Evidence that a Panel of Neurodegeneration Biomarkers Predicts Vasospasm, Infarction, and Outcome in Aneurysmal Subarachnoid Hemorrhage

Biomarkers for neurodegeneration could be early prognostic measures of brain damage and dysfunction in aneurysmal subarachnoid hemorrhage (aSAH) with clinical and medical applications. Recently, we developed a new panel of neurodegeneration biomarkers, and report here on their relationships with pathophysiological complications and outcomes following severe aSAH. Fourteen patients provided serial cerebrospinal fluid samples for up to 10 days and were evaluated by ultrasonography, angiography, magnetic resonance imaging, and clinical examination. Functional outcomes were assessed at hospital discharge and 6–9 months thereafter. Eight biomarkers for acute brain damage were quantified: calpain-derived α-spectrin N- and C-terminal fragments (CCSntf and CCSctf), hypophosphorylated neurofilament H

Use of consensus term and definition for delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

Background and purpose: In 2010, a multidisciplinary research group proposed a consensus term and definition for the complication of delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (SAH). We assessed the use of this term and its definition as an endpoint in observational studies and clinical trials. Methods: Firstly, we performed a MEDLINE abstract search from Jan 2008 to Dec 2017 for observational cohort studies and clinical trials to investigate the used terminology over the years. Next, we studied trends in citations of the original paper citing the consensus definitions since publication in 2010. Results: The number of publications citing the 2010 consensus definitions has steadily increased from 18 in 2011 to 54 in 2017. Between 2010 and 2017, 527 papers were published with delayed cerebral ischemia, or another term to describe the same complication, as an endpoint. However, the term delayed cerebral ischemia was used only in 131/527 (25%) of papers and only 14/81 (17%) of clinical trials/cohort studies published in 2017 cited the consensus definitions when outlining study endpoints. Conclusions: Despite publication of consensus terminology and definitions for DCI in 2010, the majority of cohort studies and clinical trials in patients with SAH are not using these. Researchers and editors should be reminded of the importance of using these consensus terminology and definitions in future studies, which will promote the comparability of results between studies, understand the true impact of an intervention, aggregate results in meta- analyses, and construct guidelines with a high level of evidence

Use of consensus term and definition for delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

Background and purpose: In 2010, a multidisciplinary research group proposed a consensus term and definition for the complication of delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (SAH). We assessed the use of this term and its definition as an endpoint in observational studies and clinical trials. Methods: Firstly, we performed a MEDLINE abstract search from Jan 2008 to Dec 2017 for observational cohort studies and clinical trials to investigate the used terminology over the years. Next, we studied trends in citations of the original paper citing the consensus definitions since publication in 2010. Results: The number of publications citing the 2010 consensus definitions has steadily increased from 18 in 2011 to 54 in 2017. Between 2010 and 2017, 527 papers were published with delayed cerebral ischemia, or another term to describe the same complication, as an endpoint. However, the term delayed cerebral ischemia was used only in 131/527 (25%) of papers and only 14/81 (17%) of clinical trials/cohort studies published in 2017 cited the consensus definitions when outlining study endpoints. Conclusions: Despite publication of consensus terminology and definitions for DCI in 2010, the majority of cohort studies and clinical trials in patients with SAH are not using these. Researchers and editors should be reminded of the importance of using these consensus terminology and definitions in future studies, which will promote the comparability of results between studies, understand the true impact of an intervention, aggregate results in meta- analyses, and construct guidelines with a high level of evidence

Gadolinium Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms Is Associated with an Increased Risk of Aneurysm Instability: A Follow-Up Study

BACKGROUND AND PURPOSE: Previous studies have suggested that gadolinium enhancement of the wall of unruptured intracranial aneurysms on MR imaging may reflect aneurysm wall instability. However, all previous studies were cross-sectional. In this longitudinal study, we investigated whether aneurysm wall enhancement is associated with an increased risk of aneurysm instability. MATERIALS AND METHODS: We included all patients 18 years of age or older with ≥1 unruptured aneurysm from the University Medical Center Utrecht, the Netherlands, who were included in 2 previous studies with either 3T or 7T aneurysm wall MR imaging and for whom it was decided not to treat the aneurysm but to monitor it with follow-up imaging. We investigated the risk of growth or rupture during follow-up of aneurysms with and without gadolinium enhancement of the aneurysm wall at baseline and calculated the risk difference between the 2 groups with corresponding 95% confidence intervals. RESULTS: We included 57 patients with 65 unruptured intracranial aneurysms. After a median follow-up of 27 months (interquartile range, 20-31 months), growth (n = 2) or rupture (n = 2) was observed in 4 of 19 aneurysms (21%; 95% CI, 6%-54%) with wall enhancement and in zero of 46 aneurysms (0%; 95% CI, 0%-8%) without enhancement (risk difference, 21%; 95% CI, 3%-39%). CONCLUSIONS: Gadolinium enhancement of the aneurysm wall on MR imaging is associated with an increased risk of aneurysm instability. The absence of wall enhancement makes it unlikely that the aneurysm will grow or rupture in the short term. Larger studies are needed to investigate whether aneurysm wall enhancement is an independent predictor of aneurysm instability