Concentração sérica da proteína C reativa como indicador preditivo do prognóstico clínico em indivíduos com hemorragia subaracnóidea aneurísmática

Introduction: Cerebral vasospasm is a prolonged constriction in arteries of subarachnoid space. It is the main cause of morbidity after subarachnoid hemorrhage (SAH). The objective was to study the relationships between C-reactive protein levels and clinical outcome and the development of cerebral vasospasm after aneurismal SAH. METHOD: One hundred adult patients with aneurismal SAH were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, transcranial doppler (TCD) and daily neurological examinations were recorded. Serial serum C reactive protein (CRP) measurements were evaluated daily from the admission to the 10th day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to predict the outcome. RESULTS: There was progressive increase in the CRP levels from the admission to 3rd postictal day, followed by slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels (correlation coefficient methodology; z = 8.381, p < 0.0001, r = 0,86). Clinical vasospasm patients showed the highest serum CRP levels (correlation coefficient methodology; z = 7.863, p < 0.0001, r = 0,74). Patients with lower GCS scores presented with increased CRP levels (correlation coefficient methodology; z = -8.712, p < 0.0001, r = -0,87). Low admission GCS scores were inversely correlated with high serum CRP levels. Patients with higher Hunt and Hess grades on admission presented significantly higher CRP serum levels (correlation coefficient methodology; z = 6.842, p < 0.0001, r = 0,80) Similarly, patients with higher admission Fisher grades showed increased levels of CRP (correlation coefficient methodology; z = 7.789, p < 0.0001, r = 0,84). In regard to their GOS scores, patients with higher CRP serum levels presented less favorable outcomes (correlation coefficient methodology ...Introdução: O vasoespasmo cerebral (VC) é definido como constrição gradual e prolongada das artérias cerebrais no espaço subaracnóideo após episódio de hemorragia subaracnóidea (HSA). É a causa mais importante de morbidade nestes doentes. O objetivo deste estudo é de avaliar a relação entre as concentrações séricas da proteína C reativa (PCR) e o prognóstico neurológico em indivíduos com HSA aneurismática. CASUÍSTICA E MÉTODO: Cem indivíduos adultos com diagnóstico de HSA foram avaliados prospectivamente. Escala de coma de Glasgow (GCS), escala de Hunt Hess (HH), escala de Fisher (EF), tomografia computadorizada (TC) de crânio, angiografia cerebral e exame neurológico foram anotados. A PCR sérica foi dosada diariamente da admissão ao 10° dia. Os indivíduos foram submetidos a Doppler transcraniano (DTC) seriado em dias alternados. A escala prognóstica de Glasgow (GOS) e a escala de Rhankim modificada (mRS) foram utilizadas para avaliar o prognóstico. RESULTADOS: Foi observado aumento progressivo nas concentrações séricas de PCR em todos os doentes da admissão ao terceiro dia, seguidos por uma queda lenta até o nono dia. Observou-se que a ocorrência de VC, identificada por alterações nos parâmetros hemodinâmicos do DTC foi associada com concentrações séricas mais elevadas de PCR (metodologia do coeficiente de correlação; z = 8.381, p < 0.0001, r = 0,86) e doentes que manifestaram VC sintomático apresentaram concentrações ainda mais elevados (metodologia do coeficiente de correlação; z = 7.863, p < 0.0001, r = 0,74). Indivíduos com valores menores na GCS apresentaram níveis séricos mais elevados de PCR durante a avaliação seriada (metodologia do coeficiente de correlação; z = -8.712, p < 0.0001, r = -0,87). Doentes com altos valores na escala de HH na admissão apresentaram concentrações séricas mais elevadas de PCR (metodologia do coeficiente de correlação ..

Suboccipital craniectomy with or without duraplasty: what is the best choice in patients with Chiari type 1 malformation? Craniectomia suboccipital com ou sem duroplastia: qual a melhor escolha em pacientes com malformação de Chiari tipo 1?

The best surgical treatment for Chiari malformation is unclear, especially in patients with syringomyelia. We reviewed the records of 16 patients who underwent suboccipital craniectomy at our institution between 2005 and 2008. Of the six patients who did not undergo duraplasty, four showed improvement postoperatively. Two patients without syringomyelia showed improvement postoperatively. Of the four patients with syringomyelia, three showed improvement, including two with a decrease in the cavity size. One patient showed improvement in symptoms but the syringomyelia was unchanged. The cavity size increased in the one patient who did not show improvement. Among the 10 patients who underwent duraplasty, improvements were noted in four of the five patients without syringomyelia and in all of the five with syringomyelia. There is a suggestion that patients with syringomyelia may have a higher likelihood of improvement after undergoing duraplasty.A melhor opção de tratamento cirúrgico na malformação de Chiari é desconhecido, especialmente em paciente com siringomielia. Nós revisamos casos de 16 pacientes submetidos à craniectomia suboccipital em nossa instituição de 2005 à 2008. Dos 6 pacientes que não foram submetidos à duroplastia, quatro tiveram melhora pós operatória. Dois pacientes sem siringomielia tiveram melhora pós operatória. Dos quatro pacientes com siringomielia, três tiveram melhora, incluindo dois com diminuição do tamanho da cavidade. Um paciente teve melhora da sintomatologia mas a siringomielia não se modificou. Dez pacientes foram submetidos à duroplastia. Melhora foi observada em 4 de 5 pacientes sem siringomielia e 5 de 5 casos com siringomielia. Há uma sugestão de que pacientes com siringomielia possam ter uma maior taxa de melhora após serem submetidos à duroplastia

C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1

PURPOSE:To evaluate the relationship between C reactive protein levels and clinical and radiological parameters with delayed ischemic neurological deficits and outcome after aneurysmal subarachnoid hemorrhage.METHODS:One hundred adult patients with aneurismal SAH were prospectively evaluated. Besides the baseline characteristics, daily C-reactive protein levels were prospectively measured until day 10 after subarachnoid hemorrhage. The primary end point was outcome assessed by Glasgow Outcome Scale, the secondary was the occurrence of delayed ischemic neurological deficits (DINDs).RESULTS:A progressive increase in the CRP levels from the admission to 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS on discharge and CRP levels.CONCLUSIONS:Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits. Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor