Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre's perspective.

BACKGROUND: Spontaneous subarachnoid haemorrhage (SAH) is a significant cause of stroke and associated with high morbidity and mortality. One substantial complication of SAH is cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). This study aimed to define the clinical profile in patients with SAH, CV and DCI secondary to spontaneous SAH (aneurysmal and pretruncal non-aneurysmal). MATERIALS AND METHODS: We analysed 122 consecutive patients with spontaneous SAH following intracranial aneurysmal and non-aneurysmal information (including patients' pattern characterisation and their possible risk factor association to pre-operative clinical decision and long-term clinical outcome) was documented and analysed. RESULTS: The main clinical presentations for spontaneous SAH following ruptured intracranial aneurysm and nonaneurysm were headache (77%) and nausea/vomiting (62.3%). The most common sites for SAH following ruptured intracranial aneurysm rupture were the anterior and posterior communicating arteries (57.5%). Hypertension was the most common cause for SAH at 64.8%. It was found 26.2% (n=32) out of the 122 patients developed CV and DCI. The mean day of vasospasm was 6.0 ± 2.8 (range: 1-14 days) Age, length of stay, nausea/vomiting and visual field defect were significantly associated (p<0.05) with vasospasm. Mortality rate was also higher in the CV group compared to the group without CV in both at discharge and at 6 months; 281 versus 278 per 1000 and 312 vs 300 per 1000, respectively. CONCLUSION: CV and DCI have a significant incidence among local patients with spontaneous SAH following an intracranial aneurysmal and non-aneurysmal rupture and it is associated with substantial morbidity. Prevention, effective monitoring, and early detection are keys to successful management. Regional investigation using a multicentre cohort to analyse mortality and survival rates may aid in improving national resource management of these patients.

Flow resistance analysis of extracranial-to-intracranial (EC-IC) vein bypass.

Although brain bypass surgery has often been selected to treat internal carotid arteries (ICA) which are restricted by aneurysm or artery stenosis, its effectiveness has not been quantitatively evaluated. The purpose of this study is to propose an innovative approach for the evaluation of brain extracranial-to-intracranial (EC-IC) vein bypass surgery, based on the analysis of flow resistance in vein bypasses and within their contralateral carotid arteries through the use of computational fluid dynamics (CFD). Seven patients who underwent vein bypass surgery were examined with the use of high-resolution; computed tomography angiogram (CTA). The reconstructed three-dimensional (3D) geometries were segmented to create CFD calculation domains. Colour Doppler ultrasound (CDU) was used to measure blood flow velocities at the common carotid arteries (CCA), in order to determine inflow conditions. Based on the pipe flow theory, pressure drop was expressed as Am²+Bm where A and B represent flow resistance coefficients and m represents blood mass flow rate. The CFD results revealed that for a healthy ICA, the average values of A and B were 0.013088 Pa/(ml/min)² and 3.105 Pa/(ml/min), respectively. For the vein bypass, an average value of A was 0.0143 Pa/(ml/min)² and B 3.402 Pa/(ml/min), which was approximately that of a healthy ICA. However, in the case of a bypass utilising a venous conduit possessing a large-sized valve or existing size alteration, the flow resistance in that bypass would be higher than those found in the healthy ICA. An imbalance of flow resistances may impose conditions that could predispose hemodynamic failure or distal aneurysm development.

Pneumocephalus: an uncommon finding in trauma.

Pneumocephalus (Intracranial aerocele), defined as intracranial air, is an uncommon complication in head injury patients. It can present immediately following head trauma or be delayed for many days before clinical symptoms occur. We present two cases of extensive pneumocephalus after trauma. The diagnosis was made by computed tomography (CT). When pneumocephalus is suspected, CT can play a vital role in determining the precise location of the gas collection, its relationship to the basal skull fracture site or air sinuses and the amount of mass effect on the brain.

Primary intracerebral haemorrhage in Malaysia: in-hospital mortality and outcome in patients from a hospital based registry.

Primary intracerebral haemorrhage (ICH) results in significant morbidity and mortality among patients. There is a paucity of epidemiological data on this condition in Malaysia. The purpose of this hospital based study was to define the clinical profile in patients with primary spontaneous intracerebral haemorrhage at University of Malaya Medical Centre (UMMC) and to determine the mortality rate of intracerebral haemorrhage at the time of discharge, the prognostic factors and one year outcome of this cohort of patients. Sixty-six patients were admitted at the Neurosurgical unit of University of Malaya Medical Centre for a period of 13 months from March 2002 to March 2003. Fifty percent of the subjects were female. The mean age was 61.6 +/- 16.7 years. Among our patients with intracerebral haemorrhage, the common risk factors were: hypertension (80.3%), diabetes mellitus (25.7%) and smoking (27.2%). Common presenting features for our series were: weakness (61.8%), LOC (58.5%), headache (56.3%) and speech disturbances (45.3%). On neuroimaging, the lesions were seen in basal ganglia/thalamus (45.1%), lobar (32.9%), brainstem (13.4%) and cerebelli (8.5%). The overall 30 days mortality rate for intracerebral haemorrhage (ICH) was 43.9%. The important predictors of for mortality were the GCS score on admission (p < 0.0001), haematoma volume > 30 mls (p < 0.0001), evidence of intraventricular extension (p = 0.011) and ICH score (p < 0.0001). At one year follow up, 48.5% (n = 32) were dead, 33.3% (n = 11) obtained good recovery, 36.4% (n = 12) moderate disability, 18.2% (n = 6) severe disability and 3% remain vegetative state. The overall mortality rate for our series of patients with primary intracerebral haemorrhage is quite similar to previously published epidemiological studies. ICH scoring is useful in the prognostication.

Detection of differential expression of mouse interferon-alpha subtypes by polymerase chain reaction using specific primers.

Specific primers for nine mouse interferon-alpha (IFN-alpha) subtypes, namely, IFN-alpha1, IFN-alpha1-9, IFN-alpha2, IFN-alpha4, IFN-alpha5, IFN-alpha7, IFN-alpha6/8, IFN-alpha11, and IFN-alphaB, were designed and evaluated on Poly(I).Poly(C)-induced and influenza virus-infected L929 cells. Specificity of the primers was confirmed in a cross-polymerase chain reaction (cross-PCR). IFN-alpha1, IFN-alpha1-9, IFN-alpha4, IFN-alpha6/8, IFN-alpha11, and IFN-alphaB were found to be induced in L929 cells 6-9 h after Poly(I).Poly(C) treatment. The amplification of a particular subtype was not biased in the presence of excess of other templates. Differential expression of the IFN-alpha subtypes was observed in influenza A/NWS/33- and B/Lee/40-infected L929 cells. A/NWS/33 virus was found to upregulate the gene expression of IFN-alpha1, IFN-alpha4, IFN-alpha6/8, IFN-alpha11, and IFN-alphaB in L929 cells as early as 6 h after infection. In B/Lee/40-infected L929 cells, only IFN-alpha4 was upregulated. Our results suggest that the designed primers will serve as a useful tool in analyzing the expression of IFN-alpha subtypes in various systems and hence for the evaluation of their function.