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1.
J Proteomics ; 293: 105060, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38154549

RESUMO

Currently, there are no effective methods for predicting the rupture of asymptomatic small intracranial aneurysms (IA) (<7 mm). In this study the aim was to identify early warning biomarkers in peripheral plasma for predicting IA rupture. Four experimental groups were included: ruptured intracranial aneurysm (RIA), unruptured intracranial aneurysm (UIA), traumatic subarachnoid hemorrhage control (tSAHC), and healthy control (HC) groups. Plasma proteomics of these four groups were detected using iTRAQ combined LC-MS/MS. Differentially expressed proteins (DEPs) were identified in RIA, UIA, tSAHC compared with HC. Target proteins associated with aneurysm rupture were obtained by comparing the DEPs of the RIA and UIA groups after filtering out the DEPs of the tSAHC group. The plasma concentrations of target proteins were validated using enzyme-linked immunosorbent assay (ELISA). The iTRAQ analysis showed a significant increase in plasma GPC1 concentration in the RIA group compared to the UIA group, which was further validated among the IA patients. Logistic regression analysis identified GPC1 as an independent risk factor for predicting aneurysm rupture. The ROC curve indicated that the GPC1 plasma cut-off value for predicting aneurysms rupture was 4.99 ng/ml. GPC1 may be an early warning biomarker for predicting the rupture of small intracranial aneurysms. SIGNIFICANCE: The current management approach for asymptomatic small intracranial aneurysms (<7 mm) is limited to conservative observation and surgical intervention. However, the decision-making process regarding these options poses a dilemma due to weighing their respective advantages and disadvantages. Currently, there is a lack of effective diagnostic methods to predict the rupture of small aneurysms. Therefore, our aim is to identify early warning biomarkers in peripheral plasma that can serve as quantitative detection markers for predicting intracranial aneurysm rupture. In this study, four experimental populations were established: small ruptured intracranial aneurysm (sRIA) group, small unruptured intracranial aneurysm (sUIA) group, traumatic subarachnoid hemorrhage control (tSAHC) group, and healthy control (HC) group. The tSAH group was the control group of spontaneous subarachnoid hemorrhage caused by ruptured aneurysm. Compared with patients with UIA, aneurysm tissue and plasma GPC1 in patients with RIA is significantly higher, and GPC1 may be an early warning biomarker for predicting the rupture of intracranial small aneurysms.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnoídea Traumática , Humanos , Aneurisma Roto/diagnóstico , Aneurisma Roto/etiologia , Biomarcadores , Cromatografia Líquida , Glipicanas , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/metabolismo , Fatores de Risco , Hemorragia Subaracnoídea Traumática/complicações , Espectrometria de Massas em Tandem
2.
J Surg Res ; 293: 71-78, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37722251

RESUMO

INTRODUCTION: Patients with isolated traumatic subarachnoid hemorrhage (itSAH) are often transferred to a Level I or II trauma center for neurosurgical evaluation. Recent literature suggests that some patients, such as those with high Glasgow Coma Scale (GCS) scores, may be safely observed without neurosurgical consultation. The objective of this study was to investigate characteristics of patients with itSAH to determine the clinical utility of neurosurgical evaluation and repeat imaging. MATERIALS AND METHODS: A retrospective chart review of 350 patients aged ≥ 18 y with initial computed tomography head (CTH) showing itSAH and GCS scores of 13-15. Patient demographics, medical history, medications, length of stay, transfer status, injury type and severity, and CTH results were extracted for analysis. Bivariate analyses were conducted to determine whether any factors were associated with a worsening repeat CTH. RESULTS: Most patients were female (57.4%) with blunt injuries (99.1%). The median age was 73 y. Neurosurgery was consulted for 342 (97.7%) patients, with one (0.3%) requiring intervention. Of 311 (88.9%) repeat imaging, 16 (5.1%) showed worsening. Factors with statistically significant associations with worsening CTH included injury severity; neurological deficit; lengths of stay; and a history of congestive heart failure, cirrhosis, or substance use disorder. CONCLUSIONS: The findings suggest that patients with itSAH and high GCS scores may be able to be managed safely without neurosurgical oversight. The factors strongly associated with worsening CTH may be useful in identifying patients who need transfer for intensive care. Further research is needed to confirm these findings and develop appropriate management strategies for patients with itSAH.


Assuntos
Hemorragia Subaracnoídea Traumática , Humanos , Feminino , Idoso , Masculino , Hemorragia Subaracnoídea Traumática/diagnóstico por imagem , Hemorragia Subaracnoídea Traumática/etiologia , Hemorragia Subaracnoídea Traumática/terapia , Estudos Retrospectivos , Centros de Traumatologia , Procedimentos Neurocirúrgicos , Encaminhamento e Consulta , Escala de Coma de Glasgow
3.
Acta Neurochir (Wien) ; 165(9): 2389-2398, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37552292

RESUMO

BACKGROUND: The primary aim was to determine the association of intracranial hemorrhage lesion type, size, mass effect, and evolution with the clinical course during neurointensive care and long-term outcome after traumatic brain injury (TBI). METHODS: In this observational, retrospective study, 385 TBI patients treated at the neurointensive care unit at Uppsala University Hospital, Sweden, were included. The lesion type, size, mass effect, and evolution (progression on the follow-up CT) were assessed and analyzed in relation to the percentage of secondary insults with intracranial pressure > 20 mmHg, cerebral perfusion pressure < 60 mmHg, and cerebral pressure autoregulatory status (PRx) and in relation to Glasgow Outcome Scale-Extended. RESULTS: A larger epidural hematoma (p < 0.05) and acute subdural hematoma (p < 0.001) volume, greater midline shift (p < 0.001), and compressed basal cisterns (p < 0.001) correlated with craniotomy surgery. In multiple regressions, presence of traumatic subarachnoid hemorrhage (p < 0.001) and intracranial hemorrhage progression on the follow-up CT (p < 0.01) were associated with more intracranial pressure-insults above 20 mmHg. In similar regressions, obliterated basal cisterns (p < 0.001) were independently associated with higher PRx. In a multiple regression, greater acute subdural hematoma (p < 0.05) and contusion (p < 0.05) volume, presence of traumatic subarachnoid hemorrhage (p < 0.01), and obliterated basal cisterns (p < 0.01) were independently associated with a lower rate of favorable outcome. CONCLUSIONS: The intracranial lesion type, size, mass effect, and evolution were associated with the clinical course, cerebral pathophysiology, and outcome following TBI. Future efforts should integrate such granular data into more sophisticated machine learning models to aid the clinician to better anticipate emerging secondary insults and to predict clinical outcome.


Assuntos
Lesões Encefálicas Traumáticas , Hematoma Subdural Agudo , Hemorragia Subaracnoídea Traumática , Humanos , Estudos Retrospectivos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/complicações , Pressão Intracraniana , Progressão da Doença
4.
Tomography ; 9(2): 541-551, 2023 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-36961003

RESUMO

The purpose of this systematic review was to analyze evidence based on existing studies on the ability of initial CT imaging to predict mortality in severe traumatic brain injuries (TBIs) in pediatric patients. An experienced librarian searched for all existing studies based on the inclusion and exclusion criteria. The studies were screened by two blinded reviewers. Of the 3277 studies included in the search, data on prevalence of imaging findings and mortality rate could only be extracted from 22 studies. A few of those studies had patient-specific data relating specific imaging findings to outcome, allowing the data analysis, calculation of the area under the curve (AUC) and receiver operating characteristic (ROC), and generation of a forest plot for each finding. The data were extracted to calculate the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predicted value (NPV), AUC, and ROC for extradural hematoma (EDH), subdural hematoma (SDH), traumatic subarachnoid hemorrhage (tSAH), skull fractures, and edema. There were a total of 2219 patients, 747 females and 1461 males. Of the total, 564 patients died and 1651 survived; 293 patients had SDH, 76 had EDH, 347 had tSAH, 244 had skull fractures, and 416 had edema. The studies included had high bias and lower grade of evidence. Out of the different CT scan findings, brain edema had the highest SN, PPV, NPV, and AUC. EDH had the highest SP to predict in-hospital mortality.


Assuntos
Lesões Encefálicas Traumáticas , Hematoma Epidural Craniano , Fraturas Cranianas , Hemorragia Subaracnoídea Traumática , Masculino , Feminino , Humanos , Criança , Estudos Retrospectivos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/epidemiologia , Tomografia Computadorizada por Raios X , Edema
6.
BMC Neurol ; 23(1): 68, 2023 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-36782124

RESUMO

BACKGROUND: According to the pathoanatomic classification system, progressive hemorrhagic injury (PHI) can be categorized into progressive intraparenchymal contusion or hematoma (pIPCH), epidural hematoma (pEDH), subdural hematoma (pSDH), and traumatic subarachnoid hemorrhage (ptSAH). The clinical features of each type differ greatly. The objective of this study was to determine the predictors, clinical management, and outcomes of PHI according to this classification. METHODS: Multivariate logistic regression analysis was used to identify independent risk factors for PHI and each subgroup. Patients with IPCH or EDH were selected for subgroup propensity score matching (PSM) to exclude confounding factors before evaluating the association of hematoma progression with the outcomes by classification. RESULTS: In the present cohort of 419 patients, 123 (29.4%) demonstrated PHI by serial CT scan. Of them, progressive ICPH (58.5%) was the most common type, followed by pEDH (28.5%), pSDH (9.8%), and ptSAH (3.2%). Old age (≥ 60 years), lower motor Glasgow Coma Scale score, larger primary lesion volume, and higher level of D-dimer were independent risk factors related to PHI. These factors were also independent predictors for pIPCH, but not for pEDH. The time to first CT scan and presence of skull linear fracture were robust risk factors for pEDH. After PSM, the 6-month mortality and unfavorable survival rates were significantly higher in the pIPCH group than the non-pIPCH group (24.2% vs. 1.8% and 12.1% vs. 7.3%, respectively, p < 0.001), but not significantly different between the pEDH group and the non-pEDH group. CONCLUSIONS: Understanding the specific patterns of PHI according to its classification can help early recognition and suggest targeted prevention or treatment strategies to improve patients' neurological outcomes.


Assuntos
Lesões Encefálicas Traumáticas , Hemorragia Subaracnoídea Traumática , Humanos , Pessoa de Meia-Idade , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/epidemiologia , Fatores de Risco , Hematoma Subdural , Hemorragia Subaracnoídea Traumática/complicações , Tomografia Computadorizada por Raios X , Escala de Coma de Glasgow , Estudos Retrospectivos
7.
Neurocrit Care ; 37(2): 497-505, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35606563

RESUMO

BACKGROUND: Patients with traumatic brain injury associated with intracranial hemorrhage are commonly admitted to the intensive care unit (ICU); however, the need for ICU care for patients with isolated traumatic subarachnoid hemorrhage (tSAH) remains unclear. We aimed to investigate the association between the ICU admission practices and outcomes in patients with isolated tSAH. METHODS: This observational study used a nationwide administrative database in Japan. We identified patients with isolated tSAH from the Japanese Diagnostic Procedure Combination inpatient database from July 1, 2010, to March 31, 2020. The primary outcome was in-hospital mortality, whereas the secondary outcomes were neurosurgical interventions, activities of daily living at discharge, and total hospitalization cost. We performed a risk-adjusted mixed-effect regression analysis to evaluate the association between hospital-level ICU admission rates and study outcomes. The ICU admission rates were categorized into quartiles: lowest, middle-low, middle-high, and highest. Moreover, we assessed the robustness of the results with a patient-level instrumental variable analysis. RESULTS: Of the 61,883 patients with isolated tSAH treated at 962 hospitals, 16,898 (27.3%) patients were admitted to the ICU on the day of admission. Overall, 2465 (4.0%) patients died in the hospital, and 783 (1.3%) patients underwent neurosurgical interventions. There was no significant difference between the lowest and highest ICU admission quartile in terms of in-hospital mortality (3.7% vs. 4.3%; adjusted odds ratio 0.93; 95% confidence interval [CI] 0.78-1.10), neurosurgical interventions, and activities of daily living at discharge. However, the total hospitalization cost in the lowest ICU admission quartile was significantly lower than that in the highest quartile (US $3032 vs. $4095; adjusted difference US $560; 95% CI 33-1087). The patient-level instrumental variable analysis did not reveal a significant difference in in-hospital mortality between the patients who were admitted to the ICU and those who were not (risk difference 0.2%; 95% CI - 0.1 to 0.5). CONCLUSIONS: There was no significant association between the ICU admission practices and outcomes in patients with isolated tSAH, whereas higher ICU admission rates were associated with significantly higher hospitalization costs. Our results provide an opportunity for improved health care allocation in the management of patients with isolated tSAH.


Assuntos
Hemorragia Subaracnoídea Traumática , Hemorragia Subaracnóidea , Atividades Cotidianas , Mortalidade Hospitalar , Hospitalização , Humanos , Pacientes Internados , Unidades de Terapia Intensiva , Japão/epidemiologia , Estudos Retrospectivos , Hemorragia Subaracnóidea/terapia , Hemorragia Subaracnoídea Traumática/terapia
8.
Am Surg ; 88(8): 1827-1831, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35404687

RESUMO

BACKGROUND: The management of isolated traumatic subarachnoid hemorrhage (itSAH) in non-trauma centers usually results in transfer to a Level 1 trauma center with neurosurgical capabilities. Due to lack of trauma center resources, we sought to evaluate if patients with itSAH need transfer to a Level I trauma center. METHODS: A retrospective review of the trauma registry was conducted from Jan 2015-Dec 2020. Patients with itSAH on initial computed tomographic imaging and a Glasgow Coma Scale score >13 were included. Patients with any other intracranial pathology, skull fractures, multi-system trauma or age less than 15 were excluded. RESULTS: 120 patients were identified with itSAH. Mean age was 63 years, and 44% were male. Mean injury severity score was 4.7 with 48% on anticoagulation/antiplatelet therapy. Radiology Reports were reviewed and only 2 scans (1.7%) showed an increase in itSAH, 98.3% reports revealed no change, improvement, or resolution. No patients deteriorated and no patients underwent neurosurgical intervention. Once admitted, 27 (23%) were treated for acute medical conditions and 39 (33%) required subspecialty medical consultations. There was no difference in increased itSAH on repeat imaging between patients on anticoagulation/antiplatelet therapy and those without. The population taking anticoagulant/antiplatelet therapy was older, more likely to have suffered a fall, have more comorbid conditions, was more likely to be treated for a non-traumatic medical condition and have a subspecialty medical consultation. DISCUSSION: Patients with itSAH do not require transfer to a Level 1 trauma center for acute neurosurgical intervention.


Assuntos
Hemorragia Subaracnoídea Traumática , Anticoagulantes , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária , Estudos Retrospectivos , Hemorragia Subaracnoídea Traumática/diagnóstico por imagem , Hemorragia Subaracnoídea Traumática/etiologia , Hemorragia Subaracnoídea Traumática/terapia , Centros de Traumatologia
9.
World Neurosurg ; 163: e493-e500, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35398576

RESUMO

OBJECTIVE: We sought to develop screening criteria predicting the lack of poor neurologic outcomes in patients presenting with traumatic subarachnoid hemorrhage (tSAH) and to evaluate their potential to improve resource allocation in these cases. METHODS: We retrospectively reviewed patients presenting with tSAH to the emergency department (ED) of a tertiary-care institution from 2016 to 2018. We defined good neurologic outcomes as patients with stable/improving neurologic status, who did not require neurosurgical intervention, had no expanding bleed, and needed no hospital readmission. Univariate and multivariate models were generated to predict risk factors inversely associated with good neurologic outcome. RESULTS: A total of 167 patients presented with tSAH from 2016 to 2018. The presence of depressed skull fracture, concomitant spinal fracture, low Glasgow Coma Scale (GCS) score, cranial nerve palsies, disorientation, concomitant hemorrhages, midline shift, increased international normalized ratio (INR), and emergent medical intervention were inversely correlated with likelihood of good neurologic outcome on univariate analysis. Multivariate regression showed that midline shift (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.05-0.89; P = 0.04), GCS score <13 (OR, 0.22; 95% CI, 0.05-0.99; P = 0.05), increased INR (OR, 0.18; 95% CI, 0.03-0.85; P = 0.04), and emergent medical intervention (OR, 0.18; 95% CI, 0.04-0.63; P = 0.01) were independently associated with lower likelihood of good neurologic outcome. Forty-six patients without any factors had good outcomes but were held in the ED or admitted to the hospital. These patients (if instead discharged directly) meant a potential cost savings of $179,172. CONCLUSIONS: In our study, we found multiple risk factors inversely associated with good neurologic outcome, namely low GCS score, midline shift, emergent medical intervention, and INR ≥1.4. Our findings may aid clinicians in determining which tSAH patients are candidates for safe early discharge.


Assuntos
Hemorragia Subaracnoídea Traumática , Hemorragia Subaracnóidea , Escala de Coma de Glasgow , Humanos , Alta do Paciente , Alocação de Recursos , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/cirurgia , Hemorragia Subaracnoídea Traumática/complicações , Tomografia Computadorizada por Raios X/efeitos adversos
10.
Neurosurgery ; 90(3): 300-305, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35006097

RESUMO

BACKGROUND: Isolated traumatic subarachnoid hemorrhage (tSAH) is a common finding in mild traumatic brain injury that often results in transfer to a tertiary center. Patients prescribed blood-thinning medications (BTs) are believed to be at higher risk of clinical or radiographic worsening. OBJECTIVE: To compare the rates of radiographic progression and need for neurosurgical intervention in patients with tSAH who are on anticoagulation (AC) and antiplatelet (AP) therapies with those who are not. METHODS: Analysis using a retrospective cohort design identified patients older than 18 years with isolated tSAH and a Glasgow Coma Scale of 15 on admission. Clinical information including use of BTs, administration of reversal agents, radiographic progression, and need for neurosurgical intervention was collected. Patients on BTs were divided into AP, AC, and AP/AC groups based on drug type. RESULTS: Three hundred eighty-four patients were included with 203 in the non-BT group and 181 in the BT group. Overall, 2.1% had worsening scans, and none required operative intervention. There was no difference in radiographic worsening between the non-BT and BT groups (2.4% vs 1.6%; P = 1.00). Crosswise comparison revealed no difference between the non-BT group and each BT subtype (AP, AP/AC, or AC). The non-BT group was more likely to have radiographic improvement than the BT group (45.8% vs 30.9%; P = .002). CONCLUSION: Neurologically intact patients on BTs with isolated tSAH are not at increased risk of radiographic progression or neurosurgical intervention. The presence of BTs should not influence management decisions for increased surveillance.


Assuntos
Hemorragia Subaracnoídea Traumática , Hemorragia Subaracnóidea , Anticoagulantes/uso terapêutico , Escala de Coma de Glasgow , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Retrospectivos
11.
Sci Rep ; 12(1): 187, 2022 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996928

RESUMO

We investigated the characteristics of midbrain injuries in patients with spontaneous subarachnoid hemorrhage (SAH) by using diffusion tensor imaging (DTI). Twenty-seven patients with SAH and 25 healthy control subjects were recruited for this study. Fractional anisotropy (FA) and mean diffusivity (MD) data were obtained for four regions of the midbrain (the anterior ventral midbrain, posterior ventral midbrain, tegmentum area, and tectum) in 27 hemispheres that did not show any pathology other than SAH. The mean FA and MD values of the four regions of the midbrain (anterior ventral midbrain, posterior ventral midbrain, tegmentum, and tectum) of the patient group were significantly lower and higher than those of the control group, respectively (p < 0.05). The mean FA values of the patient group were significantly different among the anterior ventral midbrain, posterior ventral midbrain, tegmentum, and tectum regions (ANOVA; F = 3.22, p < 0.05). Post hoc testing showed that the mean FA value of the anterior ventral midbrain was significantly lower than those of the posterior ventral midbrain, tegmentum, and tectum (p < 0.05); in contrast, there were no differences in mean FA values of the posterior ventral midbrain, tegmentum, and tectum (p > 0.05). However, differences were not observed among four regions of the midbrain (anterior ventral midbrain, posterior ventral midbrain, tegmentum, and tectum) in the mean MD values. We detected evidence of neural injury in all four regions of the midbrain of patients with SAH, and the anterior ventral midbrain was the most severely injured among four regions of the midbrain. Our results suggest that a pathophysiological mechanism of these neural injuries might be related to the occurrence of a subarachnoid hematoma.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão , Mesencéfalo/diagnóstico por imagem , Hemorragia Subaracnoídea Traumática/diagnóstico por imagem , Adulto , Idoso , Lesões Encefálicas/complicações , Feminino , Humanos , Masculino , Mesencéfalo/lesões , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnoídea Traumática/etiologia
13.
J Neurotrauma ; 39(1-2): 35-48, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33637023

RESUMO

Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI (n = 3); clinical management and diagnosis (n = 9); imaging (n = 3); and aneurysmal TSAH (n = 1). Of the 30 studies, two came from a low- and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.


Assuntos
Concussão Encefálica , Lesões Encefálicas Traumáticas , Hemorragia Subaracnoídea Traumática , Hemorragia Subaracnóidea , Adulto , Concussão Encefálica/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/terapia , Humanos , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapia , Hemorragia Subaracnoídea Traumática/diagnóstico por imagem , Hemorragia Subaracnoídea Traumática/etiologia , Hemorragia Subaracnoídea Traumática/terapia
14.
Med Sci Monit ; 27: e933959, 2021 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-34657118

RESUMO

BACKGROUND The pathophysiology of traumatic subarachnoid hemorrhage and brain injury has not been fully elucidated. In this study, we examined abnormalities of white matter in isolated traumatic subarachnoid hemorrhage patients by applying tract-based spatial statistics. MATERIAL AND METHODS For this study, 10 isolated traumatic subarachnoid hemorrhage patients and 10 age- and sex-matched healthy control subjects were recruited. Fractional anisotropy data voxel-wise statistical analyses were conducted through the tract-based spatial statistics as implemented in the FMRIB Software Library. Depending on the intersection between the fractional anisotropy skeleton and the probabilistic white matter atlases of Johns Hopkins University, we calculated mean fractional anisotropy values within the entire tract skeleton and 48 regions of interest. RESULTS The fractional anisotropy values for 19 of 48 regions of interest showed significant divergences (P<0.05) between the patient group and control group. The regions showing significant differences included the corpus callosum and its adjacent neural structures, the brainstem and its adjacent neural structures, and the subcortical white matter that passes the long neural tract. CONCLUSIONS The results demonstrated abnormalities of white matter in traumatic subarachnoid hemorrhage patients, and the abnormality locations are compatible with areas that are vulnerable to diffuse axonal injury. Based on these results, traumatic subarachnoid hemorrhage patients also exhibit diffuse axonal injuries; thus, traumatic subarachnoid hemorrhage could be an indicator of the presence of severe brain injuries associated with acute or excessive mechanical forces.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Hemorragia Subaracnoídea Traumática/complicações , Substância Branca/patologia , Adulto , Idoso , Anisotropia , Axônios/patologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/patologia , Estudos de Casos e Controles , Imagem de Tensor de Difusão , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Análise Espacial , Hemorragia Subaracnoídea Traumática/patologia , Substância Branca/citologia , Substância Branca/diagnóstico por imagem , Adulto Jovem
15.
Brain Res ; 1769: 147584, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34303696

RESUMO

BACKGROUND AND PURPOSE: Blood that enters the subarachnoid space (SAS) and its breakdown products are neurotoxic and are the principal inducers of brain injury after subarachnoid hemorrhage (SAH). Recently, meningeal lymphatic vessels (MLVs) have been proven to play an important role in clearing erythrocytes that arise from SAH, as well as other macromolecular solutes. However, evidence demonstrating the relationship between MLVs and brain injury after SAH is still limited. Therefore, we performed this study to observe the effects of meningeal lymphatic impairment on early brain injury (EBI) after experimental SAH. METHODS: The MLVs of C57BL/6 male adult mice were ablated by injecting Visudyne into the cisterna magna and transcranially photoconverting it with laser light. The MLVs were then examined by immunofluorescence staining for lyve-1. Next, both the MLV-ablated group and the control group (normal mice) underwent filament perforation to model SAH or sham operation. We assessed the cortical perfusion of all the mice before SAH induction, 5 min after SAH and 24 h after SAH. In addition, we evaluated neurological function deficits by Garcia scores and measured brain water content at 24 h post SAH. Then, neuroinflammation and neural apoptosis in the mouse brain were also examined. RESULTS: Visudyne and transcranial photoconversion treatment notably ablated mouse MLVs. Five minutes after SAH induction, cortical perfusion was significantly impaired, and after 24 h, this impairment was ameliorated considerably in the control group but ameliorated only slightly or worsened in the MLV-ablated group. Additionally, the MLVablated group presented worse neurological function deficits and more severe brain edema than the control group. More notably, neuroinflammation and neural apoptosis were also observed. CONCLUSION: Ablation of MLVs by Visudyne treatment exacerbated EBI after experimental SAH in mice. The worsening of EBI may have arisen from limited drainage of blood and other breakdown products, which are thought to cause brain edema, neuroinflammation, neuronal apoptosis and other pathological processes.


Assuntos
Lesões Encefálicas Traumáticas/patologia , Vasos Linfáticos/patologia , Meninges/patologia , Hemorragia Subaracnoídea Traumática/patologia , Animais , Apoptose , Água Corporal , Química Encefálica , Córtex Cerebral/irrigação sanguínea , Circulação Cerebrovascular , Cisterna Magna/patologia , Modelos Animais de Doenças , Encefalite/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL
16.
J Emerg Med ; 61(5): 456-465, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34074551

RESUMO

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) and traumatic subarachnoid hemorrhage (tSAH) differ significantly in their mortality and management. Although computed tomography angiography (CTA) is critical to guide timely interventions in aSAH, it lacks recognized benefit in assessing tSAH. Despite this, CTA commonly is included in tSAH evaluation. OBJECTIVE: Determine if any clinically significant cerebral aneurysms are identified on CTA in emergency department (ED) patients with a tSAH. METHODS: Retrospective observational study of consecutive blunt head trauma patients ages ≥ 16 years with Glasgow Coma Scale score (GCS) ≥ 13 who presented to an academic ED (100,000 annual visits) over a 7-year period. Those included had a CT-diagnosed SAH and underwent head CTA. The primary endpoint was the detection of any clinically significant brain aneurysms. RESULTS: There were 297 patients that met the inclusion criteria. Twenty-six patients (8.8%) had an incidental aneurysm discovered; one underwent elective outpatient intervention. Aneurysm-positive patients were more likely to be female (69.2% vs. 46.9%, p = 0.003), age 60 years or older (80.8% vs. 52.4%, p = 0.005), and be on anticoagulation (42.3% vs. 28.0%, p = 0.03). There were no differences between the aneurysm-positive and -negative patients with respect to GCS, history of hypertension, or mechanism of injury. CONCLUSIONS: In this 7-year retrospective chart review, CTA in patients with tSAH and GCS ≥ 13 did not reveal any clinically relevant cerebral aneurysms. One incidental aneurysm later underwent outpatient neurovascular intervention. In the absence of specific clinical concerns, CTA has minimal value in well-appearing patients with a tSAH.


Assuntos
Hemorragia Subaracnoídea Traumática , Hemorragia Subaracnóidea , Adolescente , Angiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
J Forensic Leg Med ; 80: 102173, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33895542

RESUMO

Blast injuries seen in various accidents involving pressurized containers like gas cylinders, tires, et cetera, and acts of terrorism. The associated factors can vary from poor handling of equipment to inadequate safety precautions. These injuries include a variety of injuries, such as, injuries due to shock wave, burns, fractures, et cetera, involving multi-organ systems, especially lungs and hollow organs, due to the high-pressurized shock wave. The presented case is of the death of a 24-years-old male as a result of a blast of the compressor present in the AC outdoor unit during the filling of the gas. Here, the body showed injuries due to shock wave, secondary impact, tertiary impact because of fall on the ground, and quaternary injuries due to burns. The cause of death was Blast lung associated with Subarachnoid hemorrhage.


Assuntos
Traumatismos por Explosões/patologia , Explosões , Acidentes de Trabalho , Queimaduras/patologia , Orelha/patologia , Hemorragia/patologia , Humanos , Pulmão/patologia , Masculino , Hemorragia Subaracnoídea Traumática/patologia , Adulto Jovem
18.
Acta Neurochir (Wien) ; 163(11): 3209-3216, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33646445

RESUMO

BACKGROUND: Traumatic brain injury (TBI) with isolated subarachnoid hemorrhage (iSAH) is a common finding in the emergency department. In many centers, a repeat CT scan is routinely performed 24 to72 h following the trauma to rule out further radiological progression. The aim of this study is to assess the clinical utility of the repeat CT scan in clinical practice. METHODS: We reviewed the medical charts of all patients who presented to our institution with mild TBI (mTBI) and isolated SAH between January 2015 and October 2017. CT scan at admission and control after 24 to 72 h were examined for each patient in order to detect any possible change. Neurological deterioration, antiplatelet/anticoagulant therapy, coagulopathy, SAH location, associated injuries, and length of stay in hospital were analyzed. RESULTS: Of the 649 TBI patients, 106 patients met the inclusion criteria. Fifty-four patients were females and 52 were males with a mean age of 68.2 years. Radiological iSAH progression was found in 2 of 106 (1.89) patients, and one of them was under antiplatelet therapy. No neurological deterioration was observed. Ten of 106 (9.4%) patients were under anticoagulation therapy, and 28 of 106 (26.4%) were under antiplatelet therapy. CONCLUSION: ISAH in mTBI seems to be a radiological stable entity over 72 h with no neurological deterioration. The clinical utility of a repeat head CT in such patients is questionable, considering its radiation exposure and cost. Regardless of anticoagulation/antiplatelet therapy, neurologic observation and symptomatic treatment solely could be a reasonable alternative.


Assuntos
Concussão Encefálica , Hemorragia Subaracnoídea Traumática , Hemorragia Subaracnóidea , Idoso , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
Clin Neurol Neurosurg ; 202: 106518, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33601271

RESUMO

OBJECTIVE: Intracranial hemorrhage (ICH) is frequently found on computed tomography (CT) after mild traumatic brain injury (mTBI) prompting transfer to centers with neurosurgical coverage and repeat imaging to confirm hemorrhage stability. Studies suggest routine repeat imaging has little utility in patients with minimal ICH, no anticoagulant/antiplatelet use, and no neurological decline. Additionally, it is unclear which mTBI patients benefit from transfer for neurosurgery consultation. The authors sought to assess the clinical utility and cost effectiveness of routine repeat head CTs and transfer to tertiary centers in patients with low-risk, mTBI. METHODS: Retrospective evaluation of patients receiving a neurosurgical consultation for TBI during a 4-year period was performed at a level 1 trauma center. Patients were stratified according to risk for neurosurgical intervention based on their initial clinical evaluation and head CT. Only patients with low-risk, mTBI were included. RESULTS: Of 531 patients, 119 met inclusion criteria. Eighty-eight (74.0 %) received two or more CTs. Direct cost of repeat imaging was $273,374. Thirty-seven (31.1 %) were transferred to our facility from hospitals without neurosurgical coverage, costing $61,384. No patient had neurosurgical intervention or mTBI-related in-hospital mortality despite enlarging ICH on repeat CT in three patients. Two patients had mTBI related 30-day readmission for seizure without ICH expansion. CONCLUSION: Routine repeat head CT or transfer of low-risk, mTBI patients to a tertiary center did not result in neurosurgical intervention. Serial neurological examinations may be a safe, cost-effective alternative to repeat imaging for select mTBI patients. A large prospective analysis is warranted for further evaluation.


Assuntos
Concussão Encefálica/terapia , Hemorragia Intracraniana Traumática/terapia , Neurocirurgia , Transferência de Pacientes/economia , Encaminhamento e Consulta , Fraturas Cranianas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/economia , Hemorragia Cerebral Traumática/diagnóstico por imagem , Hemorragia Cerebral Traumática/economia , Hemorragia Cerebral Traumática/terapia , Análise Custo-Benefício , Gerenciamento Clínico , Feminino , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/economia , Hematoma Subdural/terapia , Mortalidade Hospitalar , Humanos , Hemorragia Intracraniana Traumática/diagnóstico por imagem , Hemorragia Intracraniana Traumática/economia , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Readmissão do Paciente , Estudos Retrospectivos , Medição de Risco , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/economia , Hemorragia Subaracnoídea Traumática/diagnóstico por imagem , Hemorragia Subaracnoídea Traumática/economia , Hemorragia Subaracnoídea Traumática/terapia , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/economia , Centros de Traumatologia , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 148: e252-e263, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33412318

RESUMO

BACKGROUND: Increased brain edema in head injury is due to shift of cerebrospinal fluid (CSF) from cisterns at high pressure to brain parenchyma at low pressure. By opening basal cisterns and decreasing the increased cisternal pressure, basal cisternostomy (BC) results in reversal of CSF shift from parenchyma to cisterns, leading to decreased brain edema. Though the CSF-shift edema hypothesis is based on pressure difference between cisterns and brain parenchyma, the relationship of these pressures has not been studied. METHODS: A prospective clinical study was conducted from November 2018 to March 2020 including adult patients with head injury who were candidates for standard decompressive hemicraniectomy (DHC). All patients had neurological assessment and head computed tomography preoperatively and postoperatively. All patients underwent BC with DHC. Postoperatively, parenchymal and cisternal pressures and neurological condition were monitored hourly for 72 hours. RESULTS: Nine (5 men, 4 women) patients with head injury (mean age, 45.7 years; range, 25-72 years) underwent DHC-BC. Median Glasgow Coma Scale score of patients at admission was 8 (range, 4-14), and median midline shift on computed tomography was 8 mm (range, 7-12 mm). There was a significant difference between opening (25.70 ± 10.48 mm Hg) and closing (11.30 ± 5.95 mm Hg) parenchymal pressures (t9 = 3.963, P = 0.003). Immediate postoperative cisternal pressure was 1-11 mm Hg and was lower than immediate postoperative parenchymal pressure in all except 1 patient. Postoperatively, if cisternal pressure remained low, parenchymal pressure also decreased, and patients showed clinical improvement. Patients showing increased cisternal pressure showed increased parenchymal pressure and clinical worsening. CONCLUSIONS: Our study supports the CSF-shift edema hypothesis. Following DHC-BC, cisternal pressure is lowered to near-atmospheric pressure, and its relationship to parenchymal pressure predicts the future course of patients by reversal or re-reversal of CSF shift.


Assuntos
Edema Encefálico/prevenção & controle , Pressão do Líquido Cefalorraquidiano/fisiologia , Traumatismos Craniocerebrais/complicações , Craniectomia Descompressiva/métodos , Sistema Glinfático/fisiopatologia , Hematoma Subdural Intracraniano/complicações , Hipertensão Intracraniana/prevenção & controle , Modelos Biológicos , Hemorragia Subaracnoídea Traumática/complicações , Espaço Subaracnóideo/cirurgia , Adulto , Idoso , Edema Encefálico/líquido cefalorraquidiano , Edema Encefálico/etiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/fisiopatologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma Subdural Intracraniano/fisiopatologia , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Reologia , Hemorragia Subaracnoídea Traumática/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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