A Review of Genetic Polymorphisms and Susceptibilities to Complications after Aneurysmal Subarachnoid Hemorrhage.

Delayed cerebral ischemia (DCI) and vasospasm are two complications of subarachnoid hemorrhages (SAHs) which entail high risks of morbidity and mortality. However, it is unknown why only some patients who suffer SAHs will experience DCI and vasospasm. The purpose of this review is to describe the main genetic single nucleotide polymorphisms (SNPs) that have demonstrated a relationship with these complications. The SNP of the nitric oxide endothelial synthase (eNOS) has been related to the size and rupture of an aneurysm, as well as to DCI, vasospasm, and poor neurological outcome. The SNPs responsible for the asymmetric dimetilarginine and the high-mobility group box 1 have also been associated with DCI. An association between vasospasm and the SNPs of the eNOS, the haptoglobin, and the endothelin-1 receptor has been found. The SNPs of the angiotensin-converting enzyme have been related to DCI and poor neurological outcome. Studies on the SNPs of the Ryanodine Receptor yielded varying results regarding their association with vasospasm.

Cranial aseptic osteomyelitis associated with pyoderma gangrenosum.

Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum.

Cranial aseptic osteomyelitis associated with pyoderma gangrenosum. / Osteomielitis aséptica craneal asociada a pioderma gangrenoso.

Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum.

Pacientes con hemorragia subaracnoidea en mala situación neurológica, estudio de factores pronósticos / Patients with subarachnoid haemorrhage in poor grade neurological status: Study of prognostic factors

Objetivo: Evaluar y predecir factores que influyan en el pronóstico y/o resultado clínico a los 6 meses de pacientes con hemorragia subaracnoidea espontánea, en grados iv y v de la World Federation of Neurosurgical Societies (WFNS). Material y métodos: Estudio retrospectivo de una serie consecutiva de 394 pacientes que ingresaron en nuestro hospital, con diagnóstico clínico y radiológico de hemorragia subaracnoidea espontánea, desde el 1 de enero de 1999 hasta el 30 de junio de 2009. Se seleccionaron 121 pacientes que reunían el criterio de estar en grado iv o v de la WFNS antes del tratamiento; se excluyeron 3 pacientes por pérdida de seguimiento. La variable resultado se evaluó a los 6 meses del evento mediante la Escala de Resultados de Glasgow. Se consideró un resultado estadísticamente significativo un valor de p < 0,05. Resultados: Ciento veintiún pacientes se incluyeron en el análisis estadístico. La edad media de la serie fue de 54 años (14-92). Los pacientes que presentaban una puntuación en la Escala de Coma de Glasgow media inferior a 7 puntos (p < 0,0001) y un grado de v (p < 0,0001) en la escala de la WFNS pretratamiento, así como los que presentaban trastorno pupilar (p = 0,002), mostraron un peor resultado clínico final; igualmente, los que asociaron hematoma intraparenquimatoso (p = 0,020) y aquellos a los que no se les efectuó ningún tipo de tratamiento (p = 0,020) también asociaron un mal resultado clínico final, siendo estos resultados estadísticamente significativos. Conclusiones: Los pacientes que ingresan con una gradación de v en la escala de la WFNS y/o presentan trastorno pupilar y/o hematoma intraparenquimatoso asocian un peor resultado clínico final

Objective: To evaluate and predict factors influencing prognosis and/or clinical outcome at 6 months in patients with spontaneous subarachnoid haemorrhage, World Federation of Neurosurgical Societies (WFNS) grades iv and v. Material and methods: This was a retrospective study of a consecutive series of 394 patients admitted to our hospital with clinical and radiological diagnosis of spontaneous subarachnoid haemorrhage, from 1 January 1999 to 30 June 2009. We selected 121 patients who met the criteria of being in WFNS grades iv or v before treatment; 3 patients were excluded due to loss of tracking. The outcome variable was assessed 6 months after the event using the Glasgow Outcome Scale. A P value < .05 was considered statistically significant. Results: One hundred and twenty-one patients were included in the statistical analysis. The average age of the patients in the series was 54 years (14-92). Patients who had a mean Glasgow Coma Scale lower than 7 points (P < .0001), those who were grade v (P < .0001) in the pre-treatment WFNS scale and those with pupillary disorder (P = .002) had a worse clinical outcome. Likewise, those with associated intraparenchymal hematoma (P = .020) and those not receiving any treatment (P = .020) were also associated with a poor clinical outcome. These results were statistically significant. Conclusions: Patients admitted with a WFNS grade v and/or presenting pupil disorder and/or intraparenchymal hematoma were associated with worse clinical outcomes

[Patients with subarachnoid haemorrhage in poor grade neurological status: Study of prognostic factors]. / Pacientes con hemorragia subaracnoidea en mala situación neurológica, estudio de factores pronósticos.

OBJECTIVE: To evaluate and predict factors influencing prognosis and/or clinical outcome at 6 months in patients with spontaneous subarachnoid haemorrhage, World Federation of Neurosurgical Societies (WFNS) grades iv and v. MATERIAL AND METHODS: This was a retrospective study of a consecutive series of 394 patients admitted to our hospital with clinical and radiological diagnosis of spontaneous subarachnoid haemorrhage, from 1 January 1999 to 30 June 2009. We selected 121 patients who met the criteria of being in WFNS grades iv or v before treatment; 3 patients were excluded due to loss of tracking. The outcome variable was assessed 6 months after the event using the Glasgow Outcome Scale. A P value<.05 was considered statistically significant. RESULTS: One hundred and twenty-one patients were included in the statistical analysis. The average age of the patients in the series was 54 years (14-92). Patients who had a mean Glasgow Coma Scale lower than 7 points (P<.0001), those who were grade v (P<.0001) in the pre-treatment WFNS scale and those with pupillary disorder (P=.002) had a worse clinical outcome. Likewise, those with associated intraparenchymal hematoma (P=.020) and those not receiving any treatment (P=.020) were also associated with a poor clinical outcome. These results were statistically significant. CONCLUSIONS: Patients admitted with a WFNS grade v and/or presenting pupil disorder and/or intraparenchymal hematoma were associated with worse clinical outcomes.