Articles: subarachnoid-hemorrhage.
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Journal of neurosurgery · Jan 2025
Risk factors of short-term poor functional outcomes and long-term durability of ruptured large or giant intracranial aneurysms.
Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality rates. In particular, functional outcomes of SAH caused by large or giant (≥ 10 mm) ruptured intracranial aneurysms are worsened by high procedure-related complication rates. However, studies describing the risk factors for poor functional outcomes specific to ruptured large/giant aneurysms are sparse. In addition, high recurrence and rebleeding rates following treatment of such aneurysms remain a concern. This study aimed to clarify the specific risk factors for poor short-term outcomes and long-term durability of SAH due to ruptured large/giant intracranial aneurysms using a multicenter observational database in Japan. ⋯ Increasing aneurysm size was identified as a risk factor for poor functional outcomes after SAH due to large/giant aneurysms and was affected by the interaction with other conventional risk factors. Endovascular therapy was more likely to be associated with better short-term outcomes; however, a higher delayed rebleeding rate after 1 year was a concern.
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The adverse impact of disturbmitochondrialbiogenesis onearly brain injury (EBI) following subarachnoid haemorrhage (SAH) has been broadly recognized and is closely associated with oxidative stress and neuronal apoptosis. Previous studies have indicated the therapeutic potential of Ropinirole, a dopamine D2 agonist, in Ischemic Stroke. However, there is a lack of evidence regarding the ability of Ropinirole to enhance mitochondrial biogenesis and quality control after subarachnoid haemorrhage. ⋯ Further research showed that, Ropinirole therapy inhibit Drp1-mediated fission by accelerating the activity of fusion protein Mfn2/OPA1 along with regulating the translocation of PGC1-α and SIRT3 through restricting cytochrome C inside mitochondria to maintain mitochondrial metabolism. Ropinirole exerted neuroprotective effects by improving mitochondrial activity in a PGC1-α/SIRT3-dependent way via regulating Drp1 mediated fission. The effective treatment for SAH-induced EBI may involve increasing biogenesis and inhibiting excessive mitochondrial fission with Ropinirole.
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Socioeconomic status affects outcomes in cerebrovascular disease, although its role in the withdrawal of life-sustaining treatments (WLST) remains uncertain. We aim to examine the impact of socioeconomic factors on outcomes including WLST in aneurysmal subarachnoid hemorrhage (aSAH). ⋯ Higher EIS and residing in areas with higher neighborhood incomes were associated with higher odds of WLST in aSAH. Further multicenter studies are needed to investigate the underlying mechanisms that contribute to these associations.
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Eclampsia is a multisystem disorder of pregnancy and the puerperium. Posterior reversible encephalopathy syndrome (PRES), a neurotoxic condition characterized by various neurological symptoms, can arise from multiple causes including eclampsia. Although hemorrhage is a possible complication of PRES, subarachnoid hemorrhage (SAH) is a rare occurrence in eclamptic patients with this condition. ⋯ Treatment started, and the patient improved and was discharged from the hospital without any residual symptoms. This case illustrates how eclampsia can be a risk factor for PRES, and although hemorrhagic PRES is becoming more recognized, SAH remains an unusual but critical presentation. Early and accurate diagnosis, along with effective management, is crucial for achieving a positive outcome.
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J Neurosurg Anesthesiol · Jan 2025
Reducing Cerebrospinal Fluid Sampling Frequency and Costs in Patients With Ventriculostomy for Aneurysmal Subarachnoid Hemorrhage: A Quality Improvement Initiative.
We implemented a quality improvement project to transition from routine cerebrospinal fluid (CSF) sampling to indication-based sampling in aneurysmal subarachnoid hemorrhage (aSAH) patients with an external ventricular drain (EVD). ⋯ Transitioning from routine to indication-based CSF sampling in aSAH patients with an EVD reduced sampling frequency and associated costs without increasing infection rates.