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Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review.

Lo BW, Fukuda H, Nishimura Y, Macdonald RL, Farrokhyar F, Thabane L, Levine MA - Surg Neurol Int (2015)

Bottom Line: Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice.Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints.Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.

ABSTRACT

Background: Patients with ruptured brain aneurysms and aneurysmal subarachnoid hemorrhage suffer neurological damage from primary injury of the aneurysm rupture itself, as well as a number of secondary injurious processes that can further worsen the affected individual's neurological state. In addition, other body systems can be affected in a number of brain-body associations.

Methods: This systematic review synthesizes prospective and retrospective cohort studies that investigate brain-body associations in patients with ruptured brain aneurysms. The methodologic quality of these studies will be appraised.

Results: Six cohort studies were included in this systemic review. The methodologic quality of each study was assessed. They had representative patient populations, clear selection criteria and clear descriptions of study designs. Reproducible study protocols with ethics board approval were present. Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice. There were few withdrawals from the study. Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints. Several pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms were clarified through this systematic review. Sympathetic activation of the cardiovascular system in aneurysmal subarachnoid hemorrhage not only triggers the release of atrial and brain natriuretic peptides it can also lead to increased pulmonary venous pressures and permeability causing hydrostatic pulmonary edema. Natriuretic states can herald the onset or worsening of clinical vasospasm as the renin-angiotensin-aldosterone system is activated in a delayed manner.

Conclusions: This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of study selection
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Figure 2: Flow diagram of study selection

Mentions: Both investigators (BL and HF) reviewed all titles and abstracts, and full reports of all potentially relevant trials. The initial literature search (January 1, 2000–March 31, 2014) yielded 150 citations [Figure 2]. Screening by title and abstract and citation yielded 88 items. Of these 88 items, reviewers BL and HF reached agreement on 41 items for inclusion, 38 items for exclusion and were unsure on 9 items. A consensus conference was held with the assistance of a third reviewer, Yusuke Nishimura (YN). Interrater reliability was high (estimated kappa 0.81 [95% (CI) 0.76–0.87] for citation and abstract screening). Fifty full text articles were identified as potentially relevant, and were assessed, with further exclusion of articles due to:


Pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms: A systematic review.

Lo BW, Fukuda H, Nishimura Y, Macdonald RL, Farrokhyar F, Thabane L, Levine MA - Surg Neurol Int (2015)

Flow diagram of study selection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4544125&req=5

Figure 2: Flow diagram of study selection
Mentions: Both investigators (BL and HF) reviewed all titles and abstracts, and full reports of all potentially relevant trials. The initial literature search (January 1, 2000–March 31, 2014) yielded 150 citations [Figure 2]. Screening by title and abstract and citation yielded 88 items. Of these 88 items, reviewers BL and HF reached agreement on 41 items for inclusion, 38 items for exclusion and were unsure on 9 items. A consensus conference was held with the assistance of a third reviewer, Yusuke Nishimura (YN). Interrater reliability was high (estimated kappa 0.81 [95% (CI) 0.76–0.87] for citation and abstract screening). Fifty full text articles were identified as potentially relevant, and were assessed, with further exclusion of articles due to:

Bottom Line: Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice.Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints.Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.

ABSTRACT

Background: Patients with ruptured brain aneurysms and aneurysmal subarachnoid hemorrhage suffer neurological damage from primary injury of the aneurysm rupture itself, as well as a number of secondary injurious processes that can further worsen the affected individual's neurological state. In addition, other body systems can be affected in a number of brain-body associations.

Methods: This systematic review synthesizes prospective and retrospective cohort studies that investigate brain-body associations in patients with ruptured brain aneurysms. The methodologic quality of these studies will be appraised.

Results: Six cohort studies were included in this systemic review. The methodologic quality of each study was assessed. They had representative patient populations, clear selection criteria and clear descriptions of study designs. Reproducible study protocols with ethics board approval were present. Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice. There were few withdrawals from the study. Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints. Several pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms were clarified through this systematic review. Sympathetic activation of the cardiovascular system in aneurysmal subarachnoid hemorrhage not only triggers the release of atrial and brain natriuretic peptides it can also lead to increased pulmonary venous pressures and permeability causing hydrostatic pulmonary edema. Natriuretic states can herald the onset or worsening of clinical vasospasm as the renin-angiotensin-aldosterone system is activated in a delayed manner.

Conclusions: This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.

No MeSH data available.


Related in: MedlinePlus