1
|
Vardanyan R, Hagana A, Iqbal H, Arjomandi Rad A, Mahmud M, Ruparell K, Rabee N, Khan J, Poole W, Shakir RA. A Cost Utility Analysis of Minimally Invasive Surgery with Thrombolysis Compared to Standard Medical Treatment in Spontaneous Intracerebral Haemorrhagic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105934. [PMID: 34167871 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Standard medical management of spontaneous intracerebral haemorrhage (ICH) and surgical hematoma evacuation starkly differ, and whilst landmark randomised control trials report no clinical benefit of early surgical evacuation compared with medical treatment in supratentorial ICH, minimally invasive surgery (MIS) with thrombolysis has been neglected within these studies. However, recent technological advancements in MIS have renewed interest in the surgical treatment of ICH. Several economic evaluations have focused on the benefits of MIS in ischaemic stroke management, but no economic evaluations have yet been performed comparing MIS to standard medical treatment for ICH. MATERIALS AND METHOD All costs were sourced from the UK in GBP. Where possible, the 2019/2020 NHS reference costs were used. The MISTIE III study was used to analyse the outcomes of patients undergoing either MIS or standard medical treatment in this economic evaluation. RESULTS The incremental cost-effectiveness ratio (ICER) for MIS was £485,240.26 for every quality-adjusted life year (QALY) gained. Although MIS resulted in a higher QALY compared to medical treatment, the gain was insignificant at 0.011 QALY. Four sensitivity analyses based on combinations of alternative EQ-5D values and categorisation of MIS outcomes, alongside alterations to the cost of significant adverse events, were performed to check the robustness of the ICER calculation. The most realistic sensitivity analysis showed a potential increase in cost effectiveness when clot size is reduced to <15ml, with the ICER falling to £74,335.57. DISCUSSION From the perspective of the NHS, MIS with thrombolysis is not cost-effective compared to optimal medical treatment. ICER shows that intention-to-treat MIS would require a cost of £485,240.26 to gain one extra QALY, which is significantly above the NHS threshold of £30,000. Further UK studies with ICH survivor utilities, more replicable surgical technique, and the reporting of clot size reduction are indicated as the present sensitivity analysis suggests that MIS is promising. Greater detail about outcomes and complications would ensure improved cost-benefit analyses and support valid and efficient allocation of resources by the NHS.
Collapse
Affiliation(s)
- Robert Vardanyan
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
| | - Arwa Hagana
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Haseeb Iqbal
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Arian Arjomandi Rad
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Kajal Ruparell
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Nuha Rabee
- School of Medicine and Dentistry, Barts and The London, Queen Mary, University of London, London, United Kingdom
| | - Javad Khan
- Faculty of Medicine, King's College London, London, United Kingdom
| | - William Poole
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Raad A Shakir
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Wilkinson CM, Kung TF, Jickling GC, Colbourne F. A translational perspective on intracranial pressure responses following intracerebral hemorrhage in animal models. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
3
|
Al-Khaled M, Awwad S, Brüning T. Nontraumatic spontaneous intracerebral hemorrhage: Baseline characteristics and early outcomes. Brain Behav 2020; 10:e01512. [PMID: 31838785 PMCID: PMC6955838 DOI: 10.1002/brb3.1512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/17/2019] [Accepted: 11/29/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND PURPOSE Hemorrhagic stroke, particularly nontraumatic spontaneous intracerebral hemorrhage (SICH), is a cerebrovascular condition with unfavorable outcomes. The aims of the present study were to evaluate patients who suffered from SICH and investigate the early outcomes in a single-center study. METHODS During a study -period of 6 years (2008-2014), 613 consecutive patients (mean age, 72 ± 12.7 years; 51.1% female), who suffered from nontraumatic SICH and were treated at the Department of Neurology at the University Hospital of Schleswig-Holstein, Campus Lübeck, Germany, were included and prospectively analyzed. RESULTS During a mean hospitalization time of 12 days, 148 patients (24.1%) died, 47% of those within the first 2 days and 79% within the first week. The patients who died stayed at the hospital for a shorter time (3) than those who survived (p < .001). In the multivariate logistic regression, following parameters were found to be associated with the in-hospital mortality: female sex (OR, 2.0; 95%-CI, 1.2-3.4; p = .009), a NIHSS score> 10 (OR, 10.5; 95%-CI, 5.6-19.5; p < .001), history of hypertension (OR, 0.35; 95%-CI, 0.19-0.64; p = .001), previous oral anticoagulation (OR, 2; 95%-CI, 1.0-3.8; p = .032), and intraventricular extension of hemorrhage (OR, 2.8; 95%-CI, 1.7-4.7; p = .001). At discharge, 192 patients (41.2%) showed favorable outcomes (mRS ≤ 2) whereas the median mRS of patients who survived was 3 (IQR 2-4). The good functional outcome at discharge from the acute hospital was decreased by an age> 70 years (OR, 0.56; 95%-CI, 0.35-0.9; p = .017), NIHSS score> 10 at admission (OR, 0.07; 95%-CI, 0.04-0.13; p < .001), and development of pneumonia during hospitalization (OR, 0.35; 95%-CI, 0.2-0.6; p < .001). CONCLUSION The present study showed that SICH is a serious disease causing high mortality and disability, particularly in the early period after event.
Collapse
Affiliation(s)
| | - Samer Awwad
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Toralf Brüning
- Department of Neurology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
4
|
Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era. World Neurosurg 2019; 122:e961-e968. [DOI: 10.1016/j.wneu.2018.10.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 11/20/2022]
|
5
|
Al-Mufti F, Cohen ER, Amuluru K, Patel V, El-Ghanem M, Nuoman R, Majmundar N, Dangayach NS, Meyers PM. Bailout Strategies and Complications Associated with the Use of Flow-Diverting Stents for Treating Intracranial Aneurysms. INTERVENTIONAL NEUROLOGY 2018; 8:38-54. [PMID: 32231694 DOI: 10.1159/000489016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
Abstract
Background Flow-diverting stents (FDS) have revolutionized the endovascular management of unruptured, complex, wide-necked, and giant aneurysms. There is no consensus on management of complications associated with the placement of these devices. This review focuses on the management of complications of FDS for the treatment of intracranial aneurysms. Summary We performed a systematic, qualitative review using electronic databases MEDLINE and Google Scholar. Complications of FDS placement generally occur during the perioperative period. Key Message Complications associated with FDS may be divided into periprocedural complications, immediate postprocedural complications, and delayed complications. We sought to review these complications and novel management strategies that have been reported in the literature.
Collapse
Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.,Departments of Neurology and Neurosurgery, Rutgers University - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Eric R Cohen
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Krishna Amuluru
- Department of Neurointerventional Radiology, University of Pittsburgh-Hamot, Erie, Pennsylvania, USA
| | - Vikas Patel
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Mohammad El-Ghanem
- Department of Neurology and Medical Imaging, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Rolla Nuoman
- Department of Neurology, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA
| | - Neil Majmundar
- Departments of Neurology and Neurosurgery, Rutgers University - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Neha S Dangayach
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philip M Meyers
- Departments of Radiology and Neurosurgery and Columbia University Medical Center, New York, New York, New York, USA
| |
Collapse
|
6
|
Chiu CD, Chiu YP, Lin CL, Ji HR, Shen CC, Lee HT, Chang C. Acetazolamide alleviates sequelae of hyperglycaemic intracerebral haemorrhage by suppressing astrocytic reactive oxygen species. Free Radic Res 2018; 52:1010-1019. [PMID: 30079794 DOI: 10.1080/10715762.2018.1508838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hyperglycaemia is associated with the poor outcome after intracerebral haemorrhage (ICH). Acetazolamide (AZA), a kind of carbonic anhydrogenase (CA) inhibitor, its effectiveness in ICH had been reported. However, the connections between AZA and ICH, especially in hyperglycaemia condition had never been defined. In this study, adult Sprague-Dawley rats were administered with vehicle or streptozotocin (STZ) to render them into normoglycaemic (NG) or hyperglycaemic (HG), respectively. Collagenase was then injected into the striatum. The NG or HG ICH rats treated with vehicle control or 5 mg/kg AZA (oral gavage) underwent haemorrhagic area assessments on the 1st, 4th, and 7th day after ICH. The coverage of pericytes was examined by immunohistochemistry. Reactive oxygen species (ROS) levels were assessed in mouse astrocyte cell line treated with vehicle or 20 μmol/L of AZA in culture media according to two different glucose concentrations. AZA reduced the haematoma size, improved neurobehavioral functions, suppressed astrocytic ROS production in vitro, and preserved cerebral pericytes coverage, which are even more remarkable in HG conditions. The present study indicates that AZA may alleviate some sequelae after ICH, especially in poorer prognostic HG rats through the suppression of astrocytic ROS production.
Collapse
Affiliation(s)
- Cheng-Di Chiu
- a School of Medicine , China Medical University , Taichung , Taiwan.,b Graduate Institute of Biomedical Science , China Medical University , Taichung , Taiwan.,c Department of Neurosurgery , China Medical University Hospital , Taichung , Taiwan.,d Stroke Center , China Medical University Hospital , Taichung , Taiwan
| | - You-Pen Chiu
- a School of Medicine , China Medical University , Taichung , Taiwan.,d Stroke Center , China Medical University Hospital , Taichung , Taiwan
| | - Cheng-Li Lin
- a School of Medicine , China Medical University , Taichung , Taiwan
| | - Hui-Ru Ji
- b Graduate Institute of Biomedical Science , China Medical University , Taichung , Taiwan.,d Stroke Center , China Medical University Hospital , Taichung , Taiwan
| | - Chiung-Chyi Shen
- e Department of Minimally Invasive Skull Base Neurosurgery , Neurological Institute, Taichung Veterans General Hospital , Taichung , Taiwan
| | - Hsu-Tung Lee
- f Department of Neurosurgical Oncology , Neurological Institute, Taichung Veterans General Hospital , Taichung , Taiwan
| | - Chen Chang
- g Institute of Biomedical Sciences, Academic Sinica , Taipei , Taiwan
| |
Collapse
|
7
|
Chang PD, Kuoy E, Grinband J, Weinberg BD, Thompson M, Homo R, Chen J, Abcede H, Shafie M, Sugrue L, Filippi CG, Su MY, Yu W, Hess C, Chow D. Hybrid 3D/2D Convolutional Neural Network for Hemorrhage Evaluation on Head CT. AJNR Am J Neuroradiol 2018; 39:1609-1616. [PMID: 30049723 DOI: 10.3174/ajnr.a5742] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/06/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Convolutional neural networks are a powerful technology for image recognition. This study evaluates a convolutional neural network optimized for the detection and quantification of intraparenchymal, epidural/subdural, and subarachnoid hemorrhages on noncontrast CT. MATERIALS AND METHODS This study was performed in 2 phases. First, a training cohort of all NCCTs acquired at a single institution between January 1, 2017, and July 31, 2017, was used to develop and cross-validate a custom hybrid 3D/2D mask ROI-based convolutional neural network architecture for hemorrhage evaluation. Second, the trained network was applied prospectively to all NCCTs ordered from the emergency department between February 1, 2018, and February 28, 2018, in an automated inference pipeline. Hemorrhage-detection accuracy, area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value were assessed for full and balanced datasets and were further stratified by hemorrhage type and size. Quantification was assessed by the Dice score coefficient and the Pearson correlation. RESULTS A 10,159-examination training cohort (512,598 images; 901/8.1% hemorrhages) and an 862-examination test cohort (23,668 images; 82/12% hemorrhages) were used in this study. Accuracy, area under the curve, sensitivity, specificity, positive predictive value, and negative-predictive value for hemorrhage detection were 0.975, 0.983, 0.971, 0.975, 0.793, and 0.997 on training cohort cross-validation and 0.970, 0.981, 0.951, 0.973, 0.829, and 0.993 for the prospective test set. Dice scores for intraparenchymal hemorrhage, epidural/subdural hemorrhage, and SAH were 0.931, 0.863, and 0.772, respectively. CONCLUSIONS A customized deep learning tool is accurate in the detection and quantification of hemorrhage on NCCT. Demonstrated high performance on prospective NCCTs ordered from the emergency department suggests the clinical viability of the proposed deep learning tool.
Collapse
Affiliation(s)
- P D Chang
- From the Departments of Radiology (P.D.C., E.K., M.T., R.H., M.-Y.S., D.C.).,Departments of Radiology (P.D.C., L.S., C.H.), University of California, San Francisco, California
| | - E Kuoy
- From the Departments of Radiology (P.D.C., E.K., M.T., R.H., M.-Y.S., D.C.)
| | - J Grinband
- Department of Radiology (J.G.), Columbia University, New York, New York
| | - B D Weinberg
- Department of Radiology (B.D.W.), Emory University School of Medicine, Atlanta, Georgia
| | - M Thompson
- From the Departments of Radiology (P.D.C., E.K., M.T., R.H., M.-Y.S., D.C.)
| | - R Homo
- From the Departments of Radiology (P.D.C., E.K., M.T., R.H., M.-Y.S., D.C.)
| | | | - H Abcede
- Neurology (H.A., M.S., W.Y.), University of California Irvine
| | - M Shafie
- Neurology (H.A., M.S., W.Y.), University of California Irvine
| | - L Sugrue
- Departments of Radiology (P.D.C., L.S., C.H.), University of California, San Francisco, California
| | - C G Filippi
- Department of Radiology (C.G.F.), North Shore University Hospital, Long Island, New York
| | - M-Y Su
- From the Departments of Radiology (P.D.C., E.K., M.T., R.H., M.-Y.S., D.C.)
| | - W Yu
- Neurology (H.A., M.S., W.Y.), University of California Irvine
| | - C Hess
- Departments of Radiology (P.D.C., L.S., C.H.), University of California, San Francisco, California
| | - D Chow
- From the Departments of Radiology (P.D.C., E.K., M.T., R.H., M.-Y.S., D.C.)
| |
Collapse
|
8
|
Al-Mufti F, Amuluru K, Cohen ER, Patel V, El-Ghanem M, Wajswol E, Dodson V, Al-Marsoummi S, Majmundar N, Dangayach NS, Nuoman R, Gandhi CD. Rescue Therapy for Procedural Complications Associated With Deployment of Flow-Diverting Devices in Cerebral Aneurysms. Oper Neurosurg (Hagerstown) 2018; 15:624-633. [DOI: 10.1093/ons/opy020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/15/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Flow diverting devices (FDDs) have revolutionized the treatment of morphologically complex intracranial aneurysms such as wide-necked, giant, or fusiform aneurysms. Although FDDs are extremely effective, they carry a small yet significant risk of intraprocedural complications. As the implementation of these devices increases, the ability to predict and rapidly treat complications, especially those that are iatrogenic or intraprocedural in nature, is becoming increasingly more necessary.
Our objective in this paper is to provide a descriptive summary of the various types of intraprocedural complications that may occur during FDDs deployment and how they may best be treated. A systematic and qualitative review of the literature was conducted using electronic databases MEDLINE and Google Scholar. Searches consisted of Boolean operators “AND” and “OR” for the following terms in different combinations: “aneurysm,” “endovascular,” “flow diverter,” “intracranial,” and “pipeline.”
A total of 94 papers were included in our analysis; approximately 87 of these papers dealt with periprocedural endovascular (mainly related to FDDs) complications and their treatment; 7 studies concerned background material. The main categories of periprocedural complications encountered during deployment of FDDs are failure of occlusion, parent vessel injury and/or rupture, spontaneous intraparenchymal hemorrhage, migration or malposition of the FDDs, thromboembolic or ischemic events, and side branch occlusion
Periprocedural complications occur mainly due to thromboembolic events or mechanical issues related to device deployment and placement. With increasing use and expanding versatility of FDDs, the understanding of these complications is vital in order to effectively manage such situations in a timely manner.
Collapse
Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology, Neuro-surgery, and Radiology, Robert Wood Johnson Medical School, Rutgers Uni-versity, New Brunswick, New Jersey
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Newark, New Jersey
| | - Krishna Amuluru
- Department of Neurointerventional Radiology, University of Pittsburgh Medical Center Hamot, Erie, Pennsylvania
| | - Eric R Cohen
- Department of Radiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Vikas Patel
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Newark, New Jersey
- Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Mohammad El-Ghanem
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Newark, New Jersey
| | - Ethan Wajswol
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Newark, New Jersey
| | - Vincent Dodson
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Newark, New Jersey
| | - Sarmad Al-Marsoummi
- Department of Neuroscience, University of North Dakota, Grand Forks, North Dakota
| | - Neil Majmundar
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Newark, New Jersey
| | - Neha S Dangayach
- Department of Neurology and Neurosurgery, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Rolla Nuoman
- Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Chirag D Gandhi
- Department of Neurosurgery, New York Medical College, Westchester Medical Center, New York, New York
| |
Collapse
|
9
|
Ye Z, Ai X, Zheng J, Hu X, Lin S, You C, Li H. Antihypertensive treatments for spontaneous intracerebral hemorrhage in patients with cerebrovascular stenosis: A randomized clinical trial (ATICHST). Medicine (Baltimore) 2017; 96:e7289. [PMID: 28658126 PMCID: PMC5500048 DOI: 10.1097/md.0000000000007289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Antihypertensive treatment is associated with clinical outcomes in patients with spontaneous intracerebral hemorrhage (sICH). ADAPT showed that intensive blood pressure lowering (<140 mm Hg) does not reduce peri-hematoma regional cerebral blood flow (rCBF) in patients with sICH. However, the stenosis of main cerebral arteries that has a high presence in patients with sICH is well-known related to the brain ischemia. The effect of intensive BP lowering for sICH in patients with cerebrovascular stenosis is still unknown. AIM The aim of this study was to determine the safety and effectiveness of intensive BP lowering for sICH in patients with cerebrovascular stenosis. METHODS AND ANALYSIS A pilot trial has been conducted to calculate the sample size and 80 patients of sICH with cerebrovascular stenosis will be involved. The target of systolic blood pressure (SBP) will be maintained at from 120 to 140 mm Hg or from 140 to 180 mm Hg for 7 days. Cerebral ischemia will be assessed at 24 hours after onset by computed tomography (CT) perfusion imaging and the follow-up will be conducted at 30-day and 90-day. The primary outcome is the reduction of peri-hematoma rCBF. The other cerebral perfusion indexes and the rate of ischemic stroke are regarded as other primary outcomes. The secondary outcomes include clinical outcome at 30 days and 90 days, complications, and hospital stays. DISCUSSION The ATICHST trial has been signed as a parallel, prospective, randomized, assessor-blinded clinical trial to determine the effects of intensive BP lowering on sICH in patients with cerebrovascular stenosis, the results of which will contribute to guide the management of blood pressure in sICH. CONCLUSION The protocol will determine the safety and effectiveness of intensive BP lowering for sICH with cerebrovascular stenosis.
Collapse
|
10
|
Gioia L, Klahr A, Kate M, Buck B, Dowlatshahi D, Jeerakathil T, Emery D, Butcher K. The intracerebral hemorrhage acutely decreasing arterial pressure trial II (ICH ADAPT II) protocol. BMC Neurol 2017; 17:100. [PMID: 28525977 PMCID: PMC5437568 DOI: 10.1186/s12883-017-0884-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Aggressively lowering blood pressure (BP) in acute intracerebral hemorrhage (ICH) may improve outcome. Although there is no evidence that BP reduction changes cerebral blood flow, retrospective magnetic resonance imaging (MRI) studies have demonstrated sub-acute ischemic lesions in ICH patients. The primary aim of this study is to assess ischemic lesion development in patients randomized to two different BP treatment strategies. We hypothesize aggressive BP reduction is not associated with ischemic injury after ICH. Methods The Intracerebral Hemorrhage Acutely Decreasing Blood Pressure Trial II (ICH ADAPT II) is a phase II multi-centre randomized open-label, blinded-endpoint trial. Acute ICH patients (N = 270) are randomized to a systolic blood pressure (SBP) target of <140 or <180 mmHg. Acute ICH patients within 6 h of onset and two SBP measurements ≥140 mmHg recorded >2 mins apart qualify. SBP is managed with a pre-defined treatment protocol. Patients undergo MRI at 48 h, Days 7 and 30, with clinical assessment at Day 30 and 90. The primary outcome is diffusion weighted imaging (DWI) lesion frequency at 48 h. Secondary outcomes include cumulative DWI lesion rate frequency within 30 days, absolute hematoma growth, prediction of DWI lesion incidence, 30-day mortality rates, day 90 functional outcome, and cognitive status. Discussion This trial will assess the impact of hypertensive therapies on physiological markers of ischemic injury. The findings of this study will provide evidence for the link, or lack thereof, between BP reduction and ischemic injury in ICH patients. Trial registration This study is registered with clinicaltrials.gov (NCT02281838, first received October 29, 2014). Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0884-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura Gioia
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Ana Klahr
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Mahesh Kate
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | | | - Thomas Jeerakathil
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Derek Emery
- Department of Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Kenneth Butcher
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada.
| |
Collapse
|
11
|
Zhang R, Yang J, Yuan J, Song B, Wang Y, Xu Y. The Therapeutic Value of Bone Marrow-Derived Endothelial Progenitor Cell Transplantation after Intracerebral Hemorrhage in Rats. Front Neurol 2017; 8:174. [PMID: 28512445 PMCID: PMC5411418 DOI: 10.3389/fneur.2017.00174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/13/2017] [Indexed: 01/30/2023] Open
Abstract
Aims To study the effect of endothelial progenitor cell (EPC) treatment on intracerebral hemorrhage (ICH) in rats and elucidate possible mechanisms. Methods The rats were randomly divided into three groups: (1) EPC group: ICH + EPC, (2) phosphate-buffered saline group: ICH + PBS, and (3) sham group. EPCs were transplanted intravenously 6 h after ICH. Modified neurological severity score was used to evaluate neurological function. Blood–brain barrier (BBB) integrity was evaluated. Dead cells, inflammatory cytokines, and neuroprotective cytokines were assessed to investigate possible mechanisms. Results The animals in the EPC group showed significant improvement in neurological function at 48 h, 72 h, and 7 days after ICH, compared with those in the PBS group. EPC transplantation significantly reduced brain edema and the number of dead cells in the hematoma boundary areas. The intensity of Evans Blue was decreased, and expression levels of zonula occluden-1 and claudin-5 were increased in the EPC group. Proinflammatory cytokines, including interferon-γ, IL-6, and TNF-α, were decreased, whereas anti-inflammatory cytokines, including transforming growth factor-β1 and IL-10, were increased in the EPC group. In addition, expression levels of brain-derived neurotrophic factor, vascular endothelial growth factor, and neurotrophic growth factor were increased following transplantation of EPCs. Conclusion EPC transplantation could improve neurological function of ICH rats. The protective effect may be mediated by promotion of neuroprotective cytokine secretion, restoration of the BBB, reduction of cell death, and the decrease in inflammation.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
12
|
Barras CD, Asadi H, Phal PM, Tress BM, Davis SM, Desmond PM. Audit of CT reporting standards in cases of intracerebral haemorrhage at a comprehensive stroke centre in Australia. J Med Imaging Radiat Oncol 2016; 60:720-727. [DOI: 10.1111/1754-9485.12491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Christen D Barras
- Lysholm Department of Neuroradiology; The National Hospital for Neurology and Neurosurgery; Queen Square; London UK
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| | - Hamed Asadi
- Interventional Neuroradiology Service; Department of Radiology; Beaumont Hospital; Dublin Ireland
- School of Medicine; Faculty of Health; Deakin University; Victoria Australia
| | - Pramit M Phal
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
- Epworth Medical Imaging; Richmond Victoria Australia
| | - Brian M Tress
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| | - Stephen M Davis
- Department of Neurosciences; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| | - Patricia M Desmond
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
13
|
Chen M, Li X, Zhang X, He X, Lai L, Liu Y, Zhu G, Li W, Li H, Fang Q, Wang Z, Duan C. The inhibitory effect of mesenchymal stem cell on blood-brain barrier disruption following intracerebral hemorrhage in rats: contribution of TSG-6. J Neuroinflammation 2015; 12:61. [PMID: 25890011 PMCID: PMC4392640 DOI: 10.1186/s12974-015-0284-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/17/2015] [Indexed: 12/20/2022] Open
Abstract
Background Mesenchymal stem cells (MSCs) are well known having beneficial effects on intracerebral hemorrhage (ICH) in previous studies. The therapeutic mechanisms are mainly to investigate proliferation, differentiation, and immunomodulation. However, few studies have used MSCs to treat blood–brain barrier (BBB) leakage after ICH. The influence of MSCs on the BBB and its related mechanisms were investigated when MSCs were transplanted into rat ICH model in this study. Methods Adult male Sprague–Dawley (SD) rats were randomly divided into sham-operated group, PBS-treated (ICH + PBS) group, and MSC-treated (ICH + MSC) group. ICH was induced by injection of IV collagenase into the rats’ brains. MSCs were transplanted intravenously into the rats 2 h after ICH induction in MSC-treated group. The following factors were compared: inflammation, apoptosis, behavioral changes, inducible nitric oxide synthase (iNOS), matrix metalloproteinase 9 (MMP-9), peroxynitrite (ONOO−), endothelial integrity, brain edema content, BBB leakage, TNF-α stimulated gene/protein 6 (TSG-6), and nuclear factor-κB (NF-κB) signaling pathway. Results In the ICH + MSC group, MSCs decreased the levels of proinflammatory cytokines and apoptosis, downregulated the density of microglia/macrophages and neutrophil infiltration at the ICH site, reduced the levels of iNOS and MMP-9, attenuated ONOO− formation, and increased the levels of zonula occludens-1 (ZO-1) and claudin-5. MSCs also improved the degree of brain edema and BBB leakage. The protective effect of MSCs on the BBB in ICH rats was possibly invoked by increased expression of TSG-6, which may have suppressed activation of the NF-κB signaling pathway. The levels of iNOS and ONOO−, which played an important role in BBB disruption, decreased due to the inhibitory effects of TSG-6 on the NF-κB signaling pathway. Conclusions Our results demonstrated that intravenous transplantation of MSCs decreased the levels of ONOO− and degree of BBB leakage and improved neurological recovery in a rat ICH model. This strategy may provide a new insight for future therapies that aim to prevent breakdown of the BBB in patients with ICH and eventually offer therapeutic options for ICH.
Collapse
Affiliation(s)
- Min Chen
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Xifeng Li
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Xin Zhang
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Xuying He
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Lingfeng Lai
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Yanchao Liu
- Department of Neurosurgery, The First People's Hospital of Foshan and Foshan Hospital of Sun Yat Sen University, Foshan, Guangdong, 528000, China.
| | - Guohui Zhu
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Wei Li
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Hui Li
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Qinrui Fang
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Zequn Wang
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Chuanzhi Duan
- The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| |
Collapse
|
14
|
Yi HJ, Shin IY, Hwang HS. Simultaneous multiple Basal Ganglia and cerebellar hemorrhage: case report. J Cerebrovasc Endovasc Neurosurg 2014; 15:316-9. [PMID: 24729959 PMCID: PMC3983533 DOI: 10.7461/jcen.2013.15.4.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/11/2013] [Accepted: 11/14/2013] [Indexed: 11/27/2022] Open
Abstract
A 35-year-old man presented with simultaneous multiple intracranial hematomas in the right cerebellar dentate nucleus and left basal ganglia. The hematomas were visible by computed tomography performed within two hours of the patient's arrival. The initial computed tomography showed acute hemorrhage in the left basal ganglia and dentate nucleus in cerebellum. The patient then experienced a change of consciousness due to newly developed hydrocephalus, and emergent extra-ventricular drainage was performed. By discharge, fortunately, the patient was fully recovered.
Collapse
Affiliation(s)
- Ho Jun Yi
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea
| | - Il Young Shin
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea
| | - Hyung Sik Hwang
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea
| |
Collapse
|
15
|
Al-Khaled M, Eggers J. Prognosis of Intracerebral Hemorrhage after Conservative Treatment. J Stroke Cerebrovasc Dis 2014; 23:230-4. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 11/25/2012] [Accepted: 12/28/2012] [Indexed: 10/27/2022] Open
|
16
|
Goren O, Monteith SJ, Hadani M, Bakon M, Harnof S. Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage. Neurosurg Focus 2013; 34:E2. [PMID: 23634921 DOI: 10.3171/2013.2.focus1324] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green-based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and the extent of vascular anomaly resection. Intraoperative ultrasound aids navigation and evacuation assessment during intracerebral hematoma evacuation surgeries. It supports the concept of minimally invasive surgery and has undergone extensive development in recent years, with the quality of ultrasound imaging having improved considerably. Image-guided therapy, combined with modern intraoperative imaging modalities, has changed the fundamentals of conventional vascular neurosurgery by presenting real-time visualization of both normal tissue and pathological entities. These imaging techniques are important adjuncts to the surgeon's standard surgical armamentarium. Familiarity with these imaging modalities may help the surgeon complete procedures with improved safety, efficiency, and clinical outcome.
Collapse
Affiliation(s)
- Oded Goren
- Department of Neurosurgery and the Neurovascular Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | |
Collapse
|
17
|
Plasma adiponectin as an independent predictor of early death after acute intracerebral hemorrhage. Clin Chim Acta 2011; 412:1626-31. [DOI: 10.1016/j.cca.2011.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 12/15/2022]
|
18
|
Tu CJ, Liu WG, Dong XQ, Liu JS, Song DG, Yu WH, Zhang ZY, Zhen G, Luo HM. Association of Interleukin-11 with Mortality in Patients with Spontaneous Basal Ganglia Haemorrhage. J Int Med Res 2011; 39:1265-74. [PMID: 21986128 DOI: 10.1177/147323001103900414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study evaluated interleukin (IL)-11 as an independent prognostic marker of mortality following intracerebral haemorrhage (ICH). Plasma IL-11 levels in patients with ICH were significantly higher than in healthy controls. Multivariate analysis indicated that plasma IL-11 level was an independent predictor for mortality within 1 week of ICH onset and was positively associated with haematoma volume. Receiver operating characteristic curve analysis identified that a baseline plasma IL-11 level > 20.9 pg/ml predicted mortality within 1 week of ICH onset with 81.2% sensitivity and 74.1% specificity. The area under the curve for IL-11 level was significantly smaller than that for the Glasgow Coma Scale score, but similar to that for haematoma volume. IL-11 did not, however, significantly improve the predictive value of the Glasgow Coma Scale or haematoma volume. Thus, IL-11 may be considered as a new independent prognostic marker of mortality and an additional valuable tool for risk stratification and decision-making in the acute phase of ICH.
Collapse
Affiliation(s)
- CJ Tu
- Department of Neurosurgery, Shaoxing County Central Hospital, Shaoxing, China
| | - WG Liu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - XQ Dong
- Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Hangzhou, China
| | - JS Liu
- Department of Neurosurgery, Shaoxing County Central Hospital, Shaoxing, China
| | - DG Song
- Department of Neurosurgery, Shaoxing County Central Hospital, Shaoxing, China
| | - WH Yu
- Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Hangzhou, China
| | - ZY Zhang
- Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Hangzhou, China
| | - G Zhen
- Department of Neurosurgery, Shaoxing County Central Hospital, Shaoxing, China
| | - HM Luo
- Department of Neurosurgery, Shaoxing County Central Hospital, Shaoxing, China
| |
Collapse
|
19
|
Abstract
Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology.
Collapse
Affiliation(s)
- Seth Love
- Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, UK.
| |
Collapse
|
20
|
Dong XQ, Huang M, Hu YY, Yu WH, Zhang ZY. Time course of plasma microparticle concentrations after acute spontaneous basal ganglia hemorrhage. Acta Neurol Scand 2011; 123:280-8. [PMID: 20597866 DOI: 10.1111/j.1600-0404.2010.01399.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the changes in plasma microparticle (MP) levels in patients after intracerebral hemorrhage (ICH) and assess their association with outcome along with biological markers of the acute phase response. MATERIALS AND METHODS Thirty healthy controls and 86 patients with acute ICH were recruited. Plasma samples were obtained on admission and at days 1, 2, 3, 5, and 7 after ICH. MPs with procoagulant potential were measured with a prothrombinase assay. RESULTS Plasma MP levels in patients were substantially higher than those in healthy controls during the 7-day period. Plasma MP levels were strongly associated with outcome and with biological markers of the acute phase response. Multivariate analysis showed baseline plasma MP level was a good predictor of 1-week mortality (odds ratio, 1.930; 95% confidence interval, 1.229-3.031; P=0.004). A receiver operating characteristic curve identified the plasma MP cutoff level (8.4 nmol/l phosphatidylserine equivalent) that predicted 1-week mortality with high sensitivity (90.6%) and specificity (68.5.0%) (P<0.001). CONCLUSIONS Increased membrane microparticle levels occur after ICH and may contribute to the subsequent brain injury, in association with a poor clinical outcome.
Collapse
Affiliation(s)
- X-Q Dong
- Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Nanjing Medical University, 261 Huansha Road, Hangzhou, China.
| | | | | | | | | |
Collapse
|
21
|
Gupta RK, Jamjoom AAB, Nikkar-Esfahani A, Jamjoom DZA. Spontaneous intracerebral haemorrhage: a clinical review. Br J Hosp Med (Lond) 2011; 71:499-504. [PMID: 20852544 DOI: 10.12968/hmed.2010.71.9.78160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article provides a clinical overview of spontaneous intracerebral haemorrhage, focusing on clinical aspects of the aetiology, diagnosis and management (both in the emergency department and in a critical care environment) of this important and devastating condition.
Collapse
Affiliation(s)
- R K Gupta
- Department of Acute Medicine, University College Hospital, London
| | | | | | | |
Collapse
|
22
|
Dong XQ, Huang M, Yu WH, Zhang ZY, Zhu Q, Che ZH, Du Q, Wang H. Change in plasma copeptin level after acute spontaneous basal ganglia hemorrhage. Peptides 2011; 32:253-7. [PMID: 21126545 DOI: 10.1016/j.peptides.2010.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/21/2010] [Accepted: 11/22/2010] [Indexed: 11/23/2022]
Abstract
High plasma copeptin levels are associated with mortality after intracerebral hemorrhage (ICH). However, there is a paucity of data available on whether copeptin is an independent prognostic marker of mortality. Thus, we sought to furthermore evaluate this relation. Thirty healthy controls and 86 patients with acute ICH were included. Plasma samples were obtained on admission and at days 1, 2, 3, 5, and 7 after ICH. Its concentration was measured by enzyme-linked immunosorbent assay. After ICH, plasma copeptin level in patients increased during the 6-h period immediately, peaked in 24h, decreased gradually thereafter, and was substantially higher than that in healthy controls during the 7-day period. A multivariate analysis showed plasma copeptin level was an independent predictor for 1-week mortality (odds ratio, 1.013; 95% confidence interval (CI), 1.003-1.023; P=0.009) and positively associated with hematoma volume (t=6.616, P<0.001). A receiver operating characteristic curve identified that a baseline plasma copeptin level >577.5pg/mL predicted 1-week mortality with 87.5% sensitivity and 72.2% specificity (area under curve (AUC), 0.873; 95% CI, 0.784-0.935). The AUC of the copeptin concentration was similar to those of Glasgow Coma Scale (GCS) scores and hematoma volumes (P=0.136 and 0.280). However, copeptin did not statistically significantly improve the AUCs of GCS scores and hematoma volumes (P=0.206 and 0.333). Hence, increased plasma copeptin level is associated with hematoma volume and an independent prognostic marker of mortality after ICH.
Collapse
Affiliation(s)
- Xiao-Qiao Dong
- Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Nanjing Medical University, Hangzhou 310000, China
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Blood pressure management in acute intracerebral haemorrhage guidelines are poorly implemented in clinical practice. Clin Neurol Neurosurg 2010; 112:858-64. [PMID: 20702032 DOI: 10.1016/j.clineuro.2010.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 05/26/2010] [Accepted: 07/10/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Optimal management of blood pressure (BP) in spontaneous intracerebral haemorrhage (ICH) is controversial. We assessed adherence to BP guidelines and its management in ICH in a tertiary Canadian Stroke Centre. METHODS We conducted a retrospective analysis of 142 CT confirmed primary ICH patients admitted within 24h of symptoms between 2005 and 2006. Initial practice with respect to BP control was reviewed and compared with current guidelines. This retrospective sample was compared with a prospective cohort participating in a BP lowering trial for the attainment of pre-defined BP targets. We also assessed the effect of BP treatment on hematoma expansion and mortality. RESULTS Blood pressure treatment orders were established in 73% of the 142 patients (median age 71 years, 61% male). Only 26% of patients had target orders as advised in the current AHA guidelines. Only 54% achieved BP targets as compared with 83% of the prospective cohort within 1h. Patients with established BP orders were more likely to have repeat brain imaging (70.2%) than those without (39.5%; p=0.001 Mortality rates were 29.8% and 47.4% in those with and without BP targets respectively (p=0.051). CONCLUSIONS Management of BP varies considerably and there appears to be little adherence to recommended guidelines. Targets are achieved more rapidly if a BP treatment protocol is utilized.
Collapse
|
24
|
Time Course of Plasma Leptin Concentrations After Acute Spontaneous Basal Ganglia Hemorrhage. World Neurosurg 2010; 74:286-93. [DOI: 10.1016/j.wneu.2010.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 02/05/2010] [Indexed: 11/19/2022]
|
25
|
Butcher K, Jeerakathil T, Emery D, Dowlatshahi D, Hill MD, Sharma M, Buck B, Findlay M, Lee TY, Demchuk AM. The Intracerebral Haemorrhage Acutely Decreasing Arterial Pressure Trial: ICH ADAPT. Int J Stroke 2010; 5:227-33. [DOI: 10.1111/j.1747-4949.2010.00431.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The majority of intracerebral haemorrhage patients present with markedly elevated blood pressure immediately after symptom onset. Management of blood pressure in the first 24 h is extremely controversial and lends itself to two competing rationales. There is some evidence that early treatment may improve outcome, potentially by reducing the rate of haematoma expansion. It is also possible that this will reduce cerebral blood flow and therefore exacerbate the cerebral injury, particularly in the region surrounding the haematoma. Only a trial that includes both randomisation of patients to two different blood pressure management strategies and actual measurement of cerebral blood flow can effectively address this pressing debate. This is the only unequivocal way to demonstrate the haemodynamic effects of rapid blood pressure reduction. The Intracerebral Haemorrhage Acutely Decreasing Arterial Pressure Trial is designed to test the hypothesis that blood pressure reduction does not result in significant or harmful changes in cerebral blood flow in acute intracerebral haemorrhage. Two hours after randomisation to a systolic blood pressure target of <150 or <180 mmHg, cerebral blood flow is measured using computed tomography perfusion, which is the primary end-point of the trial. A study of this type is critical to establishing the safety of early blood pressure treatment and is necessary for planning larger efficacy trials in a rational manner. This trial is registered with clinicaltrials.gov (NCT00963976).
Collapse
Affiliation(s)
| | | | - Derek Emery
- Department of Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Dar Dowlatshahi
- Division of Neurology, University of Ottawa, Ottawa, ON, Canada
| | - Michael D. Hill
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mukul Sharma
- Division of Neurology, University of Ottawa, Ottawa, ON, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Max Findlay
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Ting Y. Lee
- Robarts Research Institue, London, ON, Canada
| | - Andrew M. Demchuk
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
26
|
Dong XQ, Hu YY, Yu WH, Zhang ZY. High concentrations of resistin in the peripheral blood of patients with acute basal ganglia hemorrhage are associated with poor outcome. J Crit Care 2010; 25:243-7. [DOI: 10.1016/j.jcrc.2009.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 06/28/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
|
27
|
|
28
|
High concentrations of procoagulant microparticles in the cerebrospinal fluid and peripheral blood of patients with acute basal ganglia hemorrhage are associated with poor outcome. ACTA ACUST UNITED AC 2009; 72:481-9; discussion 489. [DOI: 10.1016/j.surneu.2008.12.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 12/31/2008] [Indexed: 11/21/2022]
|
29
|
Aladdin Y, Butcher KS. Blood pressure management in acute intracerebral hemorrhage. FUTURE NEUROLOGY 2009. [DOI: 10.2217/fnl.09.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Primary intracerebral hemorrhage (ICH) results from spontaneous rupture of an intracranial vessel and is associated with high rates of early mortality and long-term morbidity. No surgical or medical intervention has been demonstrated to improve outcome. Acute blood pressure elevation is seen in the majority of patients with ICH and is correlated with poor outcome. Potential, but unproven, mechanisms for this association include facilitation of hematoma expansion as well as perihematomal edema growth. Conversely, the perihematomal region has also been hypothesized to have ischemic properties. Therefore, management of blood pressure in the acute phase lends itself to two competing rationales and the optimal target blood pressure remains unknown. A number of parenchymal and blood-flow imaging techniques have been utilized to improve our understanding of blood flow and metabolism in acute ICH. These studies generally indicate that ischemia is not a major pathophysiological mechanism of secondary injury in ICH. Ultimately, randomized, controlled trials, which are underway, will be required to definitively determine the safety and efficacy of acute blood pressure reduction. It appears most likely that earlier and more aggressive treatment of acute blood pressure will be recommended in the future.
Collapse
Affiliation(s)
- Yasser Aladdin
- Division of Neurology, 2E3 WMC Health Sciences Centre, University of Alberta, 8440 112th St, Edmonton, AB, T6G 2B7, Canada
| | - Ken S Butcher
- Division of Neurology, 2E3 WMC Health Sciences Centre, University of Alberta, 8440 112th St, Edmonton, AB, T6G 2B7, Canada
| |
Collapse
|
30
|
Bilirubin oxidation products, oxidative stress, and intracerebral hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2009; 105:7-12. [PMID: 19066073 DOI: 10.1007/978-3-211-09469-3_2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hematoma and perihematomal regions after intracerebral hemorrhage (ICH) are biochemically active environments known to undergo potent oxidizing reactions. We report facile production of bilirubin oxidation products (BOXes) via hemoglobin/Fenton reaction under conditions approximating putative in vivo conditions seen following ICH. Using a mixture of human hemoglobin, physiological buffers, unconjugated solubilized bilirubin, and molecular oxygen and/or hydrogen peroxide, we generated BOXes, confirmed by spectral signature consistent with known BOXes mixtures produced by independent chemical synthesis, as well as HPLC-MS of BOX A and BOX B. Kinetics are straightforward and uncomplicated, having initial rates around 0.002 microM bilirubin per microM hemoglobin per second under normal experimental conditions. In hematomas from porcine ICH model, we observed significant production of BOXes, malondialdehyde, and superoxide dismutase, indicating a potent oxidizing environment. BOX concentrations increased from 0.084 +/- 0.01 in fresh blood to 22.24 +/- 4.28 in hematoma at 72h, and were 11.22 +/- 1.90 in adjacent white matter (nmol/g). Similar chemical and analytical results are seen in ICH in vivo, indicating the hematoma is undergoing similar potent oxidations. This is the first report of BOXes production using a well-defined biological reaction and in vivo model of same. Following ICH, amounts of unconjugated bilirubin in hematoma can be substantial, as can levels of iron and hemoglobin. Oxidation of unconjugated bilirubin to yield bioactive molecules, such as BOXes, is an important discovery, expanding the role of bilirubin in pathological processes seen after ICH.
Collapse
|
31
|
Asdaghi N, Manawadu D, Butcher K. Therapeutic management of acute intracerebral haemorrhage. Expert Opin Pharmacother 2007; 8:3097-116. [DOI: 10.1517/14656566.8.18.3097] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
32
|
Kim JM, Lee ST, Chu K, Jung KH, Song EC, Kim SJ, Sinn DI, Kim JH, Park DK, Kang KM, Hyung Hong N, Park HK, Won CH, Kim KH, Kim M, Kun Lee S, Roh JK. Systemic transplantation of human adipose stem cells attenuated cerebral inflammation and degeneration in a hemorrhagic stroke model. Brain Res 2007; 1183:43-50. [PMID: 17920570 DOI: 10.1016/j.brainres.2007.09.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 09/04/2007] [Accepted: 09/04/2007] [Indexed: 12/18/2022]
Abstract
Adipose-derived stem cells (ASCs) are readily accessible multipotent mesenchymal stem cells and are known to secrete multiple growth factors, and thereby to have cytoprotective effects in various injury models. In the present study, the authors investigated the neuroprotective effect of ASCs in an intracerebral hemorrhage (ICH) model. ICH was induced via the stereotaxic infusion of collagenase, and human ASCs (three million cells per animal) isolated from human fresh fat tissue, were intravenously administered at 24 h post-ICH induction. Acute brain inflammation markers, namely, cell numbers positively stained for terminal transferase dUTP nick end labeling (TUNEL), myeloperoxidase (MPO), or OX-42, and brain water content were checked at 3 days post-ICH. In addition, the authors quantified brain degeneration by measuring hemispheric atrophy and perihematomal glial thickness at 6 weeks post-ICH, and determined modified limb placing behavioral scores weekly over 5 weeks post-ICH. The results showed that brain water content, TUNEL+, and MPO+ cell numbers were significantly reduced in the ASC-transplanted rats. ASC transplantation attenuated neurological deficits from 4 to 5 weeks post-ICH, and reduced both the brain atrophy and the glial proliferation at 6 weeks. Transplanted ASCs were found to densely populate perihematomal areas at 6 weeks, and to express endothelial markers (von Willebrand factor and endothelial barrier antigen), but not neuronal or glial markers. In summary, ASCs transplantation in the ICH model reduced both acute cerebral inflammation and chronic brain degeneration, and promoted long-term functional recovery.
Collapse
Affiliation(s)
- Jeong-Min Kim
- Stroke and Stem Cell Laboratory in the Clinical Research Institute, Stem Cell Research Center, Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ozdemir O, Calisaneller T, Yildirim E, Altinors N. Simultaneous supra and infratentorial hypertensive intracerebral haemorrhage. J Clin Neurosci 2007; 14:775-7. [PMID: 17493816 DOI: 10.1016/j.jocn.2006.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/21/2006] [Accepted: 02/18/2006] [Indexed: 11/27/2022]
Abstract
Spontaneous intracerebral haemorrhage is a devastating illness with highmortality and morbidity. Multiple simultaneous intracerebral haemorrhages (MSIHs) in different arterial territories occur rarely. This multiplicity complicates management and increases the mortality rate. A 67-year-old right-handed man with a long history of hypertension was admitted to our hospital with acute loss of consciousness. After the diagnosis of MSIH he was medically treated in the intensive care unit and died 2 days after initial admission. Diagnosis and management of MSIH are discussed with refence to the current literature.
Collapse
Affiliation(s)
- Ozgur Ozdemir
- Neurosurgery Department, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | |
Collapse
|
34
|
Belayev L, Obenaus A, Zhao W, Saul I, Busto R, Wu C, Vigdorchik A, Lin B, Ginsberg MD. Experimental intracerebral hematoma in the rat: Characterization by sequential magnetic resonance imaging, behavior, and histopathology. Effect of albumin therapy. Brain Res 2007; 1157:146-55. [PMID: 17543290 DOI: 10.1016/j.brainres.2007.04.077] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 04/19/2007] [Accepted: 04/20/2007] [Indexed: 11/30/2022]
Abstract
We characterized acute intracerebral hemorrhage (ICH) in the rat by sequential magnetic resonance imaging (MRI) and correlated MRI findings with neurobehavior and histopathology. In addition, we investigated whether albumin treatment would reduce ICH-induced brain injury. ICH was produced in rats by a double-injection method in which 45 microl of fresh arterial blood was injected into the right striatum. Susceptibility-weighted (SWI) and T2-weighted (T2WI) MRI was carried out on a 4.7T magnet at 0-1 h, 6 h, 24 h, 72 h, and 7 days after ICH. Animals were treated with either 25% human albumin, 1.25 g/kg, or saline vehicle i.v. at 90 min after ICH. Neurological status was evaluated before ICH and after treatment (at 4 h, 24 h, 48 h, 72 h, and 7 days). Brains were then perfusion-fixed, re-imaged on an 11.7T magnet, and studied by histopathology and immunochemistry. MRI revealed a consistent hematoma involving the striatum and overlying corpus callosum, with significant volume changes over time. Lesion volumes computed from T2WI images and by histopathology agreed closely with one another and were highly correlated (p=0.002). SWI lesion volumes were also highly correlated to histological volumes (p<0.001) but overestimated histological hematoma volume by approximately 5-fold. Albumin treatment significantly improved neurological scores compared to saline at 72 h (3.8+/-0.6 vs. 1.5+/-0.7) and 7 days (3.8+/-0.4 vs. 1.3+/-0.5, respectively, p<0.05), but did not affect histological or MRI lesion volumes. Taken together, sequential MRI plus histopathology provides a comprehensive characterization of experimental ICH. Albumin treatment improves neurological deficit after ICH but does not affect MRI or histological hematoma size.
Collapse
Affiliation(s)
- Ludmila Belayev
- Cerebral Vascular Disease Research Center, Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Maniker AH, Vaynman AY, Karimi RJ, Sabit AO, Holland B. Hemorrhagic complications of external ventricular drainage. Neurosurgery 2007; 59:ONS419-24; discussion ONS424-5. [PMID: 17041512 DOI: 10.1227/01.neu.0000222817.99752.e6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite the widespread use of external ventricular drainage (EVD), the frequency of associated hemorrhagic complications remains unclear. This retrospective study examined the frequency of hemorrhagic complications of EVD and attempted to discern associated risk factors. METHODS Treatment records from 160 patients admitted during a 2.5-year period who required EVD placement were reviewed. Indications for placement of EVD included acute complications of cerebrovascular disease (n = 94), traumatic brain injury (n = 36), primary hydrocephalus (n = 16), and tumor (n = 14). Patients received either a 3.0 or 2.5-mm outer diameter ventricular catheter (n = 82 and 78, respectively). Postinsertion computed tomographic scans were obtained within 24 hours on all patients and were analyzed for any new hemorrhage related to the ventricular catheter. Patient age, sex, catheter type, and dimensions of hemorrhage were also analyzed. RESULTS The incidence of EVD-related hemorrhage was 33 +/- 0.04%. However, the incidence of detectable change in the clinical neurological examination was 2.5%. A significant proportion of EVD-related hemorrhages were small (<4 cm), punctate, intraparenchymal hematomas. Patients with cerebrovascular disease exhibited an increased incidence (39%) of hemorrhage. The mean volume of intraparenchymal hemorrhage was larger in patients who received the 2.5-mm ventricular catheter, as well as those admitted for cerebrovascular disease. CONCLUSION Hemorrhagic complications of EVD placement are more common than previously suspected. Admitting diagnosis seems to have an effect on the development of an associated hemorrhage and its size. Catheter gauge has an effect on hematoma volume. Most of the hemorrhages seen on postinsertion computed tomographic scans do not cause detectable changes in the clinical examination.
Collapse
Affiliation(s)
- Allen H Maniker
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
| | | | | | | | | |
Collapse
|
36
|
Abstract
The incidence of cerebral hemorrhage in France is 25000 new cases per year. Their prognosis is especially grim: six months afterward, 30-50% of these patients have died and only 20% are able to live independently. Management of acute forms requires, above all, hospitalization in a specialized neurovascular unit of proven quality. Initial treatment includes general measures to avoid possible early aggravation and the prevention and treatment of some complications. Specific treatment by recombinant factor VII can be effective in the first 4 hours after symptoms begin. A phase III study is under way to confirm its efficacy against hematoma growth in the first 24 hours and prognosis at 3 months. According to the recent STICH study, surgery is indicated in the case of hydrocephaly, for large cerebellar hematomas and for cortical supratentorial hematomas located less than 1 cm from the cortical surface. Beyond these situations, surgery must be considered on a case-by-case basis, until other studies more clearly specify indications and techniques. The pathophysiology of cerebral hemorrhage remains poorly understood but numerous research pathways are being explored and should make it possible to identify new treatment targets to combat, in particular, cerebral edema and neuronal lesions.
Collapse
Affiliation(s)
- Sophie Crozier
- Service urgences cérébrovasculaires, Groupe hospitalier Pitié-Salpêtrière, Paris.
| |
Collapse
|
37
|
Cabrejo L, Chassagne P, Doucet J, Laquerrière A, Puech N, Hannequin D. Angiopathie amyloïde cérébrale sporadique. Rev Neurol (Paris) 2006; 162:1059-67. [PMID: 17086142 DOI: 10.1016/s0035-3787(06)75118-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Sporadic cerebral amyloid angiopathy (CAA) is a microangiopathy identified by neuropathological examination in more than 30 percent of patients over 85 years of age. STATE OF ART Boston criteria for diagnosis of CAA--related hemorrhage are as follows: "definite CAA", "Probable CAA with supporting pathology", "Probable CAA" and "Possible CAA". Clinical manifestations of CAA are either lobar, cortical, corticosubcortical or cerebellar hemorrhages associated with progressive dementia. Dementia, corresponding either to Alzheimer disease, vascular or mixed dementia, precedes hemorrhages in 25 to 40 percent of cases. Brain MRI can demonstrate microbleeding. PERSPECTIVES This review compares data regarding CAA prevalence, intracranial hemorrhages, and their risk factors in old patients. Diagnosis and preventive strategies are discussed. It would be useful to identify those affected by CAA among elderly demented patients with atrial fibrillation requiring anticoagulation therapy. CONCLUSIONS CAA is suspected in the presence of recurrent lobar or cerebellar hemorrhages, and moreover if associated with pre-existing dementia. In elderly demented patients, MRI criteria to detect CAA should be considered in order to prevent hemorrhage risk, particularly after anticoagulation therapy.
Collapse
Affiliation(s)
- L Cabrejo
- Département de Neurologie, CHU de Rouen.
| | | | | | | | | | | |
Collapse
|
38
|
Pascual AM, López-Mut JV, Benlloch V, Chamarro R, Soler J, Láinez MJA. Perfusion-weighted magnetic resonance imaging in acute intracerebral hemorrhage at baseline and during the 1st and 2nd week: a longitudinal study. Cerebrovasc Dis 2006; 23:6-13. [PMID: 16968980 DOI: 10.1159/000095752] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/22/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic penumbra has been suggested as a contributing mechanism to secondary neuronal injury in intracerebral hemorrhage (ICH). Preliminary data suggest the presence of perihematomal hypoperfusion within the first hours after acute ICH. Our objective was to elucidate perfusion changes in the perihematomal region over time using magnetic resonance imaging (MRI). METHODS Two perfusion-weighted MRIs were studied prospectively in 18 ICH patients. All patients had an acute perfusion-weighted MRI within 24 h of the onset of symptoms (time 0); 11 patients had a follow-up study on day 7 (time 1), and 7 patients on days 10-14 (time 2). The region of interest (ROI) was placed over the penumbral area, on high-intensity FLAIR and perfusion overlapping map imaging. Clinical data were assessed at baseline (National Institutes of Health Stroke Scale) and on day 90 (Canadian Scale, modified Rankin Scale). RESULTS The average hematoma volume was 56 (9-140) ml; 10 were located deeply, and 8 were lobar. When we compared the perfusion changes (mean transit time prolongation) in the perihematomal area (lesion ROI) relative to itself over time, we found significant differences only between times 0 and 2 (p = 0.05). There were also significant differences in mean transit time between the lesion ROI and the contralateral mirror ROI in the baseline study (p = 0.001), with a trend to significance for time 1. CONCLUSIONS Our data confirm the presence of hypoperfusion around an acute ICH and demonstrate that this change disappears completely after the first week. These data suggest that further evaluation of this feature of acute ICH is warranted, as its confirmation may lead to modifications in the current therapeutic approach.
Collapse
Affiliation(s)
- Ana M Pascual
- Department of Neurology, Hospital Clínico, Valencia, Spain.
| | | | | | | | | | | |
Collapse
|
39
|
Zhang H, Huang Z, Xu Y, Zhang S. Differentiation and neurological benefit of the mesenchymal stem cells transplanted into the rat brain following intracerebral hemorrhage. Neurol Res 2006; 28:104-12. [PMID: 16464372 DOI: 10.1179/016164106x91960] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is often a fatal event. In a patient who survives the initial ictus, the resulting hematoma within brain parenchyma can trigger a series of events that lead to secondary insults and severe neurological deficits. Great efforts have been focused on searching for new approaches to help patients recover neurological function after ICH. Previous studies indicate that mesenchymal stem cells (MSCs) grafted into the ischemic rat brain can improve neurological function. However, there is no report regarding whether MSCs can be used in the same way to improve the neurological function after ICH. We generated the ICH model by injecting collagenase VII into rat brain. Subsequently, 5-bromo-2-deoxyuridine (BrdU)-labeled mesenchymal stem cells were delivered into the brain through carotid artery, cervical vein or lateral ventricle. The distribution and differentiation of MSCs were investigated by methods of immunohistochemistry. We found that MSCs were able to differentiate into neural cells in vitro as well as in the rat brain after ICH. The injected MSCs were able to migrate into hippocampus, blooding foci and ipsilateral cortex. In the hippocampus, MSCs differentiated into neurons; but in surrounding bleeding foci, they differentiated into neurons and astrocytes. In the ipsilateral cortex, MSCs differentiated into neurons, astrocytes and oligodendrocytes. Notably, the motor function of the rats in the carotid artery (CA) group and the lateral ventricle (LV) group improved significantly. Collectively, our study indicates that MSCs are able to differentiate into neural cells in the rat brain after ICH and can significantly improve motor function.
Collapse
Affiliation(s)
- Huabiao Zhang
- Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China, 210029.
| | | | | | | |
Collapse
|
40
|
Lee JK, Lee JH. Ultrasound-guided evacuation of spontaneous intracerebral hematoma in the basal ganglia. J Clin Neurosci 2005; 12:553-6. [PMID: 16051093 DOI: 10.1016/j.jocn.2005.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Real-time ultrasonography was used for the aspiration of intracerebral hematoma in the basal ganglia in 7 patients without signs of impending herniation. The ultrasound device was used to select the trajectory and target point for hematoma drainage. Ultrasound-guided aspiration was performed via a burr hole under local anesthesia. We used a temporal burr hole entry point rather than the more frequently used pre-coronal approach. The burr hole was positioned 4 to 6 cm behind the posterior border of the frontal process of the zygomatic bone and 4 to 5 cm above the external auditory meatus. The hematoma was then evacuated with urokinase irrigation. Ultrasound guidance allows simple, precise localization of the hematoma and the distance from the surface to the target can be calculated. Ultrasound-guided catheter placement for fibrinolysis and hematoma drainage is a simple and safe procedure.
Collapse
Affiliation(s)
- Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Korea.
| | | |
Collapse
|
41
|
Butcher K, Gonzales M. Images in clinical neuroscience. J Clin Neurosci 2004; 11:395-6. [PMID: 15080955 DOI: 10.1016/j.jocn.2003.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ken Butcher
- Royal Melbourne Hospital, Parkville, 3050 Victoria, Australia
| | | |
Collapse
|