RESUMO
UNLABELLED: Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. OBJECTIVE: Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH) patients according to age. METHOD: Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo) were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. RESULTS: There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. CONCLUSION: Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.
Assuntos
Aneurisma Roto/fisiopatologia , Hemorragia Subaracnóidea/fisiopatologia , Fatores Etários , Idoso , Aneurisma Roto/classificação , Aneurisma Roto/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Feminino , Escala de Resultado de Glasgow , Homeostase/fisiologia , Humanos , Masculino , Prognóstico , Radiografia , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Hemorragia Subaracnóidea/classificação , Hemorragia Subaracnóidea/diagnóstico por imagem , Centros de Atenção TerciáriaRESUMO
Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH) patients according to age. Method Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo) were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment. .
A idade é considerada fator de risco de mau prognóstico em pacientes com aneurismas intracranianos rotos ou não-rotos; com o aumento da idade, ficam prejudicados vários padrões fisiológicos relacionados à hemodinâmica cerebral e homeostase. Objetivo Estudar o quadro clínico, os dados radiológicos e o prognóstico nos pacientes com hemorragia subaracnóide aneurismática em relação à idade. Método Foram avaliados consecutivamente, de 2002 a 2012, 389 pacientes com hemorragia subaracnóide aneurismática oriundos de uma instituição terciária brasileira. Resultados Houve associação da idade com pior quadro clínico, radiológico e prognóstico nos pacientes com hemorragia subaracnóide aneurismática. Conclusão O curso natural da hemorragia subaracnoidea é pior em pacientes idosos. O reconhecimento adequado do perfil desses pacientes e seu prognóstico é importante para estabelecer um tratamento adequado. .
Assuntos
Idoso , Feminino , Humanos , Masculino , Aneurisma Roto/fisiopatologia , Hemorragia Subaracnóidea/fisiopatologia , Fatores Etários , Aneurisma Roto/classificação , Aneurisma Roto , Circulação Cerebrovascular/fisiologia , Escala de Resultado de Glasgow , Homeostase/fisiologia , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Hemorragia Subaracnóidea/classificação , Hemorragia Subaracnóidea , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To determine the safety of acute normovolemic hemodilution (ANH) for patients undergoing neurosurgical procedures. METHODS: A group of 100 patients undergoing neurosurgical procedures was assigned prospectively to receive ANH. A group of 47 patients who underwent craniotomy for aneurysm clipping and standard anesthetic management was used as a control. Procedures conducted under ANH were performed without significant variations in physiologic parameters. RESULTS: Compared with controls, intraoperative blood loss, operative time, incidence and grade of complications, and length of hospital stay were similar between the two groups. Although the ANH group showed a difference in prothrombin levels before and after hemodilution procedures, the levels were still considered within physiologic parameters. Platelet counts and partial thromboplastin time (PTT) levels indicated no significant variations in either group. During the ANH procedure, a considerable reduction of brain oxygen extraction was observed in individuals with worse preoperative neurologic status (P < 0.05), indicating potential benefit. Among patients with cerebral aneurysm, patients with good initial clinical grades had better clinical results as indicated by Glasgow Outcome Scale scores (P < 0.02). CONCLUSIONS: ANH is a safe procedure for patients undergoing neurosurgical procedures. Further studies are necessary to confirm the improvement in brain oxygen extraction and the clinical impact. Nonetheless, patients undergoing aneurysm clipping with good clinical grades seem to profit from ANH.
Assuntos
Aneurisma Roto/cirurgia , Neoplasias Encefálicas/cirurgia , Craniotomia/métodos , Hemodiluição/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Aneurisma Roto/fisiopatologia , Perda Sanguínea Cirúrgica/fisiopatologia , Volume Sanguíneo/fisiologia , Neoplasias Encefálicas/fisiopatologia , Criança , Transfusão de Eritrócitos , Feminino , Hidratação , Humanos , Aneurisma Intracraniano/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Estudos Prospectivos , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/cirurgia , Estudos de Tempo e Movimento , Adulto JovemRESUMO
Hemodynamics plays an important role in the progression and rupture of cerebral aneurysms. The temporal and spatial variations in wall shear stress (WSS) within the aneurysmal sac are hypothesized to be correlated with the growth and rupture of the aneurysm. The current work describes the blood flow dynamics in 34 patient-specific models of saccular aneurysms located in the region of the anterior and posterior circulation of the circle of Willis. The models were obtained from three-dimensional rotational angiography image data and blood flow dynamics was studied under a physiologically representative waveform of inflow. The three-dimensional continuity and momentum equations for unsteady laminar flow were solved with commercial software using non-structured fine grid sizes. The vortex structure, the wall pressure, and the WSS showed large variations, depending on the morphology of the artery, size of the aneurysm, and form. A correlation existed between the mean WSS on the aneurysmal sac for lateral unruptured and ruptured aneurysms with an aneurysm surface index, which is defined as the ratio between the aneurysm area and the artery area at model inlet, respectively.