Database : MEDLINE
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[PMID]: 29523945
[Au] Autor:Fragata I; Canto-Moreira N; Canhão P
[Ad] Address:Neuroradiology Department, Hospital São José, Centro Hospitalar Lisboa Central, NOVA Medical School, Lisbon, Portugal. isabelfragata@gmail.com.
[Ti] Title:Comparison of cerebral perfusion in perimesencephalic subarachnoid hemorrhage and aneurysmal subarachnoid hemorrhage.
[So] Source:Neuroradiology;, 2018 Mar 09.
[Is] ISSN:1432-1920
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Perimesencephalic hemorrhage (PMH) is a benign subtype of nonaneurysmal subarachnoid hemorrhage (SAH). We aimed to investigate if cerebral perfusion in PMH is less affected than in aneurysmal SAH (aSAH). METHODS: From a prospective cohort of 80 patients with spontaneous SAH, we included PMH patients (n = 15) and selected aSAH patients (n = 39) with similar clinical grade at admission (World Federation of Neurosurgeons Scale-WFNS I/II). Computed tomography (CT) perfusion was performed at < 72 h and/or at 8-10 days. Cerebral perfusion parameter values were compared between groups with nonparametric tests. Subgroup analyses compared PMH and aSAH patients stratified according to aneurysmal location (anterior or posterior circulation) and blood burden (Fisher grade). RESULTS: At < 72 h, no significant differences in perfusion parameters were found between PMH and aSAH patients. At 8-10 days, PMH patients had lower MTT than aSAH patients, and a trend for higher CBF. PMH patients had higher CBF and CBV at < 72 h when compared to posterior circulation aSAH patients. When compared to aSAH patients with similar blood burden, PMH patients had higher CBF and lower MTT at < 72 h, and lower MTT at 8-10 days. CONCLUSION: PMH patients had better cerebral perfusion compared to patients with aSAH, particularly during the vasospasm time window. After stratifying for the amount of blood, PMH patients also had better cerebral perfusion in the first 72 h after SAH. These results are in line with the better clinical presentation and prognosis of PMH, and possibly with a different etiology.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s00234-018-1997-1

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[PMID]: 29457737
[Au] Autor:Saeedi M; Vahidi E; Asri S; Jahanshir A
[Ad] Address:From the Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Title:Determining the Value of Cerebrospinal Fluid Lactate Dehydrogenase Level in Differentiating Subarachnoid Hemorrhage From Traumatic Lumbar Puncture.
[So] Source:Arch Pathol Lab Med;, 2018 Feb 19.
[Is] ISSN:1543-2165
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:CONTEXT: - Lumbar puncture (LP) is still an important modality in the diagnosis of subarachnoid hemorrhage (SAH). Rapid and correct fluid analysis can provide patients with a better prognosis by appropriate intervention. OBJECTIVE: - To determine the value of cerebrospinal fluid lactate dehydrogenase level in differentiation between SAH and traumatic LP. DESIGN: - This was a cross-sectional observational study. Patients with a diagnostic suspicion of SAH, who were admitted to the emergency department, were enrolled in our study based on the inclusion criteria. All patients underwent head computed tomography scan without contrast. Patients with SAH confirmed on computed tomography scan and those who needed surgical intervention, underwent LP by the neurosurgical service in the operation room (group 1). Other patients who fulfilled the inclusion criteria but had a traumatic LP in the emergency setting were also enrolled in our study (group 2). The fluid samples of all LPs were sent to the laboratory to be analyzed. Finally, we compared the results of the 2 groups with each other. RESULTS: - Fifty-two patients were enrolled in our study, 26 patients (50%) from each group. The cerebrospinal fluid lactate dehydrogenase level was significantly higher in group 1 than it was in group 2 ( P < .001), and based on receiver operating characteristic curve analysis, the significant level of cerebrospinal fluid lactate dehydrogenase to differentiate SAH from traumatic LP was estimated to be 185. The red blood cell and white blood cell counts were significantly higher in group 1 than they were in group 2 ( P < .001). CONCLUSIONS: - Cerebrospinal fluid lactate dehydrogenase can effectively differentiate SAH from traumatic tap in LP samples.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.5858/arpa.2017-0157-OA

  3 / 27424 MEDLINE  
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[PMID]: 29448133
[Au] Autor:Nizamudeen ZA; Chakrabarti L; Sottile V
[Ad] Address:Wolfson STEM Centre, School of Medicine, University of Nottingham, UK.
[Ti] Title:Exposure to the ROCK inhibitor fasudil promotes gliogenesis of neural stem cells in vitro.
[So] Source:Stem Cell Res;28:75-86, 2018 Feb 06.
[Is] ISSN:1876-7753
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Fasudil is a clinically approved Rho-associated protein kinase (ROCK) inhibitor that has been used widely to treat cerebral consequences of subarachnoid hemorrhage. It is known to have a positive effect on animal models of neurological disorders including Parkinson's disease and stroke. However, its cellular effect on progenitor populations and differentiation is not clearly understood. While recent studies suggest that fasudil promotes the mobilization of neural stem cells (NSCs) from the subventricular zone in vivo and promotes the differentiation of the C17.2 cerebellar neuroprogenitor line in vitro, it is unclear whether fasudil is involved in the differentiation of primary NSCs. Here, we tested the effect of fasudil on mouse NSCs in vitro, and observed increased gliogenesis in NSCs derived from lateral ventricles. Upon treatment, fasudil promoted characteristics of neurogenesis including phenotypic changes in neural outgrowth and interkinetic nuclear-like movements as an immediate response, while Sox2 expression was maintained and GFAP expression increased. Moreover, the gliogenic response to fasudil medium was observed in both early postnatal and adult NSC cultures. Taken together, our results show that fasudil promotes the differentiation of NSCs into astroglial lineage, suggesting that it could be used to develop novel vitro gliogenesis models and regulate differentiation for neural repair.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  4 / 27424 MEDLINE  
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[PMID]: 29277281
[Au] Autor:Alons IME; Goudsmit BFJ; Jellema K; van Walderveen MAA; Wermer MJH; Algra A
[Ad] Address:Department of Neurology, MCH Westeinde, The Hague, The Netherlands. Electronic address: mandaalons@hotmail.com.
[Ti] Title:Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis.
[So] Source:J Stroke Cerebrovasc Dis;27(4):1077-1084, 2018 Apr.
[Is] ISSN:1532-8511
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Patients with acute severe headache, normal neurological examination, and a normal noncontrast head computed tomography (NCCT) may still have subarachnoid hemorrhage, cerebral venous thrombosis (CVT), cervical arterial dissection, or reversible cerebral vasoconstriction syndrome (RCVS). Computed tomography angiography (CTA) is used increasingly in the emergency department for evaluating this, but its added value remains controversial. METHODS: We retrospectively collected data on the diagnostic yield of CTA in patients with acute severe headache, normal neurological examination, and normal NCCT who received additional CTA in the acute phase in 2 secondary referral centers for vascular neurology. We combined data of our patients with those from the literature and performed a meta-analysis. RESULTS: We included 88 patients from our hospital files and 641 patients after literature search. Of 729 patients 54 had a vascular abnormality on CTA (7.4%; 95% confidence interval [CI] 5.5%-9.3%). Abnormalities consisted of aneurysms (n = 42; 5.4%; 95% CI 3.8%-7.0%), CVT (n = 3, .5%), RCVS (n = 4, .5%), Moyamoya syndrome (n = 2, .3%), arterial dissection (n = 2, .3%), and ischemia (n = 1, .1%). Because most of the aneurysms were probably incidental findings, only 12 (1.6%) patients had a clear relation between the headache and CTA findings. The number needed to scan to find an abnormality was 14 overall, and 61 for an abnormality other than an aneurysm. CONCLUSION: Diagnostic yield of CTA in patients with acute headache, normal neurological examination, and normal NCCT is low, but because of the possible therapeutic consequences, its use might be justified in the emergency setting. Prospective studies confirming these results including cost-effectiveness analyses are needed.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process

  5 / 27424 MEDLINE  
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[PMID]: 29217366
[Au] Autor:Takagi Y; Hadeishi H; Mineharu Y; Yoshida K; Ogasawara K; Ogawa A; Miyamoto S
[Ad] Address:Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
[Ti] Title:Initially Missed or Delayed Diagnosis of Subarachnoid Hemorrhage: A Nationwide Survey of Contributing Factors and Outcomes in Japan.
[So] Source:J Stroke Cerebrovasc Dis;27(4):871-877, 2018 Apr.
[Is] ISSN:1532-8511
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Subarachnoid hemorrhage (SAH) remains a significant cause of mortality in Japan. The Japan Stroke Society set out to conduct a nationwide survey to identify contributing factors and outcomes of SAH misdiagnosis. METHODS: We initially surveyed 737 training institutes and 1259 departments in Japan between April 2012 and March 2014 for the presence of misdiagnosed SAH. Clinical information was then sought from respondents with a positive misdiagnosis. Information on 579 misdiagnosed cases was collected. RESULTS: Most initial misdiagnoses occurred in nonteaching hospitals (72%). Of those presenting with headache, 55% did not undergo a computed tomography (CT) scan. In addition, SAH was missed in the patients who underwent CT scans. The clinically diagnosed rerupture rate was 27%. Mortality among all cases was 11%. Institutes achieving a final diagnosis were staffed by neurologists or neurosurgeons. Multivariate logistic regression analysis indicated that age (≥65), consciousness level (Japan Coma Scale score at correct diagnosis), rerupture of an aneurysm, and no treatment by clipping or coiling were significantly associated with poor clinical outcome. CONCLUSIONS: The prognosis of misdiagnosis of SAH is severe. Neuroradiological assessment and correct diagnosis can prevent SAH misdiagnosis. When there is a possible diagnosis of SAH, consultation with a specialist is important.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process

  6 / 27424 MEDLINE  
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[PMID]: 29214784
[Au] Autor:Lee HG; Kim WK; Yeon JY; Kim JS; Kim KH; Jeon P; Hong SC
[Ad] Address:Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
[Ti] Title:Contrast-Induced Acute Kidney Injury after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage.
[So] Source:Yonsei Med J;59(1):107-112, 2018 Jan.
[Is] ISSN:1976-2437
[Cp] Country of publication:Korea (South)
[La] Language:eng
[Ab] Abstract:PURPOSE: Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcomes after percutaneous coronary intervention. However, CI-AKI has rarely been evaluated within the neurovascular field. The aim of this study was to investigate the incidence and clinical implication of CI-AKI after coil embolization in patients with an aneurysmal subarachnoid hemorrhage (aSAH). MATERIALS AND METHODS: Between January 2005 and March 2016, 192 patients who underwent coil embolization were enrolled in this study. CI-AKI was defined as an increase from baseline serum creatinine concentration of >25% or >0.5 mg/dL within 72 hours after coil embolization. A poor clinical outcome was defined as a score of ≥3 on the modified Rankin Scale at one-year post-treatment. RESULTS: A total of 16 patients (8.3%) died as a result of medical problems within one year. CI-AKI was identified in 14 patients (7.3%). Prominent risk factors for one-year mortality included CI-AKI [odds ratio (OR): 16.856; 95% confidence interval (CI): 3.437-82.664] and an initial Glasgow Coma Scale (GCS) score ≤8 (OR: 5.565; 95% CI: 1.703-18.184). A poor clinical outcome was associated with old age (≥65 years) (OR: 7.921; 95% CI: 2.977-21.076), CI-AKI (OR: 11.281; 95% CI: 2.138-59.525), an initial GCS score ≤8 (OR 31.02; 95% CI, 10.669-90.187), and a ruptured aneurysm (p=0.016, OR: 4.278) in posterior circulation. CONCLUSION: CI-AKI seems to be an independent predictor of the overall outcomes of aSAH after endovascular treatment.
[Mh] MeSH terms primary: Acute Kidney Injury/chemically induced
Acute Kidney Injury/etiology
Aneurysm/therapy
Contrast Media/adverse effects
Embolization, Therapeutic/adverse effects
Subarachnoid Hemorrhage/therapy
[Mh] MeSH terms secundary: Acute Kidney Injury/diagnostic imaging
Acute Kidney Injury/mortality
Adult
Aged
Aged, 80 and over
Aneurysm/complications
Aneurysm/diagnostic imaging
Angiography
Female
Humans
Incidence
Male
Middle Aged
Subarachnoid Hemorrhage/complications
Subarachnoid Hemorrhage/diagnostic imaging
Treatment Outcome
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Contrast Media)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:171208
[St] Status:MEDLINE
[do] DOI:10.3349/ymj.2018.59.1.107

  7 / 27424 MEDLINE  
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[PMID]: 29521734
[Au] Autor:McLaughlin DC; Margretta MM; Freeman WD
[Ad] Address:Questions or comments about this article may be directed to Diane C. McLaughlin, DNP AGACNP-BC CCRN, at mclaughlin.diane@mayo.edu. She is Nurse Practitioner, Department of Critical Care, Mayo Clinic, Jacksonville, FL. Margaret M. Margretta, MSN FNP-BC, is Nurse Practitioner, Department of Transplant Hepatology, Mayo Clinic, Jacksonville, FL. William D. Freeman, MD, is Chair of Neurocritical Care, Mayo Clinic, Jacksonville, FL.
[Ti] Title:Aneurysmal Subarachnoid Hemorrhage Mortality After Implementation of Nocturnist Advanced Practice Provider Coverage.
[So] Source:J Neurosci Nurs;50(2):102-104, 2018 Apr.
[Is] ISSN:1945-2810
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:INTRODUCTION: We hypothesized that a nocturnist advanced practice provider (APP) model compared with overnight neurocritical care coverage with general critical care physicians and neurology residents would provide similar patient outcomes, as measured by patient mortality. METHODS: This study is a retrospective review of healthcare outcomes of aneurysmal subarachnoid hemorrhage (aSAH) patients from 2013 and 2016, after implementation of specialty-trained neurocritical care nocturnist APPs. In 2013, overnight hours were covered by the general intensive care unit team and a junior neurology resident. In 2016, these patients were cared for by APPs overnight. The primary outcome measured was comparison of mortality before and after this change of overnight coverage because the daytime coverage remained similar between years. RESULTS: In 2013, 58 patients were admitted to the neurocritical care unit with aSAH. In 2016, 19 aSAH patients were admitted to the neurocritical care unit. The mean modified Fisher grade was 3.36 in 2013, with 14 of 58 deaths (mortality rate, 24%). In 2016, the mean modified Fisher grade was 3.4. Three patients died (mortality rate, 15.7%). CONCLUSION: The active nocturnist APP model was associated with an approximately 10% reduction in SAH mortality (P = .54). This supports the hypothesis that APPs can provide noninferior care as the previous model. Further studies are needed to demonstrate the effects of both nocturnist and APP-driven models.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.1097/JNN.0000000000000352

  8 / 27424 MEDLINE  
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[PMID]: 29521594
[Au] Autor:Koyanagi M; Fukuda H; Saiki M; Tsuji Y; Lo B; Kawasaki T; Ioroi Y; Fukumitsu R; Ishibashi R; Oda M; Narumi O; Chin M; Yamagata S; Miyamoto S
[Ad] Address:Department of Neurosurgery, National Hospital Organization Himeji Medical Center, Himeji.
[Ti] Title:Effect of choice of treatment modality on the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.
[So] Source:J Neurosurg;:1-7, 2018 Mar 09.
[Is] ISSN:1933-0693
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE Shunt-dependent hydrocephalus (SDHC) may arise after aneurysmal subarachnoid hemorrhage (aSAH) as CSF resorptive mechanisms are disrupted. Using propensity score analysis, the authors aimed to investigate which treatment modality, surgical clipping or endovascular treatment, is superior in reducing rates of SDHC after aSAH. METHODS The authors' multicenter SAH database, comprising 3 stroke centers affiliated with Kyoto University, Japan, was used to identify patients treated between January 2009 and July 2016. Univariate and multivariate analyses were performed to characterize risk factors for SDHC after aSAH. A propensity score model was generated for both treatment groups, incorporating relevant patient covariates to detect any superiority for prevention of SDHC after aSAH. RESULTS A total of 566 patients were enrolled in this study. SDHC developed in 127 patients (22%). On multivariate analysis, age older than 53 years, the presence of intraventricular hematoma, and surgical clipping as opposed to endovascular coiling were independently associated with SDHC after aSAH. After propensity score matching, 136 patients treated with surgical clipping and 136 with endovascular treatment were matched. Propensity score-matched cohorts exhibited a significantly lower incidence of SDHC after endovascular treatment than after surgical clipping (16% vs 30%, p = 0.009; OR 2.2, 95% CI 1.2-4.2). SDHC was independently associated with poor neurological outcomes (modified Rankin Scale score 3-6) at discharge (OR 4.3, 95% CI 2.6-7.3; p < 0.001). CONCLUSIONS SDHC after aSAH occurred significantly more frequently in patients who underwent surgical clipping. Strategies for treatment of ruptured aneurysms should be used to mitigate SDHC and minimize poor outcomes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.3171/2017.9.JNS171806

  9 / 27424 MEDLINE  
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[PMID]: 29519285
[Au] Autor:Zhao J; Luo X; Zhang Z; Chen K; Shi G; Zhou J
[Ad] Address:Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China. Corresponding author: Shi Guangzhi, Email: shigzh@aliyun.com.
[Ti] Title:[Use of somatosensory evoked potentials for preoperative assessment in patients with severe aneurysmal subarachnoid hemorrhage before surgical or interventional treatment: a prospective observational cohort study].
[So] Source:Zhonghua Wei Zhong Bing Ji Jiu Yi Xue;30(3):251-256, 2018 Mar.
[Is] ISSN:2095-4352
[Cp] Country of publication:China
[La] Language:chi
[Ab] Abstract:OBJECTIVE: To explore the application value of short latency somatosensory evoked potentials (SLSEP) as a tool for preoperative assessment of surgical or interventional treatment in patients with severe aneurysmal subarachnoid hemorrhage (aSAH). METHODS: A prospective observational cohort study was conducted. The patients with severe aSAH with a WFNS grade of IV or V admitted to intensive care unit (ICU) of Beijing Tiantan Hospital of Capital Medical University from November 2016 to April 2017 were enrolled. The patients received SLSEP monitoring within 12 hours after onset, and the monitoring results were classified according to the Judson scale. Meanwhile, the findings on cerebral CT scans at admission were evaluated by the modified Fisher classification. The follow-up was performed at 3 months after aSAH ictus based on the modified Rankin scale (mRS), and a mRS score 0-3 was defined as favorable outcome, 4-6 was defined as unfavorable outcome. For statistical evaluation, demographic, clinical, neuroimaging and SLSEP data were evaluated by univariate analysis to identify the risk factors associated with prognosis; afterwards, those factors were analyzed by multivariate Logistic regression; also the validity was assessed by calculating the respective sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: A total of 41 patients with aSAH were selected, of which 7 were excluded because of the interference of the SLSEP monitoring results, 34 patients with aSAH were enrolled finally. Among them, 21 were classified in the unfavorable outcome group, while the rest (n = 13) were allocated into the favorable outcome group. No significant difference was found in gender, age, body mass index (BMI), time delay from ictus to treatment or the options for therapeutic methods between the two groups. The findings of univariate analysis, however, showed statistically differences in WFNS grade, the modified Fisher scale and Judson scale of SLSEP between the two groups. Yet, the further validity evaluation for these predictors demonstrated that the sensitivity, specificity, PPV and NPV of WFNS grade of V and modified Fisher scale of IV were all less than 85%, whereas the results for SLSEP Judson scale of III were much better (sensitivity: 90.5% vs. 71.4% and 71.4%, specificity: 84.6% vs. 69.2% and 76.9%, PPV: 90.5% vs. 79.0% and 83.3%). In the following multivariate Logistic analysis, only Judson scale of III was identified to be the independent risk factor for poor outcome [odds ratio (OR) = 45.73, 95% confidence interval (95%CI) = 4.25-499.31, P = 0.002], while the WFNS grade of V (OR = 1.14, 95%CI = 0.12-13.06, P = 0.912) and the modified Fisher scale of IV (OR = 7.22, 95%CI = 0.51-113.20, P = 0.160) were merely associated with poor outcomes without significant independence. CONCLUSIONS: In comparison with WFNS grade and the modified Fisher scale, SLSEP seems more accurate in the prediction of long-term outcome of severe aSAH prior to surgical or interventional treatment, and thus may be applied as an effective aid in preoperative assessment.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.3760/cma.j.issn.2095-4352.2018.03.012

  10 / 27424 MEDLINE  
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[PMID]: 29518652
[Au] Autor:Takayama M; Waters B; Fujii H; Hara K; Kashiwagi M; Matsusue A; Ikematsu N; Kubo SI
[Ad] Address:Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Japan; Fukuoka University Research Institute for Toxicological Detection and Monitoring, Japan.
[Ti] Title:Subarachnoid hemorrhage in a Japanese cocaine abuser: Cocaine-related sudden death.
[So] Source:Leg Med (Tokyo);32:43-47, 2018 Mar 02.
[Is] ISSN:1873-4162
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:Based on a prospective case-control study of forensic autopsies, the causes of cocaine (COC)-related sudden death (SD) are cardiovascular events in 62.0% of cases, cerebrovascular events in 14.0%, and others. A forensic autopsy of a male in his early forties revealed subarachnoid hemorrhage (SAH) at the base of the brain. A cerebral arterial aneurysm was not detected even though hemorrhage was clearly observed in the anterior cerebral artery (ACA) bifurcation area. The brain weighed 1488 g and was edematous. We histopathologically examined the left-ACA, right-ACA, and anterior communicating artery (Acom). Thickening of the internal vessel wall was observed as a pathological change. The internal elastic lamina of the right-ACA, near the peripheral part of Acom, was meandered with a jagged appearance. A toxicology examination detected COC and its metabolites, particularly benzoylecgonin, in blood and urine samples. Therefore, the present case was regarded as a non-fatal intoxication case, but also a COC-related death. Ethanol was also detected, indicating that COC was taken in combination with alcohol. The cause of COC-related death in the present case was SAH. COC use is known to induce aneurysmal SAH; however, whether an aneurysm had formed in the present case was unclear. Meander, extension, and degeneration of the internal elastic lamina of the right-ACA were observed near the bifurcation from the Acom. This area corresponded macroscopically with that considered to be the bleeding point from the blood vessel. Therefore, the present case was diagnosed as COC-related SD.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher


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