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BMJ Open Dec 2021Delayed cerebral ischaemia (DCI) caused by aneurysmal subarachnoid haemorrhage (aSAH) is the most frequent complication and typically contributes to poor neurological...
Development and external validation of a dynamic nomogram for delayed cerebral ischaemia after aneurysmal subarachnoid hemorrhage: a study protocol for a multicentre retrospective cohort study.
INTRODUCTION
Delayed cerebral ischaemia (DCI) caused by aneurysmal subarachnoid haemorrhage (aSAH) is the most frequent complication and typically contributes to poor neurological outcome or deterioration of patients' condition. Therefore, early accurate and effective prediction of DCI is urgently needed. This study aims to construct a dynamic nomogram for precisely calculating the risk of DCI in patients with aSAH. Internal validation of this tool is conducted using the training cohort, and independent external validation is completed by using other medical centre datasets.
METHODS AND ANALYSIS
This study is a multicentre, retrospective, observational cohort study using data from patients with aSAH. The participants include all adult patients who received surgical treatment in neurosurgery of multiple medical centres from 1 September 2019 to 1 April 2021, including Renmin Hospital of Wuhan University, Huzhou Central Hospital, First Affiliated Hospital of Harbin Medical University, General Hospital of Northern Theatre Command and Affiliated Hospital of Panzhihua University. Clinical information is collected via the electronic medical record system, including demographic data, clinical state on admission and serum laboratory tests. Modified Fisher grade at admission, admission subarachnoid clot and cerebral oedema density, and residual postoperative subarachnoid clot density are determined using the electronic imagine record software. The primary outcome is DCI.
ETHICS AND DISSEMINATION
This study protocol was reviewed and approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University, which is the principal affiliation of this study (approval number: WDRM2021-K022). The other Ethics Committees, including Huzhou Central Hospital (approval number: 202108005-01), First Affiliated Hospital of Harbin Medical University (approval number: H202156), General Hospital of Northern Theater Command (approval number: Y2021060) and Affiliated Hospital of Panzhihua University (approval number: 202105002), also approved the protocol. The results of this research will be published in a peer-reviewed medical journal.
TRIAL REGISTRATION NUMBER
ChiCTR2100044448.
Topics: Adult; Brain Ischemia; Cohort Studies; Humans; Multicenter Studies as Topic; Nomograms; Observational Studies as Topic; Retrospective Studies; Subarachnoid Hemorrhage
PubMed: 34949617
DOI: 10.1136/bmjopen-2021-051956 -
Tidsskrift For Den Norske Laegeforening... Apr 2007Subarachnoid haemorrhage (SAH) causes 3% of all strokes and is caused by a ruptured cerebral aneurysm in four of five cases. This review article presents an update of... (Review)
Review
INTRODUCTION
Subarachnoid haemorrhage (SAH) causes 3% of all strokes and is caused by a ruptured cerebral aneurysm in four of five cases. This review article presents an update of knowledge on symptoms, diagnosis and management of SAH.
MATERIAL AND METHODS
This article is based on selected literature and the authors' clinical experience.
RESULTS AND INTERPRETATION
The mortality of SAH is approximately 50% and one out of three survivors have permanent disabling neurological symptoms. Patients with suspected or diagnosed SAH need urgent examination and treatment. A large randomised multicentre study (International Subarachnoid Aneurysm Trial) suggests that endovascular repair with coiling may be less traumatic than microsurgery. Not all patients are suitable for endovascular treatment, despite new tools like balloon- and stent-assisted coiling. Centres that treat patients with SAH should have both methods available at all hours. The management of these patients involves advanced neuro-intensive care, and co-operation between neurosurgeons, neuroradiologists and neuroanestesiologists.
Topics: Aneurysm, Ruptured; Humans; Intracranial Aneurysm; Neurosurgical Procedures; Prognosis; Stroke; Subarachnoid Hemorrhage; Survival Rate; Tomography, X-Ray Computed; Vascular Surgical Procedures
PubMed: 17457396
DOI: No ID Found -
British Medical Journal (Clinical... Nov 1981
Topics: Antifibrinolytic Agents; Cerebrovascular Circulation; Humans; Intracranial Aneurysm; Recurrence; Subarachnoid Hemorrhage
PubMed: 6797534
DOI: 10.1136/bmj.283.6303.1347 -
British Medical Journal (Clinical... Apr 1983
Topics: Humans; Intracranial Aneurysm; Postoperative Complications; Rupture, Spontaneous; Subarachnoid Hemorrhage
PubMed: 6404436
DOI: 10.1136/bmj.286.6374.1299 -
Clinical Medicine (London, England) Jul 2021
Topics: Humans; Intracranial Aneurysm; Risk Factors; Subarachnoid Hemorrhage
PubMed: 35192492
DOI: 10.7861/clinmed.Let.21.4.1 -
BioMed Research International 2014Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid... (Review)
Review
Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed.
Topics: Brain Ischemia; Humans; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 24967389
DOI: 10.1155/2014/628597 -
PloS One 2017After a subarachnoid haemorrhage (SAH), continuing impairment is common and may impact the person's life. There is a lack of knowledge regarding long-term consequences...
BACKGROUND
After a subarachnoid haemorrhage (SAH), continuing impairment is common and may impact the person's life. There is a lack of knowledge regarding long-term consequences experienced.
PURPOSE
To explore experiences of the care and rehabilitation as well as the consequences and strategies used to cope with everyday life six years post SAH.
METHODS
An explorative interview study with a qualitative design. Individual interviews, with open ended questions, using an interview guide were performed with sixteen participants (mean age 63, 8 men, 8 women) six years post SAH. Data was analyzed according to a descriptive thematic analysis, and themes were discovered inductively.
RESULTS
Two major themes from the analysis, both including four sub-themes, were identified; these themes were consequences of the SAH and coping strategies. Participants were grateful to have survived the SAH and most were satisfied with their acute medical care. If discharged directly from the neurosurgical unit participants can feel abandoned. In contrast, participants who were referred to a rehabilitation clinic felt supported and informed. Cognitive problems, such as impaired memory and mental fatigue, were reported as still present six years post SAH. Coping strategies were; receiving support from family, society, employers, or technical equipment. At work, talking to colleagues and to taking breaks were common. Participants described hiding their symptoms from employers and friends, as well as trying to continue doing tasks in the same manner as prior to the SAH. If this was not possible, some refrained from doing these tasks. They went through a mourning process, fear, and worries.
CONCLUSIONS
Participants reported several long-term consequences which impacted on their daily lives post SAH, and different coping strategies were used to cope with these problems. Participants reported lack of awareness regarding the consequences of SAH and stressed the importance of structured multidisciplinary follow-ups, which mostly is missing.
Topics: Adaptation, Psychological; Aged; Emotions; Female; Humans; Male; Middle Aged; Qualitative Research; Quality of Life; Subarachnoid Hemorrhage; Workload
PubMed: 28854198
DOI: 10.1371/journal.pone.0181006 -
Revista de NeurologiaThe vascular structures in the central nervous system has a particular distribution in respect of other organs. This anatomic configuration and other conditions... (Review)
Review
INTRODUCTION
The vascular structures in the central nervous system has a particular distribution in respect of other organs. This anatomic configuration and other conditions predispose this arteries and veins to bleed frequently in the subarachnoid space, resulting in a syndrome known as subarachnoid hemorrhage.
DEVELOPMENT
We make a study of the bibliography published in the topic, beside our professional criteria concerning those themes, with regard to the elements that we have been able to evaluate in our daily practice. We carried out a wide review about etiology, physiopathology, clinical presentation, diagnosis and management of the commonest problems associated with that entity. Specially those aspects related with the clinical support and treatment of the cerebral vasoespasm, hydrocephalus and other complications of the subarachnoid hemorrhage.
CONCLUSION
In this paper we expose the most important aspects related with the clinical manifestations of certain vascular malformations like saccular aneurysm and arteriovenous malformations, the principles of it diagnosis and management.
Topics: Blood Volume; Diabetes Insipidus, Neurogenic; Diagnosis, Differential; Humans; Hydrocephalus; Spinal Puncture; Subarachnoid Hemorrhage; Time Factors
PubMed: 12134329
DOI: No ID Found -
Revue Medicale de Liege Sep 2009Brain injuries namely traumatic brain injuries (TBI) and subarachnoid haemorrhage (SAH) are relevant causes of acquired adult hypopituitarism, perhaps more prevalent... (Review)
Review
Brain injuries namely traumatic brain injuries (TBI) and subarachnoid haemorrhage (SAH) are relevant causes of acquired adult hypopituitarism, perhaps more prevalent than ever believed. TBI represent a major health problem with an annual incidence of 300 cases per 100.000. SAH affects six new cases per 1.000.000 habitants in USA. In Belgium we estimate nearly 30.000 new TBI cases and 600 SAH cases per year. In the English literature, TBI secondary hypopituitarism has been well documented in 14 retrospective and prospective series accounting for 1.077 cases. In all these series the main pituitary deficits were: GH (14%), ACTH (14%), gonadotrope (18%), TSH (7%) and diabetes insipidus (4%). SAH was documented as a cause of hypopituitarism in three retrospective series accounting for 110 cases and in one prospective series. In all these series main pituitary deficits were GH (25%), ACTH (15%), gonadotrope (8.5%), TSH (6%) and diabetes insipidus (4%). In this review, we analyze recent data and discuss diagnostic and treatment features of secondary hypopituitarism due TBI and SAH.
Topics: Belgium; Brain Injuries; Humans; Hypopituitarism; Subarachnoid Hemorrhage
PubMed: 19947316
DOI: No ID Found -
Journal of Cellular and Molecular... May 2024We investigated subarachnoid haemorrhage (SAH) macrophage subpopulations and identified relevant key genes for improving diagnostic and therapeutic strategies. SAH rat...
We investigated subarachnoid haemorrhage (SAH) macrophage subpopulations and identified relevant key genes for improving diagnostic and therapeutic strategies. SAH rat models were established, and brain tissue samples underwent single-cell transcriptome sequencing and bulk RNA-seq. Using single-cell data, distinct macrophage subpopulations, including a unique SAH subset, were identified. The hdWGCNA method revealed 160 key macrophage-related genes. Univariate analysis and lasso regression selected 10 genes for constructing a diagnostic model. Machine learning algorithms facilitated model development. Cellular infiltration was assessed using the MCPcounter algorithm, and a heatmap integrated cell abundance and gene expression. A 3 × 3 convolutional neural network created an additional diagnostic model, while molecular docking identified potential drugs. The diagnostic model based on the 10 selected genes achieved excellent performance, with an AUC of 1 in both training and validation datasets. The heatmap, combining cell abundance and gene expression, provided insights into SAH cellular composition. The convolutional neural network model exhibited a sensitivity and specificity of 1 in both datasets. Additionally, CD14, GPNMB, SPP1 and PRDX5 were specifically expressed in SAH-associated macrophages, highlighting its potential as a therapeutic target. Network pharmacology analysis identified some targeting drugs for SAH treatment. Our study characterised SAH macrophage subpopulations and identified key associated genes. We developed a robust diagnostic model and recognised CD14, GPNMB, SPP1 and PRDX5 as potential therapeutic targets. Further experiments and clinical investigations are needed to validate these findings and explore the clinical implications of targets in SAH treatment.
Topics: Subarachnoid Hemorrhage; Animals; Macrophages; Machine Learning; Single-Cell Analysis; Rats; Biomarkers; Deep Learning; Male; Gene Expression Profiling; Transcriptome; Rats, Sprague-Dawley; Disease Models, Animal; Neural Networks, Computer; Molecular Docking Simulation
PubMed: 38702954
DOI: 10.1111/jcmm.18296