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Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review

BACKGROUND: Patients with ruptured brain aneurysms and aneurysmal subarachnoid hemorrhage suffer neurological damage from primary injury of the aneurysm rupture itself, as well as a number of secondary injurious processes that can further worsen the affected individual's neurological state. In...

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Autores principales: Lo, Benjamin W. Y., Fukuda, Hitoshi, Nishimura, Yusuke, Macdonald, R. Loch, Farrokhyar, Forough, Thabane, Lehana, Levine, Mitchell A. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544125/
https://www.ncbi.nlm.nih.gov/pubmed/26322246
http://dx.doi.org/10.4103/2152-7806.162677
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author Lo, Benjamin W. Y.
Fukuda, Hitoshi
Nishimura, Yusuke
Macdonald, R. Loch
Farrokhyar, Forough
Thabane, Lehana
Levine, Mitchell A. H.
author_facet Lo, Benjamin W. Y.
Fukuda, Hitoshi
Nishimura, Yusuke
Macdonald, R. Loch
Farrokhyar, Forough
Thabane, Lehana
Levine, Mitchell A. H.
author_sort Lo, Benjamin W. Y.
collection PubMed
description BACKGROUND: Patients with ruptured brain aneurysms and aneurysmal subarachnoid hemorrhage suffer neurological damage from primary injury of the aneurysm rupture itself, as well as a number of secondary injurious processes that can further worsen the affected individual's neurological state. In addition, other body systems can be affected in a number of brain-body associations. METHODS: This systematic review synthesizes prospective and retrospective cohort studies that investigate brain-body associations in patients with ruptured brain aneurysms. The methodologic quality of these studies will be appraised. RESULTS: Six cohort studies were included in this systemic review. The methodologic quality of each study was assessed. They had representative patient populations, clear selection criteria and clear descriptions of study designs. Reproducible study protocols with ethics board approval were present. Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice. There were few withdrawals from the study. Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints. Several pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms were clarified through this systematic review. Sympathetic activation of the cardiovascular system in aneurysmal subarachnoid hemorrhage not only triggers the release of atrial and brain natriuretic peptides it can also lead to increased pulmonary venous pressures and permeability causing hydrostatic pulmonary edema. Natriuretic states can herald the onset or worsening of clinical vasospasm as the renin-angiotensin-aldosterone system is activated in a delayed manner. CONCLUSIONS: This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.
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spelling pubmed-45441252015-08-28 Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review Lo, Benjamin W. Y. Fukuda, Hitoshi Nishimura, Yusuke Macdonald, R. Loch Farrokhyar, Forough Thabane, Lehana Levine, Mitchell A. H. Surg Neurol Int Original Article BACKGROUND: Patients with ruptured brain aneurysms and aneurysmal subarachnoid hemorrhage suffer neurological damage from primary injury of the aneurysm rupture itself, as well as a number of secondary injurious processes that can further worsen the affected individual's neurological state. In addition, other body systems can be affected in a number of brain-body associations. METHODS: This systematic review synthesizes prospective and retrospective cohort studies that investigate brain-body associations in patients with ruptured brain aneurysms. The methodologic quality of these studies will be appraised. RESULTS: Six cohort studies were included in this systemic review. The methodologic quality of each study was assessed. They had representative patient populations, clear selection criteria and clear descriptions of study designs. Reproducible study protocols with ethics board approval were present. Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice. There were few withdrawals from the study. Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints. Several pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms were clarified through this systematic review. Sympathetic activation of the cardiovascular system in aneurysmal subarachnoid hemorrhage not only triggers the release of atrial and brain natriuretic peptides it can also lead to increased pulmonary venous pressures and permeability causing hydrostatic pulmonary edema. Natriuretic states can herald the onset or worsening of clinical vasospasm as the renin-angiotensin-aldosterone system is activated in a delayed manner. CONCLUSIONS: This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury. Medknow Publications & Media Pvt Ltd 2015-08-11 /pmc/articles/PMC4544125/ /pubmed/26322246 http://dx.doi.org/10.4103/2152-7806.162677 Text en Copyright: © 2015 Lo BWY. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Original Article
Lo, Benjamin W. Y.
Fukuda, Hitoshi
Nishimura, Yusuke
Macdonald, R. Loch
Farrokhyar, Forough
Thabane, Lehana
Levine, Mitchell A. H.
Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review
title Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review
title_full Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review
title_fullStr Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review
title_full_unstemmed Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review
title_short Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review
title_sort pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: a systematic review
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544125/
https://www.ncbi.nlm.nih.gov/pubmed/26322246
http://dx.doi.org/10.4103/2152-7806.162677
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