The association of Takotsubo cardiomyopathy and aneurysmal subarachnoid hemorrhage: A U.S. nationwide analysis.

OBJECTIVE: Takotsubo cardiomyopathy (TC) is a stress-induced cardiomyopathy that can be precipitated by aneurysmal subarachnoid hemorrhage (aSAH). Several studies have shown patients who develop TC following aSAH have an increased risk of disability and mortality. The goal of this study is to examine the incidence of TC in aSAH, identify its risk factors, and analyze its impact on patient outcomes. METHODS: Data for patients with aSAH between the years of 2009 and 2018 were extracted from the Nationwide Inpatient Sample (NIS) and stratified based on the diagnosis of TC. Univariate analysis was used to assess the incidence of TC and covariates including patient demographics, aneurysmal treatment, in-hospital mortality rate, length of stay and costs. Multivariate logistic regression models analyzed the relationship between TC and these variables RESULTS: 80,915 aSAH patient-discharges were included in this study, 673 (0.83%) of which, developed TC. Females (OR 3.49, CI [2.82-4.33], P < 0.001), white ethnicity (69% vs 63%, P = 0.003) and patients with certain comorbidities including smoking (OR 1.64, CI [1.38-1.95], P < 0.0001) and seizures (OR 1.32, CI [1.07, 1.64], P = 0.01) were most likely to develop TC. Patients who developed TC had significantly increased mortality (OR 1.36, CI [1.13-1.65], P = 0.001), hospital stays (mean days of 19.4 vs 11.5, P < 0.0001), and costs ($104,111 vs $48,734, P < 0.0001). Hypertension (OR 0.63, CI [0.54-0.74], P < 0.0001) and hyperlipidemia (OR 0.63, CI [0.51-0.77], P < 0.0001) were found to be protective against TC. Patients with TC after acute SAH were more likely to undergo endovascular coiling (OR 1.68, CI [1.327-2.127], P < 0.001) rather than surgical clipping (OR 0.66, CI [0.52-0.83], P < 0.0001). CONCLUSIONS: Female sex, white ethnicity, smoking and seizures represented significant predictors of developing TC after aSAH, while hypercholesterolemia and hypertension were protective.

Factors Affecting Outcomes in Geriatric Traumatic Subdural Hematoma in a Neurosurgical Intensive Care Unit.

BACKGROUND AND OBJECTIVE: Geriatric patients (age ≥65 years) who sustain a traumatic brain injury have an increased risk of poor outcomes and higher mortality compared with younger cohorts. We aimed to evaluate the risk factors for discharge outcomes in a geriatric traumatic subdural hematoma population, stratified by age and pretraumatic medical comorbidities. This was a single-center retrospective cohort study of geriatric patients (N = 207). METHODS: Patient charts were evaluated for factors including patient characteristics, comorbidities, injury-related and seizure-related factors, neurosurgical intervention, and patient disposition on discharge. RESULTS: Bivariate and multivariate analyses showed that age was nonpredictive of patient outcomes. Underlying vasculopathic comorbidities were the primary determinant of posttraumatic seizure, surgical, and discharge outcomes. Multifactor analysis showed that patients who went on to develop status epilepticus (n = 11) had a higher frequency of vasculopathic comorbidities with strong predictive power in poor patient outcomes. CONCLUSIONS: Our findings suggest a need to establish unique prognostic risk factors based on patient outcomes that guide medical and surgical treatment in geriatric patients.

The History of Epilepsy: From Ancient Mystery to Modern Misconception.

Epilepsy is an ancient disease, which has fascinated and frightened scientists and laymen alike. Before the working knowledge of the central nervous system, seizures were shrouded in mystery. In antiquity, this disease was accredited to gods and demonic possession, causing those with epilepsy to be feared and isolated. Epilepsy patients continued to face discrimination through the mid-20th century. This discrimination ranged from lack of access to health insurance, jobs, and marriage equality to forced sterilizations. Despite the strides that have been made, there are still many misconceptions globally regarding epilepsy. Studies show that patients with epilepsy in communities that understand the pathology and cause of seizures are generally more successful in social and educational environments. While there has been progress, there is more work which needs to be done to educate people across the globe about the pathology of epilepsy.

Protective Effects of Obstructive Sleep Apnea on Outcomes After Subarachnoid Hemorrhage: A Nationwide Analysis.

BACKGROUND: Obstructive sleep apnea (OSA) is typically associated with an increased risk of cardiovascular and cerebrovascular disease. Recent studies, however, have suggested that hypercapnia and chronic intermittent hypoxia may potentially provide protection against ischemic events like stroke. OBJECTIVE: To evaluate the impact of OSA with presentation, hospital course, and treatment outcomes of patients with subarachnoid hemorrhage (SAH). METHODS: Data for patients with SAH between the years 2011 and 2015 were extracted from the Nationwide Inpatient Sample (NIS) and stratified based on diagnosis codes for OSA. Univariate analysis was used to assess the prevalence of comorbidities in OSA patients diagnosed with SAH and several covariates, including patient demographics, aneurysmal treatment, in-hospital morality rate, length of stay, and costs. Multivariate logistic regression models analyzed the relationship between several comorbidities, including OSA, tobacco use, and hypertension, and poor outcomes after SAH. RESULTS: Data from 49 265 SAH patients were used in this study, of which 2408 (4.9%) also had a concomitant OSA diagnosis. Patients with OSA compared to all other SAH patients had a significantly lower in-hospital mortality rate, as well as statistically significant lower odds of vasospasm, stroke, and poor outcomes. Additionally, hypercholesterolemia, obesity, and tobacco use disorder were also associated with more favorable outcomes. CONCLUSION: SAH patients with OSA are significantly less likely to have a poor outcome when compared to non-OSA patients, despite having an increased risk of several comorbidities.