Articles: subarachnoid-hemorrhage.
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American family physician · Oct 2023
Nontraumatic Subarachnoid Hemorrhage and Ruptured Intracranial Aneurysm: Recognition and Evaluation.
Subarachnoid hemorrhage caused by a ruptured intracranial aneurysm is a neurosurgical emergency with a mortality rate of approximately 50%. Prompt identification and treatment of aneurysmal subarachnoid hemorrhage are paramount to reduce mortality, long-term morbidity, and health care burden for survivors. The prevalence of intracranial aneurysms is 2% to 6% of the global population, many of which are found incidentally during workup for an unrelated condition. ⋯ The Ottawa Subarachnoid Hemorrhage Rule is a validated clinical decision tool to help determine which patients with a sudden, acute headache require imaging with noncontrast computed tomography. Based on the results of initial computed tomography and duration of symptoms, the patient may require a lumbar puncture or additional imaging to confirm the diagnosis. Prompt diagnosis of an aneurysmal subarachnoid hemorrhage is essential to patients receiving definitive treatment.
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We analyzed the data of patients enrolled in the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to develop and validate a model to predict the risk of aneurysmal hemorrhage. ⋯ This prospective study identifies dome-to-neck ratio >2.5, irregular shape, presence of daughter sac, absence of aspirin use, and aneurysm location at anterior communicating and posterior communicating artery as factors associated with increased risk of hemorrhagic presentation in small- to medium-sized intracranial aneurysms. Our model provides an estimate of rupture risk based on the presence or absence of these factors.
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J Neurosurg Anesthesiol · Oct 2023
Cerebral Microdialysis Monitoring of Energy Metabolism: Relation to Cerebral Blood Flow and Oxygen Delivery in Aneurysmal Subarachnoid Hemorrhage.
In this study, we investigated the roles of cerebral blood flow (CBF) and cerebral oxygen delivery (CDO 2 ) in relation to cerebral energy metabolism after aneurysmal subarachnoid hemorrhage (aSAH). ⋯ While MD is a feasible tool to study cerebral energy metabolism, its validity is limited to a focal area around the MD catheter. Cerebral energy disturbances were more related to low CBF than to low CDO 2 . Considering the high rate of mitochondrial dysfunction, treatments that increase CBF but not CDO 2 , such as hemodilution, may still benefit glucose delivery to drive anaerobic metabolism.
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The brain is the command center of the rest of the body organs. The normal multiorgan talks between the brain and the rest of the body organs are essential for the normal body homeostasis. In the presence of brain injury, the disturbed talks between the brain and the rest of body organs will result in several pathological conditions. The aim of this review is to present the most recent findings for the pathological conditions that would result from the impaired multiorgan talks in the presence of brain injury. ⋯ Better understanding of the pathological conditions that could result from the impaired multiorgan talks in the presence of brain injury will open the doors for precise targeted therapies in the future for myriad of pathological conditions.
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Delayed cerebral ischemia (DCI) is a major determinant for poor neurological outcome after aneurysmal subarachnoid hemorrhage (aSAH). Detection and treatment of DCI is a key component in the neurocritical care of patients with aSAH after initial aneurysm repair. ⋯ The current literature review underscores the need for incorporating existing modalities and developing new methods to evaluate brain perfusion, brain metabolism, and overall brain function more accurately and more globally.