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Fulltext Diagnostic Dilemma of Intracranial Aneurysm in Neonatal Subarachnoid Haemorrhage (SAH)

Teo Y E, Abd Ghani F, Nik Lah N S H, Sriram P R

Borneo Journal of Medical Sciences, 2019;2(101):25-26.
MyJurnal

Cerebral aneurysm is an exceedingly rare aetiology of neonatal Subarachnoid Haemorrhage (SAH). Detailed history and pattern recognition of the SAH is crucial in suspecting aneurysm.

Matched MeSH terms: Subarachnoid Hemorrhage*
Fulltext Intracranial arteriovenous malformations in Malaysian population

Chee CP, Loh TG

Med J Malaysia, 1987 Sep;42(3):186-90.
PMID: 3506642

Thirty-four patients with intracranial arteriovenous malformations seen in the University Hospital, Kuala Lumpur, over a is-year period were reviewed. A VM was found to be more common in young, male patients with preponderance Chinese origin. The advent of the Cl-scan has increased the detection of small A VMs and intracerebral haematomas proportionally. The majority of the lesions were situated in the posterior half of the brain unlike the distributions in patients in the West and in Singapore. On the other hand, most of the intracranial bleeding were subarachnoid haemorrhage; a presentation similar to the western community, but unlike that reported from Singapore. The treatment policy is not unlike the western community with good results in 82% of patients selected for surgery.

Matched MeSH terms: Subarachnoid Hemorrhage/etiology; Subarachnoid Hemorrhage/surgery
Fulltext Isolated non-traumatic, non-aneurysmal convexal subarachnoid hemorrhage in a patient with Evans syndrome

Abdul Rashid AM, Md Noh MSF

BMC Neurol, 2017 Aug 25;17(1):165.
PMID: 28841841 DOI: 10.1186/s12883-017-0944-9

BACKGROUND: Non-traumatic, spontaneous subarachnoid hemorrhage occurs in approximately 85% of cases where there is a ruptured saccular aneurysm. An additional 10% of cases arise from non-aneurysmal peri-mesencephalic hemorrhages.
CASE PRESENTATION: We report a rare case of a young female, with underlying Evans syndrome, who was initially thought to have non-hemorrhagic stroke, eventually diagnosed having isolated non-traumatic, non-aneurysmal convexal subarachnoid haemorrhage.
CONCLUSIONS: Spontaneous non-traumatic, non-aneurysmal convexal subarachnoid hemorrhage is a rare entity - of which there are multiple possible etiologies.

Matched MeSH terms: Subarachnoid Hemorrhage*
Fulltext Subarachnoid haemorrhage of unknown aetiology--a clinico-radiological analysis of 22 consecutive cases in the Malaysian population

Chee CP

Singapore Med J, 1988 Aug;29(4):319-21.
PMID: 3249955

Over the last 8 years, 22 consecutive cases of subarachnoid haemorrhage were found to have no obvious cause on angiography. The age, neurological status and CT-scan appearance in 16 cases were studied together with the completeness and quality of the angiogram. Limited angiography was done in cases with advanced age, poor neurology or severe hypertension. There is a need for more repeat angiographic studies in the presence of vasospasm whether focal or generalised, as indicated by the fact that only 5 out of the 17 cases with vasospasm had repeated satisfactory studies.

Matched MeSH terms: Subarachnoid Hemorrhage/etiology*; Subarachnoid Hemorrhage/radiography
Fulltext Functional outcome of microsurgical clipping compared to endovascular coiling

Premananda RM, Ramesh N, Hillol KP

Med J Malaysia, 2012 Dec;67(6):585-90.
PMID: 23770950 MyJurnal

Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. In a retrospective cohort review on the treatment methods of aneurysm rupture in Hospital Kuala Lumpur over the period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured aneurysms. Statistical analysis was determined using Chi- Square tests to study these associations. In our study, 67.5% of patients presented with Good World Federation of Neurosurgical Societies (WFNS) grade (WFNS1-2) while 32.5% patients presented with Poor WFNS prior to intervention. In our outcome, it was noted that 60.4% had good functional outcome (mRS grade 0-2) as compared to 39.6% patients who had poor mRS(modified rankin scale) outcome (mRS 3-6). In the good WFNS group, 76% of patients in clipping group had a good mRS outcome while, 86.5% patients in coiling group had good mRS outcome (p=0.114). In poor WFNS presentation, it was noted that in 77.3% patients in clipping group, had poor mRS outcome. Similarly with poor WFNS presentation, 83.3% of patient in coiling group had poor outcome. (p=1.00). Hence when we control the WFNS group, there was no significant association between treatment group (clipping and coiling) and mRS outcome at 6 months. The outcome of patient is determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient.

Matched MeSH terms: Subarachnoid Hemorrhage
Intracranial aneurysms in Sarawak General Hospital over a 30-month period

Wong JS, Ng KH, Wong SH

J Clin Neurosci, 2004 Apr;11(3):254-8.
PMID: 14975412

This is a prospective study conducted from February 2000 to July 2002 in a single neurosurgeon neurosurgical service in the state of Sarawak, Malaysia. There were 66 cases of subarachnoid hemorrhage or intracranial aneurysm presenting to this hospital over the study period. Fifty cases had their aneurysms clipped. Eighty percent of our patients were operated within 48 h of presentation. Forty-four percent presented with poor WFNS grades of 4 and 5. We had a 20% operative mortality and 29% total management mortality. Twenty-nine (58%) of the operated cases had a favorable outcome with a mean follow-up of 32 weeks. Multiple aneurysms were less common. The diagnosis of aneuysmal subarachnoid hemorrhage and clipping of aneurysms have increased dramatically over the previous two and half years indicating an increased awareness of the diagnosis and treatment. This series supports the previously reported beliefs that the lower rate of aneurymal subarachnoid hemorrhage in developing countries is likely due to both underdiagnosis and undertreatment. Good results can be achieved in developing countries with early diagnosis and intensive management.

Matched MeSH terms: Subarachnoid Hemorrhage/etiology; Subarachnoid Hemorrhage/epidemiology; Subarachnoid Hemorrhage/surgery
Planned complex suicide: self-strangulation and fall from height

Nor FM, Das S

J Forensic Leg Med, 2011 Oct;18(7):336-9.
PMID: 21907941 DOI: 10.1016/j.jflm.2011.06.013

We hereby present a case of planned complex suicide. In this case study, we report a teen-aged girl who committed suicide by strangulating herself, and subsequently fell from the 13th floor of a housing apartment. The planned complex suicide was substantiated by the presence of a suicide note and a photograph captured in a mobile handset. To the best of our knowledge, it is the first case involving self-strangulation and fall from height, in which the photograph was stored in the handset. This is to further emphasize that objects like mobile handsets can be important in determining the cause and manner of death. The available evidence at the site of incident should be explored meticulously in order to arrive at a proper conclusion.

Matched MeSH terms: Subarachnoid Hemorrhage, Traumatic/pathology
Fulltext Clinical utility of 64-row multislice CT angiography in the detection of cerebral aneurysms in acute subarachnoid haemorrhage

Chang LK, Liew NS, Soh HL, Tan SZ, Wong SH

Med J Malaysia, 2008 Jun;63(2):131-6.
PMID: 18942299 MyJurnal

CT angiography (CTA) is a fast examination performed with a time-optimised contrast injection to enhance the cerebral arteries. Being a new imaging modality in our hospital, evaluation of the effectiveness of 64-row multislice CTA in detecting intracranial aneurysms in ruptured subarachnoid haemorrhage (SAH) cases is necessary. We conducted a descriptive prospective study by recruiting 30 consecutively operated SAH cases from May 2005 until November 2006. CTA findings were studied by radiologist and neurosurgeon and these were compared with operative findings. The sensitivity and specificity of CTA were 94.4% and 97.2% respectively. Approximately half of the patients were scanned within four hours and operated within 24 hours. In conclusion, CTA proves to be highly sensitive and specific in the diagnosis of intracranial aneurysms in our study.
KEY WORDS: Subarachnoid haemorrhage, Intracranial aneurysm, Computed tomography (CT), CT angiography (CTA), Sarawak

Matched MeSH terms: Subarachnoid Hemorrhage/complications*
Outcome prediction in early management of severe head injury: an experience in Malaysia

Selladurai BM, Jayakumar R, Tan YY, Low HC

Br J Neurosurg, 1992;6(6):549-57.
PMID: 1472321

The outcome of 109 patients with severe head injury was studied in relation to clinical and computed tomographic (CT) criteria on admission, after resuscitation. Age, Glasgow Coma Score (GCS) and state of pupils strongly correlated with outcome. The presence of hypothalamic disturbances, hypoxia and hypotension were associated with an adverse outcome. The CT indicators associated with poor outcome were perimesencephalic cistern (PMC) obliteration, subarachnoid haemorrhage, diffuse axonal injury and acute subdural haematoma. The prognostic value of midline shift and mass effect were influenced by concomitant presence of diffuse brain injury. For the subset of patients aged < 20 years, with GCS 6-8 and patent PMC (n = 21), 71.4% correct predictions were made for a good outcome. For the subset of patients aged > 20 years, with GCS 3-5 and partial or complete obliteration of PMC (n = 28), 89.3% correct predictions were made for a poor outcome.

Matched MeSH terms: Subarachnoid Hemorrhage/etiology
Fulltext Intracranial haemorrhage due to late haemorrhagic disease of infancy

Yeo TC

Med J Malaysia, 1987 Dec;42(4):276-83.
PMID: 3454400

Thirteen cases of late haemorrhagic disease of infancy due to vitamin K deficiency presenting with intracranial haemorrhage were seen over a three - year period from 1984 to 1986. The clinical picture was fairly typical; a short history of being unwell (poor feeding, vomiting, irritability, high pitched cry, fits) and physical findings of pallor, a normal body temperature, impairment of consciousness, abnormal respiration and a very tense anterior fontanelle. Vitamin K deficiency was implicated by the prolonged prothrombin time which rapidly returned to normal with vitamin K injection. The outcome was poor. Possible factors giving rise to vitamin K deficiency are discussed. The author suggests the introduction of the giving of vitamin K to all new-borns.

Matched MeSH terms: Subarachnoid Hemorrhage/etiology*
Bilateral internal carotid artery occlusions a cause of transient ischemic attack

Zulkifli A

Med J Malaysia, 1979 Sep;34(1):52-4.
PMID: 542153
Matched MeSH terms: Subarachnoid Hemorrhage/complications
Value of cerebral angiography

Soo YS, Ang AH

Med J Malaya, 1971 Mar;25(3):168-74.
PMID: 4253242
Matched MeSH terms: Subarachnoid Hemorrhage/radiography
Fulltext QTc Interval Prolongation and Hemorrhagic Stroke: Any Difference Between Acute Spontaneous Intracerebral Hemorrhage and Acute Non-traumatic Subarachnoid Hemorrhage?

Amin OSM, Al-Bajalan SJ, Mubarak A

Med Arch, 2017 Jun;71(3):193-197.
PMID: 28974832 DOI: 10.5455/medarh.2017.71.193-197

BACKGROUND: A variety of ECG changes occur as an aftermath of stroke. Prolongation of the QTc interval is a well-documented change. We analyzed QTc interval prolongation among patients with acute hemorrhagic strokes.
METHODS: This observational study was conducted at the Emergency Department of Sulaymaniyah General Teaching Hospital and Shar Hospital from September 1st, 2014 to August 31st, 2015. Fifty patients who developed acute spontaneous hypertensive intracerebral hemorrhage (ICH) and 50 patients who developed acute non-traumatic subarachnoid hemorrhage (SAH) were included in the study. All patients underwent resting 12-lead ECG within half an hour of admission. The QTc interval was calculated and analyzed in those 100 patients.
RESULTS: Females (62%) outnumbered males (38%) with a female to male ratio of 1.6:1. Forty percent of the patients were between 60-69 years of age. Hypertension was seen in 82% of patients while left ventricular hypertrophy was documented in 40% of patients. The QTc was prolonged in 38 patients (17 patients in the ICH group and 21 patients in the SAH group). In both groups, males demonstrated QTc prolongation more than females. However, there were no statistically significant gender difference between both groups and within the same group. There was a statistically significant association between SAH and QTc prolongation (p-value<0.001); the ICH group did not demonstrate any significant relationship with QTc prolongation.
CONCLUSION: Prolongation in the QTc interval was "statistically" associated with acute SAH only. No gender difference was noted; whether this observation is clinically significant or not, it needs further analytic studies.

Matched MeSH terms: Subarachnoid Hemorrhage/complications*
Fulltext Aneurysms are more common than arteriovenous malformations as the cause of subarachnoid haemorrhage in the Malaysian population

Chee CP, Loh TG

Singapore Med J, 1988 Oct;29(5):427-31.
PMID: 3241969

A retrospective prospective study of 84 cases of subarachnoid haemorrhage, 24 intracranial aneurysms and 18 arteriovenous malformations (AVM's) treated in the University Hospital, Kuala Lumpur, during the post CT-scan era was carried out to verify the relative frequencies of these clinical entities in the Malaysian population. Our results show that aneurysms are commoner than arteriovenous malformations as a cause of subarachnoid haemorrhage and also the most frequent as a whole, thus refuting the previous claims that AVM's are 4 to 10 times more common than aneurysms in this part of the world. Of interest was the internal carotid artery aneurysms accounted for half of the anterior circulation aneurysms and that 2/3 of the AVM's presented with intracranial haemorrhage.

Matched MeSH terms: Subarachnoid Hemorrhage/etiology*
Fulltext Coma due to malplaced external ventricular drain

Chai FY, Farizal F, Jegan T

Turk Neurosurg, 2013;23(4):561-3.
PMID: 24101284 DOI: 10.5137/1019-5149.JTN.5724-12.1

Ventriculostomy or external ventricular drain (EVD) placement by free-hand technique has a high malplacement rate. It is a blind procedure that often requires multiple attempts and revisions. To date, no neurological complication due to EVD malplacement has been reported in the literature. In this report, we present the first case of coma induced by a malplaced EVD and the patient regained consciousness after the drain was adjusted. Our discussion focused on various techniques that can improve the accuracy of EVD insertion. EVD insertion under image guidance provides better accuracy with limited disadvantages. We hypothesized that the patient's coma was due to the mass effect and irritation of the malplaced EVD exerted onto the ventral periaqueductal grey matter and the ascending neurons from upper brainstem.

Matched MeSH terms: Subarachnoid Hemorrhage/complications; Subarachnoid Hemorrhage/surgery
The prognostic value of the Glasgow Coma Scale, hypoxia and computerised tomography in outcome prediction of pediatric head injury

Ong L, Selladurai BM, Dhillon MK, Atan M, Lye MS

Pediatr Neurosurg, 1996 Jun;24(6):285-91.
PMID: 8988493

The outcome of 151 children less than 15 years of age and admitted within 24 h of head injury was studied in relation to clinical and computed tomography (CT) scan features. Thirty one (20.5%) had a poor outcome (24 died, 6 were severely disabled at 6 months after injury and 1 was in a persistent vegetative state) while 120 (79.5%) had a good outcome (89 recovered well and 31 were moderately disabled). Factors associated with a poor outcome were Glasgow Coma Scale (GCS) score 24 h following injury, presence of hypoxia on admission and CT scan features of subarachnoid haemorrhage, diffuse axonal injury and brain swelling. GCS scores alone, in the absence of other factors, had limited predictive value. The prognostic value of GCS scores < 8 was enhanced two-to fourfold by the presence of hypoxia. The additional presence of the CT scan features mentioned above markedly increased the probability of a poor outcome to > 0.8, modified only by the presence of GCS scores > 12. Correct predictions were made in 90.1% of patients, indicating that it is possible to estimate the severity of a patient's injury based on a small subset of clinical and radiological criteria that are readily available.

Matched MeSH terms: Subarachnoid Hemorrhage/diagnosis; Subarachnoid Hemorrhage/mortality
Fulltext Spontaneous spinal subarachnoid haemorrhage: a rare complication of dengue fever

Nur Hidayati Mohd Sharif, Nor Arisah Misnan, Norashikin Saidon, Phaik Yee Ooi, Hilwati Hashim

Journal of Clinical and Health Sciences, 2017;2:54-57.

A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.

Matched MeSH terms: Subarachnoid Hemorrhage
Fulltext HMGB1-Mediated Neuroinflammatory Responses in Brain Injuries: Potential Mechanisms and Therapeutic Opportunities

Paudel YN, Angelopoulou E, Piperi C, Othman I, Shaikh MF

Int J Mol Sci, 2020 Jun 29;21(13).
PMID: 32610502 DOI: 10.3390/ijms21134609

Brain injuries are devastating conditions, representing a global cause of mortality and morbidity, with no effective treatment to date. Increased evidence supports the role of neuroinflammation in driving several forms of brain injuries. High mobility group box 1 (HMGB1) protein is a pro-inflammatory-like cytokine with an initiator role in neuroinflammation that has been implicated in Traumatic brain injury (TBI) as well as in early brain injury (EBI) after subarachnoid hemorrhage (SAH). Herein, we discuss the implication of HMGB1-induced neuroinflammatory responses in these brain injuries, mediated through binding to the receptor for advanced glycation end products (RAGE), toll-like receptor4 (TLR4) and other inflammatory mediators. Moreover, we provide evidence on the biomarker potential of HMGB1 and the significance of its nucleocytoplasmic translocation during brain injuries along with the promising neuroprotective effects observed upon HMGB1 inhibition/neutralization in TBI and EBI induced by SAH. Overall, this review addresses the current advances on neuroinflammation driven by HMGB1 in brain injuries indicating a future treatment opportunity that may overcome current therapeutic gaps.

Matched MeSH terms: Subarachnoid Hemorrhage
Fulltext Spontaneous spinal subarachnoid haemorrhage: a rare complication of dengue fever

Nur Hidayati Mohd Sharif, Nor Arisah Misnan, Norashikin Saidon, Phaik Yee Ooi, Hilwati Hashim

Journal of Clinical and Health Sciences, 2017;2(2):54-57.
MyJurnal

A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.

Matched MeSH terms: Subarachnoid Hemorrhage
Early permanent cerebrospinal fluid diversion in aneurysmal subarachnoid hemorrhage: does a lower rate of nosocomial meningitis outweigh the risk of delayed cerebral vasospasm related morbidity?

Croci DM, Dalolio M, Aghlmandi S, Taub E, Rychen J, Chiappini A, et al.

Neurol Res, 2021 Jan;43(1):40-53.
PMID: 33106124 DOI: 10.1080/01616412.2020.1819091

Objective: Early permanent cerebrospinal fluid (CSF) diversion for hydrocephalus during the first 2 weeks after aneurysmal subarachnoid hemorrhage (aSAH) shortens the duration of external ventricular drainage (EVD) and reduces EVD-associated infections (EVDAI). The objective of this study was to detect any association with symptomatic delayed cerebral vasospasm (DCVS), or delayed cerebral ischemia (DCI) by the time of hospital discharge. Methods: We used a single-center dataset of aSAH patients who had received a permanent CSF diversion. We compared an 'early group' in which the procedure was performed up to 14 days after the ictus, to a 'late group' in which it was performed from the 15th day onward. Results: Among 274 consecutive aSAH patients, 39 (14%) had a permanent CSF diversion procedure with a silver-coated EVD. While the blood clot burden was similarly distributed, patients with early permanent CSF diversion (20 out of 39; 51%) had higher levels of consciousness on admission. Early permanent CSF diversion was associated with less colonized catheter, a shorter duration of extracorporeal CSF diversion (OR 0.73, 95%CI 0.58-0.92 per EVD day), and a lower rate of EVDAI (OR 0.08, 95%CI 0.01-0.80). The occurrence of CSF diversion device obstruction, the rate of symptomatic DCVS or detected DCI on computed tomography and the likelihood of a poor outcome at discharge did not differ between the two groups. Discussion: Early permanent CSF diversion lowers the occurrence of catheter colonization and infectious complication without affecting DCVS-related morbidity in good-grade aSAH patients. These findings need confirmation in larger prospective multicenter cohorts. Abbreviations: aSAH: aneurysmal subarachnoid hemorrhage; BNI: Barrow Neurological Institute Scale; CSF: Cerebrospinal fluid; DCVS: Delayed Cerebral Vasospasm; DCI: Delayed Cortical Ischemia; EKNZ: Ethik-Kommission Nordwest Schweiz; EVD: External ventricular drain; EVDAI: External ventricular drain-associated infections; GCS: Glasgow Coma Scale; IRB: Institutional Review Board; IVH: Inraventricular hemorrhage; mRS: Modified Rankin Scale; SOS: Swiss Study of Subarachnoid Hemorrhage Registry; WFNS: World Federation Neurological-Surgeon Scale.

Matched MeSH terms: Subarachnoid Hemorrhage

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