Posts tagged subarachnoid hemorrhage
Articles and news from the latest research reports.
One third of all brain aneurysms rupture: the size is not a significant risk factor
Approximately one third of all brain aneurysms rupture during a patient’s lifetime, resulting in a brain haemorrhage. A recent Finnish study demonstrates that, unlike what was previously assumed, the size of the aneurysm does not significantly impact the risk of rupture.
(Image credit: Miikka Korja)
The new Finnish study established that approximately one third of all aneurysms and up to one fourth of small aneurysms will rupture during a patient’s lifetime. The lifetime risk for rupture of a brain aneurysm depends heavily on the patient’s overall load of risk factors.
The risk of rupture is particularly high for female smokers with brain aneurysms of seven millimetres or more in diameter.
What surprised the researchers most was that the size of an aneurysm had little impact on its risk for rupture, particularly for men, despite a previously presumed correlation. In addition, the risk of rupture among non-smoking men was exceptionally low.
This is not to say that aneurysms in non-smoking men never rupture, but that the risk is much lower than we previously thought. This means treating every unruptured aneurysm may be unnecessary if one is discovered in a non-smoking man with low blood pressure, says Docent Seppo Juvela, University of Helsinki.
The study, published in Stroke 22nd May, is unique in that it monitored aneurysm patients over their entire lifetimes, whereas typical follow-up studies last only between one and five years in duration. The study is also exceptionally broad in scope.
It is unlikely that another similar, non-selected lifetime follow-up study on aneurysm patients will ever be conducted again, Juvela states.
Current care practices are based largely on the results of previous, shorter studies. Such studies have shown that the size of the aneurysm is the most significant factor predicting its risk for rupture. Consequently, small aneurysms have often been left untreated.
It is difficult to conduct reliable epidemiological research in brain aneurysms. The past 10–15 years have seen a distortion in the field due to a very limited group of researchers determining the direction for research. Now the situation is clearly changing, and clinically reasonable, population-based studies using non-selected data are on the rise again, states Docent Miikka Korja of the HUCS neurosurgery clinic.
(Source: uutiset.helsinki.fi)
Tests In Mice Identify Compound That May Keep Survivors of Ruptured Brain Aneurysms From Later Succumbing to Stroke
Johns Hopkins researchers, working with mice, say they have identified a chemical compound that reduces the risk of dangerous, potentially stroke-causing blood vessel spasms that often occur after the rupture of a bulging vessel in the brain.
They say their findings offer clues about the biological mechanisms that cause vasospasm, or constriction of blood vessels that reduces oxygen flow to the brain, as well as potential means of treating the serious condition in humans.
When an aneurysm — essentially a blister-like bulge in the wall of a blood vessel — bursts, blood spills into the fluid-filled space that cushions the brain inside the skull. If a patient survives a ruptured aneurysm, between 20 and 40 percent of the time, this brain bleed, called a subarachnoid hemorrhage, will lead to an ischemic stroke within four to 21 days, even when the aneurysm is surgically clipped.
“We’re a long way from applying this to humans, but it’s a good start,” says Johns Hopkins neurosurgery resident Tomas Garzon-Muvdi, M.D., M.Sc., one of the authors of the study led by Rafael J. Tamargo, M.D., and described in the October issue of the journal Neurosurgery.
To conduct their experiments, Garzon-Muvdi and his colleagues took blood from mouse leg arteries and injected it behind their necks to mimic what happens in a subarachnoid hemorrhage. Then they gave the mice a compound called (S)-4-carboxyphenylglycine (S-4-CPG), a placebo or nothing at all. The mice given S-4-CPG developed less vasospasm, looked better and were more active than those in the other two groups.
The scientists also found concentrations of the drug in the brains of the mice, showing that it was able to cross the often impermeable blood-brain barrier. The researchers chose the compound because it is similar to drugs that have been used in stroke research in rodents. It is not approved for any use in humans.
Garzon-Muvdi explains that when blood vessels break anywhere but the brain, the body’s immune cells easily clear the blood cells and their remnants from the area. This is what happens with a bruise, when immune cells rush to the area, and a chemical cascade scavenges and disperses the remnants of excess blood components.
When a blood vessel bursts in the space around the brain, however, the blood is trapped. A subsequent inflammatory response brings key immune system cells into the space, where they secrete the neurotransmitter glutamate outside of the blood vessels where it shouldn’t be, promoting dangerous vasospasm in those blood vessels. This can lead to ischemic stroke, the most common type of stroke, caused by a blockage of a blood vessel in the brain. Death or serious disability may result.
The Johns Hopkins researchers say S-4-CPG keeps glutamate “in check,” prevents or reduces vasospasm and allows oxygen-filled blood to continue flowing into the brain.
According to the National Institutes of Health, subarachnoid hemorrhage caused by a cerebral aneurysm that breaks open occurs in about 40 to 50 out of 100,000 people over age 30. Patients may die immediately, but those who survive are still at elevated risk for developing an ischemic stroke in the days afterward. These patients are often watched very carefully in the intensive care unit for one to two weeks to search for early signs of vasospasm so that doctors can take steps to prevent or limit damage from a stroke.
In the ICU, doctors can order regular angiograms or ultrasounds to measure blood flow in vessels. If need be, they can increase blood pressure to send blood through vessels faster in the hopes of counteracting the constriction.
A drug to prevent stroke after a serious subarachnoid hemorrhage that follows the rupture of an aneurysm would improve quality of life for patients, Garzon-Muvdi says, and could potentially save millions of dollars in health care costs if patients don’t have to endure extensive hospital stays to monitor for a delayed stroke.
(Source: hopkinsmedicine.org)
Cigarette smoking increases the risk of subarachnoid hemorrhage (SAH) in a dose-responsive manner, and cessation correlates with a reduction in SAH risk, according to a study published online Aug. 30 in the Journal of Neurology, Neurosurgery & Psychiatry.
To examine the risk of SAH in relation to smoking cessation, Chi Kyung Kim, M.D., from Seoul National University Hospital in Korea, and colleagues performed a nationwide multicenter case control study involving 426 SAH patients and 426 matched controls. Structured questionnaires were used to assess lifestyle, medical history, and smoking habits.
The researchers found that 37.4 percent of SAH patients and 24.2 percent of controls were current smokers (adjusted odds ratio, 2.84), after adjusting for potential confounders. The risk of SAH was found to increase in a dose-responsive fashion with cumulative dose of smoking (pack years). There was a significant reduction in SAH to 59 percent with smoking cessation (at least five years). A history of heavy smoking (at least 20 cigarettes per day) correlated with a 2.3-fold increased risk of SAH, compared with participants who had never smoked (P < 0.05).
"We have demonstrated that cigarette smoking increases the risk of SAH, but smoking cessation decreases the risk in a time-dependent manner, although this beneficial effect may be diminished in previous heavy smokers," the authors write. "To forestall tragic SAH events, our results call for more global and vigorous efforts for people to stop smoking."