Articles: subarachnoid-hemorrhage.
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A woman in her 60s with well-controlled dyslipidemia presented with anterior chest pain. The electrocardiogram, chest radiograph, and echocardiogram were unremarkable; however, cardiac enzymes levels were elevated. Coronary angiography performed after dual antiplatelet therapy revealed spontaneous coronary artery dissection (SCAD). ⋯ Autopsy confirmed dissections of the coronary and vertebral arteries. Although SCAD is rare, it often coexists with extracoronary vascular abnormalities due to systemic arterial fragility. Therefore, consider cerebrovascular disorders and promptly implementing diagnostic and management strategies in patients with SCAD and headaches is necessary.
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Case Reports
Microsurgical Clipping of a Ruptured Basilar Apex Aneurysm: Contending with a Formidable Clinical Scenario.
Basilar apex aneurysms (BAAs) represent 5%-8% of cerebral aneurysms.1-3 Treating BAAs is long established in neurosurgery.4-6 The morbid and lethal characteristics of aneurysmal subarachnoid hemorrhage coupled with potential medical complications of neurointensive care contribute to poor prognosis of patients with ruptured BAAs.7,8 A 58-year-old woman presented to the emergency department with a 1-day course of intense headaches that progressed to loss of consciousness. Noncontrast computed tomography of the head revealed extensive intraventricular hemorrhage (Fisher grade 4). Computed tomography angiography revealed an 8.7 × 6.3 mm wide-neck BAA. ⋯ Nonetheless, the course of BAAs can still be poor even after adequate surgical management. This case exemplifies the burdensome nature of BAAs and the difficult clinical course of patients despite meticulous microsurgical management. Fisher grade 4, which is associated with a 31% risk of vasospasm, was a notable factor contributing to this outcome.7 Further, the patient's recovery was complicated by hospital-acquired pneumonia, which has a mortality rate of 9.7%.8 Accordingly, amid the emergent discipline of enhanced recovery after surgery, optimized protocols for postoperative management could benefit these patients.9-11.
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Observational Study
Trends in hospitalisation and mortality rates associated with subarachnoid haemorrhage and unruptured cerebral aneurysms in Brazil.
Epidemiology of spontaneous subarachnoid hemorrhage (SAH) and unruptured intracranial aneurysm (UIA) is valuable for determining neurosurgical and general health care effectiveness. There is an information gap regarding these conditions in middle- and low-income countries. Therefore, we aimed to investigate hospitalization and mortality rates for SAH and UIA in Brazil from 2011 to 2019. ⋯ In Brazil, the SAH hospitalization trend is stable, although there is a worrisome increasing SAH-related mortality trend. A better scenario was observed for UIA, with an increase in hospitalizations and decrease in mortality.
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Volatile anesthetics have shown neuroprotective effects in preclinical studies, but clinical data on their use after aneurysmal subarachnoid hemorrhage (aSAH) are limited. This study aimed to analyze whether the use of volatile anesthetics for neurocritical care sedation affects the incidence of delayed cerebral ischemia (DCI), cerebral vasospasm (CVS), DCI-related infarction, or functional outcome. ⋯ Volatile sedation in aSAH patients is not associated with the incidence of DCI, CVS, DCI-related infarction, or functional outcome. Although we could not demonstrate neuroprotective effects of volatile anesthetics, our results suggest that volatile sedation after aSAH has no negative effect on the patient's outcome.
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Cerebral infarction remains an important cause of death or disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal SAH at a national level are not known. ⋯ Cerebral infarction was seen in 54% of the patients with a trend toward an increase in the affected proportion of patients with aneurysmal SAH. Patients with cerebral infarction had higher rates of adverse outcomes and required higher resources during hospitalization.