New Book: Explosions In My Brain: A ruptured cerebral aneurysm and subarachnoid haemorrhage; a survivor's story

Explosions In My Brain: A ruptured cerebral aneurysm and subarachnoid haemorrhage; a survivor’s story
By Anne Reavill

Explosions In My Brain: A ruptured cerebral aneurysm and subarachnoid haemorrhage; a survivor's story
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In 2011 I had a type of stroke, but not the more common kind. Mine was due to an aneurysm bursting in my brain. This lead to a sudden large bleed into the space surrounding my brain, known as a subarachnoid haemorrhage. Many people who suffer such a catastrophic event die or are left with severe debilitating consequences. I have been one of the lucky ones in recovering so well but, although compared to many my recovery has been fairly straightforward, recover from any brain injury is a slow process. Here I recount my own experience, first in hospital where the aneurysm was treated, followed by my recovery there and later at home in the following weeks and months, times when I often felt very alone and frustrated at my slow progress.


Product Details

  • Published on: 2015-02-18
  • Released on: 2015-02-18
  • Format: Kindle eBook

Top Read: Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial.

Lancet Neurol. 2014 May 15. pii: S1474-4422(14)70084-5. doi: 10.1016/S1474-4422(14)70084-5. [Epub ahead of print]

Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial.

Abstract

BACKGROUND:

The benefit of statins in patients with acute aneurysmal subarachnoid haemorrhage is unclear. We aimed to determine whether simvastatin 40 mg could improve the long-term outcome in patients with this disorder.

METHODS:

In this international, multicentre, randomised, double-blind trial, we enrolled patients aged 18-65 years with confirmatory evidence of an aneurysmal subarachnoid haemorrhage and presenting less than 96 h from ictus from 35 acute neurosurgical centres in nine countries. Patients were randomly allocated (1:1) to receive either simvastatin 40 mg or placebo once a day for up to 21 days. We used a computer-generated randomisation code to randomise patients in every centre by blocks of ten (five simvastatin, five placebo). Participants and investigators were masked to treatment assignment. The primary outcome was the distribution of modified Rankin Scale (mRS) score obtained by questionnaire at 6 months. Analyses were done on the intention-to-treat population. This trial has been completed and is registered with Current Controlled Trials, number ISRCTN75948817.

FINDINGS:

Between Jan 6, 2007, and Feb 1, 2013, apart from the period between May 15, 2009, and Feb 8, 2011, when recruitment was on hold, 803 patients were randomly assigned to receive either simvastatin 40 mg (n=391) or placebo (n=412). All patients were included in the intention-to-treat population. 782 (97%) patients had outcome data recorded at 6 months, of whom 560 (72%) were classed as having a favourable outcome, mRS 0-2 (271 patients in the simvastatin group vs 289 in the placebo group). The primary ordinal analysis of the mRS, adjusted for age and World Federation of Neurological Surgeons grade on admission, gave a common odds ratio (OR) of 0·97, 95% CI 0·75-1·25; p=0·803. At 6 months, we recorded 37 (10%) deaths in the simvastatin group compared with 35 (9%) in the placebo group (log-rank p=0·592). 70 (18%) serious adverse events were reported in the simvastatin group compared with 74 (18%) in the placebo group. No suspected unexpected serious adverse reactions were reported.

INTERPRETATION:

The STASH trial did not detect any benefit in the use of simvastatin for long-term or short-term outcome in patients with aneurysmal subarachnoid haemorrhage. Despite demonstrating no safety concerns, we conclude that patients with subarachnoid haemorrhage should not be treated routinely with simvastatin during the acute stages.

FUNDING:

British Heart Foundation.

Delayed post-operative haemorrhage after carmustine wafer implantation

Implantation of carmustine wafers has been associated with increased operative site complications in some series, but post-operative haematoma is not routinely reported.
A retrospective audit of surgical site haematoma after tumour resection and insertion of carmustine wafers in two neurosurgical units in the UK (University Hospital of North Staffordshire, Stoke-on-Trent, March 2003 – July 2012; Wessex Neurological Centre, Southampton, October 2005 – January 2013) in 181 operations of 177 patients showed 8 (4.4%) patients. All presented in a delayed fashion on or after Day 2 post-operatively. In contrast, acute operative site haematoma was present in 4/491 (0.81%) of patients who underwent resection without gliadel wafer insertion.
In contrast to the expected timing of bleeding following intracranial tumour resection, all carmustine wafer patients who experienced haemorrhage presented in a delayed fashion on or after Day 2 post-operatively. The causative factors for universally delayed post-operative haematoma after carmustine wafer insertion are unclear and further studies are required to characterize this phenomenon ((Shah RS, Homapour B, Casselden E, Barr JG, Grundy PL, Brydon HL. Delayed
post-operative haemorrhage after carmustine wafer implantation: a case series
from two UK centres. Br J Neurosurg. 2013 Dec 9. [Epub ahead of print] PubMed
PMID: 24313309.))
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