Presence Of Subarachnoid Haemorrhage Research Articles

The impact of SAH finding on CT to the clinical outcome after mechanical thrombectomy for large vessel occlusion

Background and purposeWhether subarachnoid haemorrhage (SAH) after mechanical thrombectomy affects the clinical outcomes of patients with acute large-vessel occlusion remains unclear. This study aimed to investigate the clinical impact of SAH on computed tomography (CT) after mechanical thrombectomy. MethodsThe SKIP study was an investigator-initiated, multicentre, randomised, open-label clinical trial. This study was performed in 23 hospital networks in Japan from January 1, 2017, to July 31, 2019. Among the 204 patients, seven were excluded because they did not undergo mechanical thrombectomy (MT) and had a modified Rankin scale (mRS) score > 2. The main outcome was the association between SAH within 36 h after mechanical thrombectomy and the clinical outcome at 90 days. ResultsAmong 197 patients, the median age was 74 (67–79) years, 62.9% were male. Moreover, 26 (13.2%) patients had SAH (seven isolated SAH) on CT within 36 h. The SAH rate did not differ according to IV rt-PA administration (p = 0.4). The rate of favourable clinical outcomes tended to be lower in patients with SAH rather than patients without SAH (11 [42%] vs. 106 [62%], p = 0.08). Among the seven patients with isolated SAH, 6 showed favourable outcomes at 90 days. In the multivariate regression analysis, the presence of SAH within 36 h from onset was not associated with clinical outcome (Odd ratio, 0.59; 95% confidence interval, 0.18–1.95; p = 0.38). ConclusionsAmong patients with acute stroke treated with MT, SAH, especially isolated SAH findings on CT, were not associated with poor clinical outcomes after 90 days.Trial Registration number: UMIN000021488.

Chronic Anterior Pituitary Dysfunction Following Traumatic Head Injury: Prospective Study in Hospital Sultanah Aminah Johor Bahru, Malaysia.

Hypopituitarism following traumatic brain injury (TBI) is not rare however most patients were left undiagnosed and untreated. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. The aim of the study is to determine the incidence of the chronic anterior pituitary deficiency in patients with traumatic brain injury. Subsequently determine the risk factor and the outcome of the patient with chronic anterior pituitary dysfunction. This is single centre cross-sectional study involved 105 traumatic head injury patients under the Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru, Malaysia. The primary investigator will do an interview and the patients will be asked question to complete a questioner from SF-36 (36 questions). Subsequently, consent for participation will be taken and blood sampling will be done. Thirty-three patients were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old. Twenty-seven patients (32.5%) were male and six patients were female (27.3%). Chronic anterior pituitary dysfunction in patients with a severe traumatic head injury around 47.1% (23 patients), as compared to a moderate head injury (8 patients, 38.1%) and 2 sustained mild head injury (5.6%). The mean duration after the onset of trauma was 10.3 ± 1.79 months. All patient with anterior pituitary dysfunction had positive CT brain findings with 22 had subarachnoid haemorrhage (SAH) at the basal cistern and 27 patients had a base of skull fracture, where 52.1% of the patient underwent surgical intervention, 84.8% involved one axis and another 5 patients had two axes involved. Severity of the head injury (P < 0.001), prolonged duration of hospital stay (P = 0.014), radiological findings of a base of skull fracture (P < 0.001) and presence of SAH at basal cistern (P < 0.001) was significantly associated with pituitary dysfunction. The patient with anterior pituitary dysfunction has the lower 36-item Short Form Survey (SF-36) marks 56.3 ± 10.3. The prevalence of hypopituitarism was 31%. Indicators are increased TBI severity, prolonged hospitalisation and positive finding in radiological assessment. Post-traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF-36 marks.

The risk factors associated with traumatic subdural effusion for patients with traumatic brain injury who did not undergo decompressive craniectomy.

The main aim of this study was to investigate the risk factors of traumatic subdural effusion (TSE) development in traumatic brain injury (TBI) patients who did not undergo decompressive craniectomy (DC). This is a retrospective study based on a database of patients treated in a single institution from January 2020 to January 2022. The clinical and demographic characteristics of the enrolled patients, including gender, age, Glasgow Coma Scale score at admission, characteristics of the initial CT scan on admission, mechanism of injury and the mannitol treatment were recorded retrospectively. Two hundred fifty-four patients with TBI who did not receive DC were enrolled in this study. Among them, 78 (30.71%) patients were assigned to the TSE group, while 176 patients (69.29%) without TSE were assigned to the control group. Univariate analysis showed that patients in the TSE group were more likely to be male (p = 0.019), older (p < 0.001), have a subarachnoid haemorrhage (p = 0.016) and have a basal cistern haemorrhage (p = 0.014). Logistic regression analysis identified that older age (odds ratio [OR] = 1.056, p < 0.001), presence of subarachnoid haemorrhage (OR = 2.022, p = 0.018) and presence of basal cistern haemorrhage (OR = 2.861, p = 0.027) were risk factors independently associated with the development of TSE. Our results showed that older age, presence of subarachnoid haemorrhage and presence of basal cistern haemorrhage were risk factors independently associated with the development of TSE for TBI patients without DC.

Cerebral Venous Thrombosis Presenting as Cortical Subarachnoid HaemorrhageA Case Report and Review

In the presence of Subarachnoid Haemorrhage (SAH), diagnosis of underlying Cerebral Venous Thrombosis (CVT) is challenging as there is no difference in clinical presentation and therapeutically it is important because CVT need to be treated with anticoagulant unlike SAH. This article is about a 50-year-old male presenting with headache, right hemiparesis, and recurrent seizures. The Computed Tomography (CT) head was suggestive of SAH in right posterior parietal region. But Magnetic Resonance Imaging (MRI) venogram showed cerebral venous sinus thrombosis. Hence, he was treated with anticoagulants. The patient showed significant clinical improvement. SAH secondary to underlying CVT is relatively rare entity. After reviewing medical literature of such cases, 42 case reports and case series forming 95 cases of SAH secondary to CVT were found.

Factors Affecting Clinical Outcome of Patients with Traumatic Brain Injury

Background: The present study aims to describe the severity of injury [Glasgow Coma Scale (GCS)] and outcome of patients [Glasgow Outcome Scale (GOS)] who presented to our hospital with TBI and factors which affect the clinical outcome.Subjects and Methods:All patients, aged equal to or more than 18 years, presenting to the Emergency Department of our hospital due to head trauma during the study period were examined and assessed using GCS at the time of admission, and GOS at the time of discharge.Results:The most common mode of injury was road traffic accident (48%). At the time of admission, 47% had GCS of 13 to 15, 37% had GCS of 9 to 12 and 16% had GCS of 3 to 8. At the time of discharge, we found that 18 patients had GOS of 1, no patient had GOS of 2, 14 patients had GOS Of 3, 28 had GOS of 4 and 29 had GOS of 5. We found that age of the patients was significantly associated with the GOS severity (p value &lt;0.05). Furthermore, GCS at admission was found to be significantly associated with GOS at discharge (p value &lt;0.01). Midline shift on CT head, effaced basal cistern, and presence of subarachnoid haemorrhage were also found to be significantly associated with poor GOS at discharge.Conclusion: The results of our study may be used for stratification of patients, and developing prognostic models to improve the clinical outcome of head injury.

Comparative study of computed tomographic scoring systems and predictors of early mortality in severe traumatic brain injury

Traumatic Brain Injury (TBI) is a significant cause of disability, mortality and socio-economic loss in developing countries. Prognostication and early prediction of outcome will help in judicious allocation of resources. The three CT scoring systems, commonly employed in predicting outcome are the Marshall, Rotterdam and the Helsinki CT Scoring system. This is a prospective observational study to compare the above scoring systems and their role in predicting the outcome after TBI. A total of 157 patients were included in this study. Primary objective was early outcome assessed by Glasgow Outcome Scale at discharge and 3 months. On comparing the three CT scoring systems, the Helsinki CT score provided a better positive predictive value of 87.5% for mortality in comparison with Marshall (79.3%) and Rotterdam Score (82.5%). Summarising the results for ROC analysis of the three CT scoring systems, the area under curve was 0.742 for Marshall score, 0.751 for the Rotterdam score and 0.815 for the Helsinki score, which upholds the superiority of the Helsinki CT score in predicting the mortality compared to other two. The linear relationship of higher the score with added risk of mortality was seen with Rotterdam score and Helsinki score. Individual CT findings of positive midline shift, obliteration of suprasellar cisterns, presence of subarachnoid haemorrhage, intraventricular haemorrhage and large mass lesions were found to be independent predictors of mortality. The Helsinki Scoring system is a better prognostic model with significantly improved outcome prediction accuracy, although the Marshall and Rotterdam scoring systems have good predictability for assessing mortality.

Prevalence of subarachnoid haemorrhage among patients with cranial venous sinus thrombosis in the presence and absence of venous infarcts.

Introduction In patients with cranial venous sinus thrombosis, the occurrence of subarachnoid haemorrhage in association with haemorrhagic venous infarcts is a well described phenomenon. However, the presence of subarachnoid haemorrhage in patients with cranial venous sinus thrombosis in the absence of a haemorrhagic venous infarct is exceedingly rare. Methods We retrospectively reviewed charts and scans of all patients who had cranial venous sinus thrombosis confirmed by magnetic resonance venography at our hospital between September 2004 and May 2015. The presence of subarachnoid haemorrhage was ascertained on fluid-attenuated inversion recovery, susceptibility-weighted imaging and/or unenhanced computed tomography scans by a single experienced neuroradiologist. Statistical analysis was performed using the Statistical Package for Social Sciences version 20. Differences in the proportion of haemorrhagic venous infarcts among patients with subarachnoid haemorrhage versus those without subarachnoid haemorrhage were compared using the chi-square test. A P value of less than 0.05 was considered significant. Results A total of 138 patients who had cranial venous sinus thrombosis were included in the study. Seventy-three (52.9%) were women and the median age of subjects was 35 (interquartile range 22-47) years. Venous infarcts and haemorrhagic venous infarcts were noted in 20/138 (14.5%) and 62/138 (44.9%) cases, respectively. Subarachnoid haemorrhage was present in 15/138 (10.9%) cases and, in three cases, subarachnoid haemorrhage occurred in the absence of a venous infarct. Haemorrhagic venous infarcts were more prevalent ( P = 0.021) among patients with subarachnoid haemorrhage (11/15) than in those without subarachnoid haemorrhage (51/123). Conclusion In patients with cranial venous sinus thrombosis, subarachnoid haemorrhage can occur even in the absence of a haemorrhagic venous infarct. The recognition of cranial venous sinus thrombosis as the underlying cause of subarachnoid haemorrhage is important to avoid misdiagnosis and inappropriate management.

Cortical venous thrombosis presenting with subarachnoid haemorrhage.

Our study retrospectively reviewed the presentation, neuro-radiological findings, and outcomes of eight adult patients presenting at our institution with subarachnoid haemorrhage (SAH), which was subsequently proven to be due to cortical venous thrombosis (CVT). We reviewed the case records and neuroimaging findings of eight patients diagnosed with SAH and CVT over a span of two years at our institution, a tertiary care centre in Western India. All details pertaining to their presentation, clinical findings, neuroimaging, management, and outcome following therapy with anticoagulants were collected until patient discharge. There were a total of eight patients, with the average age being 34 years (range 25-42). Only one patient was female. Six patients had a history of recent binge drinking. None of the patients had a past or family history of common risk factors for thrombosis. All patients presented acutely, with headache (n=6) and seizures (n=6) being the most common presenting features, occurring in three-quarters of the patients examined. Non-contrast computed tomography (NCCT) was the initial imaging study for all but one of the patients and showed cortical SAH (cSAH) without basilar haemorrhage. Magnetic resonance imaging/magnetic resonance venography (MRI/MRV) confirmed the underlying CVT. Unfractionated heparin was used in all cases. Seven patients improved and were discharged on oral anticoagulation. The eighth patient died. Localised cSAH with sparing of basal cisterns can be a presentation for CVT. In patients with cSAH, MRI/MRV can be useful to make a diagnosis of CVT. Anticoagulation for CVT, even in the presence of SAH was related to seven out of eight patients being discharged.

Hydrocephalus after decompressive craniectomy for malignant hemispheric cerebral infarction

Purpose: Several studies have investigated the incidence and risk factors of hydrocephalus after decompressive craniectomy (DC) for malignant hemispheric cerebral infarction. However, the results are controversial. Therefore, the following is a retrospective cohort study to determine the incidence and risk factors of hydrocephalus after DC for malignant hemispheric cerebral infarction. Materials and methods: From January 2004 to June 2014, patients at two medical centres in south-west China, who underwent DC for malignant hemispheric cerebral infarction, were included. The patients’ clinical and radiologic findings were retrospectively reviewed. A chi-square test, Mann–Whitney U-test and logistic regression model were used to identify the risk factors. Results: A total of 128 patients were included in the study. The incidence of ventriculomegaly and shunt-dependent hydrocephalus were 42.2% (54/128) and 14.8% (19/128), respectively. Lower preoperative Glasgow Coma Scale (GCS) score and presence of subarachnoid haemorrhage (SAH) were factors significantly associated with the development of post-operative hydrocephalus after DC. Conclusions: Cerebral infarction patients receiving DC have a moderate tendency to suffer from post-operative hydrocephalus. A poor GCS score and the presence of SAH were significantly associated with the development of hydrocephalus after DC.

Endovascular repair of posterior communicating artery aneurysms, associated with oculomotor nerve palsy: A review of nerve recovery.

Oculomotor nerve palsy (ONP) is often the presenting symptom in patients with posterior communicating artery (PCOMM) aneurysms with variable recovery of oculomotor nerve function following treatment. In this study we report the ophthalmologic outcome of 20 patients treated by endovascular coiling for PCOMM aneurysm-induced ONP. We performed 230 PCOMM aneurysm endovascular coilings between the years 2006 and 2011, of which 20 cases presented with ONP. We recorded the degree of nerve recovery - complete, partial or none - while also documenting other predictive factors, such as degree of pre-intervention nerve deficit, presence of subarachnoid haemorrhage (SAH), size and location of the PCOMM aneurysm and length of follow-up. Of the 20 patients, 9 (45%) presented with complete ONP and 11 (55%) with partial ONP. After an average follow-up period of 16 months, all patients achieved oculomotor nerve recovery; 9 (45%) patients had complete recovery and 11 (55%) patients had partial recovery. Of the 9 patients who presented with complete ONP, 5 (56%) patients made a complete recovery and 4 (44%) made a partial recovery. Of the 11 patients who initially presented with partial ONP, 4 (36%) made a complete recovery and 7 (64%) made a partial recovery. 7 (35%) patients also had a SAH, of whom 3 (43%) made a complete recovery with 4 (57%) making a partial recovery. ONP can occur with PCOMM aneurysm with or without SAH. Endovascular coiling is an effective treatment for ONP due to PCOMM aneurysms.

VSARICHS: a simple grading scale for vascular structural abnormality-related intracerebral haemorrhage

Background and purposeVascular structural abnormality-related intracerebral haemorrhage (VSARICH) accounts for 10–20% of cases of intracerebral haemorrhage (ICH), but none of the grading scales for primary ICH are reliable for VSARICH....

Limited predictive power of hospitalization variables for long‐term cognitive prognosis in adult patients with severe traumatic brain injury

Traumatic brain injury (TBI) is a main cause of mortality and morbidity. Association studies between hospitalization variables and cognitive impairment after TBI are frequently retrospective, including non-consecutive patients showing variable degrees of TBI severity, and poor management of missing (drop out) cases. We assessed prospectively the demographic and hospitalization variables of 234 consecutive patients with severe TBI (admission Glasgow Coma Scale [GCS] ≤8) and determined their independent association with cognitive performance in a representative sample (n=46) of surviving patients (n=172) evaluated 3 (±1.8) years after hospitalization. In all, 85% of patients were male and the mean age was 34 (SD ±13) years. The education level was 9 (±4.7) years. As expected, education and age showed a moderately to strong linear relationship with the cognitive performance in 14 of 15 neuropsychological tests (R coefficient=0.6-0.8). The cognitive test scores were not independently associated with gender, admission GCS, associated trauma, and Marshal CT classification. Admission-elevated blood glucose levels and the presence of sub-arachnoid haemorrhage were independently associated with lower scores on Rey Auditory Verbal Learning retention and Logical Memory-I tests, respectively. After correction for education and age distribution, the variables that are commonly associated with mortality or Glasgow Outcome Scale including admission pupils' examination, Marshal CT Classification, GCS, and serum glucose showed a limited predictive power for long-term cognitive prognosis. Identification of clinical, radiological, and laboratory variables as well as new biomarkers independently associated with cognitive outcome remains an important challenge for further work involving severe TBI patients.

Localized convexity subarachnoid haemorrhage – a sign of early cerebral venous sinus thrombosis

The diagnosis of cerebral venous sinus thrombosis (CVST) requires a high index of suspicion owing to the wide spectrum of clinical manifestations. Amongst the different presentations, radiological evidence of subarachnoid haemorrhage (SAH) often leads to diagnostic errors. Between March 2005 and December 2007, 233 patients with CVST were reviewed at our centre, and this report summarizes 10 cases that presented with SAH. The early clinico-radiological pointers towards a diagnosis of CVST are highlighted and previously published reports are reviewed. The mean age at presentation was 33 years (range 25-50), and the median duration from onset of symptoms to admission was 5 days (range 2-15). In all cases, there was radiological evidence of SAH with or without associated parenchymal bleeding or other signs of CVST. SAH was usually localized, involving the sulci of the cerebral convexity and sparing the basal cisterns. Aetiologically, there were two cases with both hyperhomocysteinaemia and polycythaemia and one case each of antiphospholipid antibody (APLA) syndrome, post-partum state, oral contraceptive use and dehydration because of diarrhoea. Eight patients improved with anticoagulant therapy despite the presence of SAH. Localized SAH (whether focal, unilateral or bilateral), especially when confined to the parasagittal or dorsolateral convexity of the brain and without involvement of the basal cisterns, may provide an early pointer towards an underlying CVST. The presence of predisposing factors for CVST accords a further diagnostic hint.

Traumatic interhemispheric subdural haematoma: Study of 35 cases

The clinical and radiological findings, management, and outcomes in 35 patients with traumatic interhemispheric subdural haematoma (ISH) were reviewed retrospectively. Twenty-five patients had favourable outcomes and 10 had poor outcomes. All patients were treated conservatively for ISH. Univariate analysis found that the Glasgow Coma Scale (GCS) score ( p < 0.001), hypovolemic shock ( p = 0.018), skull fracture ( p = 0.008), convexity or posterior fossa subdural haematoma ( p = 0.008), and subarachnoid haemorrhage (SAH) were correlated with outcome ( p < 0.001). Multivariate analysis showed that GCS score ( p = 0.031; odds ratio [OR], 0.6; 95% confidence interval [CI], 0.3–0.9) and the presence of SAH ( p = 0.023; OR, 14.2; 95% CI, 1.5–138.2) were significantly related to poor outcome. This study provides important information on the clinicoradiological findings and prognoses in patients with traumatic ISH.

Dissecting intracranial aneurysms presenting as subarachnoid haemorrhage: report of two cases and review of literature

Subarachnoid haemorrhage due to intracranial non-traumatic dissecting aneurysms is rare. Most of the published reports refer to dissecting aneurysms in the vertebrobasilar territory. Anterior circulation dissecting aneurysms are rare and their pathogenesis, clinical features, angiographic findings and management are a matter of debate. Management of patients with intracranial arterial dissection is unclear. Unlike the well-established proximal occlusion and trapping approaches to vertebral artery dissections, choices of interventions for anterior circulation and basilar dissecting aneurysms are limited, and most reports have been limited to wrapping techniques for arterial wall reinforcement. The role of anticoagulation therapy in the presence of subarachnoid haemorrhage is also a matter of debate. As no clear-cut guidelines are available, treatment should be tailored to the individual patient. We describe two cases of intracranial dissecting aneurysms, which presented as subarachnoid haemorrhage (SAH) and discuss the management issues.

Post-coma disturbance and post-traumatic amnesia as nonlinear predictors of cognitive outcome following severe closed head injury: findings from the Westmead Head Injury Project.

This study sought to identify combinations of early neurological variables which best predict cognitive outcome 12 months after severe head injury. At the time of admission patients were assessed on seven neurological indices. Twelve months later a battery of neuropsychological tests examining recent memory functioning and speed of information processing was administered. Recent memory functioning was best predicted by a combination of post-coma disturbance (PCD; i.e. the duration of post-traumatic amnesia, PTA, minus the duration of coma) and presence of subarachnoid haemorrhage (multiple r = 0.54, p < 0.001). Speed of information processing was best predicted by the duration of PTA (r = 0.35, p < 0.01). However, these conclusions were based on square root transformation of PCD and PTA variables. The success of this transformation in assisting prediction confirms suggestions that the relationship between PTA and cognitive outcome is nonlinear.

Postoperative recovery of third nerve palsy due to posterior communicating aneurysms.

Postoperative recovery of third nerve palsy due to a posterior communicating artery aneurysm was correlated with pre- and intraoperative factors. The only significant factor determining recovery was the degree of preoperative deficit. The presence of subarachnoid haemorrhage, timing of surgery and aspiration of the aneurysmal sac did not influence recovery.