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Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia

Vertebrobasilar dolichoectasia (VBD) is a chronic disorder with various cerebrovascular and compressive manifestations, involving subarachnoid hemorrhage (SAH). Occurrence of SAH shortly after worsening of clinical VBD symptoms has occasionally been reported. The goal of the study was to examine thi...

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Autores principales: Sokolov, Arseny A., Husain, Shakir, Sztajzel, Roman, Croquelois, Alexandre, Lobrinus, Johannes A., Thaler, David, Städler, Claudio, Hungerbühler, Hansjörg, Caso, Valeria, Rinkel, Gabriel J., Michel, Patrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058812/
https://www.ncbi.nlm.nih.gov/pubmed/27399083
http://dx.doi.org/10.1097/MD.0000000000004020
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author Sokolov, Arseny A.
Husain, Shakir
Sztajzel, Roman
Croquelois, Alexandre
Lobrinus, Johannes A.
Thaler, David
Städler, Claudio
Hungerbühler, Hansjörg
Caso, Valeria
Rinkel, Gabriel J.
Michel, Patrik
author_facet Sokolov, Arseny A.
Husain, Shakir
Sztajzel, Roman
Croquelois, Alexandre
Lobrinus, Johannes A.
Thaler, David
Städler, Claudio
Hungerbühler, Hansjörg
Caso, Valeria
Rinkel, Gabriel J.
Michel, Patrik
author_sort Sokolov, Arseny A.
collection PubMed
description Vertebrobasilar dolichoectasia (VBD) is a chronic disorder with various cerebrovascular and compressive manifestations, involving subarachnoid hemorrhage (SAH). Occurrence of SAH shortly after worsening of clinical VBD symptoms has occasionally been reported. The goal of the study was to examine this association, in particular its pathophysiology, clinical precursor signs, time course, and outcome. To this end, in a retrospective multicenter study, we analyzed 20 patients with VBD and SAH in regard to preceding clinical symptoms, presence of vertebrobasilar thrombosis and ischemia, outcome and neuropathological correlates. Median age of the 7 female and 13 male patients was 70 years (interquartile range [IQR] 18.3 years). Fourteen patients (70%) presented with new or acutely worsening posterior fossa signs at a median of 3 days prior to SAH (IQR 2, range 0.5–14). A thrombus within the VBD was detected in 12 patients (60%). Thrombus formation was associated with clinical deterioration (χ(2) = 4.38, P = 0.04) and ponto-cerebellar ischemia (χ(2) = 8.09, P = 0.005). During follow-up after SAH, 13 patients (65%) died, after a median survival time of 24 hours (IQR 66.2, range 2–264 hours), with a significant association between proven ponto-cerebellar ischemia and case fatality (χ(2) = 6.24, P = 0.01). The data establish an association between clinical deterioration in patients with VBD, vertebrobasilar ischemia, and subsequent SAH. Antithrombotic treatment after deterioration appears controversial and SAH outcome is frequently fatal. Our data also indicate a short window of 3 days that may allow for evaluating interventional treatment, preferably within randomized trials.
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spelling pubmed-50588122016-11-18 Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia Sokolov, Arseny A. Husain, Shakir Sztajzel, Roman Croquelois, Alexandre Lobrinus, Johannes A. Thaler, David Städler, Claudio Hungerbühler, Hansjörg Caso, Valeria Rinkel, Gabriel J. Michel, Patrik Medicine (Baltimore) 5300 Vertebrobasilar dolichoectasia (VBD) is a chronic disorder with various cerebrovascular and compressive manifestations, involving subarachnoid hemorrhage (SAH). Occurrence of SAH shortly after worsening of clinical VBD symptoms has occasionally been reported. The goal of the study was to examine this association, in particular its pathophysiology, clinical precursor signs, time course, and outcome. To this end, in a retrospective multicenter study, we analyzed 20 patients with VBD and SAH in regard to preceding clinical symptoms, presence of vertebrobasilar thrombosis and ischemia, outcome and neuropathological correlates. Median age of the 7 female and 13 male patients was 70 years (interquartile range [IQR] 18.3 years). Fourteen patients (70%) presented with new or acutely worsening posterior fossa signs at a median of 3 days prior to SAH (IQR 2, range 0.5–14). A thrombus within the VBD was detected in 12 patients (60%). Thrombus formation was associated with clinical deterioration (χ(2) = 4.38, P = 0.04) and ponto-cerebellar ischemia (χ(2) = 8.09, P = 0.005). During follow-up after SAH, 13 patients (65%) died, after a median survival time of 24 hours (IQR 66.2, range 2–264 hours), with a significant association between proven ponto-cerebellar ischemia and case fatality (χ(2) = 6.24, P = 0.01). The data establish an association between clinical deterioration in patients with VBD, vertebrobasilar ischemia, and subsequent SAH. Antithrombotic treatment after deterioration appears controversial and SAH outcome is frequently fatal. Our data also indicate a short window of 3 days that may allow for evaluating interventional treatment, preferably within randomized trials. Wolters Kluwer Health 2016-07-08 /pmc/articles/PMC5058812/ /pubmed/27399083 http://dx.doi.org/10.1097/MD.0000000000004020 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5300
Sokolov, Arseny A.
Husain, Shakir
Sztajzel, Roman
Croquelois, Alexandre
Lobrinus, Johannes A.
Thaler, David
Städler, Claudio
Hungerbühler, Hansjörg
Caso, Valeria
Rinkel, Gabriel J.
Michel, Patrik
Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
title Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
title_full Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
title_fullStr Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
title_full_unstemmed Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
title_short Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
title_sort fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058812/
https://www.ncbi.nlm.nih.gov/pubmed/27399083
http://dx.doi.org/10.1097/MD.0000000000004020
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