Preparation of a rat model of subarachnoid hemorrhage by a fiber core inserted in the internal carotid artery / 中国比较医学杂志

Objective To report a newly developed method and procedure to establish a rat model of subarachnoid hemorrhage in detail, and to provide a better model simulating the clinical subarachnoid hemorrhage caused by a ruptured aneurysm for related research.Methods One hundred and twenty healthy SPF 2-3-month old male Sprague-Dawley rats were divided into 4 groups, 30 rats in each group.The three experimental groups were sacrificed at 6, 24 and 72 hours after modeling.Rat models of subarachnoid hemorrhage were established by inserting a fiber core in the internal carotid artery and piercing this artery.Successful establishment of the subarachnoid hemorrhage model was confirmed by observation of breathing, pupil, defecation, urination and inspection at autopsy dissection.The controllability and reproducibility of this model were verified by observation of clinical manifestation and explored by mortality analysis.Results Subarachnoid hemorrhage was successfully induced by fiber core piercing the internal carotid artery at the needed location.Conclusions This method of model preparation is stable and understandable.The operation is nimble, with a good reproducibility.This model can be successfully performed after a short time learning, well simulate the sudden hemorrhage caused by a ruptured aneurysm, and suitable for research on early brain injury and vasospasm after subarachnoid hemorrhage.

Factors Related to Subarachnoid Hemorrhage as a Cause of Out-of-Hospital Cardiac Arrest

PURPOSE: Subarachnoid hemorrhage (SAH) is a common cause of out-of-hospital cardiac arrest (OHCA). Early identification of patients with SAH induced OHCA may be helpful to emergency physicians when making therapeutic decisions. We conducted an investigation of the incidence and characteristics of patients with OHCA caused by non-traumatic SAH. METHODS: We conducted a retrospective review of cases of 236 OHCA survivors who had visited the emergency department (ED) of an urban tertiary care university hospital from January 2004 to December 2010. We excluded patients for whom there was an obvious cause or trauma. Clinical characteristics of SAH induced OHCA survivors were compared with those of SAH negative OHCA survivors. RESULTS: A total of 26 patients (19.11%) had been diagnosed with SAH. Compared with SAH negative survivors, SAH positive survivors were more likely to be female (odds ratio OR, 1.262; 95% confidence interval CI, 1.300-9.605), not to have Diabetes mellitus (OR, 0.180; 95% CI, 0.037-0.879), and to have a short duration of CPR time (OR, 1.074; 95% CI, 1.003-1.150). Results of the Cardiac Troponin T assay were less likely to be positive in patients with SAH induced OHCA, compared to those with SAH negative OHCA (OR, 0.071; 95% CI, 0.008-0.526). CONCLUSION: SAH is a more frequent cause of OHCA than originally believed. Immediate brain CT scan is useful in diagnosis of SAH when patient characteristics include: female, non diabetes mellitus, short duration of CPR time, or negative TnT.

The Clinical Aspects of Subarachnoid Hemorrhage / 신경중재치료의학

Subarachnoid hemorrhage (SAH) is less frequent than ischemic stroke, but has a high public health relevance because it can affect young and middle-age adults, has considerable mortality and morbidity, it is treatable and preventable. Despite stable incidence, the mortality of SAH has decreased in the last two decades due to better neurosurgical techniques and neurocritical care and to advances in neuroendovascular treatment. Sudden headache is the cardinal feature. Rebleeding is the most imminent danger; a first aim is therefore occlusion of the aneurysms. Complications such as vasospasm/delayed cerebral ischemia, hydrocephalus, increased intracranial pressure, and seizures must be considered in the management of SAH. The authors reviewed the recent advances in the clinical aspects of SAH and grading system of the available evidence is included.

A proposed scoring system to screen for vasospasm following aneurysmal subarachnoid hemorrhage

Vasospasm has been known to cause permanent morbidity in 40-70% of survivors who suffered from subarachnoid hemorrhage (SAH). Early recognition of vasospasm is the key to better outcome of SAH. Cerebral angiography is expensive and impractical as a monitoring tool. Transcranial Doppler is operator dependent, and not readily available. The objective of this study is to devise a non invasive tool to screen for cerebral vasospasm following SAH. The proposed vasospasm score was based on clinical and cranial CT scan features. The features are hypertension, admission World Federation of Neurosurgeons Score (WFNS), amount of blood in the cisterns and subarachnoid space, intraventricular hemorrhage and hydrocephalus. Thirty six patients with aneurismal SAH were assessed retrospectively and correlated with the angiogram for vasospasm. The patients’ vasospasm score and their corresponding sensitivity and specificity were: 1 (100%, 0%), 2 (100%, 8%), 3 (100%, 8%), 4 (100%, 8%), 5 (91%, 46%), 6 (74%, 85%), 7 (48%, 85%), 8 (26%, 23%), 9 (3%, 100%), 10 (4%, 100%). A receiver operator characteristic curve was constructed that yielded a cut-off score of 6. The score of 6 was a good trade-off between sensitivity (74%) and specificity (85%). A clinical vasospasm score was proposed to screen for vasospasm after SAH. A score of 4 to 6 was found to correlate with angiographic vasospasm. Prospective study is required to validate the scoring system.

Ruptured Aneurysm of the Ophthalmic Artery

Aneurysms arising from the ophthalmic artery itself are very rare compared with aneurysms originating from the bifurcation of the ophthalmic artery and carotid artery. There was only one reported case of a ruptured aneurysm of the ophthalmic artery itself. We discuss clinical significance of an aneurysm at this site, as well as the role of three dimentional image of multislice computed tomography angiogram(3D-image of MCTA) in determining the cause of subarachnoid hemorrhage(SAH).

A Study of the Effect of Acute Subarachnoid Hemorrhage on Left Ventricular Function and the Relationship Between Acute Subarachnoid Hemorrhage and Plasma Brain Natriuretic Peptide / 医学研究杂志

0.05).②The mean of SV, the mean of CO and the mean of CI in acute SAH group were lower than those in healthy persons group respectively (33.46?11.33 vs 52.67?12.46,P

Usefulness of CT Perfusion in the Postoperative Evaluation of Ruptured Aneurysm / 대한뇌혈관외과학회지

OBJECTIVE: Our goal was to evaluate the usefulness of CT perfusion (CTP) in early detection of the post operative cerebral ischemia, alteration of treatment modality and patient prognosis in cerebral aneurysm patients. METHODS: 24 patients who underwent either surgical operation or endovascular coiling for ruptured aneurysms were selected. All patients undertook an angiogram, conventional CT, and CTP scan immediately following surgical operation or endovascular coiling. All patients performed a CT 2 weeks after treatment to evaluate possible development of a cerebral infarction. Postoperative CT results of patients with abnormal postoperative CTP scan findings were compared, and these results were compared with the CT results and clinical symptoms of patients who developed infarction or not. RESULTS: Of the 24 patients evaluated, 11 patients showed abnormal findings on CTP. 9 patients were diagnosed with cerebral infarction through a CT scan done 2 weeks after treatment; all exhibited abnormal CTP results immediately after treatment. Abnormal CTP findings were divided into two groups; patients with abnormal CBF and MTT maps, but with normal CBV maps, and patients with abnormal CBF, CBV and MTT maps. A correlation was seen between abnormality on CBV maps and cerebral infarction. Patients with abnormal CTP findings also exhibited poorer prognostic value. CONCLUSION: Postoperative CTP in ruptured aneurysm patients is a very useful and objective tool in evaluating abnormal cerebral hemodynamics. The CBV map of CTP is the most precisely predictable value of postoperative patient's status and alteration of treatement modality.

Continuous assessment of cerebral autoregulation in subarachnoid hemorrhage / 中国康复理论与实践

@#ObjectiveTo examined how autoregulation is affected by vasospasm after subarachnoid hemorrhage (SAH) by using transcranial Doppler. MethodsThe moving correlation coefficient between slow changes of arterial blood pressure and mean or systolic flow velocity (FV), termed Mx and Sx, respectively, was used to characterize cerebral autoregulation. Vasospasm was declared when the mean FV increased to more than 120 cm/s and the Lindegaard ratio was more than 3. This occurred in 15 of 32 SAH patients.On the basis of the bilateral transcranial Doppler recordings of the middle cerebral artery in vasospastic patients, Mx and Sx were calculated for baseline and vasospasm. ResultsMx increased during vasospasm (0.46±0.32) and was significantly higher (P=0.03) than at baseline (0.21±0.24) Sx was also increased (0.22±0.26 vs 0.05±0.21,P=0.03). Mx correlated with mean FV (P=0.577, P=0.006) and the Lindegaard ratio (r=0.672,P<0.01).Mx(P=0.006) and Sx (P=0.044) were higher on the vasospastic side compared with the contralateral side.ConclusionThe increased Mx and Sx during cerebral vasospasm demonstrate impaired cerebral autoregulation. Mx and Sx provide additional information on changes in autoregulation in SAH patients.

Relation of inflammatory inhibition and headache after subarachnoid hemorrhage / 中国康复理论与实践

@#ObjectiveTo explore pathogenesis of headache after subarachnoid hemorrhage (SAH) whether related with immune inflammatory reaction in subarachnoid and observe the effect of immunosuppressive action of dexamethasone on headache.Methods80 patients who was consciousness and complained headache after SAH were randomly divided into four groups, treated only with mannitol, mannitol plus cerebrospinal fluid (CSF) replacement, intrathecal and vein injection with dexamethasone. Effects of four groups were observed.ResultsEfficiencies of four groups were respectively the mannitol group 27.27%, the permutation group 66.67%, the intrathecal group 92.36% and the vein group 30.00%. There was a significantly difference between the intrathecal group and other three groups, and the time of headache remission for intrathecal group was also longer than that of other three groups (P<0.01).ConclusionThe wide immune inflammatory responses in subarachnoid induced by degenerative and hemic CSF is likely main cause of headache after SAH and intrathecal injection with dexamethasone has an obviously effect.

Clinical Value of Computed Tomographic Angiography: Our Prospective Clinical Trial / 대한뇌혈관외과학회지

OBJECTIVES: Computed tomographic angiography (CTA) to diagnose intracranial aneurysms in patients with spontaneous subarachnoid hemorrhage (SAH) has been well documented and widely accepted. In this study, it was assessed whether aneurysm surgery can be performed in aneurysm patients by using CTA regardless of their status. METHODS: To assess the clinical value of CTA, we treated patients with SAH using it as the primary means of diagnosis. During the period between August 2001 and May 2003, a consecutive series of 82 cases of ruptured cerebral aneurysms were evaluated via both CTA and postoperative transfemoral cerebral angiography(TFCA), and we investigated the detectability of cerebral aneurysms. In cases of vague CTA findings, we performed TFCA preoperatively. We correlated the CTA results with operative findings and preoperative TFCA, when performed. RESULTS: In 82 patients, 100 aneurysms (96 aneurysms via CTA, 1 aneurysm via TFCA, 3 aneurysms via operation) were disclosed. The size of aneurysms detected by CTA ranged from 1.95 mm to 19.4 mm. Aneurysms that were not found via TFCA were detected by CTA in two patients. Three additional small multiple aneurysms that could not be confirmed via CTA were found through operation. No previously undiscovered aneurysms were found via postoperative TFCA. Corresponding to the operative findings, the sensitivity of CTA was 96%. CONCLUSION: According to our results, we hold that CTA is the first choice among diagnostic methods for the treatment of SAH.

3-Dimensional Computed Tomography Angiography in Early Operation for Poor Grade Aneurysms

OBJECTIVE: The authors studied the feasibility of 3-Dimensional computed tomographic angiography(3-D CTA) in early surgery for poor grade patients with aneurysmal subarachnoid hemorrhage(SAH), therefore intended to verify the eligibility of this diagnostic tool in these special clinical settings. METHODS: During the period between July 1997 and December 2000, we studied 31 patients diagnosed as aneurysmal SAH that were classified as the Hunt-Hess grade IV or V and Fisher group III or IV. As the conventional angiography could not be conducted because of the patients' poor clinical conditions, we carried out early surgery on the same day of SAH solely based on the 3-D CTA. We compared the 3-D CTA features with intraoperative findings. RESULTS: Total of 33 aneurysms were found in preoperative 3-D CTA and, of them, all 31 ruptured aneurysms and additional another two unruptured ones were also. Undetected three aneurysms were found in the operative field(2 cases) and postoperative digital subtraction angiography(1 case). The sensitivity of 3-D CTA was 94.7% and specificity was 100%. CONCLUSION: According to our results, 3-D CTA might be sufficient for early surgery of intracranial aneurysms in poor grade SAH patients in urgent conditions.

he Changes of the Basilar Artery Following Experimental Cerebral Subarachnoidal Hemorrhage / 대한해부학회지

The cerebral artery spasm is a phenomenon frequently present in cases of subarachnoid hemorrhage (SAH). Previous reports indicated that vasospasm could be produced primarily by muscle contraction and constricted vessels that exhibit myonecrosis and subendothelial changes. Pharmacological studies have shown that vasospastic arteries decrease in contractility but increase the spontaneous tone and stiffness compared to normal cerebral arteries. We carried out electron microscopic to observe the morphological changes of the basilar artery following the experimental SAH. We examined changes in the size of the lumen and thickness of the basilar artery in SAH. Morphological changes of cerebral basilar artery following SAH : (1) The size of the lumen of basilar artery decreased about 47%, while its thickness increased about 170%. (2) The shape of the endothelial cell transformed to a cuboidal type and its thickness increased, while the length of the smooth muscle cell shortened and the thickness increased.

Detection of Acute Subarachnoid Hemorrhage: Comparison of FLAIR MR Imaging with Unenhanced CT

PURPOSE: Our aim was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging for detection of acute subarachnoid hemorrhage (SAH) compared with unenhanced CT. MATERIALS AND METHODS: We compared FLAIR MR images with unenhanced CT scans in 28 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0 (absence), 1 (suspicious), 2 (definite) in the cerebral sulci, sylvian fissure, basal cistern, and cisterns of the posterior fossa. We also compared FLAIR MR images of 28 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the posterior fossa (1.41+/-.74 vs 0.78+/-.80; p<0.05) and cortical sulci(1.11+/-.80 vs 0.70+/-.83; p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cistern and sylvian fissure. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with small amount of SAH or SAH in the posterior fossa.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

DISCUSSION ON PRIMARY SUBARACHNOID HEMORRHAGE:REPORT OFSEVEN AUTOPSY CASES / 中国法医学杂志

Prim ary subarachnoid hemorrhage(SAH)is not uncommon in forensic autopsy.This paper reported 7 cases of primary SAH.Disputes about the cause of death arose because death occured after minor head injuries.Through thorough histopathological examination,causesof primary SAH in these 7 ca- ses were determined:arteriovenous malformation of the brain in 5 cases; aneurysm in 1 case;giant cell arteritis in 1 case.Causes of SAH were undeter- mined macroscopically in all these cases.The misdiagnosis of traumatic SAH were made in 4 reappraisal cases.Facts indicated the importance of thorough histopathological examination tor determining real causes of SAH. The literature was reviewed and the methods of histopathological exa- mination,as well as the attention it must paid were discussed.