2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Stroke, Journal Year: 2023, Volume and Issue: 54(7)

Published: May 22, 2023

Aim: The “2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage” replaces 2012 “Guidelines Hemorrhage.” 2023 guideline is intended to provide patient-centric recommendations clinicians prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS: A comprehensive search literature published since guideline, derived from research principally involving human subjects, in English, indexed MEDLINE, PubMed, Cochrane Library, other selected databases relevant this was conducted between March 2022 June 2022. In addition, writing group reviewed documents on related subject matter previously by American Heart Association. Newer studies July November that affected recommendation content, Class Recommendation, or Level Evidence were included if appropriate. Structure: hemorrhage a significant global public health threat severely morbid often deadly condition. provides based current evidence treatment these patients. present an evidence-based approach preventing, diagnosing, managing hemorrhage, intent improve quality care align patients’ their families’ caregivers’ interests. Many previous guidelines have been updated new evidence, created when supported data.

Language: Английский

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Leveraging machine learning algorithms to forecast delayed cerebral ischemia following subarachnoid hemorrhage: a systematic review and meta-analysis of 5,115 participants

Neurosurgical Review, Journal Year: 2025, Volume and Issue: 48(1)

Published: Jan. 7, 2025

Language: Английский

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One-year outcome and quality of life of patients with subarachnoid hemorrhage admitted to intensive care unit: a single-center retrospective pilot study

Journal of Anesthesia Analgesia and Critical Care, Journal Year: 2025, Volume and Issue: 5(1)

Published: Jan. 3, 2025

Language: Английский

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Regulatory T Cell- and Natural Killer Cell-Mediated Inflammation, Cerebral Vasospasm, and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage—A Systematic Review and Meta-Analysis Approach

International Journal of Molecular Sciences, Journal Year: 2025, Volume and Issue: 26(3), P. 1276 - 1276

Published: Feb. 1, 2025

Aneurysmal subarachnoid hemorrhage (SAH) involves a significant influx of blood into the cerebrospinal fluid, representing severe form stroke. Despite advancements in aneurysm closure and neuro-intensive care, outcomes remain impaired due to cerebral vasospasm delayed ischemia (DCI). Previous pharmacological therapies have not successfully reduced DCI while improving overall outcomes. As result, efforts are underway better understand cellular molecular mechanisms involved. This review focuses on activation effects immune cells after SAH their interactions with neurotoxic vasoactive substances as well inflammatory mediators. Particular attention is given clinical studies highlighting roles natural killer (NK) regulatory T (Treg) cells. Alongside microglia, astrocytes, oligodendrocytes, NK Treg key contributors cascade following SAH. Their involvement modulating neuro-inflammatory response, vasospasm, underscores potential therapeutic targets prognostic markers post-SAH recovery process. We conducted systematic cell- cell-mediated inflammation ischemia. meta-analysis evaluate mortality focused mechanisms.

Language: Английский

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XGBoost Machine Learning Algorithm for Prediction of Outcome in Aneurysmal Subarachnoid Hemorrhage

Neuropsychiatric Disease and Treatment, Journal Year: 2022, Volume and Issue: Volume 18, P. 659 - 667

Published: March 1, 2022

Background: Patients suffered aneurysmal subarachnoid hemorrhage (aSAH) usually develop poor survival and functional outcome. Evaluating aSAH patients at high risk of outcome is necessary for clinicians to make suitable therapeutical strategy. This study conducted prognostic model using XGBoost (extreme gradient boosting) algorithm in aSAH. Methods: A total 351 admitted West China hospital were identified. divided into training set test with ratio 7:3 testify the predictive value based model. Additionally, logistic regression was also constructed compared Area under receiver operating characteristic curve (AUC), sensitivity specificity calculated evaluate regression. Results: There 74 (21.1%) non-survivors 148 (42.1%) unfavorable Non-survivors had older age (p=0.025), lower Glasgow coma scale (GCS) (p< 0.001), higher World Federation Neurosurgical Societies WFNS score mFisher 0.001). The incidence intraventricular (IVH) (p=0.025) delayed cerebral ischemia (DCI) 0.001) than survivors. AUC predicting mortality 0.950 0.958, which 0.767 0.829 Conclusion: more precise patients. Using helpful identify high-risk therefore strengthen medical care. Keywords: machine learning, artificial intelligence, extreme boosting, hemorrhage, prognosis

Language: Английский

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Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials

Stroke, Journal Year: 2022, Volume and Issue: 53(6), P. 1993 - 2005

Published: March 31, 2022

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and morbidity. We aimed to determine the relative benefits of pharmacological prophylactic treatments in patients aneurysmal by performing a network meta-analysis randomized trials.We searched Medline, Web Science, Embase, Scopus, ProQuest, Cochrane Central February 2020. Pairs reviewers independently identified eligible trials, extracted data, assessed risk bias. Eligible trials compared effects any oral or intravenous medications intracranial drug-eluting implants one another placebo standard care adult hospitalized confirmed hemorrhage. used GRADE (Grading Recommendations Assessment, Development Evaluation) approach assess certainty evidence.We included 53 enrolling 10 415 patients. Nimodipine likely reduces all-cause (odds ratio [OR],0.73 [95% CI, 0.53-1.00]; moderate certainty; absolute reduction (ARR), -3.35%). (OR, 1.46 1.07-1.99]; increase, 8.25%) cilostazol 3.73 1.14-12.18]; 23.15%) were most effective improving disability at longest follow-up. Compared placebo, clazosentan (10 mg/kg; OR, 0.39 0.22-0.68]; ARR, -16.65%), nicardipine 0.48 0.24-0.94]; -13.70%), fasudil 0.55 0.31-0.98]; -11.54%), magnesium 0.66 0.46-0.94]; -8.37%) proved reducing likelihood delayed cerebral ischemia.Nimodipine are preventing morbidity Clazosentan, nicardipine, fasudil, showed beneficial on ischemia vasospasm but they not found reduce disability. Future warranted elaborately investigate that may improve long-term functional outcomes, such as clazosentan.URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019122183.

Language: Английский

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Stroke Proteomics: From Discovery to Diagnostic and Therapeutic Applications

Circulation Research, Journal Year: 2022, Volume and Issue: 130(8), P. 1145 - 1166

Published: April 14, 2022

Stroke remains a leading cause of death and disability, with limited therapeutic options suboptimal tools for diagnosis prognosis. High throughput technologies such as proteomics generate large volumes experimental data at once, thus providing an advanced opportunity to improve the status quo by facilitating identification novel targets molecular biomarkers. Proteomics studies in animals are largely designed decipher pathways altered brain tissue after stroke, whereas human patients primarily focus on biomarker discovery biofluids and, more recently, thrombi extracellular vesicles. Here, we offer comprehensive review stroke conducted both animal specimen present our view limitations, challenges, future perspectives field. In addition, unique resource scientific community, provide extensive lists all proteins identified proteomic perform postanalysis reveal stroke-related cellular processes pathways.

Language: Английский

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Neutrophils and Neutrophil Extracellular Traps Cause Vascular Occlusion and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage in Mice

Arteriosclerosis Thrombosis and Vascular Biology, Journal Year: 2024, Volume and Issue: 44(3), P. 635 - 652

Published: Feb. 1, 2024

BACKGROUND: After subarachnoid hemorrhage (SAH), neutrophils are deleterious and contribute to poor outcomes. Neutrophils can produce neutrophil extracellular traps (NETs) after ischemic stroke. Our hypothesis was that, SAH, delayed cerebral ischemia (DCI) worse outcomes via cerebrovascular occlusion by NETs. METHODS: SAH induced endovascular perforation, mice were given either a neutrophil-depleting antibody, PAD4 (peptidylarginine deiminase 4) inhibitor (to prevent NETosis), DNAse-I degrade NETs), or vehicle control. Mice underwent daily neurological assessment until day 7 then euthanized for quantification of intravascular brain NETs (iNETs). Subsets used quantify infiltration, NETosis potential, iNETs, perfusion, infarction. In addition, NET markers assessed in the blood aneurysmal patients. RESULTS: mice, led infiltration within 24 hours, pro-NETosis phenotype selectively skull neutrophils, caused significant increase iNETs 1, which persisted at least 7. Neutrophil depletion significantly reduced improving leading less deficits incidence DCI (16% versus 51.9%). Similarly, inhibition improved outcome, (5% 30%), whereas degrading marginally Patients with who developed had elevated compared non-DCI CONCLUSIONS: skull-derived primed NETosis, there persistent correlated deficits. The findings from this study suggest therapeutic targets, vascular brain, thereby lessening risk DCI. Finally, may be biomarkers, predict patients developing

Language: Английский

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Using artificial intelligence to optimize anti-seizure treatment and EEG-guided decisions in severe brain injury

Neurotherapeutics, Journal Year: 2025, Volume and Issue: unknown, P. e00524 - e00524

Published: Jan. 1, 2025

Electroencephalography (EEG) is invaluable in the management of acute neurological emergencies. Characteristic EEG changes have been identified diverse neurologic conditions including stroke, trauma, and anoxia, increased utilization continuous (cEEG) has potentially harmful activity even patients without overt clinical signs or diagnoses. Manual annotation by expert neurophysiologists a major resource limitation investigating prognostic therapeutic implications these patterns expanding use to broader set who are likely benefit. Artificial intelligence (AI) already demonstrated success guiding cEEG allocation for at risk seizures, its potential uses neurocritical care alongside improvements AI itself. We review both current EEG-guided as well ongoing research directions automated seizure ischemia detection, prognostication, guidance medical surgical treatment.

Language: Английский

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Mapping Inflammatory Markers in Cerebrospinal Fluid Following Aneurysmal Subarachnoid Hemorrhage: An Age- and Sex-Matched Analysis

International Journal of Molecular Sciences, Journal Year: 2025, Volume and Issue: 26(3), P. 1302 - 1302

Published: Feb. 3, 2025

Despite extensive research on aneurysm treatment and neurocritical care, aneurysmal subarachnoid hemorrhage (SAH) is still a life-threatening disease, often leaving survivors with lasting neurological cognitive impairments. Early brain injury (EBI) delayed cerebral ischemia (DCI) are the main contributors to damage, neuroinflammation being critical shared pathophysiological process. While numerous inflammatory markers their temporal profiles in cerebrospinal fluid (CSF) have already been identified, comparisons age- sex-matched controls limited. This study analyzed CSF from 17 SAH patients requiring an external ventricular drain (EVD) due symptomatic hydrocephalus, sampled days 4 10 post-ictus. An control group included cerebrovascularly healthy lumbar drains during aortic surgery. Chemokines cytokines were quantified using immunoassays. Significantly elevated across both time points MCP-1, CXCL-13, Eotaxin-1, CXCL-10, IL-8, MIF. MIP-1α MIP-1β showed significant differences at particular points, indicating distinct profile for each parameter. These findings highlight neuroinflammation’s key role intracranial systemic pathophysiology following SAH, emphasizing its complexity individual variability. Knowing demographic factors impact specific manifestations of processes, comparison meaningful.

Language: Английский

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