Intracranial Aneurysm Hemorrhage Research Articles

The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms.

Shunt-dependent hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) which indicated intensive care unit stay and unfavorable outcome. Our aim is to study the risk factors of shunt-dependent hydrocephalus after aneurysmal subarachnoid space hemorrhage. Patients with intracranial aneurysms treated in our department from January 2014 to October 2018 were included in the study. Patients’ age, gender, history of hypertension and diabetes, location of aneurysms, Glasgow coma scale (GCS) score, Hunt–Hess grading, intraventricular hemorrhage, therapeutic option, shunt placement, clinical outcome, length of stay were analyzed. The follow-up period was 1 to 5 years. Statistics included Chi-squared, Student t test, 1-way analysis of variance, Pearson correlation coefficient, and multivariate logistic regression. About 845 cases with intracranial aneurysms treated in our department were included in the study. The mean age was 52.19 ± 9.51 years and the sex ratio was 317/528. About 14.3% (121/845) of the patients developed shunt-dependent hydrocephalus in the follow-up period. According to our results, older than 60, Hunt–Hess grading, GCS, coma, posterior circulation aneurysm, external ventricular drainage, and decompress craniotomy were risk factors of shunt dependency (P < .05). Moreover, older than 60, GCS 3 to 8, Hunt–Hess 3 to 5, and posterior circulation aneurysm were the independent risk factors of shunt dependency. Moreover, shunt dependency was related to longer hospital stay and unfavorable outcome (P < .05). In conclusion, patients older than 60, GCS 3 to 8, Hunt–Hess 3 to 5, and posterior circulation aneurysm need more strict observation and longer follow-up. Timely and appropriate treatment may benefit patients in recovery, while further exploration is still needed in the future.

Ендоваскулярне комбіноване та багатоетапне хірургічне лікування ускладненого інтракраніального аневризматичного крововиливу

Ендоваскулярне комбіноване та багатоетапне хірургічне лікування ускладненого інтракраніального аневризматичного крововиливу

Takotsubo cardiomyopathy after intracranial aneurysmal subarachnoid hemorrhage

Objective To investigate the clinical characteristics of Takotsubo cardiomyopathy (TTC) following intracranial aneurysmal subarachnoid hemorrhage (SAH). Methods Review all patients with intracranial aneurysmal SAH from January 2013 to January 2015 in our hospital, and finally a total of 14 patients who complicated TTC were selected. Their clinical data, creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), N-terminal pro-B-type natriuretic peptide (NT-proBNP), ECG and echocardiographic findings were analyzed. Results For 14 patients of TTC following aneurysmal SAH, the value of CK was (591.93 ± 248.78) IU/L in the first 24 h on admission, and significantly decreased to (137.79 ± 29.93) IU/L 2 weeks later ( t = 7.090, P = 0.000); the value of CK-MB was (27.07 ± 7.66) IU/L in the first 24 h (3 cases were at normal levels), and significantly decreased to (14.36 ± 5.58) IU/L 2 weeks later ( t = 4.897, P = 0.000); the value of NT-proBNP was (8685.36 ± 3963.44) IU/L in the first 24 h, and significantly decreased to (577.14 ± 203.37) IU/L 2 weeks later ( t = 7.778, P = 0.000). ECG on admission mainly showed ST segment alternation, T wave inversion and QT interval prolongation. Echocardiograghic findings showed segmental left ventricular wall motion abnormalities. The average left ventricular ejection fraction (LVEF) was (36.07 ± 6.15)%, and increased to (56.43 ± 3.18)% 2 weeks later ( t = 13.381, P = 0.000). The results of ECG and echocardiographic findings were normal after one month. Conclusions Intracranial aneurysmal SAH can lead to Takotsubo cardiomyopathy, the incidence of which is 4.58% approximately, and the prognosis is good. Echocardiographic findings are significantly important for early screening of Takotsubo cardiomyopathy, and coronary angiography (CAG) can be used to make a clear diagnosis in acute phase. DOI: 10.3969/j.issn.1672-6731.2016.06.010

Spontaneous Acute Subdural Hemorrhage with Rupture of Intracranial Aneurysm: A Series of Two Cases and Review of Literature

We present a rare series of two cases of spontaneous intracranial aneurysmal hemorrhage associated with acute subdural hematoma. One patient was having ruptured anterior communicating artery aneurysm and acute subdural hematoma with no evidence of subarachnoid hemorrhage and the other patient presented with subarachnoid hemorrhage with bleeding in subdural, intraparenchymal, and intraventricular location with rupture of posterior communicating artery aneurysm. In this report, we are describing the pathophysiology and radiological features of subdural hematoma with aneurysm bleed.

Decompressive craniotomy in patients with intracranial aneurysmal hemorrhage

Decompressive craniotomy (DCT) has been used for treatment of patients with acute aneurysmal subarachnoid hemorrhage (SAH) for more than 20 years. But so far, the attitude to this surgery is controversial, and the indications and contraindications for it are not clearly defined. The article reviews the domestic and foreign literature devoted to the issues of validity and efficacy of DCT in treatment of cerebral edema and intracranial hypertension in patients with aneurysmal SAH.

Cognitive disorders in patients with deep disability after surgery on intracranial aneurysmal hemorrhage

The characteristics of cognitive impairment in patients with deep disability after surgery on intracranial aneurysmal hemorrhage almost aren’t identified. Aim. To determine the state of cognitive functions in patients with severe disability after surgery on intracranial aneurysmal hemorrhage. Methods. The study included 328 patients with intracranial aneurysmal hemorrhages. 257 patients underwent intracranial surgery - arterial aneurysm clipping, 71 patients are operated by endovascular method. Immediate responses to the treatment are assessed at the end of inpatient treatment and 6 months after discharge on a scale of consequences Glasgow (GOS). Late results of the treatment were assessed by the modified Rankin scale 2.5 years after surgery. Deep disability status of patients is considered for GOS-2 (persistent vegetative state) or 3 points (severe disability) and for Rankin - 4 (Moderately severe disability) or 5 points (Severe disability). Cognitive impairment and ability to communicate was assessed using the MMSE scale. Result. Quality of life in patients with deep disability changed over time. Immediately after surgery the average score for the MMSE amounted to 10.3 points, 6 months – 13.6, 2.5 years – 21.8. Violation of a guide at the time and place was much pronounced almost the entire time of observation. The function of the perception of information 2.5 years after surgery fully recovered in 72 % of patients. Only in 6 months after surgery 100% of patients with deep disability were dysfunction of concentration and arithmetic. This function completely restored only 2.5 years after surgery in 28 % of patients. The largest number of patients who completely regenerated memory function was observed 2.5 years after surgery. After 2.5 years of observation in 12 % of patients was observed a complete regeneration of reading function. Realization of three-phase commands in most patients remained broken in all time of observation. Conclusions. Despite the presence of significant neurological deficits and dependence on others, general condition of cognitive functions within 2.5 years after surgery in patients with deep disability after surgery on intracranial aneurysmal hemorrhage is improved. Patients with deep disability after surgery on intracranial aneurysmal hemorrhages it is observe violation of all cognitive functions measured on MMSE scale. The most problematic in terms of restoring is function of realization of three-phase command

Glycemia in conditions of hypothermia in patients with intracranial aneurysmal hemorrhage

Despite the proven effectiveness of hypothermia as a method of neuroprotection, the presence of significant side effects requires further development of detailed protocols of usage, especially glucose. Aim: Improving treatment outcomes of patients with subarachnoid aneurysmal hemorrhage by preventing the development of hyperglycemia during systemic hypothermia. Materials and Methods: The study involved 48 patients with spontaneous subarachnoid hemorrhage of aneurysmal origin. All patients were conducted intracranial surgery - clipping aneurysms of cerebral vessels during regression of arterial vascular spasm (AVS) in the systemic hypothermia prevention. Therapeutic hypothermia was performed in 29 patients with complicated disease course for 48 hours. It is evaluated the effectiveness of its own method of prevention and correction of hyperglycemia - permanent short-acting insulin before the warm saline at a dose of 2 units/hour during hypothermia Results: During the prevention of hypothermia using methods of hyperglycemia episodes of above 10 mmol / L did not observe the rejection of a group of patients using the conventional method of correction of glycemia. Episodes of hypoglycemia do not observed in both groups of the study. Up to 48 hours of therapeutic hypothermia glucose levels remained stable, after 48 hours of hypothermia it is observed a significant increase in blood glucose that was cool termination criterion. Conclusions: Holding insulin infusion at short-acting dose of 2 units/hour during prophylactic hypothermia prevents episodes of hyperglycemia and consequently helps to maintain homeostasis. Carrying insulin infusion at short-acting dose of 2 units/hour during therapeutic hypothermia promotes stable blood glucose levels to 48 hours. After 48 hours of hypothermia in 51.72% of patients experienced a significant increase in blood glucose, which is one of the criteria for termination of cooling

Epidemiology of intracranial aneurysm and subarachnoid hemorrhage.

Intracranial aneurysmal hemorrhage is a common but devastating condition associated with significant morbidity and mortality. Epidemiologic studies have identified risk factors associated with this condition. Genetic factors involve family history and the presence of certain heritable connective tissue disorders such as Ehlers-Danlos syndrome, Marfan's syndrome, neurofibromatosis, and polycystic kidney disease. Acquired factors include traumatic brain injury, sepsis, smoking, and hypertension. Management of these patients consists of prevention, patient screening, and prophylactic aneurysm repair.

Case Report. Active Hemorrhage of Intracranial Aneurysms: Diagnosis by CT Angiography

Two cases of active hemorrhage from an intracranial aneurysm demonstrated by CT angiography are presented. In each case, extraluminal opacified blood was seen entering a recent hemorrhage surrounding the aneurysm, simulating a vascular structure. This is a potential pitfall in the interpretation of CT angiograms in patients with recent subarachnoid hemorrhage.