1.A proposed scoring system to screen for vasospasm following aneurysmal subarachnoid hemorrhage.
Joseph Erroll V. Navarro ; Jose C. Navarro *
Neurology Asia 2007;12(1):7-11
Vasospasm has been known to cause permanent morbidity in 40-70% of survivors who suffered from subarachnoid hemorrhage (SAH). Early recognition of vasospasm is the key to better outcome of SAH. Cerebral angiography is expensive and impractical as a monitoring tool. Transcranial Doppler is operator dependent, and not readily available. The objective of this study is to devise a non invasive tool to screen for cerebral vasospasm following SAH. The proposed vasospasm score was based on clinical and cranial CT scan features. The features are hypertension, admission World Federation of Neurosurgeons Score (WFNS), amount of blood in the cisterns and subarachnoid space, intraventricular hemorrhage and hydrocephalus. Thirty six patients with aneurismal SAH were assessed retrospectively and correlated with the angiogram for vasospasm. The patients’ vasospasm score and their corresponding sensitivity and specificity were: 1 (100%, 0%), 2 (100%, 8%), 3 (100%, 8%), 4 (100%, 8%), 5 (91%, 46%), 6 (74%, 85%), 7 (48%, 85%), 8 (26%, 23%), 9 (3%, 100%), 10 (4%, 100%). A receiver operator characteristic curve was constructed that yielded a cut-off score of 6. The score of 6 was a good trade-off between sensitivity (74%) and specificity (85%). A clinical vasospasm score was proposed to screen for vasospasm after SAH. A score of 4 to 6 was found to correlate with angiographic vasospasm. Prospective study is required to validate the scoring system.
Vasospasm
;
Subarachnoid Hemorrhage
;
Clinical
;
Vasospasm mechanism
;
Scores
2.Technique of external ventricular drainage with intraventricular administration of recombinant tissue plasminogen activator for patients with secondary intraventricular hemorrhage - Case series in a single institution.
Kevin Paul B. Ferraris ; Alain James R. Salloman ; Kenny S. Seng ; Joseph Erroll V. Navarro
Philippine Journal of Surgical Specialties 2019;74(2):33-43
INTRODUCTION:
Intraventricular hemorrhage (IVH) as an extension of
spontaneous intracerebral hemorrhage is an independent predictor of
mortality. The Clot Lysis: Evaluating Accelerated Resolution of IVH
phase 3 (CLEAR III) trial is a randomized, double-blinded, placebocontrolled, multiregional trial recently conducted to determine whether
external ventricular drainage (EVD) plus intraventricular recombinant
tissue plasminogen activator (rtPA, alteplase) improved outcome, in
comparison to EVD plus saline. This study is an application of the
rationale and principles of management in CLEAR III trial and related
literature.
METHODS:
There are five patients described in this case series. Report
followed the PROCESS guidelines.
RESULTS:
30-day mortality in this series is 2 out of 5 while actual allcause mortality is 4 out of 5. Modified Graeb scores and IVH scores
of all subjects have decreased after the intervention. However, good
functional status defined as modified Rankin scale (mRS) score of 0-3
has not been achieved with the intervention. Efficacy of completely
resolving IVH and hydrocephalus has been achieved in 2 out of 5 which
translated to a benefit of survival to one of the two. Shunt dependence
has been avoided by the subjects except for the one with the caudate
intracerebral hemorrhage. Complications related to the intervention
have been noted and discussed
CONCLUSION
In this single-institution study, patients for which rtPA was
used for intraventricular fibrinolysis of IVH clot in addition to EVD as
surgical treatment for hydrocephalus resulted to a 30-day survival of 3
out of 5 in this series, while actual survival is 1 out of 5. The intervention
was efficacious in decreasing the Modified Graeb scores and IVH scores
of all study subjects at end of treatment. Functional status of mRS 5 is
the highest score achieved among survivors.
Fibrinolysis