World Neurosurg
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Multicenter Study Comparative Study
Comparisons of 30-day mortalities and 90-day functional recoveries after first and recurrent primary intracerebral hemorrhage attacks: a multiple-institute retrospective study.
The aim of this study was to determine and compare 30-day mortalities and 90-day functional recoveries after first and recurrent primary intracerebral hemorrhage (PICH) attacks. The investigators sought to identify factors predisposing 30-day mortality and functional recovery and to compare patients after first and recurrent PICH attacks. ⋯ The factors found to predispose clinical outcome were similar in the two groups. This study shows that given optimal treatment, recurrent PICH patients can achieve the same clinical outcomes as first PICH patients.
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The outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) has improved slowly over the past 25 years. This improvement may be due to early aneurysm repair by endovascular or open means, use of nimodipine, and better critical care management. Despite this improvement, mortality remains at about 40%, and many survivors have permanent neurologic, cognitive, and neuropsychologic deficits. ⋯ The primary aim of the SAHIT data repository is to provide a unique resource for prognostic analysis and for studies aimed at optimizing the design and analysis of phase III trials in aneurysmal SAH. With this aim in mind, we convened a multinational investigator meeting to explore merging individual patient data from multiple clinical trials and observational databases of patients with SAH and to create an agreement under which such a group of investigators could submit data and collaborate. We welcome collaboration with other investigators.
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Although there have been some reports regarding body mass index (BMI) and subtypes of stroke, there have been few concerning the relationship between BMI and location of spontaneous intracerebral hemorrhage (ICH). Determining the location of spontaneous ICH is important because outcome is thought to be affected by its location. The aim of this study was to determine whether location of spontaneous ICH varied according to BMI level. ⋯ Our findings indicate that BMI can affect the location of spontaneous ICH.
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To identify the specific angioarchitectural characteristics of arteriovenous malformations (AVMs) that are associated with a clinical presentation of nonhemorrhagic neurologic deficits. ⋯ The characteristics of AVM associated with nonhemorrhagic neurological deficits include female sex, deep AVM location, more than three arterial feeders, only perforating feeding artery, more than three draining veins, the presence of varices in the venous drainage, and a Spetzler-Martin grade of III to V.
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The treatment of small unruptured intracranial aneurysms has been questioned based on the results of the International Study of Unruptured Intracranial Aneurysms. Our objective was to compare natural history rupture risk versus treatment risk for coiling and clipping small unruptured aneurysms using data in the Nationwide Inpatient Sample database. ⋯ Both clipping and coiling of unruptured intracranial aneurysms are safe. This analysis demonstrates rationale for clipping small unruptured aneurysms in patients <61-70 years and coiling small unruptured aneurysms in patients <70-80 years. Treatment beyond these age ranges is associated with increased risk of poor outcome.