CNS Neuroscience & Therapeutics,
Journal Year:
2023,
Volume and Issue:
29(4), P. 1120 - 1128
Published: Jan. 10, 2023
Abstract
Aims
To
assess
differences
in
the
clinical
prognosis
between
different
treatment
timings
poor‐grade
(Hunt
and
Hess
grade
4–5)
aneurysmal
subarachnoid
hemorrhage
patients.
Methods
The
treated
127
patients
were
divided
into
three
groups:
early
within
2
days,
on
days
3
to
10,
for
more
than
10
after
hemorrhage.
Odd
ratios
with
a
95%
confidence
interval
calculated
logistic
regression
timing
strategies
regarding
delayed
cerebral
ischemia
poor
at
months.
Subgroup
analyses
conducted
determine
whether
affect
prognosis.
Results
Patients
who
received
prone
develop
Postponing
older
55
years
or
diagnosed
an
intraventricular
hematoma
initial
computed
tomography
scan
may
lead
prognosis,
intervention
group
as
reference.
Conclusions
Early
is
suggested
be
implemented.
harbored
highest
risk
of
prognosis;
might
benefit
from
intervention,
especially
ones
hematoma.
Stroke,
Journal Year:
2023,
Volume and Issue:
54(7), P. 1930 - 1942
Published: May 26, 2023
Aneurysmal
subarachnoid
hemorrhage
(aSAH)
is
a
devastating
form
of
stroke
frequently
affecting
young
to
middle-aged
adults,
with
an
unmet
need
improve
outcome.
This
special
report
focusses
on
the
development
intrathecal
haptoglobin
supplementation
as
treatment
by
reviewing
current
knowledge
and
progress,
arriving
at
Delphi-based
global
consensus
regarding
pathophysiological
role
extracellular
hemoglobin
research
priorities
for
clinical
translation
hemoglobin-scavenging
therapeutics.
After
aneurysmal
hemorrhage,
erythrocyte
lysis
generates
cell-free
in
cerebrospinal
fluid,
which
strong
determinant
secondary
brain
injury
long-term
Haptoglobin
body's
first-line
defense
against
binding
it
irreversibly,
preventing
translocation
into
parenchyma
nitric
oxide-sensitive
functional
compartments
cerebral
arteries.
In
mouse
sheep
models,
intraventricular
administration
reversed
hemoglobin-induced
clinical,
histological,
biochemical
features
human
hemorrhage.
Clinical
this
strategy
imposes
unique
challenges
set
novel
mode
action
anticipated
drug
administration,
necessitating
early
input
from
stakeholders.
Practising
clinicians
(n=72)
scientific
experts
(n=28)
5
continents
participated
Delphi
study.
Inflammation,
microvascular
spasm,
initial
intracranial
pressure
increase,
disruption
oxide
signaling
were
deemed
most
important
pathways
determining
Cell-free
was
thought
play
mostly
related
iron
toxicity,
oxidative
stress,
oxide,
inflammation.
While
useful,
there
that
further
preclinical
work
not
priority,
believing
field
ready
phase
trial.
The
highest
confirming
haptoglobin's
safety,
individualized
versus
standard
dosing,
timing
treatment,
pharmacokinetics,
pharmacodynamics,
outcome
measure
selection.
These
results
highlight
trials
value
disciplines
scale
during
stages
translation.
Critical Care Medicine,
Journal Year:
2024,
Volume and Issue:
52(5), P. 752 - 763
Published: Jan. 11, 2024
OBJECTIVES:
To
perform
a
detailed
examination
of
sodium
levels,
hyponatremia
and
fluctuations,
their
association
with
delayed
cerebral
ischemia
(DCI)
poor
outcome
after
aneurysmal
subarachnoid
hemorrhage
(aSAH).
DESIGN:
An
observational
cohort
study
from
prospective
SAH
Registry.
SETTING:
Tertiary
referral
center
focused
on
treatment
in
the
Amsterdam
metropolitan
area.
PATIENTS:
A
total
964
adult
patients
confirmed
aSAH
were
included
between
2011
2021.
INTERVENTIONS:
None.
MEASUREMENTS
AND
MAIN
RESULTS:
277
(29%)
developed
DCI.
Hyponatremia
occurred
significantly
more
often
DCI
compared
no-DCI
(77%
vs.
48%).
Sodium
hyponatremia,
hypernatremia,
fluctuations
did
not
predict
However,
higher
levels
associated
(DCI
onset
–7,
+0,
+1,
+2,
+4,
+5,
+8,
+9
d),
(postbleed
day
6–10
12–14).
Also,
hypernatremia
greater
both
patients.
CONCLUSIONS:
occurrence
irrespective
presence
Therefore,
even
mild
changes
warrant
close
attention.
Journal of Cerebral Blood Flow & Metabolism,
Journal Year:
2024,
Volume and Issue:
44(6), P. 841 - 856
Published: Feb. 28, 2024
Subarachnoid
hemorrhage
is
a
devastating
sequela
of
aneurysm
rupture.
Because
it
disproportionately
affects
younger
patients,
the
population
impact
hemorrhagic
stroke
from
subarachnoid
substantial.
Secondary
brain
injury
significant
contributor
to
morbidity
after
hemorrhage.
Initial
causes
intracranial
pressure
elevations,
disrupted
cerebral
perfusion
pressure,
global
ischemia,
and
systemic
dysfunction.
These
initial
events
are
followed
by
two
characterized
timespans
secondary
injury:
early
period
delayed
ischemia
period.
The
identification
varying
microglial
phenotypes
across
phases
paired
with
functions
microglia
during
each
phase
provides
basis
for
serving
critical
role
in
both
promoting
attenuating
hemorrhage-induced
morbidity.
duality
effects
on
outcomes
following
SAH
highlighted
pleiotropic
features
these
cells.
Here,
we
provide
an
overview
key
as
cytotoxic
restorative
effectors.
We
first
describe
ontogeny
populations
that
respond
then
correlate
phenotypic
development
functions,
synthesizing
experimental
data
this
area.
CNS Neuroscience & Therapeutics,
Journal Year:
2023,
Volume and Issue:
29(4), P. 1120 - 1128
Published: Jan. 10, 2023
Abstract
Aims
To
assess
differences
in
the
clinical
prognosis
between
different
treatment
timings
poor‐grade
(Hunt
and
Hess
grade
4–5)
aneurysmal
subarachnoid
hemorrhage
patients.
Methods
The
treated
127
patients
were
divided
into
three
groups:
early
within
2
days,
on
days
3
to
10,
for
more
than
10
after
hemorrhage.
Odd
ratios
with
a
95%
confidence
interval
calculated
logistic
regression
timing
strategies
regarding
delayed
cerebral
ischemia
poor
at
months.
Subgroup
analyses
conducted
determine
whether
affect
prognosis.
Results
Patients
who
received
prone
develop
Postponing
older
55
years
or
diagnosed
an
intraventricular
hematoma
initial
computed
tomography
scan
may
lead
prognosis,
intervention
group
as
reference.
Conclusions
Early
is
suggested
be
implemented.
harbored
highest
risk
of
prognosis;
might
benefit
from
intervention,
especially
ones
hematoma.
