Subarachnoid hemorrhage Research Papers - Academia.edu (original) (raw)

Matrix coils are based on Gugliemi detachable coils (GDC) but are covered with polyglycolic/polylactic acid. We present our experience regarding the immediate posttreatment results of aneurysm embolization using the 2 coil systems. We... more

Matrix coils are based on Gugliemi detachable coils (GDC) but are covered with polyglycolic/polylactic acid. We present our experience regarding the immediate posttreatment results of aneurysm embolization using the 2 coil systems. We embolized 219 aneurysms in 187 patients with the use of GDCs and 145 aneurysms in 120 patients with the use of Matrix coils. Age, sex distribution, unruptured aneurysm cases, and multiple aneurysm cases were similar in the 2 groups. The percentage of patients in severe clinical condition was significantly higher in the Matrix group. The mean aneurysm size was slightly larger in the GDC group but the mean neck size was larger in the Matrix group. Satisfactory occlusion (at least 90%) was achieved in 95.9% of GDC-treated aneurysms and in 98.6% of Matrix-treated aneurysms. Procedure-related complications occurred in 19.6% of GDC procedures and in 15.6% of the Matrix ones resulting in procedure-related mortality and morbidity of 3.7% and 2.7% for the GDC g...

Subarachnoid hemorrhage (SAH) is a medical emergency which can lead to death or severe disability. Misinterpretation of computed tomography (CT) in patients with SAH is a common problem. How to improve the accuracy of diagnosis is a great... more

Subarachnoid hemorrhage (SAH) is a medical emergency which can lead to death or severe disability. Misinterpretation of computed tomography (CT) in patients with SAH is a common problem. How to improve the accuracy of diagnosis is a great challenge to both the clinical physicians and medical researchers. In this paper we proposed a method for the automatic detection of SAH on clinical non-contrast head CT scans. The novelty includes approximation of the subarachnoid space in head CT using an atlas based registration, and exploration of support vector machine to the detection of SAH. The study included 60 patients with SAH and 69 normal controls from clinical hospitals. Thirty patients with SAH and 30 normal controls were used for training, while the rest were used for testing to achieve a testing sensitivity of 100% and specificity of 89.7%. The proposed algorithm might be a potential tool to screen the existence of SAH.

Background and Purpose— The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the... more

Background and Purpose— The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the endovascular coiling procedure (particularly the coils) led health care purchasers to conclude that coiling was a more costly procedure overall. To examine this assumption and provide evidence for future policy, accurate and comprehensive data are required on the overall resource usage and cost of each strategy. Methods— We provide detailed results of patient treatment pathways, resource utilization, and costs up to 24 months postrandomization for endovascular and neurosurgical treatment of aSAH. We report data on costs related to initial and subsequent procedures (ward days, ITU, equipment, staff, consumables, etc), adverse events, complications, and follow up. The data are based on a subsample of all patients randomized in ISAT, containing all patients a...

Ecchordosis physaliphora is a rare congenital, benign, hamartomatous, retroclival mass derived from notochordal tissue that is typically located intradurally in the prepontine cistern. Ecchordosis physaliphora is usually asymptomatic. In... more

Ecchordosis physaliphora is a rare congenital, benign, hamartomatous, retroclival mass derived from notochordal tissue that is typically located intradurally in the prepontine cistern. Ecchordosis physaliphora is usually asymptomatic. In rare cases, ecchordosis physaliphora can be symptomatic due to tumor expansion and compression of the surrounding structures and extratumoral hemorrhage. To our knowledge, ecchordosis physaliphora associated with intratumoral hemorrhage and vasogenic edema has not been previously described. We present a case of 22-year-old man who presented with headache and confusion. MR imaging and CT revealed intracranial ecchordosis physaliphora associated with intratumoral hemorrhage and vasogenic edema. The neurological findings resolved completely after medical therapy.

We describe a convenient method for the separation and quantification of xanthine, hypoxanthine, and uric acid in 20 microL of cerebrospinal fluid (CSF) with use of HPLC and ultraviolet detection. The analysis is performed on a Sepharon... more

We describe a convenient method for the separation and quantification of xanthine, hypoxanthine, and uric acid in 20 microL of cerebrospinal fluid (CSF) with use of HPLC and ultraviolet detection. The analysis is performed on a Sepharon SGX C18 column and the elution system consists of potassium phosphate buffer, pH 5.1, with 20 mL/L methanol. The lower limit of detection was 4 pmol for hypoxanthine and xanthine and 6 pmol for uric acid. Analytical recoveries of purine metabolites ranged from 98.6% to 102.9%. The intra- and interassay CVs were <3%. The applicability of the method is illustrated with the determination of micromolar concentrations of xanthine, hypoxanthine, and uric acid in CSF samples obtained from 113 patients with various neurological disorders.

Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI. We used data of 3 phase II randomized clinical trials and a... more

Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI. We used data of 3 phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI. The VASOGRADE derived from previously published risk charts and consists of 3 categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [WFNS] 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1-3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade). The relation between the VASOGRADE and DCI was assessed by logistic regression models. The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots. In a cohort of 746 patients, the VASOGRADE significantly predicted DCI (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The VASOGRADE-Yellow had a tendency for increased risk for DCI (odds ratio [OR], 1.31; 95% CI, 0.77-2.23) when compared with VASOGRADE-Green; those with VASOGRADE-Red had a 3-fold higher risk of DCI (OR, 3.19; 95% CI, 2.07-4.50). Studies were not a significant confounding factor between the VASOGRADE and DCI. The VASOGRADE had an adequate discrimination for prediction of DCI (area under the receiver operating characteristics curve=0.63) and good calibration. The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.

Background The PGWBI is a 22-item health-related Quality of Life (HRQoL) questionnaire developed in US which produces a self-perceived evaluation of psychological well-being expressed by a summary score. The PGWBI has been validated and... more

Background The PGWBI is a 22-item health-related Quality of Life (HRQoL) questionnaire developed in US which produces a self-perceived evaluation of psychological well-being expressed by a summary score. The PGWBI has been validated and used in many countries on large samples of the general population and on specific patient groups. Recently a study was carried out in Italy to reduce the number of items of the original questionnaire, yielding the creation of a shorter validated version of the questionnaire (PGWB-S). The purpose of the present paper is to describe the methods adopted and to report and discuss the relevance of results. Methods Data for this study were collected from 4 different population samples: two general population samples a student and a patient sample. On the basis of the results of the first (development) sample population, six relevant items were identified statistically from the original questionnaire and grouped to assemble a new summary scale. Following the newly created 6-item questionnaire was administered in three independent population samples. Descriptive statistics, correlation coefficients, univariate and multivariate regression analyses were used to compare the performance of the long and short questionnaire, within and between population samples and across relevant subgroups. A further independent sample extracted by an ongoing cancer clinical trial served as final validation step. Results Overall, the questionnaires were administered to 1443 subjects. Six items were selected by a step-wise approach to explain 90% of the variance of the summary measure of the original questionnaire. Response rates reached 100%, while missing items were not observed. University students (n = 400) showed the highest mean value of the summary measure (75.3); while the patient sample (n = 28) had the lowest score (71.5). The correlation coefficients between the summary measures and the single items according to the different studies were satisfactory, reaching the highest estimates in the student sample. The internal consistency showed high values of the Cronbach's alpha coefficient (range 0.80 – 0.92) for all three study samples, coming close to the value of the coefficient established for the original questionnaire (0.94). A cross-validation in an independent sample of 755 cancer patients confirmed the item selection procedure and amount of variance explained by the new shorter questionnaire (ranging from 90. 2 to 95.1 %, across age and sex strata). Conclusion The newly identified PGWB-S showed good acceptability and validity for the use in various settings in Italy. The translation of the PGWB-S into different languages, and its use in other linguistic settings will add evidence about its cross-cultural validity.

Background: El vasoespasmo cerebral como complicación de hemorragia subaracnoidea genera un alto impacto en morbilidad, estancia, costos y mortalidad hospitalarias. Objective: Determinar las concentraciones séricas de óxido nítrico ON) y... more

Background: El vasoespasmo cerebral como complicación de hemorragia subaracnoidea genera un alto impacto en morbilidad, estancia, costos y mortalidad hospitalarias. Objective: Determinar las concentraciones séricas de óxido nítrico ON) y malondialdehído (MDA) en pacientes con hemorragia subaracnoidea y su relación con el vasoespasmo cerebral. Method: Se realizó un estudio observacional, descriptivo, longitudinal, de cohorte, prospectivo. Se incluyeron un total de 52 pacientes, los cuales se dividieron en 2 grupos: 1) pacientes con hemorragia subaracnoidea (n=26), 2) pacientes sanos (n=26). Se realizó un análisis estadístico mediante la prueba de ANOVA, X2 y un modelo de regresión de Cox. Results: Observamos un incremento de las concentraciones séricas del ON en la fase aguda de la hemorragia y en el estadio subagudo se observó un descenso por debajo de la concentración sérica de los controles. El MDA mostró un comportamiento similar observando un incremento de la fase aguda y posteriormente un descenso gradual sin llegar a la concentración del grupo control con diferencias significativas. Conclusions: Nuestros resultados demuestran que las concentraciones séricas de ON y MDA incrementan significativamente durante la fase aguda de la HSA y disminuyen durante su evolución, no se encontró una asociación con el desarrollo de vasoespasmo.