Early brain injury following aneurysmal subarachnoid hemorrhage: emphasis on cellular apoptosis

Self Cite

Section: A B Csupporting

confidence: 57%

The effect of hydrogen sulphide on experimental cerebral vasospasm

Emmez¹,

Börcek²,

Gönül³

et al. 2015

Self Cite

“…Every year, approximately 30,000 people in the United States experience an SAH (28). Early brain injury (27), cerebral vasospasm (CVS) (26), and delayed ischemic neurological deficit (DIND) (12) after aneurysmal SAH (aSAH) strongly determine the patient's prognosis. Many treatment options for preventing these complications are available in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Zhang¹,

Song²,

Wang³

et al. 2014

AIm:The role of statins for treating aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. In this study, the relevance of different end points was evaluated in order to clarify the action and efficacy of statins. mAterIAl and methOds: A systematic literature retrieval was carried out to obtain randomized controlled trials (RCTs) from before March 2013 on the use of statins for aSAH. Data extraction and quality evaluation of the studies were performed by 2 investigators. A meta-analysis was performed using Review Manager (RevMan) software version 5.2.3. results:Seven randomized controlled trials comprising 347 patients that met the inclusion criteria were included in this meta-analysis. Results showed that, in aSAH, statins did not reduce vasospasm on transcranial Doppler (RR=0.80; 95% CI, 0.53-1.21; p=0.29) or improve outcomes (RR=0.92; 95% CI, 0.71-1.20; p=0.54). However, statins were able to decrease delayed ischemic neurological deficits (RR=0.56; 95% CI, 0.41-0.75; p=0.0001) and mortality (RR=0.54; 95% CI, 0.32-0.91; p=0.02) compared with placebo.COnClusIOn: Acute statin treatment might not be a good choice for cerebral vasospasm after aSAH. Further large-scale, well-designed RCTs on this topic are still needed. BulGulAr: Bu meta analize çalışmaya alma kriterlerini karşılayan 347 hastalık yedi randomize kontrollü çalışma dahil edilmiştir. Sonuçlar aSAK durumunda statinlerin transkraniyal Doppler'de vazospazmı azaltmadığını (RR=0,80; %95 GA, 0,21; p=0,29) veya sonuçları daha iyi hale getirmediğini (RR=0,92; %95CI, 0,20; p=0,54) göstermiştir. Ancak statinler plaseboyla karşılaştırıldığında gecikmiş iskemik nörolojik defisitleri (RR=0,56; %95 GA, 0,41-0,75; p=0,0001) ve mortaliteyi (RR=0,54; %95 GA, 0,32-0,91; p=0,02) azaltmıştır. sOnuÇ: Akut statin tedavisi aSAK sonrasında serebral vazospazm için iyi bir tercih olmayabilir. Bu konuda daha büyük ölçekli ve iyi tasarlanmış randomize kontrollü çalışmalar gereklidir.

“…As the understanding of the SAH pathophysiology increases, it becomes gradually acknowledged that "early brain injury" (EBI) plays a major role in SAH-induced injury (36,52,53 vigorously. No publication bias was observed and sensitivity analysis identified the stability of results.…”

Section: Ultra-early Interventionmentioning

confidence: 99%

Surgical timing for aneurysmal subarachnoid hemorrhage: a meta-analysis and systematic review

Zhao

Yi²

2015

dent after surgery (19). Therefore, with the economic burdens of aSAH increasing every year, cost effectiveness and preventative strategies have become much more important.Before the 1970s, it was thought that cerebral edema and cerebral vascular dysregulation after acute aSAH, were associated with early surgery. In order to avoid the unfavorable █ INTRODUCTION A lthough intracranial aneurysmal subarachnoid hemorrhage (aSAH) accounts only for 3% to 4% of all strokes and 4.4% of deaths from stroke (18,50), aSAH is a significant health problem, which within 1 month has a mortality rate of nearly 50%, and many patients become care-depenAIm: Despite great advances in treatment of aneurysmal subarachnoid hemorrhage (aSAH), yet, a consensus as to the most optimal timing of surgery has not been reached. In order to identify the most suitable time of surgery for aSAH, the authors conducted a meta-analysis and systematic review. mATERIAl and mEThODS: PubMed and the Cochrane Library were searched for English-language studies published up to May 2015. Two independent reviewers screened abstracts, reviewed full-text articles and extracted data. Before conducting the metaanalysis, the studies were evaluated for publication bias and heterogeneity. Fixed and random effect models were used to estimate relative risks (RR) and the corresponding 95% confidence intervals (CIs). Subgroup analysis and sensitivity analysis were also performed. RESUlTS:One randomized controlled trial (RCT) and 33 observational studies of 16,793 participants were included in this paper. The overall methodological quality was satisfying. Results after excluding articles inconsistent with our surgery timing definition showed no significant difference for poor outcome, with early vs intermediate treatment (RR 0.86[0.68,1.09]), early vs late (RR 0.99[0.70,1.40]). Subgroup analysis based on age showed that early surgery could obtain more favorable outcomes for death rate, with non-early group as reference when age ≥50 years (RR 0.52[0.29,0.93]). When less than 50 years old, patients could benefit more from early intervention for poor outcome, with intermediate group as reference (RR 0.18[0.04,0.78 ]).CONClUSION: Despite the shortcomings of this study, timing of surgery for aSAH did not put a significant impact on overall surgical outcome. But subgroup analysis indicated a trend with more benefits for early treatment. Given the risks of re-bleeding and inpatient stay, early intervention should be performed as soon as possible. However, more randomized trials with long-term followup are necessary, especially in this era of endovascular coiling.