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[PMID]:28747460
[Au] Autor:Schallner N; Lieberum JL; Gallo D; LeBlanc RH; Fuller PM; Hanafy KA; Otterbein LE
[Ad] Endereço:From the Department of Surgery (N.S., J.-L.L., D.G., L.E.O.) and Department of Neurology (R.H.L., P.M.F., K.A.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesiology and Critical Care, Medical Center-University Freiburg, Faculty of Medicine, German
[Ti] Título:Carbon Monoxide Preserves Circadian Rhythm to Reduce the Severity of Subarachnoid Hemorrhage in Mice.
[So] Source:Stroke;48(9):2565-2573, 2017 09.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is associated with a temporal pattern of stroke incidence. We hypothesized that natural oscillations in gene expression controlling circadian rhythm affect the severity of neuronal injury. We moreover predict that heme oxygenase-1 (HO-1/ ) and its product carbon monoxide (CO) contribute to the restoration of rhythm and neuroprotection. METHODS: Murine SAH model was used where blood was injected at various time points of the circadian cycle. Readouts included circadian clock gene expression, locomotor activity, vasospasm, neuroinflammatory markers, and apoptosis. In addition, cerebrospinal fluid and peripheral blood leukocytes from SAH patients and controls were analyzed for clock gene expression. RESULTS: Significant elevations in the clock genes , , and were observed in the hippocampus, cortex, and suprachiasmatic nucleus in mice subjected to SAH at zeitgeber time (ZT) 12 when compared with ZT2. Clock gene expression amplitude correlated with basal expression of HO-1, which was also significantly greater at ZT12. SAH animals showed a significant reduction in cerebral vasospasm, neuronal apoptosis, and microglial activation at ZT12 compared with ZT2. In animals with myeloid-specific HO-1 deletion ( ), , and expression was reduced in the suprachiasmatic nucleus, which correlated with increased injury. Treatment with low-dose CO rescued mice, restored , expression, and reduced neuronal apoptosis. CONCLUSIONS: Clock gene expression regulates, in part, the severity of SAH and requires myeloid HO-1 activity to clear the erythrocyte burden and inhibit neuronal apoptosis. Exposure to CO rescues the loss of HO-1 and thus merits further investigation in patients with SAH.
[Mh] Termos MeSH primário: Monóxido de Carbono/metabolismo
Ritmo Circadiano/genética
Expressão Gênica/efeitos dos fármacos
Heme Oxigenase-1/genética
Proteínas de Membrana/genética
Hemorragia Subaracnóidea/genética
[Mh] Termos MeSH secundário: Fatores de Transcrição ARNTL/genética
Animais
Apoptose
Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética
Proteínas CLOCK/genética
Líquido Cefalorraquidiano/metabolismo
Heme Oxigenase-1/metabolismo
Seres Humanos
Imuno-Histoquímica
Inflamação
Leucócitos/metabolismo
Locomoção
Proteínas de Membrana/metabolismo
Camundongos
Proteínas do Tecido Nervoso/genética
Proteínas Circadianas Period/genética
Reação em Cadeia da Polimerase em Tempo Real
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Índice de Gravidade de Doença
Núcleo Supraquiasmático/metabolismo
Vasoespasmo Intracraniano
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (ARNTL Transcription Factors); 0 (Arntl protein, mouse); 0 (Basic Helix-Loop-Helix Transcription Factors); 0 (Membrane Proteins); 0 (Nerve Tissue Proteins); 0 (Npas2 protein, mouse); 0 (PER2 protein, human); 0 (Per1 protein, mouse); 0 (Per2 protein, mouse); 0 (Period Circadian Proteins); 7U1EE4V452 (Carbon Monoxide); EC 1.14.14.18 (Heme Oxygenase-1); EC 1.14.14.18 (Hmox1 protein, mouse); EC 2.3.1.48 (CLOCK Proteins); EC 2.3.1.48 (Clock protein, mouse)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016165


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[PMID]:29308866
[Au] Autor:Dilvesi D; Cigic T; Papic V; Horvat I; Karan M; Vulekovic P
[Ti] Título:The Fisher Grade in predicting a degree of cerebral vasospasm in patients after intracranial aneurysm rupture.
[So] Source:Vojnosanit Pregl;73(4):349-52, 2016 Apr.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: Intracranial aneurysms are pathological enlargement of the wall of cerebral arteries. Intracranial aneurysms rupture is a dramatic event with a significant morbidity and mortality. The Fisher Grade is widely accepted in assessment of the extensiveness of aneurysmal subarachnoid hemorrhage (aSAH) and the presence of other intracranial hemorrhage on the computed tomography (CT) scan. Significant early complication of a aSAH may be a cerebral vasospasm. The aim of this study was to determine the relationship between the extensiveness of aSAH, assessed by the Fisher Grade on admission, with the intensity of cerebral vasospasm in patients with ruptured intracranial aneurysm. Methods: This prospective clinical study included 50 patients with aSAH hospitalized at the Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia. All the patients underwent 256-layer cranial CT and CT angiography on admission and on the day 9. Based on native CT scans, they were classified according to the Fisher Grade. On CT angiography images, intensity of cerebral vasospasm was determined. Results: On the basis of admission CT images, 24% of patients were classified into the Fisher Grade group 2, while 34% and 42% were in the groups 3 and 4, respectively. A positive correlation of the Fischer Grade on admission with the intensity of cerebral vasospasm was established, but with no statistical significance (ρ = 0.273, p = 0.160). Conclusion: This study showed that the Fisher Grade is not significant in predicting the intensity of cerebral vasospasm in patients hospitalized with intracranial aneurysm rupture.
[Mh] Termos MeSH primário: Aneurisma Intracraniano/patologia
Hemorragia Subaracnóidea/patologia
Vasoespasmo Intracraniano/patologia
[Mh] Termos MeSH secundário: Angiografia por Tomografia Computadorizada
Seres Humanos
Aneurisma Intracraniano/classificação
Aneurisma Intracraniano/diagnóstico por imagem
Estudos Prospectivos
Índice de Gravidade de Doença
Hemorragia Subaracnóidea/classificação
Hemorragia Subaracnóidea/diagnóstico por imagem
Tomografia Computadorizada por Raios X
Vasoespasmo Intracraniano/classificação
Vasoespasmo Intracraniano/diagnóstico por imagem
[Pt] Tipo de publicação:CLINICAL STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.2298/VSP140927021D


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[PMID]:28463833
[Au] Autor:Fujimura M; Joo JY; Kim JS; Hatta M; Yokoyama Y; Tominaga T
[Ad] Endereço:Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
[Ti] Título:Preventive Effect of Clazosentan against Cerebral Vasospasm after Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage in Japanese and Korean Patients.
[So] Source:Cerebrovasc Dis;44(1-2):59-67, 2017.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clazosentan has been explored worldwide for the prophylaxis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). In a dose-finding trial (CONSCIOUS-1) conducted in Israel, Europe, and North America, clazosentan (1, 5, and 15 mg/h) significantly reduced the incidence of cerebral vasospasm, but its efficacy in Japanese and Korean patients was unknown. We conducted a double-blind comparative study to evaluate the occurrence of cerebral vasospasm in Japanese and Korean patients with aSAH. METHODS: The aim of this multicenter, double-blind, randomized, placebo-controlled, dose-finding phase 2 clinical trial, was to evaluate the efficacy, pharmacokinetics, and safety of clazosentan (5 and 10 mg/h) against cerebral vasospasm after clipping surgery in Japanese and Korean patients with aSAH. Patients aged between 20 and 75 years were administered the study drug within 56 h after the aneurysm rupture and up to day 14 post-aSAH. The incidence of vasospasm, defined as an inner artery diameter reduction of major intracranial arteries ≥34% based on catheter angiography, was compared between each treatment group. Cerebral infarction due to vasospasm at 6 weeks and patients' outcome at 3 months was also compared. RESULTS: Among 181 enrolled patients, 158 completed the study and were analyzed. The incidence of vasospasm up to day 14 after aSAH onset was 80.0% in the placebo group (95% CI 67.0-89.6), 38.5% in the 5 mg/h clazosentan group (95% CI 25.3-53.0), and 35.3% in the 10 mg/h clazosentan group (95% CI 22.4-49.9), indicating that the incidence of vasospasm was significantly reduced by clazosentan treatment (placebo vs. 5 mg/h clazosentan, p < 0.0001; placebo vs. 10 mg/h clazosentan, p < 0.0001). The occurrence of cerebral infarction due to vasospasm was 20.8% in the placebo group (95% CI 10.8-34.1), 3.8% in the 5 mg/h clazosentan group (95% CI 0.5-13.2), and 4.2% in the 10 mg/h clazosentan group (95% CI 0.5-14.3), indicating that clazosentan significantly reduced the occurrence of cerebral infarctions caused by vasospasm (placebo vs. 5 mg/h clazosentan, p = 0.0151; placebo vs. 10 mg/h clazosentan, p = 0.0165). The overall incidence of all-cause death and/or vasospasm-related morbidity/mortality was significantly reduced in the 10 mg/h clazosentan group compared with the placebo group (p = 0.0003). CONCLUSION: These results suggest that clazosentan prevents cerebral vasospasm and subsequent cerebral infarction, and could thereby improve outcomes after performing a clipping surgery for aSAH in Japanese and Korean patients.
[Mh] Termos MeSH primário: Infarto Cerebral/prevenção & controle
Dioxanos/uso terapêutico
Antagonistas do Receptor de Endotelina A/uso terapêutico
Procedimentos Neurocirúrgicos/efeitos adversos
Piridinas/uso terapêutico
Pirimidinas/uso terapêutico
Hemorragia Subaracnóidea/cirurgia
Sulfonamidas/uso terapêutico
Tetrazóis/uso terapêutico
Vasodilatadores/uso terapêutico
Vasoespasmo Intracraniano/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Angiografia Digital
Angiografia Cerebral/métodos
Infarto Cerebral/diagnóstico por imagem
Infarto Cerebral/etiologia
Infarto Cerebral/fisiopatologia
Dioxanos/efeitos adversos
Dioxanos/farmacocinética
Método Duplo-Cego
Antagonistas do Receptor de Endotelina A/efeitos adversos
Antagonistas do Receptor de Endotelina A/farmacocinética
Feminino
Seres Humanos
Japão
Masculino
Meia-Idade
Piridinas/efeitos adversos
Piridinas/farmacocinética
Pirimidinas/efeitos adversos
Pirimidinas/farmacocinética
República da Coreia
Hemorragia Subaracnóidea/diagnóstico por imagem
Hemorragia Subaracnóidea/fisiopatologia
Sulfonamidas/efeitos adversos
Sulfonamidas/farmacocinética
Tetrazóis/efeitos adversos
Tetrazóis/farmacocinética
Fatores de Tempo
Resultado do Tratamento
Vasodilatadores/efeitos adversos
Vasodilatadores/farmacocinética
Vasoespasmo Intracraniano/diagnóstico por imagem
Vasoespasmo Intracraniano/etiologia
Vasoespasmo Intracraniano/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Dioxanes); 0 (Endothelin A Receptor Antagonists); 0 (Pyridines); 0 (Pyrimidines); 0 (Sulfonamides); 0 (Tetrazoles); 0 (Vasodilator Agents); 3DRR0X4728 (clazosentan)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1159/000475824


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[PMID]:29030476
[Au] Autor:Mossa-Basha M; Shibata DK; Hallam DK; de Havenon A; Hippe DS; Becker KJ; Tirschwell DL; Hatsukami T; Balu N; Yuan C
[Ad] Endereço:From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.). mmossab@uw.edu.
[Ti] Título:Added Value of Vessel Wall Magnetic Resonance Imaging for Differentiation of Nonocclusive Intracranial Vasculopathies.
[So] Source:Stroke;48(11):3026-3033, 2017 Nov.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Our goal is to determine the added value of intracranial vessel wall magnetic resonance imaging (IVWI) in differentiating nonocclusive vasculopathies compared with luminal imaging alone. METHODS: We retrospectively reviewed images from patients with both luminal and IVWI to identify cases with clinically defined intracranial vasculopathies: atherosclerosis (intracranial atherosclerotic disease), reversible cerebral vasoconstriction syndrome, and inflammatory vasculopathy. Two neuroradiologists blinded to clinical data reviewed the luminal imaging of defined luminal stenoses/irregularities and evaluated the pattern of involvement to make a presumed diagnosis with diagnostic confidence. Six weeks later, the 2 raters rereviewed the luminal imaging in addition to IVWI for the pattern of wall involvement, presence and pattern of postcontrast enhancement, and presumed diagnosis and confidence. Analysis was performed on per-lesion and per-patient bases. RESULTS: Thirty intracranial atherosclerotic disease, 12 inflammatory vasculopathies, and 12 reversible cerebral vasoconstriction syndrome patients with 201 lesions (90 intracranial atherosclerotic disease, 64 reversible cerebral vasoconstriction syndrome, and 47 inflammatory vasculopathy lesions) were included. For both per-lesion and per-patient analyses, there was significant diagnostic accuracy improvement with luminal imaging+IVWI when compared with luminal imaging alone (per-lesion: 88.8% versus 36.1%; <0.001 and per-patient: 96.3% versus 43.5%; <0.001, respectively). There was substantial interrater diagnostic agreement for luminal imaging+IVWI (κ=0.72) and only slight agreement for luminal imaging (κ=0.04). Although there was a significant correlation for both luminal and IVWI pattern of wall involvement with diagnosis, there was a stronger correlation for IVWI finding of lesion eccentricity and intracranial atherosclerotic disease diagnosis than for luminal imaging (κ=0.69 versus 0.18; <0.001). CONCLUSIONS: IVWI can significantly improve the differentiation of nonocclusive intracranial vasculopathies when combined with traditional luminal imaging modalities.
[Mh] Termos MeSH primário: Arteriosclerose Intracraniana/diagnóstico por imagem
Angiografia por Ressonância Magnética/métodos
Vasculite do Sistema Nervoso Central/diagnóstico por imagem
Vasoespasmo Intracraniano/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018227


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[PMID]:28847127
[Au] Autor:Griessenauer CJ; Patel AS; Gupta R; Adeeb N; Foreman PM; Shallwani H; Moore JM; Harrigan MR; Siddiqui AH; Ogilvy CS; Thomas AJ
[Ad] Endereço:Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA. Electronic address: christoph.griessenauer@gmail.com.
[Ti] Título:In Reply to the Letter to the Editor Regarding "Safety and Efficacy of Noncompliant Balloon Angioplasty for the Treatment of Subarachnoid Hemorrhage-Induced Vasospasm: A Multicenter Study".
[So] Source:World Neurosurg;105:1023, 2017 09.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hemorragia Subaracnóidea/cirurgia
Vasoespasmo Intracraniano/cirurgia
[Mh] Termos MeSH secundário: Angioplastia com Balão
Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE


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[PMID]:28847126
[Au] Autor:Yao Z; You C
[Ad] Endereço:Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
[Ti] Título:Letter to the Editor Regarding "Safety and Efficacy of Noncompliant Balloon Angioplasty for the Treatment of Subarachnoid Hemorrhage-Induced Vasospasm: A Multicenter Study".
[So] Source:World Neurosurg;105:1022, 2017 09.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hemorragia Subaracnóidea/cirurgia
Vasoespasmo Intracraniano/cirurgia
[Mh] Termos MeSH secundário: Angioplastia com Balão
Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE


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[PMID]:28604190
[Au] Autor:Bhogal P; Paraskevopoulos D; Makalanda HL
[Ad] Endereço:1 Neuroradiology Clinic, Klinikum Stuttgart, Stuttgart, Germany.
[Ti] Título:The use of a stent-retriever to cause mechanical dilatation of a vasospasm secondary to iatrogenic subarachnoid haemorrhage.
[So] Source:Interv Neuroradiol;23(3):330-335, 2017 Jun.
[Is] ISSN:2385-2011
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Objective To report the use of a stent-retriever in the management of vasospasm secondary to craniopharyngioma resection. Postoperative improvement was seen both clinically and on perfusion imaging. Methods A patient was admitted for resection of a large craniopharygioma. On day 6 postoperatively the patient had an acute hemiparesis. A computed tomography angiogram and perfusion scan demonstrated acute right-sided cerebral vasospasm and a perfusion defect in the territory of the middle cerebral artery (MCA). Results A pREset 4 × 20 mm stent-retriever was used to dilate the M1 and proximal M2 segments of the right MCA mechanically. This resulted in immediate dilatation of the spastic segment and improvement in the transit time on the angiogram. There was an improvement in the clinical status post-procedure and a computed tomography perfusion performed 24 hours after the procedure showed symmetrical perfusion. A computed tomography angiogram and magnetic resonance imaging performed 1 week later showed a symmetrical appearance to the MCA and no evidence of restricted diffusion. Conclusion The use of commercially available stent-retrievers can cause mechanical dilatation of vasospastic vessels. The stents do not need to be deployed for a prolonged period nor do they need to be implanted to have a prolonged dilatory effect on the spastic vessels.
[Mh] Termos MeSH primário: Stents
Hemorragia Subaracnóidea/complicações
Vasoespasmo Intracraniano/etiologia
Vasoespasmo Intracraniano/terapia
[Mh] Termos MeSH secundário: Adulto
Angiografia Cerebral
Angiografia por Tomografia Computadorizada
Craniofaringioma/complicações
Craniofaringioma/diagnóstico por imagem
Remoção de Dispositivo
Dilatação
Feminino
Seres Humanos
Doença Iatrogênica
Imagem por Ressonância Magnética
Artéria Cerebral Média
Neoplasias Hipofisárias/complicações
Neoplasias Hipofisárias/diagnóstico por imagem
Hemorragia Subaracnóidea/diagnóstico por imagem
Vasoespasmo Intracraniano/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE
[do] DOI:10.1177/1591019917694838


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[PMID]:28408258
[Au] Autor:Yao PS; Chen GR; Zheng SF; Kang DZ
[Ad] Endereço:Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
[Ti] Título:Predictors of Postoperative Cerebral Ischemia in Patients with Ruptured Anterior Communicating Artery Aneurysms.
[So] Source:World Neurosurg;103:241-247, 2017 Jul.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Cerebral ischemia is a major contributor to poor outcome after ruptured anterior communicating artery aneurysms (ACoAs), and is not well classified. In this article, we develop a classification and identify risk factors of cerebral ischemia after ruptured ACoAs. METHODS: Three hundred sixty patients with ruptured ACoAs undergoing microsurgical clipping were collected. Sex, age, smoking status, Hunt-Hess grade, Fisher grade, hospital stay, surgical timing, hypertension, diabetes, postoperative cerebral ischemia, and postoperative modified Rankin Scale score were collected. Postoperative ischemic changes are classified according to a novel grade (ischemic grade I-IV). RESULTS: Predictive factors of postoperative ischemia (grade I-IV) included sex (odds ratio [OR], 1.956; 95% confidence interval [CI], 1.262-3.032; P = 0.003) and Fisher grade (OR, 1.813; 95% CI, 1.144-2.871; P = 0.011). Male sex had a tendency to develop postoperative cerebral ischemia (61.3% in the ischemia group vs. 45.7% in the nonischemia group), while surgical timing did not. However, in patients with postoperative ischemia, early surgery within 3 days (OR, 3.334; 95% CI, 1.411-7.879; P = 0.006) and advanced age greater than 55 years (OR, 2.783; 95% CI, 1.214-6.382; P = 0.016) were risk factors for postoperative neurologic deficits (grade III-IV). CONCLUSIONS: Male sex and higher Fisher grade predict postoperative ischemia (grade I-IV), whereas surgical timing does not. However, in patients with postoperative cerebral ischemia, early surgery within 3 days and age greater than 55 years can increase the frequency of postoperative neurological deficits (grade III-IV). Older male patients undergoing early microsurgery had a tendency to develop neurologic deficits.
[Mh] Termos MeSH primário: Aneurisma Roto/cirurgia
Isquemia Encefálica/epidemiologia
Aneurisma Intracraniano/cirurgia
Complicações Pós-Operatórias/epidemiologia
Hemorragia Subaracnóidea/cirurgia
[Mh] Termos MeSH secundário: Idoso
Aneurisma Roto/complicações
Aneurisma Roto/diagnóstico por imagem
Angiografia Digital
Angiografia por Tomografia Computadorizada
Intervenção Médica Precoce
Feminino
Seres Humanos
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/diagnóstico por imagem
Masculino
Microcirurgia
Meia-Idade
Procedimentos Neurocirúrgicos
Razão de Chances
Estudos Retrospectivos
Fatores de Risco
Ruptura Espontânea
Índice de Gravidade de Doença
Fatores Sexuais
Hemorragia Subaracnóidea/etiologia
Fatores de Tempo
Vasoespasmo Intracraniano/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE


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[PMID]:28397570
[Au] Autor:Kumar A; Phalak M
[Ad] Endereço:a Department of Neurosurgery , All India Institute of Medical sciences , New Delhi , India.
[Ti] Título:Is intra arterial nimodipine really beneficial in vasospasm following aneurysmal subarachnoid hemorrhage?
[So] Source:Br J Neurosurg;31(3):290, 2017 06.
[Is] ISSN:1360-046X
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Nimodipino
Hemorragia Subaracnóidea
[Mh] Termos MeSH secundário: Seres Humanos
Vasodilatadores
Vasoespasmo Intracraniano
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Nm] Nome de substância:
0 (Vasodilator Agents); 57WA9QZ5WH (Nimodipine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1080/02688697.2017.1297381


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[PMID]:28365434
[Au] Autor:Phan K; Moore JM; Griessenauer CJ; Xu J; Teng I; Dmytriw AA; Chiu AH; Ogilvy CS; Thomas A
[Ad] Endereço:NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
[Ti] Título:Ultra-Early Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.
[So] Source:World Neurosurg;102:632-638.e1, 2017 Jun.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: After aneurysmal subarachnoid hemorrhage (aSAH), prognosis is affected heavily by the presence of delayed cerebral ischemia (DCI). There is growing recognition of ultra-early angiographic vasospasm (UEAV) occurring within 48 hours of aSAH; however, its relationship with DCI and ultimately prognosis remains unclear. METHODS: Various databases limited to the English language through September 2016 were searched systematically. Eligible studies were those comparing UEAV with control non-UEAV outcomes and follow-up. Two independent reviewers evaluated the quality of studies and abstracted the data, with discrepancies resolved by a third. We calculated odds ratios (ORs) and 95% confidence intervals for all outcomes by using random-effects meta-analyses and performed a heterogeneity analysis. RESULTS: Four comparative studies were selected for analysis. Pooled analysis demonstrated that UEAV compared with no-UEAV was associated with greater proportion of rupture aneurysms sized greater than 12 mm (38.3% vs. 24.3%, P < 0.00001). A significantly greater number of patients with UEAV had ruptured MCA aneurysms compared with patients without UEAV (29.7% vs. 19.9%, P = 0.005). Compared with no-UEAV, patients with UEAV were significantly associated with symptomatic cerebral vasospasm (OR 2.07, P = 0.05) and DCI/infarction (OR 2.52, P = 0.02). A significant association also was found between UEAV and an unfavorable outcome at follow-up (OR 1.64, P = 0.03) and greater mortality (OR 2.65, P < 0.00001). CONCLUSIONS: UEAV was significantly associated with symptomatic cerebral vasospasm, DCI/infarction, unfavorable outcome at follow-up, and greater mortality. Patients with intracerebral hematoma, intraventricular hemorrhage (Fisher Grade IV), larger ruptured aneurysms >12 mm, and an MCA location were more likely to have UEAV.
[Mh] Termos MeSH primário: Isquemia Encefálica/complicações
Hemorragia Subaracnóidea/complicações
Vasoespasmo Intracraniano/etiologia
[Mh] Termos MeSH secundário: Aneurisma Roto/complicações
Aneurisma Roto/cirurgia
Angiografia Cerebral/métodos
Seres Humanos
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/cirurgia
Fatores de Risco
Hemorragia Subaracnóidea/cirurgia
Resultado do Tratamento
Vasoespasmo Intracraniano/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170403
[St] Status:MEDLINE



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