RESUMO
Background and Purpose- Preterm neonates with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus and poor neurological outcomes. Iron has been implicated in ventriculomegaly, hippocampal injury, and poor outcomes following IVH. We hypothesized that levels of cerebrospinal fluid blood breakdown products and endogenous iron clearance proteins in neonates with IVH differ from those of neonates with IVH who subsequently develop posthemorrhagic hydrocephalus. Methods- Premature neonates with an estimated gestational age at birth <30 weeks who underwent lumbar puncture for clinical evaluation an average of 2 weeks after birth were evaluated. Groups consisted of controls (n=16), low-grade IVH (grades I-II; n=4), high-grade IVH (grades III-IV; n=6), and posthemorrhagic hydrocephalus (n=9). Control subjects were preterm neonates born at <30 weeks' gestation without brain abnormality or hemorrhage on cranial ultrasound, who underwent lumbar puncture for clinical purposes. Cerebrospinal fluid hemoglobin, total bilirubin, total iron, ferritin, ceruloplasmin, transferrin, haptoglobin, and hemopexin were quantified. Results- Cerebrospinal fluid hemoglobin levels were increased in posthemorrhagic hydrocephalus compared with high-grade IVH (9.45 versus 6.06 µg/mL, P<0.05) and cerebrospinal fluid ferritin levels were increased in posthemorrhagic hydrocephalus compared with controls (511.33 versus 67.08, P<0.01). No significant group differences existed for the other cerebrospinal fluid blood breakdown and iron-handling proteins tested. We observed positive correlations between ventricular enlargement (frontal occipital horn ratio) and ferritin (Pearson r=0.67), hemoglobin (Pearson r=0.68), and total bilirubin (Pearson r=0.69). Conclusions- Neonates with posthemorrhagic hydrocephalus had significantly higher levels of hemoglobin than those with high-grade IVH. Levels of blood breakdown products, hemoglobin, ferritin, and bilirubin correlated with ventricular size. There was no elevation of several iron-scavenging proteins in cerebrospinal fluid in neonates with posthemorrhagic hydrocpehalus, indicative of posthemorrhagic hydrocephalus as a disease state occurring when endogenous iron clearance mechanisms are overwhelmed.
Assuntos
Hemorragia Cerebral , Hidrocefalia , Recém-Nascido Prematuro , Hemorragia Cerebral/sangue , Hemorragia Cerebral/líquido cefalorraquidiano , Hemorragia Cerebral/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/diagnóstico por imagem , Recém-Nascido , Recém-Nascido Prematuro/sangue , Recém-Nascido Prematuro/líquido cefalorraquidiano , Masculino , UltrassonografiaRESUMO
BACKGROUND: Transplant failure requires the consideration of numerous potential causes including rejection, acute tubular necrosis, infection, and recurrence of the original kidney disease. Kidney biopsy is generally required to approach these differential diagnoses. However, the histopathological findings on their own do not always lead to a definite diagnosis. Consequently, it is crucial to integrate them with clinical findings and patient history when discussing histopathological patterns of injury. The histopathologic finding of a membranoproliferative glomerulonephritis (MPGN) is one of the most challenging constellations since it does not refer to a specific disease entity but rather reflects a pattern of injury that is the result of many different causes. Whilst MPGN is occasionally classified as immune complex mediated, careful evaluation usually reveals an underlying disorder such as chronic infection, plasma cell dyscrasia, complement disorders, and autoimmune disease. CASE PRESENTATION: We describe the case of a 43-year-old woman who was referred to us because of a slowly rising serum creatinine 4 years after kidney transplantation. As in the native kidney, the biopsy revealed an MPGN pattern of injury. The cause of this finding had not been established prior to transplantation leading to a classification as idiopathic MPGN in the past. Further workup at the time of presentation and allograft failure revealed chronic infection of a ventriculoatrial shunt as the most probable cause. CONCLUSION: This case underlines the fact that MPGN is not a disease but a histopathological description. Consequently, the causative disorder needs to be identified to avoid kidney failure and recurrence after transplantation.
Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Glomerulonefrite Membranoproliferativa/etiologia , Transplante de Rim , Complicações Pós-Operatórias/etiologia , Infecções Estafilocócicas/complicações , Adulto , Biópsia , Creatinina/sangue , Feminino , Glomerulonefrite Membranoproliferativa/sangue , Glomerulonefrite Membranoproliferativa/patologia , Humanos , Hidrocefalia/sangue , Hidrocefalia/cirurgia , Rim/patologia , Recidiva , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis , Staphylococcus hominis , Derivação VentriculoperitonealRESUMO
PURPOSE: The aim of the study was to evaluate established risk factors and define new inflammation-associated factors associated with postoperative ventriculoperitoneal shunt placement. METHODS: The electronic medical records of children who underwent surgery for a tumor in the posterior fossa between January 2009 and January 2018 were retrospectively analyzed. Factors evaluated include age, clinical symptoms, tumor type, extent of surgical tumor resection, treatment with EVD and/or ETV, radiological findings, postoperative serum CRP, and leucocyte levels. Tumor tissue was stained immunohistochemically with antibodies against CD3, and leucocyte counts were performed. Patients with pre- or postoperative signs of infection or confirmation of a concurrent infection were excluded from some analyses. RESULTS: Seventy patients ages 0.4-20.8 years (median, 8.2) were included. Forty-five of 70 (65.3%) presented postoperative radiological signs of hydrocephalus. Fifteen of 70 (21.4%) patients required shunt placement postoperatively. Shunt placement was significantly associated with age < 3 years at diagnosis (p = 0.013), perioperative EVD placement (p < 0.001), signs of hydrocephalus in postoperative imaging (p = 0.047), a frontooccipital horn ratio (FOHR) > 0.46 within the first 72 h postoperatively (p < 0.001), and the presence of intraventricular blood postoperatively (p = 0.007). Six patients who underwent shunting had serum CRP levels > 40 mg/l (p = 0.030) within the first 48 h postoperatively. Tumor type or extent of resection did not correlate with shunt placement. CONCLUSIONS: Several established and new factors associated with shunt placement after posterior fossa tumor surgery could be identified. Additional studies are needed to explore the aseptic inflammation pathways involved with increased CRP levels and shunt placement.
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Neoplasias Infratentoriais/diagnóstico por imagem , Neoplasias Infratentoriais/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Derivação Ventriculoperitoneal/tendências , Adolescente , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Lactente , Neoplasias Infratentoriais/sangue , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Derivação Ventriculoperitoneal/efeitos adversos , Adulto JovemRESUMO
Background: Tuberculous meningitis (TBM) leads to death or disability in half the affected individuals. Tools to assess severity and predict outcome are lacking. Neurospecific biomarkers could serve as markers of the severity and evolution of brain injury, but have not been widely explored in TBM. We examined biomarkers of neurological injury (neuromarkers) and inflammation in pediatric TBM and their association with outcome. Methods: Blood and cerebrospinal fluid (CSF) of children with TBM and hydrocephalus taken on admission and over 3 weeks were analyzed for the neuromarkers S100B, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), in addition to multiple inflammatory markers. Results were compared with 2 control groups: patients with (1) a fatty filum (abnormal filum terminale of the spinal cord); and (2) pulmonary tuberculosis (PTB). Imaging was conducted on admission and at 3 weeks. Outcome was assessed at 6 months. Results: Data were collected from 44 patients with TBM (cases; median age, 3.3 [min-max 0.3-13.1] years), 11 fatty filum controls (median age, 2.8 [min-max 0.8-8] years) and 9 PTB controls (median age, 3.7 [min-max 1.3-11.8] years). Seven cases (16%) died and 16 (36%) had disabilities. Neuromarkers and inflammatory markers were elevated in CSF on admission and for up to 3 weeks, but not in serum. Initial and highest concentrations in week 1 of S100B and NSE were associated with poor outcome, as were highest concentration overall and an increasing profile over time in S100B, NSE, and GFAP. Combined neuromarker concentrations increased over time in patients who died, whereas inflammatory markers decreased. Cerebral infarcts were associated with highest overall neuromarker concentrations and an increasing profile over time. Tuberculomas were associated with elevated interleukin (IL) 12p40, interferon-inducible protein 10, and monocyte chemoattractant protein 1 concentrations, whereas infarcts were associated with elevated tumor necrosis factor α, macrophage inflammatory protein 1α, IL-6, and IL-8. Conclusions: CSF neuromarkers are promising biomarkers of injury severity and are predictive of mortality. An increasing trend suggested ongoing brain injury, even though markers of inflammation declined with treatment. These findings could offer novel insight into the pathophysiology of TBM.
Assuntos
Biomarcadores , Infarto Cerebral , Hidrocefalia , Inflamação , Tuberculose Meníngea , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Infarto Cerebral/sangue , Infarto Cerebral/líquido cefalorraquidiano , Infarto Cerebral/microbiologia , Pré-Escolar , Feminino , Proteína Glial Fibrilar Ácida/sangue , Proteína Glial Fibrilar Ácida/líquido cefalorraquidiano , Humanos , Hidrocefalia/sangue , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/microbiologia , Lactente , Recém-Nascido , Inflamação/sangue , Inflamação/líquido cefalorraquidiano , Inflamação/microbiologia , Masculino , Fosfopiruvato Hidratase/sangue , Fosfopiruvato Hidratase/líquido cefalorraquidiano , Estudos Prospectivos , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/líquido cefalorraquidiano , Tuberculose Meníngea/sangue , Tuberculose Meníngea/líquido cefalorraquidiano , Tuberculose Meníngea/complicações , Tuberculose Meníngea/epidemiologiaRESUMO
OBJECTIVE/AIM: The aim of this report was to investigate the effect of ventriculoperitoneal shunt insertion for the treatment of hydrocephalus on thyroid hormones in the first 3 months of life. METHODS: Thyroid-stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) levels were compared at 7 days (preoperatively) and at 30 and 90 days (postoperatively) after birth between 25 ventriculoperitoneal shunt-inserted hydrocephalic newborns and 20 healthy newborns. RESULTS: The TSH level at 7 days was higher in the hydrocephalic patient group (6.33 µIU) compared to the control group (3.76 µIU). This value was significantly decreased at 90 days in the ventriculoperitoneal shunt-inserted newborns (2.35 µIU) compared to the control group (3.33 µIU; p < 0.05). There were no significant differences between time points for fT4 and fT3 values in the patient group or for TSH, fT4, and fT3 values in the control group. CONCLUSION: We propose that a ventriculoperitoneal shunt inserted in the early period of life may have beneficial effects on thyroid hormones.
Assuntos
Hidrocefalia/sangue , Hidrocefalia/cirurgia , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Derivação Ventriculoperitoneal/tendências , Feminino , Seguimentos , Humanos , Hidrocefalia/diagnóstico , Lactente , Recém-Nascido , Masculino , Hormônios Tireóideos/sangueRESUMO
OBJECTIVE: This study aimed to determine the reliability and potential application of cerebral regional tissue oxygenation (rSO2) monitoring in malfunctioning ventricular shunts during tap. METHODS: This is a prospective case series using convenience sample in subjects with confirmed malfunctioning shunt who had left and right cerebral rSO2 monitoring every 5 seconds before, during, and 1 hour after shunt tap. RESULTS: Ninety-four subjects had cerebral rSO2 monitoring. Sixty-three subjects had proximal malfunctions, and 31 subjects had distal shunt malfunctions. The intrasubject's cerebral rSO2 trend and variability at pretap, during, and posttap times were highly correlated. Overall, the average rSO2 is lower in pretap as compared with posttap. Left cerebral rSO2 had lower means and larger SD as compared with right cerebral rSO2. Left pretap and posttap cerebral rSO2 variability was significantly associated with the location of shunt malfunction regardless of pretap, during, or posttap periods (P < 0.001), whereas right rSO2 variability was not predictive for malfunction location. Left cerebral rSO2 variability showed utility for identifying the location of malfunction with area under the receiver operating characteristic curve equal to 0.8. CONCLUSIONS: Reliable cerebral rSO2 readings before, during, and after shunt tap were demonstrated. Left cerebral rSO2 changes from before to after shunt tap were more predictive for shunt malfunction location than right cerebral rSO2 changes. Observing cerebral rSO2 changes in relationship to shunt tap represents a potential surrogate in measuring cerebral pressures and blood flow changes after cerebral spinal fluid drainage. Significantly greater cerebral rSO2 changes occur for distal malfunction versus proximal malfunction after shunt tap, indicating its potential as an adjunct tool for detecting shunt malfunction type.
Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hidrocefalia/sangue , Monitorização Fisiológica/métodos , Oxigênio/sangue , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Humanos , Hidrocefalia/cirurgia , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Espectroscopia de Luz Próxima ao InfravermelhoRESUMO
BACKGROUND: The serum calcium plays a role as a cofactor in critical steps such as cardiac contractility, vascular tone, and the coagulation cascade. This study aimed to determine if the level of ionized calcium can predict outcomes in patients with spontaneous subarachnoid hemorrhage (SAH) in the emergency department. METHODS: The study was a retrospective cross-sectional case series. Patients aged 18 and over diagnosed with spontaneous SAH in the emergency department were included in the study. Patients' demographic characteristics, comorbidities, vital signs, laboratory parameters, World Federation of Neurosurgical Societies score, SAH grading according to the Fisher scale, needs of mechanical ventilation and inotropic treatment, administered treatments, complications, Rankin scores at discharge, and outcome were recorded in a standard data form. RESULTS: A total of 267 patients were studied, with a mean age of 55.5 ± 13.4 years, and 53.9% (n = 144) were female. Hydrocephalus was present in 16.5% of patients. The average hospital stay was 20.4 ± 19.8 days. Mortality rate was 34.8% (n = 93). Mortality was significantly higher in patients with low calcium levels upon admission (P = 0.024). Ionized calcium levels during complication development independently predicted mortality (OR: 0.945, 95% CI: 0.898-0.996, P = 0.034). Patients with poor neurologic outcomes (Rankin: 3-6) had significantly lower initial ionized calcium levels (P = 0.002). CONCLUSIONS: The ionized calcium level is a readily accessible blood gas parameter that assists clinicians in predicting functional independence and mortality at discharge in patients presenting to the emergency department with spontaneous SAH.
Assuntos
Cálcio , Hemorragia Subaracnóidea , Humanos , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Transversais , Adulto , Prognóstico , Cálcio/sangue , Idoso , Hidrocefalia/sangue , Hidrocefalia/etiologiaRESUMO
BACKGROUND: Neurofilament light chain (NfL) is released into the peripheral circulation by damaged axons. OBJECTIVES: To evaluate the diagnostic value of serum NfL concentration in dogs with intracranial diseases. ANIMALS: Study included 37 healthy dogs, 31 dogs with idiopathic epilepsy (IE), 45 dogs with meningoencephalitis of unknown etiology (MUE), 20 dogs with hydrocephalus, and 19 dogs with brain tumors. METHODS: Cohort study. Serum NfL concentrations were measured in all dogs using single-molecule array technology. RESULTS: Serum NfL concentration in dogs with each structural disease was significantly higher than in healthy dogs and dogs with IE (P = .01). The area under the receiver operating characteristic curve of NfL for differentiating between dogs with structural diseases and IE was 0.868. An optimal cutoff value of the NfL 27.10 pg/mL had a sensitivity of 86.67% and a specificity of 74.19% to differentiate the dogs with IE from those with structural brain diseases. There were significant correlations between NfL concentrations and lesion size: (1) MUE, P = .01, r = 0.429; (2) hydrocephalus, P = .01, r = 0.563. CONCLUSIONS AND CLINICAL IMPORTANCE: Serum NfL could be a useful biomarker for distinguishing IE from structural diseases in dogs and predicting the lesion sizes of MUE and hydrocephalus.
Assuntos
Biomarcadores , Doenças do Cão , Proteínas de Neurofilamentos , Animais , Cães , Doenças do Cão/sangue , Doenças do Cão/diagnóstico , Proteínas de Neurofilamentos/sangue , Feminino , Masculino , Biomarcadores/sangue , Hidrocefalia/veterinária , Hidrocefalia/sangue , Hidrocefalia/diagnóstico , Encefalopatias/veterinária , Encefalopatias/sangue , Encefalopatias/diagnóstico , Epilepsia/veterinária , Epilepsia/sangue , Epilepsia/diagnóstico , Meningoencefalite/veterinária , Meningoencefalite/sangue , Meningoencefalite/diagnóstico , Neoplasias Encefálicas/veterinária , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/diagnóstico , Sensibilidade e Especificidade , Estudos de Coortes , Estudos de Casos e ControlesRESUMO
BACKGROUND: Congenital hydrocephalus is a condition characterized by accumulation of cerebrospinal fluid in the ventricles of the brain. Prenatal infections are risk factors for some birth defects. This pilot study investigated whether residual dried blood spots (DBS) could be used to assess infections as risk factors for birth defects by examining the associations between prenatal infection with Toxoplasma gondii (T. gondii) or cytomegalovirus (CMV) with congenital hydrocephalus. METHODS: Case-infants with hydrocephalus (N=410) were identified among live-born infants using birth defects surveillance systems in California, North Carolina, and Texas. Control-infants without birth defects were randomly selected from the same geographic areas and time periods as case-infants (N=448). We tested residual DBS from case- and control-infants for T. gondii immunoglobulin M and CMV DNA. When possible, we calculated crude odds ratios (cORs) and confidence intervals (CIs). RESULTS: Evidence for prenatal T. gondii infection was more common among case-infants (1.2%) than control-infants (0%; p=0.11), and evidence for prenatal CMV infection was higher among case-infants (1.5%) than control-infants (0.7%; cOR: 2.3; 95% CI: 0.48, 13.99). CONCLUSIONS: Prenatal infections with T. gondii and CMV occurred more often among infants with congenital hydrocephalus than control-infants, although differences were not statistically significant. This pilot study highlighted some challenges in using DBS to examine associations between certain infections and birth defects, particularly related to reduced sensitivity and specimen storage conditions. Further study with increased numbers of specimens and higher quality specimens should be considered to understand better the contribution of these infections to the occurrence of congenital hydrocephalus.
Assuntos
Infecções por Citomegalovirus/sangue , Citomegalovirus , Teste em Amostras de Sangue Seco/métodos , Hidrocefalia , Toxoplasma , Toxoplasmose Congênita/sangue , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/congênito , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/etiologia , Hidrocefalia/parasitologia , Hidrocefalia/virologia , Recém-Nascido , Masculino , Estudos Retrospectivos , Toxoplasmose Congênita/complicações , Toxoplasmose Congênita/virologiaRESUMO
BACKGROUND: Shedding light on less-known aspects of intracranial fluid dynamics may be helpful to understand the hydrocephalus mechanism. The present study suggests a mathematical framework based on in vivo inputs to compare the dynamic interaction of pulsatile blood, brain, and cerebrospinal fluid (CSF) between the healthy subject and the hydrocephalus patient. METHOD: The input data for the mathematical formulations was pulsatile blood velocity, which was measured using cine PC-MRI. Tube law was used to transfer the created deformation by blood pulsation in the vessel circumference to the brain domain. The pulsatile deformation of brain tissue with respect to time was calculated and considered to be inlet velocity in the CSF domain. The governing equations in all three domains were continuity, Navier-Stokes, and concentration. We used Darcy law with defined permeability and diffusivity values to define the material properties in the brain. RESULTS: We validated the preciseness of the CSF velocity and pressure through the mathematical formulations with cine PC-MRI velocity, experimental ICP, and FSI simulated velocity and pressure. We used the analysis of dimensionless numbers including Reynolds, Womersley, Hartmann, and Peclet to evaluate the characteristics of the intracranial fluid flow. In the mid-systole phase of a cardiac cycle, CSF velocity had the maximum value and CSF pressure had the minimum value. The maximum and amplitude of CSF pressure, as well as CSF stroke volume, were calculated and compared between the healthy subject and the hydrocephalus patient. CONCLUSION: The present in vivo-based mathematical framework has the potential to gain insight into the less-known points in the physiological function of intracranial fluid dynamics and the hydrocephalus mechanism.
Assuntos
Encéfalo , Hidrodinâmica , Humanos , Encéfalo/fisiologia , Hidrocefalia/sangue , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/diagnóstico por imagem , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/líquido cefalorraquidianoRESUMO
BACKGROUND: Cerebral vasospasm (CVS) and cerebral infarction due to vasospasm (CIV) are major complications after spontaneous subarachnoid hemorrhage (SAH). Alteration of vasomotor tone has been postulated as an important factor in the pathogenesis of CVS. Members of the transforming growth factor-ß (TGF-ß) family and their receptors have been implicated in the regulation of vascular tone. METHODS: Serum levels of soluble endoglin (sEng) and plasma levels of TGF-ß(1) of 20 consecutive SAH patients were analyzed within 15 days after SAH using ELISA and correlated with CVS, CIV and outcome. Twenty voluntary age- and sex-matched blood donors served as healthy controls (HCs). RESULTS: SAH patients showed significantly lower sEng serum levels and higher TGF-ß(1) plasma levels compared to HCs. Patients who developed Doppler sonographic CVS (dCVS) had significantly higher TGF-ß(1) levels. Patients with CIV and patients with hydrocephalus showed significantly lower sEng levels. On day 3, pSAH sEng levels below 3.88 ng/ml or TGF-ß(1) levels higher than 7.2 ng/ml had a predictive value for the development of CIV. Low mean sEng levels over the study period were highly predictive of poor long-term functional outcome (modified Rankin Scale ≥2) at 6 months after SAH. CONCLUSIONS: Concentrations of the vasoactive factors sEng in serum and TGF-ß(1) in plasma are significantly altered in SAH patients compared to HCs. The results of this pilot study indicate that sEng could represent a novel prognostic biomarker for the onset of secondary complications and long-term functional outcome after SAH.
Assuntos
Antígenos CD/sangue , Receptores de Superfície Celular/sangue , Hemorragia Subaracnóidea/complicações , Fator de Crescimento Transformador beta1/sangue , Vasoespasmo Intracraniano/etiologia , Adulto , Idoso , Análise de Variância , Áustria , Estudos de Casos e Controles , Endoglina , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/etiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Prospectivos , Hemorragia Subaracnóidea/sangue , Fatores de Tempo , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/sangue , Vasoespasmo Intracraniano/diagnóstico por imagemRESUMO
OBJECTIVE: To evaluate if type 2 diabetes mellitus (DM) constitutes a prognostic factor for death and severe disability in patients with aneurysm clipping after subarachnoid hemorrhage (ASH), in an Intensive Care Unit (ICU). MATERIAL AND METHODS: This is a cohort study in patients who were admitted to the ICU between December-2009 and June-2010; 20 with DM (exposed group) and 40 without DM (non-exposed group). Mortality was quantified during ICU stay. At ICU discharge, severe disability was measured through the Glasgow Outcome Scale (category 2); and Glasgow Coma Scale was used to estimate the difference in consciousness level between ICU arrival and discharge. Descriptive statistics and Kaplan Meier survival curves were performed. RESULTS: Mean age was similar between groups (55.8 +/- 11 and 55.6 +/- 15 years, respectively, p = 0.40). A vegetative state was present in one patient without DM. The Glasgow Coma Scale score at ICU entry was 14.1 +/- 1.4 and at discharge, 12.0 +/- 3.6 in the exposed group (p = 0.01); and 13.9 +/- 2.0 us. 13.5 +/- 2.6, in the non-exposed group, respectively (p = 0.45). There were 3 deaths in patients with DM and 5, in patients without DM (p > 0.05); survival time was 12 (95%CI 7, 16) and 10 days (95%CI 7, 13), respectively. Mean glucose remained higher in patients who died at the ICU (p < 0.001). Hydrocephaly was present in 6 exposed patients and 2, non-exposed (p = 0.007). Additionally, 7 and 5 with and without DM, respectively registered a positive blood culture (p = 0.04). CONCLUSIONS: DM was not associated with higher mortality in ICU patients, but hyperglycemia was; thus, it is essential that the intensive care provider watches closely the glycemic control.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Mortalidade Hospitalar , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Idoso , Bacteriemia/complicações , Bacteriemia/epidemiologia , Glicemia/análise , Dano Encefálico Crônico/sangue , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Feminino , Escala de Coma de Glasgow , Humanos , Hidrocefalia/sangue , Hidrocefalia/epidemiologia , Hidrocefalia/etiologia , Hiperglicemia/epidemiologia , Hiperglicemia/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/complicações , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/sangue , Estado Vegetativo Persistente/epidemiologia , Estado Vegetativo Persistente/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/complicaçõesRESUMO
BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) pathophysiology involves neurovascular proteolysis and inflammation. How these 2 phenomena are related remains unclear. We hypothesize that matrix metalloproteinases (MMPs) mediate the depletion of anti-inflammatory plasma-type gelsolin (pGSN). METHODS: We enrolled 42 consecutive SAH subjects and sampled cerebrospinal fluid (CSF) and blood on post-SAH Days 2 to 3, 4 to 5, 6 to 7, and 10 to 14. Control subjects were 20 consecutive non-SAH hydrocephalus patients with lumbar drains. Enzyme-linked immunosorbent assay, Western blotting, and zymography were used to quantify pGSN and MMP-9. RESULTS: In CSF, pGSN was lower in SAH compared with control subjects on post-SAH Days 2 to 3 (P=0.0007), 4 to 5 (P=0.041), and 10 to 14 (P=0.007). In blood, pGSN decreased over time (P=0.001) and was lower in SAH compared with control subjects on post-SAH Days 4 to 5 (P=0.037), 6 to 7 (P=0.006), and 10 to 14 (P=0.006). Western blots demonstrated that SAH CSF had novel bands at 52 and 46 kDa, representing cleaved pGSN fragments. Gelatin zymography showed that CSF MMP-9 was elevated in SAH compared with control subjects. Higher CSF MMP-9 correlated with lower CSF pGSN on post-SAH Day 7 (r=-0.38; P=0.05). CONCLUSIONS: SAH is associated with decreased CSF and blood pGSN and elevated CSF MMP-9. Novel cleaved pGSN fragments are present in CSF of SAH subjects, consistent with pGSN cleavage by MMPs. Because pGSN is known to inhibit inflammatory mediators, these findings suggest that MMPs may reduce pGSN and exacerbate inflammation after SAH. Further studies are warranted to investigate the mechanisms underlying MMP-pGSN signaling in SAH.
Assuntos
Gelsolina/metabolismo , Hemorragia Subaracnóidea/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Feminino , Gelsolina/sangue , Gelsolina/líquido cefalorraquidiano , Humanos , Hidrocefalia/sangue , Hidrocefalia/líquido cefalorraquidiano , Masculino , Metaloproteinase 9 da Matriz/sangue , Metaloproteinase 9 da Matriz/líquido cefalorraquidiano , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/líquido cefalorraquidianoRESUMO
BACKGROUND: Hydrocephalus, a common brain disorder in children, can cause permanent brain damage. A timely diagnosis of this disorder is crucial. OBJECTIVE: The aim of this study was to evaluate the levels of S-100, CK-18, and NSE brainspecific proteins in patients with hydrocephalus. We examined the levels of these proteins in the blood samples of hydrocephalic patients. METHODS: The study was conducted on the hydrocephalus (n = 31) patients and a healthy control group (n = 30). A Receiver Operating Characteristic (ROC) curve was used to assess the validity of the NSE, CK-18, and S100B to differentiate between the hydrocephalus and the control groups. The suitability of the data to the normal distribution was tested with the Shapiro Wilk test, and the Student t-test was used to compare the characteristics of the normal distribution in two independent groups. The individuals in the hydrocephalus and control groups had similar values in terms of age, height, and weight. RESULTS: It was observed that NSE, CK-18, and S100B mean values of the individuals in the hydrocephalus group were significantly higher than NSE, CK-18, and S100B mean values of the control group. CONCLUSION: Experiments have shown that the levels of these proteins increase significantly in hydrocephalus patients compared to the healthy group. These three parameters can be considered as important markers in the diagnosis of hydrocephalus.
Assuntos
Hidrocefalia/sangue , Queratina-18/sangue , Fosfopiruvato Hidratase/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Biomarcadores/sangue , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fosfopiruvato Hidratase/metabolismoRESUMO
OBJECTIVE: To investigate the association between immunologic counts on admission and acute symptomatic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We conducted a retrospective analysis of 143 consecutive patients with aSAH. Patient demographics, clinical parameters, laboratory values, and radiographic imaging were obtained. Univariate and multivariate logistic regression analyses were performed to investigate parameters independently associated with acute symptomatic hydrocephalus. Receiver operating characteristic (ROC) curve analysis determined the best threshold value of neutrophil count to differentiate patients with and without hydrocephalus. RESULTS: Overall, acute symptomatic hydrocephalus developed in 39.16% of patients. In an adjusted multivariate logistic regression model, Hunt and Hess grade 4-5 (odds ratio [OR]: 16.052, 95% confidence interval [CI]: 1.188-216.983; P = 0.037), modified Fisher score 3-4 (OR: 10.107, 95% CI: 1.715-59.572; P = 0.011), intraventricular hemorrhage (OR: 4.578, 95% CI: 1.417-14.788; P = 0.011), neutrophil count (OR: 1.183, 95% CI: 1.033-1.354; P = 0.015), and prior ischemic stroke (OR: 7.003, 95% CI: 1.293-37.929; P = 0.024) were significantly associated with hydrocephalus. ROC analysis for neutrophil count confirmed an acceptable area under the curve (AUC 0.780, 95% CI: 0.701-0.859; P < 0.001). The best threshold value of neutrophil count to predict hydrocephalus was ≥9.80 × 103/mL. Overall, 81.25% of patients who developed shunt dependence had a neutrophil count ≥9.80 × 103/mL on admission (P = 0.003). CONCLUSIONS: Neutrophil count ≥9.80 × 103/mL on admission predicts acute symptomatic hydrocephalus after aSAH in an adjusted multivariate logistic regression model. Moreover, shunt dependence was associated with higher neutrophil counts.
Assuntos
Hidrocefalia/etiologia , Contagem de Leucócitos , Neutrófilos , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Derivações do Líquido Cefalorraquidiano , Feminino , Humanos , Hidrocefalia/sangue , Hemorragias Intracranianas/etiologia , AVC Isquêmico/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Hemorragia Subaracnóidea/sangueRESUMO
OBJECTIVE: Post-traumatic hydrocephalus (PTH) is a common complication of craniocerebral injury. If not diagnosed in time, PTH can lead to clinical deterioration and a poor prognosis. The early diagnosis of PTH can lead to success with early treatment. However, PTH can be easily ignored during rehabilitation. The main purpose of the present study was to investigate whether plasma S100B protein levels can be used as a biochemical predictive index of PTH. We also explored the correlation among S100B protein levels, intracranial pressure, and PTH severity. METHODS: The data from 235 patients with traumatic brain injury treated from June 2014 to June 2019 in our hospital were retrospectively analyzed. Statistical analysis was performed on 3 serum S100B samples from each patient. The first sample was taken 1-3 days after the injury and surgery. The second sample was harvested during the stable period after treatment, and the third sample was taken when PTH had been confirmed by computed tomography. We analyzed the change in S100B protein levels, and intracranial pressure was measured by lumbar puncture. RESULTS: A total of 235 patients (Glasgow coma scale score <12) with traumatic brain injury were investigated. Of these 235 patients, 46 (19%) had developed PTH. The first and second S100B samples showed no significant differences between the patients with and without PTH. In the third sample, the S100B level of the patients with PTH was significantly greater than that of the patients without PTH, with a statistically significant difference. Statistical analysis found no correlation between the S100B level and the severity of PTH. CONCLUSIONS: Measurements of serum S100B can be used to predict for PTH. We found a positive correlation between S100B levels and intracranial pressure but no correlation with the severity of PTH. Thus, serum S100B could have important clinical significance for the early detection and evaluation of PTH.
Assuntos
Lesões Encefálicas Traumáticas/sangue , Hidrocefalia/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Diagnóstico Precoce , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Adulto JovemRESUMO
We constructed a radiomics-clinical model to predict intraventricular hemorrhage (IVH) growth after spontaneous intracerebral hematoma. The model was developed using a training cohort (N=626) and validated with an independent testing cohort (N=270). Radiomics features and clinical predictors were selected using the least absolute shrinkage and selection operator (LASSO) method and multivariate analysis. The radiomics score (Rad-score) was calculated through linear combination of selected features multiplied by their respective LASSO coefficients. The support vector machine (SVM) method was used to construct the model. IVH growth was experienced by 13.4% and 13.7% of patients in the training and testing cohorts, respectively. The Rad-score was associated with severe IVH and poor outcome. Independent predictors of IVH growth included hypercholesterolemia (odds ratio [OR], 0.12 [95%CI, 0.02-0.90]; p=0.039), baseline Graeb score (OR, 1.26 [95%CI, 1.16-1.36]; p<0.001), time to initial CT (OR, 0.70 [95%CI, 0.58-0.86]; p<0.001), international normalized ratio (OR, 4.27 [95%CI, 1.40, 13.0]; p=0.011), and Rad-score (OR, 2.3 [95%CI, 1.6-3.3]; p<0.001). In the training cohort, the model achieved an AUC of 0.78, sensitivity of 0.83, and specificity of 0.66. In the testing cohort, AUC, sensitivity, and specificity were 0.71, 0.81, and 0.64, respectively. This radiomics-clinical model thus has the potential to predict IVH growth.
Assuntos
Hemorragia Cerebral Intraventricular/mortalidade , Ventrículos Cerebrais/diagnóstico por imagem , Hidrocefalia/diagnóstico , Hipercolesterolemia/epidemiologia , Processamento de Imagem Assistida por Computador/métodos , Idoso , Hemorragia Cerebral Intraventricular/sangue , Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/etiologia , Hidrocefalia/mortalidade , Hipercolesterolemia/sangue , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Máquina de Vetores de Suporte , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Dehydroepiandrosterone is a long established neuroactive steroid. Some authors documented that 7-oxygenated derivatives of this steroid may be responsive at least by part for its physiological activity. METHODS: In the ventricular cerebrospinal fluid obtained from 15 patients with hydrocephalus (8 postmenopausal women and 7 men) potentially neuroactive steroid 7-oxygenated derivatives of dehydroepiandrosterone were quantified using gas chromatography/mass spectrometry. RESULTS: Besides free dehydroepiandrosterone 7-oxygenated steroids such as 7alpha- and 7beta-hydroxy-dehydroepiandrosterone, 5-androstene-3beta,7alpha,17beta-triol and 5-androstene-3beta,7beta,17beta-triol in picomolar concentration in serum and cerebrospinal fluid were found. CONCLUSION: Dehydroepiandrosterone and its 7-oxygenated derivatives are present in ventricular cerebrospinal fluid in concentration 2 -100 times lower than in serum.
Assuntos
Androstenóis/líquido cefalorraquidiano , Desidroepiandrosterona/análogos & derivados , Desidroepiandrosterona/líquido cefalorraquidiano , Hidrocefalia/líquido cefalorraquidiano , Adulto , Androstenóis/sangue , Desidroepiandrosterona/sangue , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/cirurgia , Masculino , Espectrometria de MassasRESUMO
BACKGROUND: The importance of blood lactate concentrations in dogs with intracranial disease has not been established, despite frequently observed hyperlactatemia in dogs undergoing general anesthesia for advanced imaging, surgery, or both. HYPOTHESIS: Blood lactate concentrations are elevated in anesthetized dogs with intracranial disease, compared with dogs with intervertebral disc disease (IVDD). ANIMALS: Eighty-five hospitalized dogs undergoing advanced imaging, surgery, or both for primary neurologic disease; 30 with intracranial disease; 55 with IVDD. METHODS: Retrospective study. Age, breed, neurologic diagnosis, time from anesthesia induction to measurement of blood lactate, blood lactate concentration under anesthesia, and concurrently measured heart rate, mean arterial pressure, PCV, arterial hemoglobin oxygen saturation, and arterial partial pressure of oxygen were included in a multivariable linear regression analysis. RESULTS: Dogs with meningioma (adjusted mean lactate 2.99 mmol/L, 95% CL 2.21-4.05, P < 0.0001) and hydrocephalus (adjusted mean lactate 1.5 mmol/L, 95% CL 0.99-2.27, P= 0.003) had higher blood lactate concentrations compared with dogs with IVDD (adjusted mean lactate 0.79 mmol/L, 95% CL 0.6-1.04). Only dogs with meningioma had clinically important hyperlactatemia (>2.5 mmol/L). CONCLUSIONS: Prospective studies are warranted to determine the degree and clinical importance of high blood lactate concentrations in dogs with intracranial disease.
Assuntos
Anestesia Geral/veterinária , Neoplasias Encefálicas/veterinária , Doenças do Cão/sangue , Hidrocefalia/veterinária , Ácido Láctico/sangue , Animais , Neoplasias Encefálicas/sangue , Cães , Hidrocefalia/sangue , Deslocamento do Disco Intervertebral/sangue , Deslocamento do Disco Intervertebral/veterináriaRESUMO
A 13-month-old, male bichon frise was examined for the investigation of intermittent seizures, ataxia, abnormal behavior, polyuria, and polydipsia. At presentation, clinical and neurological examinations were unremarkable with the exception of mild truncal ataxia and a domed skull. Severe hyponatremia and hypoosmolality were identified, and following diagnostic testing a diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was made. Magnetic resonance imaging revealed changes consistent with severe hydrocephalus. Water restriction resulted in increased serum osmolality and a reduction in severity of clinical signs. The current case report documents SIADH associated with hydrocephalus in a dog. Structural brain disease should be excluded before a diagnosis of idiopathic SIADH is made.