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Arq. bras. neurocir ; 41(1): 207-209, 07/03/2022.
Article in English | LILACS | ID: biblio-1362096


Objetivo A síndrome de Terson (ST), também conhecida como hemorragia vítrea, é relatada em pacientes com hemorragia subaracnóide causada por um aneurisma rompido. Este estudo tem como objetivo avaliar a presença de hemorragia ocular nesses pacientes, buscando identificar aqueles que poderiam se beneficiar do tratamento específico para a recuperação do déficit visual. Métodos Estudo prospectivo de 53 pacientes com hemorragia subaracnóide espontânea (SSAH) por aneurisma rompido. Os pacientes foram avaliados quanto à hemorragia vítrea por fundoscopia indireta com 6 a 12 meses de seguimento. Resultados A idade dos pacientes variou de 17 a 79 anos (média de 45,9 ± 11,7); 39 pacientes eram do sexo feminino (73%) e 14 do sexo masculino (27%). Seis pacientes (11%) apresentaram ST e 83,3% apresentaram perda transitória de consciência durante a ictus. Conclusões Uma avaliação oftalmológica deve ser realizada rotineiramente em pacientes com hemorragia subaracnóide, especialmente naqueles com pior grau neurológico. Além disso, o prognóstico foi ruim em pacientes com ST.

Humans , Male , Female , Aortic Rupture/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Vitreous Hemorrhage/diagnostic imaging , Retinal Hemorrhage/diagnostic imaging , Diagnostic Techniques, Ophthalmological , Aortic Rupture/mortality , Spinal Puncture/methods , Subarachnoid Hemorrhage/mortality , Vitrectomy/methods , Vitreous Hemorrhage/mortality , Retinal Hemorrhage/mortality , Cerebral Angiography/methods , Chi-Square Distribution , Prospective Studies
Arq. bras. neurocir ; 41(1): 58-69, 07/03/2022.
Article in English | LILACS | ID: biblio-1362088


Introduction Vasospasm is a common and potentially devastating complication in patients with subarachnoid hemorrhage, causing high morbidity and mortality. There is no effective and consistent way to prevent or treat cerebral vasospasm capable of altering the morbidity and mortality of this complication. Animal and human studies have attempted to show improvement in aneurysmal vasospasm. Some sought their prevention; others, the treatment of already installed vasospasm. Some achieved only angiographic improvement without clinical correlation, others achieved both, but with ephemeral duration or at the expense of very harmful associated effects. Endovascular techniques allow immediate and aggressive treatment of cerebral vasospasm and include methods such as mechanical and chemical angioplasty. These methods have risks and benefits. Objectives To analyze the results of chemical angioplasty using nitroglycerin (GTN). In addition, to performa comprehensive review and analysis of aneurysmal vasospasm. Methods We describe our series of 77 patients treated for 8 years with angioplasty for vasospasm, either mechanical (with balloon), chemical (with GTN) or both. Results Eleven patients received only balloon; 37 received only GTN; 29 received both. Forty-four patients (70.1%) evolved with delayed cerebral ischemia and 19 died (mortality of 24.7%). Two deaths were causally related to the rupture of the vessel by the balloon. The only predictors of poor outcome were the need for external ventricular drainage in the first hours of admission, and isolated mechanical angioplasty. Conclusions Balloon angioplasty has excellent results, but it is restricted to proximal vessels and is not without complications. Chemical angioplasty using nitroglycerin has reasonable but short-lived results and further research is needed about it. It is restricted to vasospasm angioplasties only in hospitals, like ours, where better and more potent vasodilator agents are not available.

Humans , Male , Female , Adult , Middle Aged , Aged , Nitroglycerin/therapeutic use , Angioplasty, Balloon/methods , Vasospasm, Intracranial/diagnosis , Vasospasm, Intracranial/physiopathology , Vasospasm, Intracranial/therapy , Subarachnoid Hemorrhage/therapy , Vasodilator Agents/therapeutic use , Chi-Square Distribution , Survival Analysis , Regression Analysis , Data Interpretation, Statistical
Article in Chinese | WPRIM | ID: wpr-941047


OBJECTIVE@#To investigate the impact of postoperative serious cardiovascular adverse events (CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping.@*METHODS@#This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade ≥II CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale (GOS) score at 1 year, lengths of postoperative hospital and intensive care unit (ICU) stay, and Glasgow coma scale (GCS) score at discharge.@*RESULTS@#A total of 361 patients were enrolled in the final analysis, including 20 (5.5%) patients in CAE group and 341 in the non-CAE group. No significant differences were found in the patients' demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group (20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥II was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670 (95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA (P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups (P > 0.05).@*CONCLUSION@#Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.

Craniotomy/adverse effects , Humans , Intracranial Aneurysm/surgery , Postoperative Period , Retrospective Studies , Subarachnoid Hemorrhage/surgery , Treatment Outcome
Article in English | WPRIM | ID: wpr-939784


OBJECTIVE@#To determine whether Schisandrin B (Sch B) attenuates early brain injury (EBI) in rats with subarachnoid hemorrhage (SAH).@*METHODS@#Sprague-Dawley rats were divided into sham (sham operation), SAH, SAH+vehicle, and SAH+Sch B groups using a random number table. Rats underwent SAH by endovascular perforation and received Sch B (100 mg/kg) or normal saline after 2 and 12 h of SAH. SAH grading, neurological scores, brain water content, Evan's blue extravasation, and terminal transferase-mediated dUTP nick end-labeling (TUNEL) staining were carried out 24 h after SAH. Immunofluorescent staining was performed to detect the expressions of ionized calcium binding adapter molecule 1 (Iba-1) and myeloperoxidase (MPO) in the rat brain, while the expressions of B-cell lymphoma 2 (Bcl-2), Bax, Caspase-3, nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3), apoptosis-associated specklike protein containing the caspase-1 activator domain (ASC), Caspase-1, interleukin (IL)-1β, and IL-18 in the rat brains were detected by Western blot.@*RESULTS@#Compared with the SAH group, Sch B significantly improved the neurological function, reduced brain water content, Evan's blue content, and apoptotic cells number in the brain of rats (P<0.05 or P<0.01). Moreover, Sch B decreased SAH-induced expressions of Iba-1 and MPO (P<0.01). SAH caused the elevated expressions of Bax, Caspase-3, NLRP3, ASC, Caspase-1, IL-1β, and IL-18 in the rat brain (P<0.01), all of which were inhibited by Sch B (P<0.01). In addition, Sch B increased the Bcl-2 expression (P<0.01).@*CONCLUSION@#Sch B attenuated SAH-induced EBI, which might be associated with the inhibition of neuroinflammation, neuronal apoptosis, and the NLRP3 inflammatory signaling pathway.

Animals , Apoptosis , Brain/pathology , Brain Injuries/pathology , Caspase 3/metabolism , Cyclooctanes , Evans Blue , Inflammasomes/metabolism , Interleukin-18/metabolism , Lignans , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Polycyclic Compounds , Proto-Oncogene Proteins c-bcl-2/metabolism , Rats , Rats, Sprague-Dawley , Subarachnoid Hemorrhage/drug therapy , Water , bcl-2-Associated X Protein/metabolism
Montevideo; s.n; 2022. 78 p. graf.
Thesis in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1392834


Introducción: las HSA representan el 3-5% de los ACV, siendo una patología de alto impacto en la sociedad, por su elevada morbi-mortalidad. El 80 a 85% de las HSA se deben a rotura de un aneurisma y su incidencia varía según la región entre 6 casos/100.000 habitantes-año en países como China y 22 casos/100.000 habitantes-año en países como Finlandia y Japón. Objetivo: estimar la incidencia de la HSAea en Uruguay y describir sus principales características epidemiológicas. Métodos: fueron incluidos en el estudio todos los pacientes mayores de 18 años con diagnóstico de HSAea, que consultaron en algún centro asistencial del país entre el 01/11/2019 y el 31/10/2020. Fueron relevadas las características clínicoepidemiológicas y comorbilidades al momento del diagnóstico, el tipo de tratamiento recibido y variables de evolución clínica durante los siguientes 6 meses. El análisis estadístico de los datos se basó en el cálculo de la incidencia acumulada en el período evaluado, descripción de las variables estudiadas y en la identificación de factores predictores de mala evolución clínica. Debido al carácter multicéntrico y nacional del estudio, debió ser sometido a evaluación por todos los CEI de las instituciones de salud participantes, por la CNEI y por el MSP. Resultados: se observó un total de 211 casos incidentes en el período evaluado. La media de edad fue de 57 años con predominancia del sexo femenino (75%). La tasa de incidencia fue de 8,4 nuevos casos de HSAea cada 100,000 habitantes-año. En el 24 % de los pacientes se constató que el diagnóstico inicial estuvo mal planteado (error diagnóstico). En el 82% de los casos, el estudio vascular utilizado fue la angio-TC. La topografía aneurismática más frecuente fue: arteria comunicante anterior (27,5%), arteria cerebral media (27%), y arteria comunicante posterior (23%). Un 27% tuvieron aneurismas múltiples. En el 74% de los casos fue indicado algún tipo de tratamiento específico (43% cirugía abierta y 31% terapia endovascular), mientras al resto de los pacientes no se les pudo tratar el aneurisma por su grave situación neurológica. Hubo un 25% de complicaciones vinculadas al tratamiento recibido, observándose una mayor proporción de éstas en el caso de la cirugía abierta respecto a la terapia endovascular (42% vs. 27%; p=0,006). La complicación más frecuente por la HSA fue la HCF aguda constatada en el 64% de los casos, seguida del vasoespasmo en un 38%. De las complicaciones de la HSAea vinculadas a un eventual error diagnóstico, se pudo evidenciar el vasosespasmo como único candidato. La mortalidad a los 6 meses del diagnóstico fue del 54,5%, identificándose las siguientes condiciones como predictoras independientes de un mayor riesgo de mortalidad: presencia de HSA grave desde el inicio del cuadro (HyH y WFNS 4-5), presencia de aneurismas de tipo disecante o fusiforme vs sacular, la presencia de cuello ancho o ausencia de cuello en la relación cuello-fondo del aneurisma vs cuello chico, y una edad mayor de 60 años al momento del diagnóstico. Conclusiones: Este trabajo aporta las primeras cifras sobre incidencia anual de la HSAea en el Uruguay, siendo ésta comparable a lo descrito en la literatura internacional Por otra parte, y si bien se trata de una afección grave, la sobrevida y pronóstico a corto plazo de los pacientes en nuestro país está en el límite superior de lo reportado en otras regiones del mundo

Humans , Subarachnoid Hemorrhage/epidemiology , Endovascular Procedures , Uruguay
Cambios rev. méd ; 20(2): 5-11, 30 Diciembre 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1368176


INTRODUCCIÓN. En Ecuador, las enfermedades cerebrovasculares son la tercera causa de muerte en la población general; existen pocos datos en la literatura médica sobre la hemorragia subaracnoidea aneurismática y aneurismas no rotos, por lo que fue fundamental describir un perfil clínico. OBJETIVO. Caracterizar la clínica de los pacientes con diagnóstico de aneurisma cerebral. MATERIALES Y MÉTODOS. Estudio observacional descriptivo. Población de 450 y muestra de 447 pacientes con diagnóstico de aneurisma cerebral atendidos en la Unidad de Neurología del Hospital Carlos Andrade Marín, periodo enero 2010 a diciembre 2018. Los datos clínicos e imagenológicos fueron recolectados a través de la revisión de historias clínicas digitales obtenidas del sistema informático MIS/AS400, y se analizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 23. RESULTADOS. Se identificaron 605 aneurismas en 447 pacientes. El 80,5% (360; 447) presentó aneurismas rotos, de éstos el 81,4% (293; 360) tuvo un solo aneurisma. El factor de riesgo más frecuente fue la hipertensión arterial con el 44,3% (198; 447), las manifestaciones observadas fueron: hemorragia subaracnoidea con el 98,9% (356; 360) en aneurismas rotos; y cefalea con el 65,5% (57; 87) en aneurismas no rotos. DISCUSIÓN. Se encontró datos relevantes no coincidentes con la literatura científica mundial, como el bajo número de aneurismas asintomáticos y no rotos, comparados con su contraparte. CONCLUSIÓN. Se evidenció que los aneurismas intracraneales produjeron una amplia gama de manifestaciones clínicas, que fluctuaron desde la hemorragia subaracnoidea como la más frecuente en el grupo de aneurismas rotos, hasta pacientes completamente asintomáticos en el grupo de aneurismas no rotos.

INTRODUCTION. In Ecuador, cerebrovascular diseases are the third leading cause of death in the general population; there are few data in the medical literature on aneurysmal subarachnoid hemorrhage and unruptured aneurysms, so it was essential to describe a clinical profile. OBJECTIVE. To characterize the clinical profile of patients diagnosed with cerebral aneurysm. MATERIALS AND METHODS. Descriptive observational study. Population of 450 and sample of 447 patients with a diagnosis of cerebral aneurysm seen in the Neurology Unit of the Carlos Andrade Marín Hospital, period January 2010 to December 2018. Clinical and imaging data were collected through the review of digital medical records obtained from the MIS/AS400 computer system, and were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 23. RESULTS. A total of 605 aneurysms were identified in 447 patients. A total of 80,5% (360; 447) had ruptured aneurysms, of which 81,4% (293; 360) had a single aneurysm. The most common risk factor was hypertension with 44,3% (198; 447), the manifestations observed were: subarachnoid hemorrhage with 98,9% (356; 360) in ruptured aneurysms; and headache with 65,5% (57; 87) in unruptured aneurysms. DISCUSSION. We found relevant data not consistent with the world scientific literature, such as the low number of asymptomatic and unruptured aneurysms, compared with its counterpart. CONCLUSION. It was evidenced that intracranial aneurysms produced a wide range of clinical manifestations, ranging from subarachnoid hemorrhage as the most frequent in the group of ruptured aneurysms, to completely asymptomatic patients in the group of unruptured aneurysms.

Humans , Male , Female , Adult , Middle Aged , Young Adult , Subarachnoid Hemorrhage , Intracranial Aneurysm , Aneurysm, Ruptured , Headache , Aneurysm , Neurology , Angiography, Digital Subtraction , Cerebral Arterial Diseases , Statistics, Nonparametric , Ecuador , Hemorrhagic Stroke , Hypertension
Arq. neuropsiquiatr ; 79(9): 759-765, Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345343


ABSTRACT Background: Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not well-defined. Identifying them would be beneficial in determining which patients might benefit from ET. Objective: To identify the predictive factors for poor outcomes following ET for aSAH. Methods: 120 patients with ruptured cerebral aneurysms underwent endovascular embolization between January 2017 and December 2018. Blood pressure variability was examined using the standard deviation of the 24-hour systolic blood pressure (24hSSD) and 24-hour diastolic blood pressure (24hDSD). Predictors were identified through univariate and multivariate regression analysis. All patients were followed up for three months. Results: At follow-up, 86 patients (71.7%) had good outcomes and 34 (28.3%) had poor outcomes. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The 24hDSD did not differ significantly between patients with good outcomes and those with poor outcomes (9.5 ± 2.3 vs 9.9 ± 3.5 mmHg; P = 0.464). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0-175.9; P = 0.002); Hunt-Hess grade 3-4 (OR = 6.8; 95% CI: 1.1-33.7; P = 0.039); Fisher grade 3-4 (OR = 47.1; 95% CI: 3.8-586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1-34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0-55.2; P < 0.001). Conclusion: Elevated 24hSSD is a possibly treatable predictive factor for poor outcomes after ET for aSAH.

RESUMO Antecedentes: Fatores preditores de resultados após tratamento endovascular (TE) para hemorragia subaracnóide aneurismática (HSA) não estão bem definidos. Identificá-los seria útil para determinar quais pacientes podem se beneficiar de TE. Objetivo: Identificar os fatores preditivos de resultados ruins após TE para HSA. Métodos: 120 pacientes com aneurismas cerebrais rompidos foram submetidos à embolização endovascular entre janeiro de 2017 e dezembro de 2018. A variabilidade da pressão arterial foi examinada usando-se o desvio padrão da PA sistólica de 24 horas (DPPAS- 24h) e da PA diastólica de 24 horas (DPPAD-24h). Os fatores preditores foram identificados por meio de análises de regressão univariada e multivariada. Todos os pacientes foram acompanhados por três meses. Resultados: No acompanhamento, 86 pacientes (71,7%) tiveram bons resultados e 34 (28,3%) tiveram resultados ruins. Pacientes com resultados ruins apresentaram DPPAS-24h significativamente maior do que aqueles com bons resultados (19,3 ± 5,5 vs 14,1 ± 4,8 mmHg; P <0,001). O DPPAD-24h não diferiu significativamente entre os pacientes com bons resultados e aqueles com resultados ruins (9,5 ± 2,3 vs 9,9 ± 3,5 mmHg; P = 0,464). Os fatores de risco significativos para resultados ruins após embolização endovascular foram os seguintes: idade ≥ 65 anos (razão de probabilidade [OR] = 23,0; intervalo de confiança de 95% [IC]: 3,0-175,9; P = 0,002); escala de Hunt-Hess 3-4 (OR = 6,8; IC 95%: 1,1-33,7; P = 0,039); escala de Fisher 3-4 (OR = 47,1; IC 95%: 3,8-586,5; P = 0,003); complicações pós-operatórias (OR = 6,1; IC 95%: 1,1-34,8; P = 0,042); e DPPAS 24h ≥ 15 mmHg (OR = 14,9; IC 95%: 4,0-55,2; P <0,001). Conclusão: O DPPAS 24h elevado é um fator preditivo possivelmente tratável para resultados ruins após TE para HSA.

Humans , Aged , Subarachnoid Hemorrhage/therapy , Intracranial Aneurysm/complications , Intracranial Aneurysm/therapy , Blood Pressure , Retrospective Studies , Treatment Outcome
Rev. méd. Chile ; 149(9): 1377-1381, sept. 2021. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389600


Subarachnoid hemorrhage (SAH) is a devastating disease, with a mortality rate of 35%. Among patients who survive the initial bleeding, the leading cause of morbidity and mortality is delayed cerebral ischemia (DCI). Electroencephalography (EEG) can detect cerebral ischemia in the early stages. We report a 66-year-old female patient who consulted for ictal headache and impaired consciousness. On admission, she was confused, dysarthric, and with meningeal signs. Brain angio-CT showed SAH FISHER IV and an aneurysm of the left posterior cerebral artery. After excluding the aneurysm (by coiling), the patient recovered the altered consciousness. Continuous EEG monitoring was initiated. On the sixth day of follow up, she had a transient headache and apathy. The brain MRI showed low cerebral blood flow in the left frontotemporal area, without ischemic lesions. On the seventh day, she presented expression aphasia and right facial-brachial paresis. Angiography confirmed severe vasospasm in M1 and M2 segments bilaterally. Pharmacological angioplasty with nimodipine was performed, with an excellent radiological response, although not clinical. A second MRI was carried out on the eighth day, which showed a left insular infarction and generalized vasospasm. A second therapeutic angiography was performed; the patient persisted with aphasia and left central facial paresis. The quantitative EEG analysis performed retrospectively showed a generalized reduction in the spectral edge frequency 95 (SEF95; meaning slowing in the EEG signal) at the fourth day of follow up, three days earlier than the clinical and imaging diagnosis of DCI was established.

Humans , Female , Aged , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Brain Ischemia/etiology , Brain Ischemia/diagnostic imaging , Cerebral Infarction , Retrospective Studies , Electroencephalography/adverse effects , Electroencephalography/methods
Arq. bras. neurocir ; 40(3): 207-209, 15/09/2021.
Article in English | LILACS | ID: biblio-1362098


Objective Terson syndrome (TS), also known as vitreous hemorrhage, is reported in patients with subarachnoid hemorrhage caused by a ruptured aneurysm. This study aims to evaluate the presence of ocular hemorrhage in such patients, trying to identify those who could benefit from the specific treatment for visual deficit recovery. Methods Prospective study of 53 patients with spontaneous subarachnoid hemorrhage (SSAH) due to ruptured aneurysm. The patients were evaluated for vitreous hemorrhage through indirect fundoscopy with 6 to 12 months of follow-up. Results The ages of the patients ranged from 17 to 79 years-old (mean age, 45.9 11.7); 39 patients were female (73%) and 14 were male (27%). Six patients (11%) presented TS, and 83.3% had a transient loss of consciousness during ictus. Conclusions An ophthalmologic evaluation must be routinely performed in subarachnoid hemorrhage patients, especially in those with worse neurological grade. Moreover, prognosis was bad in TS patients.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aortic Rupture/complications , Subarachnoid Hemorrhage/etiology , Vitreous Hemorrhage/mortality , Vitreous Hemorrhage/diagnostic imaging , Aortic Rupture/mortality , Aortic Rupture/diagnostic imaging , Prognosis , Subarachnoid Hemorrhage/mortality , Subarachnoid Hemorrhage/diagnostic imaging , Chi-Square Distribution , Data Interpretation, Statistical , Diagnostic Techniques, Ophthalmological
Rev. argent. neurocir ; 35(2): 97-106, jun. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1398010


Introducción:La hemorragia subaracnoidea espontánea (HSA) presenta aproximadamente el 5% de todos los ACV, siendo una patología de alto impacto en la sociedad por su elevada morbi-mortalidad. La clínica de presentación es variada, lo cual lleva múltiples veces a dificultades en el diagnóstico. El objetivo de este trabajo es analizar el error diagnóstico que existe en esta patología y evaluar si el mismo se vio modificado por la interposición de la Emergencia Sanitaria declarada en el país por la pandemia del SARS-Cov2. Materiales y Métodos: es un estudio prospectivo y multicéntrico, incluyendo a todos los pacientes que presentaron HSA en el Uruguay entre el 1 de noviembre del 2019 y el 31 de julio de 2020. Se analizaron acuerdo con 3 períodos: 1) pre-pandemia, 2) cuarentena general, y 3) nueva normalidad. Se incluyeron todos los pacientes mayores de 18 años que consultaron y se les diagnosticó una HSA espontánea aneurismática. Se definió́ error diagnóstico a la imposibilidad de reconocer esta patología en la consulta médica inicial otorgándole el alta. El análisis se procesó utilizando el software SPSS versión 22. La investigación fue aprobada por todos los Comité de Ética de los diferentes centros que participaron del estudio. Resultados: de un total de 149 pacientes, la edad media fue de 57,23 años, con mayor frecuencia en el sexo femenino. Se constató error diagnóstico en 38 pacientes (25,5%), con mayor porcentaje durante la cuarentena general. El retraso en el diagnóstico por problemas asistenciales fue de un 2,6%. Se evidenció un 22,8% de complicaciones por el tratamiento indicado, y un 71,1% por la HSA, con una mortalidad global del 51,7%. Conclusiones: en el presente trabajo se observó un error diagnóstico elevado, evidenciando una relación directa y significativa con la cefalea y la HSA leve (HyH 1 y 2) como formas de presentación. Hubo un porcentaje mayor de HSA graves en comparación a la literatura, con una relación directa y significativa entre la presencia de vasoespasmo y la mortalidad con el error diagnóstico. También es claro que la crisis sanitaria determinó que ese error diagnóstico aumentara durante los primeros meses de la pandemia en Uruguay.

Introduction: Spontaneous subarachnoid hemorrhage (SAH) represents approximately 5% of all strokes, being a pathology of high impact in society, due to its high morbidity and mortality. The clinical presentation is varied, which leads many times to difficulties in diagnosis. The objective of this work is to analyze the diagnostic error that exists in this pathology, and to assess whether it was modified by the introduction of the Health Emergency declared in the country by the SARS-Cov2 pandemic. Materials and Methods: it is a prospective and multicenter study, including all patients who presented SAH in Uruguay between November 1, 2019 and July 31, 2020. They were analyzed according to 3 periods: 1) pre-pandemic, 2) general quarantine, and 3) new normality. All patients over 18 years of age who consulted and were diagnosed with spontaneous aneurysmal SAH were included. Diagnostic error was defined as the inability to recognize this pathology in the initial medical consultation and discharge. The analysis was processed using SPSS version 22 software. The research was approved by all the Ethics Committees of the different centers that participated in the study. Results: of a total of 149 patients, the mean age was 57.23 years, more frequently in the female sex. Diagnostic error was found in 38 patients (25.5%), with a higher percentage during general quarantine. The delay in diagnosis due to healthcare problems was 2.6%. There were 22.8% complications due to the indicated treatment, and 71.1% due to SAH, with an overall mortality of 51.7%. Conclusions: in the present work, a high diagnostic error was observed, showing a significant direct relationship with headache and mild SAH (HyH 1 and 2) as forms of presentation. There was a higher percentage of severe SAH compared to the literature, with a direct and significant relationship between the presence of vasospasm and mortality with diagnostic error. It is also clear that the health crisis determined that this diagnostic error increased during the first months of the pandemic in Uruguay

Subarachnoid Hemorrhage , Stroke , Severe Acute Respiratory Syndrome , Diagnosis , Diagnostic Errors , Pandemics , Aneurysm
Arq. bras. neurocir ; 40(2): 179-182, 15/06/2021.
Article in English | LILACS | ID: biblio-1362234


Crossbow injuries to the head have seldom been reported in the literature, and they represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow results in an intracranial fragment larger than most high-velocity projectiles, usually with a lethal outcome.We present the case of a 34-year-oldman who attempted suicide with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of entry and a palpable subcutaneous tip in the left parietal region. The emergency team reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated and intubated. Computed tomography (CT) imaging scans showed that the arrow crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral contusions adjacent to its intracranial path. Careful retrograde removal of the penetrating arrow was performed in the CT suite, followed by an immediate CT scan, which excluded procedure-related complications. The patient woke up easily and was discharged 3 days later withmild left hand apraxia and no other neurologic deficits. To the best of our knowledge, there are no similar case reports describing both good clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the management of each patient is therefore crucial to achieve the best possible outcome as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.

Humans , Male , Adult , Parietal Lobe/surgery , Parietal Lobe/injuries , Wounds, Stab/surgery , Brain Injuries, Traumatic/surgery , Subarachnoid Hemorrhage/complications , Injury Severity Score , Treatment Outcome , Brain Injuries, Traumatic/diagnostic imaging
Rev. enferm. neurol ; 20(1): 66-76, ene.-abr. 2021. ilus, tab
Article in Spanish | LILACS, BDENF | ID: biblio-1349260


Los drenajes cerebrales son dispositivos utilizados como métodos terapéuticos, permitiendo la salida de líquido normal o patológico a personas que cursen por alguna enfermedad neurológica, convirtiéndose en uno de los procedimientos más comunes en el área de la enfermería neurológica. He aquí que los cuidados de enfermería deben ser considerados específicos para poder visualizar resultados satisfactorios en pacientes portadores de estos sistemas en áreas críticas. Por este motivo, las intervenciones especializadas de enfermería en el cuidado a los drenajes cerebrales se basaron en la necesidad de elaborar una guía de intervenciones específicas, y especializadas, para personas con uso de drenajes cerebrales siendo un tema de importancia en enfermería neurológica.

Brain drains are devices used as therapeutic methods, allowing the exit of normal or pathological fluid to people suffering from a neurological disease, becoming one of the most common procedures in the area of neurological nursing. Here, nursing care must be considered specific in order to visualize satisfactory results in patients with these systems in critical areas. For this reason, specialized nursing interventions in the care of brain drains were based on the need to develop a guide for specific and specialized interventions for people with use of brain drains, being a topic of importance in neurological nursing.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Subarachnoid Hemorrhage , Intracranial Pressure , Hematoma, Subdural , Persons , Nursing Care , Drainage , Catheters , Neuroscience Nursing
Rev. argent. neurocir ; 35(1): 42-46, mar. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1397520


La hemorragia subaracnoidea (HSA) secundaria a ruptura aneurismática es una causa importante de morbimortalidad. Hay muchos factores que aumentan la probabilidad de ruptura, como el tamaño, forma, localización, exclusión endovascular incompleta del aneurisma, entre otros. Existen reportes sobre el edema cerebral perianeurismático como factor de riesgo de ruptura aneurismática. Se presentan en el siguiente artículo dos casos, ambos con aneurisma silviano del lado derecho, asociado a edema "perianeurismático".

Subarachnoid hemorrhage (SAH) secondary to aneurysmal rupture is an important cause of morbidity and mortality. There are many factors that increase the probability of rupture, the size, shape, location, incomplete endovascular exclusion of the aneurysm, among others. There are reports on perianeurysmal cerebral edema as a risk factor for aneurysmal rupture. Two cases are presented in the following article, both with right-sided sylvian aneurysm, associated with "perianeursmatic" edema.

Edema , Subarachnoid Hemorrhage , Aneurysm
Acta cir. bras ; 36(8): e360804, 2021. graf
Article in English | LILACS, VETINDEX | ID: biblio-1339007


ABSTRACT Purpose: Subarachnoid hemorrhage (SAH) is a common complication of cerebral vascular disease. Hydrogen has been reported to alleviate early brain injury (EBI) through oxidative stress injury, reactive oxygen species (ROS), and autophagy. Autophagy is a programmed cell death mechanism that plays a vital role in neuronal cell death after SAH. However, the precise role of autophagy in hydrogen-mediated neuroprotection following SAH has not been confirmed. Methods: In the present study, the objective was to investigate the neuroprotective effects and potential molecular mechanisms of hydrogen-rich saline in SAH-induced EBI by regulating neural autophagy in the C57BL/6 mice model. Mortality, neurological score, brain water content, ROS, malondialdehyde (MDA), and neuronal death were evaluated. Results: The results show that hydrogen-rich saline treatment markedly increased the survival rate and neurological score, increased neuron survival, downregulated the autophagy protein expression of Beclin-1 and LC3, and endoplasmic reticulum (ER) stress. That indicates that hydrogen-rich saline-mediated inhibition of autophagy and ER stress ameliorate neuronal death after SAH. The neuroprotective capacity of hydrogen-rich saline is partly dependent on the ROS/Nrf2/heme oxygenase-1 (HO-1) signaling pathway. Conclusions: The results of this study demonstrate that hydrogen-rich saline improves neurological outcomes in mice and reduces neuronal death by protecting against neural autophagy and ER stress.

Animals , Mice , Rats , Subarachnoid Hemorrhage/drug therapy , Brain Injuries , Neuroprotective Agents/pharmacology , Autophagy , Brain , Rats, Sprague-Dawley , Apoptosis , Oxidative Stress , Hydrogen/pharmacology , Mice, Inbred C57BL
Article in English | WPRIM | ID: wpr-880644


In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.

Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Cerebral Angiography , Humans , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology
Frontiers of Medicine ; (4): 887-902, 2021.
Article in English | WPRIM | ID: wpr-922517


Monocarboxylic acid transporter 1 (MCT1) maintains axonal function by transferring lactic acid from oligodendrocytes to axons. Subarachnoid hemorrhage (SAH) induces white matter injury, but the involvement of MCT1 is unclear. In this study, the SAH model of adult male Sprague-Dawley rats was used to explore the role of MCT1 in white matter injury after SAH. At 48 h after SAH, oligodendrocyte MCT1 was significantly reduced, and the exogenous overexpression of MCT1 significantly improved white matter integrity and long-term cognitive function. Motor training after SAH significantly increased the number of ITPR2

Animals , Male , MicroRNAs/genetics , Monocarboxylic Acid Transporters/genetics , Rats , Rats, Sprague-Dawley , Subarachnoid Hemorrhage , Symporters/genetics , White Matter/injuries
Montevideo; s.n; 2021. 175 p. graf, tab.
Thesis in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1381442


La hemorragia subaracnoidea aneurismática (HSAa) aguda es una enfermedad que afecta a todas las edades, pero fundamentalmente a mujeres jóvenes en torno a los 50 años. Su impacto individual, familiar y sanitario continúa siendo aún inaceptablemente elevado. Esto se debe, en parte, al conocimiento parcial de los mecanismos injuriantes y reparadores que se desencadenan una vez que el aneurisma se rompe y la sangre arterial se vuelca al espacio subaracnoideo y/o ventricular. La respuesta inmune locorregional y sistémica tiene, potencialmente, un rol protagónico como uno de los principales mecanismos en juego desde los primeros minutos (injuria precoz). Su posible rol como puente o enlace hacia la injuria diferida (vasoespasmo-isquemia) también ha sido postulado. La respuesta innata ha recibido mayor atención (investigación) a la fecha. Sin embargo, la respuesta inmune adquirida también ha captado el interés neurocientífico en los últimos años. No menos importante es la interacción neuro-sistémica que caracteriza a esta enfermedad como una entidad clínica con un impacto multiorgánico precoz. En la presente tesis exploramos tanto la respuesta inmune innata como adquirida. Hicimos énfasis en aquellos efectores celulares más importantes y lo complementamos con el análisis de las citoquinas relacionadas y aquellas variables clínicas de interés tales como severidad del sangrado, vasoespasmo, mortalidad y con la técnica seleccionada para el tratamiento del saco aneurismático. Los resultados encontrados son originales, en algunos casos, mientras que otros corroboran hechos ya conocidos, típicos de la enfermedad. Entre los mismos destacamos que la muestra de pacientes enrolados padeció una HSAa aguda grave tanto desde el punto de vista clínico (pobre grado clínico) como tomográfico (abundante sangre volcada al espacio subaracnoideo). En estas condiciones, observamos una hiperleucocitosis con un aumento de los neutrófilos con un mayor estado de activación, particularmente a nivel del LCR. Concomitantemente aumentaron los monocitos totales y sus subpoblaciones a nivel de la sangre periférica. Por otra parte, tanto las células dendríticas como Natural Killers disminuyeron a nivel de la sangre periférica. Particularmente interesante e intrigante resultó ser la objetivación del predominio en LCR de la subpoblación NK CD56brigth CD16-. Con respecto al análisis de los linfocitos y subpoblaciones, observamos un descenso relativo de los mismos a nivel de la sangre periférica, pero no a nivel del LCR. Sin duda alguna, entre los hallazgos originales más atractivos desde un punto de vista patogénico, se encuentran los referentes a las variaciones de las subpoblaciones de células T CD4+ y CD8+ y su mayor estado de activación tanto a nivel de la sangre periférica como del LCR. Pero, además, detectamos un disbalance proinflamatorio del eje Th17/Treg (aumento del cociente) tanto a nivel de la sangre periférica como del LCR. Concomitantemente, la IL-17A aumentó en ambos compartimentos y su incremento a nivel de la sangre periférica en la etapa precoz se asoció al desarrollo ulterior de vasoespasmo y mayor mortalidad. Las restantes citoquinas analizadas (IL-2, IL-4, IL-6, IL-10, TNFα, INFγ) también se incrementaron significativamente tanto a nivel de la sangre periférica como del LCR, pero su incremento no se asoció estadísticamente con ninguna de las variables clínicas de interés mencionadas. Con respecto al posible impacto de la estrategia terapéutica seleccionada para el tratamiento del saco aneurismático sobre la respuesta inmune precoz y diferida, encontramos resultados potencialmente opuestos en las subpoblaciones Th1/Th2 a nivel del LCR, pero sin una asociación estadísticamente significativa con el perfil de citoquinas secretadas a dicho nivel. En suma, hemos demostrado, al igual que diversos investigadores alrededor del mundo, que la respuesta inmune innata tiene un papel protagónico en esta patología. Además, con el estudio del estado de activación hemos jerarquizado el rol de la respuesta inmune adaptativa CD4+ y CD8+. Postulamos al disbalance proinflamatorio del eje Th17/Treg como un potencial jugador patogénico clave y proponemos a la IL-17A como un prometedor biomarcador precoz de mayor morbimortalidad. Sin duda alguna, nuevas estrategias de investigación, experimental y clínica, podrán eventualmente, confirmar nuestros alentadores resultados preliminares comentados

Humans , Subarachnoid Hemorrhage/immunology , Subarachnoid Hemorrhage/cerebrospinal fluid , Subarachnoid Hemorrhage/blood , Cytokines , Flow Cytometry
Rev. bras. neurol ; 56(4): 35-38, out.-dez. 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1140817


A persistência e a falha da involução das comunicações embrionárias entre a circulação cerebral anterior e posterior contribuem para anomalias vasculares em adultos. Esta variação é comumente detectada de forma incidental, causando sintomas muito raramente. Sua proximidade com os nervos oculomotor, troclear e abducente podem levar a paresia muscular ocular. Em alguns casos pode causar tinnitus pulsátil e ao espasmo de hemiface. Muitos casos de artéria trigeminal foram relatados como associados a aneurismas intracranianos.

The persistence and failure of the involution of embryonic communications between the anterior and posterior cerebral circulation contribute to vascular anomalies in adults. This variation is commonly detected incidentally, rarely causing symptoms. Its proximity to the oculomotor, trochlear, and abducent nerves can lead to ocular muscle paresis. Sometimes it can cause pulsatile tinnitus and hemiface spasm. Many cases of trigeminal artery have been reported to be associated with intracranial aneurysms.

Humans , Male , Adult , Subarachnoid Hemorrhage/surgery , Subarachnoid Hemorrhage/diagnostic imaging , Carotid Arteries/abnormalities , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Vascular Malformations , Computed Tomography Angiography
Rev. bras. ter. intensiva ; 32(4): 592-602, out.-dez. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1156240


RESUMO Objetivo: Revisar sistematicamente a evidência atual da eficácia de milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea. Métodos: Triaram-se as bases de dados Pubmed®, Cochrane e Embase quanto a artigos publicados entre abril de 2001 e fevereiro de 2019. Dois revisores independentes realizaram uma triagem metodológica da qualidade e a extração dos dados dos estudos. Resultados: Encontraram-se 22 estudos considerados relevantes, sendo que apenas um deles era um ensaio randomizado controlado. Os estudos demonstraram acentuada heterogeneidade e debilidade de seus critérios metodológicos. A maioria dos pacientes apresentava vasoespasmo moderado a grave. O principal método para diagnóstico do vasoespasmo foi a angiografia. Em três estudos, realizou-se administração de milrinona por via intra-arterial; em nove estudos, a administração foi endovenosa, e, em seis estudos, utilizaram-se ambas as vias de administração. A via intratecal foi utilizada em dois estudos, em um estudo, a administração foi realizada via cisterna e, em um estudo, a via de administração foi a endovascular. Os efeitos colaterais de milrinona foram descritos em seis estudos. Vinte e um estudos indicaram a resolução do vasoespasmo. Conclusão: A evidência atual indica que o uso de milrinona teve um papel no tratamento do vasoespasmo após hemorragia subaracnóidea aneurismática. Contudo, só foi realizado um ensaio randomizado controlado, com baixo nível de qualidade. Nossos achados indicam a necessidade de futuros estudos randomizados controlados com desfechos centrados no paciente, com o fim de proporcionar recomendações definitivas.

ABSTRACT Objective: To systematically review the current evidence on the efficacy of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage. Methods: The Pubmed®, Cochrane and Embase databases were screened for articles published from April 2001 to February 2019. Two independent reviewers performed the methodological quality screening and data extraction of the studies. Results: Twenty-two studies were found to be relevant, and only one of these was a randomized control trial. Studies showed marked heterogeneity and weaknesses in key methodological criteria. Most patients presented with moderate to severe vasospasm. Angiography was the main method of diagnosing vasospasm. Intra-arterial administration of milrinone was performed in three studies, intravenous administration was performed in nine studies, and both routes of administration in six studies; the intrathecal route was used in two studies, the cisternal route in one study and endovascular administration in one study. The side effects of milrinone were described in six studies. Twenty-one studies indicated resolution of vasospasm. Conclusion: The current evidence indicates that milrinone may have a role in treatment of vasospasm after aneurysmal subarachnoid hemorrhage. However, only one randomized control trial was performed, with a low quality level. Our findings indicate the need for future randomized control trials with patient-centered outcomes to provide definitive recommendations.

Humans , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/drug therapy , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/drug therapy , Vasodilator Agents/adverse effects , Infusions, Intravenous , Randomized Controlled Trials as Topic , Milrinone/therapeutic use