scholarly journals The Fisher Grade in predicting a degree of cerebral vasospasm in patients after intracranial aneurysm rupture

2016 ◽  
Vol 73 (4) ◽  
pp. 349-352 ◽  
Author(s):  
Djula Djilvesi ◽  
Tomislav Cigic ◽  
Vladimir Papic ◽  
Igor Horvat ◽  
Mladen Karan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Ct Angiography ◽  
Cerebral Vasospasm ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Statistical Significance ◽  
Aneurysm Rupture ◽  
Prospective Clinical Study ◽  
Ruptured Intracranial Aneurysm ◽  
Fisher Grade

Background/Aim. Intracranial aneurysms are pathological enlargement of the wall of cerebral arteries. Intracranial aneurysms rupture is a dramatic event with a significant morbidity and mortality. The Fisher Grade is widely accepted in assessment of the extensiveness of aneurysmal subarachnoid hemorrhage (aSAH) and the presence of other intracranial hemorrhage on the computed tomography (CT) scan. Significant early complication of a aSAH may be a cerebral vasospasm. The aim of this study was to determine the relationship between the extensiveness of aSAH, assessed by the Fisher Grade on admission, with the intensity of cerebral vasospasm in patients with ruptured intracranial aneurysm. Methods. This prospective clinical study included 50 patients with aSAH hospitalized at the Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia. All the patients underwent 256-layer cranial CT and CT angiography on admission and on the day 9. Based on native CT scans, they were classified according to the Fisher Grade. On CT angiography images, intensity of cerebral vasospasm was determined. Results. On the basis of admission CT images, 24% of patients were classified into the Fisher Grade group 2, while 34% and 42% were in the groups 3 and 4, respectively. A positive correlation of the Fischer Grade on admission with the intensity of cerebral vasospasm was established, but with no statistical significance (? = 0.273, p = 0.160). Conclusion. This study showed that the Fisher Grade is not significant in predicting the intensity of cerebral vasospasm in patients hospitalized with intracranial aneurysm rupture.

383 Fever and Leukocytosis as a Predictor of DCI After SAH

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 291-291
Author(s):  
Diane Aum ◽  
Ananth K Vellimana ◽  
Alexander Padovano ◽  
Eric J Arias ◽  
Umeshkumar Athiraman ◽  
...  
Keyword(s):  
Cerebral Vasospasm ◽  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Aneurysm Rupture ◽  
Poor Outcome ◽  
Angiographic Vasospasm ◽  
Fisher Grade ◽  
Potential Risk Factors ◽  
Primary Driver

Abstract INTRODUCTION Aneurysmal subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. Delayed cerebral ischemia (DCI) is a major cause for poor outcome after SAH. Cerebral vasospasm is the primary driver of DCI, and the largest independent contributor to poor outcome after SAH. Prior studies have reported an association between fever and leukocytosis, and cerebral vasospasm. In this study, we assessed the utility of fever and/or leukocytosis to predict DCI after SAH. METHODS We performed a retrospective analysis of 187 SAH patients. Univariate and multivariate logistic regression was performed to identify potential risk factors for three different endpoints - (a) Mild, Moderate, or Severe Angiographic Vasospasm, (b) Moderate or Severe Angiographic Vasospasm, and (c) Symptomatic DCI. Multiple independent variables including age, Hunt-Hess grade, modified Fisher grade, fever (T>/= 38.0 °C), WBC >/= 10, WBC >/= 15, fever and WBC >/= 10, fever and WBC >/= 15 were examined over the course of each hospital stay. RESULTS >Presence of fever and/or leukocytosis were both significant predictors of symptomatic DCI. In addition, number of days with fever following aneurysm rupture was strongly associated with angiographic vasospasm, while number of days with WBC>/= 15 was strongly associated with symptomatic DCI. When these variables were combined, number of days with concurrent fever and WBC>/= 10 was an independent predictor of angiographic vasospasm, and number of days with concurrent fever and WBC>/= 15 was an independent predictor of both angiographic vasospasm and symptomatic DCI. Time intervals of Day 0–3 and Day 3–7 after aneurysm rupture had the highest odds ratios for angiographic vasospasm. CONCLUSION Patients with aneurysmal SAH who had higher number of days with fever and/or leukocytosis after aneurysm rupture were more likely to have angiographic vasospasm and symptomatic DCI. Presence of fever and/or leukocytosis may have utility in assessing the risk of DCI following SAH.

‘Plug and pipe’ strategy for treatment of ruptured intracranial aneurysms

2018 ◽  
Vol 11 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Brian M Howard ◽  
Jason M Frerich ◽  
Thomas P Madaelil ◽  
Jacques E Dion ◽  
Frank C Tong ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Acute Stage ◽  
Flow Diversion ◽  
Medical Illness ◽  
Ruptured Intracranial Aneurysm ◽  
Aneurysm Occlusion ◽  
Ruptured Intracranial Aneurysms

BackgroundAneurysmal subarachnoid hemorrhage is a potentially devastating condition, and among the first priorities of treatment is aneurysm occlusion to prevent re-hemorrhage. An emerging strategy to treat patients whose aneurysms are not ideal for surgical or endovascular treatment is subtotal coiling followed by flow diversion in the recovery phase or ‘plug and pipe’. However, data regarding the safety and efficacy of this strategy are lacking.MethodsA retrospective cohort study was performed to evaluate the efficacy and safety of ‘plug and pipe’. All patients with a ruptured intracranial aneurysm intentionally, subtotally treated by coiling in the acute stage followed by flow diversion after recovery, were included. The primary outcome was re-hemorrhage. Secondary outcomes included aneurysm occlusion and functional status. Complications were reviewed.Results22 patients were included. No patient suffered a re-hemorrhage, either in the interval between coiling and flow diversion or in follow-up. The median interval between aneurysm rupture and flow diversion was 3.5 months. Roy–Raymond (R-R) class I or II occlusion was achieved in 91% of target aneurysms at the last imaging follow-up (15/22(68%) R-R 1 and 5/22(23%) R-R 2). Complications occurred in 2 (9%) patients, 1 of which was neurological.ConclusionsOverall, these data suggest that subtotal coiling of ruptured intracranial aneurysms followed by planned flow diversion is both safe and effective. Patients who may most benefit from ‘plug and pipe’ are those with aneurysms that confer high operative risk and those whose severity of medical illness increases the risk of microsurgical clip ligation.

Clip ligation for ruptured intracranial aneurysm in a child with Loeys-Dietz syndrome: case report

2018 ◽  
Vol 21 (4) ◽  
pp. 375-379 ◽  
Author(s):  
Steven B. Carr ◽  
Greg Imbarrato ◽  
Robert E. Breeze ◽  
C. Corbett Wilkinson
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Pediatric Patient ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
The Other ◽  
Parent Artery ◽  
Ruptured Intracranial Aneurysm ◽  
Arterial Branch

The authors present the case of a pediatric patient with Loeys-Dietz syndrome (LDS) who underwent craniotomy for clip ligation of a ruptured intracranial aneurysm. To the authors’ knowledge, this is the youngest reported patient with LDS who has been treated for a ruptured intracranial aneurysm. The patient presented with aneurysmal subarachnoid hemorrhage even though the results of surveillance screening were negative, and the aneurysm arose from the wall of the parent artery away from an arterial branch point. She was treated with open clip ligation and recovered well. The authors review the other reported cases of treated intracranial aneurysms in patients with LDS.

scholarly journals Secular pattern of aneurismal rupture with the lunar cycle and season

2016 ◽  
Vol 23 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Jillian C Banfield ◽  
Mohamed Abdolell ◽  
Jai S Shankar
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Full Moon ◽  
Lunar Cycle ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
The Moon ◽  
Moon Phases ◽  
Ruptured Intracranial Aneurysm ◽  
New Moon

Background The lunar cycle and seasons may be associated with rates of rupture of intracranial aneurysms, but the literature is mixed. Studies of the association between the lunar cycle and rates of aneurysm rupture used the eight qualitative moon phases. The purpose of this study was to assess any association of aneurysm rupture with the lunar cycle and with the season. Materials and methods We retrospectively reviewed all cases of subarachnoid haemorrhage secondary to ruptured intracranial aneurysm treated with endovascular coiling in our institution over a 10-year period. We included only cases with a known rupture date. We used the degree of illumination of the moon to quantitatively code the lunar cycle. Results A total of 212 cases were included in our analyses. The odds of aneurysm rupture were significantly greater ( p < 0.001) when the moon was least (new moon) and most (full moon) illuminated, as compared to the middle of the lunar cycle. The odds of rupture tended to be higher ( p = 0.059) in the summer, compared to autumn. Conclusions The odds of aneurysm rupture were greater when the moon was least illuminated (new moon) and most illuminated (full moon), compared to the middle of the lunar cycle.

scholarly journals Identification of upregulated NF-κB inhibitor alpha and IRAK3 targeting lncRNA following intracranial aneurysm rupture-induced subarachnoid hemorrhage

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Leng ◽  
Dan Fan ◽  
Zhong Ren ◽  
Qiaoying Li
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Signaling Pathway ◽  
Aneurysm Rupture ◽  
Cytokine Receptor ◽  
Gene Set Enrichment Analysis ◽  
Receptor Interaction ◽  
Regulatory Pathways ◽  
Ruptured Intracranial Aneurysm ◽  
Neurotrophin Signaling

Abstract Background This study was performed to identify genes and lncRNAs involved in the pathogenesis of subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysm (RIA). Methods Microarray GSE36791 was downloaded from Gene Expression Omnibus (GEO) database followed by the identification of significantly different expressed RNAs (DERs, including lncRNA and mRNA) between patients with SAH and healthy individuals. Then, the functional analyses of DEmRNAs were conducted and weighted gene co-expression network analysis (WGCNA) was also performed to extract the modules associated with SAH. Following, the lncRNA-mRNA co-expression network was constructed and the gene set enrichment analysis (GSEA) was performed to screen key RNA biomarkers involved in the pathogenesis of SAH from RIA. We also verified the results in a bigger dataset GSE7337. Results Totally, 561 DERs, including 25 DElncRNAs and 536 DEmRNAs, were identified. Functional analysis revealed that the DEmRNAs were mainly associated with immune response-associated GO-BP terms and KEGG pathways. Moreover, there were 6 modules significantly positive-correlated with SAH. The lncRNA-mRNA co-expression network contained 2 lncRNAs (LINC00265 and LINC00937) and 169 mRNAs. The GSEA analysis showed that these two lncRNAs were associated with three pathways (cytokine-cytokine receptor interaction, neurotrophin signaling pathway, and apoptosis). Additionally, IRAK3 and NFKBIA involved in the neurotrophin signaling pathway and apoptosis while IL1R2, IL18RAP and IL18R1 was associated with cytokine-cytokine receptor interaction pathway. The expression levels of these genes have the same trend in GSE36791 and GSE7337. Conclusion LINC00265 and LINC00937 may be implicated with the pathogenesis of SAH from RIA. They were involved in three important regulatory pathways. 5 mRNAs played important roles in the three pathways.

scholarly journals Morphological variables associated with ruptured basilar tip aneurysms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jian Zhang ◽  
Anil Can ◽  
Pui Man Rosalind Lai ◽  
Srinivasan Mukundan ◽  
Victor M. Castro ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Multivariable Analysis ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Width Ratio ◽  
Maximum Height ◽  
Morphological Parameters ◽  
Flow Angle ◽  
Aneurysm Wall ◽  
Fisher Grade

AbstractMorphological factors of intracranial aneurysms and the surrounding vasculature could affect aneurysm rupture risk in a location specific manner. Our goal was to identify image-based morphological parameters that correlated with ruptured basilar tip aneurysms. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 200 patients with basilar tip aneurysms diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016 were evaluated. We examined aneurysm wall irregularity, the presence of daughter domes, hypoplastic, aplastic or fetal PCoAs, vertebral dominance, maximum height, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. In multivariable analysis, presence of a daughter dome, aspect ratio, and larger flow angle were significantly associated with rupture status. We also introduced two new variables, diameter size ratio and parent-daughter angle ratio, which were both significantly inversely associated with ruptured basilar tip aneurysms. Notably, multivariable analyses also showed that larger diameter size ratio was associated with higher Hunt-Hess score while smaller flow angle was associated with higher Fisher grade. These easily measurable parameters, including a new parameter that is unlikely to be affected by the formation of the aneurysm, could aid in screening strategies in high-risk patients with basilar tip aneurysms. One should note, however, that the changes in parameters related to aneurysm morphology may be secondary to aneurysm rupture rather than causal.

Abstract WMP30: Circulating MicroRNAs as Potential Novel Diagnostic Biomarkers for Ruptured Intracranial Aneurysm

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Zhang Xin ◽  
Liu L Ping
Keyword(s):  
Intracranial Aneurysm ◽  
Target Genes ◽  
Bioinformatic Analysis ◽  
Aneurysm Rupture ◽  
Pathological Process ◽  
Differentially Expressed ◽  
Diagnostic Biomarkers ◽  
Ruptured Intracranial Aneurysm ◽  
Novel Biomarkers ◽  
Aneurysm Development

Background and Objective: MicroRNAs have been shown to regulate in several pathological process of intracranial aneurysms. The study aimed to estimate whether miRNAs have the potential to become novel biomarkers for intracranial aneurysm rupture. Materials and methods Forty-five ruptured intracranial aneurysm patients were enrolled according to the inclusion criteria, meanwhile thirty-five healthy individuals were recruited in this study. Differentially expressed plasma miRNA profiles were screened in five pairs of patients and controls in microarray study. Then validation was performed in the rest of the objects using quantitative real-time PCR assays. Results: Fourteen significantly changed miRNAs were screened out from patients with aneurysms compared with healthy controls. More than three thousand target genes related to these disregulated miRNAs were found and bioinformatic analysis revealed that these miRNA were involved in intracranial aneurysm development and rupture. Ultimately four miRNAs from screening profile and one supplementary miRNA were demonstrated to be significantly altered. Conclusion: We demonstrated that several miRNAs were differentially expressed among ruptured aneurysm patients and healthy participants, and plasma miRNAs may be novel diagnostic biomarkers in intracranial aneurysm rupture.

Abstract 147: Role of Nicotine in the Development of Intracranial Aneurysm Rupture

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yoshinobu Kamio ◽  
Hajime Furukawa ◽  
Kimihiko Yokosuka ◽  
Masaaki Korai ◽  
Kazuha Mitsui ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Tobacco Smoke ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Alpha7 Nicotinic Acetylcholine Receptor ◽  
Acetate Salt ◽  
Nicotine Receptors ◽  
Aneurysm Wall ◽  
Salt Hypertension

Background: Nicotine is one of main chemicals of tobacco smoke and promotes atherosclerosis and stroke. Tobacco smoke is considered an independent risk factor for intracranial aneurysm formation, growth, and rupture. There are mainly 5 subtypes of nicotine receptors. Roles of alpha7 nicotinic acetylcholine receptor (α7nAChR) in inflammation and vascular remodeling are diverse and context-dependent. Notably, endothelial α7nAChR is considered to mediate nicotine-induced inflammation. Activation of endothelial α7nAChR by nicotine may promote aneurysm rupture by increasing the aneurysm wall inflammation. Using a mouse model of intracranial aneurysm, we examined effects of nicotine in aneurysm rupture. Moreover we investigated potential roles of α7nAChR stimulation by nicotine in the pathophysiology of intracranial aneurysms. Methods: Intracranial aneurysms were induced by a combination of elastase injection into the cerebrospinal fluid and deoxycorticosteron acetate-salt (DOCA-salt) hypertension in male mice. Mice were treated with (1) nicotine (5 mg/kg/day, n=25); (2) saline sc (n=22) for three weeks after aneurysm induction. To investigate the effect of α7nAChR, mice were treated with (1) saline sc + saline ip (n=11); (2) saline sc + α7nAChR antagonist (Methyllycaconitine, MLA 5mg/kg/day) ip (n=13); (3) nicotine (5 mg/kg/day, sc, 28 days) + saline ip (n=18); (4) nicotine sc + MLA ip (n=18). Results: Nicotine alone significantly increased aneurysmal rupture compared with saline treatment (89% vs 46%, p=0.009). While α7nAChR antagonist did not affect the incidence of aneurysm or rupture rates, the α7nAChR antagonist significantly reduced the deleterious effect of nicotine as indicated by the reduction of the rupture rates (41% vs 100%: nicotine sc + MLA ip group vs nicotine sc + saline ip group, p=0.027). Conclusion: Our data indicate the promotion of aneurysm rupture by nicotine may be mediated by its stimulation of alpha7nAChR.

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