Neurosurgical Review,
Год журнала:
2024,
Номер
47(1)
Опубликована: Май 17, 2024
Abstract
Objective
Delayed
cerebral
ischemia
(DCI)
is
a
potentially
reversible
adverse
event
after
aneurysmal
subarachnoid
hemorrhage
(aSAH),
when
early
detected
and
treated.
Computer
tomography
perfusion
(CTP)
used
to
identify
the
tissue
at
risk
for
DCI.
In
this
study,
predictive
power
of
CTP
was
compared
with
that
blood
distribution
on
initial
CT
localization
Methods
A
consecutive
patient
cohort
aSAH
treated
between
2012
2020
retrospectively
analyzed.
Blood
semi-quantitatively
assessed
Hijdra-score.
The
vessel
territory
most
surrounding
one
deficits
performed
day
3
ictus
were
considered
be
DCI,
respectively.
Results
total
324
patients
included.
infarction
occurred
in
17%
(56/324)
patients.
Early
82%
(46/56)
patients,
85%
(39/46)
them
developed
within
predicted
risk.
46%
(25/56)
reliably
determined
by
distribution.
For
prediction
amount/distribution
inferior
CTP.
Concerning
identification
“tissue
risk”
combination
both
methods
resulted
an
increase
sensitivity
64%,
positive
value
58%,
negative
92%.
Conclusions
Regarding
DCI-prediction,
superior
amount/distribution,
while
consideration
may
help
territories
DCI
without
deficits.
Stroke,
Год журнала:
2023,
Номер
54(7), С. 1930 - 1942
Опубликована: Май 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.
Journal of Cerebral Blood Flow & Metabolism,
Год журнала:
2024,
Номер
44(6), С. 841 - 856
Опубликована: Фев. 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.
Neurosurgical Review,
Год журнала:
2024,
Номер
47(1)
Опубликована: Май 17, 2024
Abstract
Objective
Delayed
cerebral
ischemia
(DCI)
is
a
potentially
reversible
adverse
event
after
aneurysmal
subarachnoid
hemorrhage
(aSAH),
when
early
detected
and
treated.
Computer
tomography
perfusion
(CTP)
used
to
identify
the
tissue
at
risk
for
DCI.
In
this
study,
predictive
power
of
CTP
was
compared
with
that
blood
distribution
on
initial
CT
localization
Methods
A
consecutive
patient
cohort
aSAH
treated
between
2012
2020
retrospectively
analyzed.
Blood
semi-quantitatively
assessed
Hijdra-score.
The
vessel
territory
most
surrounding
one
deficits
performed
day
3
ictus
were
considered
be
DCI,
respectively.
Results
total
324
patients
included.
infarction
occurred
in
17%
(56/324)
patients.
Early
82%
(46/56)
patients,
85%
(39/46)
them
developed
within
predicted
risk.
46%
(25/56)
reliably
determined
by
distribution.
For
prediction
amount/distribution
inferior
CTP.
Concerning
identification
“tissue
risk”
combination
both
methods
resulted
an
increase
sensitivity
64%,
positive
value
58%,
negative
92%.
Conclusions
Regarding
DCI-prediction,
superior
amount/distribution,
while
consideration
may
help
territories
DCI
without
deficits.
