1,721,092 research outputs found
Monocyte Count and Systemic Immune-Inflammation Index Score as Predictors of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage
Full text linkObjective: Delayed cerebral ischemia (DCI) is a major cause of disability in patients who survive aneurysmal subarachnoid hemorrhage (aSAH). Systemic inflammatory markers, such as peripheral leukocyte count and systemic immune-inflammatory index (SII) score, have been considered predictors of DCI in previous studies. This study aims to investigate which systemic biomarkers are significant predictors of DCI. Methods: We conducted a retrospective, observational, single-center study of 170 patients with SAH admitted between May 2018 and March 2022. We analyzed the patients’ clinical and laboratory parameters within 1 hour and 3–4 and 5–7 days after admission. The DCI and non-DCI groups were compared. Variables showing statistical significance in the univariate logistic analysis (p<0.05) were entered into a multivariate regression model. Results: Hunt-Hess grade “4–5” at admission, modified Fisher scale grade “3–4” at admission, hydrocephalus, intraventricular hemorrhage, and infection showed statistical significance (p<0.05) on a univariate logistic regression. Lymphocyte and monocyte count at admission, SII scores and C-reactive protein levels on days 3–4, and leukocyte and neutrophil counts on days 5–7 exhibited statistical significance on the univariate logistic regression. Multivariate logistic regression analysis revealed that monocyte count at admission (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.04–2.65; p=0.036) and SII score at days 3–4 (OR, 1.55; 95% CI, 1.02–2.47; p=0.049) were independent predictors of DCI. Conclusion: Monocyte count at admission and SII score 3–4 days after rupture are independent predictors of clinical deterioration caused by DCI after aSAH. Peripheral monocytosis may be the primer for the innate immune reaction, and the SII score at days 3–4 can promptly represent the propagated systemic immune reaction toward DCI
Conservative Management of Unruptured Spontaneous Intracranial Vertebral Artery Dissection
No full textOBJECTIVE: The present study investigated the clinical and morphological characteristics of the vertebrobasilar artery associated with vascular healing in patients with unruptured spontaneous intracranial vertebral artery (VA) dissection (VAD).
METHODS: We retrospectively reviewed the data from 69 consecutive patients with a diagnosis of unruptured VAD who were treated conservatively for >/=21 days from November 2003 to February 2018 at our institute. Univariate and multivariate analyses were performed to evaluate the clinical characteristics and morphological findings of VAD.
RESULTS: Of the 69 patients, vascular normalization of VAD was observed in 26, including a significantly greater proportion of women and nonsmokers (P = 0.04 and P = 0.034, respectively). Patients with normalization of VAD had a significantly lower proportion of posteroinferior cerebellar artery involvement and a smaller vertebral-union-basilar angle of the nondissecting VA, smaller vertebral-union-vertebral angle, distal dissection from the VA union, and less basilar artery bending. Luminal irregularity/steno-occlusion of the VAD on the initial images exhibited vascular resolution/normalization in 25 patients (67.6%) on subsequent images. The morphology of VAD in the dominant or codominant VAs included fusiform/aneurysmal dilatation in 25 patients (78.1%). The morphology in the nondominant VA included luminal irregularity/steno-occlusion in 23 patients (62.2%).
CONCLUSIONS: Spontaneous vascular normalization of unruptured spontaneous intracranial VAD might be associated with female sex, nonsmoking, no posteroinferior cerebellar artery involvement, a smaller vertebral-union-basilar angle and vertebral-union-vertebral angle, distal dissection from the VA union, less basilar artery bending, and luminal irregularity/steno-occlusion
Aneurysms of the Proximal (A1) Segment of the Anterior Cerebral Artery: A Clinical Analysis of 31 Cases
No full textOBJECTIVE: This study aimed to investigate the characteristics of A1 aneurysms according to their locations and to compare their imaging appearances so as to identify factors associated with their rupture.
METHODS: We retrospectively reviewed the medical records of 31 patients harboring 32 A1 aneurysms diagnosed and treated between March 2009 and September 2018 at our institute.
RESULTS: Thirteen (41.9%) of the patients had vascular abnormalities, and multiple aneurysms were found in 13 (41.9%) patients. A total of 16 (53.3%) aneurysms were located on the proximal A1 segment, whereas the middle segments were affected in 7 (23.3%) and the distal segments in 7 (23.3%). Altogether, 93.8% of proximal A1 aneurysms projected posteriorly, 85.7% of middle aneurysms projected superiorly, and 85.7% of distal aneurysms projected inferiorly (P = 0.000). Four (33.3%) of the 12 total ruptured aneurysms were located on the distal A1 segment. Nine (69.2%) ruptured aneurysms were elongated or irregular in shape (P = 0.004). The aspect and height-width ratios of the ruptured aneurysms were higher than those of the unruptured aneurysms (P = 0.001, P = 0.018, respectively).
CONCLUSIONS: Most A1 aneurysms showed a directional predilection according to the location of the A1 segment. Additionally, A1 aneurysms with elongated or irregular shapes, high aspect or height-width ratios, and distal locations of the A1 segment showed high risks of rupture. Therefore, a thorough assessment of the characteristics of A1 aneurysms can enhance the selection of proper treatment strategies
Abusive head traumas in 4 infants
Full text linkPediatric abusive head trauma (AHT) is a serious, repeated child abuse that causes grave brain damage. In Korea, AHT cases have been reported rarely, especially infants. We present 4 cases of AHT in infants diagnosed in our institution during last 2 years. We collected the demographic data, ophthalmologic examination, imaging study, and outcomes. The mean age was 7.2 months, and 2 infants were girls and the others were boys. All four were admitted with no history of head trauma, and among them 2 patients presented with an episode of seizure and respiratory arrest with no history of head trauma. The initial mental status was semi-coma in 3 cases, and stupor in 1 case. There were multiple retinal hemorrhages in both eyes in 2 cases; one had multiple old fractures on the extremities and another child showed multiple skull fractures. All patients underwent emergent surgery for acute bilateral subdural hemorrhages; 3 had craniotomy and another had burr-hole drainage. Two children expired and the other 2 are in vegetative status. The AHT has recently become more frequent in Korea so that neurosurgeons must alert AHT even in infants with head trauma. Copyright © 2020 Korean Neurotraumatology Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited
Outcomes of Bypass Surgery in Adult Moyamoya Disease by Onset Type
Full text linkImportance: Moyamoya disease (MMD) is a rare chronic cerebrovascular disease, and the outcomes of bypass management in adult patients remain controversial. Objective: To categorize adult MMD based on asymptomatic, ischemic, and hemorrhagic onset and compare the outcomes (death, hemorrhagic stroke [HS], and ischemic stroke [IS]) of bypass surgery (direct or indirect) with those of conservative management. Design, Setting, and Participants: This retrospective, nationwide, population-based longitudinal cohort study used Korean National Health Insurance Research data to identify adults (aged ≥15 years) with MMD who were diagnosed between January 1, 2008, and December 31, 2020, and followed up until December 31, 2021 (median follow-up, 5.74 [IQR, 2.95-9.42] years). A total of 19700 participants (3194 with hemorrhagic, 517 with ischemic, and 15989 with asymptomatic MMD) were included. Data were analyzed from January 2 to April 1, 2023. Exposures: Bypass surgery and conservative management. Main Outcomes and Measures: Death constituted the primary outcome; secondary outcomes consisted of HS or IS. Kaplan-Meier survival curve and Cox proportional hazards regression analysis were applied. The propensity score-matching and stratified analyses were performed to control covariate effects. Results: A total of 19700 patients (mean [SD] age, 45.43 [14.98] years; 12766 [64.8%] female) were included. Compared with conservative management, bypass was associated with a reduced risk of death (adjusted hazard ratio [AHR], 0.50 [95% CI, 0.41-0.61]; P <.001) and HS (AHR, 0.36 [0.30-0.40]; P <.001) in hemorrhagic MMD; reduced risk of IS (AHR, 0.55 [95% CI, 0.37-0.81]; P =.002) in ischemic MMD; and reduced risk of death (AHR, 0.74 [95% CI, 0.66-0.84]; P <.001) in asymptomatic MMD. However, bypass was associated with an increased risk of HS (AHR, 1.76 [95% CI, 1.56-2.00]; P <.001) in asymptomatic MMD. Both direct and indirect bypass demonstrated similar effects in hemorrhagic and asymptomatic MMD, except only direct bypass was associated with a reduced risk of IS (AHR, 0.52 [95% CI, 0.33- 0.83]; P =.01) in ischemic MMD. After stratification, bypass was associated with a reduced risk of death in patients younger than 55 years with ischemic (AHR, 0.34 [95% CI, 0.13- 0.88]; P =.03) and asymptomatic (AHR, 0.69 [95% CI, 0.60-0.79]; P <.001) MMD, but an increased risk of HS in patients 55 years or older with ischemic MMD (AHR, 2.13 [95% CI, 1.1-4.16]; P =.03). Conclusions and Relevance: The findings of this cohort study of bypass outcomes for patients with MMD emphasize the importance of tailoring management strategies in adult patients based on onset types
Response by Song et al to Letter Regarding Article, "Prevalence of Intracranial Aneurysms in Patients With Systemic Vessel Aneurysms: A Nationwide Cohort Study"
No full textDepression or Anxiety According to Management Modalities in Patients With Unruptured Intracranial Aneurysms
No full textBACKGROUND: In the treatment of unruptured intracranial aneurysms, the risk was usually estimated by objective neurological sequelae. However, their effects on depression and anxiety are rare and remain controversial. We aimed to evaluate the risk of depression and anxiety in patients with unruptured intracranial aneurysm stratified by management strategies in a population-based, longitudinal cohort study. METHODS: Using the Korean National Health Insurance Research Database, 71 750 patients with unruptured intracranial aneurysms between 2008 and 2011 were identified and followed up until the end of 2020. The risk of depression and anxiety was compared among management strategies with respect to age, sex, and medical comorbidities. RESULTS: The Kaplan-Meier survival curves indicated that the treatment (clipping and endovascular treatment) group developed depression more frequently than the observation group (P<0.001). The adjusted hazard ratio was 1.11 (95% CI, 1.07-1.15) in the treatment group. According to the management modality, the Kaplan-Meier survival curves indicated that clipping and endovascular treatment groups developed depression more frequently than the observation group (P<0.0001). The adjusted hazard ratio was 1.15 (95% CI, 1.10-1.21) for clipping and 1.07 (95% CI, 1.02-1.12) for endovascular treatment. The depression risk was higher with advanced age (hazard ratio for 45-64 years, 1.37 [95% CI, 1.29-1.45] and hazard ratio for >/=65 years, 2.04 [95% CI, 1.92-2.17]). The risk for anxiety did not differ among the management modalities. CONCLUSIONS: In this study, the risk of depression was slightly greater after clipping surgery than endovascular treatment. Data on treatment-related, long-term psychological outcomes, such as depression, may aid decision-making for preventive treatment of asymptomatic unruptured intracranial aneurysm patients
Correction to: Response by Song et al to Letter Regarding Article, “Prevalence of Intracranial Aneurysms in Patients With Systemic Vessel Aneurysms: A Nationwide Cohort Study”
No full textPrevalence of Intracranial Aneurysms in Patients With Systemic Vessel Aneurysms: A Nationwide Cohort Study
No full textBackground and Purpose- Most aneurysms are a focal manifestation of a systemic condition. Some reports have suggested genetic and environmental factors may play a role in pathogenesis. The aim of the present study was to evaluate the prevalence of intracranial aneurysms (IA) in a large cohort of patients with other systemic vessel aneurysms and dissections (OVAD) and identify potential risk factors for IA in this population. Methods- We defined OVAD as systemic vessel aneurysms, excluding aortic dissections and aneurysms. A cohort of 1.1 million patients was extracted from the population-based cohort from the Korea National Health Insurance Service, which holds almost all medical data including diagnostic codes, procedures, and personal information. Using chi(2) or Fisher exact test, the prevalence of the IA concerning OVAD status was analyzed. Results- In OVAD individuals, 25.7% (261/1017) of patients had been concurrently diagnosed with IA. The odds ratios for having concurrent IA in patients with OVAD were 56.31 (95% CI, 48.821-64.949; P=0.000). OVAD patients with dyslipidemia were >7x likely to be affected by IA (adjusted odds ratio, 7.7 [95% CI, 6.59-9.01]; P=0.000). Hypertension, diabetes mellitus, old age (>60 years), and male sex had increased odds for having concurrent IA by 5.89, 3.48, 1.83, and 1.35, respectively. Subgroup analysis with socioeconomic or disability revealed that the prevalence of IA was significantly higher in all groups. Uncertainty regarding the temporal sequence of onset and lack of detail on disease severity and subtype prevented more conclusive results. Conclusions- Patients with OVAD have a higher prevalence of IA than control groups. Therefore, we may approach aneurysms as systemic disease, and further investigations about their pathophysiology must follow
Association between Air Pollutants and Initial Hospital Admission for Ischemic Stroke in Korea from 2002 to 2013
Full text linkObjectives: There is limited information regarding the association between air pollution exposure and stroke incidence. Therefore, this study aimed to assess the associations between short-term exposure to ambient air pollutants and initial hospital admission for ischemic stroke. Materials and Methods: From the Korea National Health Insurance Service–National Sample Cohort 2002–2013 database in South Korea, 55,852 first hospital admissions for ischemic stroke were identified. A generalized additive Poisson model was used to explore the association between air pollutants, including particulate matter, sulfur dioxide, nitrogen dioxide, and carbon monoxide and admissions for ischemic stroke. Results: All air pollutant models showed significant associations with ischemic stroke in the single lag model. In all air pollutant models excluding particulate matter 10 μm, a significant association was found between nitrogen dioxide exposure and initial admission for ischemic stroke after adjusting for other pollutants. An increment of 10 μg/m3 in nitrogen dioxide concentration at lag 0 and 14 days corresponded to a 0.259% (95% confidence interval, 0.231–0.287%) and 0.110% (95% confidence interval, 0.097–0.124) increase in initial admission for ischemic stroke, respectively. Conclusions: The exposure-response relationship between nitrogen dioxide and initial admissions for ischemic stroke was approximately linear, with a sharper response at higher concentrations. Short-term exposure to nitrogen dioxide was positively associated with initial hospital admission for ischemic stroke
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