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Assessment of the development and impact of cerebral vasospasm on the treatment outcome of patients with subarachnoid hemorrhage

dc.contributor.advisorLukić, Snežana
dc.contributor.otherVojinović, Radiša
dc.contributor.otherJanković, Slobodan
dc.contributor.otherŠaponjski, Jovica
dc.creatorOpančina, Valentina
dc.date.accessioned2021-10-29T11:18:58Z
dc.date.available2021-10-29T11:18:58Z
dc.date.issued2021-04-01
dc.identifier.urihttp://eteze.kg.ac.rs/application/showtheses?thesesId=8140
dc.identifier.urihttps://fedorakg.kg.ac.rs/fedora/get/o:1370/bdef:Content/download
dc.identifier.urihttps://nardus.mpn.gov.rs/handle/123456789/18698
dc.description.abstractUvod: Subarahnoidalno krvarenje je definisano kao ekstravazacija krvi u subarahnoidni prostor. Aneurizmatsko subarahnoidno krvarenje je vrsta spontanog hemoragičnog udara koji je uzrokovan rupturiranom cerebralnom aneurizmom. Cerebralne aneurizme predstavljaju lokalna proširenja koja se nalaze na zidovima moždanih arterija. Cerebralni vazospazam je najteža komplikacija subarahnoidnog krvarenja. Cilj: Glavni cilj ove studije bio ispitivanje fakora koji su povezani sa povećanim ili smanjenim rizikom od nastanka cerebralnog vazospazma koji se razvija posle subarahnoidalnog krvarenja izazvanog rupturom intrakranijalne aneurizme. Osim toga, ispitivani su i faktori koji su povezani sa povećanim ili smanjenim rizikom od nastanka odloženog ishemijskog neurološkog deficita, odložene cerebralne ishemije i intrahospitalnog mortaliteta posle aneurizmatskog subarahnoidlanog krvarenja. Metode: Studija je dizajnirana kao studija preseka. Studija je obuhvatila sve pacijente kojima je prvi put, na snimcima načinjenim kompjuterizovanom tomografijom, dijagnostikovana subarahnoidalna hemoragija izazvana rupturom aneurizme, u Službi za radiološku dijagnostiku, Kliničkog centra u Kragujevcu u petogodišnjem vremenskom intervalu, od 01.01.2014. do 31.12.2018.godine. Rezultati: Rezultati ove teze su pokazali je da su zabeležene vrednosti INR-a posle endovaskularne procedure, kod pacijenata koji nisu primali antikoagulantnu terapiju i zabeleženi leukociti posle embolizacije aneurizme, bili snažno povezani sa cerebrovaskularnim spazmom, povećavajući njegove šanse za 4.4 i 8.4 puta sa svakim brojem vrednosti INR-a, a hiljadama belih krvnih zrnaca. Na taj način utvrđeno je da subarahnoidalno krvarenje koje je nastalo usled rupture cerebralne aneurizme stvara endokranijalno inflamatorno stanje, čiji je intenzitet verovatno direktno povezan sa stvaranjem vazospazma, odloženog neurološkog deficitia i odložene ishemije. Takođe, utvrđeno je da je starost pacijenta prediktor za nastanak odloženog ishemijskog neurološkog deficita, kao i da krv u komorskom sistemu mozga povećava šansu za nastanak odložene cerebralne ishemije 14.7 puta. Osim toga, dokazano je da odloženi ishemijski neurološki deficit snažno utiče na intrahospitalni mortalitet i povećava njegove šanse 16.3 puta, dok povećanje vrednosti uree iznad referentnih vrednosti nakon endovaskularne procedure, povećava šansu za smrt pacijenta 12.6 puta.sr
dc.description.abstractIntroduction: Subarachnoid hemorrhage is defined as the extravasation of blood located in the subarachnoid space. Aneurysmal subarachnoid hemorrhage is a type of spontaneous hemorrhagic stroke which is caused by a ruptured cerebral aneurysm. Cerebral aneurysms are local dilatations on the walls of the cerebral arteries. Cerebral vasospasm is the most severe complication of subarachnoid hemorrhage. Objective: The main objective of this study was to examine the factors associated with an increased or decreased risk of cerebral vasospasm that develops after subarachnoid hemorrhage caused by rupture of an intracranial aneurysm. In addition, factors associated with an increased or decreased risk of delayed ischemic neurological deficit, delayed cerebral ischemia and intrahospital mortality after aneurysmal subarachnoid hemorrhage were examined. Methods: The study was designed as a cross-sectional study. The study included all patients who were diagnosed for the first time with subarachnoid hemorrhage caused by aneurysm rupture, on computed tomography scans, at the Radiology Department of the Clinical Center Kragujevac, with the five years time frame, from January 1st , 2014 until December 31st , 2018. Results: The results of this thesis showed that the observed INR values after endovascular procedure, in patients not receiving anticoagulant therapy and the observed white blood cells after aneurysm embolization, were strongly associated with cerebrovascular spasm, increasing its chances by 4.4 and 8.4 times with each by the number of INR values, and by thousands of white blood cells. Thus, it was determined that subarachnoid hemorrhage caused by rupture of a cerebral aneurysm creates an endocranial inflammatory condition, the intensity of which is probably directly related to the formation of vasospasm, delayed neurological deficit and delayed ischemia. Also, it was determined that the age of the patient is a predictor for the development of delayed ischemic neurological deficit, as well as that the blood in the ventricular system of the brain increases the chance of developing delayed cerebral ischemia 14.7 times. In addition, delayed ischemic neurological deficit has been shown to strongly affect in-hospital mortality and increase its chances by 16.3 times, while increasing urea values above reference values after endovascular procedures increases the patient's chance of death by 12.6 times.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Крагујевцу, Факултет медицинских наукаsr
dc.rightsopenAccessen
dc.rights.urihttps://creativecommons.org/licenses/by-nd/4.0/
dc.sourceУниверзитет у Крагујевцуsr
dc.subjectsubarahnoidalno krvarenje, cerebralni vazospazam, odložena cerebralna ishemija, odložen ishemijski neurološki deficit, intrahospitalni mortalitet, aneurizma, neuroinflamacijasr
dc.subjectsubarachnoid hemorrhage, cerebral vasospasm, delayed cerebral ischemia, delayed ischemic neurological deficit, intrahospital mortality, aneurysm, neuroinflammationen
dc.titleProcena razvoja i uticaja cerebralnog vazospazma na ishod lečenja bolesnika sa subarahnoidalnim krvarenjemsr
dc.title.alternativeAssessment of the development and impact of cerebral vasospasm on the treatment outcome of patients with subarachnoid hemorrhageen
dc.typedoctoralThesis
dc.rights.licenseBY-ND
dc.identifier.fulltexthttps://nardus.mpn.gov.rs/bitstream/id/77363/Valentina_Opancina_Medicinski.pdf
dc.identifier.fulltexthttps://nardus.mpn.gov.rs/bitstream/id/77362/Doctoral_thesis_11660.pdf
dc.identifier.rcubhttps://hdl.handle.net/21.15107/rcub_nardus_18698


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