جستجوی مقالات مرتبط با کلیدواژه « Subarachnoid Hemorrhage » در نشریات گروه « پزشکی »

Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition witha high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate theangiographic findings of non-traumatic or spontaneous SAH. This retrospective cohort study included 642 health records of patients with non-traumatic SAH overa 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type,size, location, disease severity classification, and secondary complications, were extracted. The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) anddissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were theanterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery(MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA(p< 0.0001), and ACoA – A1 (p=0.02). Patient age and sex were also significantly correlated with one another(p<0.0001). There was no statistically significant correlation between sex, aneurysm size, Glasgow coma scale(GCS), and modified Rankin scale (MRS). Based on our findings, the presence of aneurysms at ACoA, ACoA – A1, and ICA should bethoroughly ruled out in patients with severe headaches of sudden onset, particularly male patients of youngerages.

Aneurysmal subarachnoid hemorrhage (SAH) constitutes a life-threatening condition, and identifyingthe ruptured aneurysm is essential for further therapy. This study aimed to evaluate the diagnostic accuracy of hypo-attenuating berry sign (HBS) observed on computed tomography (CT) scan in distinguishing ruptured aneurysms.

In this diagnostic accuracy study, patients who had SAH and underwent non-enhanced brain CT scan wererecruited. The HBS was defined as a hypo-attenuating area with an identifiable border in the blood-filled hyper-densesubarachnoid space. The screening performance characteristics of HBS in identifying ruptured aneurysms were calcu-lated considering the digital subtraction angiography (DSA) as the gold standard.

A total of 129 aneurysms in131 patients were analyzed. The overall sensitivity and specificity of HBS in the diagnosis of aneurysms were determinedto be 78.7% (95%CI: 73.1% - 83.4%) and 70.7% (95%CI: 54.3% - 83.4%), respectively. Notably, the sensitivity increased to90.9% (95%CI: 84.3% - 95.0%) for aneurysms larger than 5mm. The level of inter-observer agreement for assessing thepresence of HBS was found to be substantial (kappa=0.734). The diagnostic accuracy of HBS in individuals exhibitedenhanced specificity, sensitivity, and reliability when evaluating patients with a solitary aneurysm or assessing rup-tured aneurysms. The multivariate logistic regression analysis revealed a statistically significant relationship betweenaneurysm size and the presence of HBS (odds ratios of 1.667 (95%CI: 1.238 - 2.244; p < 0.001) and 1.696 (95%CI: 1.231- 2.335; p = 0.001) for reader 1 and reader 2, respectively).

The HBS can serve as a simple and easy-to-useindicator for identifying a ruptured aneurysm and estimating its size in SAH patients.

Spinal anesthesia has been performed on patients who undergo cesarean section, for years. A variety of complications are reported which are followed by spinal anesthesia; but subarachnoid hemorrhage is not one of them. In this study, we present two cases of Subarachnoid hemorrhage resulting from spinal anesthesia. In both cases, patients suffered from a thunderclap sudden-onset headache after undergoing cesarean section. Imaging and laboratory investigations were performed in order to determine the reason contributing to the headache, which revealed subarachnoid hemorrhage. After investigation and excluding other underlying causes, normal imaging studies suggested that the occurrence of subarachnoid hemorrhage as a possible complication of spinal anesthesia should be considered.

One of the clinical manifestations and complications of traumatic brain injury patients is traumatic intracranial hemorrhages, divided into primary and secondary hemorrhages.

The present study was conducted to determine the prevalence of subarachnoid hemorrhage (SAH) in traumatic brain injury (TBI) patients.

The present cross-sectional study was conducted on all TBI patients with SAH for one year. Data collection tools include a demographic profile form and a researcher-made checklist. The severity of TBI is divided according to the Glasgow Coma Scale (GCS) score. The patient’s history and clinical examinations were considered when admitting to the hospital. The consciousness level was measured at 6-to-24-hour intervals, a computed tomography (CT) scan was performed, and any abnormal SAH-related clinical findings and symptoms were recorded. If the patient had other hemorrhages besides SAH, the hematoma volume was recorded. The collected data were entered into and analyzed by SPSS version 16 software.

A total of 534 patients were investigated, of whom84 (15.3%) had intracranial hemorrhage. Out of 84 patients with intracranial hemorrhage, 12 (2.2%) had SAH, of whom ten were male and 2 were female. Also, SAH occurred to traffic accidents, falls, and other related reasons in 7 (58.3%), 4 (33.3%), and 1 (8.3%) patients, respectively. It was also shown that 1 (8.3%), 2 (16.6%), and 9 (75%) patients with SAH had mild, moderate, and severe consciousness, respectively. Regarding the frequency of SAH-related diseases, it was shown that 2 (16.6%) and 10 (82.3%) patients were diabetic and non-diabetic, 4 (33.3%) and 8(66.6%) patients were hypertensive and non-hypertensive, and 7 (58.3%) and 5 (41.6%) patients were with and without a history of skull fractures, respectively, 12 (100%) of them had a history of coagulation disorders.

The prevalence of intracranial hemorrhage and SAH in TBI patients is significantly high, which should be taken into consideration when performing diagnostic and therapeutic procedures for these patients.

 Cerebrovascular incidents are considered uncommon but important complications of vaccination against coronavirus disease-2019 (COVID-19). Subarachnoid hemorrhages (SAH) usually occur due to an underlying cerebral aneurysm. In this study, we have reported a subarachnoid hemorrhage incidence in a patient shortly after receiving the COVID-19 vaccine (ChAdOx1-AstraZeneca).

 A 69-year-old male with no remarkable risk factors referred to the emergency room with complaints of headache, nausea, and vomiting. The patient had received his first dose of vaccine against COVID-19 four days before symptoms started. An aggravated headache, nausea, elevated blood pressure (180/100), and drowsiness occurred on the second day of admission. Imaging implied on acute hydrocephalus and increased intracranial pressure (ICP) caused by subarachnoid hemorrhage. The condition was treated by inserting an external ventricular drain (EVD). We found no underlying vascular abnormality in primary and follow-up cerebral angiographies.

 Reported cerebral haemorrhages caused by COVID-19 vaccination are mostly intra-parenchymal. Our study observed a type of cerebrovascular event that has not been reported frequently. Vaccine-associated cerebrovascular events, however rarely, are critical. It is important to demonstrate possible risks and complications, as vaccination programs against COVID-19 have become an essential part of health care in most countries.

In the management of aneurysmal subarachnoid hemorrhage (aSAH), endocrine dysfunction is infrequently considered. Pituitary (neuroendocrine) dysfunction is highly prevalent after aSAH, leading to residual symptoms such as decreased cognition and quality of life. Although hypopituitarism following SAH may present with non-specific subtle symptoms, it can lead to potentially serious consequences if left undiagnosed.

Methods and Materials/Patients: 

This study was performed to observe the incidence and pattern of neuroendocrine alterations in cases of acute aSAH. A total of 25 patients with acute SAH within 7 days of ictus were included in this prospective study, and an endocrine assessment was performed. The pituitary axes were evaluated for possible dysfunctions, including somatotropic, gonadotropic, corticotropic, and thyrotropic axes.

A total of 25 SAH cases (10 males and 15 females; mean age 55.24 years) were included in the study. Aneurysms were more commonly found in the anterior circulation (n=22) than in the posterior circulation (n=3). Most of the patients presented with the Hunt-Hess grade of 1, followed by grades 3, 2, and 4, respectively. Growth hormone deficiency (48%) was the most common pituitary dysfunction, followed by adrenocorticotrophic hormone (24%), gonadotropins (FSH/LH) (24%), and thyroid stimulating hormone (16%) deficiencies, respectively. Single pituitary axis neuroendocrine dysfunction was noted in 9 patients (36%) and multiple pituitary axes dysfunction was observed in 8 patients (32%). Overall, 17 patients (68%) had neuroendocrine dysfunction in single or multiple pituitary hormone axes.

Neuroendocrine dysfunction in acute aSAH is 68%. Accordingly, 32% of the participants had single-axis pituitary dysfunction and 36% had multiple axes pituitary dysfunction. The most common endocrine dysfunction is growth hormone deficiency (48%), followed by adrenocorticotrophic hormone, gonadotropins (LH & FSH), and thyroid stimulating hormone. Therefore, it is suggested to include hormonal evaluation in the management of acute SAH for better clinical outcomes.

The novel SARS COV-2 virus has had an undeniable widespread effect on the world in different aspects. Although cerebrovascular disease and especially SAH has been reported earlier in COVID patients, there is confusion on different types and patterns of SAH.

A 63-year-old female presented in the emergency department with a headache. Her headaches were severe (Hunt&Hess 2). She was diagnosed with COVID by a positive nasopharyngeal swab PCR test. Her CT revealed a peri mesencephalic, thick SAH without any signs of hydrocephalus or intra-ventricular hemorrhage.

Reviewing the different associations of SAH and COVID, the peri mesencephalic hemorrhage in our case is a novel type which although is not uncommon among non-infected populations, its relation to COVID patients has not been reported before and needs further investigation.

Given its cerebral amyloid angiopathy, subarachnoid hemorrhage might represent transient focal neurological episodes erroneously diagnosed as transient ischemic attacks. The earliest neuroimaging findings in emergency room brain computed tomography indicating subarachnoid hemorrhage in these patients might be very subtle and missed by the clinician.

An 80-year-old man referred with transient focal neurological episodes, suggestive of transient ischemic attacks. In general, except for some cognitive dysfunctions, no remarkable point was noticed in his neurological examination. Nonenhanced brain-computer tomography and magnetic resonance imaging revealed evidence indicating slight convexity subarachnoid hemorrhage at the left frontal cortical region.

The transient focal neurological episodes uncommonly represent intracranial hemorrhage. Nevertheless, this clinical representation might occur in patients with subarachnoid hemorrhage due to cerebral amyloid angiopathy. In such cases, the neuroimaging findings play a major role in the differential diagnosis. The misdiagnosis of transient ischemic attacks in these cases might lead to the consumption of antiplatelet drugs and end in catastrophic hemorrhage and life-threatening complications. Close attention to patients’ clinical findings and judicious use of further neuroimaging studies would help clinicians to avoid making such mistakes.

 Subarachnoid hemorrhage (SAH) is one of the most costly and important causes of death and disability worldwide. Aneurysmal type of this hemorrhage has high fatality and permanent disability rates.

 In the present study, demographic and clinical characteristics of SAH with and without an aneurysm were compared.

 In this cross-sectional study, via the census method, all patients diagnosed with subarachnoid hemorrhage who were admitted to Farshchian Hospital in Hamadan during 2015 - 2016 were assessed. For SAH patients, both with and without an aneurysm, we used medical records to obtain demographic and clinical information. Data was analyzed using SPSS software version 21, at a 95% confidence level.

 Overall, the medical records of 69 patients were investigated in this study. Among them, 17 (24.63%) had an aneurysm. There was a significant difference between the age of SAH patients and aneurysm (P = 0.003). Concerning patient risk factors, 59.4% had a history of hypertension, 29% had a history of smoking, and 17.4% had a history of diabetes. These risk factors and patient aneurysm status were not significantly correlated (P > 0.05). The proportion of death, persistent defect, hydrocephaly, and re-bleeding in investigated patients was 36.23%, 43.48%, 26.09%, and 17.39%, respectively.

 According to the findings, hypertension and smoking were two of the common modifiable risk factors in aneurysmal and non-aneurysmal SAH patients. Unlike non-aneurysmal SAH, aneurysmal SAH was more common in younger patients.
 

Many signs in relation to vascular events and consequent loss of consciousness could be easily incorrectly explained (unclear) in a setting of trauma, especially when these events are a result of the car accident. Third cranial nerve palsy widely occurs due to internal carotid and posterior communicating artery aneurysm. An anterior communicating(ACOM) aneurysm is a rare reason that could lead to oculomotor dysfunction. ACOM ruptured aneurysm may present with sub arachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH) but isolated IVH is a rare finding for ACOM ruptured aneurysm.

A 56-year-old male presented to the hospital emergency department because of trauma after a car accident. He was unconscious with left-sided dilated pupil and ptosis with a brain CT indicating IVH. Brain CT angiography that performed two weeks after the accident revealed ACOM aneurysm. The patient underwent craniotomy and clipping the aneurysm. He was discharged, after completing the period of the following treatmentA combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used.

This report is a unique case of synchronization of third cranial nerve palsy and isolated IVH without SAH due to ACOM aneurysm. In addition, it could be interesting to re-emphasize the need for a comprehensive assessment of traumatic patients for finding some primary pathologies, which could result in an accident.

Intracranial hemorrhage (ICH) is divided into two traumatic and non-traumatic categories. The present study sought to investigate the anatomical properties of non-traumatic intracranial hemorrhage in Kerman, Iran.

A total of 305 non-traumatic ICH cases were chosen in Shafa medical center. Data from patients’ files and CT scan images, including demographic factors and type of malformation, aneurysm size and shape, as well as the invovled location and artery were gathered and statistically analyzed.

Most cases were 40-60 years old. SAH, ICH and SAH+IVH were 69.5%, 14.4 and 8.5% respectively. From all, 65.2% had arteriovenous malformation and following furthure assessment, aneurysm with 148 cases (74.4%) was the most frequent and 57.4% of aneurysm cases were located in the right hemisphere. In 14.9% of cases, multiple aneurysms were observed.

According to the results of this study, non-traumatic intracranial hemorrhages caused by arteriovenous malformation were in the shape of an aneurysm; an increase in age may result in higher probability of aneurysm occurence.

To investigate the effect of Ginkgo biloba extract EGb761 in early brain injury (EBI) after subarachnoid hemorrhage (SAH) and its mechanism. The SAH rat model was constructed and pre-treated with EGb761.The neurological function, severity of SAH, water content of brain tissue, damage degree of the blood-brain barrier, related indexes of oxidative stress, and the level of inflammatory cytokines were compared among the groups. The expression of TXNIP/NLRP3 signaling pathway-related proteins in brain tissues was detected by Western blot. After SAH modeling, the neurological function score was significantly reduced, the degree of brain injury, levels of oxidative stress, inflammatory factors, expression of NLRP3 and TXNIP were all increased. Compared with the SAH rats, the neurological function score of rats pre-treated by EGb761 was higher, the degree of brain injury, levels of oxidative stress and inflammatory factors, expression of NLRP3 and TXNIP were all lower. EGb761 could protect neurological injury after SAH and its mechanism may be that EGb761 could inhibit the activation of the TXNIP/NLRP3 signaling pathway and inflammatory reaction after oxidative stress.

Psilocybin mushroom, which is worldwide famous as magic mushroom, is a relatively well-characterized hallucinogen manifesting a diverse dose-dependently spectrum of effects on healthy humans. As psilocybin has been increasingly abused among the youth, this research aimed to review the effects of the psilocybin administration, which is considered as either a good or bad trip among the consumers.

This research reported a 20-year-old man who presented with severe thunderclap headache and consequent subarachnoid hemorrhage as a result of magic mushroom consumption.

The neurologic presentation of psilocybin could be various, which might lead to emergent situations as subarachnoid hemorrhage, and the notion of the harmlessness of magic mushroom was called into question.

We aimed to explore the treatment and safety of subarachnoid hemorrhage.

A retrospective analysis was applied on 137 patients with subarachnoid hemorrhage treated in Binzhou Central Hospital, Bingzhou, China from March 2015 to October 2018.  Seventy cases with interventional embolization of intracranial aneurysms were divided as the observation group, and 67 cases with craniotomy for aneurysm clipping were divided as the control group. The changes of immune globulins before and after surgery, CD4+, CD8+, NIHSS scores, BI scores, the total effective rate of subarachnoid hemorrhage, the total length of postoperative hospital stay and conditions of postoperative complications as well as 30-day survival were compared between the two groups.

The levels of Ig G, Ig M, Ig A, and CD4+ after surgery in the observation group were significantly lower than those before surgery (P<0.05), but significantly higher than those in the control group (P<0.05); the total time of postoperative hospitalization in the observation group was shorter than that in the control group (P<0.05). The incidence of intracranial infection and cerebral vasospasm in the observation group was significantly lower than that in the control group (P<0.05). The NIHSS score of the observation group was significantly lower than that of the control group (P<0.05), and the BI score was significantly higher than that of the control group (P<0.05).

Patients with subarachnoid hemorrhage undergoing interventional embolization of aneurysms can reduce the impact on immune function, decrease the adverse reactions caused by treatments, shorten the length of hospital stay and fully improve the efficacy.

This preliminary study evaluates the possible responsibility of ischemia-induced vagosympathetic imbalances following subarachnoid hemorrhage (SAH), for the onset of autoimmune thyroiditis.

Twenty-two rabbits were chosen from our former experimental animals, five of which were picked from healthy rabbits as control (nG-I=5). Sham group (nG-II=5) and animals with thyroid pathologies (nG-III=12) were also included after a one-month-long experimental SAH follow-up. Thyroid hormone levels were measured weekly, and animals were decapitated. Thyroid glands, superior cervical ganglia, and intracranial parts of vagal nerve sections obtained from our tissue archives were reexamined with routine/immunohistochemical methods. Thyroid hormone levels, hormone-filled total follicle volumes (TFVs) per cubic millimeter, degenerated neuron density (DND) of vagal nuclei and neuron density of superior cervical ganglia were measured and statistically compared.

The mean neuron density of both superior cervical ganglia was estimated as 8230±983/ mm3 in study group animals with severe thyroiditis, 7496±787/mm3 in the sham group and 6416±510/mm3 in animals with normal thyroid glands. In control group (group I), T3 was 107±11 μg/dL, T4: 1,43±0.32 μg/dL and TSH <0.5, while mean TFV was 43%/mm3 and DND of vagal nuclei was 3±1/mm3. In sham group (group II), T3 was 96±11 μg/dL, T4: 1.21±0.9 μg/ dL and TSH>0.5 while TFV was 38%/mm3 and DND of vagal nuclei was 13±4. In study group, T3 was 54±8 μg/dL, T4: 1,07±0.3 μg/dL and TSH >0.5, while TFV was 27%/mm3 and DND of vagal nuclei was 42±9/mm3.

Sympathovagal imbalance characterized by relative sympathetic hyperactivity based on vagal insufficiency should be considered as a new causative agent for hypothyroidism.

The vagal network has a major potential role in the immune-life of Peyer’s patches, but there is no satisfying information if vagal ischemia causes Peyer’s patches (PP) disruption following subarachnoid hemorrhage (SAH).

Twenty-two rabbits were used as control (GI, n=5), "sham" (GII, n=5), and SAH (GIII, n=12) groups in this experiment. 0.5 cc saline for GII and 0.5 cc autologous blood for GIII was injected into cisterna magna of the rabbits. Four weeks later, they were euthanized. Their brains, vagal nerves, nodose ganglia, Peyer’s patches, and intestines were examined, using stereological methods. The Peyer’s patches volumes (PPVs)/intestine volume per cubic millimeter was accepted as PP injury score based on a total of 10 points.

The mean degenerated neuron densities of the nodose ganglia and degenerated axon densities of vagal nerves were 5±2/mm3 and 6±2/mm2 in the GI, 13±4/mm3 and 89±16/mm2 in the GII and 321±83/mm3 and 293±88/mm2 in GIII. The mean PPVs and PP score were 8±1×106 µm3 /mm3 and 0-3 in the GI, 10±3×106 µm3 /mm3 and 4-7 in the GII, and 21±5×106 µm3 /mm3 and 8-10 in GIII. P<0.0001 in PPV/PP score/degenerated axon densities of vagal nerves; P<0.0005 in PPV/PP score/degenerated neuron densities of the nodose ganglia between GI/GIII; P<0.001 in (PPV/PP score)/degenerated axon densities of vagal nerves; P<0.005 in PPV/PP score/degenerated neuron densities of the nodose ganglia between GII/GIII; and P>0.05 in GI/GII were noted.

Vagal ischemia/insult may be responsible for PP denervation, and injury-induced dangerous intestinal immunodeficiency following SAH.