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Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound
Published on: June 3, 2021
Racial differences in cerebral vasospasm: a systematic review of the literature
J Mocco1, Evan R Ransom, Ricardo J Komotar
1Department of Neurological Surgery, Columbia University, New York, New York 10032, USA.
Insights
Japanese patients experienced significantly higher rates of cerebral vasospasm (CV) after aneurysmal subarachnoid hemorrhage (aSAH) compared to European patients. This finding suggests potential genetic differences influencing CV incidence in these populations.
Area of Science:
- Neurology
- Neurosurgery
- Epidemiology
Background:
- Cerebral vasospasm (CV) is a major complication of aneurysmal subarachnoid hemorrhage (aSAH), contributing to significant morbidity and mortality.
- Despite aggressive management, predicting and preventing CV remains challenging.
- Previous research has not specifically compared CV incidence between Asian and white patient populations.
Purpose of the Study:
- To investigate and compare the incidence of cerebral vasospasm (CV) in Japanese and European patients following aneurysmal subarachnoid hemorrhage (aSAH).
- To analyze differences in CV incidence based on diagnostic methods across these populations.
- To explore potential genetic or demographic factors contributing to observed disparities.
Main Methods:
- A systematic literature review of studies published between 1990 and 2004 was conducted using Medline and PubMed.
- Included studies originated from Japan or Europe and reported CV incidence after aSAH.
- Data were categorized by patient origin and CV diagnostic method (angiography, delayed ischemic neurological deficit, CT scan) for comparative analysis using chi-squared tests and relative risk estimation.
Main Results:
- Out of 102 identified studies, 32 met the inclusion criteria.
- Japanese studies reported significantly higher incidences of CV across all diagnostic methods (angiography, delayed ischemic neurological deficit, CT scan) compared to European studies (P < 0.001).
- Relative risks for Japanese patients were 2.04 for angiographic CV, 2.07 for delayed ischemic neurological deficit, and 1.53 for new infarct attributed to CV.
Conclusions:
- Patients in Japanese studies demonstrated a higher likelihood of experiencing CV after aSAH compared to those in European studies.
- These observed differences may indicate underlying genetic variations between Japanese and European populations.
- Clinicians should consider potential population-specific differences when interpreting aSAH and CV research from different geographic origins.
Objective:
Despite a significant body of clinical research and the widespread use of early intervention with aggressive postoperative management, cerebral vasospasm (CV) continues to contribute significantly to the morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH). Many studies have evaluated predictive factors, although none to date has investigated a possible difference in the incidence of CV between Asian and white patients. We present a review of the modern aSAH literature to examine the incidence of CV in Japan and Europe, two highly researched populations.
Methods:
A literature search was performed using the Medline and PubMed databases. Studies conducted in Japan or Europe published between 1990 and 2004 that reported an incidence of CV after aSAH were subjected to a thorough review. Data from included studies were categorized by origin (Japan or Europe) and method of CV diagnosis (angiography, delayed ischemic neurological deficit, or new infarct attributable to CV), and then were combined. Recorded incidences then were compared using a chi test, and estimates of the relative risk of vasospasm were computed.
Results:
The initial literature search identified 102 studies, and 32 studies met all inclusion criteria. The incidence of vasospasm diagnosed by angiography, delayed ischemic neurological deficit, and computed tomography was significantly greater in Japanese studies (all P < 0.001). The relative risks for Japanese patients as compared with European patients were 2.04, 2.07, and 1.53 for angiographic CV, delayed ischemic neurological deficit, and new infarct, respectively.
Conclusion:
Patients in Japanese studies were more likely to experience CV after aSAH across diagnostic methods. This may be a manifestation of genetic differences between Japanese and European populations. Clinicians should consider possible patient differences when interpreting CV research conducted in these populations.
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