Posts Tagged ‘subarachnoid hemorrhage’
Background: Cerebral microbleeds (CMBs) are commonly found after stroke, but have not been previously studied in patients with subarachnoid hemorrhage (SAH).
Objective: To study the prevalence, radiographic patterns, predictors, and impact on outcome of CMBs in patients with SAH.
Methods: We analyzed retrospectively 39 consecutive patients who underwent T2*-weighted gradient-echo imaging within seven days after onset of spontaneous SAH. We report frequency and location of CMBs and show their association with demographics, vascular risk factors, the Hunt-Hess grade, the modified Fisher Scale, the Acute Physiologic and Chronic Health Evaluation II, MRI findings including diffusion-weighted imaging lesions (DWILs), and laboratory data, as well as data on rebleeding, global cerebral edema, delayed cerebral ischemia, seizures, the Telephone Interview for Cognitive Status, and the modified Rankin Scale.
Background: Computed tomographic angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, though digital subtraction angiography is often required for more detailed aneurysm shape delineation.
Objective: To determine if a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making prior to intervention.
Methods: 15 patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared to contemporaneous catheter three-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line-plots of identical projections on all imaging datasets and compared by matched-pair statistics.
Background: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown.
Objective: To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications.
Methods: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications.
Background: Animal studies suggest that ischemic preconditioning prolongs coagulation times.
Objective: Because coagulation changes could hinder the translation of preconditioning into clinical settings where hemorrhage may be an issue, such as ischemic or hemorrhagic stroke, we evaluated the effects of remote ischemic preconditioning (RIPC) on coagulation in patients undergoing RIPC after aneurysmal subarachnoid hemorrhage (SAH).
Methods: 21 patients with SAH (mean age 56.3) underwent 137 RIPC sessions, 2-12 days following SAH, each consisting of 3-4 cycles of 5-10 minutes of lower limb ischemia followed by reperfusion. Partial thromboplastin time (PTT), prothrombin time (PT), and international normalized ratio (INR) were analyzed before and after sessions. Patients were followed for hemorrhagic complications.
Background: Cerebral infarction is a major contributor to poor outcome after subarachnoid hemorrhage (SAH). While usually considered a complication of delayed cerebral ischemia (DCI), infarcts may also occur early, in relation to initial brain injury or aneurysm-securing procedures.
Objective: We analyzed the relative frequency and volume of early vs. delayed infarcts after SAH and their relationship to hospital outcome.
Methods: Retrospective review of consecutive patients admitted with aneurysmal SAH over 4-years who had follow-up brain imaging >=7 days after admission. Imaging 24-48-hours after aneurysm-securing procedures was reviewed to classify infarcts seen on final imaging as early or delayed. Infarct volumes were measured by perimeter tracing and infarct burden calculated for each patient.