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1.
Medicine (Baltimore) ; 99(5): e18654, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000370

RESUMO

INTRODUCTION: Acute hydrocephalus is a common complication of spontaneous or traumatic intracranial bleeding with extensive subarachnoid hemorrhage (SAH) or ventricular extension. However, it has never been reported to be secondary to pneumocephalus. PATIENT CONCERNS: A 32-year-old man was admitted following a motorcycle accident. Head computed tomography (CT) performed right after the accident revealed a skull base fracture and mild perimesencephalic SAH. Three days later, repeated CT revealed delayed perimesencephalic pneumocephalus and an evident enlargement of the ventricular system. DIAGNOSIS: The patient was diagnosed with acute obstructive hydrocephalus, which was secondary to pneumocephalus and traumatic SAH. INTERVENTIONS: The patient was treated with temporary external ventricular drainage (EVD). OUTCOMES: The patient experienced an unremarkable recovery process. At follow-up 3 months later, he showed no recurrence of the hydrocephalus and the score of Glasgow Outcome Scale was 5. CONCLUSION: Transient mechanical obstruction of CSF circulation and disturbance of CSF physiology might conjointly lead to the acute obstructive hydrocephalus.


Assuntos
Hidrocefalia/etiologia , Pneumocefalia/complicações , Fratura da Base do Crânio/complicações , Hemorragia Subaracnóidea/complicações , Acidentes de Trânsito , Adulto , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Fratura da Base do Crânio/diagnóstico por imagem
3.
Fortschr Neurol Psychiatr ; 88(1): 33-39, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31986550

RESUMO

The present review focuses on cognitive and participation impairments after aneurysmal subarachnoidal hemorrhage (aSAH). Such impairments may be present even in cases without evidence of damage in the neuropsychologically expected brain area. Neuroinflammation and oxidative stress may be responsible for this finding. Most frequently, cognitive impairment can be found in the verbal memory domain, visuospatial skills and memory domain, attention and working memory domain, executive functions (planning, central control, problem solving, attention, decision making), psychomotor speed and language domain. The presence of cognitive deficits is a major risk factor not to return to work again. Together with cognitive impairment, psychiatric symptoms like anxiety, depression and fatigue may be observed. Psychiatric disturbances result in impairments of social and vocational participation and - consecutively - worsening of quality of life.


Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/fisiopatologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Transtornos Cognitivos/psicologia , Função Executiva , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Testes Neuropsicológicos , Qualidade de Vida , Hemorragia Subaracnóidea/psicologia
4.
World Neurosurg ; 135: e505-e509, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863887

RESUMO

OBJECTIVE: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by acute onset after central nervous system injury. Here, we investigated the clinical features of NPE in patients with subarachnoid hemorrhage (SAH). METHODS: We retrospectively analyzed a total of 350 patients with SAH who were treated at our hospital from April 2014 to September 2017. Patient demographics, aneurysm size and location, clinical characteristics, and patient outcomes were reviewed and compared between an NPE and a non-NPE group. RESULTS: Sixteen patients (4.6%) presented with NPE at admission. Ten of these (62.5%) recovered from NPE immediately, and ventilatory support was withdrawn within 2 days from onset. A univariate analysis showed that patients with NPE were younger (P = 0.04), had a higher rate of vertebral artery dissection (P < 0.01), more severe World Federation of Neurosurgical Societies (WFNS) grades (P = 0.01), and lower systolic blood pressure on admission (P = 0.01). A multivariate analysis revealed significant differences in the frequency of vertebral artery dissection (odds ratio 4.83, 95% confidence interval 1.50-15.56, P < 0.01) and in WFNS grades (odds ratio 3.73, 95% confidence interval 1.02-13.66, P = 0.04) between the groups. No significant group differences were found in other factors including heart rate, radiographic sign (Fisher grade), aneurysm size and location, blood sample tests on admission, and neurologic outcomes. CONCLUSIONS: Vertebral artery dissection and severe WFNS grade on admission were confirmed as significant risk factors for NPE. However, neurologic outcomes at discharge did not differ between groups, suggesting that poor outcomes due to NPE could be reduced by appropriate diagnosis and treatment.


Assuntos
Edema Pulmonar/patologia , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Dissecação da Artéria Vertebral/etiologia , Dissecação da Artéria Vertebral/patologia
5.
World Neurosurg ; 135: e664-e670, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881342

RESUMO

BACKGROUND: The effect of intoxicating substances on assessment of Glasgow Coma Scale (GCS) in the trauma setting has not been completely elucidated. METHODS: A trauma registry was queried for patients with blunt head trauma in 2013-2017. Initial GCS score and toxicology screening from the database were reviewed. Next recorded GCS score from the neurosurgery evaluation and change in GCS score (ΔGCS) were compared. RESULTS: We reviewed 468 patients. In 217 (46.4%) patients, no toxic substances were found, whereas >1 toxic substance was found in 104 (22.2%) patients. Alcohol level above the legal limit was found in 109 (23.3%) patients, marijuana was found in 105 (22.4%) patients, benzodiazepines were found in 94 (20.1%) patients, opiates were found in 48 (10.3%) patients, and cocaine was found in 41 (8.8%) patients. Mean change in GCS score was significantly higher in impaired patients compared with patients with a negative screening test (1.74 ± 2.4 vs. 0.75 ± 2.7, P < 0.001); this is despite both groups having a similar initial GCS score (6.23 ± 3.86 in impaired group vs. 6.47 ± 3.52 in sober group, P = 0.677). Initial GCS score was 3 in 187 patients, of whom 150 had a positive toxicology screen. Change in GCS score was significantly higher in the impaired group (2.75 ± 2.7 vs. 1.19 ± 1.8, P < 0.001). CONCLUSIONS: Intoxicating substances can confound GCS assessment in trauma patients. This can have effects on patient care as well as performance metrics and predictive analytics. These patients should be screened, and intoxicating substances should be reversed or allowed to wear off before GCS score is recorded for benchmarking or quality reporting.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Escala de Coma de Glasgow , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intoxicação Alcoólica/complicações , Criança , Pré-Escolar , Feminino , Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Sistema de Registros , Hemorragia Subaracnóidea/complicações , Estados Unidos , Adulto Jovem
6.
World Neurosurg ; 135: 214-216, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881344

RESUMO

Pure pial arterial malformations (PAMs) are poorly understood owing to the limited number of reported cases. Because PAMs have been thought to have a benign natural history, they have generally been managed conservatively, unlike arteriovenous malformations or arteriovenous fistulas. In the present report, we have described a spontaneous subarachnoid hemorrhage from the rupture of a PAM at the cerebellomedullary junction. This hemorrhage was surgically treated using clip trapping.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Artérias Cerebrais/anormalidades , Hemorragia Subaracnóidea/cirurgia , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Humanos , Masculino , Bulbo/diagnóstico por imagem , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
World Neurosurg ; 135: e657-e663, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881345

RESUMO

BACKGROUND: Endovascular procedures such as intraarterial (IA) vasodilator injection and balloon angioplasty are used to treat medically refractory cerebral vasospasm. The effects of IA therapy may be short lived and thus require multiple treatments. Balloon angioplasty also has limitations including transient occlusion of the spastic blood vessel, possible endothelial injury, and limited access to proximal vessels. We aim to demonstrate a novel technique using a stent retriever for the management of medically refractory vasospasm, especially in distal vessels. Compared with balloon angioplasty, stent retrievers provide a passive, self-limiting expansion of blood vessels. Other benefits over balloon angioplasty include 1) ability to simultaneously inject IA vasodilators, 2) limited contact and damage to vessel wall, 3) nonocclusive expansion, and 4) technical ease. METHODS: Fourteen blood vessels from 6 patients with symptomatic vasospasm after subarachnoid hemorrhage were identified. We injected 5 mg of IA vasodilator medication into the vasospastic segments without radiographic improvement in vessel diameter and blood flow. The stent retriever was deployed for 2-5 minutes in each vasospastic segment. RESULTS: Distal anterior and posterior circulation segments were easily accessible with the stent retriever system. It resulted in improved vessel diameter and blood flow with subsequent improvement in neurologic examination. All patients demonstrated radiographic resolution of vasospasm. No procedural-related complications were noted. CONCLUSIONS: We demonstrate the safety and efficacy of a novel technique for the treatment of medically refractory cerebral vasospasm using stent retriever angioplasty in distal vessels. Stent angioplasty can be used as an additional tool in the management of subarachnoid hemorrhage-induced cerebral vasospasm.


Assuntos
Angioplastia com Balão/métodos , Stents , Vasoespasmo Intracraniano/cirurgia , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/métodos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/complicações , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia
8.
Acta Neurochir Suppl ; 127: 15-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407057

RESUMO

Aneurysmal subarachnoid hemorrhage (aSAH) remains a significant cause of stroke disability despite gradual reductions in physical morbidity and mortality. Heparin is an effective anti-inflammatory agent and may potentially prevent delayed neurological injury in the days to weeks after the hemorrhage. Various human studies have shown the safety of a continuous infusion of low-dose unfractionated heparin in the setting of subarachnoid hemorrhage as well as its efficacy in minimizing delayed neurological deficits including symptomatic cerebral vasospasm, vasospasm-related infarction, and cognitive dysfunction. Studies have also shown mixed results with low-molecular-weight heparin usage in this patient population. Heparin treatment is not associated with significant hemorrhagic complications; however, vigilance is essential for early detection of heparin-induced thrombocytopenia in order to prevent devastating sequelae. Multicenter randomized controlled trials are necessary for objective characterization of the effects of heparin.


Assuntos
Anticoagulantes , Heparina , Acidente Vascular Cerebral , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Humanos , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/tratamento farmacológico , Vasoespasmo Intracraniano/tratamento farmacológico
9.
Acta Neurochir Suppl ; 127: 21-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407058

RESUMO

Epilepsy is a significant worldwide public health problem that leads to reduced quality of life and negative psychosocial consequences and significantly increases mortality rates in those who are affected. The development of epilepsy from subarachnoid hemorrhage (SAH) has an important negative impact on long-term survival, functional status, and cognitive recovery in patients following aneurysmal rupture. Anticonvulsant medication (AED) administration to prevent the development of epilepsy following SAH is controversial, and studies to date have not shown effectiveness of AED use as prophylaxis. This paper reviews the pathophysiology of SAH in the development of epilepsy, the scope of the problem of epilepsy related to SAH, and the studies that have evaluated AED administration as prophylaxis for seizures and epilepsy.


Assuntos
Epilepsia , Hemorragia Subaracnóidea , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/etiologia , Humanos , Qualidade de Vida , Convulsões , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia
10.
Acta Neurochir Suppl ; 127: 55-58, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407063

RESUMO

Vasospasm after subarachnoid hemorrhage (SAH) has been studied, but the mechanisms remain to be unveiled. Tenascin-C (TNC), which is a matricellular protein and reported to increase in spastic cerebral artery wall after SAH, is a ligand for both Toll-like receptor 4 (TLR4) and epidermal growth factor receptor (EGFR). Our previous studies suggested the involvement of TNC and these receptors in vasoconstriction or vasospasm after SAH. In this study, we investigated whether upregulation of TNC and TLR4 is observed and if an EGFR inhibitor has suppressive effects against them in a mice endovascular perforation SAH model. At 24 h after SAH, TNC and TLR4 expressions were widely observed in spastic cerebral arteries, and these expressions were suppressed by the administration of an EGFR inhibitor. From these results, EGFR inhibitors possibly suppress the expression of not only EGFR but also TLR4 at least partly through regulating TNC upregulation. More studies are needed to clarify the precise mechanisms linking these receptors.


Assuntos
Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Animais , Camundongos , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/complicações , Tenascina , Vasoconstrição , Vasoespasmo Intracraniano/etiologia
11.
Acta Neurochir Suppl ; 127: 121-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407072

RESUMO

Subarachnoid hemorrhage (SAH) is a devastating stroke type. Approximately 50% of survivors suffer from the permanent disability, caused by the cognitive deficits. To enrich the pre-clinical research on the neurological deficits after SAH, we investigate the temporal cognitive deficits and the longitudinal course of cognitive recovery in endovascular perforation SAH murine model. The SAH mice show reproducible body weakness and headache-symbolized moaning symptoms, which is closed to clinical patients. SAH mice exhibit significantly impaired cognitive function in domains of learning ability, short-term and long-term memory. The cognitive deficits occur mostly in the early phase and recover gradually till day 10 after SAH. The systematical assessments of cognitive function after experimental aneurysmal SAH elucidate the time course of cognitive deficits and provide the time window of potential interventions.


Assuntos
Disfunção Cognitiva , Hemorragia Subaracnóidea , Animais , Cognição , Disfunção Cognitiva/etiologia , Cefaleia , Humanos , Camundongos , Hemorragia Subaracnóidea/complicações
12.
Acta Neurochir Suppl ; 127: 127-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407073

RESUMO

BACKGROUND: Because treatments for cerebral arterial spasm-a delayed consequence of subarachnoid hemorrhage (SAH)-are clinically inconsistent, we describe here a new method for reversal of arterial spasm, possibly extensible to nitric oxide (NO)-sensitive microvasculature. METHODS: We subjected dogs to the intracisternal double-hemorrhage model of SAH (autologous blood injection on days 1 and 3) and began endovascular treatment of the spasmed basilar artery (BA) on Day 4. A conical-tip fused silica optical fiber was introduced via a microcatheter (inserted femorally) into the proximal vicinity of the spasmed BA. After local saline flushing of blood, an ultraviolet (UV) pulsed laser beam (355 nm Nd:YAG) was focused into the optical fiber and converted into a concentric ring beam, which facilitated endovascular irradiation for 30 s at intensities of 12-20 W/cm2. BA diameters were measured angiographically using a semiautomated routine over the entire BA length as well as the proximal, medial, and distal segments. RESULTS: On Day 4 the BAs had constricted by 21 ± 11%. After UV laser irradiation on Day 4, the constricted BAs dilated to 93 ± 15% of their normal diameters within minutes, and the dilation (91 ± 12%) persisted on Day 5. Most BA segments recovered to their respective baselines after UV irradiation, even when the UV beam was located considerably proximal to the BA origin. At days 4 and 5, the percent BA dilation normalized to Day 4 pre-treatment decreased linearly (by scatter plot, p < 0.02) over a range of about 60 mm from the UV irradiation site. CONCLUSIONS: We conjecture that the vasodilator nitric oxide, produced at high local concentration from its vascular storage forms (chiefly nitrites) by UV laser-induced photoscission, stimulates a wave of arterial dilation, possibly by longitudinal propagation of transnitrosation reactions in the arterial wall, which reverses cerebral vasospasm semi-locally and thus avoids the deleterious effects of systemic treatment.


Assuntos
Terapia a Laser , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Animais , Artéria Basilar , Cães , Espasmo , Hemorragia Subaracnóidea/complicações , Raios Ultravioleta , Vasoconstrição , Vasoespasmo Intracraniano/etnologia , Vasoespasmo Intracraniano/terapia
13.
Acta Neurochir Suppl ; 127: 141-144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407074

RESUMO

BACKGROUND: Detection of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) in patients with a poor clinical exam is challenging. Brain tissue oxygen tension monitoring (PbtO2) and cerebral microdialysis (CMD) can detect ischemia and metabolic derangements. Our aim was to evaluate efficacy of these modalities in real-time detection of DCI. METHODS: All patients with aSAH who underwent with multimodality monitoring (MMM) with PbtO2 and/or CMD between the years of 2013 and 2015 at our institution were retrospectively studied. Mean PbTO2, lactate to pyruvate ratio (LPR), and glucose over the 24-h period prior to each angiogram for evaluation and treatment of vasospasm were correlated to the extent of vasospasm observed in the hemisphere with the monitors. The average measurements were also compared in the setting of presence and absence of angiographically significant vasospasm. RESULTS: A total of ten patients with aSAH who underwent MMM were identified. PbtO2 decline correlates with severity of proximal vasospasm (r = -0.66). PbtO2 was significantly lower in the setting of vasospasm (17.6 vs. 25.8, p = 0.003), but LPR (34.5 vs. 26.8, p = 0.1) and glucose (0.8 vs. 1.1, p = 0.6) were not significantly different. CONCLUSION: Proximal vasospasm after aSAH is associated with MMM indicator of tissue ischemia and/or metabolic derangement. PbtO2 and CMD help in real-time detection and management of DCI.


Assuntos
Isquemia Encefálica , Testes Imediatos , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Humanos , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/diagnóstico , Vasoespasmo Intracraniano/etiologia
14.
Acta Neurochir Suppl ; 127: 175-178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407081

RESUMO

Five frontal systems circuits connect with the basal ganglia and other structures to control and regulate thinking and behavior. Subarachnoid hemorrhage and stroke following anterior circulation aneurysms typically disrupt these circuits, sometimes markedly affecting a patient's function. This article reviews the primary pathways and associated brain functions. The principles of cognitively and behaviorally rehabilitating these functions are also discussed by creating external structure and building on what the brain is still capable of doing.


Assuntos
Transtornos Cognitivos , Acidente Vascular Cerebral , Hemorragia Subaracnóidea , Gânglios da Base , Encéfalo , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/reabilitação , Humanos , Acidente Vascular Cerebral/complicações , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/reabilitação
16.
Neurology ; 93(23): e2105-e2109, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31719131

RESUMO

OBJECTIVE: Two recent hospital-based studies have reported that both smoking and hypertension-the 2 most important risk factors for aneurysmal subarachnoid hemorrhage (aSAH)-may improve survival after aSAH. We tested the hypothesis that a higher case fatality among smokers and hypertensive individuals after aSAH contributes to these paradoxical findings. METHODS: We followed 65,521 population-based FINRISK participants during 1.52 million person-years and identified 445 first-ever hospitalized aSAHs and 98 sudden-death aSAHs occurring between 1974 and 2014. We measured risk factors prior to disease onset in the cohort surveys, and confirmed, among all sudden-death aSAHs, 80% by extensive (including the brain) forensic autopsy; the remaining 20% were based on clinical examination (CT of the head, spinal tap, or both). The Cox proportional hazards model estimated survival curves. RESULTS: Analyses repeating the protocol of the 2 recent hospital-based studies again showed improved survival among smokers and those with hypertension. Conversely, in analyses including more accurate risk factor measurements and including patients with sudden-death aSAH who never reached a hospital, these paradoxical results were reversed. Smokers had reduced survival compared to that of never-smokers (p = 0.04), and those with high systolic blood pressure (SBP) (≥160 mm Hg) had reduced survival when compared to survival of those with SBP <160 mm Hg (p = 0.05). CONCLUSIONS: After aSAH, smoking and hypertension were associated with worse survival. The earlier and opposite findings are likely explained by inadequate risk factor measurement and by survival bias inherent to hospital-based risk factor studies lacking information on out-of-hospital deaths confirmed by autopsy.


Assuntos
Hipertensão/complicações , Fumar/efeitos adversos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/mortalidade , Adulto , Idoso , Viés , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artigo em Holandês | MEDLINE | ID: mdl-31556498

RESUMO

Subarachnoid haemorrhages (SAH) are acute life-threatening events that are frequently misdiagnosed. 4% of patients with SAH do not have the typical acute intense headaches, but present with other symptoms. Misdiagnosis leads to treatment delays and, consequently, higher morbidity and mortality. We describe two patients with atypical symptoms after SAH and delay in diagnosis. The first patient came to the emergency room with cervical, back and radicular pain that spread to both legs. An acute headache had started 11 days earlier. Physical examination showed signs of meningeal irritation. A cerebral CT scan revealed a subarachnoid haemorrhage. The second patient came to the outpatient clinic with pain in his lower back, apathy, apraxia and unsteady gait after an acute headache had started nine days before. When the patient visited our outpatient clinic, the headache had disappeared. A cerebral CT scan nevertheless revealed a subarachnoid haemorrhage. When diagnosing SAH, it is important not to miss the acute headache in the history, even though this headache may no longer be present at the time of presentation.


Assuntos
Dor nas Costas/etiologia , Cefaleia/etiologia , Neuralgia/etiologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Idoso , Apatia , Apraxias/etiologia , Diagnóstico Tardio , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Exame Físico , Tempo para o Tratamento , Tomografia Computadorizada por Raios X
20.
Folia Neuropathol ; 57(2): 182-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31556577

RESUMO

INTRODUCTION: Hydrocephalus is a common complication of subarachnoid haemorrhage (SAH). As transmembrane water channels, aquaporins 1 and 4 (AQP1 and AQP4) are involved in the pathogenesis of hydrocephalus. We aimed to assess the association between the expressions of AQP1 and AQP4 and the severity and duration of hydrocephalus after SAH. MATERIAL AND METHODS: A double haemorrhage model by injection of autologous blood into the cisterna magna was used to induce SAH in rats. Sham rats received the same procedures, but with the injection of normal saline. The SAH group was divided into the SAH with hydrocephalus group and SAH without hydrocephalus group after identifying hydrocephalus histologically. AQP1 and AQP4 in ventricle regions were detected by immunofluorescence, quantitative polymerase chain reaction (qPCR) and western blot. RESULTS: Hydrocephalus was the most severe at day 3 after SAH. AQP1 and AQP4 mRNA and protein levels increased at day 1 and peaked at day 3. The SAH with hydrocephalus group had a higher expression of AQP1 and AQP4 than the SAH without hydrocephalus group. Higher AQP1 levels were found at the apical and basolateral membrane of the choroid plexus epithelium, while higher AQP4 levels were found in the ependymal cells. A positive correlation between the relative lateral ventricle area and the ratio of AQP1/AQP4 proteins was identified. CONCLUSIONS: AQP1 and AQP4 are remarkably correlated with the severity of hydrocephalus induced by SAH. AQP1 and AQP4 are potential drug targets for developing therapeutic strategies against hydrocephalus.


Assuntos
Aquaporina 1/metabolismo , Aquaporina 4/metabolismo , Encéfalo/metabolismo , Hidrocefalia/metabolismo , Hemorragia Subaracnóidea/metabolismo , Animais , Modelos Animais de Doenças , Hidrocefalia/etiologia , Masculino , Ratos , Ratos Sprague-Dawley , Hemorragia Subaracnóidea/complicações
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