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Frontiers in Neurology 2024
PubMed: 38867887
DOI: 10.3389/fneur.2024.1419224 -
Transfusion Clinique Et Biologique :... Jun 2024
PubMed: 38866075
DOI: 10.1016/j.tracli.2024.06.003 -
The New England Journal of Medicine Jun 2024
Topics: Female; Humans; Middle Aged; Acute Disease; Brain; Diagnosis, Differential; Headache; Magnetic Resonance Imaging; Subarachnoid Hemorrhage; Takotsubo Cardiomyopathy; Tomography, X-Ray Computed; Vasospasm, Intracranial; Syndrome
PubMed: 38865664
DOI: 10.1056/NEJMcpc2402484 -
Acute and Critical Care May 2024This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes,...
BACKGROUND
This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes, mortality, and complications such as vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus.
METHODS
Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Cochrane Central, up to November 2023. Nine studies involving 368 patients were selected based on eligibility criteria focusing on TH in poor-grade SAH patients. Data extraction, bias assessment, and evidence certainty were systematically performed.
RESULTS
The primary analysis of unfavorable outcomes in 271 participants showed no significant difference between the TH and standard care groups (risk ratio [RR], 0.87). However, a significant reduction in vasospasm was observed in the TH group (RR, 0.63) among 174 participants. No significant differences were found in DCI, hydrocephalus, and mortality rates in the respective participant groups.
CONCLUSIONS
TH did not significantly improve primary unfavorable outcomes in poor-grade SAH patients. However, the reduction in vasospasm rates indicates potential specific benefits. The absence of significant findings in other secondary outcomes and mortality highlights the need for further research to better understand TH's role in treating this patient population.
PubMed: 38863359
DOI: 10.4266/acc.2024.00612 -
Trials Jun 2024Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurosurgical emergency with a high mortality rate. Delayed cerebral ischemia (DCI) and cerebral...
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurosurgical emergency with a high mortality rate. Delayed cerebral ischemia (DCI) and cerebral vasospasm (CVS) are delayed products of early brain injury (EBI), which may constitute the principal determinant of an unfavorable patient prognosis. Consequently, the mitigation of DCI and CVS assumes paramount significance in the pursuit of enhanced patient outcomes. However, except for oral nimodipine, there is no effective therapy available in the current guideline. Hence, the exigency arises to proffer novel treatment paradigms. The diversity of hydrogen therapeutic targets has been largely reported in basic research, unveiling its latent capacity to ameliorate EBI in aSAH patients.
METHODS
Early Hydrogen-Oxygen Gas Mixture Inhalation in Patients with Aneurysmal Subarachnoid Hemorrhage (HOMA), a single-center, prospective, open-labeled, randomized controlled clinical trial, endeavors to evaluate the efficacy and safety of hydrogen-oxygen gas mixture inhalation therapy in aSAH patients. A cohort of 206 patients will be randomized to either hydrogen-oxygen gas mixture inhalation group (8 h per day, 3 L/min, hydrogen concentration of 67%, oxygen concentration of 33%) or oxygen inhalation group (8 h per day, 3 L/min, oxygen concentration of 33%) within 72 h after aSAH and treated for 7 days in the ICU ward. The primary outcomes are the incidence of DCI and CVS during hospitalization.
DISCUSSION
The HOMA aims to evaluate the effectiveness of hydrogen-oxygen gas mixture inhalation therapy in preventing DCI or CVS and improving outcomes in aSAH patients. Notably, this is the first large-scale trial of hydrogen therapy in aSAH patients. Given that the Chinese population represents a significant portion of the global population and the increasing incidence of stroke due to aging, optimizing patient care is vital. Given the current challenges in aSAH patient outcomes, initiating more prospective clinical trials is essential. Recent research has shown hydrogen's therapeutic potential, aligning with EBI in aSAH, driving our exploration of hydrogen therapy's mechanisms in post-aneurysm rupture damage.
ETHICS AND DISSEMINATION
The protocol for the HOMA study was approved by the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University (KY 2022-020-02). All results of the present study will be published in peer-reviewed journals and presented at relevant conferences.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05282836. Registered on March 16, 2022.
Topics: Humans; Subarachnoid Hemorrhage; Prospective Studies; Hydrogen; Randomized Controlled Trials as Topic; Oxygen Inhalation Therapy; Oxygen; Treatment Outcome; Time Factors; Adult; Vasospasm, Intracranial; Middle Aged; Female; Male; Aged; Administration, Inhalation; Brain Ischemia; Young Adult
PubMed: 38863026
DOI: 10.1186/s13063-024-08231-5 -
Current Molecular Medicine Jun 2024Subarachnoid hemorrhage is a serious subtype of stroke with high mortality and disability. The rupture of intracranial aneurysms is the main cause. However, in recent...
Subarachnoid hemorrhage is a serious subtype of stroke with high mortality and disability. The rupture of intracranial aneurysms is the main cause. However, in recent years, with the popularization of CT, MRI, and cerebral angiography, the detection rate of unruptured aneurysms has increased, and the incidence of aneurysm rupture and hemorrhage has gradually decreased. However, there are still some patients who fail to detect aneurysms in time and receive treatment, resulting in the occurrence of aneurysm rupture and bleeding, and these patients usually have a poor prognosis and leave a lasting disability. Therefore, exploring the causes of aneurysm formation and the mechanism of brain injury caused by aneurysm rupture is of great significance for preventing aneurysm formation and improving the prognosis of patients. MicroRNAs (miRNAs) are highly conserved non-coding RNAs that can bind to the 3'UTR of target mRNAs to regulate gene expression. Studies have shown that miRNAs can affect the formation and rupture of intracranial aneurysms by participating in apoptosis, inflammation, phagocyte migration, and vascular smooth muscle cells (VSMCs) regulation, and regulate the damage of brain tissue after aneurysm rupture. They play a role in multiple pathophysiological processes of aneurysmal subarachnoid hemorrhage. This article reviews the role of miRNAs in different pathophysiological stages of aneurysmal subarachnoid hemorrhage (aSAH). We further described the research progress of miRNAs as biomarkers for the diagnosis and prognosis of aSAH and discussed their application prospects in the prevention and treatment of aSAH.
PubMed: 38847169
DOI: 10.2174/0115665240306767240603091329 -
Der Nervenarzt Jun 2024Reversible cerebral vasoconstriction syndrome (RCVS) is a complex and etiologically diverse neurovascular disorder that typically presents with severe thunderclap... (Review)
Review
Reversible cerebral vasoconstriction syndrome (RCVS) is a complex and etiologically diverse neurovascular disorder that typically presents with severe thunderclap headaches (TCH) as the primary symptom, accompanied by reversible vasoconstriction of the cerebral arteries. The clinical course may include focal neurological deficits or epileptic seizures. There are two types: idiopathic RCVS and secondary RCVS, the latter triggered by various substances, medical interventions, or diseases. In clinical practice, various medical specialists may initially encounter this condition, underscoring the importance of accurate recognition and diagnosis of RCVS. The clinical course often appears monophasic and self-limiting, with recurrences reported in only 1.7% of cases annually. Complications such as cerebral hemorrhages and cerebral ischemia can lead to death in 5-10% of cases. This article utilizes a case study to explore RCVS, its complications, and the diagnostic procedures involved.
Topics: Humans; Vasospasm, Intracranial; Headache Disorders, Primary; Diagnosis, Differential; Stroke; Female; Cerebral Angiography; Syndrome; Rare Diseases; Middle Aged
PubMed: 38842549
DOI: 10.1007/s00115-024-01674-w -
Journal of Intensive Care Medicine Jun 2024Elevation of Troponin I (TnI) in spontaneous subarachnoid hemorrhage (SAH) patients is a well-known phenomenon and associated with cardiopulmonary complications and poor...
OBJECTIVE
Elevation of Troponin I (TnI) in spontaneous subarachnoid hemorrhage (SAH) patients is a well-known phenomenon and associated with cardiopulmonary complications and poor outcome. The present study was conducted to investigate the association of the TnI value on admission, and the occurrence of cerebral vasospam in SAH patients.
PATIENTS AND METHODS
A total of 142 patients with SAH, who were admitted to the neurosurgical intensive care unit (ICU) between December 2014 and January 2021 were evaluated. Blood samples were drawn on admission to determine TnI value. Each patient's demographic, radiological and medical data on admission, the modified Ranking Scale score at discharge as well as continuous measurements of transcranial Doppler sonography were analyzed. A maximum mean flow velocity (MMFV) > 120 cm/sec was defined as any vasospasm. These were stratified into severe vasospasms, which were defined as at least two measurements of MMFVs > 200 cm/sec or an increase of MMFV > 50 cm/sec/24 h over two consecutive days or a new neurological deterioration and mild vasospasm defined as MMFVs > 120 cm/sec in absence of severe vasospasm criteria. The total study population was dichotomized into patients with an initially elevated TnI (>0.05 µg/L) and without elevated TnI (≤0.05 μg/L).
RESULTS
A total of 52 patients (36.6%) had an elevated TnI level upon admission, which was significantly associated with lower GCS score (p < 0.001), higher WFNS score (p < 0.001) and higher Fisher grade (p = 0.01) on admission. In this context a higher rate of ischemic brain lesions (p = 0.02), a higher modified Rankin Scale score (p > 0.001) and increased mortality (p = 0.02) at discharge were observed in this group. In addition, TnI was identified as an independent predictor for the occurrence of any vasospasm and severe vasospasm.
CONCLUSION
An initially elevated TnI level is an independent predictor for the occurrence of any and severe vasospasm in patients with SAH.
PubMed: 38839250
DOI: 10.1177/08850666241253213 -
South African Journal of Surgery.... May 2024Cannabis legalisation continues to grow globally and its effects on the vascular system have been scrutinized. Cannabis has become recognised as a contributor to...
Cannabis legalisation continues to grow globally and its effects on the vascular system have been scrutinized. Cannabis has become recognised as a contributor to cardiovascular, cerebrovascular and peripheral vascular disease. This case report highlights the case of a young male patient presenting with atypical symptoms following cannabis use who developed gangrenous cholecystitis (GC) following vasospasm of his cystic artery. We believe that this is the first-ever case, shared with the anticipation of stimulating more research and prompting recognition of vascular events in this group of patients as our knowledge on the effects of cannabis continues to grow.
Topics: Humans; Male; Gangrene; Acalculous Cholecystitis; Cannabinoids; Adult
PubMed: 38838128
DOI: No ID Found -
European Radiology Jun 2024Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening event with major complications. Delayed cerebral infarct (DCI) occurs most frequently 7 days after aSAH...
BACKGROUND/OBJECTIVES
Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening event with major complications. Delayed cerebral infarct (DCI) occurs most frequently 7 days after aSAH and can last for a prolonged period. To determine the most predictive radiological scales in grading subarachnoid or ventricular haemorrhage or both for functional outcome at 3 months in a large aSAH population, we conducted a single-centre retrospective study.
METHODS
A 3-year single-centre retrospective cohort study of 230 patients hospitalised for aSAH was analysed. Initial computed tomography (CT) scans in patients hospitalised for aSAH were blindly assessed using eight grading systems: the Fisher grade, modified Fisher grade, Barrow Neurological Institute scale, Hijdra scale, Intraventricular Haemorrhage (IVH) score, Graeb score and LeRoux score.
RESULTS
Of 200 patients with aSAH who survived to day 7 and were included for DCI analysis, 39% of cases were complicated with DCI. The Hijdra scale was the best predictor for DCI, with a receiver operating characteristic area under the curve (ROC) of 0.80 (95% confidence interval (CI), 0.74-0.85). The IVH score was the most effective grading system for predicting acute hydrocephalus, with a ROC of 0.85 (95% CI, 0.79-0.89). In multivariate analysis, the Hijdra scale was the best predictor of the occurrence of DCI (hazard ratio, 1.18; 95% CI, 1.10-1.25).
CONCLUSIONS
Although these results have yet to be prospectively confirmed, our findings suggest that the Hijdra scale may be a good predictor of DCI and could be useful in daily clinical practice.
CLINICAL RELEVANCE STATEMENT
Better assessment of subarachnoid haemorrhage patients would allow for better prognostication and management of expectations, as well as referral for appropriate services and helping to appropriate use limited critical care resources.
KEY POINTS
Aneurysmal subarachnoid haemorrhage is a life-threatening event that causes severe disability and leads to major complications such as delayed cerebral infarction. Accurate assessment of the amount of blood in the subarachnoid spaces on computed tomography with the Hijdra scale can better predict the risk of delayed cerebral infarct. The Hijdra scale could be a good triage tool for subarachnoid haemorrhage patients.
PubMed: 38836940
DOI: 10.1007/s00330-024-10814-4