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The harmful effects of subarachnoid hemorrhage on extracerebral organs.

Chen S, Li Q, Wu H, Krafft PR, Wang Z, Zhang JH - Biomed Res Int (2014)

Bottom Line: Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common.Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients.We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China ; Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.

ABSTRACT
Subarachnoid hemorrhage (SAH) is a devastating neurological disorder. Patients with aneurysmal SAH develop secondary complications that are important causes of morbidity and mortality. Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common. The related mechanisms include activation of the sympathetic nervous system, release of catecholamines and other hormones, and inflammatory responses. Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients. This review provides an overview of the extracerebral complications after SAH. We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH.

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High-resolution pictures of subarachnoid hemorrhage and sporadic pulmonary hemorrhagic lesions in a rat endovascular puncture model (white arrow).
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fig2: High-resolution pictures of subarachnoid hemorrhage and sporadic pulmonary hemorrhagic lesions in a rat endovascular puncture model (white arrow).

Mentions: Pulmonary complications after SAH are a cluster of lung dysfunctions, which includes pneumonia, aspiration, and neurogenic pulmonary edema (NPE) (Figure 2) [85]. Pulmonary complications are the most frequent extracerebral cause of death after SAH [44, 86]. Oxygenation deficits occur in the acute stage of SAH. Indeed, oxygenation disturbances were found in 43% to 92% of SAH patients, which most often resulted from pulmonary edema. Patients with World Federation of Neurological Surgeons IV and V were significantly higher scored in the extravascular lung water index, pulmonary vascular permeability index, and systemic vascular resistance index on day 2 after SAH [76]. Differential diagnosis of the pulmonary complications can be difficult. NPE is usually suspected when there are no underlying lung diseases, and NPE is found in 23% to 71% patients during hospitalization [10, 87]. The incidence of pathological diagnosis of NPE is higher than its clinical diagnosis. The abnormality of NPE after SAH is often unilateral on chest X-ray. SAH patients with NPE were usually younger and died sooner than those without. The development of pulmonary edema most frequently occurs within the first week from the beginning of the SAH with a peak around day 3. The incidence of NPE decreased with time after SAH.


The harmful effects of subarachnoid hemorrhage on extracerebral organs.

Chen S, Li Q, Wu H, Krafft PR, Wang Z, Zhang JH - Biomed Res Int (2014)

High-resolution pictures of subarachnoid hemorrhage and sporadic pulmonary hemorrhagic lesions in a rat endovascular puncture model (white arrow).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109109&req=5

fig2: High-resolution pictures of subarachnoid hemorrhage and sporadic pulmonary hemorrhagic lesions in a rat endovascular puncture model (white arrow).
Mentions: Pulmonary complications after SAH are a cluster of lung dysfunctions, which includes pneumonia, aspiration, and neurogenic pulmonary edema (NPE) (Figure 2) [85]. Pulmonary complications are the most frequent extracerebral cause of death after SAH [44, 86]. Oxygenation deficits occur in the acute stage of SAH. Indeed, oxygenation disturbances were found in 43% to 92% of SAH patients, which most often resulted from pulmonary edema. Patients with World Federation of Neurological Surgeons IV and V were significantly higher scored in the extravascular lung water index, pulmonary vascular permeability index, and systemic vascular resistance index on day 2 after SAH [76]. Differential diagnosis of the pulmonary complications can be difficult. NPE is usually suspected when there are no underlying lung diseases, and NPE is found in 23% to 71% patients during hospitalization [10, 87]. The incidence of pathological diagnosis of NPE is higher than its clinical diagnosis. The abnormality of NPE after SAH is often unilateral on chest X-ray. SAH patients with NPE were usually younger and died sooner than those without. The development of pulmonary edema most frequently occurs within the first week from the beginning of the SAH with a peak around day 3. The incidence of NPE decreased with time after SAH.

Bottom Line: Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common.Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients.We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China ; Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.

ABSTRACT
Subarachnoid hemorrhage (SAH) is a devastating neurological disorder. Patients with aneurysmal SAH develop secondary complications that are important causes of morbidity and mortality. Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common. The related mechanisms include activation of the sympathetic nervous system, release of catecholamines and other hormones, and inflammatory responses. Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients. This review provides an overview of the extracerebral complications after SAH. We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH.

Show MeSH
Related in: MedlinePlus