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1
Ryttlefors, Mats. "Subarachnoid Hemorrhage in the Elderly." Doctoral thesis, Uppsala universitet, Institutionen för neurovetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9504.
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Subarachnoid hemorrhage (SAH) is a disease with high risk of mortality and morbidity. Elderly patients have an even higher risk of poor outcome. The incidence of SAH increases with age and the elderly constitute a substantial and increasing proportion of the population. Thus, the management of elderly SAH patients is an imminent clinical challenge. Time trends in clinical management and outcome were investigated in 281 SAH patients aged ≥65 years admitted over an 18-year period. The volume of elderly patients, especially patients ≥70 years and patients in worse clinical condition increased over time. The proportion of patients with favorable outcome increased over time, without an increase in severely disabled patients. Technical results and clinical outcome of endovascular aneurysm treatment (EVT) was investigated in 62 elderly SAH patients. EVT can be performed in elderly SAH patients with high technical success, acceptable aneurysm occlusion degree, acceptable procedural complication rate, and fair outcome results. EVT was compared to neurosurgical clipping (NST) in 278 elderly SAH patients in the International Subarachnoid Aneurysm Trial. In good grade elderly SAH patients, EVT should probably be the favored treatment for internal carotid and posterior communicating artery aneurysms, while elderly patients with middle cerebral artery aneurysms appear to benefit from NST. Occurrence of secondary insults and their impact on clinical deterioration were studied in 99 patients with severe SAH. High intracranial pressure increased and high cerebral perfusion pressure decreased the risk of clinical deterioration. Elderly patients had less intracranial hypertension insults and more hypertensive, hypotensive and hypoxemic insults. Good outcome was achieved in 24% of elderly patients with severe SAH, and the proportion of severe disability was similar to that of younger patients. Patient age was not a significant predictor for vasospasm in 413 SAH patients when admission and treatment variables were adjusted for with multiple logistic regression.
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Ekelund, Anders. "Detection and haemodilutive treatment of cerebral arterial vasospasm and delayed ischaemia after aneurysmal subarachnoid haemorrhage." Lund : Lund University, 1999. http://catalog.hathitrust.org/api/volumes/oclc/68945106.html.
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Lee, Hubert. "Clinical Prediction of Symptomatic Vasospasm in Aneurysmal Subarachnoid Hemorrhage." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35673.
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Objective: This study aims to derive a clinically-applicable decision rule to predict the risk of symptomatic vasospasm, a neurological deficit primarily due to abnormal narrowing of cerebral arteries supplying an attributable territory, in aneurysmal subarachnoid hemorrhage (SAH).
Methods: SAH patients presenting from 2002 to 2011 were analyzed using logistic regression and recursive partitioning to identify clinical, radiological, and laboratory features that predict the occurrence of symptomatic vasospasm.
Results: The incidence of symptomatic vasospasm was 21.0%. On multivariate logistic regression analysis, significant predictors of symptomatic vasospasm included age 40-59 years, high Modified Fisher Grade (Grades 3 and 4), and anterior circulation aneurysms.
Conclusion: Development of symptomatic vasospasm can be reliably predicted using a clinical decision rule created by logistic regression. It exhibits increased accuracy over the Modified Fisher Grade alone and may serve as a useful clinical tool to individualize vasospasm risk once prospectively validated in other neurosurgical centres.
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Alsalman, Abdulkhaliq. "Impact of Statin Therapy on Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients." VCU Scholars Compass, 2009. http://scholarscompass.vcu.edu/etd/1994.
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There is conflicting data on the effects of statins on cerebral vasospasm and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients. In this retrospective cohort study, patients were divided into those who received pravastatin (PRAV group) 40mg/d and those who did not (NP group). Data were analyzed using multivariate logistic regression. Eighty-one patients met inclusion criteria. There was a statistically significant decreased in the incidence of vasospasm in the PRAV group; however, this association did not retain significance after adjusting for WFNS, race, elevated WBC, and clipping (59% PRAV vs. 88% NP, p=0.08). There was no statistically significant difference in proportion of severe radiological vasospasm or mortality between groups. However, there was a trend towards a decreased mean length of stay (P=0.06) and a significantly higher proportion of survivors discharged to home in the PRAV group (P<0.0001). In conclusion, there was a trend towards a decrease in the incidence of vasospasm in the aSAH receiving pravastatin, but this trend did not achieve statistical significance after adjusting for potential confounders. Pravastatin was associated with other favorable clinical outcomes.
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Blissitt, Patricia A. "The effect of head of bed elevation on cerebrovascular dynamics in mild or moderate cerebral vasospasm following aneurysmal subarachnoid hemorrhage /." Thesis, Connect to this title online; UW restricted, 2002. http://hdl.handle.net/1773/7309.
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Pyne, Gail Jean. "Vascular smooth muscle oxidative metabolism and function during vasospasm after subarachnoid haemorrhage." Thesis, University of Oxford, 1999. http://ora.ox.ac.uk/objects/uuid:a6b78de5-1f66-4225-992e-e490cf68d0e8.
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Aims: The purpose of the research presented in this thesis is to elucidate the mechanism of the stimulation of oxidative metabolism and contractile function that occurs in vascular smooth muscle during cerebral vasospasm (CV) after subarachnoid haemorrhage (SAH). The biochemical mechanisms leading to CV were investigated using an in vitro model of CV developed for this research. CSF (cerebrospinal fluid) from SAH patients at risk of vasospasm which stimulated oxygen consumption (CSF S ) was used to model vasospasm. The hypothesis is CSFS contains a substance which stimulates tension generation over that of CSFN ,(non-stimulatory cerebrospinal fluid) and also inhibits the myosin light chain phosphatase. Methods: The porcine carotid artery was used as a model for the human basilar artery. The rate of oxygen consumption (JO2) was measured in response to CSFS and tension generation was also examined. Various agents were used to treat or pretreat the tissue such as magnesium and andalpha;1-adrenergic receptor agonists. Their effects on the CSFS-induced stimulation were measured to study the mechanism of vasospasm. A myosin light chain phosphatase (MLCP) assay was developed to study the mechanisms leading to CV. Results and conclusion: Addition of CSFS to the porcine carotid artery is a reliable and reproducible in vitro model of CV. Using this model, it was found that Mg++ loading and andalpha;1-adrenergic receptor agonists attenuated the vasospasm, but a non-specific endothelin antagonist had no effect. Acute addition of 12mM Mg++ relaxed the tissue from a CSFS induced contraction significantly and rendered the contraction rinsible. Okadaic acid (InM), a phosphatase inhibitor, had very similar effects to CSFS because it stimulated JO2 and slowed relaxation after a stretch. There was also significant inhibition of phosphatase caused by the CSFS. Vasospasm appears to be caused by a combination of a contractile stimulus, and inhibition of MLCP activity.
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Vora, Yashail Y. "The role of transcranial Doppler ultrasonography in the diagnosis of cerebral vasospasm following aneursymal subarachnoid hemorrhage." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0002/MQ34429.pdf.
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Trandafir, Cristina Corina. "Study on participation of arginine vasopressin and leukotrienes in development of cerebral vasospasm after subarachnoid hemorrhage." Kyoto University, 2006. http://hdl.handle.net/2433/144056.
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Kyoto University (京都大学)0048
新制・課程博士
博士(人間・環境学)
甲第12400号
人博第318号
新制||人||79(附属図書館)
17||D||177(吉田南総合図書館)
24236
UT51-2006-J392
京都大学大学院人間・環境学研究科相関環境学専攻
(主査)教授 五十棲 泰人, 助教授 倉橋 和義, 教授 津田 謹輔
学位規則第4条第1項該当
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Paschoal, Eric Homero Albuquerque. "Biomarcadores genéticos na hemorragia subaracnoidea aneurismática em pacientes da Amazônia." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-10112017-125704/.
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Hemorragia subaracnoidea aneurismática (HSAa) é considerada causa importante de morte e de sequelas neurológicas. A taxa de mortalidade desta doença pode alcançar 50% nos primeiros dois meses após sangramento de aneurisma encefálico. Apesar dos avanços científicos da modernidade, o resultado do tratamento da HSAa não mudou nos últimos anos. O presente estudo avaliou o papel de 14 biomarcadores genéticos, incluindo o polimorfismo (SNP) do gene eNOS, em pacientes da Amazônia com HSAa, para verificar as alterações alélicas associadas ao risco de vasoespasmo encefálico e déficit neurológico tardio. Avaliou-se a ancestralidade desta amostra de pacientes em que se utilizou 48 marcadores para identificar possível etnia associada à predisposição ao VE. Investigou-se 14 biomarcadores genéticos no tocante à resposta inflamatória encefálica na HSAa. Foram avaliados 265 doentes que foram divididos em dois grupos: grupo I (pacientes com vasoespasmo encefálico) e grupo 2 (pacientes sem vasoespasmo). A média das idades foi 51 anos, havia 224 mulheres (84%) e 124 pacientes (46,79%) apresentaram vasoespasmo encefálico (VE). A maior incidência de VE ocorreu na idade entre 50 e 59 anos. Tabagismo e hipertensão arterial sistêmica foram os fatores de risco mais associados à VE. Aneurismas encefálicos de tamanho pequeno e médio predominaram nesta casuística. As escalas amarela e vermelha do VASOGRADE associaram-se ao risco de VE (p < 0,001). Não houve variação na distribuição ancestral entre os grupos estudados e o que ocorre na população brasileira saudável na região Amazônica. O gene da eNOS com seus respectivos polimorfismos T-786C e 27VNTR4 correlacionaram-se com VE. Outros marcadores observados foram TP53, CASP8, ACE2, IL4 e XRCC1. O gene TP53 (modelo recessivo alelo 1) mostrou-se ser um fator protetor de VE, enquanto que genes com mutações INDEL CASP8 (modelo recessivo alelo 2) e o XRCC1 (modelo recessivo alelo 1) mostraram tendência ao desenvolvimento de VE com risco 2 vezes maior e 1,4 vezes maior que o grupo II (p < 0,001). Conclui-se que SNPs da eNOS se correlacionam com desenvolvimento de VE sintomático pós-HSAa. Este estudo também mostrou o papel dos marcadores inflamatórios na HSAa, o que auxiliaria na condução da terapia clínica.Aneurysmal subarachnoid hemorrhage (aSAH) is a leading cause of premature death and neurological disability. It is considered as a devastating condition that accounts to 50% of mortality during the first two months after a hemorrhagic event. Despite foremost advances in the clinical management of post-aSAH patients, the rates of mortality and morbidity have not changed in recent years. This study appraised the role of 14 genetic biomarkers, including the eNOS polymorphism (SNP) between Amazon\'s patients with aSAH, as means to document how variant alleles are related to a higher disposition to cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). 265 patients were evaluated and then divided into two clusters: Group I (with symptomatic CV) and group II (presenting no symptomatic CV). The median ages of patients were 51.61 years of age, 224 (84.52%) were women and 124 patients (46.97%) had symptoms of cerebral vasospasm (CV). Tobacco smoking and systemic arterial hypertension are the risk factors most associated to CV. In the course of this research, most aneurysms found were small and medium-sized. The score VASOGRADE yellow and VASOGRADE red presented a high risk of CV (p < 0.001). We established a panel of 48 ancestry informative markers for estimating which ethnicity could present a predisposition to CV. There was no variation in the ancestral distribution between study groups and healthy brazilian folk over the Amazon region. The eNOS gene with its polymorphisms T-786C and 27 VNTR4 were correlated to CV. Other markers were accomplished: TP53, CASP8, ACE2, IL4, and XRCC1. The TP53 gene (recessive genetic model allele 1) supporting evidence of the protective role to CV. Whilst other genes with INDEL mutation like as CASP8 (recessive model allele 2) and the XRCC1 (recessive model allele 1) indicated a propensity to spread out CV with odds 2-fold higher, and 1.414 times greater than group II (p < 0.001). It follows that eNOS SNPs correlate to a positive association with a syntomatic CV post-aSAH. Also, this study showed up the role of inflammatory markers at aSAH to a further educated therapeutic choice for a better clinical response
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Wallmark, Svante. "Life after Subarachnoid Hemorrhage." Doctoral thesis, Uppsala universitet, Neurokirurgi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-307949.
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Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH. Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery. Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients. The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.
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English, Shane. "Subarachnoid Hemorrhage: The Ottawa Hospital Experience." Thesis, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/30349.
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Background: Primary subarachnoid hemorrhage (1°SAH) is an important disease that causes significant morbidity and mortality. The sparse Canadian epidemiologic literature on 1° SAH is outdated and relies on diagnostic coding for case ascertainment which misses true cases and incorrectly labels non-cases.
Objectives: Primary objective was to identify all patients with 1° SAH presenting to the Ottawa Hospital (TOH) between July 1, 2002 and June 30, 2011 by deriving and validating a search algorithm using an enriched administrative database. Secondary objectives included: 1) determine incidence and case-fatality rates (CFR) of 1° SAH at TOH; and 3) derive and validate a method to identify 1° SAH using routinely collected administrative data.
Methods: A cohort of 1° SAH patients were identified with a case-defining algorithm that was derived and validated using a combination of cerebrospinal fluid analysis results and text-search algorithms of both cranial imaging and post-mortem reports. The incidence of 1° SAH was calculated using the total number of hospital encounters over the same time period. CFR was calculated by linking to vital statistic data of hospitalized patients at discharge. An optimal1° SAH prediction model was derived and validated using binomial recursive partitioning built with independent variables obtained from routinely collected administrative data.
Results: Using the case-defining algorithm, 831 patients were identified with a 1° SAH over the study period. Hospital incidence of 1° SAH was 17.2 events per 10,000 inpatient encounters (or 0.17% of encounters) with a case-fatality rate of 18.1%. A validated SAH prediction model based on administrative data using a recursive partitioning model had a sensitivity of 96.5% (95% CI 93.9-98.0), a specificity of 99.8% (95%CI 99.6-99.9), and a +LR of 483 (95% CI 254-879). This results in a post-test probability of disease of 45%.
Conclusion: We identified almost all cases of 1° SAH at our hospital using an enriched administrative data. Accurately identifying such patients with routinely collected health administrative data is possible, providing important opportunities to examine and study this patient population. Further studies, involving multiple centres are needed to reproduce these results.
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Prunell, dos Santos Giselle F. "Pathophysiology of subarachnoid hemorrhage in the rat /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-610-3/.
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Schatlo, Bawarjan [Verfasser]. "Cerebral ischemia in experimental subarachnoid hemorrhage / Bawarjan Schatlo." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2011. http://d-nb.info/1026265347/34.
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Budohoski, Karol Paweł. "Cerebral autoregulation and subarachnoid haemorrhage." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648435.
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Nyberg, Christoffer. "Metabolic and Endocrine Response in the Acute Stage of Subarachnoid Hemorrhage." Doctoral thesis, Uppsala universitet, Neurokirurgi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-328121.
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The rupture of an aneurysm in subarachnoid hemorrhage (SAH) is a dramatic event causing a severe impact on the brain and a transient or permanent ischemic condition. Several types of responses to meet the challenges of SAH have been found in the acute phase, including activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, elevated levels of brain natriuretic peptide (BNP), and disturbances in cerebral and systemic metabolism. Cerebral metabolism and the endocrine stress response in the ultra-early phase was investigated in a novel porcine model of SAH in which autologous blood was injected to the anterior skull base. Early activation of the HPA axis was found with rapid elevation of adrenocorticotrophic hormone, cortisol and aldosterone. The peak values of these hormones were early and may be impossible to catch in patients. There were indications of a sympathetic nervous response with excretion of catecholamines in urine as well as plasma chromogranin-A elevation. Cerebral microdialysis suggested immediate substrate failure followed by hypermetabolism of glucose. The animal model seems suited for further studies of aneurysmal SAH. NT-proBNP was investigated in 156 patients with SAH, there was a dynamic course with increasing levels during the first 4 days of the disease. Factors predicting high NT-proBNP load included female sex, high age, high Troponin-I at admission, angiographic finding of an aneurysm and worse clinical condition at admission. High levels of NT-proBNP were correlated to factors indicating a more severe disease, suggesting the initial injury in aneurysmal SAH is an important factor in predicting high NT-proBNP during the acute stage of the disease. Measurements with indirect calorimetry were performed daily during the first week after SAH on 32 patients with SAH. There was a dynamic course with increasing energy expenditure (EE) the first week after SAH. Comparisons with three predictive equations indicated that measured EE generally is higher than predicted, but considerable variation exists within and between patients, indicating that prediction of EE in SAH is difficult. Altogether, the studies demonstrate a complicated response in acute SAH that needs to be further studied to increase possibility of good outcome in SAH patients.
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Oh, Justin. "Near infrared spectroscopy in detecting delayed cerebral ischemia in subarachnoid hemorrhage patients." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12176.
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Thesis (M.A.)--Boston UniversityBackground: Aneurysmal subarachnoid hemorrhage (aSAH) affects 30,000 Americans each year. Delayed cerebral ischemia caused by cerebral vasospasm is a complication that occurs in approximately 30% of aSAH patients and is a major cause of morbidity and mortality (Hijdra et al., 1986; Roos et al., 2000). The only two established screening methods for vasospasm, transcranial doppler (TCD) and CT angiography (CTA), have their own shortcomings (Jan van Gijn, Kerr, & Rinkel). Studies have shown that TCD has a 63% sensitivity and 52% specificity in detecting vasospasm (Carrera et al., 2009). Furthermore, TCDs require skilled technicians to insonate the cerebral blood vessels thereby explaining why TCDs can only be performed once per day. While CTA is highly specific and sensitive in detecting vasospasm, it requires the use of contrast dye which and carries the risk of contrast nephropathy. Near Infrared Spectroscopy (NIRS), however, is an FDA approved imaging technique that has been used in carotid endarterectomy surgeries to monitor for cerebral ischemia. It is a non-invasive technique and can take continuous, 24-hour measurements of cortical oxygenation. Additionally, NIRS does not require a trained technician to operate, nor does it confer any risk of nephropathy. Also, it is markedly cheaper than the other methods of detection mentioned here because there is no other cost other than the purchase of the machine and the disposable sensors. [TRUNCATED]
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Gelshorn, Jana. "Zusammenhang zwischen hyperglykämer Stoffwechsellage und klinischem Verlauf bei Patienten nach Subarachnoidalblutung und möglicher Einfluss einer intensivierten Insulintherapie." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-165744.
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Viele Studien haben sich bereits mit Nutzen und Risiken einer intensivierten Insulintherapie (IIT) intensivmedizinischer Patienten auseinandergesetzt. Die unterschiedlichen Ergebnisse gaben Anlass, die Auswirkungen einer Hyperglykämie auf Patienten mit einer Subarachnoidalblutung (SAB) weiter zu analysieren. In diesem Zusammenhang war der Stellenwert einer IIT von besonderem Interesse. Um den Einfluss des erhöhten Blutzuckers möglichst genau zu erfassen, wurde mittels Integralfunktion die Blutzuckerhöhe in Abhängigkeit der Zeit bestimmt.
Es konnte ein negativer Einfluss einer hyperglykämen Stoffwechsellage auf den Krankheitsverlauf der Patienten dargestellt werden. Hervorzuheben sind hier vor allem Patienten, die sich initial in einem besseren Zustand befanden.
Anschließend erfolgte die Einführung einer intensivierten Insulintherapie. In der IIT war es nicht immer möglich, den gewünschten Zielbereich des Blutzuckers zu erreichen, um einen signifikanten Unterschied beider Therapiegruppen bezüglich der Blutzuckereinstellung zu erhalten. Dennoch zeigte sich ein deutlicher Trend zugunsten der intensiviert therapierten Gruppe und dessen Krankheitsverlauf.
Die Behandlung der Hyperglykämie durch eine IIT bleibt ein wichtiger Aspekt in der Intensivmedizin. Anzustreben ist eine moderate Insulintherapie, damit sowohl Hypo- als auch Hyperglykämien weitestgehend verhindert und so das Genesungspotential der Patienten unterstützt werden kann.
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Winkler, Maren Katharina Laura [Verfasser]. "Cortical spreading depolarization in patients with aneurysmal subarachnoid hemorrhage / Maren Katharina Laura Winkler." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2012. http://d-nb.info/1026788943/34.
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Pappas, Anthony Christ. "Impact of Subarachnoid Hemorrhage on Astrocyte Calcium Signaling: Implications for Impaired Neurovascular Coupling." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/475.
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Deficits within the brain microcirculation contribute to poor patient outcome following aneurysmal subarachnoid hemorrhage (SAH). However, the underlying pathophysiology is not well understood. Intra-cerebral (parenchymal) arterioles are encased by specialized glial processes, called astrocyte endfeet. Ca2+ signals in the endfeet, driven by the ongoing pattern of neuronal activity, regulate parenchymal arteriolar diameter and thereby influence local cerebral blood flow. In the healthy brain, this phenomenon, called neurovascular coupling (NVC), matches focal increases in neuronal activity with local arteriolar dilation. This ensures adequate delivery of oxygen and other nutrients to areas of the brain with increased metabolic demand. Recently, we demonstrated inversion of NVC from vasodilation to vasoconstriction in brain slices obtained from SAH model animals. This pathological change, which would restrict blood flow to active brain regions, was accompanied by an increase in the amplitude of spontaneous Ca2+ events in astrocyte endfeet. It is possible that the emergence of higher amplitude endfoot Ca2+ events shifts the polarity of NVC after SAH by elevating levels of vasoactive agents (e.g. K+ ions) within the perivascular space. In the first aim of this dissertation we tested whether altered endfoot Ca2+ signaling underlies the inversion of NVC after SAH.
Brain injury is often associated with increased levels of extracellular purine nucleotides (e.g. ATP). A recent study found that ATP levels in the cerebrospinal fluid of aneurysmal SAH patients were roughly 400-fold higher than that of non-SAH controls. Astrocytes express a variety of purinergic (P2) receptors that, when activated, could trigger a spike in intra-cellular Ca2+. It is possible that enhanced signaling via astrocyte P2 receptors underlies the change in endfoot Ca2+ signaling after SAH. In the second aim of this dissertation we determined the role of purinergic signaling in the generation of high-amplitude spontaneous endfoot Ca2+ events after SAH.
Parenchymal arteriolar diameter and endfoot Ca2+ dynamics were recorded simultaneously in fluo-4-loaded rat brain slices using combined infrared-differential interference contrast and multi-photon fluorescence microscopy. We report that SAH led to a time-dependent emergence of spontaneous endfoot high-amplitude Ca2+ signals (eHACSs) that were only present in brain slices exhibiting inversion of NVC. Depletion of intracellular Ca2+ stores abolished spontaneous endfoot Ca2+ signals, including eHACSs, and restored arteriolar dilation in SAH brain slices to two downstream elements in the NVC signaling cascade, (1) increased endfoot Ca2+ and (2) elevated extracellular K+. We next tested the role of purinergic signaling in the generation of SAH-induced eHACSs by recording endfoot activity before and after treatment with the broad-spectrum purinergic receptor antagonist, suramin. Remarkably, suramin selectively abolished eHACSs and restored vasodilatory NVC in SAH brain slices. Desensitization of Ca2+-permeable ionotropic purinergic (P2X) receptors had no effect on eHACSs after SAH. However, eHACSs were selectively blocked using a cocktail of inhibitors targeting Gq-coupled purinergic (P2Y) receptors. Collectively, our results support a model in which SAH leads to an emergence of P2Y receptor-mediated eHACSs that cause inversion of NVC. Further, we identify the FDA-approved drug, suramin, as a potential therapy to be used in the treatment of aneurysmal SAH.
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Johnson, Ulf. "Pressure autoregulation of cerebral blood flow in traumatic brain injury and aneurysmal subarachnoid hemorrhage." Doctoral thesis, Uppsala universitet, Neurokirurgi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-294190.
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The ability of the brain to keep a stable and adequate cerebral blood flow (CBF) independently of fluctuations in systemic blood pressure is referred to as cerebral pressure autoregulation (CPA). When the brain is injured by trauma or hemorrhage, this ability may be impaired, leaving the brain vulnerable to events of high or low blood pressure. The aims of this thesis were to study CPA in patients with severe traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH), the relation between CPA and other physiological parameters, and the influence of CPA on outcome. Four retrospective studies are included in the thesis. All patients were treated at the neurointensive care unit, Uppsala University hospital. In paper I, 58 TBI patients were studied. In patients with impaired CPA, cerebral perfusion pressure between 50-60 mm Hg was associated with favorable outcome while CPP > 70 and >80 mm Hg was associated with unfavorable outcome. In patients with intact CPA there was no association between CPP and outcome. In paper II, 107 TBI patients were studied. High CPP was associated with unfavorable outcome in patients with focal injuries. In patients with diffuse injury and impaired CPA, CPP > 70 mm Hg was associated with favorable outcome. In paper III, 47 SAH patients were studied. CBF was measured bedside with Xenon-enhance CT (Xe-CT). Patients with impaired CPA had lower CBF, both in the early (day 0-3) and late (day 4-14) acute phase of the disease. In paper IV, 64 SAH patients were studied. Optimal CPP (CPPopt) was calculated automatically as the level of CPP where CPA works best for the patient, i.e., where PRx is lowest. Patients with actual CPP below their calculated optimum had higher amounts of low-flow regions (CBF < 10 ml/100g/min). The findings in this thesis emphasize the importance of taking CPA into account in the management of TBI and SAH patients, and suggest that treatment should be individualized depending on status of autoregulation. PRx and CPPopt may be used bedside to guide management according to status of autoregulation. In the future CPA-guided management should be tested in prospective studies
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Nystoriak, Matthew. "Role of Voltage-Dependent Calcium Channels in Subarachnoid Hemorrhage-Induced Constriction of Intracerebral Arterioles." ScholarWorks @ UVM, 2010. http://scholarworks.uvm.edu/graddis/168.
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Subarachnoid hemorrhage (SAH) following cerebral aneurysm rupture is associated with substantial morbidity and mortality. The ability of SAH to induce vasospasm in large diameter pial arteries has been extensively studied, although the contribution of this phenomenon to patient outcome is unclear. Conversely, little is known regarding the impact of SAH on intracerebral (parenchymal) arterioles, which are critical for regulation of cerebral blood flow. To assess the function of parenchymal arterioles following SAH, measurements of diameter, intracellular Ca2+ ([Ca2+]i) and membrane potential were performed in intact arterioles from unoperated (control), sham-operated and SAH model rats. At physiological intravascular pressure, parenchymal arterioles from SAH animals exhibited significantly elevated [Ca2+]i and enhanced constriction compared with arterioles from control and sham-operated animals. Elevated [Ca2+]i and enhanced tone following SAH were observed in the absence of vascular endothelium and were abolished by the L-type voltage-dependent Ca2+ channel (VDCC) inhibitor nimodipine. Molecular assessment of the L-type VDCC CaV1.2 indicated unchanged mRNA and protein expression in arterioles from SAH animals. Increased CaV1.2 activity following SAH may also reflect enhanced pressure-induced membrane potential depolarization of arteriolar smooth muscle. Membrane potential measurements in arteriolar myocytes using intracellular microelectrodes revealed approximately 7 mV depolarization at 40 mmHg in myocytes from SAH animals. Further, when membrane potential was adjusted to similar values, arteriolar [Ca2+]i and tone were similar between groups. These results demonstrate that greater pressure-dependent membrane potential depolarization results in increased activity of CaV1.2 channels, elevated [Ca2+]i and enhanced constriction of parenchymal arterioles from SAH animals. Thus, impaired regulation of parenchymal arteriolar [Ca2+]i and diameter may restrict cerebral blood flow in SAH patients. Although nimodipine is used clinically to prevent delayed neurological deficits in SAH patients, the use of this drug has been limited by hypotension and treatment options remain inadequate. Therefore, our next objective was to explore strategies to selectively suppress CaV1.2 channels in the cerebral vasculature. To do so, we examined the physiological role of smooth muscle CaV1.2 splice variants containing the alternatively-spliced exon 9* in cerebral artery constriction. Using antisense oligonucleotides, we demonstrate that suppression of exon 9*-containing CaV1.2 splice variants results in substantially reduced cerebral artery constriction to elevated extracellular [K+]. In addition, no further reduction in constriction was observed following suppression of all Cav1.2 splice variants, suggesting that exon 9* splice variants are functionally dominant in cerebral artery constriction. In summary, results shown in this dissertation demonstrate that increased CaV1.2 activity following SAH results in enhanced constriction of parenchymal arterioles. Furthermore, evidence is provided supporting the concept that CaV1.2 splice variants with exon 9* are critical for cerebral artery constriction and may provide a novel target for the prevention of delayed ischemic deficits in SAH patients.
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Fridriksson, Steen M. "Changing strategies in the treatment of aneurysmal subarachnoid haemorrhage : challenging the second bleed /." Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med870s.pdf.
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Morris, Paul Graham. "Long-term neuropsychological outcome following subarachnoid haemorrhage or traumatic brain injury." Thesis, University of Stirling, 2001. http://hdl.handle.net/1893/1877.
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Purpose: The principal aim of this project was to investigate the influence of clinical indices of injury severity and polymorphism of the apolipoprotein E gene upon the long-term physical, cognitive and emotional sequelae of traumatic brain injury and spontaneous subarachnoid haemorrhage. It was also intended to determine the extent to which changes occur in these sequelae beyond the initial six months post injury. Method: Sixty-two brain injury patients who had previously taken part in a neuropsychological assessment at six months post injury were traced and participated in a follow-up assessmens some 6-9 years subsequent to their injury. Separately, a group of 70 subarachnoid patients drawn from a consecutive series of neurosurgical admissions participated in a neuropsychological assessment at 14 months subsequent to their haemorrhage. In both studies, the assessment comprised a semi-structured interview and a battery of cognitive measures focusing principally upon memory and executive function tasks. A questionnaire including a range of standardised measures of anxiety, depression and quality of life was left with patients to be returned by post. Results: The ApoE e4 allele did not appear to influence recovery amongst these brain injury survivors, though there are suggestions that it may have an influence upon subgroups of patients. Amongst traumatic brain injury survivors, post-traumatic amnesia was a better predictor of functional or emotional outcome than consciousness based measures. However, consciousness based measures were more predictive of cognitive sequelae and low admission Glasgow Coma Scale was associated with continued improvement on information processing tasks. Other than on these tasks, there was little evidence of change between 6 months and 6-9 years post injury. Amongst the subarachnoid haemorrhage patients, Fisher Grade was found to be more predictive of subsequent Glasgow Outcome Scale and cognitive function than WFNS Grade or other clinical indices. Surviving aneurysmal patients had comparable levels of recovery to patients who had a negative angiogram. In both studies emotional sequelae, in particular anxiety-related difficulties, were found to be a principal factor in the functional outcome of some 40% of patients. Conclusions: Greater emphasis should be placed upon measures of post-traumatic amnesia as predictors of functional recovery in surviving patients. The use of an amnesia measure may also be warranted in studies of outcome following subarachnoid haemorrhage or other stroke. The ApoE e4 allele does not appear to have a strong influence upon functional recovery after brain injury across all patients, though it is possible that it interacts with other factors to influence recovery in subgroups. Greater emphasis should be placed upon the prevention and/or detection and treatment of mood disorders following brain injury. In the absence of intensive rehabilitative interventions, survivors of serious brain injury are more likely to deteriorate than to continue to recover beyond six months post injury.
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Ladenvall, Claes. "Genetic association studies in stroke /." Göteborg : Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University, 2008. http://hdl.handle.net/2077/9416.
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Mutel, Alexandre. "La Filamine A, acteur central relayant les mécanismes d'invasion des gliomes de haut-grades : implication dans la signalisation et le trafic du récepteur chimiotactique de l'urotensine II Re-expression of Filamin A in glioblastoma promotes tne endogenous and chemokine receptor UT-induced migration/invasion : marker of aggressiveness and survival Association between vasoactive peptide urotensin II in plasma and cerebral vasospasm after aneurysmal subarachnoid hemorrhage : a potential therapeutic target." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMR081.
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Les glioblastomes multiformes (GBM) sont les tumeurs les plus fréquentes et agressives du système nerveux central. Le traitement standard des GBM suit le « Protocole de Stupp » qui consiste en une résection chirurgicale de la tumeur la plus large possible, suivie d’une radiothérapie/chimiothérapie au temozolomide (TMZ) concomitante. Malgré ce traitement lourd de première ligne, les patients atteints de GBM présentent une survie médiane de seulement 14,6 mois. Même si la résection semble la plus complète possible, le caractère diffus et invasif des cellules de GBM est à l’origine de récidives quasi-systématiques en bordure de la cavité de résection. L’invasion du parenchyme cérébrale sain par les cellules de GBM, enbordure ou à distance de la zone de résection, constitue par conséquent un enjeu thérapeutique majeur. Ces mécanismes d’invasion sont portés par des transformations cellulaires liées aux contraintes environnementales telles que l’hypoxie et l’angiogenèse, responsables d’une transition mésenchymateuse (TM) principalement contrôlée par les facteurs de transcriptions STAT3 et CEBPα qui stimulent 70% des gènes secondaires mésenchymateux. L’hypoxie associée à la TM entraînent notamment la surexpression de récepteurs à 7 domaines transmembranaires couplés aux protéines G (RCPGs) de chimiokines, entres autres. Le RCPG chimiotactique le plus largement étudié dans le GBM est le CXCR4 relayant ses effets promigratoires via les couplages et les voies Gαi/PIγK/PIPγ et Gα12/13/Rho/ROCK ainsi que son endocytose clathrine-dépendante et le recyclage relayé par l’activité de β-arrestines. Des travaux déjà réalisés dans notre équipe ont aussi pu mettre en évidence que le récepteur UT du neuropeptide urotensine II (UII) se comporte comme un récepteur de chimiokine pouvant stimuler la migration directionnelle de cellules de GBM via l’activation séquentielle de Gαi/PIγK/PIPγ puis de Gα12/13/Rho/ROCK permettant la polarisation cellulaire, l’émission de lamellipodes, la polymérisation des fibres de stress d’actine, et la contraction cellulaire. Ainsi il apparait que la redondance d’expression et de couplages des RCPGs chimiotactiques constitue un verrou majeur en termes de ciblage thérapeutique de l’un de ces systèmes. C’est sur la base de ces observations que nous avons entrepris d’isoler de nouveaux partenaires protéiques communs à ces récepteurs pouvant être la source de développement de nouvelles stratégies anti-invasivesMultiform glioblastoma (GBM) are the most frequent and aggressive tumor of the central nervous system (CNS). The standard treatment therapy for GBM follows the “Stupp protocol”consisting in the most complete surgical resection combined with radio/chemotherapy with temozolomide (TMZ). Despite this heavy first line treatment, patients with GBM display a survival median of only 14.6 months. Even if the resection as large as possible, the diffuse properties of GBM cells leads to a quasi-systematic invasion of the margin of the resection cavity. The healthy brain parenchyma invasion by GBM cells, in margin or at distance of the resection cavity, constitutes a main therapeutic issue. These invasion mechanisms are carried by cell transformations caused by the microenvironment such as hypoxia and angiogenesis responsible for mesenchymal transition (MT) mainly controlled by two transcription factors STATγ and CEBPα which stimulate 70% of secondary mesenchymal genes. Hypoxia associated with MT triggers the expression of chemokine G protein-coupled receptor (GPCRs). The most studied chemotactic GPCR in GBM is CXCR4 which mediates promigratory effects through Gαi/PIγK/PIPγ and Gα13/Rho/ROCK as well as its endocytosis and recycling mediated by β-arrestins. Our team already demonstrated that the UT receptor of the neuropeptide urotensin II (UII) behaves like a chemokine receptor and stimulates GBM directional migrationby Gαi/PIγK/PIPγ and Gα13/Rho/ROCK allowing cell polarization, lamellipodia formation, actin stress fiber polymerization and cell contraction. Thus it appears that the expression and coupling redundancy of chemotactic GPCRs constitute a major brake for the development oftargeted therapy against these systems. Based on these observations, we proposed to identify new protein partners common to these chemokine GPCRs which could then be targeted by future anti-invasive therapies. First, we validated the systematic redundancy of expression of CXCR4/SDF-1α and UT/UII systems by immunohistochemical studies carried in various patient glioma grades (Collaboration with Pr A. Laquerrière, CHU Rouen Hospital). These systems are more strongly co-expressed in pseudopalisadic peri-necrotic hypoxic GBM areas. A two-hybrid screening of a bank of human brain cDNA allowed us to demonstrate that the 332-352 C-terminal amino acid sequence of UT interacts with the repeat D19-D20 domains of a platform protein called Filamin A (FlnA)
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WADA, KENTARO, TOMOYUKI NODA, KENICHI HATTORI, HIDEKI MAKI, AKIRA KITO, and HIROFUMI OYAMA. "TREATMENT OF A CEREBRAL DISSECTING ANEURYSM IN ANTERIOR CIRCULATION: REPORT OF 11 SUBARACHNOID HEMORRHAGE CASES." Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16743.
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Nehrkorn, Kathrin [Verfasser], and Nikolaus [Akademischer Betreuer] Plesnila. "The role of pericytes in microcirculatory dysfunction after subarachnoid hemorrhage / Kathrin Nehrkorn. Betreuer: Nikolaus Plesnila." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2016. http://d-nb.info/1104697963/34.
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Said, Ahmed Degmo. "Quantitative determination of cerebrospinal fluid bilirubin on a high throughput chemistry analyzer." Thesis, Uppsala University, Department of Medical Biochemistry and Microbiology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-110290.
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Background Subarachnoid hemorrhage is a condition with high rates of mortality and morbidity. The diagnosis requires an urgent cerebral computed tomography scan and also a lumbar puncture if the scan fails to demonstrate intracranial blood. In Sweden the cerebrospinal fluid (CSF) is analyzed by spectrophotometric scanning for the presence of hemoglobin and bilirubin. The aim of the study was to develop a quantitative diazo reagent based analysis of cerebrospinal fluid bilirubin as a replacement for spectrophotometric scanning.
Methods The CSF bilirubin assay on an Architect C8000 chemistry analyzer was compared with spectrophotometry using patient samples.
Results The method correlates with spectrophotometry, has a good linearity and precision.
Conclusions Quantitative bilirubin measurement offers shorter turnaround times, simplifies the interpretation of the results and reduces work load in comparison with spectrophotometry.
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Anderson, Glenn B. "The role of computed tomographic angiography in subarachnoid hemorrhage, and in the assessment of carotid stenosis." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0013/MQ60087.pdf.
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Liu, Hanhan [Verfasser], and Nikolaus [Akademischer Betreuer] Plesnila. "The role of blood components in microcirculatory dysfunction after subarachnoid hemorrhage / Hanhan Liu ; Betreuer: Nikolaus Plesnila." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2018. http://d-nb.info/1176409662/34.
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Sandvei, Marie Søfteland. "Incidence, mortality, and risk factors for aneurysmal subarachnoid hemorrhage : Prospective analyzes of the HUNT and Tromsø studies." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for nevromedisin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-15607.
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Forekomst, dødelighet og risikofaktorer for subaraknoidalblødning Prospektive analyser av HUNT og Tromsøundersøkelsen Subaraknoidalblødning (SAB) utgjør omtrent 1-7 % av alle hjerneslag. Forekomsten har blitt estimert til å ligge mellom 7 og 10 per 100.000 personår. Det virker som forekomsten er relativt stabil over tid og mellom land, unntatt i Finland og Japan, hvor forekomsten er høyere. Noen studier har antydet at forekomsten har gått noe ned de senere tiår, mens sykeligheten og dødeligheten etter SAB fortsatt er høy. Siden blødningen er relativt sjelden, har det vært vanskelig å påvise risikofaktorer i prospektive studier, men røyking, høyt blodtrykk, høyt alkoholinntak og det å være kvinne er kjent å øke risikoen. Det er mer usikkerhet vedrørende kroppsmasseindeks (KMI) og serumlipider. Det er også lite kunnskap om hvilke kjennetegn ved pasientene som fører til økt risiko for død etter SAB. Vi registrerte alle som fikk SAB etter deltakelse i befolkningsundersøkelsene HUNT 1 og 2 (1984-86 og 1995-97) og Tromsø 3 og 4 (1985-87og 1994-95) ved hjelp av diagnoseregistrene på sykehusene som populasjonene sogner til og Dødsårsaksregisteret. Vi identifiserte til sammen 214 pasienter. Vi estimerte forekomst og overlevelse, og studerte effekten av risikofaktorer ved hjelp av Cox og Poisson regresjonsanalyser. De fire artiklene omhandler forekomst og dødelighet av SAB (artikkel I, HUNT 1 og 2 og Tromsø 3 og 4), risikofaktorer for SAB (artikkel II, HUNT 1), KMI og serum lipider og risiko for SAB (artikkel III, HUNT 2 og Tromsø 4) og kjønnsforskjeller i risikofaktorer for SAB (artikkel IV, HUNT 2 og Tromsø 4). Vi fant at forekomsten av SAB fra 1984 til 2007 var 10,3 per 100.000 personår, 13,3 hos kvinner og 7,1 hos menn. Insidensen kan ha økt litt siden 1984, noe som kan skyldes endring i diagnostikk, men den har vært stabil siden 1995. 30 dagers letalitet var 36 % og tenderte til å øke med alder, men forble stabil over de 23 årene i oppfølgningen. Vi fant en lineær og positiv sammenheng mellom systolisk og diastolisk blodtrykk og risiko for SAB. Røykere hadde høyere risiko for SAB enn dem som aldri hadde røykt, og det kan virke som om risikoen assosiert med røyking er høyere hos kvinner enn hos menn. Det kan også virke som om overvekt (KMI 25-29.9) er negativt assosiert med risiko for SAB. Derimot fant vi ingen sammenheng mellom totalkolesterol, HDL-kolesterol eller triglyserider og risiko for SAB i totalpopulasjonen, men hos deltakere under 50 år var HDL-kolesterol negativt assosiert med risiko.
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Lenz, Irina Johanna [Verfasser], and Nikolaus [Akademischer Betreuer] Plesnila. "Importance of endothelial nitric oxide synthase after experimental subarachnoid hemorrhage in mice / Irina Johanna Lenz ; Betreuer: Nikolaus Plesnila." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2020. http://d-nb.info/1206878142/34.
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Poll, Eva [Verfasser], and Dirk [Akademischer Betreuer] Hellhammer. "The role of cortisol and cortisol dynamics in patients after aneurysmal subarachnoid hemorrhage / Eva Poll ; Betreuer: Dirk Hellhammer." Trier : Universität Trier, 2012. http://d-nb.info/1197698086/34.
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Chaudhry, Shafqat Rasul [Verfasser]. "Investigation of systemic inflammation in aneurysmal subarachnoid hemorrhage (aSAH) and its impact on post-aSAH complications / Shafqat Rasul Chaudhry." Bonn : Universitäts- und Landesbibliothek Bonn, 2018. http://d-nb.info/1161462317/34.
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McIntosh, Arthur P. "Factors Influencing Long-Term Health-Related Quality of Life Among Patients After Aneurysmal and Nonaneurysmal Subarachnoid Hemorrhage: A Dissertation." eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsn_diss/24.
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Subarachnoid hemorrhage (SAH) causes 5% of all strokes and is responsible for about 18,000 deaths per year in the United States (Aneurysmal Subarachnoid Hemorrhage, 2008). The incidence of SAH has been estimated at 6 to 8 per 100,000 persons per year (Linn, Rinkel, Algra, & van Gijn, 1996). In nearly 15% (range 5–34%) of patients with SAH, no source of hemorrhage can be identified via four-vessel cerebral angiography (Alen et al., 2003; Gupta et al., 2009), resulting in two major types of SAH: aneurysmal (ASAH) and nonaneurysmal (NASAH). Anecdotal evidence and contradictory research suggest that patients with NASAH experience some of the same health-related quality of life (HRQOL) issues as patients with ASAH. The purpose of this quantitative survey design study was to compare health-related quality of life (HRQOL) 1 to 3 years post-hemorrhage in patients who have experienced a NASAH to those who have experienced an ASAH. This is the first US study to specifically investigate HRQOL in NASAH and the second study comparing HRQOL outcomes between aneurysmal and nonaneurysmal subarachnoid hemorrhage patients. Our results are comparable to the first study by Hutter and Gilsbach, (1995), which also found that the two groups are much more similar than different. There were no significant differences between 28 of the 36 demographic and clinical characteristics examined in this study. Our study confirms previous findings that there is a significant impact on employment for both hemorrhage groups and an even greater inability to return to work for the NASAH patients. The nonaneurysmal group had more physical symptom complaints while the aneurysmal group had more emotional symptoms. Lastly, both groups had low levels of PTSD, and these levels did not differ significantly between groups. However, PTSD and social support were shown by regression analysis to impact HRQOL for both groups. We recommend that clinicians assess for PTSD in all subarachnoid hemorrhage patients and institute treatment early, which will decrease the negative effects on HRQOL. This may include offering psychological services or social work early in the hospital course to all SAH patients. Further research and policy changes are needed to assist in interventions that improve vocational reintegration after SAH. NASAH patients should no longer be referred to as having suffered a “benign hemorrhage.” They have had a life changing hemorrhage that may forever change their lives and impact their HRQOL.
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Isokangas, J. M. (Juha-Matti). "Endovascular treatment of 467 consecutive intracranial aneurysms in Oulu University Hospital:angiographic and clinical results." Doctoral thesis, University of Oulu, 2006. http://urn.fi/urn:isbn:9514283112.
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Abstract
The purpose of the study was to analyze the angiographic and clinical results of endovascularly treated intracranial aneurysms in Oulu University Hospital, Finland.
The study population consisted of 416 consecutive patients (467 aneurysms, 332 ruptured), who were referred for endovascular treatment of intracranial aneurysm(s) between December 1993 and July 2004. Technical failures were analyzed for an assesment of technical feasibility. Angiographic results were assessed using modified Raymond Classification. Clinical results were analyzed from patient files using the Glasgow Outcome Scale (GOS). Patient, aneurysm, and procedure related variables were tested with an intention to find the predictors of the angiographic and clinical outcome. The clinical effects on presenting symptoms were analyzed for a subgroup of patients with a symptomatic unruptured aneurysm (n = 30). The mean results on technical feasibility, complications, and angiographic results were separately assessed for three time periods (1993–1997, 1998–2000 and 2001–2004) to demonstrate potential significant changes in outcome.
Endovascular treatment of saccular aneurysms was technically feasible in 91.4% of the treatments. Initially, 25.7% of the aneurysms were completely occluded, 57.9% had a neck remnant, and 16.3% remained incompletely occluded. In follow-up, the rates for complete occlusions, neck remnants and incomplete occlusions were 37.6%, 49.7% and 12.7%, respectively. Small aneurysm size predicted complete aneurysm occlusion, while a wide aneurysm neck and location in the posterior circulation predicted incomplete occlusion. In follow-up (mean 38.2 months), 78.1% of the patients with a ruptured aneurysm and 92.3% of the patients with an unruptured aneurysm had resumed independent life (GOS 4-5). The predictors of good outcome were young age, good preprocedural clinical condition, small amount of blood in CT scan, and uncomplicated procedure. Ten of the treated aneurysms involved intracranial bleeding in follow-up, and the annual risk for bleeding after endovascular treatment was 0.95% among the patients with ruptured aneurysms and 0.33% among those with unruptured aneurysms. The risk of bleeding was associated with larger aneurysm size and lower occlusion grade. In the subgroup of symptomatic unruptured aneurysms, 53.4% of the patients showed either resolution or improvement of the symptoms after treatment. The rates of procedural complications, morbidity, and mortality were 16.5%, 6.7%, and 1.7%, respectively. The risk for procedural complications was higher when the balloon remodeling technique was used and lower in retreatments. Technical feasibility (85.6%, 90.6%, and 95.7%, respectively) and the percentage of complete occlusions (initially 16.5%, 23.0%, and 32.9%, respectively) were significantly improved by increased experience, while no statistical difference was detected in the total procedural complication rates (15.4%, 15.7%, and 18.3%, respectively) or the combined procedural morbidity and mortality rates (8.0%, 8.3%, and 9.1%, respectively). All six dissecting aneurysms treated with parent artery occlusion or the stent remodeling technique resulted in complete occlusions.
The present results confirmed endovascular treatment of intracranial aneurysms as a feasible, safe, and effective method in preventing further bleeding of aneurysms. Increased experience in a single center improved the feasibility of the treatment as well as the angiographic results.
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Dreier, Jens P. "Cortical spreading ischaemia and delayed ischaemic neurological deficits after subarachnoid haemorrhage." Doctoral thesis, [S.l.] : [s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=970109342.
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Rukskul, Pataravit. "Analysis of different respiratory and blood gas parameters to optimize brain tissue oxygen tension (PtiO2) in patients with acute subarachnoid hemorrhage." [S.l.] : [s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=970018304.
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Weiss, Miriam [Verfasser], Gerrit Alexander [Akademischer Betreuer] Schubert, and Martin [Akademischer Betreuer] Wiesmann. "Endovascular rescue treatment for delayed cerebral ischemia after subarachnoid hemorrhage is safe and effective / Miriam Weiss ; Gerrit Alexander Schubert, Martin Wiesmann." Aachen : Universitätsbibliothek der RWTH Aachen, 2019. http://d-nb.info/1215927614/34.
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Milakara, Denny [Verfasser]. "Simulation of spreading depolarization trajectories in cerebral cortex : correlation of velocity and susceptibility in patients with aneurysmal subarachnoid hemorrhage / Denny Milakara." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2018. http://d-nb.info/1176632361/34.
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Nylén, Karin. "Studies of biochemical brain damage markers in patients at a neurointensive care unit /." Göteborg : Institute of Neuroscience and Physiology, Department of Neurology, Göteborg University, 2007. http://hdl.handle.net/2077/4599.
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Hedlund, Mathilde. "Coping, Psychiatric Morbidity and Perceived Care in Patients with Aneurysmal Subarachnoid Haemorrhage." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ-bibl. [distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-109761.
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Welling, Leonardo Christiaan. "Estudo prospectivo sobre os resultados estéticos, funcionais e clínicos da craniotomia minipterional em comparação com a craniotomia pterional clássica." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-14102013-115952/.
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Introdução: O acesso pterional é uma das craniotomias mais utilizadas. Entretanto, apresenta algumas desvantagens, como a dissecação ampla do músculo temporal, que pode causar atrofia e deformidade do contorno facial. A craniotomia minipterional descrita em 2007 propiciou exposição anatômica semelhante a da craniotomia pterional clássica. Objetivos: Comparar os resultados clínicos, funcionais e estéticos dos dois acessos cirúrgicos destinados ao tratamento de aneurismas da circulação anterior. Métodos: Cinquenta e oito doentes, com aneurismas rotos (40) e não rotos (18) foram admitidos no estudo. No grupo A, 28 indivíduos foram submetidos à craniotomia minipterional. No grupo B, 30 doentes foram operados com a craniotomia pterional clássica. Doentes com hematomas intracranianos, aneurismas do segmento oftálmico e aneurismas gigantes foram excluídos. Os resultados estéticos foram analisados por meio de dois métodos. No primeiro, uma autoavaliação utilizava uma régua escalonada de 0 a 100, na qual o zero representou o melhor resultado e 100 o pior resultado na percepção do próprio doente. Fotografias dos doentes foram mostradas a dois observadores independentes. Os resultados foram classificados como ótimo, bom, regular e mau (de acordo com uma escala pré-determinada). A gradação da atrofia foi mensurada por meio de três métodos, utilizando a tomografia computadorizada de crânio. No primeiro, observou-se a percentagem de redução do complexo músculo temporal, tecido subcutâneo e pele. No segundo método, a percentagem de redução da espessura do músculo temporal foi analisada isoladamente. O terceiro método foi a mensuração da volumetria do músculo temporal, tecido subcutâneo e pele calculados a partir da margem superior do arco zigomático até a linha temporal superior utilizando-se o software OsiriX (Pixmeo Sarl Geneva/ Suíça OsiriX). Para os resultados clínicos e funcionais, foi utilizada a Escala de Rankin modificada. Outras variáveis, como paralisia do ramo frontal do nervo facial, hemorragia pós-operatória, fistula liquórica, hidrocefalia e mortalidade, também foram analisadas. Resultados: Em ambos os grupos, os dados demográficos e as características pré-operatórias foram similares. A satisfação com o resultado estético foi observada em 79% (19) no grupo A e 52% (13) no grupo B (p=0,07). O valor médio da régua foi 27 no grupo A e 45,8 no grupo B (p=0,03). Quando somente doentes classificados como Rankin modificado 0 ou 1 foram analisados, o valor médio da régua foi de 25,2 no grupo A e 39,4 no grupo B (p=0,11). Dois avaliadores independentes analisaram as fotografias dos doentes e o coeficiente de correlação kappa para os resultados estéticos foi de 0,73. De acordo com os mesmos ótimo e bom, foram observados em 87% (21) no grupo minipterional e 48% (12) no grupo pterional. A percentagem de redução do músculo temporal, subcutâneo e pele (método 1) foi de 14,9% no grupo A e 24,3% no grupo B (p=0,01). Quando somente o músculo temporal foi analisado (método 2), a percentagem de redução foi de 12,7% no grupo A e 22% no grupo B (p=0,005). A redução volumétrica das estruturas (método 3) foi de 14,8% no grupo A e 24,5% no grupo B (p=0,012). Na avaliação clínica no 6? mês, os valores da Escala de Rankin modificada foram similares (p=0,99). O óbito ocorreu em 4 doentes no grupo A e 5 doentes no grupo B (p=1,0). Conclusão: Os resultados clínicos demonstraram que a craniotomia minipterional é um procedimento seguro, com prognóstico similar ao da técnica convencional. Os resultados cosméticos foram melhores com menor deformidade no contorno facial, uma vez que a percentagem de redução da espessura, do volume do músculo temporal, do tecido subcutâneo e da pele foi menor com a técnica proposta. A craniotomia minipterional foi a melhor alternativa em relação à craniotomia pterional clássica para tratar aneurismas rotos e não rotos da circulação anteriorIntroduction: The pterional approach is one of the most commonly used craniotomy. However it has disadvantages, such as complete dissection of the temporalis muscle. This may lead to muscular atrophy and facial deformity. The minipterional craniotomy was described in 2007 and the anatomic exposure provided by the pterional and minipterional approaches were similar in the total area of exposure and angular view. Objectives: This prospective randomized study was designed to compare the clinical, functional and aesthetic results of two surgical techniques for microsurgical clipping of anterior circulation aneurysms. Methods: Overall, 58 eligible patients admitted with ruptured and unruptured anterior circulation aneurysms were enrolled in the study. In group A, 28 patients were operated with the minipterional technique. In Group B 30 patients were operated according to the classical pterional craniotomy. Patients with intracranial haematomas, ophthalmic aneurysms and giant aneurysms were excluded. The aesthetic results were analyzed with 2 methods. In the first, the patients were showed to a rule, with a scale from 0 to 100, in which 0 mean the best result and 100 the worst result. Photos were taken and showed to two independent observers, the results were classified as excellent, good, regular or poor, according to a pre-determined scale. The degree of atrophy was measured with three methods. In the first one, the authors observed the percentage of thick reduction in the temporal muscle, subcutaneous tissue and skin. In the second method the percentage of thick reduction of the isolated temporal muscle was observed and the third the volumetric analysis of the temporal muscle, subcutaneous tissue and skin was calculated from the superior edge of zygomatic arch to superior temporal line using the OsiriX software (OsiriX - Pixmeo Sarl Geneva/Suíça). The functional results were compared using the Modified Rankin Score. Others variables such frontal facial palsy, post-operative hemorrhage, cerebrospinal fistulas, hydrocephalus and mortality were also analyzed. Results: In both groups the demographic and pre-operative characteristics were similar. The satisfaction with aesthetic results were observed in 79% (19) in group A and 52% (13) in group B (p=0,07). The mean value observed in the rule was 27 in group A and 45,8 in group B (p=0,03). When patients classified as Rankin Modified Score of 0 or 1 only were included the mean value observed in the rule was 25,2 in group A and 39,4 in group B (p=0,11). Two independent observers analyzed the patients photos and the kappa coefficient correlation for the aesthetic results was 0,73. According to them excellent and good results were observed in 87% (21) in minipterional group and 48% (12) in the pterional group. The degree of atrophy of temporal muscle, subcutaneous tissue and skin (method 1) was14,9% in group A and 24,3% in group B (p=0,01). The measurement of temporal muscle (method 2) revealed that the degree of atrophy was 12,7% in group A and 22% in group B (p=0,005). The volumetric reduction of the structures (method 3) was 14,8% in group A and 24,5% in group B (p=0,012). Rankin Modified Score was similar in both groups in the 6-month evaluation (p=0,99). Mortality occurred in 4 patients in group A and 5 patients in group B (p=1,0). Conclusion: These clinical results indicate that the minipterional is a safe procedure. We can estimate the better cosmetic results with less facial contour deformity since the percentage of thick and volumetric reduction in temporal muscle, subcutaneous tissue and skin were demonstrated. It can be an excellent and better alternative to the classical pterional approach
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Pittelli, Sergio Domingos. "Modificação da craniotomia subtemporal: Contribuição ao acesso cirúrgico à bifurcação da artéria basilar." Universidade de São Paulo, 1986. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-27092011-162820/.
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Esta pesquisa analisa experimentalmente as diferenças de comportamento entre a versão clássica e a modificada da craniotomia subtemporal quanto à retração do lobo temporal. A retração é medida pelo ângulo de visão, através do microscópio, obtido ao mirar-se estruturas previamente estabelecidas. Estudou-se a correlação estatística entre a retração cerebral e os diâmetros transversos do crânio, a profundidade da fossa temporal e a altura da bifurcação medida em relação à tenda do cerebelo e à clinóide posterior. É considerada a relação entre estes achados e os aspectos pertinentes à opção entre as craniotomias pterional e subtemporal para o tratamento cirúrgico dos aneurismas da porção superior da artéria basilar.This paper is an experimental analysis between the classic and the modified subtemporal procedures, regarding the cerebral retraction required to approach the interpeduncular cistern and the basilar artery bifurcation. The retraction is assumed to be proportional to the angle of sight, through the microscope, required to observe the basilar bifurcation and other structures. The statistical correlations between the degree of brain retraction and the transverse diameters of the skull, the vertical length of the temporal fossa and the position of the basilar bifurcation in relation to the posterior clinoid and the tentorium are analysed. Considerations are made regarding these findings and the many aspects involved in the options between the pterional and the subtemporal approaches in the surgical treatment of the basilar bifurcation aneurysms
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Kim, Helen. "Genetic susceptibility to early-onset stroke in young adults /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/10924.
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Kaleff, Paulo Roland 1976. "Angiotomografia cerebral 3D no manejo precoce da hemorragia subaracnóide aguda." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308842.
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Orientador: Donizeti Cesar HonoratoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A angiotomografia cerebral 3D (ATC) passou a ser uma alternativa à angiografia por subtração digital (ASD) para a detecção dos aneurismas intracranianos. As recomendações atuais para a hemorragia subaracnóidea aguda (HSA) secundária à ruptura de aneurismas intracranianos incluem o tratamento definitivo precoce. O objetivo primário deste estudo foi o de avaliar a contribuição da ATC para a diminuição do tempo entre o diagnóstico da HSA e o diagnóstico do aneurisma, bem como para a diminuição do tempo entre a admissão do paciente e a exclusão do aneurisma, quando comparada com a ASD. Como objetivo secundário buscou-se comparar a sensibilidade de ambos os métodos diagnósticos, comparar os resultados clínicos de dois grupos de pacientes diagnosticados pala ATC e/ou pela ASD e avaliar a contribuição da ATC na abordagem cirúrgica aos hematomas secundários à ruptura de aneurismas intracranianos. Uma análise retrospectiva foi conduzida cobrindo 100 pacientes admitidos com HSA e diagnosticados para aneurisma via ATC (n=60) ou via ASD (n=40). Os dados coletados foram divididos de acordo com o método diagnóstico utilizado inicialmente para a detecção do aneurisma. Os tempos transcorridos entre o diagnostico da HSA e o diagnóstico do aneurisma foi consistentemente inferior para os pacientes submetidos à ATC (p<0.000005). Em relação ao tempo transcorrido entre a admissão e o tratamento definitivo, 70% das ocorrências para pacientes submetidos à ATC ficaram abaixo de 72 horas enquanto 60% das ocorrências para pacientes submetidos à ASD excederam 72 horas (p<0.003). A sensibilidade da ATC para aneurismas rotos foi de 0, 967 e para todos os aneurismas de 0, 931. A maioria dos casos submetidos à ATC antes da drenagem do hematoma teve o aneurisma tratado no mesmo procedimento cirúrgico. A ATC contribuiu para a redução do tempo entre o diagnóstico da HSA e o diagnóstico do aneurisma, bem como para a redução do tempo entre a admissão e o tratamento definitivo do aneurisma. A sensibilidade dos métodos foi equivalente, especialmente para os aneurismas rotos, em exames tecnicamente satisfatórios. Nos casos de hematomas secundários à ruptura de aneurismas intracranianos, a realização da ATC previamente à abordagem cirúrgica contribuiu para o tratamento definitivo do aneurisma no mesmo procedimento cirúrgico da drenagem do hematoma
Abstract: Due to its technical advancements, 3D cerebral computed tomography angiography (CTA) is increasingly being considered as an alternative to digital subtraction angiography (DSA) in the detection of intracranial aneurysms. Actual guidelines for acute subarachnoid hemorrhage (aSAH) recommend early definitive treatment. The primary goal of this study was to evaluate the contribution of CTA in shortening of time span between the diagnosis of the aSAH and the diagnosis of the aneurysm, as well as the shortening of time span between admission and definitive aneurysm treatment, when compared to DSA. As secondary goals we aimed at comparing the sensitivity of both methods, at comparing the clinical results between two studied patient groups diagnosed by CTA and/or by DSA and at evaluating the contribution of CTA to the surgical approach to intracranial hematomas secondary to aneurysm rupture. A retrospective analysis was performed covering 100 patients admitted with aSAH and diagnosed with intracranial aneurysms either by CTA (n=60) or by DSA (n=40). The data collected for both groups were separated according to the method used for the initial diagnosis of the aneurysm. The time spans between the diagnosis of the aSAH and the diagnosis of the aneurism were consistently smaller for CTA patients than for DSA patients (p<0.000005). Regarding the time spans between the admission and the final treatment, 70% of the outcomes for CTA patients remained below 72 hours and 60% of the outcomes for the DSA group exceeded 72 hours (p<0.003). The sensitivity for ruptured aneurysms was 0,967 and for all aneurysms 0,931. In the majority of cases where a CTA was performed previously to the hematoma evacuation the aneurysm could be treated in the same surgical procedure. CTA contributed to the shortening of the time elapsed between the diagnosis of the aSAH and the diagnosis of the aneurysm, as well as to the shortening of the time elapsed between admission and definitive treatment. The sensitivity of the methods was equivalent, especially for ruptured aneurysms, in technically satisfactory CTA. The use of CTA did not have a negative impact in the clinical outcome or the treatment. CTA performed previously to hematoma evacuation contributed to the definitive treatment of the aneurism in the same surgical approach
Doutorado
Neurologia
Doutor em Ciências Médicas
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Mendes, Tiago Santos. "Efeitos da hemorragia subaracnÃidea sobre a motilidade gastrintestinal de ratos acordados." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=11985.
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CoordenaÃÃo de AperfeiÃoamento de NÃvel SuperiorA hemorragia subaracnÃidea (HSA) pode advir de diversos agravos ao sistema nervoso central. A HSA pode aumentar a pressÃo intracraniana (PIC) a patamares de grande morbidade. AlÃm de sintomas neurolÃgicos e cardiovasculares, bem descritos na literatura; sintomas gastrintestinais como nÃuseas, vÃmitos e gastrenterites sÃo comuns, mas pouco estudados. O retardo do esvaziamento gÃstrico (EG) à uma das alteraÃÃes fisiolÃgicas encontrada em pacientes com hipertensÃo intracraniana (HIC). Tal distÃrbio reduz as respostas terapÃuticas tendo em vista a reduÃÃo na absorÃÃo dos nutrientes e fÃrmacos, alÃm de levar à aspiraÃÃo pulmonar, que pode levar a Ãbito. Avaliamos o efeito da HSA sobre as alteraÃÃes da motilidade gastrintestinal (Esvaziamento GÃstrico - EG; TrÃnsito Intestinal â TI e ComplacÃncia GÃstrica â CG), dos parÃmetros hemodinÃmicos (PressÃo Arterial MÃdia â PAM, FreqÃÃncia CardÃaca - FC) e sobre a PIC. Bem como os mecanismos neuro-humorais relacionados a essas alteraÃÃes. Utilizamos ratos Wistar (300-350g, N=113), sob auspÃcios do COBEA (CEUA/UFC- Protocolo 41/13). ApÃs anestesia (Ketamina/Xilasina 20-10mg/Kg-IP), os animais foram contidos por estereotÃxico sendo injetados 0,1; 0,2 ou 0,3ml na cisterna magna (sangue autÃlogo â grupo HSA ou Liquor sÃmile â grupo Sham). No momento da induÃÃo da HSA os animais foram submetidos à canulaÃÃo dos ventrÃculos laterais para monitoraÃÃo da PIC e dos vasos femorais Direito a fim de se obter dados hemodinÃmicos. ApÃs 72h da induÃÃo, e sob jejum (24h) com soluÃÃo de reidrataÃÃo oral ad libitum, procedemos aos estudos de EG, TI e CG. Para determinaÃÃo da taxa de EG, uma refeiÃÃo teste (1ml/100g) (vermelho-fenol 0,5mg/ml em glicose-5%) foi administrada via gavagem. Jà o TI foi determinado com administraÃÃo direta da refeiÃÃo no duodeno por meio de cÃnula previamente implantada. Jà a CG foi avaliada utilizando um sistema de barostato a 4, 8 e 12 cm de pressÃo de distensÃo gÃstrica. A PA, FC e PIC foram aferidas no momento da avaliaÃÃo da motilidade gastrintestinal. Os dados, mÃdiaÂEPM, foram analisados pelo teste âtâ de Student (P<0,05). A HSA retardou o EG (38,90Â2,73 vs 47,00Â0,72%; 52,85Â5,14 vs 31,12Â2,0% ou 22,89Â4,46 vs 46,24Â3,56%) e aumentou a PIC (3,33Â0,47 vs 16,10Â0,47cmH2O; 7,68Â0,650 vs 30,86Â0,82cmH2O ou 17,50Â1,29 vs 37,90Â1,38cmH2O) nos diferentes volumes de sangue, seja 0,1; 0,2 ou 0,3ml respectivamente, quando comparados ao controle. A HSA tambÃm promoveu retarde no TI e diminuiÃÃo da CG, aumento da PA e diminuiÃÃo da FC. A vagotomia subdiafragmÃtica, a esplancnotomia e o prÃ-tratamento com guanetidina reverteram o efeito da HSA sobre as alteraÃÃes do EG. Os resultados sugerem que os agravos gastrintestinais advindos da HSA refletem um padrÃo de dismotilidade secundÃrios a HIC, mostrando uma forte correlaÃÃo com os valores de PIC
Subarachnoid hemorrhage (SAH) can arise from various types of damage to the central nervous system. The HSA can increase intracranial pressure (ICP) to levels high morbidity. In addition to neurological and cardiovascular symptoms, well described in the literature; gastrointestinal symptoms such as nausea, vomiting and gastroenteritis are common but little studied. The delay gastric emptying (GE) is one of the physiological changes found in patients with intracranial hypertension (ICH). This disorder reduces therapeutic responses with a view to reducing the absorption of nutrients and drugs, and lead to lung aspiration, which can lead to death. We evaluated the effect of HSA on gastrointestinal motility disorders (Gastric Emptying - EG; Intestinal Transit â IT or Gastric Compliance - CG), hemodynamic parameters (Mean Arterial Pressure - MAP, Heart Rate - HR) and the PIC. As well as neurohumoral mechanisms related to these changes. We used Wistar rats (300 - 350g, N=113) under the auspices COBEA (CEUA/UFC- Protocol 41/13). After anesthesia (Ketamine/Xylazine 20-10mg/Kg-IP), the animals were restrained by stereotactic aparatus being injected 0.1, 0.2 or 0.3 ml in the cisterna magna (autologous blood - HSA group or Liquor simile - Control group). At the time of induction of HSA, the animals were subjected to cannulation of the lateral ventricles for measurement of ICP and rigth femoral vessels in order to obtain the hemodynamic data. After 72h of induction, and fasted (24h) animals with oral rehydration solution ad libitum, proceeded studies EG, IT and CG. To determine the rate of GE a test meal (1ml/100g - phenol red - 0.5 mg/ml in 5 % glucose) was administered by gavage. The IT was already determined on direct administration of the meal into the duodenum through previously implanted cannula. Since the CG was evaluated using a barostat system at 4, 8 and 12 cm of gastric pressure distension. The MAP, HR and ICP were measured when assessing gastrointestinal motility. Data, mean  SEM, were analyzed by the "t" Student test (p<0.05). The HSA delayed gastric emptying (38.90  2.73 vs 47.00  0.72 %; 52.85  5.14 vs 31.12  2.0 % and 22.89  4.46 vs 46,24  3.56 % ) and increased the ICP (3.33  0.47 vs 16.10  0.47 cmH2O; 7.68  0.650 vs 30.86Â0.82 cmH2O and 17.50  1.29 vs 37.90  1.38 cmH2O ) in different volumes of blood, either 0.1, 0.2 or 0.3 ml, respectively, when compared to control. The HSA also promoted delay in IT and GC, increased BP and decreased HR. The subdiaphragmatic vagotomy, the esplancnotomia and pretreatment with guanethidine reversed the effect of HSA on changes in EG. The results suggest that the SAH arising gastrointestinal diseases reflect a pattern of secondary gut dysmotility, showing a strong correlation with the values of ICP
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LIMA, Sandro Júnior Henrique. "Características do olfato de pacientes pré e pós-tratamento cirúrgico para hemorragia subaracnóidea aneurismática." Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/17844.
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Introdução: Os aneurismas intracranianos trazem consequências importantes para o paciente acometido. A hemorragia subaracnóidea (HSA) possui uma forte correlação com aneurismas saculares e devido a sua gravidade e alta ocorrência de sequelas, o seu estudo merece importância. Uma alteração sensorial que pode esta relacionada à HSA é o déficit olfatório. Dentre os métodos de avaliação do olfato descritos, os quantitativos são ferramentas que podem ser utilizados a fim de garantir resultados mais fidedignos considerando o quadro clínico desses pacientes. Objetivos: Caracterizar o olfato de pacientes pré e pós tratamento cirúrgico para hemorragia subaracnóidea aneurismática. Método: Esta dissertação está composta por dois artigos. O primeiro constou de um artigo de revisão com título Métodos de avaliação do olfato em pacientes vítimas de hemorragia subaracnóidea: revisão sistemática. O segundo é um artigo original intitulado Avaliação do olfato na hemorragia subaracnóidea aneurismática antes e após o tratamento cirúrgico, neste foram estudados 15 adultos com hemorragia subaracnóidea aneurismática, atendidos no Hospital da restauração de Pernambuco, avaliados em três momentos distintos: Após a hemorragia, com uma semana de pós-operatório e com três meses de pós-operatório. A pesquisa foi iniciada após aprovação pelo Comitê de Ética em Pesquisa do hospital. Após a aplicação do Termo de Consentimento Livre e Esclarecido foi realizada a revisão do prontuário, entrevista com o participante e avaliação do olfato por meio de um teste de soluções aquosas, adaptado de outros estudos, construído pela farmácia escola da UFPE. Resultados: O primeiro artigo mostrou heterogeneidade nos métodos utilizados para avaliação do olfato na hemorragia subaracnóidea, como também no momento selecionado para aplicação das avaliações, com evidencias de déficit olfatório nesta população. Nos resultados provenientes do estudo original desta dissertação foi observado maior número de classificações olfatórias normais, além disso, não foi encontrada correlação significativa entre a pontuação olfatória com as seguintes variáveis (Idade, Intervalo em dias entre a hemorragia subaracnóidea e a avaliação olfatória, escolaridade e topografia do aneurisma). Não houve mudança significativa na pontuação olfatória após a cirurgia. Houve diferença estatística significativa na comparação entre a pontuação olfatória com uma semana de pós-operatório e com três meses de pós-operatório. Considerações finais: Os resultados deste estudo mostram a ocorrência de alteração olfatória após a hemorragia subaracnóidea aneurismática, assim como piora na classificação do olfato após a cirurgia. Foi observada melhora no olfato após três meses de pós-operatório, com significância estatística. Sugere-se a continuação de estudos com o tema, como também que façam investigação da percepção subjetiva do olfato visando o esclarecimento dos prejuízos que a alteração olfatória causa na vida dessa população.
Introduction: Intracranial aneurysms bring important consequences for the affected patient. The subarachnoid hemorrhage (HSA) has a strong correlation with saccular aneurysms and due to its gravity and high occurrence of sequels, its study deserves importance. A sensory change can this ASH-related is the olfactory deficit. Among the methods of valuation of smell described, are quantitative tools that can be used to ensure more reliable results considering the clinical picture of these patients.Objectives: Characterize the smell of patients before and after surgical treatment for aneurysmal subarachnoid hemorrhage. Method: This dissertation is composed of two articles. The first consisted of a review article with title Methods of evaluation of smell in victims of subarachnoid hemorrhage patients: a systematic review. The second is an original article entitled Olfactory evaluation in aneurysmal subarachnoid hemorrhage before and after surgery, this 15 were studied adults with aneurysmal subarachnoid hemorrhage, met at the Hospital da Restauração de Pernambuco, evaluated in three different moments: After the bleeding, a week after surgery and three months postoperatively. The search was started after approval by the Research Ethics Committee of the Hospital. After the application of informed consent was held to review the medical records, interview with the participant and evaluation of smell through a test of aqueous solutions, adapted from other studies, built by the Pharmacy School, Federal University of Pernambuco. Results: The first article showed heterogeneity of the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations, with evidence of olfactory deficits in this population. The results from the original study of this dissertation it was observed as many olfactory normal ratings, moreover, was not found significant correlation between olfactory score with the following variables (age, interval in days between the subarachnoid hemorrhage and the olfactory evaluation, education and topography of the aneurysm). There was no significant change in scoring olfactory after surgery. There was a statistically significant difference in the comparison between the olfactory score with a week after surgery and three months postoperatively. Final considerations: The results of this study show the occurrence of olfactory disfunction after aneurysmal subarachnoid hemorrhage, as well as worsens the classification of smell after surgery. Improvement was observed in the nose after three months postoperatively, with statistical significance. It is suggested a continuation of studies with the theme, but also to make the subjective perception of smell to identify the problems that the disfunction olfactory cause in this population´s life.
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Minasyan, Ararat. "Retrospektive Analyse zum Outcome von Patienten mit aneurysmaler Subarachnoidalblutung im Klinikum Chemnitz." Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-234080.
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Einleitung
Die aneurysmale Subarachnoidalblutung und ihre Komplikationen stellen eine akut lebensbedrohliche Erkrankung dar. Aufgrund einer hohen Letalität und Morbidität sowie zahlreichen, nicht modifizierbaren Risikofaktoren und fehlenden eindeutigen Präventionsmaßnahmen bleibt diese Krankheit eines der aktuellen Themen der Neurochirurgie.
Ziel
Ziel dieser Studie ist der Vergleich der Behandlungsergebnisse von Patienten mit aneurysmaler SAB im Klinikum Chemnitz mit aktuellen Literaturdaten.
Material und Methode
In dieser Arbeit wurden die Daten von insgesamt 200 Patienten mit aneurysmaler Subarachnoidalblutung retrospektiv zusammengefasst. Es wurde eine Populationsanalyse zusammen mit einer Analyse der Korrelationen zwischen verschiedenen Ausgangs- und Verlaufsparametern mit dem allgemeinen Outcome und der Mortalität durchgeführt. Zusätzlich erfolgte eine Follow-up-Analyse der Mortalität und Morbidität bei 108 Patienten. Im statistischen Modell wurden eine Uni- und Bivariatanalyse sowie binäre und multinomiale logistische Regression angewendet. Kaplan-Meier-Kurven in Verbindung mit Cox-Regressionsanalysen wurden zur Beurteilung der Mortalität eingesetzt. Die Ergebnisse wurden mit Literaturdaten verglichen. Das Votum der Ethikkommission der TU Dresden liegt vor (EK 181052014 vom 15.09.2014).
Ergebnisse
Von 200 Patienten mit einem Durchschnittsalter von 52 J (20-82 J, Medianalter 51 ± 13,6 J) waren 69 Patienten männlich (34,5 %), 131 – weiblich (65,2 %). Das männlich : weiblich Verhältnis betrug 1:1,9. Der klinische Schweregrad der Patienten bei Aufnahme wurde durch die WFNS- und die HH-Skalen evaluiert. Zusätzlich wurden die BNI- und Fisher-Skalen zwecks Evaluation des radiologischen Schweregrades der aSAB eingesetzt. Die Patientendistribution anhand der WFNS-Skala war: WFNS °I – 42,0 %, WFNS °II – 10,0 %, WFNS °II – 16,5 %, WFNS °IV – 22,5%, WFNS °V – 9,0 %. Die Verteilung der Patienten durch die HH-Skala war vergleichbar. 14,5 % der Patienten hatten eine BNI 1, 41,5 % - BNI 2, 32,0 % – BNI 3, 10,5 % - BNI 4, 1,5 % - BNI 5 Blutung. Bei 5,5 % der Patienten lag eine Fisher 1, 10,5 %– Fisher 2, 28,0% - Fisher 3 und 56,0 % - Fisher 4 SAB vor. 77,5 % der Aneurysmata waren klein (<11mm), 18,5 % - groß (11-25mm), 4 % - Giant (>25mm). Die Aneurysmen war meist im Bereich der Acom (41,5 %) und MCA (36,5 %) lokalisiert. Insgesamt 94,5 % der Aneurysmen gehörten zur vorderen Zirkulation. Die primäre Mortalitätsrate betrug 14,5 %. 21,5% der Patienten hatten einen mRS von 0-1 bei Entlassung, 26,0 % - einen mRS 2-3, 38,0 % - einen mRS 4-5. Die mittlere Follow-up-Dauer betrug 71,3 ± 43,2 Monate (Spannweite 2-168 Monate). Von den initial Überlebenden und im Follow-up eingeschlossenen Patienten sind 10,2 % im Verlauf verstorben. 48,1 % hatten einen mRS 0-1, 30,6% mRS 2-3, 11,1 % - mRS 4-5.
Diskussion
Das Outcome der Patienten mit einer aSAB trägt einen multifaktoriellen Charakter. Die wesentlichen Prädiktoren des Outcomes sind das Alter, der klinische und radiologische Schweregrad der Blutung, die Notwendigkeit der Versorgung eines posthämorrhagischen Hydrozephalus (temporäre und dauerhafte CSF-Ableitung), ein Vasospasmus, DIND und Entgleisun-gen im Serum-Natrium-Spiegel. Die Mortalitätsrate bei der primären Versorgung der Patienten mit einer aSAB in unserer Ko-horte ist um etwa 5 % niedriger als in der Literatur angegeben. Die Mortalitätsrate steigert sich allmählich während der ersten 3 Wochen. Sie wird im Wesentlichen vom Patientengeschlecht, dem klinischen und radiologischen Schweregrad der Blutung, der Notwendigkeit einer Akutversorgung eines aufgetretenen Hydrozephalus, einem Vasospasmus, Entgleisungen im Serum-Natrium-Spiegel sowie der Notwendigkeit einer CSF-Dauerableitung beeinflusst. Die Notwendigkeit einer CSF-Außenableitung bei Aufnahme korreliert mit einem schlechten Zustand der Patienten bei Entlassung und im Follow-up. Der Vasospasmus ist ein unabhängiger Prädiktor eines primär schlechten Outcomes und einer hohen Mortalität, zeigt sich aber als nicht signifikanter Faktor im Langzeit-Follow-up. Die Shuntpflicht ist bei Patienten mit Elektrolytentgleisungen, beidseitigen EVDs und DIND 3-4fach erhöht, beeinflusst jedoch nur die primäre Morbidität/Mortalität. Entgleisungen im Serum-Natrium-Spiegel zeigten sich als unabhängiger Prädiktor eines schlechten Outcomes und erhöhter Mortalität sowohl während des stationären Aufenthaltes, als auch im Langzeit-Follow-up. Die Notwendigkeit einer dekompressiven Kraniektomie wiederspiegelt sich in einem niedrigen BI der Patienten im primären Outcome und ist Prädiktor eines schlechten Outcomes und erhöhter Mortalität im Langzeit-Follow-up.
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Piske, Ronie Leo. "Avaliação radiológica imediata, aos seis meses e aos 18 meses, do uso do copolímero etileno vinil álcool (Onyx®) no tratamento endovascular de aneurismas saculares intracranianos de colo largo." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-05082008-145743/.
Full textAbstract:
Introdução: A alta incidência de oclusão incompleta e recanalização dos aneurismas intracranianos de colo largo tratados por via endovascular levaram ao desenvolvimento de novas técnicas, entre elas o uso do Onyx ®. Objetivos: avaliar a eficiência do agente embólico líquido Onyx® em produzir oclusão completa dos aneurismas intracranianos de colo largo e avaliar a estabilidade do tratamento aos 6 meses e aos 18 meses, por meio de controles angiográficos. Casuística e métodos: Esta tese foi realizada na Seção de Neuroradiologia Intervencionista da Med Imagem, do Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, através da revisão de dados clínicos e radiológicos de 69 pacientes tratados pelo autor, com 84 aneurismas intracranianos de colo largo no período de julho de 2002 a fevereiro de 2006. Dez pacientes eram do sexo masculino e 59 do sexo feminino, com idade variando de 24 anos a 86 anos (mediana de 52 anos). Todos os aneurismas tinham origem lateral à artéria e apresentavam pelo menos um dos critérios usados para definir colo largo - colo maior que 4 mm de diâmetro e relação saco/colo menor que 1,5. Cinqüenta aneurismas eram pequenos, 30 grandes e quatro gigantes (diâmetro máximo menor que 12mm, de 12mm a 25mm e maiores que 25mm, respectivamente). As apresentações clínicas mais comuns foram: achado incidental em 34 pacientes, pós-hemorragia sub aracnóide e recanalização após tratamento com espirais destacáveis em 10. A maioria dos aneurismas era da artéria carótida interna (76 aneurismas). Controles angiográficos foram feitos ao final, aos seis meses e aos 18 meses do tratamento (controles I, II e III respectivamente), sendo analisados principalmente o grau de oclusão (completa ou incompleta), incidência de recanalização e complicações clínicas. Avaliação estatística foi feita pelo método de Kaplan-Meier para o percentual cumulativo de oclusão completa e percentual de recanalização e análise univariada e multivariada dos fatores preditivos de oclusão total imediata e tardia através de regressão logística. Resultados: O índice de oclusão completa foi de 65,5%, 84,6% e de 90,3% para todos os aneurismas, nos controles I, II e III respectivamente. Estes índices foram de 74%, 95,1% e de 95,2% para os aneurismas pequenos e de 53,3%, 70% e de 80% para os aneurismas grandes nos controles I, II e III respectivamente. Oclusão completa ocorreu em 50% dos aneurismas gigantes nos controles I e II, sem haver controle III neste grupo. Recanalização ocorreu em 3 aneurismas (4,6%). O porcentual cumulativo de oclusão completa foi de 97,63% (IC de 95% variando de 95,27 a 100) para os aneurismas pequenos aos 9 meses e de 83,86% (IC de 95% variando de 67,73 a 100) para os aneurismas grandes aos 21 meses. Três pacientes faleceram (4,3%), havendo relação com o procedimento em dois (2,9%). Morbidade permanente ocorreu em cinco pacientes (7,2%), sendo incapacitante em um (1,4%). Conclusões: 1. O uso do Onyx® foi eficiente na oclusão completa dos aneurismas intracranianos de colo largo. 2. O tratamento foi estável nos controles angiográficos aos 6 meses e aos 18 meses.Introduction: The high rate of incomplete occlusion and intracranial large neck aneurysms recanalization lead to the development of new techniques, including the use of Onyx®. Purpose: to evaluate the efficacy of the liquid embolic system Onyx ® to produce completes occlusion of the intracranial large neck aneurysms and evaluates the stability of the treatment at 6 month and 18 month angiographic control. Materials and Methods: this thesis has been performed at Section of Interventional Neuroradiology of Med Imagem, at the Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, based on a review of clinical and radiological records of 69 patients treated by the author, harboring 84 large neck intracranial aneurysms between July 2002 and February 2006. Ten patients were male and 59 female, with age ranging from 24 to 86 years old. All aneurysms were lateral to the parent vessel and were wide neck (neck > 4 mm and/or domus to neck ratio < 1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to 25 mm) and 4 were giant (> 25 mm). Thirty four aneurysms were incidental, 10 were ruptured and 10 were recanalized after coil treatment and the majority was located in the internal carotid artery (76). Angiographic follow-up was done at the end of the procedure, at six month and at 18 month (controls I, II and III respectively), analyzing the rate of complete occlusion, recanalization and clinical complication. Statically analysis were done by Kaplan-Meier method for cumulative percentage of complete aneurysm occlusion and for recanalization, and univariate and multivariate analysis of predictive factors of immediate and late complete occlusion through logistic regression. Results: Complete aneurysm occlusion was achieved in 65.5% on immediate control, in 84.6% at 6 month, and in 90.3% at 18 month follow-up periods for all aneurysms. This rate was 74%, 95.1% and 95.2% for small and 53.3%, 70% and 80% for large aneurysms at the same follow-up periods. In the giant aneurysm group, two had complete and stable occlusion at six month follow-up angiography. Recanalization was seen in three aneurysms (4,6%). Kaplan Meyer\'s cumulative percentage of complete aneurysm occlusion was 97.63% (CI 95% ranging from 95,27 to 100) for small aneurysms at 9 months and 83.86% (CI 95% ranging from 67,73 to 100) for large aneurysms at 21 months. There were three deaths (4,3%), two procedure-related (2.9%). Overall morbidity was 7.2%, being disabling in one (1,4%). Conclusions: 1. The use of Onyx was efficient in the complete occlusion of wide neck intracranial aneurysms. 2. The treatment was stable at 6 month and 18 month angiographic controls.