Statins for neuroprotection in spontaneous intracerebral hemorrhage.

Statins, a common drug class for treatment of dyslipidemia, may be neuroprotective for spontaneous intracerebral hemorrhage (ICH) by targeting secondary brain injury pathways in the surrounding brain parenchyma. Statin-mediated neuroprotection may stem from downregulation of mevalonate and its derivatives, targeting key cell signaling pathways that control proliferation, adhesion, migration, cytokine production, and reactive oxygen species generation. Preclinical studies have consistently demonstrated the neuroprotective and recovery enhancement effects of statins, including improved neurologic function, reduced cerebral edema, increased angiogenesis and neurogenesis, accelerated hematoma clearance, and decreased inflammatory cell infiltration.

Cocaine Use is Associated with More Rapid Clot Formation and Weaker Clot Strength in Acute Stroke Patients.

Introduction: 1.1.Cocaine use is a known risk factor for stroke and has been associated with worse outcomes.

Dehydroepiandrosterone sulphate: diabolical hormone or epiphenomenon in aneurysmal subarachnoid hemorrhage?

Inflammation is purported to play an important role in the clinical course of subarachnoid hemorrhage. The current study by Höllig et al. entails using dehydroepiandrosterone sulfate, a hormone that inhibits key inflammatory pathways, as a predictor of functional outcome in these patients.

Cocaine use as an independent predictor of seizures after aneurysmal subarachnoid hemorrhage.

Objective: Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), poor neurological grade, increased clot thickness, and cerebral infarction are considered highest risk for seizures. The purpose of this study was to evaluate the impact of recent cocaine use on seizure incidence following aSAH.

Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes.

Purpose: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners.

Materials And Methods: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage.

In-hospital outcomes of aneurysmal subarachnoid hemorrhage associated with cocaine use in the USA.

Cocaine use is associated with higher mortality in small retrospective studies of brain-injured patients. We aimed to explore in-hospital outcomes in a large population based study of aneurysmal subarachnoid hemorrhage (aSAH) with cocaine use. aSAH patients were identified from the 2007-2010 USA Nationwide Inpatient Sample using International Classification of Disease, Ninth Revision codes.

Withdrawal of technological life support following subarachnoid hemorrhage.

Background: Prognostication of mortality or severe disability often prompts withdrawal of technological life support in patients following aneurysmal subarachnoid hemorrhage (aSAH). We assessed admission factors impacting decisions to withdraw treatment after aSAH.

Methods: Prospectively collected data of aSAH patients admitted to our institution between 1991 and 2009 were reviewed.

The SAH Score: a comprehensive communication tool.

Background: The Hunt and Hess grade and World Federation of Neurological Surgeons (WFNS) scale are commonly used to predict mortality after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to improve the accuracy of mortality prediction compared with the aforementioned scales by creating the "SAH score."

Methods: The aSAH database at our institution was analyzed for factors affecting in-hospital mortality using multiple logistic regression analysis.

Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage.

Background And Purpose: Acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH). This study analyzes the impact of cocaine use on patient presentation, complications, and outcomes.

Methods: Data of patients admitted with aSAH between 1991 and 2009 were reviewed to determine impact of acute cocaine use (C).

Controversies in neurosciences critical care.

Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and reversal of coagulopathy; (2) indications for seizure prophylaxis and choice of antiepileptic agent; and (3) the role of specialized neurocritical care units and specialists in the care of critically ill neurology and neurosurgery patients.

Improved aneurysmal subarachnoid hemorrhage outcomes: a comparison of 2 decades at an academic center.

Objective: Management of aneurysmal subarachnoid hemorrhage (aSAH) has evolved over the past 2 decades, including refinement of neurosurgical techniques, availability of endovascular options, and evolution of neurocritical care; their impact on SAH outcomes is unclear.

Design/methods: Prospectively collected data of patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed. We compared survival to discharge and functional outcomes at initial clinic appointment postdischarge (30-120 days) in patients admitted between 1991 and 2000 (phase 1 [P1]) and 2000 and 2009 (phase 2 [P2]), respectively, using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5).

Impact of pattern of admission on outcomes after aneurysmal subarachnoid hemorrhage.

Objective: Patients with aneurysmal subarachnoid hemorrhage (aSAH) require management in centers with neurosurgical expertise necessitating emergent interhospital transfer (IHT). Our objective was to compare outcomes in aSAH IHTs to our institution with aSAH admissions from our institutional emergency department (ED).

Methods: Data for consecutive patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed from a prospectively obtained database.

Impact of pattern of admission on ICH outcomes.

Background: Intracerebral hemorrhage (ICH) is associated with the highest mortality of all strokes. Admission to a Neurosciences Critical Care Unit (NCCU) compared to a general ICU has been associated with reduced mortality following ICH. Such association has led to several hospitals transferring ICH patients to Neuro-ICUs in tertiary care centers.

Intensive care of aneurysmal subarachnoid hemorrhage: an international survey.

Background: Patients with aneurysmal subarachnoid hemorrhage (SAH) are routinely admitted to the intensive care unit for the management of neurological and systemic complications.

Objective: To determine the clinical practices of intensive care physicians treating SAH, and to evaluate the relationship between these practices and published evidence.

Design: Survey.

Impact of statins on validation of ICH mortality prediction models.

Background: Intracerebral hemorrhage (ICH) has the highest mortality rate of all strokes. Hemphill's ICH score is commonly used to predict mortality after ICH. More recently, the ICH grading scale (ICH-GS) has been shown to improve sensitivity of 30 day mortality prediction in this patient group.

Management of spontaneous intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) has the highest mortality of all cerebrovascular events. Thirty-day mortality approaches 50%, and only 20% of survivors achieve meaningful functional recovery at 6 months. Many clinicians believe that effective therapies are lacking; however, this is changing because of new data on the pathophysiology and treatment of ICH, particularly research establishing the role of medical therapies to promote hematoma stabilization.

Management of spontaneous intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) has the highest mortality of all cerebrovascular events. Thirty-day mortality approaches 50%, and only 20% of survivors achieve meaningful functional recovery at 6 months. Many clinicians believe that effective therapies are lacking; however, this is changing because of new data on the pathophysiology and treatment of ICH, particularly research establishing the role of medical therapies to promote hematoma stabilization.

Controversies in neurosciences critical care.

Perhaps the greatest recent controversy in the medical management of complex neurologic and neurosurgical patients has been the defining of the optimal care arena. Despite some early skepticism and measured recognition by the ICU community, neurosciences critical care has grown into a well-recognized subspecialty. Within this environment, the diverse expertise of surgeons, neurologists, and anesthesiologists come together to define best therapeutic strategies.

Prior statin use reduces mortality in intracerebral hemorrhage.

Objective: To assess the impact of blood glucose, coagulopathy, seizures and prior statin and aspirin use on clinical outcome following intracerebral hemorrhage (ICH).

Background: Intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes with mortality rates approaching 50%. Glasgow Coma Scale (GCS), ICH volume, age, pulse pressure, ICH location, intraventricular hemorrhage (IVH) and hydrocephalus are known to impact 30-day survival following ICH and are included in various prediction models.

An association of prior statin use with decreased perihematomal edema.

Objective: To investigate the impact of statins on perihematomal edema following spontaneous supratentorial intracerebral hemorrhage (ICH).

Background: Hematoma expansion and evolution of perihematomal edema are most commonly responsible for neurological deterioration following ICH. A possible role of statins in reducing perihematomal edema has been suggested based on studies in animal models.

ICH aspiration and thrombolysis.

Intracerebral hemorrhage (ICH) is associated with the highest mortality among all forms of stroke. Evolution in the medical management of ICH has not improved patient outcomes while the results of conventional surgery have generally been disappointing. Minimally invasive surgery (MIS) using stereotactic clot aspiration followed by clot lysis is gaining credibility as an alternative management strategy.

Advances in the management of spontaneous intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) is associated with the highest mortality of all cerebrovascular events, and most survivors never regain functional independence. Many clinicians believe that effective therapies are lacking for patients who have ICH; however, this perception is changing in light of new data on the pathophysiology and treatment of this disorder, in particular, research establishing the role of medical therapies to promote hematoma stabilization. This article discusses the basic principles of management of ICH, including initial stabilization, the prevention of hematoma growth, treatment of complications, and identification of the underlying etiology.