Articles: subarachnoid-hemorrhage.
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William Edward Hunt (1921-1999) and Robert McDonald Hess Jr. (1931-2019) were pioneers in revolutionizing the early surgical management of ruptured intracranial aneurysms. Early on in his career as a professor of neurosurgery at Ohio State University, Dr. Hunt adopted a systematic method to identify clinical symptoms of patients presenting with subarachnoid hemorrhage as candidates for either immediate or delayed surgery. ⋯ Hunt was widely regarded internationally as an expert in the field of treating intracranial aneurysms, eventually serving as a World Federation of Neurosurgical Societies (WFNS) committee member to also publish a universal subarachnoid hemorrhage grading scale. To pay tribute to Drs. Hunt and Hess for their substantial contributions, we present historical vignettes of their lives along with highlighting the role of the Hunt-Hess classification system in transforming management of ruptured aneurysms.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2022
Prevalence of unruptured intracranial aneurysms: impact of different definitions - the Tromsø Study.
Management of incidental unruptured intracranial aneurysms (UIAs) remains challenging and depends on their risk of rupture, estimated from the assumed prevalence of aneurysms and the incidence of aneurysmal subarachnoid haemorrhage. Reported prevalence varies, and consistent criteria for definition of UIAs are lacking. We aimed to study the prevalence of UIAs in a general population according to different definitions of aneurysm. ⋯ Prevalence in this study was higher than previously observed in other Western populations and was substantially influenced by definitions according to size and extradural or intradural location. The high prevalence of UIAs sized <5 mm may suggest lower rupture risk than previously estimated. Consensus on more robust and consistent radiological definitions of UIAs is warranted.
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Acute headache is a common emergency department (ED) chief complaint that usually has a benign course. Rare etiologies such as subarachnoid hemorrhage (SAH) can lead to extensive disability or even death. If suspected, SAH requires an intricate and intensive diagnostic investigation. ⋯ However, 3 days later upon re-presentation to the ED with the same symptoms, an LP was positive for increasing red blood cell count in subsequent tubes. She was transferred to a facility with interventional neurology capabilities where digital subtraction angiography showed a left anterior choroidal saccular aneurysm for which she underwent coiling. Given recent changes in SAH clinical practice guidelines, this case highlights the importance of understanding the current limitations of CT imaging, understanding the risks and benefits of both CT and LP, and always maintaining a high suspicion for especially lethal and disabling conditions such as SAH.
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Observational Study
Pilot study of neurological pupil index as a predictor of external ventricular drain clamp trial failure after subarachnoid hemorrhage.
External ventricular drains (EVDs) provide a temporary egress for cerebrospinal fluid (CSF) in patients with symptomatic hydrocephalus following aneurysmal subarachnoid hemorrhage. Before EVD removal, a wean trial, which involves clamping the EVD, is typically attempted to ensure that CSF self-regulation is achieved. Automated infrared pupillometry (AIP) has been shown to detect early neurologic decline. We sought to explore the use of AIP to detect early EVD clamping trial failure. ⋯ The pilot study data support that Neurological Pupil index <3 is a potential indicator of early clamp trial failure, but a CT scan has a higher sensitivity and NPV for predicting successful EVD removal. This finding suggests the benefits of including AIP assessments during clamping trials.
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Journal of neurosurgery · Aug 2022
Clinical and radiological risk factors for rupture of vertebral artery dissecting aneurysm: significance of the stagnation sign.
The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA. ⋯ This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.