Background
Intracranial
hemorrhage
due
to
a
ruptured
aneurysm
is
one
of
the
most
serious
neurosurgical
emergencies.
The
patient
mostly
presents
with
severe
headaches
and
neurological
deterioration.
A
rapid
diagnosis
an
interdisciplinary
approach
play
major
role
in
fate
these
patients.
treatment
can
vary
from
endovascular
surgical
must
be
carefully
individually
planned.
Neurovascular
expertise
are
vital
importance
obligatory
for
best
possible
outcome.
Methods
In
this
narrative
review,
we
scrutinize
current
literature
discuss
actual
data
guidelines
order
emphasize
patients
intracranial
aneurysm.
Results
inhomogeneous
often
ineffective
internal
disputes
between
different
disciplines.
Although
there
plenty
hard
evidence
“show
way,”
many
still
choose
base
their
decisions
on
personal
experience
or
opinion.
Conclusions
Every
brain
should
approached
manor
treated
according
guidelines.
Translational Stroke Research,
Год журнала:
2024,
Номер
unknown
Опубликована: Фев. 23, 2024
Abstract
While
subarachnoid
hemorrhage
is
the
second
most
common
hemorrhagic
stroke
in
epidemiologic
studies,
recent
DISCHARGE-1
trial
has
shown
that
reality,
three-quarters
of
focal
brain
damage
after
ischemic.
Two-fifths
these
ischemic
infarctions
occur
early
and
three-fifths
are
delayed.
The
vast
majority
cortical
infarcts
whose
pathomorphology
corresponds
to
anemic
infarcts.
Therefore,
we
propose
this
review
as
an
ischemic-hemorrhagic
rather
a
third,
separate
entity
addition
purely
or
strokes.
Cumulative
damage,
determined
by
neuroimaging
first
2
weeks,
strongest
known
predictor
patient
outcome
half
year
initial
hemorrhage.
Because
unique
ability
implant
neuromonitoring
probes
at
surface
before
onset
perform
longitudinal
MRI
scans
stroke,
delayed
cerebral
ischemia
currently
variant
humans
pathophysiological
details
far
best
characterized.
Optoelectrodes
located
directly
over
newly
developing
have
that,
mechanistic
correlates
infarct
development,
spreading
depolarizations
trigger
(1)
ischemia,
(2)
severe
hypoxia,
(3)
persistent
activity
depression,
(4)
transition
from
clustered
negative
ultraslow
potential.
Furthermore,
traumatic
injury
third
etiologies
death
during
continued
systemic
circulation.
Here,
use
examples
illustrate
although
cascades
associated
with
global,
they
closely
resemble
local
development
Delayed
cerebral
ischemia
(DCI)
is
one
of
the
main
contributing
factors
to
poor
clinical
outcome
after
aneurysmal
subarachnoid
hemorrhage
(SAH).
Unsuccessful
treatment
can
cause
irreversible
brain
injury
in
form
DCI-related
infarction.
We
aimed
assess
association
between
location,
distribution,
and
size
infarction
relation
outcome.
Translational Stroke Research,
Год журнала:
2024,
Номер
unknown
Опубликована: Фев. 29, 2024
Subarachnoid
haemorrhage
(SAH)
is
a
subtype
of
stroke
that
predominantly
impacts
younger
individuals.
It
associated
with
high
mortality
rates
and
can
cause
long-term
disabilities.
This
review
examines
the
contribution
initial
blood
load
dynamics
clot
clearance
to
pathophysiology
SAH
risk
adverse
outcomes.
These
outcomes
include
hydrocephalus
delayed
cerebral
ischaemia
(DCI),
particular
focus
on
impact
located
in
cisternal
spaces,
as
opposed
ventricular
blood,
development
DCI.
The
literature
described
underscores
prognostic
value
haematoma
characteristics,
such
volume,
density,
anatomical
location.
limitations
traditional
radiographic
grading
systems
are
discussed,
compared
more
accurate
volumetric
quantification
techniques
for
predicting
patient
prognosis.
Further,
significance
red
cells
(RBCs)
their
breakdown
products
secondary
brain
injury
after
explored.
presents
novel
interventions
designed
accelerate
or
mitigate
effects
toxic
byproducts
released
from
erythrolysis
cerebrospinal
fluid
following
SAH.
In
conclusion,
this
offers
deeper
insights
into
complex
discusses
potential
pathways
available
advancing
its
management.
Translational Stroke Research,
Год журнала:
2024,
Номер
unknown
Опубликована: Апрель 30, 2024
The
recently
published
DISCHARGE-1
trial
supports
the
observations
of
earlier
autopsy
and
neuroimaging
studies
that
almost
70%
all
focal
brain
damage
after
aneurysmal
subarachnoid
hemorrhage
are
anemic
infarcts
cortex,
often
also
affecting
white
matter
immediately
below.
not
limited
by
usual
vascular
territories.
About
two-fifths
ischemic
occurs
within
~
48
h;
remaining
three-fifths
delayed
(within
3
weeks).
Using
neuromonitoring
technology
in
combination
with
longitudinal
neuroimaging,
entire
sequence
both
early
cortical
infarct
development
has
been
recorded
patients.
Characteristically,
caused
acute
severe
vasospastic
events,
so-called
spreading
ischemia,
triggered
spontaneously
occurring
depolarization.
In
locations
where
a
depolarization
passes
through,
cerebral
blood
flow
can
drastically
drop
few
seconds
remain
suppressed
for
minutes
or
even
hours,
followed
high-amplitude,
sustained
hyperemia.
depolarization,
neurons
lead
event,
other
cells
neurovascular
unit
(endothelium,
smooth
muscle,
pericytes,
astrocytes,
microglia,
oligodendrocytes)
follow.
However,
dysregulation
three
supersystems-nervous,
vascular,
immune-is
very
likely
involved
dysfunction
underlying
ischemia.
It
is
assumed
blood,
which
lies
directly
on
cortex
enters
parenchyma
via
glymphatic
channels,
triggers
these
dysregulations.
This
review
discusses
neuroglial,
neurovascular,
neuroimmunological
dysregulations
context
ischemia
as
critical
elements
pathogenesis
hemorrhage.
Scientific Reports,
Год журнала:
2025,
Номер
15(1)
Опубликована: Март 12, 2025
Abstract
Spreading
depolarizations
(SD)
in
the
cerebral
cortex
are
a
novel
mechanism
of
lesion
development
and
worse
outcomes
after
acute
brain
injury,
but
accurate
diagnosis
by
neurophysiology
is
barrier
to
more
widespread
application
neurocritical
care.
Here
we
developed
an
automated
method
for
SD
detection
training
machine-learning
models
on
electrocorticography
data
from
14-patient
cohort
that
included
1,548
examples
direct-current
waveforms
as
identified
expert
manual
scoring.
As
determined
leave-one-patient-out
cross-validation,
optimal
performance
was
achieved
with
gradient-boosting
model
using
30
features
computed
400-s
segments
sampled
at
0.1
Hz.
This
applied
continuous
generating
time
series
probability
[
P
(t)
],
threshold
values
trigger
predictions
were
empirically.
The
algorithm
then
tested
dataset
10
patients,
resulting
1,252
true
positive
detections
(/1,953;
64%
sensitivity)
323
false
positives
(6.5/day).
Secondary
review
showed
majority
(224,
or
69%)
likely
real
SDs,
highlighting
conservative
nature
scoring
utility
automation.
sparse
sampling
(0.1
Hz)
streaming
use
cloud
computing
applications
Brain Sciences,
Год журнала:
2024,
Номер
14(9), С. 849 - 849
Опубликована: Авг. 23, 2024
Delayed
cerebral
ischemia
(DCI)
is
a
severe
complication
following
aneurysmal
subarachnoid
hemorrhage
(aSAH),
linked
to
poor
functional
outcomes
and
prolonged
intensive
care
unit
(ICU)
stays.
Timely
DCI
diagnosis
crucial
but
remains
challenging.
Dysregulated
blood
glucose,
commonly
observed
after
aSAH,
may
impair
the
constant
glucose
supply
that
vital
for
brain
function,
potentially
contributing
DCI.
This
study
aimed
assess
whether
indices
could
help
identify
at-risk
patients
improve
detection.
retrospective,
single-center
observational
examined
151
aSAH
between
2016
2019.
Additionally,
70
of
these
(46.4%)
developed
81
did
not
(no-DCI).
To
determine
value
glycemic
DCI,
they
were
analyzed
separately
in
period
before
(pre-DCI)
(post-DCI).
The
time-weighted
average
(TWAG,
p
=
0.024),
mean
(p
0.033),
novel
time-unified
dysglycemic
rate
(TUDR140,
calculated
as
ratio
total
periods
within
target
range
70–140
mg/dL,
0.042),
showed
significantly
higher
values
pre-DCI
group
than
no-DCI
group.
In
time-series
analysis,
significant
increases
TWAG
TUDR140
at
onset.
conclusion,
elevated
levels
further
increase
Prospective
studies
are
needed
confirm
findings,
this
cannot
completely
exclude
confounders
limitations.
future
might
become
valuable
parameters
multiparametric
models
risk
detect
onset
earlier.
Scientific Reports,
Год журнала:
2024,
Номер
14(1)
Опубликована: Янв. 27, 2024
Abstract
We
analyzed
the
correlation
between
duration
of
electroencephalogram
(EEG)
recovery
and
histological
outcome
in
rats
acute
stage
subarachnoid
hemorrhage
(SAH)
to
find
a
new
predictor
subsequent
outcome.
SAH
was
induced
eight
by
cisternal
blood
injection,
cortical
depolarization
measured.
EEG
power
spectrums
were
given
time
frequency
analysis,
histology
evaluated.
The
appropriate
band
percentage
(defined
as
time)
predict
neuronal
damage
determined
from
25
patterns
(5
bands
×
5
rates)
receiver
operating
characteristic
(ROC)
curves.
Probit
regression
curves
depicted
evaluate
relationships
injury
recovery.
optimal
values
10–15
Hz
40%,
respectively
(area
under
curve
[AUC]:
0.97).
There
close
relationship
damaged
neurons
or
time.
These
results
suggest
that
time,
above
rate,
may
be
novel
marker
after
SAH.
Neurosurgical Review,
Год журнала:
2024,
Номер
47(1)
Опубликована: Апрель 10, 2024
Abstract
Recent
studies
suggest
that
differential
DNA
methylation
could
play
a
role
in
the
mechanism
of
cerebral
vasospasm
(CVS)
and
delayed
ischemia
(DCI)
after
aneurysmal
subarachnoid
hemorrhage
(aSAH).
Considering
significance
this
matter
lack
effective
prophylaxis
against
DCI,
we
aim
to
summarize
current
state
knowledge
regarding
their
associations
with
identify
gaps
for
future
trial.
PubMed
MEDLINE,
Scopus,
Web
Science
were
searched
by
two
authors
three
waves
relevant
association
DCI
aSAH.
PRISMA
checklist
was
followed
systematic
structure.
STROBE
statement
used
assess
quality
risk
bias
within
studies.
This
research
funded
National
Centre,
Poland
(grant
number
2021/41/N/NZ2/00844).
Of
70
records,
7
peer-reviewed
articles
met
eligibility
criteria.
Five
candidate
gene
approach,
epigenome-wide
(EWAS),
one
utilized
bioinformatics
previous
EWAS,
using
more
than
approach.
Methylation
status
four
cytosine-guanine
dinucleotides
(CpGs)
related
distinct
genes
(ITPR3,
HAMP,
INSR,
CDHR5)
have
been
found
significantly
or
suggestively
associated
Analysis
epigenetic
clocks
yielded
significant
lower
age
acceleration
radiological
CVS
but
not
DCI.
Hub
hypermethylation
(VHL,
KIF3A,
KIFAP3,
RACGAP1,
OPRM1)
hypomethylation
(ALB,
IL5)
indicated
through
analysis.
As
none
CpGs
overlapped
across
studies,
meta-analysis
applicable.
The
identified
sites
might
potentially
serve
as
biomarker
early
diagnosis
aSAH
future.
However,
overlapping
results
prompts
need
large-scale
multicenter
Challenges
prospects
are
discussed.
International Journal of Molecular Sciences,
Год журнала:
2023,
Номер
24(13), С. 10769 - 10769
Опубликована: Июнь 28, 2023
Brain
ischemia
induces
slow
voltage
shifts
in
the
cerebral
cortex,
including
waves
of
spreading
depolarization
(SD)
and
negative
ultraslow
potentials
(NUPs),
which
are
considered
as
brain
injury
markers.
However,
different
electrode
materials
locations
yield
variable
SD
NUP
features.
Here,
we
compared
terminal
cortical
events
during
isoflurane
or
sevoflurane
euthanasia
using
intracortical
linear
iridium
arrays
Ag/AgCl-based
electrodes
rat
somatosensory
cortex.
Inhalation
anesthetics
caused
respiratory
arrest,
associated
with
hyperpolarization
followed
by
on
both
Ir
Ag
electrodes.
Ag-NUPs
were
bell
shaped
waned
within
half
an
hour
after
death.
Ir-NUPs
biphasic,
early
fast
phase
corresponding
to
Ag-NUP,
late
absent
electrodes,
a
progressive
depolarizing
shift
reaching
−100
mV
two
hours
In
addition,
more
ample
deep
layers
than
at
surface.
Thus,
reliably
assess
manifestations
hyperpolarization,
NUP,
while
late,
giant
amplitude
is
present
only
probably
related
sensitivity
yet
unidentified
factor
