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Whole-brain CT Perfusion at Admission and During delayed Time-window Detects the delayed cerebral ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage

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Current Medical Science 2023年第2期43卷 409-416页

作者： Feng YOU Wen-juan TANG Chao ZHANG Ming-quan YE Xing-gen FANG Yun-feng ZHOU Department of Radiology the First Affiliated Hospital of Wannan Medical CollegeWuhu241001China Department of Radiology Affiliated Hangzhou First People’s HospitalHangzhou310000China Department of Radiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China School of Medical Information Wannan Medical CollegeWuhu241001China Department of Neurosurgery the First Affiliated Hospital of Wannan Medical CollegeWuhu241001China

Objective To evaluate the utility of computed tomography perfusion(CTP)both at admission and during delayed cerebral ischemia time-window(DCITW)in the detection of delayed cerebral ischemia(DCI)and the change in CTP parameters from admission to DCITW following aneurysmal subarachnoid hemorrhage.Methods Eighty patients underwent CTP at admission and during DCITW.The mean and extreme values of all CTP parameters at admission and during DCITW were compared between the DCI group and non-DCI group,and comparisons were also made between admission and DCITW within each group.The qualitative color-coded perfusion maps were recorded.Finally,the relationship between CTP parameters and DCI was assessed by receiver operating characteristic(ROC)analyses.Results With the exception of cerebral blood volume(P=0.295,admission;P=0.682,DCITW),there were significant differences in the mean quantitative CTP parameters between DCI and non-DCI patients both at admission and during DCITW.In the DCI group,the extreme parameters were significantly different between admission and DCITW.The DCI group also showed a deteriorative trend in the qualitative color-coded perfusion maps.For the detection of DCI,mean transit time to the center of the impulse response function(Tmax)at admission and mean time to start(TTS)during DCITW had the largest area under curve(AUC),0.698 and 0.789,respectively.Conclusion Whole-brain CTP can predict the occurrence of DCI at admission and diagnose DCI during DCITW.The extreme quantitative parameters and qualitative color-coded perfusion maps can better reflect the perfusion changes of patients with DCI from admission to DCITW.

关键词： aneurysmal subarachnoid hemorrhage delayed cerebral ischemia admission time window computed tomography perfusion

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Hypoperfusion assessed by pressure reactivity index is associated with delayed cerebral ischemia after subarachnoid hemorrhage:an observational study

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Chinese Neurosurgical Journal 2021年第3期7卷 204-212页

作者： Bin Bin Fan Xiao Chuan Sun Zhi Jian Huang Xiao Min Yang Zong Duo Guo Zhao Hui He Department of Neurosurgery The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina

Background:Dysfunction of cerebral autoregulation is one of the pathophysiological mechanisms that causes delayed cerebral ischemia(DCI)after subarachnoid hemorrhage(SAH).Pressure reactivity index(PRx)have been confirmed to reflect the level of cerebral autoregulation and used to derive optimal cerebral perfusion pressure(CPPopt).The goal of this study is to explore the associations between autoregulation,CPPopt,PRx,and DCI.Methods:Continuous intracranial pressure(ICP),arterial blood pressure(ABP),and cerebral perfusion pressure(CPP)signals acquired from 61 aSAH patients were retrospectively analyzed.PRx was calculated and collected by Pneumatic computer system.The CPP at the lowest PRx was determined as the CPPopt.The duration of a hypoperfusion event(dHP)was defined as the cumulative time that the PRx was>0.3 and the CPP was

关键词： cerebral perfusion pressure Pressure reactivity index delayed cerebral ischemia Subarachnoid hemorrhage

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Therapeutic potential of stem cells in subarachnoid hemorrhage

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Neural Regeneration Research 2025年第4期20卷 936-945页

作者： Hideki Kanamaru Hidenori Suzuki Department of Neurosurgery Mie University Graduate School of MedicineTsuJapan

Aneurysm rupture can result in subarachnoid hemorrhage,a condition with potentially severe consequences,such as disability and death.In the acute stage,early brain injury manifests as intracranial pressure elevation,global cerebral ischemia,acute hydrocephalus,and direct blood–brain contact due to aneurysm rupture.This may subsequently cause delayed cerebral infarction,often with cerebral vasospasm,significantly affecting patient outcomes.Chronic complications such as brain volume loss and chronic hydrocephalus can further impact outcomes.Investigating the mechanisms of subarachnoid hemorrhage-induced brain injury is paramount for identifying effective treatments.Stem cell therapy,with its multipotent differentiation capacity and anti-inflammatory effects,has emerged as a promising approach for treating previously deemed incurable conditions.This review focuses on the potential application of stem cells in subarachnoid hemorrhage pathology and explores their role in neurogenesis and as a therapeutic intervention in preclinical and clinical subarachnoid hemorrhage studies.

关键词： delayed cerebral ischemia early brain injury matricellular protein neurogenesis stem cell therapy subarachnoid hemorrhage

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A prospective cohort study on serum A20 as a prognostic biomarker of aneurysmal subarachnoid hemorrhage

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World Journal of Emergency Medicine 2023年第5期14卷 360-366页

作者： Tian Yan Ziyin Chen Shengdong Zou Zefan Wang Quan Du Wenhua Yu Wei Hu Yongke Zheng Keyi Wang Xiaoqiao Dong Shuangyong Dong The Fourth School of Clinical Medicine Zhejiang Chinese Medical UniversityHangzhou 322000China Department of Neurosurgery Affi liated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhou 310006China Department of Intensive Care Unit Affi liated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhou 310006China Clinical Laboratory Center Affi liated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhou 310006China Emergency Department Affi liated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhou 310006China

BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS) scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.

关键词： Subarachnoid hemorrhage Aneurysm A20 delayed cerebral ischemia Outcome Biomarkers

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Hydroxyethylstarch revisited for acute brain injury treatment

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Neural Regeneration Research 2021年第7期16卷 1372-1376页

作者： Martin A.Schick Malgorzata Burek Carola Y.Forster Michiaki Nagai Christian Wunder Winfried Neuhaus Department of Anesthesiology and Critical Care Medical Center-University of FreiburgFreiburgGermany Faculty of Medicine University of FreiburgFreiburgGermany Department of Anaesthesia and Critical Care University Hospital WürzburgWürzburgGermany Department of Internal Medicine General Medicine and CardiologyHiroshima City Asa HospitalHiroshimaJapan Robert-Bosch-Krankenhaus Department of Anesthesiology and Intensive Care MedicineStuttgartGermany Competence Unit Molecular Diagnostics Center Health and BioresourcesAustrian Institute of Technology GmbHViennaAustria

Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch can aggravate acute kidney injury, especially in septic patients.Because of the serious risk for critically ill patients, the administration of hydroxyethylstarch was restricted for clinical use.Animal studies and recently published in vitro experiments showed that hydroxyethylstarch might exert protective effects on the blood-brain barrier.Since the prevention of blood-brain barrier disruption was shown to go along with the reduction of brain damage after several kinds of insults, we revisit the topic hydroxyethylstarch and discuss a possible niche for the application of hydroxyethylstarch in acute brain injury treatment.

关键词： acute subarachnoid hemorrhage astrocyte chronic kidney disease delayed cerebral ischemia microglia neurovascular unit osmotic pressure pericyte stroke traumatic brain injury

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New Developments in Drug Therapy and Research of cerebral Vasospasm

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Open Journal of Modern Neurosurgery 2013年第4期3卷 72-93页

作者： Eleftherios Archavlis Peter Ulrich Mario Carvi YNievas Department of Neurosurgery Sana Klinikum OffenbachAkademisches Lehrkrankenhaus der UniversitatFrankfurtGermany Department of Neurosurgery Klinikum TraunsteinAkademisches Lehrkrankenhaus der UniversitatMünchenGermany

In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new agents available for treatment of cerebral vasospasm is expanding rapidly along with rapid advances in pharmacology and physiology that are uncovering the mechanisms of this disease. Although there are many publications for treatment of cerebral vaso-spasm, most are focusing on different aspects of vasospasm treatment and many have limited value due to insufficient quality. Moreover, the complexity of this, in many cases deleterious condition, is enormous and the information needed to understand drug effects is accordingly often not readily available in a single source. A number of pharmacological and medical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Current research efforts promise the eventual production of new medical therapies. At last, recommendations for the use of different treatment stages based on currently available clinical data are provided.

关键词： cerebral Vasospasm Drug Therapy Subarachnoid Hemorrhage delayed cerebral ischemia New Developments Treatment

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