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IF 2.5 3区医学 Q2 CLINICAL NEUROLOGY

Neurosurgical Review Pub Date : 2025-04-04 DOI:10.1007/s10143-025-03493-2

Youssef M Zohdy, Jason Lamanna, Laurie Dimisko Bsn, Jonathan A Grossberg, Daniel L Barrow, C Michael Cawley, Hassan Saad, Feras Akbik, Gustavo Pradilla, Tomas Garzon-Muvdi, Ofer Sadan, Owen B Samuels, Ali M Alawieh, Brian M Howard

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引用次数: 0

摘要

导言：感染性颅内动脉瘤（IIAs）是全身感染和颅内感染的一种罕见并发症。感染性颅内动脉瘤通常在破裂时被诊断出来，破裂后通常会导致蛛网膜下腔出血（SAH），这与非感染性动脉瘤（non-IIAs）相似。虽然血管痉挛是 SAH 和脑膜炎的常见并发症，但 IIA 患者血管痉挛的发生率、时间和处理方法尚待研究：这是一项回顾性研究，研究对象为2015年至2023年间继发于IIA或非IIA的SAH患者。排除了在 48 小时内死亡的 SAH 患者。研究人员查阅了患者的病历，了解其人口统计学特征、影像学检查结果、处理方法以及血管痉挛的时间、严重程度和处理方法。采用倾向分数匹配法比较 IIAs 和非 IIAs 患者。主要结果包括血管痉挛发生率。次要结果包括血管痉挛发生时间和治疗反应：本研究共纳入了20例IIA破裂患者，其中30%（n = 6）的患者出现了血管痉挛。在血管痉挛患者中，83%的患者因血管痉挛而出现神经功能缺损。5名患者（83%）使用了鞘内尼卡地平治疗血管痉挛，2名患者需要使用动脉内血管扩张剂。与倾向分数匹配的非 IIAs 患者相比，IIA 患者的血管痉挛发生率相当（30%vs39%,P = 0.448）。然而，IIAs 患者出现血管痉挛的时间明显更早，从破裂到血管痉挛的平均时间为 3.5 ± 1.05 天，而非 IIAs 患者为 5.27 ± 3.15 天（P = 0.002）：与非IIA相比，IIA破裂患者发生血管痉挛的风险相似；但是，他们在病程中较早出现血管痉挛的症状和影像学证据。这些发现表明，有必要对破裂的 IIAs 患者进行常规和早期的血管痉挛筛查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Earlier onset of cerebral vasospasm in ruptured infectious intracranial aneurysms.

Introduction: Infectious intracranial aneurysms(IIAs) are a rare complication of systemic and intracranial infections. IIAs are often diagnosed upon rupture, often leading to subarachnoid hemorrhage(SAH) similar to non-infectious aneurysms(non-IIAs). Although vasospasm is a common complication of both SAH and meningitis, the incidence, timing, and management of vasospasm in IIA patients are yet to be studied.

Methods: This is a retrospective study of patients presenting with SAH secondary to IIAs or non-IIAs between 2015 and 2023. Patients with SAH who died within 48 h were excluded. Patients' charts were reviewed for demographics, imaging findings, management, and the timing, severity, and management of vasospasm. Propensity-score-matching was used to compare patients with IIAs versus non-IIAs. Primary outcome included incidence of vasospasm. Secondary outcomes included time to vasospasm, and treatment response.

Results: Twenty patients with ruptured IIAs were included in this study of which 30%(n = 6) developed vasospasm. Among patients with vasospasm, 83% had neurological deficits due to vasospasm. Vasospasm was managed using intrathecal nicardipine in 5 patients(83%), while 2 patients required intra-arterial vasodilators. Compared to propensity-score-matched non-IIAs, patients with IIAs had a comparable rate of vasospasm(30%vs39%,P = 0.448). However, patients with IIAs developed vasospasm significantly earlier with a mean time from rupture to vasospasm of 3.5 ± 1.05days compared to 5.27 ± 3.15days in non-IIAs(P = 0.002).

Conclusion: Patients with ruptured IIAs are at a similar risk of vasospasm compared to non-IIAs; however, they develop symptomatic and radiographic evidence of vasospasm earlier in the course of their disease. These findings argue for the need for routine and early screening for vasospasm in patients with ruptured IIAs.

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来源期刊

Neurosurgical Review 医学-临床神经学

CiteScore

5.60

自引率

7.10%

发文量

191

审稿时长

6-12 weeks

期刊介绍： The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.