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Neurosurgery. 2002 Jun;50(6):1223-9; discussion 1229-30.
Endothelial cell activation after subarachnoid hemorrhage.
Frijns CJ, Rinkel GJ, Castigliego D, Van Gijn J, Sixma JJ, Fijnheer R.
Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands. C.J.M.Frijnzu.nl
OBJECTIVE: Evidence from animal experiments suggests that endothelial cell activation plays a pathogenetic role in the development of cerebral ischemia after subarachnoid hemorrhage (SAH). We measured plasma concentrations of two markers of endothelial cell activation, i.e., ED1-fibronectin (ED1-fn) and von Willebrand factor (vWf), among patients with aneurysmal SAH. We analyzed the relationships of concentrations to initial clinical conditions, treatment modalities, and the occurrence of delayed cerebral ischemia. METHODS: We collected 123 blood samples from 27 patients with aneurysmal SAH. Aneurysms were treated surgically in 19 cases, were treated endovascularly in 7 cases, and remained untreated in 1 case. Twelve patients developed symptomatic delayed cerebral ischemia. RESULTS: Initial concentrations of ED1-fn (4.3 +/- 3.7 microg/ml) and vWf (17.8 +/- 8.2 microg/ml) were higher than the reference values (ED1-fn, 1.7 +/- 0.9 microg/ml, P < 0.001; vWf, 11.5 +/- 5.2 microg/ml, P = 0.003). Concentrations were higher among patients in poor clinical condition at admission, compared with patients in good clinical condition (mean difference, ED1-fn, 5.7 microg/ml, P = 0.04; vWf, 10.4 microg/ml, P = 0.02). Levels of both markers increased significantly after surgery (mean increase, ED1-fn, 7.5 microg/ml, P = 0.01; vWf, 13.2 microg/ml, P = 0.05) and after ischemic episodes (mean increase, ED1-fn, 8.3 microg/ml, P = 0.02; vWf, 5.0 microg/ml, P = 0.04). CONCLUSION: Plasma concentrations of markers of endothelial cell activation were increased early after SAH and were significantly associated with the clinical condition at admission. We also observed a significant increase in concentrations after surgery and after ischemic episodes. Whether endothelial cell activation is a causal or indirectly related factor in the pathogenesis of delayed cerebral ischemia after SAH is still uncertain.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12015839&dopt=Abstract hemorrhage
Neurosurgery. 2002 Jun;50(6):1268-74; discussion 1274-6.
Long-term hardware-related complications of deep brain stimulation.
Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM.
Division of Neurosurgery, The Toronto Hospital, Western Division, University of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: To determine the incidence of long-term hardware-related complications of deep brain stimulation (DBS). METHODS: The study design is a retrospective chart review of a single-surgeon, single-institution experience with DBS in 84 consecutive cases from 1993 to 1999. Only patients with a minimum follow-up of 1 year were considered. Five patients were excluded because trial stimulation failed to achieve pain relief (n = 4) or because the procedure was aborted owing to hemorrhage (n = 1). Seventy-nine patients received 124 permanent DBS electrode implants. RESULTS: The mean follow-up period was 33 months, and the cumulative follow-up time was 217 patient-years or 310 electrode-years. Overall, 20 patients (25.3%) had 26 hardware-related complications involving 23 (18.5%) of the electrodes. There were 4 lead fractures, 4 lead migrations, 3 short or open circuits, 12 erosions and/or infections, 2 foreign body reactions, and one cerebrospinal fluid leak. The hardware-related complication rate per electrode-year was 8.4%. The most common complications were related to the electrode connectors. A significant finding was a high number of complications involving erosions or infections, which occurred in 7 of 12 instances as a late complication (beyond 12 mo). CONCLUSION: Long-term follow-up reveals that hardware-related complications occur in a significant number of patients. Factors that lead to such complications must be identified and addressed to maximize the important benefits of DBS therapy.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12015845&dopt=Abstract hemorrhage
Neurosurgery. 2002 Jun;50(6):1283-8; discussion 1288-9.
Complementary use of computed tomographic angiography in treatment planning for posterior fossa subarachnoid hemorrhage.
Carvi y Nievas MN, Haas E, Hollerhage HG, Drathen C.
Neurosurgical Clinic, Stadtische Kliniken Frankfurt am Main Hochst, Akademisches Lehrkrankenhaus der Johann-Wolfgang-Goethe-Universitat, Frankfurt am Main, Germany. MCNieva-online.de
OBJECTIVE: The goal of this study was to determine whether the complementary use of computed tomographic angiographic (CTA) assessments would provide additional benefits in the evaluation and treatment of ruptured vertebrobasilar artery aneurysms. METHODS: In the past 4.5 years, 35 patients with an infratentorial dominant pattern of subarachnoid hemorrhage were complementarily examined with CTA scanning, after undergoing one or more three-dimensional rotational projection digital subtraction angiographic (DSA) studies. The results of these studies were interpreted by the treating neurosurgeon and an interventional radiologist, to examine the usefulness of the findings for the detection of aneurysms and to determine the grade of parent artery vascular filling and the optical definition of the aneurysm. This information provided additional benefits for case management. RESULTS: Thirty-three aneurysms were detected. For 10 patients, no aneurysm was identified in repeated examinations with the two methods. We detected only 16 of the 25 ruptured aneurysms (64%) on the first DSA scans and, even with repeated examinations, 6 aneurysms were not clearly identified with this technique. CTA scanning revealed the ruptured aneurysms in 25 cases and demonstrated increased vascular filling and improved optical definition of the aneurysms, compared with DSA scanning, in 12 cases (48%). The information obtained from the CTA scans allowed the selection of five patients for endovascular treatment and facilitated the surgical procedures in five cases. CONCLUSION: Complementary CTA examination of the vertebrobasilar complex provides a higher rate of aneurysm detection and improves the optical definition and anatomic projection of these aneurysms, compared with DSA scanning alone. This facilitates therapeutic decision-making (surgical versus endovascular procedures) and allows neurosurgeons to use more restricted surgical exposures.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12015847&dopt=Abstract hemorrhage
Neurosurgery. 2002 Jun;50(6):1372-4; discussion 1374-5.
Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage: report of three cases.
Otawara Y, Ogasawara K, Ogawa A, Kogure T.
Department of Neurosurgery, Iwate Medical University, Uchimaru, Morioka, Japan. ootawara-nsmin.ac.jp
OBJECTIVE AND IMPORTANCE: Treatment of one side in cases of dissecting aneurysms of the bilateral vertebral arteries (VAs) with subarachnoid hemorrhage may result in dissection or rupture on the contralateral side. CLINICAL PRESENTATION: Three patients presented with dissecting aneurysms of the bilateral VAs with subarachnoid hemorrhage. INTERVENTION: Two patients underwent trapping of the ruptured VA, with side-to-side anastomosis between the bilateral posteroinferior cerebellar arteries. One patient underwent resection of the ruptured VA, with interposition of a saphenous vein graft. Two patients died as a result of rupture of the contralateral VA dissecting aneurysm after surgery. One patient demonstrated development of an unruptured dissecting aneurysm in the contralateral VA 1 month after surgery. CONCLUSION: Surgical intervention to treat dissecting aneurysms of the bilateral VAs on one side carries the risk of rupture of the contralateral lesion. Increased hemodynamic stress may be important in the development and rupture of dissections in the contralateral VA.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12015860&dopt=Abstract hemorrhage
Infection. 2002 Apr;30(2):109-12.
Fatal intracerebral hemorrhage due to leptospirosis.
Theilen HJ, Luck C, Hanisch U, Ragaller M.
Dept of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Medical Faculty, Technical University of Dresden, Germany. theilecs.urz.tu-dresden.de
Intracerebral hemorrhage in leptospirosis is a rare event. We report on a fatal case of intracerebral hemorrhage complicating leptospirosis in a 47-year-old sewage drain worker. Since substantial thrombocytopenia was observed during the course of the disease, postmortem autopsy was performed to further elucidate the genesis of platelet destruction. Due to immunohistological findings, immunologically mediated thrombolysis was considered responsible for thrombocytopenia, whereas no signs of disseminated intravasal coagulopathy or deranged platelet production in the bone marrow were detected.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12018468&dopt=Abstract hemorrhage
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