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1.
Emerg Med Clin North Am ; 39(1): 67-85, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218663

RESUMO

In the initial assessment of the headache patient, the emergency physician must consider several dangerous secondary causes of headache. A thorough history and physical examination, along with consideration of a comprehensive differential diagnosis may alert the emergency physician to the diagnosis of a secondary headache particularly when the history is accompanied by any of the following clinical features: sudden/severe onset, focal neurologic deficits, altered mental status, advanced age, active or recent pregnancy, coagulopathy, malignancy, fever, visual deficits, and/or loss of consciousness.


Assuntos
Serviço Hospitalar de Emergência , Cefaleia/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Cefaleia/etiologia , Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico
2.
A A Pract ; 14(14): e01357, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33278088

RESUMO

Morbidity and mortality associated with the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 2019 [COVID-19]) are not only due to acute respiratory distress syndrome but also related to multiorgan involvement and dysfunction. In this report, we present a critically ill patient with severe COVID-19 pneumonia, during which he required extracorporeal membrane oxygenation and suffered from multiple complications. Bedside sonography became an important tool to manage the patient by adapting artificial ventilation parameters and played a key role in the diagnosis of thrombotic events and the monitoring of subarachnoid hemorrhage that unexpectedly complicated the case.


Assuntos
/complicações , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Embolia Pulmonar/complicações , Hemorragia Subaracnóidea/complicações , Ultrassonografia/métodos , Estado Terminal , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Monitorização Fisiológica , Pneumonia/etiologia , Sistemas Automatizados de Assistência Junto ao Leito , Respiração Artificial , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Trombose/diagnóstico , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 99(50): e23388, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327263

RESUMO

BACKGROUND: Despite the rapid advances in medical technology, including endovascular interventions and medications, cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) is still one of the major threats to the lives of patients with SAH. In East Asian countries, various types of herbal medicines have been used to treat cerebrovascular diseases, including SAH. In this review, we aim to evaluate the efficacy and safety of herbal medicines for the prevention and treatment of CVS after SAH. METHODS AND ANALYSIS: Seven databases will be searched for relevant studies from inception to the present date "June 2020". Only randomized controlled trials (RCTs) that assess the effect and safety of herbal medicines for the prevention and treatment of CVS after SAH will be included. The methodological quality will be evaluated using the Cochrane risk of bias assessment tool. After selecting the appropriate studies, a meta-analysis of the RCTs will be performed. RESULTS: This study will provide a high-quality synthesis of current evidence of herbal medicines for CVS after SAH. CONCLUSION: Our systematic review will provide evidence to judge whether herbal medicines are effective interventions for patients with CVS after SAH. ETHICS AND DISSEMINATION: Ethical approval is not required, as this study is based on a review of published research. This review will be published in a peer-reviewed journal and disseminated electronically and in print. TRIAL REGISTRATION NUMBER: Research registry reviewregistry923.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Hemorragia Subaracnóidea/tratamento farmacológico , Vasoespasmo Intracraniano/tratamento farmacológico , Humanos , Metanálise como Assunto , Plantas Medicinais , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Hemorragia Subaracnóidea/complicações , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia
4.
Neurol Neurochir Pol ; 54(6): 576-584, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33252137

RESUMO

AIM OF THE STUDY: Among subarachnoid haemorrhage (SAH) patients, delayed cerebral injury (DCI) and infarction are the most important causes of death and major disability. Cerebral vasospasm (cVS) and DCI remain the major cause of death and disability. Thymoquinone (TQ) is the substance most responsible for the biological activity of nigella sativa (NS) and is useful in the treatment of ischaemic and neurodegenerative diseases, oxidative stress, inflammatory events, cardiovascular and neurological diseases. We conducted an experimental study aimed to investigate the preventive and corrective effects of TQ. MATERIALS AND METHODS: 24 Sprague-Dawley rats were randomly divided into three groups. The first was the control group which was a sham surgery group. The second group was the SAH group where the double haemorrage SAH protocol was used to induce vasospasm. The third group was the SAH+TQ group, where cVS was induced by the SAH protocol and the animals received oral 2 cc thymoquinone solution for seven days at a dose of 10 mg/kg, after the induction of SAH. The rats were euthanised seven days after the first procedure. The degree of cerebral vasospasm was evaluated by measuring the basilar artery luminal area and arterial wall thickness. Apoptosis was measured by the western blot method at brainstem neural tissue. Oxidative stress was measured by the Erel Method. Endothelin-1 was measured with ELISA analysis at blood. Statistical analysis was performed. RESULTS: Endothelin-1 values were found to be statistically significantly lower in the control and SAH+TQ groups compared to the SAH group (P < 0.001). Mean lumen area values were significantly higher in the control and SAH+TQ groups than in the SAH group (P < 0.001). In the control and SAH+TQ groups, wall thickness values decreased significantly compared to the SAH group (P < 0.001). OSI values were significantly lower in the control and SAH+TQ groups than in the SAH group (P < 0.001). Apoptosis was significantly lower in the control and SAH+TQ groups than in the SAH group (P < 0.001). CONCLUSION: Our results show that post-SAH TQ inhibits/improves DCI and cVS with positive effects on oxidative stress, apoptosis, ET-1, lumen area, and vessel wall thickness, probably due to its anti-ischaemic, antispasmodic, antioxidant, anti-inflammatory, anti-apoptotic and neuroprotective effects.


Assuntos
Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Animais , Artéria Basilar , Benzoquinonas/uso terapêutico , Modelos Animais de Doenças , Humanos , Ratos , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/tratamento farmacológico , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/prevenção & controle
6.
PLoS One ; 15(10): e0240122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017422

RESUMO

OBJECTIVES: More and more evidence suggests oxidative stress and inflammation contribute importantly to subarachnoid hemorrhage (SAH)-induced cerebral vasospasm and secondary brain injury. Recent evidence indicates Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) increases the expression of antioxidant genes and decreases the expression of pro-inflammatory genes. This study examines the effects of an activator of Nfr2, RTA 408, on SAH-induced cerebral vasospasm and possible mechanism underlying its effect in a two-hemorrhage rodent model of SAH. METHODS: We randomly assigned 60 Sprague-Dawley male rats (350 to 420g) to five groups twelve rats each: one control group (no SAH), one untreated SAH only group and three RTA-408 treatment groups (SAH+ RTA 408 0.5 mg/kg/day, SAH+RTA 408 1 mg/kg/day and a SAH+RTA 408 1.5 mg/kg/day). The treatment groups were administered RTA 408 by intraperitoneal injection thirty min following first induction of SAH for seven days starting with first hemorrhage. Cerebral vasospasm was determined by averaging the cross-sectional areas of basilar artery 7 days after first SAH. Expressions of Nrf2, NF-κB and iNOS in basilar artery and expressions of Nrf2, HO-1, NQO1 and Cleaved caspase-3 were evaluated. Tissue TNF-alpha was assessed by ELISA using the protein sampled from the dentate gyrus, cerebral cortex, and hippocampus. RESULTS: Prior to perfusion fixation, there were no significant physiological differences among the control and treated groups. RTA 408 treatment attenuated the morphological changes caused by cerebral vasospasm. It mitigated SAH-induced suppression of Nrf2 and increased expression of NF-κB and iNOS in the basilar artery. In dentate gyrus, it reversed SAH-decreases in Nrf2, HO-1, NQO-1 and cleaved caspase-3 and RTA 408 1.5 mg/kg/day reversed SAH increases in TNF-alpha. CONCLUSION: It was concluded that RTA 408 reversal vasospasm was achieved via increases in Nrf2 and decreases in NF-κB and iNOS. It exerted a neuron-protection effect by decreasing the apoptosis-related protein cleaved caspase-3 and decreasing the information cytokine TNF-alpha expression, which it achieved by increasing HO-1 and NQO-1 protein found downstream from Nrf2 and Nrf2. We believe that RTA 408 can potentially be used to manage of cerebral vasospasm and secondary brain injury following SAH.


Assuntos
Anti-Inflamatórios/uso terapêutico , Lesões Encefálicas/tratamento farmacológico , Fator 2 Relacionado a NF-E2/agonistas , Hemorragia Subaracnóidea/complicações , Triterpenos/uso terapêutico , Vasoespasmo Intracraniano/tratamento farmacológico , Animais , Lesões Encefálicas/etiologia , Lesões Encefálicas/patologia , Masculino , Fator 2 Relacionado a NF-E2/análise , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/patologia , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/patologia
7.
J Stroke Cerebrovasc Dis ; 29(11): 105262, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066936

RESUMO

The utility of quantitative EEG in early detection of cerebral ischemia is still underappreciated in clinical practice. We present a case of aneurysmal subarachnoid hemorrhage complicated by vasospasm as detected by the cerebral angiogram. The patient was being monitored on electroencephalogram. It showed early signs of cerebral ischemia represented by decline in the Alpha-Delta-Ratio (ADR) and the Relative-Alpha-Variability (RAV). Surprisingly, the RAV changes preceded the ADR changes. This is a significant finding that can also apply to early reocclusion or reperfusion injuries after mechanical thrombectomy.


Assuntos
Isquemia Encefálica/diagnóstico , Eletroencefalografia , Hemorragia Subaracnóidea/diagnóstico , Vasoespasmo Intracraniano/diagnóstico , Idoso , Ritmo alfa , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Ritmo Delta , Diagnóstico Precoce , Feminino , Humanos , Valor Preditivo dos Testes , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Fatores de Tempo , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/fisiopatologia
8.
J Vis Exp ; (163)2020 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-33044445

RESUMO

A common technique for inducing stroke in experimental rodent models involves the transient (often denoted as MCAO-t) or permanent (designated as MCAO-p) occlusion of the middle cerebral artery (MCA) using a catheter. This generally accepted technique, however, has some limitations, thereby limiting its extensive use. Stroke induction by this method is often characterized by high variability in the localization and size of the ischemic area, periodical occurrences of hemorrhage, and high death rates. Also, the successful completion of any of the transient or permanent procedures requires expertise and often lasts for about 30 minutes. In this protocol, a laser irradiation technique is presented that can serve as an alternative method for inducing and studying brain injury in rodent models. When compared to rats in the control and MCAO groups, the brain injury by laser induction showed reduced variability in body temperature, infarct volume, brain edema, intracranial hemorrhage, and mortality. Furthermore, the use of a laser-induced injury caused damage to the brain tissues only in the motor cortex unlike in the MCAO experiments where destruction of both the motor cortex and striatal tissues is observed. Findings from this investigation suggest that laser irradiation could serve as an alternative and effective technique for inducing brain injury in the motor cortex. The method also shortens the time for completing the procedure and does not require expert handlers.


Assuntos
Lesões Encefálicas/etiologia , Lasers/efeitos adversos , Córtex Motor/lesões , Animais , Barreira Hematoencefálica/patologia , Temperatura Corporal , Edema Encefálico/complicações , Edema Encefálico/patologia , Modelos Animais de Doenças , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/patologia , Masculino , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/complicações
10.
Stroke ; 51(10): 3039-3044, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32867601

RESUMO

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a major contributor to the high morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Spreading depolarizations may play a role in DCI pathophysiology. Because patients with migraine are probably more susceptible to spreading depolarizations, we investigated whether patients with aneurysmal subarachnoid hemorrhage with migraine are at increased risk for DCI. METHODS: We included patients with aneurysmal subarachnoid hemorrhage from 3 hospitals in the Netherlands. We assessed lifetime migraine history with a short screener. DCI was defined as neurological deterioration lasting >1 hour not attributable to other causes by diagnostic work-up. Adjustments were made for possible confounders in multivariable Cox regression analyses and adjusted hazard ratios (aHR) were calculated. We assessed the interaction effects of age and sex. RESULTS: We included 582 patients (mean age 57 years, 71% women) mostly with mild to moderate aneurysmal subarachnoid hemorrhage of whom 108 (19%) had a history of migraine (57 with aura). Patients with migraine were not at increased risk of developing DCI compared with patients without migraine (22% versus 24%, aHR, 0.89 [95% CI, 0.56-1.43]). Additionally, no increased risk was found in patients with migraine with possible aura (aHR, 0.74 [95% CI, 0.39-1.43]), in women (aHR, 0.88 [95% CI, 0.53-1.45], Pinteraction=0.859), or in young patients aged <50 years (aHR, 1.59 [95% CI, 0.72-3.49]), although numbers in these subgroups were limited. We found an interaction between migraine and age with an increased risk of DCI among young patients with migraine (Pinteraction=0.075). CONCLUSIONS: Patients with migraine are in general not at increased risk of DCI. Future studies should focus in particular on young SAH patients, in whom there might be an association between migraine history and development of DCI.


Assuntos
Isquemia Encefálica/etiologia , Transtornos de Enxaqueca/complicações , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo
11.
Stroke ; 51(9): 2795-2800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772685

RESUMO

BACKGROUND AND PURPOSE: Hemorrhages are a serious complication of brain surgery, and magnesium has shown hemostatic properties in hemorrhagic stroke and non-neurological surgeries. External ventricular drain (EVD) insertion is an advantageous model of emergency neurosurgical hemorrhage risk because it is common, standardized, and the operator is blinded to the outcome during the procedure. We tested the hypothesis that low magnesium is associated with risk of hemorrhagic complications from EVD insertion. METHODS: Patients with spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage were enrolled in a prospective, observational study. Demographic and clinical variables were prospectively recorded, including serum magnesium measurements. Catheter tract hemorrhage (CTH) was measured on postoperative head computed tomography within 48 hours of EVD insertion. RESULTS: We observed 50 CTH among 327 EVD procedures (15.3%) distributed similarly among intracerebral hemorrhage (21/116 [18.1%]) and subarachnoid hemorrhage (29/211 [13.7%]). Magnesium was lower in patients with CTH compared with those without (median 1.8 versus 2.0 mg/dL, P<0.0001). Higher magnesium was associated with lower odds of CTH (odds ratio 0.67 per 0.1 mg/dL magnesium [95% CI, 0.56-0.78], P<0.0001) after adjustment for other risk factors, with similar effect in the intracerebral hemorrhage and subarachnoid hemorrhage subgroups. Preprocedural increase in magnesium (odds ratio 0.68 [0.52-0.85]) and dose of preprocedural magnesium sulfate (odds ratio 0.67 [0.40-0.97]) were associated with reduced CTH risk after adjustment for initial magnesium and other risk factors. CONCLUSIONS: Lower magnesium at the time of EVD insertion was an independent predictor of hemorrhagic complications. Baseline risk was attenuated by preprocedural increases in magnesium, suggesting a therapeutic opportunity.


Assuntos
Hemorragia Cerebral/etiologia , Deficiência de Magnésio/complicações , Sulfato de Magnésio/uso terapêutico , Ventriculostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Deficiência de Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/farmacologia , Complicações Pós-Operatórias , Estudos Prospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
J Stroke Cerebrovasc Dis ; 29(9): 105005, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807421

RESUMO

BACKGROUND: Delayed cerebral ischemia is a serious complication of aneurysmal subarachnoid hemorrhage with debilitating and fatal consequences. Lack of well-established risk factors impedes early identification of high-risk patients with delayed cerebral ischemia. A nomogram provides personalized, evidence-based, and accurate risk estimation. To offset the lack of a predictive tool, we developed a nomogram to predict delayed cerebral ischemia before performing surgical interventions for aneurysmal subarachnoid hemorrhage to aid surgical decision-making. METHODS: We retrospectively collected data from 887 consecutive eligible Chinese patients who underwent surgical clipping or endovascular coiling for aneurysmal subarachnoid hemorrhage. Patients who previously underwent surgery formed the training cohort (n = 621) for nomogram development; those who underwent surgery later formed the validation cohort (n = 266) to confirm the performance of the model. A multivariate logistic regression analysis identified the independent risk factors associated with delayed cerebral ischemia, which were then incorporated into the nomogram. RESULTS: Delayed cerebral ischemia was identified in 158/621 patients (25.4%) in the training cohort and in 66/266 patients (24.8%) in the validation cohort. Preoperative factors associated with delayed cerebral ischemia were age > 65 years, modified Fisher grade of 3-4, ruptured aneurysm in the anterior circulation, Hunt-Hess grade of 4-5, high blood pressure on admission, and plasma homocysteine level ≥ 10 µmol/L. Incorporating these six factors in the nomogram achieved efficient concordance indices of 0.73 (95% confidence interval, 0.68-0.77) and 0.65 (95% confidence interval, 0.57-0.72) in predicting delayed cerebral ischemia in the training and validation cohorts, respectively. CONCLUSIONS: Our model can help determine an individual's risk of developing delayed cerebral ischemia in the Chinese population, and thereby, facilitate reasonable treatment-related decision-making.


Assuntos
Isquemia Encefálica/etiologia , Regras de Decisão Clínica , Nomogramas , Hemorragia Subaracnóidea/complicações , Idoso , Grupo com Ancestrais do Continente Asiático , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , China/epidemiologia , Tomada de Decisão Clínica , Embolização Terapêutica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etnologia , Hemorragia Subaracnóidea/terapia , Fatores de Tempo , Resultado do Tratamento
16.
J Neurovirol ; 26(5): 802-804, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32797352
17.
J Stroke Cerebrovasc Dis ; 29(9): 105011, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807426

RESUMO

The current COVID-19 pandemic has recently brought to attention the myriad of neuro- logic sequelae associated with Coronavirus infection including the predilection for stroke, particularly in young patients. Reversible cerebral vasoconstriction syndrome (RCVS) is a well-described clinical syndrome leading to vasoconstriction in the intracra- nial vessels, and has been associated with convexity subarachnoid hemorrhage and oc- casionally cervical artery dissection. It is usually reported in the context of a trigger such as medications, recreational drugs, or the postpartum state; however, it has not been described in COVID-19 infection. We report a case of both cervical vertebral ar- tery dissection as well as convexity subarachnoid hemorrhage due to RCVS, in a pa- tient with COVID-19 infection and no other triggers.


Assuntos
Betacoronavirus/patogenicidade , Artérias Cerebrais/fisiopatologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Hemorragia Subaracnóidea/complicações , Vasoconstrição , Dissecação da Artéria Vertebral/complicações , Adulto , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/efeitos dos fármacos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/fisiopatologia , Síndrome , Vasoconstrição/efeitos dos fármacos , Vasodilatação , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/tratamento farmacológico , Dissecação da Artéria Vertebral/fisiopatologia
18.
J Stroke Cerebrovasc Dis ; 29(9): 105027, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807442

RESUMO

BACKGROUND: Cognitive impairment is common after aneurysmal subarachnoid hemorrhage (SAH). However, compared to predictors of functional outcome, meaningful predictors of cognitive impairment are lacking. OBJECTIVE: Our goal was to assess which factors during hospitalization can predict severe cognitive impairment in SAH patients, especially those who might otherwise be expected to have good functional outcomes. We hypothesized that the degree of early brain injury (EBI), vasospasm, and delayed neurological deterioration (DND) would predict worse cognitive outcomes. METHODS: We retrospectively reviewed SAH patient records from 2013 to 2019 to collect baseline information, clinical markers of EBI (Fisher, Hunt-Hess, and Glasgow Coma scores), vasospasm, and DND. Cognitive outcome was assessed by Montreal Cognitive Assessment (MoCA) and functional outcomes by modified Rankin Scale (mRS) at hospital discharge. SAH patients were compared to non-neurologic hospitalized controls. Among SAH patients, logistic regression analysis was used to identify predictors of severe cognitive impairment defined as a MoCA score <22. RESULTS: We screened 288 SAH and 80 control patients. Cognitive outcomes assessed via MoCA at discharge were available in 105 SAH patients. Most of these patients had good functional outcome at discharge with a mean mRS of 1.8±1.3. Approximately 56.2% of SAH patients had MoCA scores <22 compared to 28.7% of controls. Among SAH patients, modified Fisher scale was an independent predictor of cognitive impairment after adjustment for baseline differences (OR 1.638, p=0.043). MoCA score correlated inversely with mRS (r=-0.3299, p=0.0006); however, among those with good functional outcome (mRS 0-2), 48.7% still exhibited cognitive impairment. CONCLUSIONS: Severe cognitive impairment is highly prevalent after SAH, even among patients with good functional outcome. Higher modified Fisher scale on admission is an independent risk factor for severe cognitive impairment. Cognitive screening is warranted in all SAH patients, regardless of functional outcome.


Assuntos
Cognição , Disfunção Cognitiva/etiologia , Hemorragia Subaracnóidea/complicações , Adulto , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/psicologia , Fatores de Tempo
19.
J Nippon Med Sch ; 87(3): 162-165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32655093

RESUMO

BACKGROUND: Aneurysmal subarachnoid hemorrhage is a rare but important cause of maternal death during pregnancy. CASE DESCRIPTION: A 34-year-old primigravida (31 weeks of pregnancy) with acute headache but no neurological deficits or neck stiffness was prescribed medication and returned home. Four weeks later she presented with severe headache and consciousness disturbance. She was admitted to our hospital, where she fell into a deep coma. Brain CT and three-dimensional CT angiography showed subarachnoid hemorrhage and a 5-mm right internal carotid-posterior communicating artery aneurysm. Fetal heart rate was 60 beats per minute. Emergent cesarean section and surgical clipping were performed. Intraoperative examination revealed that the aneurysm originated at the right posterior communicating artery. There were no postoperative neurological focal deficits. On postoperative day 13 she developed delayed cerebral ischemia of the right temporo-parieto-occipital lobe. She was discharged home 36 days after surgery with left hemianopsia. The infant was free of complications and was discharged at age 17 days. CONCLUSIONS: A pregnant woman with severe headache should undergo brain CT or magnetic resonance imaging to rule out subarachnoid hemorrhage.


Assuntos
Cefaleia/etiologia , Complicações na Gravidez , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Doença Aguda , Adulto , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Artérias Carótidas , Angiografia por Tomografia Computadorizada , Transtornos da Consciência/etiologia , Feminino , Humanos , Imageamento Tridimensional , Gravidez , Complicações na Gravidez/etiologia , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
20.
J Clin Neurosci ; 78: 353-359, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32622650

RESUMO

To assess the association between hyponatraemia and long-term functional outcome and other relevant outcomes in patients with aneurysmal subarachnoid haemorrhage (aSAH) we conducted a prospective cohort study in a Neurosciences Intensive Care Unit (ICU) in Sydney, Australia. The primary exposure variable was hyponatraemia (Na+ <135 mmol/L). The primary outcome was favourable outcome, a score of 5-8 on the extended Glasgow Outcome Score (GOSe) at 12 months. We also measured mortality, the incidence of delayed cerebral ischaemia (DCI) and cerebral arterial vasospasm and duration of ICU and hospital admission. There were 200 participants, 111 (56%) developed hyponatraemia. Hyponatraemia was not associated with favourable outcome at 12 months (unadjusted odds ratio [OR] OR 1.31, 95% confidence interval [CI] 0.65-2.65, p = 0.56). The result was similar after adjustment for baseline covariates (adjusted OR 0.60, 95% CI 0.16-1.99, p = 0.43). There was no association between hyponatraemia and the incidence of DCI (OR 0.95, 95% CI 0.46 to 2.0, p > 0.99) nor cerebral arterial vasospasm (OR 1.4, 95% CI 0.8 to 2.5, p = 0.27). Those who developed hyponatraemia had a longer median duration of ICU admission (17 days, interquartile range [IQR] 12 to 20, compared to 13 days, IQR 8-21, p = 0.02) and longer median duration of hospital admission (24 days, IQR 21-30, compared to 22 days IQR 14-31, p = 0.05). While hyponatraemia is common following aSAH, it is not associated with worse long-term functional outcome, increased rate of DCI, nor cerebral arterial vasospasm. Hyponatraemia in patients with aSAH was associated with longer duration of ICU and hospital admission.


Assuntos
Hospitalização , Hiponatremia/complicações , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Austrália/epidemiologia , Isquemia Encefálica , Infarto Cerebral , Estudos de Coortes , Feminino , Humanos , Hiponatremia/epidemiologia , Hiponatremia/mortalidade , Incidência , Unidades de Terapia Intensiva , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologia , Fatores de Tempo , Vasoespasmo Intracraniano/etiologia
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