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Guntu R, Patel A, Movahed MR, Hashemzadeh M, Hashemzadeh M. Association Between Idiopathic Thrombocytopenic Purpura and Hemorrhagic and Nonhemorrhagic Stroke. Crit Pathw Cardiol 2024; 23:26-29. [PMID: 37625190 DOI: 10.1097/hpc.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Idiopathic thrombocytopenic purpura (ITP) is characterized by a low platelet count. This may lead to an increased risk of hemorrhagic stroke but a lower rate of nonhemorrhagic stroke. The goal of this study was to evaluate the association between ITP and both hemorrhagic and nonhemorrhagic strokes using a large database. METHODS We used the Nationwide Inpatient Sample (NIS) database to analyze the occurrence of hemorrhagic and nonhemorrhagic stroke in patients with and without a diagnosis of ITP from 2005 to 2014. RESULTS Univariate analysis revealed a higher incidence of hemorrhagic stroke in patients with ITP in the year studied. (for example, in 2005: OR, 1.75; 95% CI, 1.57-1.94; P < 0.001; 2014: OR, 2.19; 95% CI, 2.03-2.36; P < 0.001). After adjusting for age, gender, race, and hypertension, hemorrhagic stroke remained significantly associated with ITP (in 2005: OR, 1.85; 95% CI, 1.49-1.89; P < 0.001; 2014: OR, 2.01; 95% CI, 1.86-2.18; P < 0.001) for all the years studied. Nonhemorrhagic stroke occurred at a lower rate in patients with ITP in most years (2006: OR, 0.91; 95% CI, 0.85-0.97; P = 0.004; 2014: OR, 0.88; 95% CI, 0.83-0.93; P < 0.001). Multivariate analysis confirmed a higher rate of nonhemorrhagic stroke in ITP patients. CONCLUSION Our analysis showed that there was a higher rate of hemorrhagic stroke but a lower rate of ischemic stroke in ITP patients, suggesting an important role of platelets in the occurrence of stroke.
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Affiliation(s)
- Rachna Guntu
- From the University of Arizona, College of Medicine Phoenix, AZ
| | - Aamir Patel
- From the University of Arizona, College of Medicine Phoenix, AZ
| | - Mohammad Reza Movahed
- From the University of Arizona, College of Medicine Phoenix, AZ
- University of Arizona, Sarver Heart Center
| | | | - Mehrnoosh Hashemzadeh
- From the University of Arizona, College of Medicine Phoenix, AZ
- Pima Community College, Tucson, AZ
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Peng C, Wang Y, Hu Z, Chen C. Selective HDAC6 inhibition protects against blood-brain barrier dysfunction after intracerebral hemorrhage. CNS Neurosci Ther 2024; 30:e14429. [PMID: 37665135 PMCID: PMC10915991 DOI: 10.1111/cns.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/30/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUNDS Blood-brain barrier (BBB) disruption after intracerebral hemorrhage (ICH) significantly induces neurological impairment. Previous studies showed that HDAC6 knockdown or TubA can protect the TNF-induced endothelial dysfunction. However, the role of HDAC6 inhibition on ICH-induced BBB disruption remains unknown. METHODS Hemin-induced human brain microvascular endothelial cells (HBMECs) and collagenase-induced rats were employed to investigated the underlying impact of the HDAC6 inhibition in BBB lesion and neuronal dysfunction after ICH. RESULTS We found a significant decrease in acetylated α-tubulin during early phase of ICH. Both 25 or 40 mg/kg of TubA could relieve neurological deficits, perihematomal cell apoptosis, and ipsilateral brain edema in ICH animal model. TubA or specific siRNA of HDAC6 inhibited apoptosis and reduced the endothelial permeability of HBMECs. HDAC6 inhibition rescued the degradation of TJ proteins and repaired TJs collapses after ICH induction. Finally, the results suggested that the protective effects on BBB after ICH induction were exerted via upregulating the acetylated α-tubulin and reducing stress fiber formation. CONCLUSIONS Inhibition of HDAC6 expression showed beneficial effects against BBB disruption after experimental ICH, which suggested that HDAC6 could be a novel and promising target for ICH treatment.
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Affiliation(s)
- Cuiying Peng
- Department of Neurology, Second Xiangya HospitalCentral South UniversityChangshaHunanChina
- Department of Neurology, Hunan Provincial Rehabilitation HospitalHunan University of MedicineChangshaHunanChina
| | - Yilin Wang
- Department of Neurology, Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Zhiping Hu
- Department of Neurology, Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Chunli Chen
- Department of Neurology, Second Xiangya HospitalCentral South UniversityChangshaHunanChina
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Ceskoutsé RFT, Bomgni AB, Gnimpieba Zanfack DR, Agany DDM, Bouetou Bouetou T, Gnimpieba Zohim E. Sub-clustering based recommendation system for stroke patient: Identification of a specific drug class for a given patient. Comput Biol Med 2024; 171:108117. [PMID: 38335820 PMCID: PMC10981530 DOI: 10.1016/j.compbiomed.2024.108117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Stroke is one of the leading causes of death worldwide. Previous studies have explored machine learning techniques for early detection of stroke patients using content-based recommendation systems. However, these models often struggle with timely detection of medications, which can be critical for patient management and decision-making regarding the prescription of new drugs. In this study, we developed a content-based recommendation model using three machine learning algorithms: Gaussian Mixture Model (GMM), Affinity Propagation (AP), and K-Nearest Neighbors (KNN), to aid Healthcare Professionals (HCP) in quickly detecting medications based on the symptoms of a patient with stroke. Our model focused on three classes of drugs: antihypertensive, anticoagulant, and fibrate. Each machine learning algorithm was used to accomplish specific tasks, thereby reducing the partial search space, computational cost, and accurately detecting a primary drug class without loss of precision and accuracy. Our proposed model, called CRGANNC (Clustering Recommendation Gaussian Affinity Nearest Neighbors Classifier), effectively addresses the sparsity and scalability issues faced by content-based recommendation models. The CRGANNC model dynamically partition clusters into sub-clusters with variable numbers based on the group, and can diagnose healthy, sick, and at-risk patients, and recommend drugs to the HCP. In addition to our analysis, we developed a semi-artificial dataset with new features such as weakness, dizziness, headache, nausea, and vomiting, using a pipeline. This dataset serves as a valuable resource for researchers in the sensitive domain of stroke, providing a starting point for building and testing models when real data is often restricted. Our work not only contributes to the development of predictive models for stroke but also establishes a framework for creating similar datasets in other sensitive domains, accelerating research efforts and improving patient care. Our experiments were conducted on our dataset consisting of 9691 patient records, with 1206 records for stroke attacks and 8485 healthy patients. The CRGANNC model achieved an average precision of 0.98, recall of 0.95 and F1-score of 0.96 across all three drugs classes. Furthermore, our model demonstrated significant improvement in computational efficiency compared to existing content-based recommendation models, reducing the processing time by 25.80% . This results indicate the effectiveness of our model in accurately detecting medications for stroke patients based on their symptoms.
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Affiliation(s)
- Ribot Fleury T Ceskoutsé
- Ecole Nationale Supérieure Polytechnique, University of Yaounde I, P.O. Box. 8390, Yaoundé, Cameroon.
| | - Alain Bertrand Bomgni
- University of South Dakota, 4800 N Career Avenue, 57107, SD, USA; Departement of Mathematics and computer science, University of Dschang, P.O. Box. 67, Dschang, Cameroon.
| | - David R Gnimpieba Zanfack
- Laboratory of Innovative Technologies (LTI), University of Picardie Jule Verne (UPJV), 48 Rue Raspail, 02100 Saint Quentin, France.
| | - Diing D M Agany
- University of South Dakota, 4800 N Career Avenue, 57107, SD, USA.
| | - Thomas Bouetou Bouetou
- Ecole Nationale Supérieure Polytechnique, University of Yaounde I, P.O. Box. 8390, Yaoundé, Cameroon.
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Li B, Wu J, Cao D, Cao C, Zhang J, Li X, Li H, Shen H, Yu Z. ERBB1 alleviates secondary brain injury induced by experimental intracerebral hemorrhage in rats by modulating neuronal death via PLC-γ/PKC pathway. CNS Neurosci Ther 2024; 30:e14679. [PMID: 38528842 PMCID: PMC10964039 DOI: 10.1111/cns.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
AIMS Intracerebral hemorrhage (ICH) is a disease with high rates of disability and mortality. The role of epidermal growth factor receptor 1 (ERBB1) in ICH was elucidated in this study. METHODS ICH model was constructed by injecting autologous arterial blood into the right basal ganglia. The protein level of ERBB1 was detected by western blot analysis. To up- and downregulation of ERBB1 in rats, intraventricular injection of a lentivirus overexpression vector of ERBB1 and AG1478 (a specific inhibitor of ERBB1) was used. The cell apoptosis, neuronal loss, and pro-inflammatory cytokines were assessed by TUNEL, Nissl staining, and ELISA. Meanwhile, behavioral cognitive impairment of ICH rats was evaluated after ERBB1-targeted interventions. RESULTS ERBB1 increased significantly in brain tissue of ICH rats. Overexpression of ERBB1 remarkably reduced cell apoptosis and neuronal loss induced by ICH, as well as pro-inflammatory cytokines and oxidative stress. Meanwhile, the behavioral and cognitive impairment of ICH rats were alleviated after upregulation of ERBB1; however, the secondary brain injury (SBI) was aggravated by AG1478 treatment. Furthermore, the upregulation of PLC-γ and PKC in ICH rats was reversed by AG1478 treatment. CONCLUSIONS ERBB1 can improve SBI and has a neuroprotective effect in experimental ICH rats via PLC-γ/PKC pathway.
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Affiliation(s)
- Bing Li
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
- Department of Neurosurgery, Yancheng City No. 1 People's Hospital, Yancheng First HospitalAffiliated Hospital of Nanjing University Medical SchoolYanchengJiangsu ProvinceChina
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
| | - Demao Cao
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
- Department of NeurosurgeryThe Affiliated Hospital of Yangzhou UniversityYangzhouJiangsu ProvinceChina
| | - Cheng Cao
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
- Department of Neurocritical Intensive Care UnitJiangyin Clinical College of Xuzhou Medical CollegeJiangyinJiangsu ProvinceChina
| | - Juyi Zhang
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
| | - Xiang Li
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
| | - Zhengquan Yu
- Department of Neurosurgery & Brain and Nerve Research LaboratoryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsu ProvinceChina
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Lernon SM, Frings D, Terry L, Simister R, Browning S, Burgess H, Chua J, Reddy U, Werring DJ. Doctors and nurses subjective predictions of 6-month outcome compared to actual 6-month outcome for adult patients with spontaneous intracerebral haemorrhage (ICH) in neurocritical care: An observational study. eNeurologicalSci 2024; 34:100491. [PMID: 38274038 PMCID: PMC10809071 DOI: 10.1016/j.ensci.2023.100491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background Acute spontaneous intracerebral haemorrhage is a devastating form of stroke. Prognostication after ICH may be influenced by clinicians' subjective opinions. Purpose To evaluate subjective predictions of 6-month outcome by clinicians' for ICH patients in a neurocritical care using the modified Rankin Scale (mRS) and compare these to actual 6-month outcome. Method We included clinicians' predictions of 6-month outcome in the first 48 h for 52 adults with ICH and compared to actual 6-month outcome using descriptive statistics and multilevel binomial logistic regression. Results 35/52 patients (66%) had a poor 6-month outcome (mRS 4-6); 19/52 (36%) had died. 324 predictions were included. For good (mRS 0-3) versus poor (mRS 4-6), outcome, accuracy of predictions was 68% and exact agreement 29%. mRS 6 and mRS 4 received the most correct predictions. Comparing job roles, predictions of death were underestimated, by doctors (12%) and nurses (13%) compared with actual mortality (36%). Predictions of vital status showed no significant difference between doctors and nurses: OR = 1.24 {CI; 0.50-3.05}; (p = 0.64) or good versus poor outcome: OR = 1.65 {CI; 0.98-2.79}; (p = 0.06). When predicted and actual 6-month outcome were compared, job role did not significantly relate to correct predictions of good versus poor outcome: OR = 1.13 {CI;0.67-1.90}; (p = 0.65) or for vital status: OR = 1.11 {CI; 0.47-2.61}; p = 0.81). Conclusions Early prognostication is challenging. Doctors and nurses were most likely to correctly predict poor outcome but tended to err on the side of optimism for mortality, suggesting an absence of clinical nihilism in relation to ICH.
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Affiliation(s)
- Siobhan Mc Lernon
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
- London South Bank University, School of Health and Social Care, London, UK
| | - Daniel Frings
- London South Bank University, School of Applied Sciences, London, UK
| | - Louise Terry
- London South Bank University, School of Health and Social Care, London, UK
| | - Rob Simister
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
- University College London Hospital NHS Foundation Trust, Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, UK
| | - Simone Browning
- University College London Hospital NHS Foundation Trust, Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, UK
| | - Helen Burgess
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
| | - Josenile Chua
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
| | - Ugan Reddy
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
| | - David J. Werring
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, Queen Square, London, UK
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106
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Bao D, Ni S, Chang B, Zhang W, Zhang H, Niu C. Short-term outcomes of robot-assisted minimally invasive surgery for brainstem hemorrhage: A case-control study. Heliyon 2024; 10:e25912. [PMID: 38384554 PMCID: PMC10878924 DOI: 10.1016/j.heliyon.2024.e25912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This work focused on investigating if robot-assisted minimally invasive surgery improved middle term vital outcome for primary brainstem hemorrhage (PBSH). Methods This work obtained clinical data from patients with PBSH admitted from July 2019 to August 2021. All cases were classified as surgical or conservative treatment group. The general information, Glasgow coma scale (GCS) score, Glasgow outcome score (GOS), along with survival time in patients 60 days after robot-assisted surgery were recorded and analyzed. Results A prospective analysis was performed on 82 cases meeting eligibility criteria, including 36 from surgical group whereas 46 from the conservative group. Sixty days after onset, the death rate was found to be 19.44% and 50.00% of surgical and conservative groups, separately (cases versus controls, P < 0.05). Furthermore, postoperative GOS and GCS scores of surgical group were significantly higher, and hydrocephalus was lower compared with conservative group. Central fever incidence did not exhibit any significant difference between two groups. Conclusion Robot-assisted PBSH drainage may improve survivorship and reduce the occurrence of hydrocephalus.
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Affiliation(s)
- Dejun Bao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Shengyuan Ni
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Bowen Chang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Wang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Hong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
- Anhui Province Key Laboratory of Brain Function and Brain Disease, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
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107
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Tang Z, Huang W, Chen Q, Guo C, Zheng K, Wei W, Jiang Q, Yang R. Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage. Front Neurol 2024; 15:1352949. [PMID: 38469591 PMCID: PMC10925720 DOI: 10.3389/fneur.2024.1352949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment. Methods Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed. Results A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), p < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), p < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), p = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), p = 0.001], and hemorrhage location (p = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH. Conclusion Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.
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Affiliation(s)
- Zhiji Tang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Weilong Huang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Qiqi Chen
- Department of Magnetoencephalography, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Changgui Guo
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Kuan Zheng
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Wenjin Wei
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
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Huang Z, Liu C, Wu Z, Xiao X, Chen Z, Huang Q, Liu D, Deng Z. Elevated platelet count is associated with decreased mortality from hemorrhagic stroke in hospital: a multi-center retrospective cohort study. Sci Rep 2024; 14:3797. [PMID: 38360953 PMCID: PMC10869352 DOI: 10.1038/s41598-024-53956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
This study aimed to investigate the relationship between platelet count (PC) and mortality in patients with hemorrhagic stroke (HS). The research reviewed data from 10,466 patients hospitalized in 208 hospitals in the United States from January 1, 2014, to December 31, 2015. Of these, 3262 HS patients were included in the primary analysis for those admitted to the intensive care unit (ICU). The average age of these patients was 67.05 years, with 52.79% being male. The median PC was (221.67 ± 73.78) × 109/L. Multivariate logistic regression analysis revealed that PC was a protective factor for mortality in HS patients (OR = 0.98, 95% CI 0.97-1.00, P < 0.05). Additionally, a non-linear association between PC and mortality in HS patients was found using a generalized additive model (GAM) and smooth curve fitting (penalty spline method). For the first time, a recursive algorithm identified the inflection point of platelet count as 194 × 109/L. On the left side of the inflection point, for every increase of 10 units in platelet count, the mortality rate of HS patients decreases by 10%. The study demonstrates a non-linear relationship between PC and the risk of mortality in HS patients. A platelet counts higher than the inflection point (194 × 109/L) may be a significant intervention to reduce mortality in HS patients.
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Affiliation(s)
- Zhenhua Huang
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Chenglin Liu
- Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Guangzhou Medical University, Shenzhen, 518035, China
| | - Zhanxing Wu
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Xiaoyong Xiao
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Zhongqin Chen
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Qun Huang
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Dehong Liu
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
| | - Zhe Deng
- Department of Emergency, Shenzhen Second People's Hospital and The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
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Abiodun OO, Anya T, Chukwu JC, Adekanmbi V. Prevalence, Risk Factors and Cardiovascular Comorbidities of Resistant Hypertension among Treated Hypertensives in a Nigerian Population. Glob Heart 2024; 19:17. [PMID: 38344745 PMCID: PMC10854423 DOI: 10.5334/gh.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
The true prevalence and cardiovascular comorbidities of resistant hypertension (RH) in Nigeria and Africa are not known. We sought to determine the prevalence and cardiovascular comorbidities of resistant hypertension in a treated Nigerian hypertensive population. We analyzed 1,378 patients with essential hypertension from a prospective clinical registry, the Federal Medical Centre Abuja Hypertension Registry. Resistant hypertension was defined as blood pressure ≥140/90 mmHg despite the use of ≥3 guideline-recommended antihypertensive medications including a diuretic, reninangiotensin system blocker and calcium-channel blocker at optimal or best-tolerated doses or blood pressure <140/90 mmHg on ≥4 antihypertensive medications. Resistant hypertension was confirmed with the use of home blood pressure monitoring while adherence was determined by monitoring prescription orders. The prevalence of resistant hypertension was 15.5%, with 12.3% as controlled resistant hypertension and 3.3% as uncontrolled resistant hypertension. Risk factors independently associated with the odds of resistant hypertension were male sex (adjusted odds ratio [AOR]: 1.62, 95% confidence interval [CI] 1.19-2.21, p = 0.002), obesity, and diabetes mellitus. Furthermore, patients with resistant hypertension were more likely to have heart failure with preserved ejection fraction (AOR: 3.36, 95% CI 1.25-9.07, p = 0.017), cerebrovascular disease, and chronic kidney disease. In our treated hypertensive cohort, resistant hypertension was associated with an increased risk of cerebrovascular disease, chronic kidney disease, and heart failure with preserved ejection fraction, and it appears this burden maybe 2-3 times more in those with resistant hypertension compared to those without. Concerted efforts to prevent or promptly treat resistant hypertension in our population will reduce cardiovascular comorbidities.
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Affiliation(s)
| | - Tina Anya
- Department of Internal Medicine, Federal Medical Centre, Abuja, Nigeria
| | - Janefrances Chima Chukwu
- Department of Internal Medicine, Federal Medical Centre, Abuja, Nigeria
- Trinity Health IHA Medical Group, 24 Frank Lloyd Wright Drive, Suite J2000 Ann Arbor, MI 48105, United States
| | - Victor Adekanmbi
- Department of Obstetrics and Gynaecology, University of Texas Medical Branch at Galveston, Texas, United States
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Kong Y, Wang D, Jin X, Liu Y, Xu H. Unveiling the significance of TREM1/2 in hemorrhagic stroke: structure, function, and therapeutic implications. Front Neurol 2024; 15:1334786. [PMID: 38385036 PMCID: PMC10879330 DOI: 10.3389/fneur.2024.1334786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Stroke has long been a major threat to human health worldwide. Hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, exhibits a high incidence rate and a high mortality and disability rate, imposing a substantial burden on both public health and the economy and society. In recent years, the triggering receptor expressed on myeloid cells (TREM) family has garnered extensive attention in various pathological conditions, including hemorrhagic stroke. This review comprehensively summarizes the structure and function of TREM1/2, as well as their roles and potential mechanisms in hemorrhagic stroke, with the aim of providing guidance for the development of targeted therapeutic strategies in the future.
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Affiliation(s)
- Yancheng Kong
- Trauma Emergency Center, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Di Wang
- Trauma Emergency Center, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Xu Jin
- Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, China
| | - Yi Liu
- Trauma Emergency Center, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Hui Xu
- Trauma Emergency Center, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
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Anand K, Shahid P, Shameel K. Evaluating GCS and FOUR Score in Predicting Mortality of Traumatic Brain Injury Patients (TBI): A Prospective Study in a Tertiary Hospital of South Malabar. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S598-S600. [PMID: 38595468 PMCID: PMC11001153 DOI: 10.4103/jpbs.jpbs_884_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 04/11/2024] Open
Abstract
Objective This study evaluated the full outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) to predict traumatic brain injury (TBI) outcomes. Methods Among 107 patients, FOUR and GCS grading systems analyzed emergency department patients within 24 hours. FOUR and GCS were assessed simultaneously. Patients were followed for 15 days/discharge/death to evaluate the results. Modified Rankin scores measured in-hospital mortality, morbidity, and stay. Results 65.42% of patients were 25-65. 10% were under 25, and 25% were over 65. Patients were 81% male. Road traffic accidents (RTAs) (90%), falls (7.48%), and assaults (1.47%) caused TBI. 19.62% died. 85.7% of 21 non-survivors had GCS <5 and FOUR <4. GCS mortality sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.71%, 93.02%, 75, and 96.4 (P < 0.0001). FOUR score mortality sensitivity, specificity, PPV, and NPV were 85.71%, 96.51%, 85.7, and 96.5 (P < 0.0001). GCS and FOUR AUCs matched (P = 0.52). The unadjusted model reduced in-hospital mortality by 14% for every one point increase in GCS. Every 1-point FOUR score increase reduced in-hospital mortality by 40% in the unadjusted model. GCS and FOUR scored 0.9 Spearman. Conclusion The FOUR score was comparable in the prediction of mortality in these patients.
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Affiliation(s)
- K.V Anand
- Emergency Medicine, Mes Medical College and Hospital, Malappuram, Kerala, India
| | - P.T Shahid
- Emergency Medicine, Mes Medical College and Hospital, Malappuram, Kerala, India
| | - K.K Shameel
- Emergency Medicine, Mes Medical College and Hospital, Malappuram, Kerala, India
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Lim MJR, Quek RHC, Ng KJ, Tan BYQ, Yeo LLL, Low YL, Soon BKH, Loh WNH, Teo K, Nga VDW, Yeo TT, Motani M. Prognostication of Outcomes in Spontaneous Intracerebral Hemorrhage: A Propensity Score-Matched Analysis with Support Vector Machine. World Neurosurg 2024; 182:e262-e269. [PMID: 38008171 DOI: 10.1016/j.wneu.2023.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The role of surgery in spontaneous intracerebral hemorrhage (SICH) remains controversial. We aimed to use explainable machine learning (ML) combined with propensity-score matching to investigate the effects of surgery and identify subgroups of patients with SICH who may benefit from surgery in an interpretable fashion. METHODS We conducted a retrospective study of a cohort of 282 patients aged ≥21 years with SICH. ML models were developed to separately predict for surgery and surgical evacuation. SHapley Additive exPlanations (SHAP) values were calculated to interpret the predictions made by ML models. Propensity-score matching was performed to estimate the effect of surgery and surgical evacuation on 90-day poor functional outcomes (PFO). RESULTS Ninety-two patients (32.6%) underwent surgery, and 57 patients (20.2%) underwent surgical evacuation. A total of 177 patients (62.8%) had 90-day PFO. The support vector machine achieved a c-statistic of 0.915 when predicting 90-day PFO for patients who underwent surgery and a c-statistic of 0.981 for patients who underwent surgical evacuation. The SHAP scores for the top 5 features were Glasgow Coma Scale score (0.367), age (0.214), volume of hematoma (0.258), location of hematoma (0.195), and ventricular extension (0.164). Surgery, but not surgical evacuation of the hematoma, was significantly associated with improved mortality at 90-day follow-up (odds ratio, 0.26; 95% confidence interval, 0.10-0.67; P = 0.006). CONCLUSIONS Explainable ML approaches could elucidate how ML models predict outcomes in SICH and identify subgroups of patients who respond to surgery. Future research in SICH should focus on an explainable ML-based approach that can identify subgroups of patients who may benefit functionally from surgical intervention.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
| | - Raphael Hao Chong Quek
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Kai Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Ying Liang Low
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Betsy Kar Hoon Soon
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Will Ne-Hooi Loh
- Department of Anesthesia, National University Hospital, Singapore, Singapore
| | - Kejia Teo
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Vincent Diong Weng Nga
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Mehul Motani
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health, National University of Singapore, Singapore, Singapore; Institute of Data Science, National University of Singapore, Singapore, Singapore; Institute for Digital Medicine (WisDM), National University of Singapore, Singapore, Singapore
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Palahati A, Luo Y, Qin L, Duan Y, Zhang M, Gan H, Zhai X. TonEBP: A Key Transcription Factor in Microglia Following Intracerebral Hemorrhage Induced-Neuroinflammation. Int J Mol Sci 2024; 25:1438. [PMID: 38338716 PMCID: PMC10855931 DOI: 10.3390/ijms25031438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Transcription factors within microglia contribute to the inflammatory response following intracerebral hemorrhage (ICH). Therefore, we employed bioinformatics screening to identify the potential transcription factor tonicity-responsive enhancer-binding protein (TonEBP) within microglia. Inflammatory stimuli can provoke an elevated expression of TonEBP in microglia. Nevertheless, the expression and function of microglial TonEBP in ICH-induced neuroinflammation remain ambiguous. In our recent research, we discovered that ICH instigated an increased TonEBP in microglia in both human and mouse peri-hematoma brain tissues. Furthermore, our results indicated that TonEBP knockdown mitigates lipopolysaccharide (LPS)-induced inflammation and the activation of NF-κB signaling in microglia. In order to more deeply comprehend the underlying molecular mechanisms of how TonEBP modulates the inflammatory response, we sequenced the transcriptomes of TonEBP-deficient cells and sought potential downstream target genes of TonEBP, such as Pellino-1 (PELI1). PELI has been previously reported to mediate nuclear factor-κB (NF-κB) signaling. Through the utilization of CUT & RUN, a dual-luciferase reporter, and qPCR, we confirmed that TonEBP is the transcription factor of Peli1, binding to the Peli1 promoter. In summary, TonEBP may enhance the LPS-induced inflammation and activation of NF-κB signaling via PELI1.
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Affiliation(s)
- Ailiyaer Palahati
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
| | - Yujia Luo
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
| | - Le Qin
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
| | - Yuhao Duan
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
| | - Mi Zhang
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
| | - Hui Gan
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
| | - Xuan Zhai
- Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400010, China; (A.P.)
- Center for Neuroscience Research, Chongqing Medical University, Chongqing 400016, China
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Yang H, Lu S, Yang L. Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review. Syst Rev 2024; 13:38. [PMID: 38268059 PMCID: PMC10807185 DOI: 10.1186/s13643-024-02449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive cessation or reduction in airflow during sleep. Stroke patients have a higher risk of OSA, which can worsen their cognitive and functional disabilities, prolong their hospitalization, and increase their mortality rates. METHODS We conducted a comprehensive literature search in the databases of PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, and CNKI, using a combination of keywords and MeSH words in both English and Chinese. Studies published up to March 1, 2022, which reported the development and/or validation of clinical prediction models for OSA diagnosis in stroke patients. RESULTS We identified 11 studies that met our inclusion criteria. Most of the studies used logistic regression models and machine learning approaches to predict the incidence of OSA in stroke patients. The most frequently selected predictors included body mass index, sex, neck circumference, snoring, and blood pressure. However, the predictive performance of these models ranged from poor to moderate, with the area under the receiver operating characteristic curve varying from 0.55 to 0.82. All the studies have a high overall risk of bias, mainly due to the small sample size and lack of external validation. CONCLUSION Although clinical prediction models have shown the potential for diagnosing OSA in stroke patients, their limited accuracy and high risk of bias restrict their implications. Future studies should focus on developing advanced algorithms that incorporate more predictors from larger and representative samples and externally validating their performance to enhance their clinical applicability and accuracy.
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Affiliation(s)
- Hualu Yang
- Department of Rehabilitation, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 581052, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Shuya Lu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China.
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Gu T, Pan J, Chen L, Li K, Wang L, Zou Z, Shi Q. Association of inflammatory cytokines expression in cerebrospinal fluid with the severity and prognosis of spontaneous intracerebral hemorrhage. BMC Neurol 2024; 24:7. [PMID: 38167007 PMCID: PMC10759732 DOI: 10.1186/s12883-023-03487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To investigate the potential diagnostic and prognostic implications of inflammatory cytokine levels in the cerebrospinal fluid (CSF) of patients with spontaneous intracerebral hemorrhage (SICH) upon their initial hospital admission. METHODS Our cohort included 100 patients diagnosed with acute SICH, presenting to the Department of Neurosurgery. Additionally, we recruited 50 individuals without central nervous system (CNS) pathology, treated concurrently at our facility, as controls. CSF samples, collected upon hospital entry, were quantitatively assessed for 10 inflammatory cytokines using the Mesoscale Discovery Platform (MSD, Rockville, MD, USA) electrochemiluminescence technology, followed by validation through enzyme-linked immunosorbent assay (ELISA). RESULTS We observed a marked elevation of IL-6, IL-8, IL-10, and TNF-α in the CSF of the SICH subgroup compared to controls. Higher Glasgow Coma Scale (GCS) scores in SICH patients corresponded with lower CSF concentrations of IL-6, IL-8, IL-10, and TNF-α, indicating an inverse relationship. Notably, CSF inflammatory cytokine levels were consistently higher in SICH patients with hydrocephalus than in those without. Increases in IL-6, IL-8, IL-10, and TNF-α in the CSF were notably more pronounced in the poor prognosis group (Glasgow Outcome Scale, GOS 1-3) compared to those with a favorable prognosis (GOS 4-5). The AUC values for these cytokines in predicting SICH prognosis were 0.750, 0.728, 0.717, and 0.743, respectively. CONCLUSIONS Initial CSF levels of IL-6, IL-8, IL-10, and TNF-α upon admission provide significant insights into the severity of neural damage and are robust indicators for prognosis in SICH patients.
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Affiliation(s)
- Tianyan Gu
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Jingyu Pan
- Medical College of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - Ling Chen
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Kai Li
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Li Wang
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Zhihao Zou
- Department of Neurosurgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China.
| | - Qinghai Shi
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China.
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Deng S, Feng S, Xin Y, He Y, Wang Y, Tian M, Gong Y. Establishment of a rat model of severe spontaneous intracerebral hemorrhage. JOURNAL OF INTENSIVE MEDICINE 2024; 4:108-117. [PMID: 38263974 PMCID: PMC10800770 DOI: 10.1016/j.jointm.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/24/2023] [Accepted: 08/16/2023] [Indexed: 01/25/2024]
Abstract
Background Severe intracerebral hemorrhage (ICH) is the most devastating subtype of stroke resulting in high mortality and disability. At present, the development of targeted treatments to minimize the high morbidity and mortality is limited partly due to the lack of a severe ICH animal model. In this study, we aimed to establish an accurate severe ICH model in rats and examine the pathological and physiological changes associated with ICH. Methods A rat model of severe ICH model was established by intrastriatal injection of autologous blood using different blood volumes (ICH 100 µL group, ICH 130 µL group, ICH 160 µL group, ICH 170 µL group, and ICH 180 µL group). The mortality was assessed during the 28-day post-ICH period. Short- and long-term neurological deficits were evaluated using the Longa method, foot fault, falling latency, and Morris water maze tests. Brain water content, hematoma volume, hemoglobin content, and magnetic resonance imaging were assessed to determine the extent of brain injury. Immunofluorescence staining was conducted to examine microglial activation and neuronal apoptosis. Hematoxylin and eosin (H&E) staining, lung water content, and western blotting were used to assess lung injury following ICH. Results The mortality of ICH rats increased significantly with an increase in autologous blood injection. The 28-day mortality in the 100 µL, 130 µL, 160 µL, 170 µL, and 180 µL ICH groups were 5%, 20%, 40%, 75%, and 100%, respectively. A significantly higher 28-day mortality was observed in the ICH 160 µL group compared to the ICH 100 µL group. The ICH 160 µL group exhibited significantly increased neurological deficits, brain edema, hematoma volume, and hemoglobin content compared to the sham group. Compared with the sham operation group, the activation of microglia and neuronal death in ICH 160 µL rats increased. The use of H&E staining and western blotting demonstrated that disruption of the intra-alveolar structure, alveolar edema, and infiltration of inflammatory cells and cytokines into the lung tissue were more severe in the ICH 160 µL group than the sham group. Conclusions A severe ICH model in rats was successfully established using an injection of autologous blood at a volume of 160 µL. This model may provide a valuable tool to examine the pathological mechanisms and potential therapeutic interventions of severe ICH.
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Affiliation(s)
- Shuixiang Deng
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shengjie Feng
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuewen Xin
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu He
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yao Wang
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mi Tian
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Akyol ME, Demir C, Görken G. Investigation of Oxidative Stress Level and Antioxidant Enzyme Activities in Operated and Nonoperated Patients with Spontaneous Intracerebral Hematoma. J Neurol Surg A Cent Eur Neurosurg 2024; 85:21-25. [PMID: 36070790 DOI: 10.1055/a-1938-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Complex underlying mechanisms consisting of cytotoxic, excitotoxic, and inflammatory effects of intraparenchymal hemorrhage (ICH) are responsible for the highly detrimental effects on brain tissue. Oxidative stress also plays a significant role in brain damage after ICH; however, it is less important than other factors. In this study, we aimed to evaluate the oxidative stress parameters malondialdehyde (MDA) and antioxidant-reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CT) activities in operated and nonoperated patients with spontaneous ICH. METHODS One hundred patients with spontaneous ICH and 100 healthy controls were included in this study. Within the indication, 50 of the 100 patients underwent decompressive surgery. MDA, GSH, SOD, and CT activities were measured in the serum obtained from the patients. RESULTS SOD and CT levels were lower in the nonoperated group than in the operated and control groups. GSH was similar in the operated and nonoperated groups, but it was lower in the control group. However, MDA was higher in those who did not undergo surgery than in the other groups. CONCLUSIONS In our study, MDA, an indicator of oxidative stress, was found to be lower, and CT and SOD activities were found to be higher in ICH patients who underwent decompression than in those who did not. This is the first study to present the correlations of MDA, SOD, CT, and GSH in operated and nonoperated patients with spontaneous ICH.
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Affiliation(s)
- Mehmet Edip Akyol
- Department of Neurosurgery, Van YY University Faculty of Medicine, Van, Turkey
| | - Canan Demir
- Van YY University Vocational School of Health Services, Van, Turkey
| | - Gökhan Görken
- Department of Neurology, Regional Training and Research Hospital, Van, Turkey
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Wang L, Liu Q, Yue D, Liu J, Fu Y. Cerebral Amyloid Angiopathy: An Undeniable Small Vessel Disease. J Stroke 2024; 26:1-12. [PMID: 38326703 PMCID: PMC10850457 DOI: 10.5853/jos.2023.01942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 02/09/2024] Open
Abstract
Cerebral amyloid angiopathy (CAA) has been proven to be the most common pathological change in cerebral small vessel disease except arteriosclerosis. In recent years, with the discovery of imaging technology and new imaging markers, the diagnostic rate of CAA has greatly improved. CAA plays an important role in non-hypertensive cerebral hemorrhage and cognitive decline. This review comprehensively describes the etiology, epidemiology, pathophysiological mechanisms, clinical features, imaging manifestations, imaging markers, diagnostic criteria, and treatment of CAA to facilitate its diagnosis and treatment and reduce mortality.
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Affiliation(s)
- Litao Wang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongqi Yue
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Fu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dong C, Li Y, Ma Md Z. Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage: A Review. Neurologist 2024; 29:54-58. [PMID: 37582632 DOI: 10.1097/nrl.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND Patients with spontaneous intracerebral hemorrhage (sICH) are at high risk for venous thromboembolism (VTE). The administration of mechanical and pharmacological VTE prophylaxis after sICH is important but challenging. The safety and efficacy of the optimal anticoagulant dose, timing, and type of VTE chemoprophylaxis in cases of sICH are still unclear, and clinicians are concerned that it may lead to cerebral hematoma expansion, which is associated with poor prognosis. Through this literature review, we aim to summarize the latest guidelines, recommendations, and clinical research progress to support evidence-based treatment strategies. REVIEW SUMMARY It has been proven that intermittent pneumatic compression can effectively reduce the risk of VTE and should be used at the time of hospital admission, whereas gradient compression stockings or lack of prophylaxis in sICH cases are not recommended by current guidelines. Studies regarding pharmacological VTE prophylaxis in patients with ICH were reviewed and summarized. Prophylactic anticoagulation for VTE in patients with ICH seems to be safe and was not associated with cerebral hematoma expansion. Meanwhile, the prophylactic efficacy of anticoagulation for pulmonary embolism seems to be more obvious than that of deep vein thrombosis in patients with ICH. CONCLUSIONS Clinicians should pay attention to the prevention and management of VTE after sICH. Intermittent pneumatic compression should be applied to patients with sICH on the day of hospital admission. After documentation of bleeding cessation, early initiation of pharmacological VTE prophylaxis (24 h to 48 h from sICH onset) seems to be safe and effective in pulmonary embolism prophylaxis.
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Affiliation(s)
- Chang Dong
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University
| | - Ying Li
- Department of Neurology, Dalian Municipal Central Hospital
| | - Zhuang Ma Md
- Department of Clinical Medicine, Graduate School of Dalian Medical University, Dalian Medical University, Dalian
- Department of Respiratory and Critical Care Medicine, General Hospital of Northern Theater Command, Shenyang, China
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Ramos MB, Rech MM, Telles JPM, Moraes WM, Teixeira MJ, Figueiredo EG. Repercussions of the Emergency neurological life support on scientific literature: a bibliometric study. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-10. [PMID: 38272043 PMCID: PMC10810700 DOI: 10.1055/s-0043-1777110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND In 2012, the Neurocritical Care Society launched a compilation of protocols regarding the core issues that should be addressed within the first hours of neurological emergencies - the Emergency neurological life support (ENLS). OBJECTIVE We aim to evaluate this repercussion through a bibliometric analysis. METHODS We searched Scopus on October 2022 for articles mentioning ENLS. The following variables were obtained: number of citations; number of citations per year; number of publications per year; year of publication; research type; research subtype; country of corresponding author and its income category and world region; journal of publication and its 5-year impact factor (IF); and section where ENLS appeared. RESULTS After applying eligibility criteria, we retrieved 421 articles, published from 2012 to 2022. The mean number of citations per article was 17.46 (95% Confidence Interval (CI) = 8.20-26.72), while the mean number of citations per year per article was 4.05 (95% CI = 2.50-5.61). The mean destiny journal 5-year IF was 5.141 (95% CI = 4.189-6.093). The majority of articles were secondary research (57.48%; n = 242/421) of which most were narrative reviews (71.90%; n = 174/242). High-Income countries were the most prominent (80.05%; n = 337/421 articles). There were no papers from low-income countries. There were no trials or systematic reviews from middle-income countries. CONCLUSION Although still low, the number of publications mentioning ENLS is increasing. Articles were mainly published in journals of intensive care medicine, neurology, neurosurgery, and emergency medicine. Most articles were published by authors from high-income countries. The majority of papers were secondary research, with narrative review as the most frequent subtype.
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Affiliation(s)
- Miguel Bertelli Ramos
- Hospital do Servidor Público Estadual de São Paulo, Departamento de Neurocirurgia, São Paulo SP, Brazil.
| | - Matheus Machado Rech
- Universidade de Caxias do Sul, Faculdade de Medicina, Departamento de Neurocirurgia, Caxias do Sul RS, Brazil.
| | - João Paulo Mota Telles
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Willian Medeiros Moraes
- Hospital Nossa Senhora da Conceição, Departamento de Medicina Interna, Porto Alegre RS, Brazil.
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
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Yu W, Zhou L, Shi Z, Mao J, Li Z, Chen X, Tan G, Wang Z, Chen S. Hematoma Enlargement After Intracerebral Hemorrhage: A Bibliometric Analysis. World Neurosurg 2024; 181:e713-e721. [PMID: 37898277 DOI: 10.1016/j.wneu.2023.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To conduct a quantitative analysis of published studies on hematoma enlargement after intracerebral hemorrhage. METHODS Studies on hematoma enlargement after cerebral hemorrhage were retrieved from the Web of Science database on June 30, 2023. Microsoft Excel, VOSviewer, and CiteSpace software were used for bibliometric analysis and visualization, focusing on the quantitative characteristics of the literature. RESULTS A total of 444 articles were published in 161 journals, with 2161 authors from 41 countries and 717 institutions. The most published authors, countries, and institutions were Goldstein, the USA, and Massachusetts General Hospital. Stroke published the most studies, but the average citation number per year of Lancet Neurology far exceeded that of other journals. The research field of hematoma enlargement is mainly divided into 3 focuses, including mechanisms, identification (computed tomography signs, predictive models), and treatment (hemostasis, antihypertensive therapy). Most bursts in publication number have been since 2010, where the highest burst was from research on spot signs, and the latest burst focused on tranexamic acid. Treatment using tranexamic acid based on different computed tomography signs is a focus of current research, but the effectiveness still requires further exploration. CONCLUSIONS This bibliometric analysis analyzed the research framework and hotspots on hematoma enlargement after cerebral hemorrhage, which can help researchers better understand this field and provide potential suggestions for collaborations and research.
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Affiliation(s)
- Weijie Yu
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Liwei Zhou
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhongjie Shi
- School of Medicine, Xiamen University, Xiamen, China
| | - Jianyao Mao
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhangyu Li
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xi Chen
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Guowei Tan
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Sifang Chen
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Ding L, Tao X, Zhou J. Effect of a comprehensive geriatric assessment-based individualized intervention on postoperative patients with cerebral hemorrhage: A randomized controlled study. Technol Health Care 2024; 32:1555-1567. [PMID: 38073343 DOI: 10.3233/thc-230611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) has been used in inpatient, outpatient, and emergency patients in Western countries and is an important evaluation tool in medicine. In China, the application of CGA to multiple single diseases has achieved satisfactory intervention effects. OBJECTIVE To explore the effect of CGA on postoperative quality of life (QoL), psychological state, neurological recovery, and self-efficacy in patients with cerebral hemorrhage. METHODS In this randomized controlled trial, a total of 133 postoperative patients with cerebral hemorrhage who were treated and nursed in our hospital between March 2019 and March 2021 were randomly assigned to a control group (68 patients) and an observation group (65 patients). The control group was given a general comprehensive care intervention. The observation group was evaluated using an electronic medical record-based CGA system that assessed patient prognosis and was given individualized interventions based on the CGA findings. The postoperative QoL, psychological state, neurological recovery, and self-efficacy of the two groups were compared. RESULTS After the intervention, self-decompression, self-decision-making, and positive attitudes of the observation group were higher than those of the control group. However, the National Institute of Health Stroke Scale score of the observation group was lower than that of the control group, the Self-rating anxiety scale and self-rating depression scale scores of the observation group were lower than those of the control group, and the social support score was significantly higher in the observation group than in the control group. After the intervention, the mental vitality, social interaction, emotional restriction, and mental status scores of the observation group were significantly higher than those of the control group. CONCLUSION Comprehensive evaluation of patients with cerebral hemorrhage based on a CGA, targeting the individual factors that affect the prognosis of patients, and formulating and implementing individualized nursing intervention programs based on the CGA results can effectively relieve the symptoms of cerebral hemorrhage, reduce anxiety and depression, and improve the QoL of patients with cerebral hemorrhage.
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Affiliation(s)
- Ling Ding
- Department of Neurology, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Neurology, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinyan Tao
- VIP Ward, Hubei Cancer Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Neurology, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jingjing Zhou
- Department of Neurology, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Sun E, Lu S, Chen B, Wu Q. An endoscopic-assisted contralateral paramedian supracerebellar infratentorial approach in the treatment of thalamic hemorrhage with hematoma extension into the brainstem: a case report. Front Surg 2023; 10:1277990. [PMID: 38179316 PMCID: PMC10766349 DOI: 10.3389/fsurg.2023.1277990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Thalamic hemorrhage (TH) with hematoma extension into the brainstem can lead to poor outcomes. In this study, we discuss the feasibility of the endoscopic-assisted contralateral paramedian supracerebellar infratentorial (SCIT) approach as a therapeutic method for treating such patients. Case presentation A patient suffered from a sudden loss of consciousness and right limb weakness, and a CT scan indicated TH with hematoma extension into the brainstem. She consented to undergo surgery by the endoscopic-assisted contralateral paramedian SCIT approach. Results Now, the patient can open her eyes on her own and move her left arm in response to commands. Conclusion The endoscopic-assisted contralateral paramedian SCIT approach may be a viable therapeutic method for treating TH patients with hematoma extension into the brainstem.
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Affiliation(s)
- Eryi Sun
- Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Siyuan Lu
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Bo Chen
- Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Qi Wu
- Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
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Huang YC, Wong YS, Wu CS, Tsai CF, Ong CT. Modified CAVE score for predicting late seizures after intracerebral hemorrhage. BMC Neurol 2023; 23:448. [PMID: 38114955 PMCID: PMC10729474 DOI: 10.1186/s12883-023-03510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Seizures commonly occur in patients with intracerebral hemorrhage (ICH). Anticonvulsants are commonly used for preventing seizures in patients with ICH. Thus, patients with ICH at high risk of seizures must be identified. The study aims to elucidate whether double the score of cortex involvement in ICH patients can increase accuracy of CAVE score for predicting late seizures. METHOD This retrospective analysis of the medical records of surviving patients admitted between June 1, 2013, and December 31, 2019. Validated the CAVE score and modified it (CAVE2). The main outcome of patients with ICH was seizures. The first seizures occurring within 7 days after a stroke were defined as early seizures. Seizures occurring after 1 week of stroke onset, including patients who had experienced early seizures or patients who had not, were defined as late seizures. CAVE and CAVE2 scores were validated using the cohort. The accuracy and discrimination of those two scores were accessed by the area under the operating characteristic curve. Akaike information criterion, integrated discrimination improvement, and continuous net reclassification improvement were used to assess the performance of the CAVE and CAVE2 scores. RESULTS In the cohort showed that late seizures occurred in 12.7% (52/408) of patients with ICH. Male sex, age > 65 years, cortex involvement, and early seizures were associated with the occurrence of late seizures, with odds ratios of 2.09, 2.04, 4.12, and 3.78, respectively. The risk rate of late seizures was 6.66% (17/255), 14.8% (17/115), and 47.4% (18/38) for CAVE scores ≤ 1, 2, and ≥ 3, and 4.6% (12/258), 18.3% (13/71), and 54.4 (20/37) for CAVE2 scores ≤ 1, 2, and ≥ 3 respectively. The C-statistics for the CAVE and CAVE2 scores were 0.73 and 0.74 respectively. CONCLUSION The CAVE score can identify patients with ICH and high risk for late seizures. The CAVE can be modified by changing the score of cortex involvement to 2 points to improve accuracy in predicting late seizures in patients with ICH.
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Affiliation(s)
- Yu-Ching Huang
- Department of Neurology, Tao-yuan General Hospital, Ministry of Healthy and Welfare, Tao-yuan, Taiwan
- Department of Industrial Engineering and Management, Yuan-Ze University, Tao-yuan, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Chi-Shun Wu
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan.
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Wan Y, He QW, Chen S, Li M, Xia Y, Zhang L, Sun Z, Chen X, Wang D, Chang J, Hu B. Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study. JMIR Public Health Surveill 2023; 9:e34386. [PMID: 38090794 PMCID: PMC10720699 DOI: 10.2196/34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/19/2023] [Accepted: 09/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH). OBJECTIVE This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH. METHODS Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups. RESULTS From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality. CONCLUSIONS Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817.
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Affiliation(s)
- Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolu Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - David Wang
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Jiang Chang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hakami F, Alhazmi E, Busayli WM, Althurwi S, Darraj AM, Alamir MA, Hakami A, Othman RA, Moafa AI, Mahasi HA, Madkhali MA. Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke. Cureus 2023; 15:e50577. [PMID: 38107212 PMCID: PMC10723021 DOI: 10.7759/cureus.50577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.
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Affiliation(s)
- Faisal Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Essam Alhazmi
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Wafa M Busayli
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Alyaj Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Renad A Othman
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Amal I Moafa
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Mohammed Ali Madkhali
- Internal Medicine, and Hematology and Oncology, Faculty of Medicine, Jazan University, Jazan, SAU
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Wang JY, Wilson M, Andreev A, Tarsia J, Selim M, Lioutas VA. The role of hyperglycemia in the outcome of intracerebral hemorrhage: A causative analysis. J Stroke Cerebrovasc Dis 2023; 32:107439. [PMID: 38488808 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Hyperglycemia in the acute phase of intracerebral hemorrhage (ICH) has been associated with poor functional outcomes, however all interventions to lower glucose have yielded neutral or negative results. We attempt an explanation of the causal role of hyperglycemia in ΙCH outcome using generalized structural equation modeling. MATERIALS AND METHODS Consecutive primary ICH patients admitted to an academic hospital between 2007 and 2018 were identified. Patients with missing baseline or follow up CT scans and without 90 day follow up status were excluded. We constructed a causal model accounting for pre-defined markers of ICH severity to evaluate the association between mean 72 h glucose and 90 day functional outcome measured by modified Rankin Scale, dichotomized as favorable ≤2 or unfavorable >2. RESULTS Primary analyses included 410 patients (70.4 ± 13.8years, 43 % female). Mean 72 h glucose was 137.5 ± 33.4mg/dl and 102 (25 %) patients were diabetic. On univariable analysis, higher glucose levels were negatively correlated with favorable outcome (p < 0.0001). However in the structural equation model, this relationship was significantly attenuated (p = 0.06) after accounting for the causal effect of diabetes (p < 0.0001), hematoma volume (p < 0.0001), intraventricular extension (p = 0.01) and Glasgow coma scale (p = 0.001) on glucose levels. On secondary analyses stratifying by diagnosis of diabetes, higher glucose levels were negatively correlated with favorable outcome in patients without diabetes (p = 0.04), but not in patients with diabetes (p = 0.35). CONCLUSIONS Hyperglycemia may be a downstream effect of other markers of ICH severity, particularly among patients without diabetes, suggesting a possible explanation for the limited evidence of glucose lowering interventions in outcome.
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Affiliation(s)
- Jia-Yi Wang
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Mitchell Wilson
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Alexander Andreev
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Joseph Tarsia
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Vasileios-Arsenios Lioutas
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
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Nithimathachoke A, Tiensawang S, Deechot N, Sutaparak C, Sriamornrattanakul K. A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose. Heliyon 2023; 9:e22812. [PMID: 38125548 PMCID: PMC10731089 DOI: 10.1016/j.heliyon.2023.e22812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives To determine whether addition of an intravenous bolus dose before continuous nicardipine infusion would improve blood pressure reduction in the hyperacute phase in patients with spontaneous intracerebral hemorrhage (ICH). Design Double-blind randomized controlled trial. Setting One academic emergency department (ED) in Bangkok, Thailand. Participants Adult patients with spontaneous ICH presented to the ED between June 30, 2022, and July 15, 2023. Interventions The bolus group (n = 31) received an intravenous bolus dose of nicardipine before nicardipine continuous infusion, whereas the non-bolus group (n = 31) was given a placebo and nicardipine continuous infusion. Main outcomes Systolic blood pressure (SBP) within the first hour (being measured every 5 min), neurological deterioration, and infusion dosage at 60 min were assessed. Results Basic characteristic features including the mean baseline SBP were not significantly different between the two groups. At 10 min after treatment initiation, the bolus group had a significant decrease in SBP (32.1 ± 13.6 vs 22.3 ± 18.5 mmHg; p-value = 0.020). Moreover, the target SBP of 180 mmHg could be achieved within 10 min in the bolus group compared with 15 min in the non-bolus group. However, the overall mean SBPs were not significantly different, with 152 ± 12 mmHg in the bolus group compared with 150 ± 15 mmHg in the non-bolus group (p-value = 0.564). None of the patients in both groups had neurological deterioration over the first hour of the treatment. The infusion dosages of nicardipine at 1 h were 6.2 mg/h (5.9, 7.7 mg/h) and 6.8 mg/h (5.9, 8.4 mg/h) in the bolus and non-bolus groups, respectively (p-value = 0.618). Conclusions Administering a 1-mg bolus dose of nicardipine before continuous nicardipine infusion notably reduces SBP at 10 min. However, the overall SBP does not exhibit a significant decline during the hyperacute phase of spontaneous intracerebral hemorrhage.
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Affiliation(s)
- Adisak Nithimathachoke
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand
| | - Supatpinee Tiensawang
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand
| | - Natradee Deechot
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand
| | | | - Kitiporn Sriamornrattanakul
- Neurosurgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand
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Phan J, Elgendi K, Javeed M, Aranda JM, Ahmed MM, Vilaro J, Al-Ani M, Parker AM. Thrombotic and Hemorrhagic Complications Following Left Ventricular Assist Device Placement: An Emphasis on Gastrointestinal Bleeding, Stroke, and Pump Thrombosis. Cureus 2023; 15:e51160. [PMID: 38283491 PMCID: PMC10811971 DOI: 10.7759/cureus.51160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
The left ventricular assist device (LVAD) is a mechanical circulatory support device that supports the heart failure patient as a bridge to transplant (BTT) or as a destination therapy for those who have other medical comorbidities or complications that disqualify them from meeting transplant criteria. In patients with severe heart failure, LVAD use has extended survival and improved signs and symptoms of cardiac congestion and low cardiac output, such as dyspnea, fatigue, and exercise intolerance. However, these devices are associated with specific hematologic and thrombotic complications. In this manuscript, we review the common hematologic complications of LVADs.
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Affiliation(s)
- Joseph Phan
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Kareem Elgendi
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Masi Javeed
- Internal Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine, Graduate Medical Education: Bayonet Point Hospital, Hudson, USA
| | - Juan M Aranda
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Mustafa M Ahmed
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Juan Vilaro
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Mohammad Al-Ani
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Alex M Parker
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, USA
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Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Egbunu EO, Ndam AR, Ogala F, Ologunde T, Peterson JC, Boluwatife AI, Okongko AO, Fatoye JO, Akpovona OL, Onyekweli SO, Temitope AY, Achimugu AO, Temilade AV. Stroke and cognitive impairment: understanding the connection and managing symptoms. Ann Med Surg (Lond) 2023; 85:6057-6066. [PMID: 38098605 PMCID: PMC10718363 DOI: 10.1097/ms9.0000000000001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023] Open
Abstract
Stroke is a leading cause of long-term disability worldwide, and cognitive impairment is a common consequence of stroke. Understanding the connection between stroke and cognitive impairment is crucial for effectively managing symptoms and improving patients' quality of life. This abstract provides an overview of the relationship between stroke and cognitive impairment and explores strategies for managing cognitive symptoms in stroke survivors. A comprehensive review of relevant literature was conducted to examine the association between stroke and cognitive impairment. Various factors contributing to cognitive impairment after stroke were explored, including the location and severity of the stroke, vascular risk factors, and underlying mechanisms. Evidence-based strategies for managing cognitive symptoms in stroke survivors were also analyzed, such as cognitive rehabilitation, pharmacological interventions, and lifestyle modifications. The review revealed a strong link between stroke and cognitive impairment. The location and severity of the stroke play a significant role in determining the specific cognitive deficits experienced by individuals. Vascular risk factors, including hypertension, diabetes, and atrial fibrillation, contribute to cognitive decline after stroke. Mechanisms such as cerebral hypoperfusion, white matter damage, and neuroinflammation also play a role. Cognitive rehabilitation programs have shown promising results in improving cognitive function, while certain medications may help manage specific cognitive symptoms. Lifestyle modifications like physical exercise and a healthy diet have been associated with better cognitive outcomes in stroke survivors.
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Affiliation(s)
| | | | | | | | | | | | - Faith Ogala
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Tunde Ologunde
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | | | | | | | | | - Otite L. Akpovona
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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Zhang J, Zhang Z, Wang X, Liu Y, Yu Q, Wang K, Fang Y, Lenahan C, Chen M, Chen S. Connection between oxidative stress and subcellular organelle in subarachnoid hemorrhage: Novel mechanisms and therapeutic implications. CNS Neurosci Ther 2023; 29:3672-3683. [PMID: 37408392 PMCID: PMC10651993 DOI: 10.1111/cns.14348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/12/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
Spontaneous subarachnoid hemorrhage (SAH) is one of the most devastating forms of stroke, with limited treatment modalities and poor patient outcomes. Previous studies have proposed multiple prognostic factors; however, relative research on treatment has not yet yielded favorable clinical outcomes. Moreover, recent studies have suggested that early brain injury (EBI) occurring within 72 h after SAH may contribute to its poor clinical outcomes. Oxidative stress is recognized as one of the main mechanisms of EBI, which causes damage to various subcellular organelles, including the mitochondria, nucleus, endoplasmic reticulum (ER), and lysosomes. This could lead to significant impairment of numerous cellular functions, such as energy supply, protein synthesis, and autophagy, which may directly contribute to the development of EBI and poor long-term prognostic outcomes. In this review, the mechanisms underlying the connection between oxidative stress and subcellular organelles after SAH are discussed, and promising therapeutic options based on these mechanisms are summarized.
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Affiliation(s)
- Jiahao Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
| | - Zeyu Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
- Department of Neurosurgery, Renji Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
| | - Yibo Liu
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
| | - Qian Yu
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
| | - Kaikai Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
| | - Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
| | - Cameron Lenahan
- Center for Neuroscience ResearchLoma Linda University School of MedicineLoma LindaCaliforniaUSA
| | - Maohua Chen
- Department of Neurosurgery, Wenzhou Central HospitalAffiliated Dingli Clinical Institute of Wenzhou Medical UniversityWenzhouChina
| | - Sheng Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- Clinical Research Center for Neurological Diseases of Zhejiang ProvinceHangzhouChina
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Yu N, Tian W, Liu C, Zhang P, Zhao Y, Nan C, Jin Q, Li X, Liu Y. miR-122-5p Promotes Peripheral and Central Nervous System Inflammation in a Mouse Model of Intracerebral Hemorrhage via Disruption of the MLLT1/PI3K/AKT Signaling. Neurochem Res 2023; 48:3665-3682. [PMID: 37594575 DOI: 10.1007/s11064-023-04014-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
Intracerebral hemorrhage (ICH) is a recognized central nervous system inflammation complication. Several microRNAs (miRNAs or miRs) have been documented to be vital modulators in peripheral and central nervous system inflammation. Based on whole transcriptome sequencing and bioinformatics analysis, this study aims to reveal the possible molecular mechanisms by which miR-122-5p affects the inflammatory response in the peripheral and central nervous system in a mouse model of ICH. Differentially expressed ICH-related miRNAs were screened. Adeno-associated viral vectors were used to knock down miR-122-5p in mice to evaluate the effect of miR-122-5p on peripheral and central nervous system inflammation. The downstream target gene of miR-122-5p was analyzed. Neurons were isolated from mice and treated with hemin to construct an in vitro model of ICH, followed by transduction with miR-122-5p mimic or combined with oe-MLLT1. The neurons were then co-cultured with microglia BV2 to assess their activation. It was found that miR-122-5p was highly expressed in ICH, and MLLT1 was lowly expressed. In vivo experiments showed that miR-122-5p knockdown decreased neurological deficits, BBB permeability, and inflammation in the peripheral and central nervous system in ICH mice. It involved its binding to MLLT1 and downregulation of the activity of the PI3K/AKT pathway. In vitro data exhibited that miR-122-5p stimulated the generation of inflammatory factors and microglia activation by targeting MLLT1 and inhibiting the PI3K/AKT pathway. Collectively, our work reveals a novel miR-122-5p/MLLT1-mediated regulatory network in ICH that may be a viable target for neuroinflammation alleviation.
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Affiliation(s)
- Ning Yu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China
| | - Wenbin Tian
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China
| | - Chao Liu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China
| | - Pei Zhang
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China
| | - Yinlong Zhao
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China
| | - Chengrui Nan
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China
| | - Qianxu Jin
- Department of Neurosurgery, Hebei Medical University, Shijiazhuang, 050000, P.R. China
| | - Xiaopeng Li
- Department of Neurosurgery, The First Hospital of Handan City, Handan, 056000, P.R. China
| | - Ya Liu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, P.R. China.
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Hazra D, Chandy GM, Ghosh AK. Surgical Outcome of Basal Ganglia Hemorrhage: A Retrospective Analysis of Nearly 3,000 Cases over 10 Years. Asian J Neurosurg 2023; 18:742-750. [PMID: 38161616 PMCID: PMC10756771 DOI: 10.1055/s-0043-1776049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Basal ganglia hemorrhage (BGH) is a severe neurologic condition associated with significant morbidity and mortality, and its optimal management remains a topic of debate. Our study assessed the surgical outcomes of BGH patients at the 3-month mark using the modified Rankin Scale (mRS). Methods This retrospective observational study was conducted over 10 years at an advanced neuro-specialty hospital in Eastern India, including patients who underwent decompressive craniotomy and hematoma evacuation. Variables were systematically coded and analyzed to evaluate the postoperative outcome with age (in years), preoperative motor (M) status, and hematoma volume. Results This study enrolled 2,989 patients with a mean age of 59.62 (standard deviation: 9.64) years, predominantly males ( n = 2,427; 81.2%). Hypertension (1,612 cases) and diabetes mellitus (1,202 cases) were the most common comorbidities. Common clinical presentations included ipsilateral weakness (1,920 cases) and/or altered mental status (1,670 cases). At the 3-month mark postsurgery, 2,129 cases (71.2%) had a favorable outcome based on mRS, while 389 cases (13.0%) had an unfavorable outcome. The regression equation showed that age was inversely related to the percentage of individuals achieving a favorable outcome. It also revealed that the preoperative motor score was positively correlated with favorable outcomes. Hematomas smaller than 60 mL had better outcomes, with 1,311 cases (69.1%) classified as good outcomes and 337 cases (17.8%) as bad outcomes. Fatal outcomes related to the illness were observed in 471 patients (15.8%) within the study population. Conclusion Surgery for BGH showed a substantial improvement in outcomes, particularly in patients with M5/M4 motor status. The preoperative motor score (M status) emerged as a crucial predictor of favorable neurological outcomes. Age and hematoma volume, however, were found to be nondefinitive factors in determining good outcomes.
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Affiliation(s)
- Darpanarayan Hazra
- Department of Emergency Medicine, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Gina M. Chandy
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Amit K. Ghosh
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
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Qiang J, Wang Y, Zhai Q, Zhao J, Yang Y, Wang W. Predictors of unprovoked seizures in intracerebral hemorrhages. Acta Neurol Belg 2023; 123:2195-2200. [PMID: 36871270 DOI: 10.1007/s13760-023-02226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Seizures are a common complication of intracerebral hemorrhage (ICH). We aimed to identify predictors of unprovoked seizures (US) after ICH in a Chinese cohort. METHODS We retrospectively included patients with ICH admitted in the Second Hospital of Hebei Medical University between November 2018 and December 2020. Incidence and risk factors of US were identified with univariate and then multiple Cox regression analysis. We used χ2 test to compare incidence of US between groups with or without prophylactic anti-seizure medications (ASM) in patients with craniotomy. RESULTS A total of 488 patients were included in the cohort, 58 (11.9%) patients developed US within 3 years after ICH. Analysis on the 362 patients without prophylactic ASM showed that craniotomy (HR 8.35, 95% CI 3.80-18.31) and acute symptomatic seizures (ASS) (HR 13.76, 95% CI 3.56-53.17) are independent predictors of US. No significant effect of prophylactic ASM use was found on incidence of US in ICH patients with craniotomy (P = 0.369). CONCLUSIONS Craniotomy and acute symptomatic seizures were independent predictors for unprovoked seizures after ICH, suggesting that more attention should be paid for such patients during follow-up. Whether prophylactic ASM treatment benefits ICH patients underwent craniotomy remains uncertain.
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Affiliation(s)
- Jing Qiang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yanyan Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Qiongqiong Zhai
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jing Zhao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yaping Yang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Weiping Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Wang G, Chen X, Meng L, Liu Y, Dai Y, Wang W. The Application Effect of Craniotomy through Transsylvian Rolandic Point-Insular Approach on Hypertensive Intracerebral Hemorrhage in Posterior Basal Ganglia. Behav Neurol 2023; 2023:2266691. [PMID: 38074419 PMCID: PMC10699897 DOI: 10.1155/2023/2266691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Objective To evaluate the hematoma clearance and safety of small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach for patients with hypertensive intracerebral hemorrhage (HICH) in posterior basal ganglia. Methods This retrospective study enrolled a total of 86 patients with HICH in the posterior basal ganglia region who underwent surgery between January 2020 and December 2021. These patients were divided into two groups: the conventional group and the study group. The intraoperative information, postoperative hematoma clearance rate, increasing rate of cerebral edema and rebleeding occurrence rate, postoperative complication rate, and prognoses were compared between the two groups. Additionally, we observed and compared the rate of postoperative cerebral hematoma increase, as well as the neurological function and activities of daily living (ADL) at admission, 3 months, and 6 months after surgery in both groups. Univariate and multivariate logistic regression analyses were performed to explore factors affecting the prognosis of patients with HICH in the posterior basal ganglia region after small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach. Results The study group exhibited significantly shorter automatic eye-opening times and hospital stays compared to the conventional group (P < 0.05). Furthermore, the study group demonstrated better hematoma clearance rates, lower rates of cerebral hematoma at postoperative 48 h and 72 h, and lower rates of rebleeding compared to the conventional group (P < 0.05). At 3 and 6 months postsurgery, the study group exhibited a significantly greater improvement in neurological function and ADL compared to the conventional group (P < 0.05). Additionally, the incidence of postoperative complications in the study group was lower than that in the conventional group (P < 0.05). Furthermore, the prognosis of the study group was significantly better than that of the conventional group at the 6-month follow-up (P < 0.05). Conclusion A small bone window craniotomy via transsylvian Rolandic point-insular approach has been shown to improve the hematoma clearance rate in patients with HICH in the posterior basal ganglia region while also reducing the incidence of complications. This approach is highly safe and feasible for implementation in clinical practice.
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Affiliation(s)
- Guobing Wang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Xin Chen
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Linghu Meng
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Ying Liu
- Department of Gynecology and Obstetrics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Yongjian Dai
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Wenxin Wang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
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Kamabu LK, Oboth R, Bbosa G, Baptist SJ, Kaddumukasa MN, Deng D, Lekuya HM, Kataka LM, Kiryabwire J, Moses G, Sajatovic M, Kaddumukasa M, Fuller AT. Predictive models for occurrence of expansive intracranial hematomas and surgical evacuation outcomes in traumatic brain injury patients in Uganda: A prospective cohort study. RESEARCH SQUARE 2023:rs.3.rs-3626631. [PMID: 38045250 PMCID: PMC10690308 DOI: 10.21203/rs.3.rs-3626631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hematoma expansion is a common manifestation of acute intracranial hemorrhage (ICH) which is associated with poor outcomes and functional status. Objective We determined the prevalence of expansive intracranial hematomas (EIH) and assessed the predictive model for EIH occurrence and surgical evacuation outcomes in patients with traumatic brain injury (TBI) in Uganda. Methods We recruited adult patients with TBI with intracranial hematomas in a prospective cohort study. Data analysis using logistic regression to identify relevant risk factors, assess the interactions between variables, and developing a predictive model for EIH occurrence and surgical evacuation outcomes in TBI patients was performed. The predictive accuracies of these algorithms were compared using the area under the receiver operating characteristic curve (AUC). A p-values of < 0.05 at a 95% Confidence interval (CI) was considered significant. Results A total of 324 study participants with intracranial hemorrhage were followed up for 6 months after surgery. About 59.3% (192/324) had expansive intracranial hemorrhage. The study participants with expansive intracranial hemorrhage had poor quality of life at both 3 and 6-months with p < 0.010 respectively. Among the 5 machine learning algorithms, the random forest performed the best in predicting EIH in both the training cohort (AUC = 0.833) and the validation cohort (AUC = 0.734). The top five features in the random forest algorithm-based model were subdural hematoma, diffuse axonal injury, systolic and diastolic blood pressure, association between depressed fracture and subdural hematoma. Other models demonstrated good discrimination with AUC for intraoperative complication (0.675) and poor discrimination for mortality (0.366) after neurosurgical evacuation in TBI patients. Conclusion Expansive intracranial hemorrhage is common among patients with traumatic brain injury in Uganda. Early identification of patients with subdural hematoma, diffuse axonal injury, systolic and diastolic blood pressure, association between depressed fracture and subdural hematoma, were crucial in predicting EIH and intraoperative complications.
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137
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de Courcy L, Connaughton J. Spontaneous rectal sheath bleed while on DOAC anticoagulation. BMJ Case Rep 2023; 16:e254313. [PMID: 37993147 PMCID: PMC10668200 DOI: 10.1136/bcr-2022-254313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 11/24/2023] Open
Abstract
A man in his 80s was transferred from his nursing home residence with sudden onset right-sided abdominal pain. The nursing home staff reported that he was walking to the bathroom when he became diaphoretic, reported he was feeling unwell, then sat on the ground and was reluctant to move. Past medical history was significant for longstanding atrial fibrillation for which he was taking apixaban 2.5 mg twice daily. A CT scan of the abdomen and pelvis was performed which showed a 21×11 cm rectus sheath haematoma on the right extending into the lumbar region. Surgical review advised no invasive intervention. Two units of red cell concentrate were transfused and he was monitored for 5 days before being transferred back to the nursing home.
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Affiliation(s)
- Louis de Courcy
- General Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Ireland
| | - John Connaughton
- Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Ireland
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Suehiro E, Ishihara H, Kogeichi Y, Ozawa T, Haraguchi K, Honda M, Honda Y, Inaba M, Kabeya R, Kanda N, Koketsu K, Murakami N, Nakamoto H, Oshio K, Saigusa K, Shuto T, Sugiyama S, Suzuyama K, Terashima T, Tsuura M, Nakada M, Kobata H, Higashi T, Sakai N, Suzuki M. Retrospective Observational Study of Patients With Subdural Hematoma Treated With Idarucizumab. Neurotrauma Rep 2023; 4:790-796. [PMID: 38028276 PMCID: PMC10659013 DOI: 10.1089/neur.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Use of anticoagulants is increasing with the aging of societies. The safe first-line drug is likely to be a direct oral anticoagulant (DOAC), but outcomes of treatment of traumatic brain injury (TBI) with anticoagulants are uncertain. Therefore, we examined the clinical effect of idarucizumab as reversal therapy in elderly patients with TBI who were treated with dabigatran. A retrospective multi-center observational study was performed in patients ≥65 years of age who developed acute traumatic subdural hematoma during treatment with dabigatran and underwent reversal therapy with idarucizumab. The items examined included patient background, neurological and imaging findings at arrival, course after admission, complications, and outcomes. A total of 23 patients were enrolled in the study. The patients had a mean age of 78.9 years. Cause of TBI was fall in 60.9% of the subjects. Mean Glasgow Coma Scale score at arrival was 8.7; anisocoria was present in 31.8% of cases. Exacerbation of consciousness was found in 30.4%, but only in 13.3% of subjects treated with idarucizumab before consciousness and imaging findings worsened. Dabigatran was discontinued in 81.8% of cases after hematoma development, with a mean withdrawal period of 12.1 days. The favorable outcome rate was 21.7%, and mortality was 39.1%. In multi-variate analysis, timing of idarucizumab administration was associated with a favorable outcome. There were ischemic complications in 3 cases (13.1%), and all three events occurred ≥7 days after administration of idarucizumab. These findings suggest that in cases that develop hematoma during treatment with dabigatran, it is important to administer idarucizumab early and restart dabigatran after conditions stabilize.
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Affiliation(s)
- Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan
| | - Yohei Kogeichi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Koichi Haraguchi
- Department of Neurosurgery, Hakodate Shintoshi Hospital, Hakodate, Japan
| | - Masaru Honda
- Department of Neurosurgery, Shunan Memorial Hospital, Kudamatsu, Japan
| | - Yumie Honda
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Japan
| | - Makoto Inaba
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Ryusuke Kabeya
- Department of Neurosurgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoaki Kanda
- Department of Neurology, Imamura General Hospital, Kagoshima, Japan
| | - Kenta Koketsu
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Japan
| | - Nobukuni Murakami
- Department of Neurosurgery, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan
| | | | - Kotaro Oshio
- Department of Neurosurgery, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Kuniyasu Saigusa
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Shuichi Sugiyama
- Department of Neurosurgery, Yamaguchi Rosai Hospital, Sanyoonoda, Japan
| | - Kenji Suzuyama
- Department of Neurosurgery, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Tsuguaki Terashima
- Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Mitsuharu Tsuura
- Department of Neurosurgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Hitoshi Kobata
- Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi Graduate School of Medicine, Ube, Japan
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients. J Stroke Cerebrovasc Dis 2023; 32:107327. [PMID: 37677895 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Xing Y, Cheng H, Yang C, Xiao Z, Yan C, Chen F, Li J, Zhang Y, Cui C, Li J, Liu C. Evaluation of skin sympathetic nervous activity for classification of intracerebral hemorrhage and outcome prediction. Comput Biol Med 2023; 166:107397. [PMID: 37804780 DOI: 10.1016/j.compbiomed.2023.107397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/02/2023] [Accepted: 08/26/2023] [Indexed: 10/09/2023]
Abstract
Classification and outcome prediction of intracerebral hemorrhage (ICH) is critical for improving the survival rate of patients. Early or delayed neurological deterioration is common in ICH patients, which may lead to changes in the autonomic nervous system (ANS). Therefore, we proposed a new framework for ICH classification and outcome prediction based on skin sympathetic nervous activity (SKNA) signals. A customized measurement device presented in our previous papers was used to collect data. 117 subjects (50 healthy control subjects and 67 ICH patients) were recruited for this study to obtain their 5-min electrocardiogram (ECG) and SKNA signals. We extracted the signal's time-domain, frequency-domain, and nonlinear features and analyzed their differences between healthy control subjects and ICH patients. Subsequently, we established the ICH classification and outcome evaluation model based on the eXtreme Gradient Boosting (XGBoost). In addition, heart rate variability (HRV) as an ANS assessment method was also included as a comparison method in this study. The results showed significant differences in most features of the SKNA signal between healthy control subjects and ICH patients. The ICH patients with good outcomes have a higher change rate and complexity of SKNA signal than those with bad outcomes. In addition, the accuracy of the model for ICH classification and outcome prediction based on the SKNA signal was more than 91% and 83%, respectively. The ICH classification and outcome prediction based on the SKNA signal proved to be a feasible method in this study. Furthermore, the features of change rate and complexity, such as entropy measures, can be used to characterize the difference in SKNA signals of different groups. The method can potentially provide a new tool for rapid classification and outcome prediction of ICH patients. Index Terms-intracerebral hemorrhage (ICH), skin sympathetic nervous activity (SKNA), classification, outcome prediction, cardiovascular and cerebrovascular diseases.
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Affiliation(s)
- Yantao Xing
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Hongyi Cheng
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210096, China
| | - Chenxi Yang
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Zhijun Xiao
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Chang Yan
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - FeiFei Chen
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Jiayi Li
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Yike Zhang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210096, China
| | - Chang Cui
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210096, China
| | - Jianqing Li
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China.
| | - Chengyu Liu
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China.
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141
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Lal A, Wahab A, Tekin A, Lahori S, Park JG. Pre-hospital use of direct oral anticoagulants agents is associated with a lower risk of major bleeding events in critically ill patients: A single academic center experience. Heart Lung 2023; 62:264-270. [PMID: 37633010 DOI: 10.1016/j.hrtlng.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The last decade has witnessed significant advancements in direct oral anticoagulants (DOACs), transforming the landscape of anticoagulation therapy. With the uptrend in DOACs use, critical care physicians are encountering more patients with pre-hospital DOACs prescription. Safety and real world outcomes-related data on DOACs use in critically ill patients are scarce. OBJECTIVE We assess the risk of major bleeding (MB) events and patient-centered outcomes with pre-hospital use of direct oral anticoagulant agents (DOACs) compared to warfarin therapy. METHODS Observational study in a single large academic center from January 1st, 2012, through May 4th, 2018. We included adult critically ill patients with warfarin or one of the DOACs, as active medications at the time of hospital admission. The primary outcome was major bleeding (MB), based on the ISTH criteria RESULTS: 99,481 patients were screened; 558 and 3037 patients were included in the final analysis for the DOAC and warfarin groups, respectively. Multivariable analysis showed that the pre-hospital use of DOACs was associated with lower odds for major bleeding events, GI bleeding, need for endoscopic intervention, hemorrhagic shock, any blood transfusion; but higher odds of intracranial bleeding, as compared to warfarin use. There was no difference in hospital length of stay or ICU-free days. CONCLUSIONS Pre-hospital use of DOACs among critically ill patients is associated with lower major bleeding events, GI bleeding, need for endoscopic intervention, and blood transfusion but a higher risk for intracranial bleeding.
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Affiliation(s)
- Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Abdul Wahab
- Division of Hospital Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Aysun Tekin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Simmy Lahori
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - John G Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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142
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Wong YS, Tsai CF, Ong CT. The impact of antiplatelet drugs on recurrent stroke in patients with intracerebral hemorrhage. Heliyon 2023; 9:e21988. [PMID: 38027841 PMCID: PMC10663914 DOI: 10.1016/j.heliyon.2023.e21988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/30/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background The influence of antiplatelet drugs on the risk of hemorrhagic stroke and the reduction of ischemic stroke in patients with intracerebral hemorrhage (ICH) remains unclear. This study aimed to elucidate the impact of antiplatelet therapy on the risk of recurrent stroke in ICH patients. Methods The study encompassed ICH survivors discharged from a central Taiwanese teaching hospital between January 1, 2013, and December 31, 2019. Patient hospitalization and treatment data were retrieved from electronic medical records. The primary endpoint was re-hospitalization due to ischemic or hemorrhagic stroke. Patients who continued antiplatelet drug use for over a month prior to stroke recurrence constituted the antiplatelet drug use group. Risk factors for recurrent hemorrhagic and ischemic strokes were evaluated using binary logistic regression. Results The study incorporated 407 ICH patients, each monitored for 4 years post-stroke. Recurrent stroke incidence showed no significant disparity between hemorrhagic and ischemic strokes. Hemorrhagic stroke recurrence stood at 5.16 % (21/407), and ischemic stroke recurrence was 4.42 % (18/407). In the non-antiplatelet group, hemorrhagic and ischemic stroke rates were 5.48 % (20/365) and 3.56 % (13/365) respectively. In the antiplatelet group, the rates were 2.38 % (1/42) for hemorrhagic and 11.9 % (5/42) for ischemic stroke, with a significantly higher ischemic stroke rate (p = 0.03). Hypertension emerged as a risk factor for recurrent hemorrhagic stroke, while diabetes mellitus was identified as a risk factor for ischemic stroke. Antiplatelet drug use did not escalate the risk of recurrent ICH. Conclusion Diabetes mellitus and hypertension are risk factors for recurrent ischemic and hemorrhagic strokes respectively in ICH patients. Antiplatelet therapy does not appear to elevate the risk of recurrent hemorrhagic stroke in these patients.
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Affiliation(s)
- Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
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143
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Wang H, Chen J, Gao Z, Zeng Z. Iatrogenic pseudoaneurysm rupture of the middle cerebral artery after an intracranial pressure monitor placement: a case report and literature review. Neurol Sci 2023; 44:4103-4106. [PMID: 37561233 PMCID: PMC10570186 DOI: 10.1007/s10072-023-06987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
Thalamic hemorrhage (TH) is a devastating disease with a high mortality rate; however, no specific form of therapy has been proven to reduce mortality. Patients with hemorrhagic stroke undergo intracranial pressure (ICP) monitoring. However, cases involving pseudoaneurysms caused by ICP monitoring in patients with intracerebral hemorrhage have not been reported previously. Here, we report a case of pseudoaneurysm caused by an ICP monitor that was fitted due to hypertensive cerebral hemorrhage.
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Affiliation(s)
- Haibin Wang
- Institute of Neurology, Department of Neurosurgery, The First Affiliated Hospital of Gannan Medical University, No. 23Qingnian Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China
| | - Jinming Chen
- Institute of Neurology, Department of Neurosurgery, The First Affiliated Hospital of Gannan Medical University, No. 23Qingnian Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China
| | - Zhiqiang Gao
- Institute of Neurology, Department of Neurosurgery, The First Affiliated Hospital of Gannan Medical University, No. 23Qingnian Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China
| | - Zhaobin Zeng
- Institute of Neurology, Department of Neurosurgery, The First Affiliated Hospital of Gannan Medical University, No. 23Qingnian Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China.
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144
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Serrano E, Moreno J, Llull L, Rodríguez A, Zwanzger C, Amaro S, Oleaga L, López-Rueda A. Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma. RADIOLOGIA 2023; 65:519-530. [PMID: 38049251 DOI: 10.1016/j.rxeng.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/03/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.
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Affiliation(s)
- E Serrano
- Departamento Radiología, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - J Moreno
- Clínica Iribas-IRM, Asunción, Paraguay
| | - L Llull
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - A Rodríguez
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - C Zwanzger
- Departamento Radiología, Hospital del Mar, Barcelona, Spain
| | - S Amaro
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - L Oleaga
- Departamento Radiología, Hospital Clínic, Barcelona, Spain
| | - A López-Rueda
- Departamento Radiología, Hospital Clínic, Barcelona, Spain; Servicio de Informática Clínica, Hospital Clínic, Barcelona, Spain.
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145
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Mazurek MH, Parasuram NR, Peng TJ, Beekman R, Yadlapalli V, Sorby-Adams AJ, Lalwani D, Zabinska J, Gilmore EJ, Petersen NH, Falcone GJ, Sujijantarat N, Matouk C, Payabvash S, Sze G, Schiff SJ, Iglesias JE, Rosen MS, de Havenon A, Kimberly WT, Sheth KN. Detection of Intracerebral Hemorrhage Using Low-Field, Portable Magnetic Resonance Imaging in Patients With Stroke. Stroke 2023; 54:2832-2841. [PMID: 37795593 PMCID: PMC11103256 DOI: 10.1161/strokeaha.123.043146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Neuroimaging is essential for detecting spontaneous, nontraumatic intracerebral hemorrhage (ICH). Recent data suggest ICH can be characterized using low-field magnetic resonance imaging (MRI). Our primary objective was to investigate the sensitivity and specificity of ICH on a 0.064T portable MRI (pMRI) scanner using a methodology that provided clinical information to inform rater interpretations. As a secondary aim, we investigated whether the incorporation of a deep learning (DL) reconstruction algorithm affected ICH detection. METHODS The pMRI device was deployed at Yale New Haven Hospital to examine patients presenting with stroke symptoms from October 26, 2020 to February 21, 2022. Three raters independently evaluated pMRI examinations. Raters were provided the images alongside the patient's clinical information to simulate real-world context of use. Ground truth was the closest conventional computed tomography or 1.5/3T MRI. Sensitivity and specificity results were grouped by DL and non-DL software to investigate the effects of software advances. RESULTS A total of 189 exams (38 ICH, 89 acute ischemic stroke, 8 subarachnoid hemorrhage, 3 primary intraventricular hemorrhage, 51 no intracranial abnormality) were evaluated. Exams were correctly classified as positive or negative for ICH in 185 of 189 cases (97.9% overall accuracy). ICH was correctly detected in 35 of 38 cases (92.1% sensitivity). Ischemic stroke and no intracranial abnormality cases were correctly identified as blood-negative in 139 of 140 cases (99.3% specificity). Non-DL scans had a sensitivity and specificity for ICH of 77.8% and 97.1%, respectively. DL scans had a sensitivity and specificity for ICH of 96.6% and 99.3%, respectively. CONCLUSIONS These results demonstrate improvements in ICH detection accuracy on pMRI that may be attributed to the integration of clinical information in rater review and the incorporation of a DL-based algorithm. The use of pMRI holds promise in providing diagnostic neuroimaging for patients with ICH.
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Affiliation(s)
- Mercy H. Mazurek
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Teng J. Peng
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Annabel J. Sorby-Adams
- Department of Neurology, Division of Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Dheeraj Lalwani
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Julia Zabinska
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Emily J. Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Nils H. Petersen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Sam Payabvash
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Gordon Sze
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Steven J. Schiff
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Yale Center for Brain & Mind Heath, Yale School of Medicine, New Haven, CT, USA
| | - Juan Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Centre for Medical Image Computing, University College London, London, UK
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew S. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - W. Taylor Kimberly
- Department of Neurology, Division of Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Yale Center for Brain & Mind Heath, Yale School of Medicine, New Haven, CT, USA
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Noiphithak R, Phumichard T, Ratanavinitkul W, Rukskul P. Prediction of Permanent Shunt Dependency in Patients with Intraventricular Hemorrhage: Outcomes of Early External Ventricular Drainage Weaning Protocol. World Neurosurg 2023; 179:e575-e581. [PMID: 37689359 DOI: 10.1016/j.wneu.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Hydrocephalus remains a common sequela of intraventricular hemorrhage (IVH) despite adequate drainage of the hematoma, including endoscopic surgery, intraventricular fibrinolysis, and external ventricular drainage (EVD). Moreover, the appropriate timing for conversion from EVD to ventriculoperitoneal shunt (VPS) is uncertain. This study aimed to evaluate the predictors of shunt dependency in patients with IVH based on the early EVD weaning protocol in our institution. METHODS We retrospectively reviewed medical records of patients who were diagnosed with primary IVH and secondary IVH from spontaneous intracerebral hemorrhage during the period 2018-2021. Predictors associated with shunt dependency were identified using a logistic regression model. The cutoff point of each variable was selected by receiver operating characteristic curve analysis. Furthermore, shunt complications were reported as a safety measure of our early EVD weaning protocol. RESULTS The analysis included 106 patients. After IVH treatment, 15 (14%) patients required ventriculoperitoneal shunt, whereas 91 (86%) patients were shunt-free. The diameter of posttreatment temporal horn and the degree of IVH reduction were the significant predictors of shunt dependency. Moreover, patients with IVH reduction of >45% and temporal horn diameter of <9 mm had a lower probability of shunt dependency. Shunt failure was found in 2 (13.3%) patients. CONCLUSIONS This study showed that a large temporal horn diameter and a lower degree of IVH removal were predictors of shunt dependency in patients with IVH. In addition, early conversion from EVD to ventriculoperitoneal shunt is safe and feasible.
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Affiliation(s)
- Raywat Noiphithak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand.
| | - Thapakorn Phumichard
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand
| | - Warot Ratanavinitkul
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand
| | - Pataravit Rukskul
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand
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147
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Ding Y, Xu Y, Wang Y, Dong J. A nomogram risk prediction model for poor outcome of primary brainstem hemorrhage based on clinical data and radiographic features. Neurol Sci 2023; 44:3967-3978. [PMID: 37213039 DOI: 10.1007/s10072-023-06866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Primary brainstem hemorrhage (PBSH) is a devastating acute neurological disorder with a poor prognosis. This study aimed to identify risk factors associated with poor outcomes in PBSH patients and develop a novel nomogram for predicting prognosis, with external validation. METHODS A total of 379 patients with PBSH were included in the training cohort. The primary outcome of interest was a modified Rankin Scale score (mRS) of 4-6 at 90 days post-onset. Multivariable logistic regression was used to construct a nomogram based on relevant variables. Model performance was tested in the training cohort and externally validated for discriminatory ability, calibration, and clinical utility at a separate institution. The nomogram was also compared to the ICH score in terms of predictive ability. RESULTS The poor outcome rate at 90 days was 57.26% (217/379) in the training cohort and 61.27% (106/173) in the validation cohort. Multivariable logistic regression analysis identified age, Glasgow Coma Scale (GCS) score, and hematoma size as significant risk factors for poor outcomes. Nomograms based on these variables demonstrated good discrimination, with an area under the curve (AUC) of 0.855 and 0.836 in the training and validation cohorts, respectively. Furthermore, the nomogram showed superior predictive value to the ICH score for the 90-day outcome in both cohorts. CONCLUSION This study developed and externally validated a nomogram risk prediction model for predicting poor outcomes at 90 days in patients with PBSH, using age, GCS score, and hematoma size as predictors. The nomogram demonstrated good discrimination, calibration, and clinical validity, serving as a valuable assessment and decision-making tool.
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Affiliation(s)
- Yingying Ding
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, The 904Th Hospital of PLA), Wuxi, 214044, Jiangsu Province, China
| | - Yawen Xu
- Department of Emergency Medicine, Wuxi Clinical College of Anhui Medical University, The 904Th Hospital of PLA), Wuxi, 214044, Jiangsu Province, China
| | - Yuhai Wang
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, The 904Th Hospital of PLA), Wuxi, 214044, Jiangsu Province, China
| | - Jirong Dong
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University, The 904Th Hospital of PLA), Wuxi, 214044, Jiangsu Province, China.
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148
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Kamabu LK, Bbosa GS, Lekuya HM, Cho EJ, Kyaruzi VM, Nyalundja AD, Deng D, Sekabunga JN, Kataka LM, Obiga DOD, Kiryabwire J, Kaddumukasa MN, Kaddumukasa M, Fuller AT, Galukande M. Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design. BMC Surg 2023; 23:326. [PMID: 37880635 PMCID: PMC10601114 DOI: 10.1186/s12893-023-02227-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). METHODS A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. RESULTS Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH. CONCLUSION EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH.
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Affiliation(s)
- Larrey Kasereka Kamabu
- Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda.
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
- Department of Surgery, Makerere University College of Health Medicine, Mulago Upper Hill, Kampala, Uganda.
| | - Godfrey S Bbosa
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hervé Monka Lekuya
- Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda
- Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda
- Department of Human Structure & Repair/ Neurosurgery, Faculty of Medicine, Ghent University, Ghent, Belgium
| | | | - Victor Meza Kyaruzi
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of the Congo
| | - Daniel Deng
- Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC, USA
| | - Juliet Nalwanga Sekabunga
- Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda
- Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda
| | - Louange Maha Kataka
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Doomwin Oscar Deogratius Obiga
- Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda
- Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda
| | - Joel Kiryabwire
- Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda
- Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke University, Durham, NC, USA
- Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC, USA
| | - Moses Galukande
- Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda
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Morotti A, Boulouis G, Nawabi J, Li Q, Charidimou A, Pasi M, Schlunk F, Shoamanesh A, Katsanos AH, Mazzacane F, Busto G, Arba F, Brancaleoni L, Giacomozzi S, Simonetti L, Warren AD, Laudisi M, Cavallini A, Gurol ME, Viswanathan A, Zini A, Casetta I, Fainardi E, Greenberg SM, Padovani A, Rosand J, Goldstein JN. Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume. Neurology 2023; 101:e1606-e1613. [PMID: 37604661 PMCID: PMC10585678 DOI: 10.1212/wnl.0000000000207728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE. METHODS This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression. RESULTS We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%, p < 0.001 and 18.3% vs 7.2%, p < 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82, p < 0.001; aHE OR 1.73, 95% CI 1.23-2.45, p = 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL. DISCUSSION The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.
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Affiliation(s)
- Andrea Morotti
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
| | - Gregoire Boulouis
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jawed Nawabi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Qi Li
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andreas Charidimou
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Marco Pasi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Frieder Schlunk
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Ashkan Shoamanesh
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Aristeidis H Katsanos
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Federico Mazzacane
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Giorgio Busto
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Francesco Arba
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Laura Brancaleoni
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Sebastiano Giacomozzi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Luigi Simonetti
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrew D Warren
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Michele Laudisi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anna Cavallini
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrea Zini
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Ilaria Casetta
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Enrico Fainardi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Padovani
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Joshua N Goldstein
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
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Wang Y, Chen Y, Chen R, Xu Y, Zheng H, Xu J, Xia J, Cai Y, Xu H, Wang X. Development and validation of a nomogram model for prediction of stroke-associated pneumonia associated with intracerebral hemorrhage. BMC Geriatr 2023; 23:633. [PMID: 37805464 PMCID: PMC10559607 DOI: 10.1186/s12877-023-04310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND We aimed to establish risk factors for stroke-associated pneumonia (SAP) following intracerebral hemorrhage (ICH) and develop an efficient and convenient model to predict SAP in patients with ICH. METHODS Our study involved 1333 patients consecutively diagnosed with ICH and admitted to the Neurology Department of the First Affiliated Hospital of Wenzhou Medical University. The 1333 patients were randomly divided (3:1) into the derivation cohort (n = 1000) and validation Cohort (n = 333). Variables were screened from demographics, lifestyle-related factors, comorbidities, clinical symptoms, neuroimaging features, and laboratory tests. In the derivation cohort, we developed a prediction model with multivariable logistic regression analysis. In the validation cohort, we assessed the model performance and compared it to previously reported models. The area under the receiver operating characteristic curve (AUROC), GiViTI calibration belt, net reclassification index (NRI), integrated discrimination index (IDI) and decision curve analysis (DCA) were used to assess the prediction ability and the clinical decision-making ability. RESULTS The incidence of SAP was 19.9% and 19.8% in the derivation (n = 1000) and validation (n = 333) cohorts, respectively. We developed a nomogram prediction model including age (Odds Ratio [OR] 1.037, 95% confidence interval [CI] 1.020-1.054), male sex (OR 1.824, 95% CI 1.206-2.757), multilobar involvement (OR 1.851, 95% CI 1.160-2.954), extension into ventricles (OR 2.164, 95% CI 1.456-3.215), dysphagia (OR 3.626, 95% CI 2.297-5.725), disturbance of consciousness (OR 2.113, 95% CI 1.327-3.362) and total muscle strength of the worse side (OR 0.93, 95% CI 0.876-0.987). Compared with previous models, our model was well calibrated and showed significantly higher AUROC, better reclassification ability (improved NRI and IDI) and a positive net benefit for predicted probability thresholds between 10% and 73% in DCA. CONCLUSIONS We developed a simple, valid, and clinically useful model to predict SAP following ICH, with better predictive performance than previous models. It might be a promising tool to assess the individual risk of developing SAP for patients with ICH and optimize decision-making.
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Affiliation(s)
- Ying Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Graduate school, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuting Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Graduate school, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Roumeng Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Graduate school, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuchen Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Han Zheng
- First Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiajun Xu
- First Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinyang Xia
- First Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yifan Cai
- First Clinical School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huiqin Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Department of Geriatrics, Geriatric Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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