Cortical spreading ischaemia and delayed ischaemic neurological deficits after subarachnoid haemorrhage [Elektronische Ressource] / von Jens P. Dreier

Dr. Med. Jens P. Dreier

Description

Cortical Spreading Ischaemia and Delayed Ischaemic Neurological Deficits after Subarachnoid Haemorrhage Habilitationsschrift zur Erlangung der Lehrbefähigung für das Fach Neurologie vorgelegt dem Fakultätsrat der Medizinischen Fakultät Charité der Humboldt-Universität zu Berlin von Herrn Dr. Jens P. Dreier geboren am 11.09.1965 in Kassel Präsident: Prof. Dr. rer. nat. J. Mlynek Dekan: Prof. Dr. Joachim W. Dudenhausen eingereicht am: 12/2002 Öffentlich-wissenschaftlicher Vortrag am: 21.07.2003 Gutachter: 1. Herr Prof. Dr. rer. nat. Heiko Luhmann 2. Herr Prof. Dr. med. Peter Schmiedek CONTENTS Volume 1 I DELAYED ISCHAEMIC NEUROLOGICAL DEFICITS (DIND) 1 AFTER ANEURYSMAL SUBARACHNOID HAEMORRHAGE 1 Epidemiology 1 2 Clinical presentation 23 Risk factors 24 Differential diagnosis 44.1 Rebleeding 44.2 Hydrocephalus 44.3 Hyponatraemia 44.4 Peri- and intra-operative complications associated with aneurysm clipping 54.5 Ischaemic stroke unrelated to surgical complications or DIND in the post-operative course 75 Pathoanatomy 76 Treatment 106.1 Relative risk reduction of poor outcome after SAH by nimodipine 106.2 Systemic blood volume and DINDs 117 Animal models 12II SUMMARY OF OUR OWN RESULTS 141 Dreier et al. J Cereb Blood Flow Metab. 1995 15:914-919.

Sujets

• Gesundheit

Informations

• Publié par: humboldt-universitat_zu_berlin
• Publié le: 01 janvier 2003
• Nombre de lectures: 22

Extrait

 

     

Cortical Spreading Ischaemia and Delayed Ischaemic Neurological Deficits after Subarachnoid Haemorrhage         Habilitationsschrift zur Erlangung der Lehrbefähigung für das Fach     Neurologie       vorgelegt dem Fakultätsrat der Medizinischen Fakultät Charité der Humboldt-Universität zu Berlin       von   Herrn Dr. Jens P. Dreier   geboren am 11.09.1965 in Kassel       Präsident: Prof. Dr. rer. nat. J. Mlynek   Dekan:   Prof. Dr. Joachim W. Dudenhausen     eingereicht am: 12/2002   Öffentlich-wissenschaftlicher Vortrag am: 21.07.2003     Gutachter: 1. Herr Prof. Dr. rer. nat. Heiko Luhmann           2. Herr Prof. Dr. med. Peter Schmiedek

       

 

 

  CONTENTSVolume 1

       

I DELAYED ISCHAEMIC NE UROLOGICAL DEFICITS (DIND)  AFTER ANEURYSMAL SUBARACHNOID HAEMORRHAGE   1 E idemiolo 2 Clinical presentation 3 Risk factors 4 Differential diagnosis 4.1 Rebleedin 4.2 Hydrocephalus 4.3 Hyponatraemia 4.4 Peri- and intra-operative complications associated with aneurysm clipping 4.5 Ischaemic stroke unrelated to surgical complications or DIND in the post-operative course 5 Pathoanatomy 6 Treatment 6.1 Relative risk reduction of oor outcome after SAH b nimodi ine 6.2 S stemic blood volume and DINDs 7 Animal models

II SUMMARY OF OUR OWN RESULTS 1 Dreier et al.J Cereb Blood Flow Metab. 1995 15:914-919. 2 Dreier et al.J Cereb Blood Flow Metab. 1998 18:978-990. 3 Dreier et al.J Neurosurg. 2000 93:658-666. 4 Dreier et al.J Physiol (Lond). 2001 531(Pt2):515-526. 5 Dreier et al.Neurology. 2001 57:1344-1345. 6 Dreier et al.Brain. 2002 125:102-112. 7 Dreier et al.Neurosurgery. 2002 51:1457-1467. 8 Dreier et al.Ann Neurol. 2002 52:825-829.

III ASSESSMENT/CONCLUSION  References  Eidesstattliche Erklärung

 

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P DELAYED ISCHAEMIC NEUROLOGICAL DEFICITS (DIND) AFTER ANEURYSMAL SUBARACHNOID HAEMORRHAGE I 1 Epidemiology   Although cerebral haemorrhage represents only 10%-15% of all strokes, it has been estimated to cause more than 50% of the overall stroke mortality (Bamford et al. 1990). The 30-day mortality rate at around 45% is similar for intracranial and subarachnoid haemorrhage (SAH) (Broderick et al. 1993). SAH represents one quarter to one third of all cerebral haemorrhages (Nilsson et al. 2000). The more recent studies have estimated an annual rate of SAH between 6 in North America and 10 in Europe per 100,000 population (Broderick et al. 1993; Nilsson et al. 2000). Women are affected about twice as often compared with men (Broderick et al. 1993; Nilsson et al. 2000). Approximately 75% of spontaneous SAHs are caused by intracranial aneurysms (Nilsson et al. 2000). In a recent population-based European study, 16% of the patients with SAH died before reaching the hospital. Another 5% deceased at the day of haemorrhage after admission (Pobereskin 2001). Among patients surviving the initial haemorrhage treated without surgery, rebleeding is the major cause of morbidity and mortality. The risk is between 15% and 20% within the first two weeks. The goal of early surgery is to reduce this risk. Of those reaching neurosurgical care, secondary deterioration caused by delayed ischaemic neurological deficits (DINDs) is assumed to be the predominant complication after SAH. In the international cooperative study on the timing of aneurysm surgery, DINDs were responsible for disability in 6.3% and mortality in 7.2% among patients with SAH (Kassell et al. 1990a). The recent randomised, double-blind, vehicle-controlled trials of tirilazad mesylate found a rate of 33% to 38% for DINDs in all patients of the vehicle group. Cerebral infarctions occurred in 10% to 13% (Haley et al. 1997; Lanzino and Kassell 1999; Lanzino et al. 1999).        

 

 

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