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Article ; Online: Lumbar puncture for treating acute hydrocephalus after aneurysmal subarachnoid haemorrhage.

Tack, R W P / Lindgren, A / Vergouwen, M D I / van der Zwan, A / van der Schaaf, I / Rinkel, G J E

2023 Volume 446, Page(s) 120566

Abstract: ... acute hydrocephalus (i.e. neurological deterioration and ventricular enlargement <72 h after aSAH ...

Abstract	Background: External ventricular drainage (EVD) for acute hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH) carries a risk of complications. We studied the proportion of patients in whom EVD can be avoided by treating acute hydrocephalus with ≥1 lumbar punctures (LP). Methods: From a prospectively collected database, we retrieved data on all aSAH patients admitted between 2007 and 2017 who developed acute hydrocephalus (i.e. neurological deterioration and ventricular enlargement <72 h after aSAH). Our regime is to consider LP as initial treatment. We calculated the proportions of patients (with corresponding 95% confidence interval (CI)) who improved after the initial LP and the extent of clinical improvement, the proportions of patients who were treated with only ≥1 LP(s), and those of patients needing continuous external ventricular or external lumbar drainage, or permanent ventriculoperitoneal or lumboperitoneal drainage. Results: Of 1391 consecutive aSAH patients, 473 (34%) had acute hydrocephalus, of whom 388 (82%) were treated. Of the 86 patients with LP as initial treatment, 70 (81% [95% CI 72-88]) showed initial improvement (with increase in median Glasgow Coma Score from 10 (IQR 7-12) to 12 (IQR 9-14) after initial LP), 39 (45% [95% CI 35-56]) improved with LP only, 41 (48% [95% CI 37-58]) needed continuous drainage and six (7% [95% CI 3-14]) needed permanent drainage. Conclusion: Around half the patients treated with LP for deterioration from acute hydrocephalus after aSAH does not require continuous extraventicular or extralumbar drainage.
MeSH term(s)	Humans ; Drainage/adverse effects ; Hydrocephalus/etiology ; Retrospective Studies ; Spinal Puncture/adverse effects ; Subarachnoid Hemorrhage/complications
Language	English
Publishing date	2023-01-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2023.120566
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Article ; Online: Pulsatility Attenuation along the Carotid Siphon in Pseudoxanthoma Elasticum.

Bartstra, J W / van Tuijl, R J / de Jong, P A / Mali, W P T M / van der Schaaf, I C / Ruigrok, Y M / Rinkel, G J E / Velthuis, B K / Spiering, W / Zwanenburg, J J M

AJNR. American journal of neuroradiology

2021 Volume 42, Issue 11, Page(s) 2030–2033

Abstract: We compared velocity pulsatility, distensibility, and pulsatility attenuation along the intracranial ICA and MCA between 50 patients with pseudoxanthoma elasticum and 40 controls. Patients with pseudoxanthoma elasticum had higher pulsatility and lower ... ...

Abstract	We compared velocity pulsatility, distensibility, and pulsatility attenuation along the intracranial ICA and MCA between 50 patients with pseudoxanthoma elasticum and 40 controls. Patients with pseudoxanthoma elasticum had higher pulsatility and lower distensibility at all measured locations, except for a similar distensibility at C4. The pulsatility attenuation over the siphon was similar between patients with pseudoxanthoma elasticum and controls. This finding suggests that other disease mechanisms are the main contributors to increased intracranial pulsatility in pseudoxanthoma elasticum.
MeSH term(s)	Carotid Artery, Internal ; Humans ; Pseudoxanthoma Elasticum/diagnostic imaging
Language	English
Publishing date	2021-09-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
DOI	10.3174/ajnr.A7288
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Article: Natural history, epidemiology and screening of unruptured intracranial aneurysms.

Rinkel, G J E

Revue neurologique

2008 Volume 164, Issue 10, Page(s) 781–786

Abstract: Introduction: The prevalence of unruptured intracranial aneurysms is around 2%; most of these aneurysms are small and located in the anterior circulation. Unruptured intracranial aneurysms may give rise to subarachnoid hemorrhage in the near or distant ... ...

Abstract	Introduction: The prevalence of unruptured intracranial aneurysms is around 2%; most of these aneurysms are small and located in the anterior circulation. Unruptured intracranial aneurysms may give rise to subarachnoid hemorrhage in the near or distant future and sometimes, these lesions warrant preventive intervention. State of the art: Most studies, on risk of rupture, have methodological weaknesses; the overall risk of rupture found in follow-up studies is around 1% per year. Size is the most important risk factor for rupture, with smaller risks for smaller aneurysms. Other risk factors are site of the aneurysm (higher risk for posterior-circulation aneurysms), age, female gender, population (higher risks in Finland and Japan) and probably also smoking. For aneurysms smaller than 10mm, treatment carries a risk of around 5% of complications leading to death or dependence on help for activities of daily living. Perspectives: There are no good comparisons between clipping and coiling of unruptured aneurysms. The efficacy of coiling in the long-term is unsettled. Good-quality data are urgently needed to settle these questions. Conclusions: In deciding whether or not to treat an aneurysm, life expectancy is a pivotal factor; other important factors are size and site of the aneurysm.
MeSH term(s)	Aneurysm, Ruptured/epidemiology ; Aneurysm, Ruptured/pathology ; Humans ; Intracranial Aneurysm/diagnosis ; Intracranial Aneurysm/epidemiology ; Intracranial Aneurysm/pathology ; Neurosurgical Procedures
Language	English
Publishing date	2008-10
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	4593-7
ISSN	2213-0004 ; 0035-3787
ISSN (online)	2213-0004
ISSN	0035-3787
DOI	10.1016/j.neurol.2008.07.012
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Book: Subarachnoid hemorrhage in clinical practice

Rinkel, G. J. E / Greebe, Paut

(In clinical practice,)

2015

Abstract: This pocket-sized book is a quick-reference practical guide for physicians who deal with patients with subarachnoid hemorrhage or intracranial aneurysms outside the hospital. It describes briefly the epidemiology of subarachnoid hemorrhage, the early ... ...

Author's details	Gabriel J. E. Rinkel, Paut Greebe
Series title	In clinical practice,
Abstract	"This pocket-sized book is a quick-reference practical guide for physicians who deal with patients with subarachnoid hemorrhage or intracranial aneurysms outside the hospital. It describes briefly the epidemiology of subarachnoid hemorrhage, the early recognition and clinical course, and in more depth the aftercare, residual symptoms and deficits. The prognosis and management in the long term are discussed in detail. It also provides information on the counselling and treatment of patients with unruptured intracranial aneurysms. Subarachnoid Hemorrhage in Clinical Practice is aimed at general practitioners and family physicians and will also be informative for other specialists such as rehabilitation physicians, nursing home physicians, and physicians working for health insurance companies. It may also be of interest to patients, relatives, and paramedics."--Back cover.
MeSH term(s)	Subarachnoid Hemorrhage ; Intracranial Aneurysm ; Clinical Medicine
Language	English
Dates of publication	2015-2015
Size	ix, 101 pages :, illustrations (some color) ;, 21 cm.
Document type	Book
ISBN	9783319178394 ; 3319178393 ; 9783319178400 ; 3319178407
Database	Catalogue of the US National Library of Medicine (NLM)

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Article: Natural history, epidemiology and screening of unruptured intracranial aneurysms.

Rinkel, G J E

Journal of neuroradiology = Journal de neuroradiologie

2008 Volume 35, Issue 2, Page(s) 99–103

Abstract: The prevalence of intracranial aneurysms is 2.3% (95% CI, 1.7-3.1%); most of these aneurysms are small and located in the anterior circulation. Risk factors are age, female gender, smoking, hypertension, excessive use of alcohol, having one or more ... ...

Abstract	The prevalence of intracranial aneurysms is 2.3% (95% CI, 1.7-3.1%); most of these aneurysms are small and located in the anterior circulation. Risk factors are age, female gender, smoking, hypertension, excessive use of alcohol, having one or more affected relatives with SAH and autosomal dominant polycystic kidney disease. Most studies on risk of rupture have methodological weaknesses; an important flaw is that observed risks are recalculated to yearly risks of rupture, assuming a constant risk of growth and rupture of aneurysms. In reality, it is much more likely that aneurysms have long periods of low risk and short periods of high risk of growth and rupture. The overall risk of rupture found in follow-up studies is around 1% per year. Size is the most important risk factor for rupture, with smaller risks for smaller aneurysms. Other risk factors are the site of the aneurysm (higher risk for posterior circulation aneurysms), age, female gender, population (higher risks in Finland and Japan) and, probably also, smoking. There are no good comparisons between clipping and coiling of unruptured aneurysms. Both treatment modalities have a risk of around 6% of complications leading to death or dependence of help for activities of daily living for aneurysms smaller than 10mm. These risks increase with larger size of aneurysms. For clipping, the risk seems to increase with age, for coiling this is less apparent. The efficacy of coiling on the long term is unsettled. In deciding whether or not to treat an aneurysm, life expectancy is a pivotal factor; other important factors are the size and the site of the aneurysm. If the aneurysm is left untreated, follow-up imaging may be considered to detect growth of aneurysms, but the frequency and effectiveness of repeated imaging are unknown.
MeSH term(s)	Age Factors ; Female ; Humans ; Intracranial Aneurysm/diagnosis ; Intracranial Aneurysm/epidemiology ; Intracranial Aneurysm/pathology ; Intracranial Aneurysm/therapy ; Male ; Mass Screening ; Prevalence ; Risk Factors ; Sex Factors
Language	English
Publishing date	2008-02-01
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	131763-5
ISSN	1773-0406 ; 0150-9861
ISSN (online)	1773-0406
ISSN	0150-9861
DOI	10.1016/j.neurad.2007.11.004
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Article ; Online: PHASES and the natural history of unruptured aneurysms: science or pseudoscience?

Rinkel, G J E / Algra, A / Greving, J P / Vergouwen, M D I / Etminan, N

Journal of neurointerventional surgery

2017 Volume 9, Issue 6, Page(s) 618

Language	English
Publishing date	2017
Publishing country	England
Document type	Letter
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/neurintsurg-2016-012436
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Article ; Online: The association of intracranial aneurysms and meningiomas: a hospital-based case-control study.

Sluis, W M / Rinkel, G J E / Velthuis, B K / Ruigrok, Y M

European journal of neurology

2017 Volume 25, Issue 1, Page(s) e5

Language	English
Publishing date	2017-12-22
Publishing country	England
Document type	Letter
ZDB-ID	1280785-0
ISSN	1468-1331 ; 1351-5101 ; 1471-0552
ISSN (online)	1468-1331
ISSN	1351-5101 ; 1471-0552
DOI	10.1111/ene.13479
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Zs.A 4738: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Screening for intracranial aneurysms in persons ⩾35 years with hypertension and atherosclerotic disease who smoke(d).

Mensing, Liselore A / van Tuijl, Rick J / de Kort, Gerard A / van der Schaaf, Irene C / Visseren, Frank L / Rinkel, Gabriel Je / Velthuis, Birgitta K / Ruigrok, Ynte M

European stroke journal

2023 Volume 8, Issue 4, Page(s) 1071–1078

Abstract: ... subgroups (e.g. women older than 50 years of age) or other ethnic populations should be the subject ...

Abstract	Introduction: Lifetime risk of aneurysmal subarachnoid haemorrhage (aSAH) is high (7%) in persons ⩾35 years with hypertension who smoke(d). Whether screening for intracranial aneurysms (IAs) to prevent aSAH is effective in these patients is unknown. Patients and methods: Participants were retrieved from a cohort of patients with clinically manifest atherosclerotic vascular disease included between 2012 and 2019 at the University Medical Centre Utrecht (SMART-ORACLE, NCT01932671) in whom CT-angiography (CTA) of intracranial arteries was performed. We selected patients ⩾35 years with hypertension who smoke(d). CTAs were reviewed for the presence of IAs by experienced neuroradiologists. Patients with IAs were offered follow-up imaging to detect aneurysmal growth. We determined aneurysm prevalence and developed a diagnostic model for IA risk at screening using multivariable logistic regression. Results: IA were found in 25 of 500 patients (5.0% prevalence, 95%CI: 3.3%-7.3%). Median 5 year risk of rupture assessed with the PHASES score was 0.9% (IQR: 0.7%-1.3%). During a median follow-up of 57 months (IQR: 39-83 months) no patients suffered from aSAH. Aneurysmal growth was detected in one patient for whom preventive treatment was advised. IA risk at screening ranged between 1.6% and 13.4% with predictors being age, female sex and current smoking. Discussion and conclusion: IA prevalence in persons ⩾35 years with hypertension and atherosclerotic vascular disease who smoke(d) was 5%. Given the very small proportion of IA that needed preventive treatment, we currently do not advise screening for Caucasian persons older than 35 years of age who smoke and have hypertension in general. Whether screening may be effective for certain subgroups (e.g. women older than 50 years of age) or other ethnic populations should be the subject of future studies.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Hypertension/epidemiology ; Intracranial Aneurysm/diagnostic imaging ; Logistic Models ; Smoking/adverse effects ; Subarachnoid Hemorrhage/diagnostic imaging ; Middle Aged
Language	English
Publishing date	2023-08-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2851287-X
ISSN	2396-9881 ; 2396-9873
ISSN (online)	2396-9881
ISSN	2396-9873
DOI	10.1177/23969873231193296
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Article ; Online: The course of cerebrospinal fluid parameters ≤ 20 days after aneurysmal subarachnoid hemorrhage.

Koopman, Inez / Zuithoff, Nicolaas P A / Rinkel, Gabriel J E / Vergouwen, Mervyn D I

Journal of the neurological sciences

2020 Volume 415, Page(s) 116899

Abstract: ... within the normal range. The estimated median protein concentration decreased from 3.3 g/L (95%CI:2.5-4.2) on day 0 to 1.0 ... g/L (95%CI:0.8-1.2) on day 14.: Conclusion: The limits we found for the inflammatory reaction ...

Abstract	Background: Aneurysmal subarachnoid hemorrhage (aSAH) patients have an inflammatory response in the cerebrospinal fluid (CSF). We determined CSF cell counts, erythrocyte/leukocyte ratio, and glucose- and protein concentrations in patients ≤20 days after aSAH without bacterial meningitis. Such knowledge may help to interpret CSF parameters in patients with an external drain if nosocomial bacterial meningitis or ventriculitis is suspected. Methods: Patients with aSAH admitted between 2010 and 2017 with at least one CSF sample ≤ 20 days after ictus were included from a prospectively collected database. CSF samples were excluded if the patient used antibiotics or if the CSF culture was positive. We calculated estimated marginal means with 95% confidence intervals (CIs) with linear mixed models for CSF cell counts, glucose- and protein concentrations. Results: We included 209 patients with 306 CSF samples. Highest estimated median leukocyte count was 305 (95%CI:225-412) x10^6/L, and the lowest estimated median erythrocyte/leukocyte ratio was 109 (95%CI:73-163). Estimated mean glucose concentrations remained within the normal range. The estimated median protein concentration decreased from 3.3 g/L (95%CI:2.5-4.2) on day 0 to 1.0 g/L (95%CI:0.8-1.2) on day 14. Conclusion: The limits we found for the inflammatory reaction in aSAH patients may help physicians to interpret CSF parameters in aSAH patients with an external CSF drain. Future studies are needed to compare CSF parameters in aSAH patients with and without bacterial meningitis or ventriculitis.
MeSH term(s)	Cerebrospinal Fluid ; Drainage ; Glucose ; Humans ; Inflammation ; Meningitis, Bacterial ; Subarachnoid Hemorrhage/complications
Chemical Substances	Glucose (IY9XDZ35W2)
Language	English
Publishing date	2020-05-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2020.116899
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Article ; Online: Gadolinium Enhancement of the Aneurysm Wall in Unruptured Intracranial Aneurysms Is Associated with an Increased Risk of Aneurysm Instability: A Follow-Up Study.

Vergouwen, M D I / Backes, D / van der Schaaf, I C / Hendrikse, J / Kleinloog, R / Algra, A / Rinkel, G J E

AJNR. American journal of neuroradiology

2019 Volume 40, Issue 7, Page(s) 1112–1116

Abstract: Background and purpose: Previous studies have suggested that gadolinium enhancement of the wall of unruptured intracranial aneurysms on MR imaging may reflect aneurysm wall instability. However, all previous studies were cross-sectional. In this ... ...

Abstract	Background and purpose: Previous studies have suggested that gadolinium enhancement of the wall of unruptured intracranial aneurysms on MR imaging may reflect aneurysm wall instability. However, all previous studies were cross-sectional. In this longitudinal study, we investigated whether aneurysm wall enhancement is associated with an increased risk of aneurysm instability. Materials and methods: We included all patients 18 years of age or older with ≥1 unruptured aneurysm from the University Medical Center Utrecht, the Netherlands, who were included in 2 previous studies with either 3T or 7T aneurysm wall MR imaging and for whom it was decided not to treat the aneurysm but to monitor it with follow-up imaging. We investigated the risk of growth or rupture during follow-up of aneurysms with and without gadolinium enhancement of the aneurysm wall at baseline and calculated the risk difference between the 2 groups with corresponding 95% confidence intervals. Results: We included 57 patients with 65 unruptured intracranial aneurysms. After a median follow-up of 27 months (interquartile range, 20-31 months), growth ( Conclusions: Gadolinium enhancement of the aneurysm wall on MR imaging is associated with an increased risk of aneurysm instability. The absence of wall enhancement makes it unlikely that the aneurysm will grow or rupture in the short term. Larger studies are needed to investigate whether aneurysm wall enhancement is an independent predictor of aneurysm instability.
MeSH term(s)	Adolescent ; Adult ; Aged ; Algorithms ; Contrast Media ; Female ; Follow-Up Studies ; Gadolinium ; Humans ; Image Interpretation, Computer-Assisted ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/pathology ; Longitudinal Studies ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Netherlands ; Neuroimaging/methods
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2019-06-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
DOI	10.3174/ajnr.A6105
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