Wyniki wyszukiwania - Biblioteka Nauki

1

Predictors of recanalization after endovascular treatment of posterior circulation aneurysms

100%

Wiśniewski K. , Tomasik B. , Bobeff E. J. , Stefańczyk L. , Jaskólski D. J.

Polish Journal of Surgery

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2017

|

tom 89(6)

7-11

EN

Introduction. Posterior circulation aneurysms account for approximately 30% of all intracranial aneurysms, and their rupture often causes aneurysmal subarachnoid hemorrhage (aSAH). Because surgical treatment of posterior circulation aneurysms is difficult, endovascular treatment is commonly indicated. However, simple coil embolization is associated with a high rate of recanalization. Our goal was to investigate morphometric aneurysmal features assessed on pre-embolization computed tomography angiography (CTA) as predictors of recanalization in patients with posterior circulation aneurysms. Material and Methods. We retrospectively analyzed data of 24 patients who underwent coil embolization due to rupture of saccular posterior circulation aneurysms. The morphometric features of aneurysms were measured based on pre-embolization 3D-CTA-aneurysm models, and aneurysmal size and volume were measured on digital subtraction angiography (DSA) images. The effectiveness of initial endovascular treatment was determined visually with the modified Raymond Roy classification directly after embolization and on follow-up DSAs. Recanalization was diagnosed when, compared to the primary embolization aneurysm appearance, compaction and filling of the aneurysm occurred. Statistical analysis was performed with Statistica 13.1 software. Results. Higher maximal aneurysm height perpendicular to the aneurysmal neck was associated with a greater aneurysm recanalization risk (12.12±5.13mm vs. 7.41±3.97mm, p=0.039), and this relationship remained significant after adjustment for patient’s age, sex and aneurysm localization (OR=1.26, 95%CI: 1.01-1.60, p=0.047). Maximal aneurysm height perpendicular to the aneurysmal neck distinguished well between recanalized and non-recanalized aneurysms (AUC=0.755, 95%CI: 0.521- 0.989, p=0.033). Conclusions. Predictors of aneurysm recanalization can help choose best endovascular treatment strategies, which could reduce complication rates.

2

Factors determining the best surgical exposure and safe clip positioning in surgical treatment of anterior communicating artery (AComA) aneurysms – particular significance of AComA complex rotation in the axial plane

100%

Świątnicki W. , Radomiak-Załuska A. , Heleniak M. , Komuński P.

Polish Journal of Surgery

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2019

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tom 91(6)

6-10

EN

Introduction: The aim of this study was to evaluate whether Anterior Communicating Artery (AComA) complex rotation in axial plane may influence the ease of surgical exploration in this region and safety of clip positioning when left vs right-sided approach is compared. Materials and methods: This is a retrospective study based on analysis of patients operated due to AComA aneurysm, both ruptured and unruptured. AComA complex position in relation to coronal plane was evaluated using 3D-CTA VR reconstructions. Next, comparison between surgical approach from the side where A1-A2 junction (angle) was located anterior and posterior to coronal plane was performed in relation to surgical difficulties and intra- and postoperative complications. Results: Subgroup statistical analysis revealed that there is a strong and statistically significant correlation between AComA complex rotation and surgical difficulties expressed by the need of repeated temporary clip application and brain transgression. When anterior vs posterior angle side approach was compared in relation to surgical difficulties and complications, there was a statistically significant difference with strong correlation (p < 0.05) in favour of posterior angle side approach. Interestingly, in 72.7% and 45.5% of patients that were operated from the side where A1-A2 junction was located posterior to coronal plane, the approach was performed form the side of a non-dominant A1 and aneurysm dome projection side, respectively. Conclusions: Despite its limitations, our results suggest that microsurgical clipping strategy of AComA aneurysms should at least include AComA complex rotation in axial plane, besides well acknowledged factors, when deciding from which side these lesions will be approached.

3

CT negative subarachnoid hemorrhage in emergency department

100%

Szypenbejl J. , Siemiński M. , Szurowska E. , Szmuda T. , Basiński A.

European Journal of Translational and Clinical Medicine

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2020

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tom 3

|

nr 1

43-48

EN

Background: Subarachnoid hemorrhage (SAH) is rare but potentially life-threatening cause of acute headache. First diagnostic test performed in the Emergency Department (ED) for acute “thunderclap” headache is computed tomography of the head (CT) without contrast enhancement. Negative non-contrast head CT may be erroneously interpreted as an exclusion of SAH and lead to ED discharge. The consequences of overlooking SAH are of special interest to the Emergency Physician. The aim of this study was to assess prevalence and clinical picture of CT-negative cases of SAH admitted to the ED. Material and methods: Retrospective analysis of charts of patients admitted to the ED and diagnosed with SAH during 18 consecutive months. Results: Our data gives information about clinical picture of patients with CT-negative SAH and their further clinical course. Out of 126 patients diagnosed with SAH, 5 (4.0%) were diagnosed with SAH despite negative non-contrast head CT scan. All cases were diagnosed by means of lumbar puncture and analysis of cerebrospinal fluid. In all patients with CT-negative SAH computed tomographic angiography (CTA) was performed and no vascular abnormalities were found. In one case digital subtraction angiography was performed due to equivocal CTA picture and it demonstrated small unruptured aneurysm of the medial cerebral artery. All patients with CT-negative SAH were admitted to a neurological ward and later discharged from the hospital without neurological deficit. There were no episodes of clinical deterioration and none of the patients required an urgent neurosurgical intervention. Conclusions: Although lumbar puncture remains a gold standard in exclusion of SAH, head CT scan without contrast enhancement appears to be a satisfying diagnostic tool in ED.

4

CT negative subarachnoid hemorrhage in emergency department

100%

Szypenbejl J. , Siemiński M. , Szurowska E. , Szmuda T. , Basiński A.

European Journal of Translational and Clinical Medicine

|

2020

|

tom 3

|

nr 1

43-48

EN

Background Subarachnoid hemorrhage (SAH) is rare but potentially life-threatening cause of acute headache. First diagnostic test performed in the Emergency Department (ED) for acute “thunderclap” headache is computed tomography of the head (CT) without contrast enhancement. Negative non-contrast head CT may be erroneously interpreted as an exclusion of SAH and lead to ED discharge. The consequences of overlooking SAH are of special interest to the Emergency Physician. The aim of this study was to assess prevalence and clinical picture of CT-negative cases of SAH admitted to the ED. Material and methods Retrospective analysis of charts of patients admitted to the ED and diagnosed with SAH during 18 consecutive months. Results Our data gives information about clinical picture of patients with CT-negative SAH and their further clinical course. Out of 126 patients diagnosed with SAH, 5 (4.0%) were diagnosed with SAH despite negative non-contrast head CT scan. All cases were diagnosed by means of lumbar puncture and analysis of cerebrospinal fluid. In all patients with CT-negative SAH computed tomographic angiography (CTA) was performed and no vascular abnormalities were found. In one case digital subtraction angiography was performed due to equivocal CTA picture and it demonstrated small unruptured aneurysm of the medial cerebral artery. All patients with CT-negative SAH were admitted to a neurological ward and later discharged from the hospital without neurological deficit. There were no episodes of clinical deterioration and none of the patients required an urgent neurosurgical intervention. Conclusions Although lumbar puncture remains a gold standard in exclusion of SAH, head CT scan without contrast enhancement appears to be a satisfying diagnostic tool in ED.

5

Traumatic “TERSON SYNDROME PLUS”: Pneumocephalocele with optic atrophy

88%

Sanjoy Chowdhury S. , Madhumita Srivastava M. , Nilanjan Chowdhury N.

European Journal of Clinical and Experimental Medicine

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2020

|

nr 2

116-120

EN

Introduction. Terson Syndrome is subarachnoid hemorrhage (SAH) with sub retinal hemorrhage flowing through channel. Reduced vision in such fresh case is due to hemorrhage itself, blocking macula/other photo receptors in the long run macular cellophane retinopathy which causes profound visual loss. SAH causes neurological problems which can become a risk factor for evacuating blood from vitreous. Hypertension is commonest cause to cause Terson Syndrome, but trauma is also devastating cause as it can lead to irreversible visual consequences like total loss of perception of light or blindness. Aim. Here we describe a case of Terson Syndrome plus disease features SAH in frontal lobe. Description of the case. When there is traumatic pneumocephalocele, it gives space to blood to imbibe towards bony optic canal and form hematoma around nerve sheath which causes compression around the same and leads to optic atrophy. Optic nerve can be injured by direct traumatic dissection during road traffic accidents (RTA), but even without that blood may accumulate around optic nerve and in turn leads to formation of hematoma and subsequently pressure induced optic atrophy. Moreover, blood can slowly travel to sub hyaloid space/sub retinal space (beneath internal limiting membrane or sub ILM) with probable gliosis covering typical boat shaped blood as seen in this case. This sub ILM hemorrhage or gliosis may have resolved through three injections of Triamcinolone in the orbital floor (OFTA) near apex, but optic atrophy snatches vision. This protocol was followed to treat traumatic compressive (peri optic hematoma) optic neuropathy and traumatic retinopathy associated with sub hyaloid hemorrhage. Conclusion. Diagnosis of Terson syndrome plus disease was established by addressing all features on computed tomography (CT) scan and magnetic resonance imaging (MRI). Plus, features include pneumocephalus, optic nerve sheath hematoma, optic atrophy and gliosis over sub-hyaloid hemorrhage, typical boat shaped. The part of hemorrhage still endured as seen on optical coherence topography, but vision was lost by virtue of optic atrophy. OCT shows clot in sub hyaloid space

6

Cystatin C and neuropeptid Y levels in brain tissues after experimental subarachnoid hemorrhage

75%

Acikgoz S. , Can M. , Guven B. , Edebali N. , Barut F. , Buyukuysal C. , Tekin I. O. , Acikgoz B.

Acta Biochimica Polonica

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2014

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tom 61

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nr 4

7

Cerebral angiogenesis after subarachnoid hemorrhage (SAH) and endothelin receptor blockage with BQ-123 antagonist in rats

75%

Josko J. , Hendryk S. , Jedrzejowska-Szypulka H. , Slowinski J. , Gwozdz B. , Lange D. , Snietura M. , Zwirska-Korczala K. , Jochem J.

Journal of Physiology and Pharmacology

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2001

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tom 52

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nr 2

8

Tętniaki olbrzymie naczyń mózgowych u dzieci

63%

Kropiwnicki T. , Kazanek M. , Polis L. , Zakrzewski K.

Aktualności Neurologiczne

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2008

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tom 8

|

nr 2

90-94

EN

Although children are a minority among patients with cerebral artery aneurysms, aneurisms in this age group remain a problem not to be ignored. The cause of this is a much higher incidence of giant aneurisms in child - ren in comparison to adults, sometimes with dramatic manifestation. Two children with giant aneurysms of cerebral arteries, operated on at the Department of Neurosurgery Polish Mother Memorial Hospital Research Institute in Łódź are presented in this paper. Thirteen-year-old girl had an aneurysm on the left internal cerebral artery (25 mm in diameter). Ten-year-old boy had an aneurysm on the right medial cerebral artery (40 mm in diameter). Both aneurysms presented with subarachnoid hemorrhage. Surgical treatment consisted of aneurysm clipping in the case of the boy and proximal internal cerebral artery ligation in case of the girl. In spite of surgery, the treatment was unsuccessful. on the basis of presented cases some problems connected with the management of pediatric patients with giant cerebral aneurysms are discussed.

PL

Wśród ogółu pacjentów z tętniakami naczyń mózgowych pacjenci pediatryczni stanowią zdecydowaną mniejszość, jednak w tej grupie wiekowej stanowią one istotny problem kliniczny. Wynika to między innymi z faktu znacznie częstszego w stosunku do populacji dorosłych występowania tętniaków olbrzymich, których przebieg kliniczny bywa niekiedy dramatyczny. W pracy przedstawiono przypadki dwojga dzieci z tętniakami olbrzymimi naczyń mózgowych leczonych operacyjnie w Klinice Neurochirurgii Instytutu Centrum Zdrowia Matki Polki w Łodzi. U 13-letniej dziewczynki stwierdzono obecność tętniaka o średnicy 25 mm położonego na lewej tętnicy szyjnej wewnętrznej. U 10-letniego chłopca rozpoznano tętniaka o średnicy 40 mm zlokalizowanego na prawej tętnicy środkowej mózgu. Chorzy zostali przyjęci do szpitala z objawami krwotoku podpajęczynówkowego, w stanie ciężkim. W obu przypadkach zastosowano leczenie chirurgiczne polegające na zaklipsowaniu szyi tętniaka u chłopca oraz zaklipsowaniu naczynia doprowadzającego u dziewczynki. U obojga dzieci dalszy przebieg leczenia był niepomyślny. W oparciu o prezentowane przypadki w pracy omówiono problemy związane z leczeniem dzieci z tętniakami olbrzymimi naczyń mózgowych.

9

Mechanisms of vascular dysfunction after subarachnoid hemorrhage

63%

Kozniewska E. , Michalik R. , Rafalowska J. , Gadamski R. , Walski M. , Frontczak-Baniewicz M. , Piotrowski P. , Czernicki Z.

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tom 57

|

nr 11

145-160

EN

The main consequence of subarachnoid hemorrhage, for those who survive bleeding, is delayed, persistent vasospasm of intracranial conduit arteries which occurs between the third and seventh day after the insult and results in symptomatic brain ischemia in about 40% of cases. This vasospasm is considered to be a major cause of disability of post-SAH patients. Despite extensive experimental and clinical research, mechanisms of vasospasm are not fully understood. Dysfunction of the endothelium resulting in enhanced production of vasoconstrictors, phenotypic changes of the receptors in endothelium and smooth muscle cells, increased sensitivity of vascular smooth muscle cells to vasoconstrictors, release of spasmogens from lysed blood clot and inflammatory response of the vascular wall have been demonstrated and discussed as pathological mechanisms participating in the development of spasm. In recent years more attention is paid to the functional and structural changes in microcirculation and a concept of microvascular spasm is evolving. Our experimental studies in rat model of SAH strongly suggest that microcirculatory dysfunction and delayed vasospasm are related to the severity of acute, transient ischemia caused by critical decrease of perfusion pressure and active vasoconstriction immediately after the bleeding.

10

Ocena neuropsychologiczna wczesnych i odległych wyników leczenia operacyjnego chorych z krwawieniem z tętniaków tętnicy łączącej przedniej i tętnicy łączącej tylnej

63%

Ormezowska E. A. , Zawirski M. , Jaskólski D. J.

Aktualności Neurologiczne

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2007

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tom 7

|

nr 4

270-276

EN

Introduction: The aim of the paper was to assess a character, magnitude and dynamism of neuropsychological disorders in patients operated on for intracranial aneurysms located either on anterior communicating or posterior communicating arteries. We attempted to establish the usefulness of the Hunt and Hess grading as a predictor of subsequent postoperative neuropsychological disorders. Material and methods: To this study 82 patients with SAH from a single aneurysm located either on the anterior or posterior communicating arteries were enrolled. Directly before surgery the patients were assessed according to Hunt and Hess grading and only those assigned to grades I, II and III were taken into consideration. Neurological outcome of all these patients a discharge was described as good (GOS 4-5). The neuropsychological tests were carried out first about three weeks after the surgery and again six months later. Results: Compared to average results found in the population, our patients displayed decreased scores in the range of all functions examined with Wechsler Intelligence Scale. This was particularly true in patients Hunt and Hess grade III. Neuropsychological tests six months after the surgery confirmed apparent dynamics of the changes, particularly in the non-verbal tests. Conclusions: Hunt and Hess grading proved to be of satisfying prognostic value for future neuropsychological disorders. As a rule, Hunt and Hess grade I and II patients achieved better results in neuropsychological tests then those grade III. The only exception was noted in the case of the factor of the susceptibility to distraction, where the results were below average in all patients, both directly and six months after the surgery.

PL

Wstęp: Celem pracy było określenie rodzaju, nasilenia i dynamiki zaburzeń neuropsychologicznych u chorych po operacji tętniaka wewnątrzczaszkowego. Dokonano również analizy czynników wpływających na stan neuropsychologiczny pacjentów ze szczególnym uwzględnieniem wartości rokowniczej skali Hunta i Hessa. Materiał i metody: Do badania zakwalifikowano 82 pacjentów z krwawieniem podpajęczynówkowym (ang. subarachnoid haemmorhage, SAH), z pojedynczym tętniakiem umiejscowionym na tętnicy łączącej przedniej lub tylnej. Bezpośrednio przed zabiegiem pacjentów przypisano do grup I-III wg Hunta i Hessa, a ich stan neurologiczny przy wypisie określono jako dobry (GOS 4-5). Chorych dwukrotnie badano za pomocą skali Wechslera - mniej więcej trzy tygodnie i pół roku od operacji tętniaka. Wyniki: W zakresie wszystkich funkcji neuropsychologicznych badanych skalą Wechslera odnotowano obniżenie wyników w porównaniu z przeciętnymi w populacji, szczególnie wyraźne u pacjentów z III grupy wg Hunta i Hessa. W obydwu porównywanych grupach zaobserwowano też wyraźną dynamikę zmian stwierdzonych w badaniu neuropsychologicznym w ciągu pół roku od zabiegu, szczególnie w zakresie testów niewerbalnych. Wnioski: Wartość rokownicza skali Hunta i Hessa okazała się zadowalająca w odniesieniu do zaburzeń neuropsychologicznych. Pacjenci z niższym indeksem klasyfikacji Hunta i Hessa osiągali lepsze wyniki w testach neuropsychologicznych. Jedynie w przypadku czynnika podatności na dystrakcję uzyskano wyniki poniżej przeciętnej zarówno we wczesnym, jak i odległym badaniu w obydwu porównywanych grupach.

11

Effect of endothelin-1 receptor antagonist BQ-123 on basilar artery diameter after subarachnoid hemorrhage (SAH) in rats

63%

Josko J. , Hendryk S. , Jedrzejowska-Szypulka H. , Slowinski J. , Gwozdz B. , Lange D. , Harabin-Slowinska M.

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nr 2

12

Influence endothelin ET A receptor antagonist - BQ-123 - on changes of endothelin-1 level in plasma of rats with acute vasospasm following subarachnoid hemorrhage

51%

Josko J. , Hendryk S. , Jedrzejowska-Szypula H. , Gwozdz B. , Herman Z. S. , Gawlik R.

Journal of Physiology and Pharmacology

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1998

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tom 49

|

nr 3

13

Corticotropin releasing hormone [CRH] increases beta-endorphin [beta-end like] concentration in cerebrospinal fluid of rats with vasospasm following subarachnoid hemorrhage

51%

Henryk S. , Josko J. , Jedrzejowska-Szypulka H. , Jarzab B. , Dohler K. D.

Journal of Physiology and Pharmacology

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1999

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tom 50

|

nr 3

14

Atrial natriuretic peptide secretion following subarachnoid hemorrhage in spontaneously hypertensive rats

44%

Josko J. , Hendryk S. , Jedrzejowska-Szypulka H. , Gwozdz B. , Herman Z. S. , Latka D. , Kopec N.

Journal of Physiology and Pharmacology

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1996

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tom 47

|

nr 4

15

Vasopressin in vascular regulation and water homeostasis in the brain

38%

Kozniewska E. , Romaniuk K.

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tom 59

|

nr 8