Erythropoietin for the Treatment of Subarachnoid Hemorrhage: A Review

Objective: Subarachnoid hemorrhage (SAH) has a worldwide incidence of approximately 10.5 cases per 100,000 person-years and constitutes 3% of all strokes. Erythropoietin (EPO) has recently been proposed for the treatment of a variety of brain diseases, including SAH, because of its neuroprotective effects. Hence, the current evidence in the published literature was reviewed to determine the potential utility of EPO in the treatment of SAH. Methods: A careful retrospective review of the literature was performed to determine the potential benefit of employing EPO in the treatment of SAH and its sequelae. Results: Careful literature review revelaed that the use of EPO may not necessarily reduce the incidence of vasospasm after SAH, but it may reduce the severity and its eventual outcome. Conclusion: Given the recent trial results, a dose-escalation study and subsequent randomized trial should be considered. © 2010 Elsevier Inc. All rights reserved

Introduction. Formation, growth, and rupture: the biology and physics of cerebral aneurysms

his issue of Neurosurgical Focus addresses several of the important biological and genetic aspects of aneurysm formation. The reader will be exposed to the latest theories of aneurysm formation that invoke genetic predispositions and the role of inflammation and matrix metalloproteinases in the genesis of a cerebral aneurysm. Observational studies provide additional insight into the role of estrogen and other female sex steroids and tobacco use with respect to the evolution of multiple aneurysms

Endovascular treatment for acute ischemic stroke in octogenarians compared with younger patients: a meta-analysis.

BACKGROUND: Little is known about the safety and efficacy of endovascular therapy for acute ischemic stroke in octogenarians. AIM: We performed a systematic review and meta-analysis of published studies comparing outcomes of octogenarians and younger patients after endovascular treatment for acute ischemic stroke. METHODS: A computerized search of the medical literature from 1990 to 2012 was performed to identify comparative studies of endovascular treatment of ischemic stroke patients 80 years or older and younger patients. Data on clinical outcomes, mortality, symptomatic intracerebral hemorrhage, and recanalization were abstracted. RESULTS: Data from eight studies with 2729 patients were included in the final analysis. Good functional outcome defined as modified Rankin score 2 or less within 90 days was more common in younger patients compared with octogenarians [odds ratio 2.694; 95% confidence interval 1.941-3.740, P \u3c 0.001). Symptomatic hemorrhage and death were significantly more come in patients 80 years or older (odds ratio 1.604; 95% confidence interval 1.013-2.540, P = 0.04 and odds ratio 3.695; 95% confidence interval 2.517-5.424, P \u3c 0.001, respectively). Successful recanalization defined as Thrombolysis in Myocardial Infarction (TIMI) 2-3 was seen less frequently in older patients; however, this did not reach statistical significance (odds ratio 0.814; 95% confidence interval 0.522-1.269, P = 0.364). CONCLUSION: Formal meta-analysis showed that octogenarians are less likely to achieve functional independence and have higher rates of mortality and intracerebral hemorrhage following endovascular treatment for ischemic stroke compared with younger patients. Decisions regarding endovascular treatment of elderly patients should be individualized until randomized controlled trials are available