Neurovascular Critical Care

2018 ◽  
Author(s):  
Jose Manuel Sarmiento ◽  
Shouri Lahiri
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Cerebral Vasospasm ◽  
Cerebral Edema ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
High Morbidity ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Decompressive Hemicraniectomy

Ischemic stroke and intracranial hemorrhage are among the most devastating and debilitating injuries in medicine. Initial management principles for acute ischemic stroke rely on prompt revascularization before the brain parenchymal is infarcted. Large hemispheric infarctions and malignant cerebral edema occur uncommonly in a subset of patients with acute ischemic stroke and are associated with high morbidity and mortality rates. The indications for decompressive hemicraniectomy for malignant cerebral edema are reviewed. Medical management of intraparenchymal hematomas and aneurysmal subarachnoid hemorrhage in the intensive care setting is emphasized. Important clinical sequelae of subarachnoid hemorrhage such as rebleeding, cerebral vasospasm, and cerebral salt wasting are reviewed.   This review contains 5 figures, 4 tables and 52 references Key Words:  acute ischemic stroke, cerebral aneurysm, cerebral vasospasm, decompressive hemicraniectomy, intracerebral hemorrhage, large hemispheric infarctions, subarachnoid hemorrhage, malignant cerebral edema

Prediction of Cerebral Vasospasm in Patients Presenting with Aneurysmal Subarachnoid Hemorrhage: A Review

Neurosurgery ◽  
2005 ◽  
Vol 56 (4) ◽  
pp. 633-654 ◽  
Author(s):  
Christopher G. Harrod ◽  
Bernard R. Bendok ◽  
H Hunt Batjer
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
English Language ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Medical Complication ◽  
High Morbidity ◽  
Language Literature

Abstract OBJECTIVE: Cerebral vasospasm is a devastating medical complication of aneurysmal subarachnoid hemorrhage (SAH). It is associated with high morbidity and mortality rates, even after the aneurysm has been treated. A substantial amount of experimental and clinical research has been conducted in an effort to predict and prevent its occurrence. This research has contributed to significant advances in the understanding of the mechanisms leading to cerebral vasospasm. The ability to accurately and consistently predict the onset of cerebral vasospasm, however, has been challenging. This topic review describes the various methodologies and approaches that have been studied in an effort to predict the occurrence of cerebral vasospasm in patients presenting with SAH. METHODS: The English-language literature on the prediction of cerebral vasospasm after aneurysmal SAH was reviewed using the MEDLINE PubMed (1966–present) database. RESULTS: The risk factors, diagnostic imaging, bedside monitoring approaches, and pathological markers that have been evaluated to predict the occurrence of cerebral vasospasm after SAH are presented. CONCLUSION: To date, a large blood burden is the only consistently demonstrated risk factor for the prediction of cerebral vasospasm after SAH. Because vasospasm is such a multifactorial problem, attempts to predict its occurrence will probably require several different approaches and methodologies, as is done at present. Future improvements in the prevention of cerebral vasospasm from aneurysmal SAH will most likely require advances in our understanding of its pathophysiology and our ability to predict its onset.

scholarly journals Aneurysmal Subarachnoid Hemorrhage Following Intravenous Thrombolysis in Acute Ischemic Stroke

2017 ◽  
Vol 10 (2) ◽  
pp. 107-111 ◽  
Author(s):  
Hyo Jae Kim ◽  
Dong-Wha Kang ◽  
Sun U. Kwon ◽  
Jong S. Kim ◽  
Sang-Beom Jeon
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Intravenous Thrombolysis

Abstract 3499: Novel Nitric Oxide-Containing Echogenic Liposome for the Treatment of Vasospasm Following Subarachnoid Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
George L Britton ◽  
Tao Peng ◽  
Jaroslaw Aronowski ◽  
David D McPherson ◽  
Shao-Ling Huang ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Femoral Vein ◽  
High Morbidity ◽  
Sprague Dawley ◽  
Treatment Groups ◽  
Echogenic Liposomes ◽  
The Right

Background: Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of high morbidity and mortality. The reduced availability of nitric oxide (NO) in blood and cerebrospinal fluid (CSF) is suggested an important mechanism underlying cerebral vasospasm, a complication of SAH. NO or NO donors are known to have potent effects on cerebral vascular relaxation. We have developed NO-containing echogenic liposomes (NO-ELIP) for NO delivery to assess the role of NO in SAH-induced vasospasm. We hypothesized that NO-ELIP can produce vasodilation and provide an effective therapeutic approach to treat vasospasm following SAH. Methods: NO-ELIP was created by a freeze-under-pressure method. Male Sprague- Dawley rats (n=9) underwent SAH by puncturing the right middle cerebral artery with a sharp tip nylon monofilament. In the treatment groups, NO-ELIP were administered through the right femoral vein at 24 hours after SAH onset. The brain tissue was obtained for H&E staining at 30 min after NO-ELIP administration. Measurement of the posterior communicating artery was performed to evaluate the effects of NO-ELIP treatment on vasospasm following SAH. Results: After SAH, the normalized lumenal and wall thickness areas decreased from 1.02 ± 0.08 to 0.40 ± 0.15 (p<0.001). NO-ELIP inhibited SAH-induced vasospasm by 67% (normalized area decreased to 0.82 ± 0.10 (p=0.004). Conclusion: This study demonstrates that NO-ELIP have the potential to deliver NO for therapeutic treatment of vasospasm. Enhancing the release of NO from circulating NO-ELIP by combining ultrasound exposure over the carotid artery may further provide an improved treatment strategy. This suggests that targeted therapeutic gas can be delivered to the cerebral circulation for the treatment of vasospasm following SAH

Abstract 42: Haptoglobin 2-2 Phenotype Is associated with Cerebral Salt Wasting Syndrome in Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Santosh B Murthy ◽  
Justin Caplan ◽  
Shalom Hadar ◽  
Wendy C Ziai ◽  
Andrew P Levy ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebrovascular Disorders ◽  
Demographic Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Wasting Syndrome ◽  
Genetically Determined

INTRODUCTION: The Haptoglobin (Hp) phenotype has been shown to be a predictor of clinical outcomes in cerebrovascular disorders. We sought to determine if the Hp phenotype was predictive of cerebral salt wasting (CSW) following aneurysmal subarachnoid hemorrhage (SAH). METHODS: Patients admitted with a diagnosis of SAH were divided into three groups based on their genetically determined Hp phenotype: 1-1, 2-1, and 2-2. Outcome measures included CSW, delayed cerebral infarction (DCI) and favorable outcome -Glasgow Outcome score (GOS) of 4-5 at 30 days. CSW was diagnosed by a clinician, and met the following criteria: hyponatremia 4 liters in 12 hours with urine sodium > 40 mEq/L. Pearson’s Chi Square and Wilcoxon-Mann-Whitney tests were used for categorical and continuous variables respectively. Logistic regression was used to assess association between Hp phenotype and SAH outcomes. RESULTS: A total of 133 patients were included in the study. The distribution of Hp phenotype was- Hp 1-1: 29 (21.8%), Hp 2-1: 57 (42.9%), Hp 2-2: 47 (35.3%). The three Hp subgroups did not differ in terms of demographic variables, comorbidities or SAH characteristics. CSW occurred in 1 patient (3.4%) with Hp 1-1, 8 (14.0%) with Hp 2-1 and 15 (31.9%) with Hp 2-2 (p=0.004). In the multivariate analysis adjusted for age, sex, race, Hunt-Hess score and hydrocephalus, Hp 2-2 was associated with CSW (OR: 4.94 CI: 1.78-17.43, p=0.013) but Hp 2-1 was not (OR: 2.92, CI: 0.56-4.95, p=0.150). There were no associations between Hp phenotypes and favorable outcomes or DCI. CSW correlated strongly with development of DCI (OR: 7.16, OR: 2.48-20.62, p<0.001). CONCLUSIONS: Hp 2-2 phenotype was an independent predictor of cerebral salt wasting following SAH. There were no associations between Hp phenotype and DCI or good functional outcome.

scholarly journals A review on covid-19 and acute ischemic stroke, malignant cerebral edema & decompressive hemicraniectomy: A perfect storm; tackling this crisis by understanding it

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Ardavan Ahmadvand ◽  
◽  
Hamidreza Seifmanesh ◽  
Maryam Ghandali ◽  
Ali Afrasiabi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Edema ◽  
Neurological Complication ◽  
Healthcare Providers ◽  
Neurological Complications ◽  
Current Data ◽  
Vessel Occlusion ◽  
Decompressive Hemicraniectomy ◽  
Novel Coronavirus

Since the world was hit by novel coronavirus pandemic, so many challenges for all healthcare providers have been arisen. It is safe to say that no specialty was singled out in the matter of different complication from this viscous covid-19 situation and neurologists and neurosurgeon were no different. There are some studied reporting neurological complication associated with coronavirus infections but when it comes to life threatening and acute neurological complications such as strokes and malignant cerebral edema the data is scant. Here we are going to review the possible pathophysiology of this phenomenon, the relationship between covid-19 and acute ischemic stroke and malignant cerebral edema by taking a closer look at current data regarding this matter. Keywords: covid-19; acute ischemic stroke; malignant cerebral edema; covid-19 associated neurological complications. Abbreviations: DHC: Decompressive Hemicraniectomy; ELVO: Emergent Large Vessel Occlusion; MCE: Malignant Cerebral Edema.

Haptoglobin 2-2 Genotype Is Associated With Cerebral Salt Wasting Syndrome in Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2015 ◽  
Vol 78 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Santosh B. Murthy ◽  
Justin Caplan ◽  
Andrew P. Levy ◽  
Gustavo Pradilla ◽  
Yogesh Moradiya ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Wasting Syndrome ◽  
Symptomatic Vasospasm ◽  
Baseline Characteristics ◽  
Definition Of ◽  
Salt Wasting Syndrome

Abstract BACKGROUND: Haptoglobin (Hp) genotype has been shown to be a predictor of clinical outcomes in subarachnoid hemorrhage. Cerebral salt wasting (CSW) has been suggested to precede the development of symptomatic vasospasm. OBJECTIVE: To determine if Hp genotype was associated with CSW and subsequent vasospasm after aneurysmal subarachnoid hemorrhage. METHODS: Hp genotypic determination was done for patients admitted with a diagnosis of subarachnoid hemorrhage. Outcome measures included CSW, delayed cerebral infarction, and Glasgow Outcome Score of 4 to 5 at 30 days. Criteria for CSW included hyponatremia &lt;135 mEq/L, and urine output &gt;4 L in 12 hours with urine sodium &gt;40 mEq/L. RESULTS: A total of 133 patients were included in the study. The 3 Hp subgroups did not differ in terms of baseline characteristics. CSW occurred in 1 patient (3.4%) with Hp 1-1, 8 (14.0%) patients with Hp 2-1, and 15 (31.9%) patients with Hp 2-2 (P = .004). In the multivariate regression model, Hp 2-2 was associated with CSW (odds ratio [OR]: 4.94; CI: 1.78-17.43; P = .01), but Hp 2-1 was not (OR: 2.92; CI: 0.56-4.95; P = .15) compared with Hp 1-1. There were no associations between Hp genotypes and functional outcome or delayed cerebral infarction. CSW was associated with delayed cerebral infarction (OR: 7.46; 95% CI: 2.54-21.9; P &lt; .001). CONCLUSION: Hp 2-2 genotype was an independent predictor of CSW after subarachnoid hemorrhage. Because CSW is strongly associated with delayed cerebral infarction, the use of Hp genotype testing requires more investigation, and larger prospective confirmation is warranted. Additionally, a more objective definition of CSW needs to be delineated.

scholarly journals Concurrent Acute Ischemic Stroke and Non-aneurysmal Subarachnoid Hemorrhage in COVID-19

2020 ◽  
pp. 1-6
Author(s):  
Lennie Lynn C. de Castillo ◽  
Katrina Hannah D. Ignacio ◽  
Karl Josef Niño J. Separa ◽  
Jose Danilo B. Diestro ◽  
Paul Matthew D. Pasco ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Aneurysmal Subarachnoid Hemorrhage

Prevalence and clinical demographics of cerebral salt wasting in patients with aneurysmal subarachnoid hemorrhage

Pituitary ◽  
2009 ◽  
Vol 12 (4) ◽  
pp. 347-351 ◽  
Author(s):  
Lily Kao ◽  
Zahraa Al-Lawati ◽  
Joli Vavao ◽  
Gary K. Steinberg ◽  
Laurence Katznelson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Salt Wasting ◽  
Salt Wasting
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