Ahead of Print: Cardiac Complications after aSAH

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, years 2002-2009. We used generalized estimating equations (GEE) to determine whether cardiac complications were associated with the patient outcomes, and to evaluate potential predictors of cardiac complications.

Ahead of Print: The Impact of the Body-Mass-Index After SAH

Background: Obesity is a risk factor for cardiovascular disease and associated with poor outcome, especially for intensive care patients. Yet, recent studies have described favorableoutcomes of obese patients after stroke, a phenomenon called “obesity paradox”.

Objective: To assess the impact of BMI (Body-Mass-Index) on outcome after subarachnoid hemorrhage (SAH).

Methods: We analyzed the data of 741 SAH patients. BMI>25 kg/m2 was considered overweight and >30 kg/m2 obese. Outcome according to the Glasgow Outcome scale (GOS) at discharge and after 6 months was assessed using logistic regression analysis.

Ahead of Print: Unruptured Intracranial Aneurysms in the Norwegian HUNT-study

Background: Rupture risk of unruptured intracranial aneurysms (UIA) has been investigated in studies observing the natural history of this condition. Such studies have been prone to selection bias that may influence the results.

Objective: To calculate the overall rupture risk from data of prevalence of UIA, which constitutes the population at risk, and the incidence of aneurysmal subarachnoid hemorrhage (aSAH) in the same population.

Methods: Data were collected from the Norwegian Nord-Trondelag Health Study (HUNT) study, a large population-based cohort study. Prevalence of UIA was estimated by performing MR angiography in 1006 randomly selected volunteers aged 50 – 65 years from this population cohort. The incidence of aSAH was investigated by searching national and hospital registers with thorough case ascertainment to avoid inclusion of non-aneurysmal SAH.

Ahead of Print: Basilar Bifurcation in Peri-Mesencephalic Hemorrhage

Background: The angle of bifurcation of the basilar artery (BAB angle) is thought to influence the risk for development and rupture of aneurysms at this site. It is, however, unknown if the BAB angle also influences the incidence of angiographically negative peri-mesencephalic subarachnoid hemorrhage (PMSAH).

Objective: We performed a retrospective cross-sectional study comparing the BAB angle in a series of patients who presented with subarachnoid hemorrhage from a ruptured aneurysm at the top of the basilar artery (BSAH) with the BAB angle in a series of patients who presented with PMSAH.

Methods: Consecutive patients who presented to our institution with PMSAH or BSAH between Jan 1, 2005 and Dec 31, 2010 were studied. Patients with PMSAH were further subdivided into patients with classic PMSAH (CPMSAH) and those with non-classic PMSAH (NCPMSAH) based on initial head CT exams. In each patient, the BAB angle was measured on the standard cranial AP projections after vertebral artery injections.

Free Study Protocol: High-Dose Simvastatin for Aneurysmal Subarachnoid Hemorrhage

Background: Experimental evidence has indicated the benefit of simvastatin in the treatment of subarachnoid hemorrhage. However, no clinical data are available to answer whether a high-dose regimen is more effective than a normal-dose regimen, even though the biochemical actions and related neuroprotective mechanisms are thought to be dose related.

Objective: To determine whether 80 mg simvastatin daily (high dose) over 3 weeks initiated within 96 hours of the ictus will reduce the incidence of delayed ischemic deficits after subarachnoid hemorrhage compared with 40 mg simvastatin daily (normal dose), leading to improvements in clinical outcomes and thus cost-effectiveness.

Methods: The study design is a randomized, controlled, double-blind clinical trial (www.ClinicalTrials.gov; identifier: NCT01077206). Two hundred forty patients with aneurysmal subarachnoid hemorrhage (presenting within 96 hours of the ictus) from 6 neurosurgical centers are being recruited over 3 years. The primary outcome measure is the presence of delayed ischemic deficits. Secondary outcome measures include modified Rankin Disability Score at 3 months and cost-effectiveness analysis.