The neuro‐cardio‐endocrine response to acute subarachnoid haemorrhage

Espiner, Eric A.; Leikis, Robert; Ferch, Richard; MacFarlane, Martin R.; Bonkowski, Janusz; Frampton, Christopher M.; Richards, A. Mark

doi:10.1046/j.1365-2265.2002.01285.x

Cited by 98 publications

(68 citation statements)

References 36 publications

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“…13,22,23,30) A lesion in the solitary tract nucleus also seems to alter the secretion of brain natriuretic peptide, which may also be involved in the pathogenesis of NPE. 6,7) These findings may explain why poor-grade patients with ruptured posterior circulation aneurysm were significantly more likely to sustain NPE compared with anterior circulation aneurysm, as previously reported. 25,26) The results of this study, shown in Fig.…”

supporting

confidence: 55%

“…12,20,21,24,31) The common pathophysiology involves massive catecholamine release, particularly norepinephrine, into the circulation immediately after aneurysm rupture, and is responsible for endothelial damage, vasoconstriction, and increased vascular permeability. 7,20,21) However, how often SAH patients complicated with NPE also have concomitant TCM (NPE-TCM) remains unclear, since evaluation of cardiac wall motion using transthorac-…”

Section: Introductionmentioning

confidence: 99%

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Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Inamasu

Nakatsukasa

Mayanagi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Patients with poor-grade subarachnoid hemorrhage (SAH) are often complicated with acute cardiopulmonary dysfunctions, particularly neurogenic pulmonary edema (NPE) and takotsubo-like cardiomyopathy (TCM). This study retrospectively investigated the incidence, demographics, clinical characteristics, and outcomes of patients with SAH complicated with both NPE and TCM (NPE-TCM). The effects of aneurysm location and other clinical variables on the incidence of NPE-TCM were also investigated. Among 234 SAH patients treated during 5-year period, 16 (7%) presented with NPE, and transthoracic ultrasonography revealed that 14 of these 16 patients (88%) also had TCM. All 14 patients with NPE-TCM had poor-grade SAH (World Federation of Neurosurgical Societies grades IV and V). Ruptured posterior circulation aneurysm was predictive of NPE-TCM, but other clinical variables were not. Eight of the 14 patients with NPE-TCM could undergo treatment for ruptured aneurysm. Long-term outcomes were favorable in 5 of the 8 patients. Grade IV SAH patients had significantly better outcomes than grade V patients. TCM develops frequently in SAH patients presenting with NPE, and transthoracic ultrasonography should be conducted routinely in that population. Patients with ruptured posterior circulation aneurysm may have elevated risk of developing NPE-TCM. Endovascular obliteration of the aneurysm may be preferable to open surgery, but the optimal treatment modality needs to be evaluated further. Considering the limited number of SAH patients complicated with NPE-TCM, a multi-center cooperative study may be required.

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confidence: 55%

Section: Introductionmentioning

confidence: 99%

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Inamasu

Nakatsukasa

Mayanagi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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“…In other studies with longer observation periods, hyponatremia developed frequently after SAH [1,23] and was associated with negative sodium balance [1,24] and fluid balance [25]. The authors found almost uniformly increased ANP and/or BNP concentrations and delayed activation of the renin-aldosterone axis [1,2,24]. Unfortunately, we did not measure ANP, BNP, or renin/aldosterone concentrations, and therefore cannot evaluate their potential contribution to our findings.…”

Section: Discussionmentioning

confidence: 59%

“…Serum sodium concentration and fluid balance are frequently abnormal in patients after subarachnoid hemorrhage (SAH) [1,2], with dysnatremia causing morbidity in patients with SAH [3][4][5]. Moreover, in other critically ill or emergency patient populations, both severe hyper-and hyponatremia are associated with persistent neurological deficits and high mortality [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

et al. 2012

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Background Hyper-and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid-base disturbances, and fluid balance. Methods Thirty-six consecutive patients with SAH were randomized double-blinded to either normal saline and hydroxyethyl starch dissolved in normal saline (Voluven Ò ; saline) or balanced crystalloid and colloid solutions (Ringerfundin Ò and Tetraspan Ò ; balanced, n = 18, each) for 48 h. Laboratory samples and fluid balance were evaluated at baseline and at 24 and 48 h. Results Age [57 ± 13 years (mean ± SD; saline) vs. Conclusions Treatment with saline-based fluids resulted in a greater number of patients with hyperchloremia, hyperosmolality, and positive fluid balance >1,500 mL early after SAH, while administration of balanced solutions did not cause more frequent hyponatremia or hypo-osmolality. These results should be confirmed in larger studies.

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“…5,29 The presumed purpose of the stress reaction is to restore cerebral blood flow, but it can also cause adverse effects.…”

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confidence: 99%

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Nyberg¹,

Karlsson

Ronne-Engström³

2014

JNS

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RuptuRe of an intracranial aneurysm is followed by an acute phase with a complex chain of events. Most obvious are the intracranial complications of clots, hydrocephalus, and brain ischemia in various degrees and combinations. Many patients also show serious systemic complications, probably as a result of the intracranial pathophysiology. It is generally thought that a main trigger for systemic changes is the increase in the intracranial pressure that occurs at the time of aneurysm rupture. The elevated intracranial pressure decreases cerebral blood flow and causes a transient or permanent global ischemia. A major stress reaction follows, including the release of adrenocorticotropic hormone, cortisol, Object. The rupture of an intracranial aneurysm is followed by increased intracranial pressure and decreased cerebral blood flow. A major systemic stress reaction follows, presumably to restore cerebral blood flow. However, this reaction can also cause adverse effects, including myocardial abnormalities, which are common and can be serious, and increased levels of natriuretic peptides, especially brain natriuretic peptide (BNP). The association of BNP with fluid and salt balance, vasospasm, brain ischemia, and cardiac injury has been studied but almost exclusively regarding events after admission. Brain natriuretic peptide has also been measured at various time points and analyzed in different ways statistically. The authors approached BNP measurement in a new way; they used the calculated area under the curve (AUC) for the first 4 days to quantitatively measure the BNP load during the first critical part of the disease state. Their rationale was a suspicion that early BNP load is a marker of the severity of the ictus and will influence the subsequent course of the disease by disturbing the fluid and salt balance.Methods. The study included 156 patients with acute spontaneous subarachnoid hemorrhage (SAH). Mean patient age was 59.8 ± 11.2 years, and 105 (67%) of the patients were female. An aneurysm was found in 138 patients. A total of 82 aneurysms were treated by endovascular coiling, 50 were treated by surgery, and 6 were untreated. At the time of admission, serum samples were collected for troponin-I analysis and for the N-terminal prohormone of BNP (NT-proBNP); daily thereafter, samples were collected for the NT-proBNP analysis. The cumulative BNP load was calculated as the AUC for NT-proBNP during the first 4 days. The following variables were studied in terms of their influence on the AUC for NT-proBNP: sex, age, World Federation of Neurosurgical Societies grade of SAH, Fisher grade, angiographic result, treatment of aneurysm, clinical neurological deterioration, verified infections, vasospasm treatment, and 6-month outcome.Results. The AUC for NT-proBNP was larger when variables indicated a more severe SAH. These variables were higher Fisher and World Federation of Neurosurgical Societies grades, high levels of troponin-I at admission, an aneurysm, neurological deficits, and infections. The AUC for NT-proBN...

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The neuro‐cardio‐endocrine response to acute subarachnoid haemorrhage

Cited by 98 publications

References 36 publications

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

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