of the patients, particularly on the second postoperative day. Plasma atrial natriuretic factor was increased in 92.60% of the patients in at least one of the postoperative days; however, there was no statistically significant association between the atrial natriuretic factor and plasma sodium and between the atrial natriuretic factor and urinary sodium.ConclusionHyponatremia and natriuresis were present in most patients after neurosurgery; however, the atrial natriuretic factor cannot be considered to be directly responsible for these alterations in neurosurgery patients. Other natriuretic factors are likely to be involved.

THE PATH OGENESIS OF CEREBRAL AN GIOSPASM AND BRAIN ISCHEMIA IN PATIENTS WITH NON-TRAUMATIC SUBARACHNOID HEMORRHAGE DUE TO CEREBRAL ANEURYSM RUPTURE

The problem of cerebral angiospasm in patients with subarachnoid hemorrhage due to cerebral aneurism rupture is reviewed. The article presents the main aspects of etiology, pathogenesis of permanent angiospasm and ischemic damage of brain.

Surgical treatment of cerebral vascular diseases

Theoretical and practical aspects of the complex treatment of brain and spinal vascular diseases using microsurgical, endovascular and radiosurgical methods are considered. Authors present the data demonstrating that, due to the implementation of the program of development of vascular centers in the Russian Federation, considerable progress was made in the treatment of cerebral aneurisms and hemorrhagic stroke. In author's opinion, wide introduction of surgical methods in the treatment of occlusive lesions of the blood vessels supplying the brain is needed.

Botulinum toxin type A in the healing of chronic lesion following bilateral spasticity of gluteus muscle

Use of botulinum toxin is expanding as the clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is above all used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations. A 17-year-old man had a sub-arachnoid haemorrhage following the rupture of cerebral aneurism. The patient presented gluteus maximus and medius bilaterally spasticity that produced a chronic lesion in the intergluteal cleft, a flexed wrist and a flexed elbow. As treatment for this spasticity, a total of 100 U botulinum toxin type A were injected into the glutei muscles. This treatment allowed for application of topical medication and subsequently, chronic lesion healing. Botulinum toxin A may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by spasticity.