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The Rabbit Shunt Model of Subarachnoid Haemorrhage
Abstract Aneurysmal subarachnoid haemorrhage (SAH) is a disease with devastating complications that leads to stroke, permanent neurological deficits and death. Clinical and ex-perimental work has demonstrated the importance of the contribution of delayed cerebral vasospasm (DCVS) indepen-dent early events to mortality, morbidity and functional out-come after SAH. In order to elucidate processes involved in early brain injury (EBI), animal models that reflect acute events of aneurysmal bleeding, such as increase in intracranial pressure (ICP) and decrease in cerebral perfusion pressure, are needed. In the presented...
Source: Translational Stroke Research - October 19, 2014 Category: Neurology Source Type: research

Red blood cell transfusion in neurosurgical patients
Purpose of reviewAnemia is common in neurosurgical patients, and is associated with secondary brain injury. Although recent studies in critically ill patients have shifted practice toward more restrictive red blood cell (RBC) transfusion strategies, the evidence for restrictive versus liberal transfusion strategies in neurosurgical patients has been controversial. In this article, we review recent studies that highlight issues in RBC transfusion in neurosurgical patients. Recent findingsRecent observational, retrospective studies in patients with traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage ...
Source: Current Opinion in Anaesthesiology - October 1, 2014 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Kristin Engelhard Source Type: research

Postoperative ICU management of patients after subarachnoid hemorrhage
This article reviews recent advances in the postoperative ICU management of patients after subarachnoid hemorrhage (SAH), especially with regards to hemodynamic management, methods of improving neurological outcomes, and management of cardiac and pulmonary complications. Recent findingsSeveral hemodynamic monitors and parameters may be useful for guiding volume therapy, including cardiac output, stroke volume variation monitoring, and global end-diastolic volume index. Early goal-directed hemodynamic therapy after SAH has recently been shown to improve clinical outcomes in patients with a poor clinical grade or coexisting ...
Source: Current Opinion in Anaesthesiology - October 1, 2014 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Kristin Engelhard Source Type: research

Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model
BACKGROUNDPulse pressure variations (PPVs) and stroke volume variations (SVVs) are dynamic indices for predicting fluid responsiveness in intensive care unit patients. These hemodynamic markers underscore Frank-Starling law by which volume expansion increases cardiac output (CO). The aim of the present study was to evaluate the impact of the administration of catecholamines on PPV, SVV, and inferior vena cava flow (IVCF). METHODSIn this prospective, physiologic, animal study, hemodynamic parameters were measured in deeply sedated and mechanically ventilated pigs. Systemic hemodynamic and pressure-volume loops obtained by i...
Source: Journal of Trauma and Acute Care Surgery - October 1, 2014 Category: Surgery Tags: Original Articles Source Type: research

Hemorrhagic stroke and new oral anticoagulants.
Abstract The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addi...
Source: Annales Francaises d'Anesthesie et de Reanimation - October 1, 2014 Category: Anesthesiology Authors: Derlon V, Corbonnois G, Martin M, Toussaint-Hacquard M, Audibert G Tags: Ann Fr Anesth Reanim Source Type: research

'Safe' stem cell therapy may help stroke recovery
Conclusion This study provides evidence that a new technique using a patient's own stem cells to aid the recovery from severe ischaemic stoke is feasible and appears to be safe. It was not designed to test whether the technique was better than doing nothing or better than other types of care or treatment. The authors are perfectly clear that this "proof-of-concept study was not designed with a control group or powered to be able to detect efficacy". This means we cannot be sure that the improvements seen in the five patients were caused by the stem cell treatment. They could have occurred anyway as part of the na...
Source: NHS News Feed - August 11, 2014 Category: Consumer Health News Tags: Genetics/stem cells Heart/lungs Source Type: news

Vessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke.
Abstract The authors report a case of an intracranial extravasation during the withdrawal of a Trevo ProVue stent retriever device in a patient being treated for acute ischemic stroke. An 82-year-old woman developed sudden left hemiparesis and aphasia during an urgent cardiac catheterization procedure for a non-ST elevation myocardial infarction. She had a baseline National Institutes of Health Stroke Scale (NIHSS) score of at least 10 and no improvement with intravenous administration of tissue plasminogen activator (tPA). Cerebral angiography was performed with conscious sedation, confirming an occlusion of the ...
Source: Journal of Neurosurgery - June 13, 2014 Category: Neurosurgery Authors: Leishangthem L, Satti SR Tags: J Neurosurg Source Type: research

ICP Monitoring in Patients With Haemorrhagic StrokeICP Monitoring in Patients With Haemorrhagic Stroke
ICP monitoring useful in patients with hemorrhagic stroke? BMC Anesthesiology
Source: Medscape Today Headlines - May 30, 2014 Category: Consumer Health News Tags: Anesthesiology Journal Article Source Type: news

The THRIVE score strongly predicts outcomes in patients treated with the Solitaire device in the SWIFT and STAR trials
ConclusionsThe THRIVE score strongly predicts clinical outcome and mortality in patients treated with the Solitaire device in the SWIFT and STAR trials. The lack of interaction between THRIVE and procedure‐specific elements such as vessel recanalization or device choice makes the THRIVE score a reasonable candidate for use as a patient selection criterion in stroke clinical trials.
Source: International Journal of Stroke - May 22, 2014 Category: Neurology Authors: Alexander C. Flint, Sean P. Cullen, Vivek A. Rao, Bonnie S. Faigeles, Vitor M. Pereira, Elad I. Levy, Tudor G. Jovin, David S. Liebeskind, Raul G. Nogueira, Reza Jahan, Jeffrey L. Saver, Tags: Research Source Type: research

Sheehan syndrome: acute presentation with severe headache
Postpartum headache has an incidence of 11–80%.1,2 The majority of headaches in the postpartum period are of primary etiology, and include migraine, tension-type, cervicogenic, cluster headaches, and other trigeminal autonomic cephalgias.2–5 While secondary headaches are less common, they can be associated with significant morbidity and mortality, and a high index of suspicion and low threshold for neurodiagnostic imaging should be maintained. Secondary headaches may be due to complications of neuraxial anesthesia such as post-dural puncture headache (PDPH) and pneumocephalus, obstetric disease including hypertensive d...
Source: International Journal of Obstetric Anesthesia - May 14, 2014 Category: Anesthesiology Authors: B. Hale, A.S. Habib Tags: Case report Source Type: research

North American SOLITAIRE Stent-Retriever Acute Stroke Registry: Choice of Anesthesia and Outcomes Clinical Sciences
Conclusions— The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.
Source: Stroke - April 28, 2014 Category: Neurology Authors: Abou-Chebl, A., Zaidat, O. O., Castonguay, A. C., Gupta, R., Sun, C.-H. J., Martin, C. O., Holloway, W. E., Mueller-Kronast, N., English, J. D., Linfante, I., Dabus, G., Malisch, T. W., Marden, F. A., Bozorgchami, H., Xavier, A., Rai, A. T., Froehler, M. Tags: Acute Cerebral Infarction, Emergency treatment of Stroke, Other Stroke Treatment - Surgical Clinical Sciences Source Type: research

Clinical neuroprotection and secondary neuronal injury mechanisms
Abstract: Multiple disease processes can ultimately lead to cerebral injury, a common cause of both severe morbidity and mortality in patients of all age groups. Cerebral injury is seen in a variety of both medical and surgical conditions, including stroke, subarachnoid haemorrhage, central nervous system infection, epilepsy, post cardiac arrest and, of course, traumatic brain injury.Although the primary damage to brain tissue may be irreversible, aggressive early physiological, pharmacological and surgical interventions may limit the ensuing secondary brain injury caused by ongoing ischaemia, and reduce the risk of severe...
Source: Anaesthesia and intensive care medicine - April 1, 2014 Category: Anesthesiology Authors: Katharine Hunt, Surbhi Virmani Tags: Neurosurgical anaesthesia Source Type: research

Decreased risk of secondary brain herniation with intracranial pressure monitoring in patients with haemorrhagic stroke
In this study, we investigated the clinical value of ICP monitoring in patients with hemorrhagic stroke. Methods: We conducted a randomized, unblinded, controlled trial in which 90 patients with hemorrhagic stroke were randomly assigned to ICP monitoring or a control group. The primary outcome was a composite of incidence rate of hematoma enlargement and secondary brain herniation. The secondary outcome was neurological status assessed using the Glasgow Outcome Scale scores at 6 months post-onset. Characteristics of the patients at baseline and outcome measurements were also compared between the two groups. Results: There ...
Source: BMC Anesthesiology - March 21, 2014 Category: Anesthesiology Authors: Jingsong ZengPing ZhengWusong TongWeimin Fang Source Type: research

Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock
ConclusionsIn this SV‐guided bleeding and fluid resuscitation model, both ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.
Source: Acta Anaesthesiologica Scandinavica - March 19, 2014 Category: Anesthesiology Authors: M. NÉMETH, K. TÁNCZOS, G. DEMETER, D. ÉRCES, J. KASZAKI, A. MIKOR, Z. MOLNÁR Tags: Original Article Source Type: research

Patient with acute renal injury presenting dabigatran overdose: Hemodialysis for surgery.
We report a case of an 80-year-old man presenting hemorrhage with dabigatran overdose caused by obstructive acute renal failure. Before nephrostomy, several hemodialysis sessions were necessary to remove dabigatran probably because of its large volume of distribution. PMID: 24378048 [PubMed - as supplied by publisher]
Source: Annales Francaises d'Anesthesie et de Reanimation - December 27, 2013 Category: Anesthesiology Authors: Bachellerie B, Ruiz S, Conil JM, Crognier L, Seguin T, Georges B, Fourcade O Tags: Ann Fr Anesth Reanim Source Type: research

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