Pifithrin-α reduces cerebral vasospasm by attenuating apoptosis of endothelial cells in a subarachnoid haemorrhage model of rat

Background The mechanism of cerebral vasospasm following subarachnoid haemorrhage （SAH） is not understood. Here, we hypothesized that apoptosis of endothelial cells induced by p53 and its target gene em dash p53 upregulated modulator of apoptosis （PUMA） played an important role in development of cerebral vasospasm. We also observed the effects of a p53 inhibitor, pifithrin-α （PFT-α）, on reducing the expression of p53 and PUMA, consequently decreasing the apoptosis of endothelial cells and alleviating cerebral vasospasm. Methods Male Sprague-Dawley rats weighing 300-350 g were randomly divided into five groups： a control group （sham surgery）, a SAH group, a SAH＋dimethyl sulfoxide （DMSO） group, a SAH＋PFT-α （0.2 mg/kg） group and a SAH＋PFT-α （2.0 mg/kg） group. PFT-α was injected intraperitoneally immediately after SAH. Rats were sacnficed 24 hours after SAH. Western blot and immunohistochemical staining were used to detect the levels of p53, PUMA and caspase-3 protein. In addition, mortality and neurological scores were assessed for each group. Statistical significance was assured by analysis of variance performed in one way ANOVA followed by the Tukey test. The neurological and mortality scores were analyzed by Dunn＇s method and Fisher exact test, respectively. Results After SAH, Western blot and immunohistochemical staining showed the levels of p53, PUMA and caspase-3 in the endothelial cells and the numbers of TdT mediated dUTP nick end labelling （TUNEL） positive endothelial cells were all significantly increased in the basilar arteries （P 〈0.05）, but significantly reduced by PFT-a （P 〈0.05）. These changes were accompanied by increasing diameters and declining wall thickness of basilar arteries （P〈O.05）, as well as reduced mortality and neurological deficits of the rats （P〈O.05）. Conclusions PFT-a could protect cerebral vessels from development of vasospasm and improve neurological outcome as well as reduce the mortality via suppressing apoptosis induced by p53 in the endothelial cells of cerebral vessels.

Pituitary Function in the Acute Phase of Traumatic Brain Injury and Subarachnoid Hemorrhage

Background: Pituitary insufficiencies after traumatic brain injury (TBI) and subarachnoid haem-orrhage (SAH) have been reported with very varying frequencies. The aim of this study was to describe the pituitary function in the acute phase after TBI and SAH in a cohort of adults and relate the results to injury variables. Methods: Adults admitted to the neurointensive care unit in our hospital after moderate and severe TBI or SAH were included prospectively. Demographic, clinical, laboratory, including ACTH stimulation test, and radiological data were collected. Results: A total of 130 adults, 84 (19 women/65 men) with TBI and 46 (38 women/8 men) with SAH were included. Nine patients with TBI and six patients with SAH responded insufficiently to ACTH stimulation;14 patients with TBI and 9 patients with SAH had low fT4 and low-normal TSH levels. No relations were seen between hormonal levels and injury variables. Conclusions: Pituitary deficiencies occur after TBI and SAH, and a continuous endocrine evaluation of these patients is important. Our study could not define a marker for increased risk for pituitary deficiency. The long-term clinical outcome of the pathological hormone levels in the early phase after TBI and SAH is not known in detail and further studies to elucidate this are needed.

Microsurgical Management of Intracranial Aneurysms in Côte d’Ivoire: A Series of 128 Cases

Introduction: The management of intracranial aneurysms in sub-Saharan Africa is essentially surgical. In this retrospective study, the authors report their experience in surgical management of intracranial aneurysm in Côte d’Ivoire. Methods: We carried out a retrospective study on patients operated for a ruptured or unruptured intracranial aneurysm between January 1st, 2012 and December 31st, 2018. Data on epidemiological characteristics of patients and aneurysms, treatments and patient outcomes were analyzed. Results: One hundred twenty eight aneurysms were operated. Sixty-six percent of the patients were female. According to the World Federation of Neurosurgical Societies (WFNS) scale, 58, 5% of patients were in grade I. Fisher scale showed 29% of Fisher 2 and 49% of Fisher 4. The aneurysms were mainly located on the internal carotid artery in 38% and anterior complex in 36%. The average size of aneurysms was 6.5 mm. In 81.4% the size of the aneurysms was less than 10 mm. Most aneurysms (90%) were treated at late stage. According to the modified Rankin Scale, 92 patients (83%) had good outcome, 7 patients (6%) had poor outcome, and the mortality rate was 11%. Conclusions: This study shows encouraging results if we refer to the overall postoperative results. However, there is a sub-diagnosis and low treatment rate of ruptured intracranial aneurysms. The improvement of intracranial aneurysms management requires improving the standard of health in the country.

Association of aneurysmatic subarachnoid hemorrhage rate with environmental changes or emotional bursts

Introduction In the present letter we share the results of an analysis of more than 140,000 non traumatic arterial subarachnoid hemorrhages whereas the majority of them is expected to be after aneurysm rupture,in which we investigate a possible correlation of climatic changes and emotional bursts as correlating factors for such a rupture.Methods We obtained the daily number of SAH from 2006 to 2018 for males and females from the German National statistics agency.The ICD codes provided to us were I60.1-I60.7,which are SAHs originating from intracranial arteries and excluding traumatic SAH and other not specified SAH.Results An increase of mean SAH per day could be seen in winter compared to summer and family events seemed to have a protective effect against aneurysmal SAH.Additionally 6.55 more women per day suffer an SAH compared to men.Conclusion There is a statistical significant higher risk of aneurysm ruptures in winter and in females,and a statistical lower number in Mother’s day.