The role of advanced neuroimaging in intracerebral hemorrhage.

In this report, the authors sought to summarize existing literature to provide an overview of the currently available techniques and to critically assess the evidence for or against their application in intracerebral hemorrhage (ICH) for management, prognostication, and research. Functional imaging in ICH represents a potential major step forward in the ability of physicians to assess patients suffering from this devastating illness due to the advantages over standing imaging modalities focused on general tissue structure alone, but its use is highly controversial due to the relative paucity of literature and the lack of consolidation of the predominantly small data sets that are currently in existence. Current data support that diffusion tensor imaging and tractography, diffusion-perfusion weighted MRI techniques, and functional MRI all possess major potential in the areas of highlighting motor deficits, motor recovery, and network reorganization.

The modified pterional keyhole craniotomy for open cerebrovascular surgery: a new workhorse?

Background: The frontotemporal craniotomy is the most commonly used approach for vascular neurosurgery. However, this approach requires significant mobilization of overlying soft tissues, resulting in muscle atrophy and temporomandibular joint pain. We describe a modified pterional keyhole approach and its use in our initial clinical experience.

Volume-dependent effect of perihaematomal oedema on outcome for spontaneous intracerebral haemorrhages.

Introduction: It is still unknown whether subsequent perihaematomal oedema (PHE) formation further increases the odds of an unfavourable outcome.

Methods: Demographic, clinical, radiographic and outcome data were prospectively collected in a single large academic centre. A multiple logistic regression model was then developed to determine the effect of admission oedema volume on outcome.

Does Cognitive Dysfunction after Carotid Endarterectomy Vary by Statin Type or Dose?

Our previous work demonstrates that asymptomatic carotid endarterectomy (CEA) patients demonstrate less perioperative neurologic injury, defined as stroke and early cognitive dysfunction (eCD) observed within 24hr of CEA, when taking statins pre-operatively. This study examines whether the incidence of eCD observed 24hr after asymptomatic CEA varies as a function of statin type or dose. Patients with asymptomatic carotid stenosis scheduled for CEA consented to participate in an observational IRB-approved study (N=324).

Endovascular thrombectomy following acute ischemic stroke: a single-center case series and critical review of the literature.

Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world. Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease. Here, we review the treatment options for cerebrovascular thromboembolic occlusion with a focus on the evolution of strategies and devices that are utilized for achieving endovascular clot extraction.

Familial intracranial aneurysms: is anatomic vulnerability heritable?

Background And Purpose: Previous studies have suggested that family members with intracranial aneurysms (IAs) often harbor IAs in similar anatomic locations. IA location is important because of its association with rupture. We tested the hypothesis that anatomic susceptibility to IA location exists using a family-based IA study.

Post-subarachnoid hemorrhage vasospasm in patients with primary headache disorders.

Background: Altered cerebral vasomotor reactivity leading to vasospasm can be seen both in patients with primary headache disorders (PHD) and in patients with subarachnoid hemorrhage (SAH). The pathogenesis of vasospasm in post-SAH patients and in headache disorder sufferers may be related. To address this hypothesis, we analyzed a large cohort of SAH patients to determine whether a diagnosis of PHD predisposes to vasospasm, delayed cerebral ischemia, or worsened clinical outcome.

Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients.

Introduction: Daily interruption of sedation (IS) has been implemented in 30 to 40% of intensive care units worldwide and may improve outcome in medical intensive care patients. Little is known about the benefit of IS in acutely brain-injured patients.

Methods: This prospective observational study was performed in a neuroscience intensive care unit in a tertiary-care academic center.

Epidemiological trends in the neurological intensive care unit from 2000 to 2008.

Intensive care units (ICU) specializing in the treatment of patients with neurological diseases (Neuro-ICU) have become increasingly common. However, there are few data on the longitudinal demographics of this patient population. Identifying admission trends may provide targets for improving resource utilization.

Seizures after aneurysmal subarachnoid hemorrhage: a systematic review of outcomes.

Objective: The risk for early and late seizures after aneurysmal subarachnoid hemorrhage (aSAH), as well as the effect of antiepileptic drug (AED) prophylaxis and the influence of treatment modality, remain unclear. We conducted a systematic review of case series and randomized trials in the hope of furthering our understanding of the risk of seizures after aSAH and the effect of AED prophylaxis and surgical clipping or endovascular coiling on this important adverse outcome.

Methods: We performed a MEDLINE (1985-2011) search to identify randomized controlled trials and retrospective series of aSAH.

Early neurological deterioration after subarachnoid haemorrhage: risk factors and impact on outcome.

Background: Early neurological deterioration occurs frequently after subarachnoid haemorrhage (SAH). The impact on hospital course and outcome remains poorly defined.

Methods: We identified risk factors for worsening on the Hunt-Hess grading scale within the first 24 h after admission in 609 consecutively admitted aneurysmal SAH patients.

Genome-wide association study of intracranial aneurysms confirms role of Anril and SOX17 in disease risk.

Background: Genomewide association studies have identified novel genetic factors that contribute to intracranial aneurysm (IA) susceptibility. We sought to confirm previously reported loci, to identify novel risk factors, and to evaluate the contribution of these factors to familial and sporadic IA.

Method: We utilized 2 complementary samples, one recruited on the basis of a dense family history of IA (discovery sample 1: 388 IA cases and 397 controls) and the other without regard to family history (discovery sample 2: 1095 IA cases and 1286 controls).

Mortality and causes of death in the Familial Intracranial Aneurysm study.

Background: Higher mortality for patients with aneurysmal subarachnoid haemorrhage has been reported.

Aims: In families with intracranial aneurysms, we sought to determine whether mortality among subjects with intracranial aneurysm (affected) was higher and related to rupture, compared with unaffected family members.

Methods: Subjects enrolled in the Familial Intracranial Aneurysm protocol were contacted yearly and their status was obtained.

Real time estimation of brain water content in comatose patients.

Objective: Although brain swelling is an important cause of neurological deterioration, real time measurement of brain edema does not currently exist. Because thermal conductivity is proportional to percentage water content, we used the thermal conductivity constant to estimate brain water content (BWC).

Methods: Between June 2008 and November 2010, 36 comatose brain-injured patients underwent cerebral blood flow monitoring using a thermal diffusion probe in our neurocritical care unit.

Serum biomarkers of spontaneous intracerebral hemorrhage induced secondary brain injury.

Intracerebral hemorrhage (ICH) is a devastating form of stroke associated with a high rate of morbidity and mortality. It is now believed that much of this damage occurs in the subacute period following the initial insult via a cascade of complex pathophysiologic pathways that continues to be investigated. Increased levels of certain serum proteins have been identified as biomarkers that may reflect or directly participate in the inflammation, blood brain barrier disruption, endothelial dysfunction, and neuronal and glial toxicity that occur during this secondary period of cerebral injury.

Complement inhibition promotes endogenous neurogenesis and sustained anti-inflammatory neuroprotection following reperfused stroke.

Background And Purpose: The restoration of blood-flow following cerebral ischemia incites a series of deleterious cascades that exacerbate neuronal injury. Pharmacologic inhibition of the C3a-receptor ameliorates cerebral injury by attenuating post-ischemic inflammation. Recent reports also implicate C3a in the modulation of tissue repair, suggesting that complement may influence both injury and recovery at later post-ischemic time-points.

The Molecular Mechanisms that Promote Edema After Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is a devastating type of stroke with no effective therapies. Clinical advances in ICH treatment are limited by an incomplete understanding of the molecular mechanisms responsible for secondary injury and poor outcome. Increasing evidence suggests that cerebral edema is a major contributor to secondary injury and poor outcome in ICH.