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Akkash N, Alshutaihi MS. A case of hypertensive crisis following administration of nonionic low molecular weight contrast in hemorrhagic stroke patient: a case report. Ann Med Surg (Lond) 2024; 86:6285-6288. [PMID: 39359803 PMCID: PMC11444532 DOI: 10.1097/ms9.0000000000002538] [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: 04/25/2024] [Accepted: 08/25/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Radiocontrast agents can be iodinated or noniodinated. Iodinated agents are further divided into low and high molecular weights. In recent decades, LOCM has largely replaced the use of HOCM due to safety concerns, but an increasing number of severe side effects cases have been reported. Case presentation A 62-year-old woman presented with acute right hemiparesis. A CT scan revealed ICH with IVH. A contrasted CTA was ordered, during which Iohexol was administered. Shortly after the injection, she developed a hypertensive crisis. She was transferred to the ICU, intubated, and given labetalol. Repeated CT scan showed increased IVH with posterior edema. Her family declined surgical intervention. Unfortunately, she died. Discussion This represents a unique adverse effect of a low molecular weight contrast agent that has been rarely reported before, particularly in pheochromocytoma patients. Nevertheless, our patient had subtle hypertension that was revealed during hospital admission but without pheochromcytoma. Conclusion This case represents an unusual instance of a severe adverse. It suggests that the malignant rise in blood pressure may not be catecholamine-induced.
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Affiliation(s)
- Nour Akkash
- Department of Internal Medicine, Division of Neurology, Aleppo University Hospital, Aleppo, Syria
| | - Mohamad S Alshutaihi
- Department of Internal Medicine, Division of Neurology, Aleppo University Hospital, Aleppo, Syria
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Choi SY, Kim JH, Chung HS, Lim S, Kim EH, Choi A. Impact of a deep learning-based brain CT interpretation algorithm on clinical decision-making for intracranial hemorrhage in the emergency department. Sci Rep 2024; 14:22292. [PMID: 39333329 PMCID: PMC11436911 DOI: 10.1038/s41598-024-73589-0] [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: 06/06/2024] [Accepted: 09/19/2024] [Indexed: 09/29/2024] Open
Abstract
Intracranial hemorrhage is a critical emergency that requires prompt and accurate diagnosis in the emergency department (ED). Deep learning technology can assist in interpreting non-enhanced brain CT scans, but its real-world impact on clinical decision-making is uncertain. This study assessed a deep learning-based intracranial hemorrhage detection algorithm (DLHD) in a simulated clinical environment with ten emergency medical professionals from a tertiary hospital's ED. The participants reviewed CT scans with clinical information in two steps: without and with DLHD. Diagnostic performance was measured, including sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. Consistency in clinical decision-making was evaluated using the kappa statistic. The results demonstrated that DLHD minimally affected experienced participants' diagnostic performance and decision-making. In contrast, inexperienced participants exhibited significantly increased sensitivity (59.33-72.67%, p < 0.001) and decreased specificity (65.49-53.73%, p < 0.001) with the algorithm. Clinical decision-making consistency was moderate among inexperienced professionals (k = 0.425) and higher among experienced ones (k = 0.738). Inexperienced participants changed their decisions more frequently, mainly due to the algorithm's false positives. The study highlights the need for thorough evaluation and careful integration of deep learning tools into clinical workflows, especially for less experienced professionals.
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Affiliation(s)
- So Yeon Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sona Lim
- CONNECT-AI Research Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Arom Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute for Innovation in Digital Healthcare, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Ma Y, Wang J, Tang C, Li W, Lv X, Zhu S. Serum IRAK3 may serve as a prognostic biomarker in acute supratentorial intracerebral hemorrhage: findings from a prospective observational cohort study. Front Neurol 2024; 15:1436997. [PMID: 39346771 PMCID: PMC11427260 DOI: 10.3389/fneur.2024.1436997] [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: 05/23/2024] [Accepted: 08/27/2024] [Indexed: 10/01/2024] Open
Abstract
Background Interleukin-1 receptor-associated kinase 3 (IRAK3) modulates neuroinflammation. This study aimed to determine the prognostic role of serum IRAK3 in acute intracerebral hemorrhage (ICH). Methods In this prospective observational cohort study, 152 patients with supratentorial ICH, along with 63 healthy controls, were recruited. Serum IRAK3 levels were measured at the time of enrollment for controls, at admission for all patients, and on poststroke days 1, 3, 5, 7, 10, and 15 in a subset of 63 patients. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Poststroke 6-month modified Rankin Scale (mRS) scores were registered, with scores of 3-6 representing a poor prognosis. Multivariate models were established to investigate severity correlation and prognosis association. Results Serum IRAK3 levels were significantly elevated at the admission of patients, peaked at day 1, plateaued at day 3, gradually declined until day 15, and were substantially higher over the first 15 days poststroke than in controls. Admission serum IRAK3 levels were independently associated with NIHSS scores, hematoma volume, and 6-month mRS scores in a multivariate linear regression model. They were linearly correlated with the risk of poor prognosis in a restricted cubic spline analysis and were independently predictive of poor prognosis in a binary logistic regression model. Additionally, they demonstrated strong prognostic ability in the receiver operating characteristic curve analysis. Using subgroup analysis, no interactions were found between admission serum IRAK3 levels and some routine variables, such as age, gender, hypertension, and diabetes mellitus. Moreover, the model combining admission serum IRAK3, NIHSS scores, and hematoma volume demonstrated stability and clinical value in calibration and decision curve analyses. Conclusion A significant increase in serum IRAK3 levels during the early phase after ICH, strongly correlated with disease severity, is independently associated with a poor 6-month prognosis, establishing serum IRAK3 as a valuable prognostic biomarker for ICH.
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Affiliation(s)
- Yijun Ma
- Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China
- Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Wang
- Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China
- Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Tang
- Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China
- Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Li
- Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China
- Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xuan Lv
- Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China
- Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Suijun Zhu
- Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China
- Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Jiang Y, Yu Y, Fan J, Zhang L, Ye Y, Hu YH, Su LD. Development of Extubation Success Prediction Model for Mechanically Ventilated Patients with Spontaneous Cerebellar Hemorrhage. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01737-3. [PMID: 39222195 DOI: 10.1007/s12311-024-01737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
Spontaneous cerebellar hemorrhage (SCH) patients have a low success rate in extubation, but there are currently no guidelines establishing specifically for SCH patients extubation. The study included 68 SCH patients who received mechanical ventilation for more than 24 h, with 39 cases (57.3%) resulting in successful extubation. The multivariate analysis identified four factors significantly associated with extubation success: patient age under 66 years, an Intracerebral Hemorrhage (ICH) score less than 4 points, the presence of tissue shift, and a Glasgow Coma Scale (GCS) score (excluding language) above 6 points at extubation. By simplifying the prediction model, we obtained the Spontaneous Cerebellar Hemorrhage Extubation Success scoring system (SCHES-SCORE). Within the scoring system, 2 points were allocated for a GCS score (excluding language) above 6 at extubation, 1 point each for age under 66 years and an ICH score below 4, while tissue shift was assigned a negative point. A score of Grade A (SCHES-SCORE = 3-4) was found to correlate with a 92.9% success rate for extubation. The area under the receiver operating characteristic curve was 0.923 (95% CI, 0.863 to 0.983). Notably, successful extubation was significantly linked to reduced durations of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. In conclusion, the scoring system developed for assessing extubation outcomes in SCH patients has the potential to enhance the rate of successful extubation and overall patient outcomes.
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Affiliation(s)
- Yao Jiang
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, 310009, China
- Emergency Department, The First Affiliated Hospital of Ningbo University, 315010, Ningbo, China
| | - Yue Yu
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China
| | - Jing Fan
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China
| | - Lei Zhang
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China
| | - Yang Ye
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China
| | - Ying-Hong Hu
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China
| | - Li-da Su
- Neuroscience Care Unit (Key Laboratory of Multiple Organ Failure, National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Rd 88#, Hangzhou, 310009, China.
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, 310009, China.
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Eminovic S, Orth T, Dell'Orco A, Baumgärtner L, Morotti A, Wasilewski D, Guelen MS, Scheel M, Penzkofer T, Nawabi J. Clinical and imaging manifestations of intracerebral hemorrhage in brain tumors and metastatic lesions: a comprehensive overview. J Neurooncol 2024:10.1007/s11060-024-04811-2. [PMID: 39222188 DOI: 10.1007/s11060-024-04811-2] [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: 07/16/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This observational study aims to provide a detailed clinical and imaging characterization/workup of acute intracerebral hemorrhage (ICH) due to either an underlying metastasis (mICH) or brain tumor (tICH) lesion. METHODS We conducted a retrospective, single-center study, evaluating patients presenting with occult ICH on initial CT imaging, classified as tICH or mICH on follow-up MRI imaging according to the H-Atomic classification. Demographic, clinical and radiological data were reviewed. RESULTS We included 116 patients (tICH: 20/116, 17.24%; mICH: 96/116, 82.76%). The most common malignancies causing ICH were lung cancer (27.59%), malignant melanoma (18.10%) and glioblastoma (10.34%). The three most common stroke-like symptoms observed were focal deficit (62/116, 53.45%), dizziness (42/116, 36.21%) and cognitive impairment (27/116, 23.28%). Highest mICH prevalence was seen in the occipital lobe (mICH: 28.13%, tICH: 0.00%; p = 0.004) with tICH more in the corpus callosum (tICH: 10.00%, mICH: 0.00%; p = 0.029). Anticoagulation therapy was only frequent in mICH patients (tICH: 0.00%, mICH: 5.21%; p = 0.586). Hemorrhage (tICH: 12682 mm3, mICH: 5708 mm3, p = 0.020) and edema volumes (tICH: 49389 mm3, mICH: 20972 mm3, p = 0.035) were significantly larger within tICH patients. CONCLUSION More than half of the patients with neoplastic ICH exhibited stroke-like symptoms. Lung cancer was most common in mICH, glioblastoma in tICH. While clinical presentations were similar, significant differences in tumor location and treatments were discernible.
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Affiliation(s)
- Semil Eminovic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Tobias Orth
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Andrea Dell'Orco
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lukas Baumgärtner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Andrea Morotti
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - David Wasilewski
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Melisa S Guelen
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jawed Nawabi
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
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Diao H, Lu G, Wang Z, Zhang Y, Liu X, Ma Q, Yu H, Li Y. Risk factors and predictors of venous thromboembolism in patients with acute spontaneous intracerebral hemorrhage: A systematic review and meta-analysis. Clin Neurol Neurosurg 2024; 244:108430. [PMID: 39032425 DOI: 10.1016/j.clineuro.2024.108430] [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: 05/23/2024] [Revised: 07/04/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable complication of patients with acute spontaneous intracerebral hemorrhages (ICH). Knowledge of VTE risk factors in patients with acute spontaneous ICH continues to evolve while remains controversial. Therefore, this study aims to summarize the risk factors and predictors of VTE in patients with acute spontaneous ICH. METHODS EMBASE, PubMed, Web of Science and Cochrane databases were searched for articles containing Mesh words "Cerebral hemorrhage" and "Venous thromboembolism." Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. We performed meta-analysis to determine risk factors for the development of VTE in acute spontaneous ICH patients. Sensitivity analysis were performed to explore the sources of heterogeneity. RESULTS Of the 12,362 articles retrieved, 17 cohort studies were included.Meta-analysis showed that longer hospital stay [OR=15.46, 95 % CI (12.54, 18.39), P<0.00001], infection [OR=5.59, 95 % CI (1.53, 20.42), P=0.009], intubation [OR=4.32, 95 % CI (2.79, 6.69), P<0.00001] and presence of intraventricular hemorrhage (IVH) [OR=1.89, 95 % CI (1.50, 2.38), P<0.00001] were significant risk factors for VTE in acute spontaneous ICH patients. Of the 17 studies included, five studies reported six prediction models, including 15 predictors. The area under the receiver operating curve (AUC) ranged from 0.71 to 0.95. One of the models was externally validated. CONCLUSION Infection, the intubation, presence of IVH and longer hospital stay were risk factors for the development of VTE in acute spontaneous ICH patients. Prediction models of VTE based on acute spontaneous ICH patients have been poorly reported and more research will be needed before such models can be applied in clinical settings.
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Affiliation(s)
- Haiqing Diao
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
| | - Guangyu Lu
- School of Public Health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhiyao Wang
- School of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yang Zhang
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiaoguang Liu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Qiang Ma
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yuping Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China; Department of Neurosurgery, Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Essibayi MA, Ibrahim Abdallah O, Mortezaei A, Zaidi SE, Vaishnav D, Cherian J, Parikh G, Altschul D, Labib M. Natural History, Pathophysiology, and Recent Management Modalities of Intraventricular Hemorrhage. J Intensive Care Med 2024; 39:813-819. [PMID: 37769332 DOI: 10.1177/08850666231204582] [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: 09/30/2023]
Abstract
Intraventricular hemorrhage (IVH) is a clinical challenge observed among 40-45% of intracerebral hemorrhage (ICH) cases. IVH can be classified according to the source of the hemorrhage into primary and secondary IVH. Primary intraventricular hemorrhage (PIVH), unlike secondary IVH, involves only the ventricles with no hemorrhagic parenchymal source. Several risk factors of PIVH were reported which include hypertension, smoking, age, and excessive alcohol consumption. IVH is associated with high mortality and morbidity and several prognostic factors were identified such as IVH volume, number of ventricles with blood, involvement of fourth ventricle, baseline Glasgow Coma Scale score, and hydrocephalus. Prompt management of patients with IVH is required to stabilize the clinical status of patients upon admission. Nevertheless, further advanced management is crucial to reduce the morbidity and mortality associated with intraventricular bleeding. Recent treatments showed promising outcomes in the management of IVH patients such as intraventricular anti-inflammatory drugs, lumbar drainage, and endoscopic evacuation of IVH, however, their safety and efficacy are still in question. This literature review presents the epidemiology, physiopathology, risk factors, and outcomes of IVH in adults with an emphasis on recent treatment options.
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Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Ali Mortezaei
- School of Medicine, Gonabad University of Medical Sciences, Gonabad, Razavi Khorasan, Iran
| | - Saif Eddine Zaidi
- School of Medicine, University of Paris, Paris, France
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Dhrumil Vaishnav
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
| | - Gunjan Parikh
- Department of Neurology and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Altschul
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohamed Labib
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
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Pezzini A, Tarantino B, Zedde M, Marcheselli S, Silvestrelli G, Ciccone A, DeLodovici ML, Princiotta Cariddi L, Vidale S, Paciaroni M, Azzini C, Padroni M, Gamba M, Magoni M, Del Sette M, Tassi R, De Franco IG, Cavallini A, Calabrò RS, Cappellari M, Giorli E, Giacalone G, Lodigiani C, Zenorini M, Valletta F, Cutillo G, Bonelli G, Abrignani G, Castellini P, Genovese A, Latte L, Trapasso MC, Ferraro C, Piancatelli F, Pascarella R, Grisendi I, Assenza F, Napoli M, Moratti C, Acampa M, Grassi M. Early seizures and risk of epilepsy and death after intracerebral haemorrhage: The MUCH Italy. Eur Stroke J 2024; 9:630-638. [PMID: 38627943 PMCID: PMC11418551 DOI: 10.1177/23969873241247745] [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: 02/01/2024] [Accepted: 03/30/2024] [Indexed: 08/23/2024] Open
Abstract
INTRODUCTION It is unclear which patients with non-traumatic (spontaneous) intracerebral haemorrhage (ICH) are at risk of developing acute symptomatic seizures (provoked seizures occurring within the first week after stroke onset; early seizures, ES) and whether ES predispose to the occurrence of remote symptomatic seizures (unprovoked seizures occurring more than 1 week after stroke; post-stroke epilepsy, PSE) and long-term mortality. PATIENTS AND METHODS In the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) we examined the risk of ES and whether they predict the occurrence of PSE and all-cause mortality in a cohort of patients with first-ever spontaneous ICH and no previous history of epilepsy, consecutively hospitalized in 12 Italian neurological centers from 2002 to 2014. RESULTS Among 2570 patients (mean age, 73.4 ± 12.5 years; males, 55.4%) 228 (8.9%) had acute ES (183 (7.1%) short seizures and 45 (1.8%) status epilepticus (SE)). Lobar location of the hematoma (OR, 1.49; 95% CI, 1.06-2.08) was independently associated with the occurrence of ES. Of the 2,037 patients who were followed-up (median follow-up time, 68.0 months (25th-75th percentile, 77.0)), 155 (7.6%) developed PSE. ES (aHR, 2.34; 95% CI, 1.42-3.85), especially when presenting as short seizures (aHR, 2.35; 95% CI, 1.38-4.00) were associated to PSE occurrence. Unlike short seizures, SE was an independent predictor of all-cause mortality (aHR, 1.50; 95% CI, 1.005-2.26). DISCUSSION AND CONCLUSION The long-term risk of PSE and death after an ICH vary according to ES subtype. This might have implications for the design of future clinical trials targeting post-ICH epileptic seizures.
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Affiliation(s)
- Alessandro Pezzini
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italia
- Dipartimento di Emergenza-Urgenza, Programma Stroke Care, Azienda Ospedaliero Universitaria, Parma, Italia
| | - Barbara Tarantino
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Italia
| | - Marialuisa Zedde
- S.C. Neurologia, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italia
| | - Simona Marcheselli
- Neurologia d’Urgenza and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italia
| | | | - Alfonso Ciccone
- Stroke Unit, Dipartimento di Neuroscienze, ASST Mantova, Italia
| | | | | | - Simone Vidale
- Unità di Neurologia, Ospedale di Circolo, Università dell’Insubria, Varese, Italia
| | - Maurizio Paciaroni
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Italia
| | - Cristiano Azzini
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Marina Padroni
- Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Italia
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia
| | - Mauro Magoni
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Italia
| | - Massimo Del Sette
- Struttura Complessa di Neurologia, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | | | | | - Anna Cavallini
- UOC Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino,” Pavia, Italia
| | - Rocco Salvatore Calabrò
- Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italia
| | - Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italia
| | | | - Giacomo Giacalone
- Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italia
| | - Corrado Lodigiani
- UOC Centro Trombosi e Malattie Emorragiche, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italia
| | - Mara Zenorini
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italia
| | - Francesco Valletta
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Italia
| | - Gianni Cutillo
- Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italia
| | - Guido Bonelli
- Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italia
| | - Giorgia Abrignani
- Dipartimento di Emergenza-Urgenza, Programma Stroke Care, Azienda Ospedaliero Universitaria, Parma, Italia
| | - Paola Castellini
- Dipartimento di Emergenza-Urgenza, Programma Stroke Care, Azienda Ospedaliero Universitaria, Parma, Italia
| | - Antonio Genovese
- Dipartimento di Emergenza-Urgenza, Programma Stroke Care, Azienda Ospedaliero Universitaria, Parma, Italia
| | - Lilia Latte
- Dipartimento di Emergenza-Urgenza, Programma Stroke Care, Azienda Ospedaliero Universitaria, Parma, Italia
| | - Maria Claudia Trapasso
- Dipartimento di Emergenza-Urgenza, Programma Stroke Care, Azienda Ospedaliero Universitaria, Parma, Italia
| | - Chiara Ferraro
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italia
| | - Francesco Piancatelli
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Italia
| | | | - Ilaria Grisendi
- S.C. Neurologia, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italia
| | - Federica Assenza
- S.C. Neurologia, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italia
| | - Manuela Napoli
- SSD Neuroradiologia, AUSL-IRCCS di Reggio Emilia, Italia
| | | | | | - Mario Grassi
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Italia
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9
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Jang JS, Park YS. Contributing factors of spontaneous intracerebral hemorrhage development in young adults. J Cerebrovasc Endovasc Neurosurg 2024; 26:274-283. [PMID: 38897595 DOI: 10.7461/jcen.2024.e2023.11.001] [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: 11/06/2023] [Accepted: 05/04/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE The incidence of spontaneous intracerebral hemorrhage (ICH) in young people is relatively low; however, it leads to devastating lifelong neurologic deficits. We focused on spontaneous ICH occurring in young adults between 30 and 50 years of age. METHODS We retrospectively reviewed the records of 139 patients, aged 30-50 years, diagnosed with spontaneous ICH between 2011 and 2021. Cases of ICH attributable to discernible causative lesions were excluded. Demographic data, laboratory results, image findings, and clinical outcome were analyzed. RESULTS After exclusions, 73 patients were included in this study. Common characteristics among the study patients included male sex (83.6%), high body mass index (>25 kg/m2, 45.8%), smoking history (47.2%), heavy alcohol consumption (30.6%), previously diagnosed hypertension (41.1%), high serum triglyceride level (>150 mg/dL, 33.3%), and microbleeds or white matter changes observed on magnetic resonance images (51.3%). In the multivariate analysis, previously diagnosed hypertension was the sole significant risk factor for cerebral small vessel (OR 7.769, P=0.031). Age, brain stem location, Glasgow Coma Scale score at admission, and hematoma volume were associated with poor outcomes. CONCLUSIONS Hypertension, obesity, smoking, and cerebral small vessel disease were important factors associated with non-lesional spontaneous intracerebral hemorrhage in young patients. Radiologic changes corresponding to cerebral small vessel disease appeared in young patients (in their 30s) and they were associated with hypertension.
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Affiliation(s)
- Ju-Sung Jang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Yong-Sook Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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10
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Huang X, Lan Z, Hu Z. Role and mechanisms of mast cells in brain disorders. Front Immunol 2024; 15:1445867. [PMID: 39253085 PMCID: PMC11381262 DOI: 10.3389/fimmu.2024.1445867] [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: 06/08/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024] Open
Abstract
Mast cells serve as crucial effector cells within the innate immune system and are predominantly localized in the skin, airways, gastrointestinal tract, urinary and reproductive tracts, as well as in the brain. Under physiological conditions, brain-resident mast cells secrete a diverse array of neuro-regulatory mediators to actively participate in neuroprotection. Meanwhile, as the primary source of molecules causing brain inflammation, mast cells also function as the "first responders" in brain injury. They interact with neuroglial cells and neurons to facilitate the release of numerous inflammatory mediators, proteases, and reactive oxygen species. This process initiates and amplifies immune-inflammatory responses in the brain, thereby contributing to the regulation of neuroinflammation and blood-brain barrier permeability. This article provides a comprehensive overview of the potential mechanisms through which mast cells in the brain may modulate neuroprotection and their pathological implications in various neurological disorders. It is our contention that the inhibition of mast cell activation in brain disorders could represent a novel avenue for therapeutic breakthroughs.
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Affiliation(s)
- Xuanyu Huang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziwei Lan
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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11
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Chan AA, Lam TL, Liu J, Ng ACK, Zhang C, Kiang KM, Leung GKK. Acute calcitriol treatment mitigates vitamin D deficiency-associated mortality after intracerebral haemorrhage. Neurosci Lett 2024; 838:137922. [PMID: 39127125 DOI: 10.1016/j.neulet.2024.137922] [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: 05/24/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Vitamin D deficiency (VDD) is emerging as a predictor of poor prognosis in various neurological conditions, where clinical outcomes are often worse in stroke patients with VDD. This study aimed to provide experimental evidence on whether and how pre-existing VDD would affect survival and neurofunctional outcomes in intracerebral haemorrhage (ICH), and to evaluate whether acute vitamin D (VD) supplementation would improve post-stroke outcomes. METHODS Experimental ICH models were induced in mice with and without VDD. Haematoma size was measured using T2*-weighted MRI and haemoglobin concentration. Post-ICH mortality, neurofunctional outcomes and the extent of blood-brain barrier (BBB) leakage were assessed to identify their correlations with VD status. Therapeutic benefits of acute VD administration were also evaluated. RESULTS Mice with VDD exhibited significantly higher acute mortality rates and more severe motor deficits than mice without VDD post-ICH. Marked haematoma expansion and increased Evans blue extravasation were observed in VDD mice, suggesting that VDD was associated outcomes with increased BBB disruption. Acute treatment with a loading dose of VD (calcitriol) significantly improved outcomes in VDD mice. CONCLUSION This study provides novel insights into the pathophysiological mechanisms at play in ICH concomitant with VDD and a scientific rationale for acute treatment with VD.
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Affiliation(s)
- Andrian A Chan
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tsz-Lung Lam
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jiaxin Liu
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Anson Cho-Kiu Ng
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cuiting Zhang
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Karrie M Kiang
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Gilberto Ka-Kit Leung
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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12
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Alhadidi QM, Nash KM, Bahader GA, Zender E, McInerney MF, Shah ZA. Hyperglycemia in a NOD Mice Model of Type-I Diabetes Aggravates Collagenase-Induced Intracerebral Hemorrhagic Injury. Biomedicines 2024; 12:1867. [PMID: 39200331 PMCID: PMC11352023 DOI: 10.3390/biomedicines12081867] [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: 07/05/2024] [Revised: 07/30/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a severe type of stroke with high mortality. Persistent hyperglycemia following ICH is linked to deteriorated neurological functions and death. However, the exacerbating effect of hyperglycemia on ICH injury at the molecular level is still unclear. Therefore, this study explores the impact of diabetes on ICH injury using a non-obese diabetic (NOD) mouse model of type I diabetes mellitus. METHODS NOD and non-diabetic (non-obese resistant) mice subjected to ICH by intrastriatal injection of collagenase were sacrificed three days following the ICH. Brains were collected for hematoma volume measurement and immunohistochemistry. Neurobehavioral assays were conducted 24 h before ICH and then repeated at 24, 48 and 72 h following ICH. RESULTS NOD mice showed increased hematoma volume and impairment in neurological function, as revealed by rotarod and grip strength analyses. Immunohistochemical staining showed reduced glial cell activation, as indicated by decreased GFAP and Iba1 staining. Furthermore, the expression of oxidative/nitrosative stress markers represented by 3-nitrotyrosine and inducible nitric oxide synthase was reduced in the diabetic group. CONCLUSIONS Overall, our findings support the notion that hyperglycemia exacerbates ICH injury and worsens neurological function and that the mechanism of injury varies depending on the type of diabetes model used.
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Affiliation(s)
- Qasim M. Alhadidi
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
- Department of Pharmacy, Al-Yarmok University College, Diyala 21163, Iraq
| | - Kevin M. Nash
- Department of Pharmacology, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Ghaith A. Bahader
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Emily Zender
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Marcia F. McInerney
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
| | - Zahoor A. Shah
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
- Department of Pharmacology, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
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13
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Asmat KN, Nadeem MS, Maryam A, Fatima A. Unravelling the potential of serum secretoneurin: a prognostic biomarker for intracerebral haemorrhage (ICH). Neurosurg Rev 2024; 47:426. [PMID: 39141258 DOI: 10.1007/s10143-024-02675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 07/25/2024] [Accepted: 08/10/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Kashaf Noor Asmat
- Nishtar Medical College, Nishtar Medical University, Nishtar Road, Gillani Colony, Multan, Punjab, 66000, Pakistan.
| | - Muhammad Salman Nadeem
- Nishtar Medical College, Nishtar Medical University, Nishtar Road, Gillani Colony, Multan, Punjab, 66000, Pakistan
| | - Ayesha Maryam
- Nishtar Medical College, Nishtar Medical University, Nishtar Road, Gillani Colony, Multan, Punjab, 66000, Pakistan
| | - Ayesha Fatima
- Nishtar Medical College, Nishtar Medical University, Nishtar Road, Gillani Colony, Multan, Punjab, 66000, Pakistan
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14
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D'Angelo T, Bucolo GM, Kamareddine T, Yel I, Koch V, Gruenewald LD, Martin S, Alizadeh LS, Mazziotti S, Blandino A, Vogl TJ, Booz C. Accuracy and time efficiency of a novel deep learning algorithm for Intracranial Hemorrhage detection in CT Scans. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01867-y. [PMID: 39123064 DOI: 10.1007/s11547-024-01867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To evaluate a deep learning-based pipeline using a Dense-UNet architecture for the assessment of acute intracranial hemorrhage (ICH) on non-contrast computed tomography (NCCT) head scans after traumatic brain injury (TBI). MATERIALS AND METHODS This retrospective study was conducted using a prototype algorithm that evaluated 502 NCCT head scans with ICH in context of TBI. Four board-certified radiologists evaluated in consensus the CT scans to establish the standard of reference for hemorrhage presence and type of ICH. Consequently, all CT scans were independently analyzed by the algorithm and a board-certified radiologist to assess the presence and type of ICH. Additionally, the time to diagnosis was measured for both methods. RESULTS A total of 405/502 patients presented ICH classified in the following types: intraparenchymal (n = 172); intraventricular (n = 26); subarachnoid (n = 163); subdural (n = 178); and epidural (n = 15). The algorithm showed high diagnostic accuracy (91.24%) for the assessment of ICH with a sensitivity of 90.37% and specificity of 94.85%. To distinguish the different ICH types, the algorithm had a sensitivity of 93.47% and a specificity of 99.79%, with an accuracy of 98.54%. To detect midline shift, the algorithm had a sensitivity of 100%. In terms of processing time, the algorithm was significantly faster compared to the radiologist's time to first diagnosis (15.37 ± 1.85 vs 277 ± 14 s, p < 0.001). CONCLUSION A novel deep learning algorithm can provide high diagnostic accuracy for the identification and classification of ICH from unenhanced CT scans, combined with short processing times. This has the potential to assist and improve radiologists' ICH assessment in NCCT scans, especially in emergency scenarios, when time efficiency is needed.
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Affiliation(s)
- Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University of Messina, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
| | - Giuseppe M Bucolo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University of Messina, Messina, Italy
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Tarek Kamareddine
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Simon Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Leona S Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University of Messina, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt Am Main, Germany
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15
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Geest V, Oblak JP, Popović KŠ, Nawabi J, Elsayed S, Friedrich C, Böhmer M, Akkurt B, Sporns P, Morotti A, Schlunk F, Steffen P, Broocks G, Meyer L, Hanning U, Thomalla G, Gellissen S, Fiehler J, Frol S, Kniep H. How much of the variance in functional outcome related to intracerebral hemorrhage volume is already apparent in neurological status at admission? J Neurol 2024; 271:5003-5011. [PMID: 38775933 PMCID: PMC11319529 DOI: 10.1007/s00415-024-12427-9] [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: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Hematoma volume is a major pathophysiological hallmark of acute intracerebral hemorrhage (ICH). We investigated how the variance in functional outcome induced by the ICH volume is explained by neurological deficits at admission using a mediation model. METHODS Patients with acute ICH treated in three tertiary stroke centers between January 2010 and April 2019 were retrospectively analyzed. Mediation analysis was performed to investigate the effect of ICH volume (0.8 ml (5% quantile) versus 130.6 ml (95% quantile)) on the risk of unfavorable functional outcome at discharge defined as modified Rankin Score (mRS) ≥ 3 with mediation through National Institutes of Health Stroke Scale (NIHSS) at admission. Multivariable regression was conducted to identify factors related to neurological improvement and deterioration. RESULTS Three hundred thirty-eight patients were analyzed. One hundred twenty-one patients (36%) achieved mRS ≤ 3 at discharge. Mediation analysis showed that NIHSS on admission explained 30% [13%; 58%] of the ICH volume-induced variance in functional outcome at smaller ICH volume levels, and 14% [4%; 46%] at larger ICH volume levels. Higher ICH volume at admission and brainstem or intraventricular location of ICH were associated with neurological deterioration, while younger age, normotension, lower ICH volumes, and lobar location of ICH were predictors for neurological improvement. CONCLUSION NIHSS at admission reflects 14% of the functional outcome at discharge for larger hematoma volumes and 30% for smaller hematoma volumes. These results underscore the importance of effects not reflected in NIHSS admission for the outcome of ICH patients such as secondary brain injury and early rehabilitation.
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Affiliation(s)
- Vincent Geest
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Janja Pretnar Oblak
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Šurlan Popović
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Neuroradiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jawed Nawabi
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Elsayed
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constanze Friedrich
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maik Böhmer
- Department of Radiology, University Hospital Muenster, Muenster, Germany
| | - Burak Akkurt
- Department of Radiology, University Hospital Muenster, Muenster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Andrea Morotti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Frieder Schlunk
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Steffen
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellissen
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Senta Frol
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Durand NC, Kim HG, Patel VN, Turnbull MT, Siegel JL, Hodge DO, Tawk RG, Meschia JF, Freeman WD, Zubair AC. Mesenchymal Stem Cell Therapy in Acute Intracerebral Hemorrhage: A Dose-Escalation Safety and Tolerability Trial. Neurocrit Care 2024; 41:59-69. [PMID: 38114796 PMCID: PMC11335835 DOI: 10.1007/s12028-023-01897-w] [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: 06/26/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND We conducted a preliminary phase I, dose-escalating, safety, and tolerability trial in the population of patients with acute intracerebral hemorrhage (ICH) by using human allogeneic bone marrow-derived mesenchymal stem/stromal cells. METHODS Eligibility criteria included nontraumatic supratentorial hematoma less than 60 mL and Glasgow Coma Scale score greater than 5. All patients were monitored in the neurosciences intensive care unit for safety and tolerability of mesenchymal stem/stromal cell infusion and adverse events. We also explored the use of cytokines as biomarkers to assess responsiveness to the cell therapy. We screened 140 patients, enrolling 9 who met eligibility criteria into three dose groups: 0.5 million cells/kg, 1 million cells/kg, and 2 million cells/kg. RESULTS Intravenous administration of allogeneic bone marrow-derived mesenchymal stem/stromal cells to treat patients with acute ICH is feasible and safe. CONCLUSIONS Future larger randomized, placebo-controlled ICH studies are necessary to validate this study and establish the effectiveness of this therapeutic approach in the treatment of patients with ICH.
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Affiliation(s)
- Nisha C Durand
- Center for Regenerative Biotherapeutics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
- Human Cellular Therapy Laboratory, Mayo Clinic, Jacksonville, FL, USA.
| | - H G Kim
- Clinical Research Intern Scholar Program, Mayo Clinic, Jacksonville, FL, USA
| | - Vishal N Patel
- Division of Neuroradiology, Mayo Clinic, Jacksonville, FL, USA
| | - Marion T Turnbull
- Research Collaborator in the Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Jason L Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - David O Hodge
- Biostatistics Unit, Mayo Clinic, Jacksonville, FL, USA
| | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - W David Freeman
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Abba C Zubair
- Center for Regenerative Biotherapeutics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
- Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA
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Shu J, Wang W, Ye R, Zhou Y, Tong J, Li X, Lv X, Zhang G, Xu F, Zhang J. Risk factors of prognosis for spontaneous cerebellar hemorrhage: a systematic review and meta-analysis. Acta Neurochir (Wien) 2024; 166:291. [PMID: 38985355 PMCID: PMC11236867 DOI: 10.1007/s00701-024-06174-z] [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: 05/15/2024] [Accepted: 06/22/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND The most deadly type of spontaneous intracerebral hemorrhage is spontaneous cerebellar hemorrhage (SCH). The purpose of this meta-analysis was to investigate risk factors for prognosis in SCH patients to provide a basis for taking preventive and therapeutic measures. METHODS Seven electronic databases were searched from inception to May 2023 for randomized controlled trial, cohort study, case control study and cross-sectional study on prognosis of spontaneous cerebellar hemorrhage. The quality of the selected studies were assessed by the American Agency for Healthcare Research and Quality (AHRQ). To assess the impact of the included risk factors on the prognosis of spontaneous cerebellar hemorrhage, combined odds ratios (ORs) with matching 95% confidence intervals (CIs) were combined. RESULTS Eight studies were included, including 539 participants. And a total of 31 potentially associated risk factors were identified. Ultimately, 6 risk factors were included in the meta-analysis after assessing. The factors supported by moderate evidence include the hydrocephalus (OR = 4.3, 95% CI: 2.33 to 7.91) and drug-induced coagulopathy (OR = 2.74, 95% CI: 1.23 to 6.09). The factors supported by limited evidence include the intraventricular bleeding(OR = 1.86, 95% CI: 1.13 to 3.07) and hematoma size>3 cm(OR = 3.18, 95% CI: 1.87 to 5.39). Meta-analysis revealed no association between hypertension, diabetes mellitus and SCH prognosis. CONCLUSION The current meta-analysis revealed obvious risk factors for prognosis in spontaneous cerebellar hemorrhage patients, including hydrocephalus, drug-induced coagulopathy, intraventricular bleeding and hematoma size>3 cm.
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Affiliation(s)
- Junbin Shu
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Wei Wang
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Ruyong Ye
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Yonggang Zhou
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Jianfeng Tong
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Xiaobo Li
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Xiaojun Lv
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Guangliang Zhang
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Feng Xu
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China
| | - Jing Zhang
- Department of Neurosurgery, The First People's Hospital of Yongkang City, Yongkang, China.
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Kjølhede M, Hjort N, Homburg S, Nørholt M, Dalby RB, Simonsen CZ, Blauenfeldt RA. Diagnostic yield of computed tomography angiography in patients presenting with spontaneous intracerebral hemorrhage. Acta Radiol 2024; 65:817-824. [PMID: 38772562 DOI: 10.1177/02841851241254516] [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: 05/23/2024]
Abstract
BACKGROUND Hypertension and cerebral amyloid angiopathy are the most common causes of spontaneous intracerebral hemorrhage (ICH); however, these conditions do not imply macrovascular pathology. Still, computed tomography (CT) angiography (CTA) is often performed in the acute phase in patients with ICH. PURPOSE To assess the diagnostic yield of CTA in the detection of secondary etiology in consecutive patients with spontaneous ICH. MATERIAL AND METHODS We performed a retrospective analysis of data from a prospective single-center cohort study of 203 patients presenting with spontaneous ICH admitted to a comprehensive stroke center over a two-year period (15 October 2016 to 15 October 2018). The underlying vascular pathology was assessed using CTA. RESULTS CTA was performed in addition to non-contrast CT and/or magnetic resonance imaging (MRI). Vascular pathology was found in 11 of 203 (5.4%) patients and included arteriovenous malformations (n=4), aneurysms (n=4), vasospasms (n=1), cerebral venous thrombosis (n=1), and other vascular malformations (n=1). In eight cases, the finding was deemed symptomatic. Patients with vascular pathology on CTA more often had lobar located hemorrhages (63.6% vs. 36.4%, P = 0.049). Numerically, patients with vascular pathology were younger, had smaller hematoma volumes, and lower mortality. CONCLUSION Underlying macrovascular pathology was detected on CTA in only approximately 1 of 20 consecutive patients with ICH. The patients with vascular pathology more often had a hemorrhage with a lobar location and young age and the present study is supportive of a risk-based stratification approach in performing CTA.
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Affiliation(s)
- Maria Kjølhede
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Skejby, Denmark
| | - Niels Hjort
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Sif Homburg
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Skejby, Denmark
| | - Morten Nørholt
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Skejby, Denmark
| | - Rikke Beese Dalby
- Hospital South West Jutland, University hospital of Southern Denmark & Department of Neuroradiology, Aarhus University Hospital, Skejby, Denmark
| | - Claus Ziegler Simonsen
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Rolf Ankerlund Blauenfeldt
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Skejby, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
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19
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Ma F, Zeng Z, Chen J, Zhang J. A new score for predicting intracranial hemorrhage in patients using antiplatelet drugs. Ann Hematol 2024; 103:2511-2521. [PMID: 38630131 DOI: 10.1007/s00277-024-05734-8] [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: 01/15/2024] [Accepted: 03/29/2024] [Indexed: 07/06/2024]
Abstract
Antiplatelet drugs in patients increase the risk of intracranial hemorrhage (ICH), which can seriously affect patients' quality of life and even endanger their lives. Currently, there is no specific score for predicting the risk of ICH caused by antiplatelet drugs. We aimed to identify factors associated with ICH in patients on antiplatelet drugs and to construct and validate a predictive model that would provide a validated tool for the clinic. Data were obtained from the patient medical records inpatient system. Prediction models were built by logistic regression, the area under the curve (AUC), and column line plots. Internal validation, analytical identification and calibration of the model using AUC, calibration curves and Hosmer-Lemeshow test. The registration number of this study is ChiCTR2000031909, and the ethical review number is 2020KY087. This single-center retrospective study enrolled 753 patients treated with antiplatelet drugs, including 527 in the development cohort. Multifactorial analysis showed that male, headache or vomiting, hypertension, cerebrovascular disease, CT-defined white matter hypodensity, abnormal GCS, fibrinogen and D-dimer were independent risk factors for ICH, and lipid-lowering drugs was a protective factor. The model was constructed using these nine factors with an AUC value of 0.949. In the validation cohort, the model showed good discriminatory power with an AUC value of 0.943 and good calibration (Hosmer-Lemeshow test P value of 0.818). Based on 9 factors, we derived and validated a predictive model for ICH with antiplatelet drugs in patients. The model has good predictive value and may be an effective tool to reduce the occurrence of ICH.
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Affiliation(s)
- Fuxin Ma
- Department of School, Fujian Medical University, Fuzhou, China
| | - Zhiwei Zeng
- Department of Pharmacy, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China
| | - Jiana Chen
- Department of Pharmacy, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China
| | - Jinhua Zhang
- Department of Pharmacy, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China.
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20
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Sun S, Huang X, Fei X, Gong K, Ye F, Gao H. Neuroendoscopic Surgery Versus Stereotactic Aspiration in the Treatment of Supratentorial Intracerebral Hemorrhage: A Meta-Analysis. World Neurosurg 2024; 187:e585-e597. [PMID: 38679374 DOI: 10.1016/j.wneu.2024.04.132] [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: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Debate persists over the relative merits of neuroendoscopic surgery (NS) compared to stereotactic aspiration (SA) for treating supratentorial intracerebral hemorrhage (ICH). Consequently, we undertook this meta-analysis to assess the efficacy and safety of NS versus SA. METHODS We searched for the all-relevant studies systematically from English databases including PubMed, Embase, Web of Science, and the Cochrane Library. Three independent researchers identified and selected these literatures that met the inclusion criteria. Then we evaluated the quality of these studies according to the Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa Scale. RevMan 5.4 statistical software was used to conduct this meta-analysis. RESULTS Sixteen studies, including 2722 supratentorial ICH patients, were included in our meta-analysis. The pooled results showed that NS could effectively improve the functional prognosis (P = 0.002), reduce the postoperative mortality (P < 0.00001), and increase the hematoma evacuation rate (P < 0.00001). In addition, SA had more advantages in shortening operation time (P < 0.00001) and reducing intraoperative blood loss (P < 0.0001). However, there was no obvious statistical difference in intensive care unit stays (P = 0.23) between NS and SA. Besides, no sufficient evidence could support a significant difference in hospital stays. In the aspect of complications, NS was discovered to have a positive effect on preventing rebleeding (P = 0.005) and intracranial infection (P = 0.003). However, no significant differences between the 2 groups in digestive tract ulcer (P = 0.34), epilepsy (P = 0.99), and pneumonia (P = 0.58) were discovered. In the subgroup analysis, factors including publication time, Glasgow Coma Scale score, age, and follow-up, all significantly influenced the good functional outcome and mortality. Meanwhile, NS behaved more advantageous in improving functional prognosis for patients with hematoma located in the basal ganglia. CONCLUSIONS NS may hold more advantages over SA in the treatment of supratentorial ICH. However, SA is also an effective and suitable alternative for elderly patients, especially those with multiple comorbidities intolerant to extended surgical procedures. Further high-quality studies are warranted to substantiate our findings in the future.
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Affiliation(s)
- Shuwen Sun
- Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China.
| | - Xin Huang
- Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China
| | - Xiaobin Fei
- Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China
| | - Kai Gong
- Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China
| | - Fuhua Ye
- Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China
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21
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Dong R, Li F, Li B, Chen Q, Huang X, Zhang J, Huang Q, Zhang Z, Cao Y, Yang M, Li J, Li Z, Li C, Liu G, Zhong S, Feng G, Zhang M, Xiao Y, Lin K, Shen Y, Shao H, Shi Y, Yu X, Li X, Yao L, Du X, Xu Y, Kang P, Gao G, Ouyang B, Chen W, Zeng Z, Chen P, Chen C, Yang H. Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial. Anesthesiology 2024; 141:100-115. [PMID: 38537025 DOI: 10.1097/aln.0000000000004986] [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: 06/12/2024]
Abstract
BACKGROUND Although it has been established that elevated blood pressure and its variability worsen outcomes in spontaneous intracerebral hemorrhage, antihypertensives use during the acute phase still lacks robust evidence. A blood pressure-lowering regimen using remifentanil and dexmedetomidine might be a reasonable therapeutic option given their analgesic and antisympathetic effects. The objective of this superiority trial was to validate the efficacy and safety of this blood pressure-lowering strategy that uses remifentanil and dexmedetomidine in patients with acute intracerebral hemorrhage. METHODS In this multicenter, prospective, single-blinded, superiority randomized controlled trial, patients with intracerebral hemorrhage and systolic blood pressure (SBP) 150 mmHg or greater were randomly allocated to the intervention group (a preset protocol with a standard guideline management using remifentanil and dexmedetomidine) or the control group (standard guideline-based management) to receive blood pressure-lowering treatment. The primary outcome was the SBP control rate (less than 140 mmHg) at 1 h posttreatment initiation. Secondary outcomes included blood pressure variability, neurologic function, and clinical outcomes. RESULTS A total of 338 patients were allocated to the intervention (n = 167) or control group (n = 171). The SBP control rate at 1 h posttreatment initiation in the intervention group was higher than that in controls (101 of 161, 62.7% vs. 66 of 166, 39.8%; difference, 23.2%; 95% CI, 12.4 to 34.1%; P < 0.001). Analysis of secondary outcomes indicated that patients in the intervention group could effectively reduce agitation while achieving lighter sedation, but no improvement in clinical outcomes was observed. Regarding safety, the incidence of bradycardia and respiratory depression was higher in the intervention group. CONCLUSIONS Among intracerebral hemorrhage patients with a SBP 150 mmHg or greater, a preset protocol using a remifentanil and dexmedetomidine-based standard guideline management significantly increased the SBP control rate at 1 h posttreatment compared with the standard guideline-based management. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Rui Dong
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fen Li
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Bin Li
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Qiming Chen
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xianjian Huang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jiehua Zhang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qibing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, China
| | - Zeli Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, China
| | - Yunxing Cao
- Department of Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingbiao Yang
- Neurosurgery Department, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, China
| | - Jianwei Li
- Department of Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, China
| | - Zhanfu Li
- Department of Intensive Care Unit, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Cuiyu Li
- Department of Intensive Care Unit, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Guohua Liu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shu Zhong
- Department of Neurosurgery, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Nanning, China
| | - Guang Feng
- Department of Neurosurgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Zhang
- Department of Neurosurgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yumei Xiao
- Neurological Intensive Medicine Department, Maoming People's Hospital, Maoming, China
| | - Kangyue Lin
- Neurological Intensive Medicine Department, Maoming People's Hospital, Maoming, China
| | - Yunlong Shen
- Department of Neurosurgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Huanzhang Shao
- Department of Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Shi
- Department of Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyou Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaopeng Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lan Yao
- Department of Emergency Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xinyu Du
- Department of Emergency Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ying Xu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Pei Kang
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Guoyi Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Ouyang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjin Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Zeng
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Hong Yang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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22
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Mao B, Ling L, Pan Y, Zhang R, Zheng W, Shen Y, Lu W, Lu Y, Xu S, Wu J, Wang M, Wan S. Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit. Sci Rep 2024; 14:14195. [PMID: 38902304 PMCID: PMC11190185 DOI: 10.1038/s41598-024-65128-8] [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: 09/26/2023] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
This study aimed to develop a machine learning (ML)-based tool for early and accurate prediction of in-hospital mortality risk in patients with spontaneous intracerebral hemorrhage (sICH) in the intensive care unit (ICU). We did a retrospective study in our study and identified cases of sICH from the MIMIC IV (n = 1486) and Zhejiang Hospital databases (n = 110). The model was constructed using features selected through LASSO regression. Among five well-known models, the selection of the best model was based on the area under the curve (AUC) in the validation cohort. We further analyzed calibration and decision curves to assess prediction results and visualized the impact of each variable on the model through SHapley Additive exPlanations. To facilitate accessibility, we also created a visual online calculation page for the model. The XGBoost exhibited high accuracy in both internal validation (AUC = 0.907) and external validation (AUC = 0.787) sets. Calibration curve and decision curve analyses showed that the model had no significant bias as well as being useful for supporting clinical decisions. XGBoost is an effective algorithm for predicting in-hospital mortality in patients with sICH, indicating its potential significance in the development of early warning systems.
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Affiliation(s)
- Baojie Mao
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Lichao Ling
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Yuhang Pan
- Urology Department, Lin'an Hospital of Traditional Chinese Medicine, Hangzhou, 311321, China
| | - Rui Zhang
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Wanning Zheng
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yanfei Shen
- Department of Intensive Care, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, 310030, China
| | - Wei Lu
- ArteryFlow Technology Co., Ltd., Hangzhou, 310051, China
| | - Yuning Lu
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Shanhu Xu
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Jiong Wu
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Ming Wang
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China.
| | - Shu Wan
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China.
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23
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Kondabathini R, Venishetty N, Madineni KU. Endoscopic Evacuation Versus Open Craniotomy and Evacuation of Non-traumatic Intracerebral Bleed: A Comparative Study. Cureus 2024; 16:e62233. [PMID: 39006658 PMCID: PMC11242739 DOI: 10.7759/cureus.62233] [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: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Objective In patients with intracerebral hemorrhage (ICH), the usage of microsurgical instrumentation and techniques can reduce traction-related injuries and enhance postoperative outcomes compared with traditional hematoma evacuation. The purpose of this study was to compare the results of endoscopic evacuation of spontaneous non-traumatic ICH with conventional open craniotomies and evacuations of ICH in terms of safety, feasibility, and neurological outcomes. Methods This was a prospective study that included 21 patients with spontaneous intracerebral hematomas managed by surgical evacuation endoscopically and another 24 patients with spontaneous supratentorial ICH who underwent hematoma evacuation by open craniotomy. Primary outcomes included operation duration, operative blood loss, hematoma evacuation rate, re-bleeding rate, and postoperative Glasgow Coma Scale (GCS) score. Results The median operation durations were 110 (90-200) and 230 (120-460) minutes in the endoscopic and open procedure groups, respectively (p = 0.00001). The median operative blood loss was 160 (80-300) and 530 (100-2000) mL in the endoscopic and open procedure groups, respectively (p < 0.00001). The median hematoma removal rates were 90% (60%-99%) and 85% (60%-100%) in the endoscopic and open procedure groups, respectively (p = 0.0348). Re-bleeding rates were higher in the endoscopic group (p = 0.46). Postoperative Glasgow Outcome Scale scores at two-month and six-month intervals were similar between the groups (p = 0.87). Conclusion Endoscopic hematoma evacuation for spontaneous supratentorial hemorrhage is becoming a standard surgical procedure, and promising clinical results can be expected. In addition, an endoscope can enhance time efficiency, hematoma evacuation rates, and reduce bleeding. Although endoscopic surgeries have higher re-bleeding rates, the difference is not significant when compared to open craniotomies with similar postoperative GCS scores. It is therefore important to be familiar with the endoscope and its associated equipment in order to achieve better results and reduce complications.
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Affiliation(s)
| | - Nagaraju Venishetty
- Department of Neurological Surgery, St. John's Medical College, Bengaluru, IND
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24
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Lind ANR, Krabbenhøft MG, Valentin JB, Haldrup M, Dyrskog S, Rasmussen M, Simonsen CZ, Korshoej AR. Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage. Stroke Vasc Neurol 2024:svn-2023-003062. [PMID: 38782496 DOI: 10.1136/svn-2023-003062] [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: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale, cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH. We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators. We extracted ORs from the individual studies and aggregated these using a random effects model. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations assessment and ROBINS-I or RoB-2. RESULTS 24 articles were included. In SAH, we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality (OR: 0.68, 95% CI 0.46 to 1.00), higher probability of favourable functional outcome (OR: 1.80, 95% CI 1.30 to 2.51), and reduced risks of DCI (OR: 0.28, 95% CI 0.18 to 0.42) and cerebral vasospasm (OR: 0.28, 95% CI 0.18 to 0.42), compared with conventional therapy. Cisternal irrigation with vasodilatory agents was associated with lower mortality (OR: 0.32, 95% CI 0.13 to 0.79) and reduced risk of cerebral vasospasm (OR: 0.37, 95% CI 0.17 to 0.79). The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect. CONCLUSION In this study, we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy. There is no evidence to support cisternal irrigation treatment of IVH.
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Affiliation(s)
- Allice Nyborg Rosenkrans Lind
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Mette Haldrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig Dyrskog
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Rasmussen
- Department of Anesthesiology, Gødstrup Regional Hospital, Herning, Denmark
| | - Claus Ziegler Simonsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Rosendal Korshoej
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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25
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Song J, Bai H, Chen S, Xing Y, Lou J. Inhibition of sugar-binding activity of Galectins-8 by thiogalactoside (TDG) attenuates secondary brain damage and improves long-term prognosis following intracerebral hemorrhage. Heliyon 2024; 10:e30422. [PMID: 38737270 PMCID: PMC11088311 DOI: 10.1016/j.heliyon.2024.e30422] [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: 02/05/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Galectins-8 (Gal-8), the tandem repeat sequences of the galectin family, can influence the pathophysiologic processes in neurological disorders. However, its effect on intracerebral hemorrhage and related mechanisms remains nebulous. Using collagenase VII-S-induced ICH in the left striatum of mice, we investigated the effects of Gal-8 on cellular and molecular immune inflammatory responses in hemorrhagic brain and evaluated the severity of short- and long-term brain injury. Our results showed that activated microglia in the periphery of hematoma in mice with intracerebral hemorrhage expressed Gal-8, while Gal-8 could regulate the expression of cytokines, such as HMGB-1 (P = 0.0032), TNF-α (P = 0.0158), and IL-10 (P = 0.0379). Inhibition of the glucose-binding activity of Gal-8 by thiogalactoside (TDG) significantly reduced the volume of cerebral hematoma (P = 0.0241) and hydrocephalus (P = 0.0112) during the acute phase of cerebral hemorrhage and improved the long-term prognosis. TDG can reduce acute-phase brain tissue injury and improve the prognosis by inhibiting the activation of immune-inflammatory cells in the periphery of hematoma and reducing the release of pro-inflammatory factors.
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Affiliation(s)
- Jingjing Song
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Hongying Bai
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Si Chen
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yuanyuan Xing
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Jiyu Lou
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
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26
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Bah MG, Dowlati E, Fleigner M, Koduri S, Pandey A, Lin LY, Chenevert TL, Troost J, Xi G, Keep R, Chaudhary N. MR Imaging-based Biomarker Development in Hemorrhagic Stroke Patients Including Brain Iron Quantification, Diffusion Tensor Imaging, and Phenomenon of Ultra-early Erythrolysis. Neuroimaging Clin N Am 2024; 34:215-224. [PMID: 38604706 DOI: 10.1016/j.nic.2024.01.001] [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: 04/13/2024]
Abstract
This review article discusses the role of MR imaging-based biomarkers in understanding and managing hemorrhagic strokes, focusing on intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage. ICH is a severe type of stroke with high mortality and morbidity rates, primarily caused by the rupture of small blood vessels in the brain, resulting in hematoma formation. MR imaging-based biomarkers, including brain iron quantification, ultra-early erythrolysis detection, and diffusion tensor imaging, offer valuable insights for hemorrhagic stroke management. These biomarkers could improve early diagnosis, risk stratification, treatment monitoring, and patient outcomes in the future, revolutionizing our approach to hemorrhagic strokes.
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Affiliation(s)
- Momodou G Bah
- Michigan State University College of Human Medicine, Lansing, MI, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Max Fleigner
- Oakland University, William Beaumont School of Medicine, Detroit, MI, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Leanne Y Lin
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jonathan Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Otorhinolaryngology, University of Michigan, Ann Arbor, MI 48109, USA.
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27
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Du C, Li Y, Yang M, Ma Q, Ge S, Ma C. Prediction of Hematoma Expansion in Intracerebral Hemorrhage in 24 Hours by Machine Learning Algorithm. World Neurosurg 2024; 185:e475-e483. [PMID: 38387789 DOI: 10.1016/j.wneu.2024.02.058] [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: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The significance of noncontrast computer tomography (CT) image markers in predicting hematoma expansion (HE) following intracerebral hemorrhage (ICH) within different time intervals in the initial 24 hours after onset may be uncertain. Hence, our objective was to examine the predictive value of clinical factors and CT image markers for HE within the initial 24 hours using machine learning algorithms. METHODS Four machine learning algorithms, including extreme gradient boosting (XGBoost), support vector machine, random forest, and logistic regression, were employed to assess the predictive efficacy of HE within every 6-hour interval during the first 24 hours post-ICH. The area under the receiver operating characteristic curves was utilized to appraise predictive performance across various time periods within the initial 24 hours. RESULTS A total of 604 patients were included, with 326 being male, and 112 experiencing hematoma expansion (HE). The findings from machine learning algorithms revealed that computed tomography (CT) image markers, baseline hematoma volume, and other factors could accurately predict HE. Among these algorithms, XGBoost demonstrated the most robust predictive model results. XGBoost's accuracy at different time intervals was 0.89, 0.82, 0.87, and 0.94, accompanied by F1-scores of 0.89, 0.80, 0.87, and 0.93, respectively. The corresponding area under the curve was 0.96, affirming the precision of the predictive capability. CONCLUSIONS Computed tomography (CT) imaging markers and clinical factors could effectively predict HE within the initial 24 hours across various time periods by machine learning algorithms. In the expansive landscape of big data and multimodal cerebral hemorrhage, machine learning held significant potential within the realm of neuroscience.
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Affiliation(s)
- Chaonan Du
- Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yan Li
- Department of Mathematics Science, Xi'an Jiaotong-Liverpool University, Suzhou, Jiangsu, China
| | - Mingfei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Qingfang Ma
- Department of Neurosurgery, Xuzhou City Centre Hospital, Xuzhou, Jiangsu, China
| | - Sikai Ge
- Department of Mathematics Science, Xi'an Jiaotong-Liverpool University, Suzhou, Jiangsu, China
| | - Chiyuan Ma
- Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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28
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Sobowale OA, Hostettler IC, Wu TY, Heal C, Wilson D, Shah DG, Strbian D, Putaala J, Tatlisumak T, Vail A, Sharma G, Davis SM, Werring DJ, Meretoja A, Allan SM, Parry-Jones AR. Baseline perihematomal edema, C-reactive protein, and 30-day mortality are not associated in intracerebral hemorrhage. Front Neurol 2024; 15:1359760. [PMID: 38645743 PMCID: PMC11026700 DOI: 10.3389/fneur.2024.1359760] [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: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood. Objective Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH. Methods Analysis of pooled data from multicenter ICH registries. We included patients presenting within 24 h of symptom onset, using multifactorial linear regression model to assess the association between CRP and edema extension distance (EED), and a multifactorial Cox regression model to assess the association between CRP, PHE volume and 30-day mortality. Results We included 1,034 patients. Median age was 69 (interquartile range [IQR] 59-79), median baseline ICH volume 11.5 (IQR 4.3-28.9) mL, and median baseline CRP 2.5 (IQR 1.5-7.0) mg/L. In the multifactorial analysis [adjusting for cohort, age, sex, log-ICH volume, ICH location, intraventricular hemorrhage (IVH), statin use, glucose, and systolic blood pressure], baseline log-CRP was not associated with baseline EED: for a 50% increase in CRP the difference in expected mean EED was 0.004 cm (95%CI 0.000-0.008, p = 0.055). In a further multifactorial analysis, after adjusting for key predictors of mortality, neither a 50% increase in PHE volume nor CRP were associated with higher 30-day mortality (HR 0.97; 95%CI 0.90-1.05, p = 0.51 and HR 0.98; 95%CI 0.93-1.03, p = 0.41, respectively). Conclusion Higher baseline CRP is not associated with higher baseline edema, which is also not associated with mortality. Edema at baseline might be driven by different pathophysiological processes with different effects on outcome.
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Affiliation(s)
- Oluwaseun A. Sobowale
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Isabel C. Hostettler
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Teddy Y. Wu
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Calvin Heal
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Duncan Wilson
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Darshan G. Shah
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andy Vail
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Gagan Sharma
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M. Davis
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - David J. Werring
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Atte Meretoja
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Stuart M. Allan
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Adrian R. Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
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Avadhani R, Ziai WC, Thompson RE, Mould WA, Lane K, Nanni A, Iacobelli M, Sharrock MF, Sansing LH, Van Eldik LJ, Hanley DF. Clinical Trial Protocol for BEACH: A Phase 2a Study of MW189 in Patients with Acute Nontraumatic Intracerebral Hemorrhage. Neurocrit Care 2024; 40:807-815. [PMID: 37919545 PMCID: PMC10959780 DOI: 10.1007/s12028-023-01867-2] [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: 06/05/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
Patients with acute spontaneous intracerebral hemorrhage (ICH) develop secondary neuroinflammation and cerebral edema that can further damage the brain and lead to increased risk of neurologic complications. Preclinical studies in animal models of acute brain injury have shown that a novel small-molecule drug candidate, MW01-6-189WH (MW189), decreases neuroinflammation and cerebral edema and improves functional outcomes. MW189 was also safe and well tolerated in phase 1 studies in healthy adults. The proof-of-concept phase 2a Biomarker and Edema Attenuation in IntraCerebral Hemorrhage (BEACH) clinical trial is a first-in-patient, multicenter, randomized, double-blind, placebo-controlled trial. It is designed to determine the safety and tolerability of MW189 in patients with acute ICH, identify trends in potential mitigation of neuroinflammation and cerebral edema, and assess effects on functional outcomes. A total of 120 participants with nontraumatic ICH will be randomly assigned 1:1 to receive intravenous MW189 (0.25 mg/kg) or placebo (saline) within 24 h of symptom onset and every 12 h for up to 5 days or until hospital discharge. The 120-participant sample size (60 per group) will allow testing of the null hypothesis of noninferiority with a tolerance limit of 12% and assuming a "worst-case" safety assumption of 10% rate of death in each arm with 10% significance and 80% power. The primary outcome is all-cause mortality at 7 days post randomization between treatment arms. Secondary end points include all-cause mortality at 30 days, perihematomal edema volume after symptom onset, adverse events, vital signs, pharmacokinetics of MW189, and inflammatory cytokine concentrations in plasma (and cerebrospinal fluid if available). Other exploratory end points are functional outcomes collected on days 30, 90, and 180. BEACH will provide important information about the utility of targeting neuroinflammation in ICH and will inform the design of future larger trials of acute central nervous system injury.
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Affiliation(s)
- Radhika Avadhani
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Wendy C Ziai
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W Andrew Mould
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Karen Lane
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Angeline Nanni
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Michael Iacobelli
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA
| | - Matthew F Sharrock
- Division of Neurocritical Care, Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren H Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging and Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Daniel F Hanley
- BIOS Clinical Trials Coordinating Center, Johns Hopkins School of Medicine, 750 East Pratt Street, 16th Floor, Baltimore, MD, 21202, USA.
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Zheng S, Banerji R, LeBourdais R, Zhang S, DuBois E, O’Shea T, Nia HT. Alteration of mechanical stresses in the murine brain by age and hemorrhagic stroke. PNAS NEXUS 2024; 3:pgae141. [PMID: 38659974 PMCID: PMC11042661 DOI: 10.1093/pnasnexus/pgae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Residual mechanical stresses, also known as solid stresses, emerge during rapid differential growth or remodeling of tissues, as observed in morphogenesis and tumor growth. While residual stresses typically dissipate in most healthy adult organs, as the growth rate decreases, high residual stresses have been reported in mature, healthy brains. However, the origins and consequences of residual mechanical stresses in the brain across health, aging, and disease remain poorly understood. Here, we utilized and validated a previously developed method to map residual mechanical stresses in the brains of mice across three age groups: 5-7 days, 8-12 weeks, and 22 months. We found that residual solid stress rapidly increases from 5-7 days to 8-12 weeks and remains high in mature 22 months mice brains. Three-dimensional mapping revealed unevenly distributed residual stresses from the anterior to posterior coronal brain sections. Since the brain is rich in negatively charged hyaluronic acid, we evaluated the contribution of charged extracellular matrix (ECM) constituents in maintaining solid stress levels. We found that lower ionic strength leads to elevated solid stresses, consistent with its unshielding effect and the subsequent expansion of charged ECM components. Lastly, we demonstrated that hemorrhagic stroke, accompanied by loss of cellular density, resulted in decreased residual stress in the murine brain. Our findings contribute to a better understanding of spatiotemporal alterations of residual solid stresses in healthy and diseased brains, a crucial step toward uncovering the biological and immunological consequences of this understudied mechanical phenotype in the brain.
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Affiliation(s)
- Siyi Zheng
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Rohin Banerji
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Rob LeBourdais
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Sue Zhang
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Eric DuBois
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Timothy O’Shea
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Hadi T Nia
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
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Li W, Wang J, Tang C, Lv X, Zhu S. A Prospective Cohort Study of Elevated Serum NLRP1 Levels to Prognosticate Neurological Outcome After Acute Intracerebral Hemorrhage at a Single Academic Institution. Neuropsychiatr Dis Treat 2024; 20:737-753. [PMID: 38566883 PMCID: PMC10986417 DOI: 10.2147/ndt.s455049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 1 (NLRP1) participates in neuroinflammation. This study aimed to identify serum NLRP as a potential prognostic biomarker of acute intracerebral hemorrhage (ICH). Methods This prospective cohort study enrolled 145 patients with supratentorial ICH and 51 healthy controls. Serum NLRP1 levels were quantified on admission of all 145 patients, on days 1, 3, 5, 7, and 10 after stroke in 51 of 145 patients and at entry into the study of controls. Poststroke 6-month modified Rankin Scale (mRS) scores of 3-6 signified a poor prognosis. Results Compared to controls, patients had prominently increased serum NLRP1 levels until day 10 after ICH, with the highest levels at days 1 and 3. Serum NLRP1 levels were independently correlated with National Institutes of Health Stroke Scale (NIHSS) scores, hematoma volume and six-month mRS scores, and independently predicted six-month bad prognosis. A linear relationship was observed between serum NLRP1 levels and the risk of poor prognosis in a restricted cubic spline. Under the receiver operating characteristic (ROC) curve, serum NLRP levels efficiently discriminated poor prognosis. Serum NLRP1, NIHSS, and hematoma volume were merged into a prognosis prediction model, which was portrayed using a nomogram. Good performance of the model was verified using calibration curve, decision curve, and ROC curve. Conclusion Serum NLRP1 levels are elevated during the early period following ICH and are independently related to hemorrhagic severity and poor prognosis, suggesting that serum NLRP1 may represent a promising prognostic biomarker of ICH.
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Affiliation(s)
- Wei Li
- Department of Neurosurgery, First People’s Hospital of Linping District, Hangzhou, People’s Republic of China
- Department of Neurosurgery, Linping Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jun Wang
- Department of Neurosurgery, First People’s Hospital of Linping District, Hangzhou, People’s Republic of China
- Department of Neurosurgery, Linping Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Chao Tang
- Department of Neurosurgery, First People’s Hospital of Linping District, Hangzhou, People’s Republic of China
- Department of Neurosurgery, Linping Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xuan Lv
- Department of Neurosurgery, First People’s Hospital of Linping District, Hangzhou, People’s Republic of China
- Department of Neurosurgery, Linping Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Suijun Zhu
- Department of Neurosurgery, First People’s Hospital of Linping District, Hangzhou, People’s Republic of China
- Department of Neurosurgery, Linping Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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32
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Verma Y, Perera Molligoda Arachchige AS. Revolutionizing brain interventions: the multifaceted potential of histotripsy. Neurosurg Rev 2024; 47:124. [PMID: 38509320 DOI: 10.1007/s10143-024-02353-9] [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: 09/29/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Histotripsy, a non-thermal ultrasound technique, holds significant promise in various applications within the realm of brain interventions. While its use for treating brain tumors is somewhat limited, focused ultrasound technology has been extensively investigated for a wide range of purposes within the brain, including disrupting the blood-brain barrier, supporting immunotherapy, addressing conditions like essential tremor, Parkinson's disease, Alzheimer's disease, epilepsy, and neuropathic pain. Research findings indicate that histotripsy can reduce tumor cells with fewer pulses, minimizing the risk of bleeding and cellular injury. The use of MRI sequences such as T2 and T2* enhances the evaluation of the effects of histotripsy treatment, facilitating non-invasive assessment of treated areas. Furthermore, histotripsy displays promise in creating precise brain lesions with minimal edema and inflammation, particularly in porcine models, suggesting considerable progress in the treatment of brain lesions. Moreover, studies confirm its feasibility, safety, and effectiveness in treating intracerebral hemorrhage by safely liquefying clots without causing significant harm to surrounding brain tissue., opening exciting possibilities for clinical applications. The development of transcranial MR-guided focused ultrasound systems based on histotripsy represents a significant breakthrough in overcoming the limitations associated with thermal ablation techniques. Histotripsy's ability to efficiently liquefy clots, minimize skull heating, and target shallow lesions near the skull establishes it as a promising alternative for various brain treatments. In conclusion, histotripsy offers diverse potential in the field of brain interventions, encompassing applications ranging from tumor treatment to the management of intracerebral hemorrhage. While challenges such as accurate monitoring and differentiation of treatment effects persist, ongoing research efforts and technological advancements continue to expand the role of histotripsy in both neurology and neurosurgery.
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Affiliation(s)
- Yash Verma
- Norfolk and Norwich University Hospital, Norwich, UK
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33
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Lu N, Qiao D, Xue C, Pang Y. Contact neuro-endoscopy-assisted cerebral hematoma evacuation under direct vision. Front Surg 2024; 11:1351291. [PMID: 38516393 PMCID: PMC10954806 DOI: 10.3389/fsurg.2024.1351291] [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: 12/06/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Neuro-endoscopic hematoma evacuation is a crucial therapeutic approach for intracerebral hemorrhage. Our research team has developed a portable and contact neuro-endoscopy technique to enhance the conventional endoscopy procedure. compared to traditional endoscopy, this innovative approach involves miniaturizing the lens, light source, and camera system. These components are integrated into a stainless steel tube with a diameter of 4 mm, referred to as the portable endoscopy in this study. The portable endoscopy is powered by a USB cable and the video is displayed on a tablet computer. This portable endoscope facilitates easier operation with both hands by a single surgeon.
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Affiliation(s)
- Na Lu
- Department of Neurosurgery, Qingdao Huangdao District Central Hospital, Qingdao, China
- Department of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Dong Qiao
- Department of Neurosurgery, Qingdao Huangdao District Central Hospital, Qingdao, China
| | - ChengJiang Xue
- Department of Neurosurgery, Qingdao Huangdao District Central Hospital, Qingdao, China
| | - YeGuang Pang
- Department of Neurosurgery, Qingdao Huangdao District Central Hospital, Qingdao, China
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Lee BC, Tsai HH, Chen ZW, Chang CC, Huang JZ, Chang YY, Tsai CH, Chou CH, Liao CW, Pan CT, Wu VC, Hung CS, Tsai LK, Lin YH. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage. Hypertens Res 2024; 47:608-617. [PMID: 37993592 DOI: 10.1038/s41440-023-01458-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: 01/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023]
Abstract
Primary aldosteronism is associated with various types of cardiovascular and cerebrovascular damage independently of hypertension. Although chronic hypertension and related cerebral arteriosclerosis are the main risk factors for intracerebral hemorrhage, the effects of aldosteronism remain poorly understood. We enrolled 90 survivors of hypertensive intracerebral hemorrhage, 21 of them with aldosteronism and 69 with essential hypertension as controls in this study. Clinical parameters and neuroimaging markers of cerebral small vessel disease were recorded, and its correlations with aldosteronism were investigated. Our results showed that the aldosteronism group (55.2 ± 9.7 years, male 47.6%) had similar hypertension severity but exhibited a higher cerebral microbleed count (interquartile range) (8.5 [2.0‒25.8] vs 3 [1.0‒6.0], P = 0.005) and higher severity of dilated perivascular space in the basal ganglia (severe perivascular space [number >20], 52.4% vs. 24.6%, P = 0.029; large perivascular space [>3 mm], 52.4% vs. 20.3%, P = 0.010), compared to those with essential hypertension (53.8 ± 11.7 years, male 73.9%). In multivariate models, aldosteronism remained an independent predictor of a higher (>10) microbleed count (odds ratio = 8.60, P = 0.004), severe perivascular space (odds ratio = 4.00, P = 0.038); the aldosterone-to-renin ratio was associated with dilated perivascular space (P = 0.043) and large perivascular space (P = 0.008). In conclusions, survivors of intracerebral hemorrhage with aldosteronism showed a tendency towards more severe hypertensive arteriopathy than the essential hypertension counterparts independently of blood pressure; aldosteronism may contribute to dilated perivascular space around the deep perforating arteries. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Medical Imaging, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Zheng-Wei Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jia-Zheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan, ROC
- National Taiwan University Cancer Center, Taipei, Taiwan, ROC
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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Takamatsu Y, Inoue T, Nishio T, Soma K, Kondo Y, Mishima T, Takamura H, Okamura M, Maejima H. Potential effect of physical exercise on the downregulation of BDNF mRNA expression in rat hippocampus following intracerebral hemorrhage. Neurosci Lett 2024; 824:137670. [PMID: 38342427 DOI: 10.1016/j.neulet.2024.137670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Physical exercise is known to induce expression of the neuroprotective brain derived neurotrophic factor (BDNF) in the hippocampus. This study examined the effects of physical exercise on hippocampal BDNF expression and the potential benefits for preventing remote secondary hippocampal damage and neurological impairment following intracerebral hemorrhage (ICH). MATERIALS AND METHODS Wistar rats were randomly assigned to sham-operated, ICH, and ICH followed by exercise (ICH/Ex) groups. The two ICH groups were injected with type IV collagenase into the left basal ganglia, while sham animals were injected with equal-volume saline. The ICH/Ex group rats ran on a treadmill at 11 m/min for 30 min/day from day 3 to 16 post-ICH. All animals were examined for neurological function on day 2 pretreatment and from day 3 to 15 posttreatment, for spontaneous motor activity in the open field on day 15, and for cognitive ability using the object location test on day 16. Animals were then euthanized and bilateral hippocampi collected for gene expression analyses. RESULTS Experimental ICH induced neurological deficits that were not reversed by exercise. In contrast, ICH did not alter spontaneous activity or object location ability. Expression of BDNF mRNA of the ICH group was significantly downregulated in the ipsilateral hippocampus compared to the SHAM group, but this downregulation was not shown in the ICH/Ex group. The ICH/Ex group showed the downregulation of caspase-3 mRNA expression in the contralateral hippocampus compared to the SHAM group, while neither ICH nor exercise influenced toll-like receptor 4 mRNA expression. CONCLUSIONS ICH induced the secondary BDNF downregulation in the hippocampus remote from the lesion, whereas physical exercise might partially mitigate the downregulation.
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Affiliation(s)
- Yasuyuki Takamatsu
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan; Department of Physical Therapy, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Japan.
| | - Takahiro Inoue
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo, 060-0812, Japan; Department of System Pathology for Neurological Disorders, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8585, Japan
| | - Taichi Nishio
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
| | - Kiho Soma
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Yuki Kondo
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Taiga Mishima
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Hana Takamura
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Misato Okamura
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
| | - Hiroshi Maejima
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
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Kuo PY, Tsai HH, Lee BC, Chiang PT, Liu CJ, Chen YF, Jeng JS, Yen RF, Tsai LK. Differences in lobar microbleed topography in cerebral amyloid angiopathy and hypertensive arteriopathy. Sci Rep 2024; 14:3774. [PMID: 38355951 PMCID: PMC10866968 DOI: 10.1038/s41598-024-54243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/10/2024] [Indexed: 02/16/2024] Open
Abstract
Lobar cerebral microbleeds are a characteristic neuroimaging finding in cerebral amyloid angiopathy (CAA) but can also be found in hypertensive arteriolosclerosis. We aimed to investigate whether CAA is more associated with intracortical lobar microbleeds than hypertensive arteriosclerosis. Ninety-one survivors of spontaneous intracerebral hemorrhage with at least one lobar microbleed were included and underwent brain MRI and amyloid PET. We categorized lobar microbleeds as intracortical, juxtacortical, or subcortical. We assessed the associations between the lobar microbleed categories and microangiopathy subtypes or cerebral amyloid load based on the Pittsburgh Compound-B PET standardized uptake value ratio (SUVR). Patients with CAA had a higher prevalence of intracortical lobar microbleeds (80.0% vs. 50.8%, P = 0.011) and lower prevalence of subcortical lobar microbleeds (13.3% vs. 60.1%, P < 0.001) than patients with hypertensive arteriolosclerosis. Strictly intracortical/juxtacortical lobar microbleeds were associated with CAA (OR 18.9 [1.9-191.4], P = 0.013), while the presence of subcortical lobar microbleeds was associated with hypertensive arteriolosclerosis (OR 10.9 [1.8-68.1], P = 0.010). Amyloid retention was higher in patients with strictly intracortical/juxtacortical CMBs than those without (SUVR = 1.15 [1.05-1.52] vs. 1.08 [1.02-1.19], P = 0.039). Amyloid retention positively correlated with the number of intracortical lobar microbleeds (P < 0.001) and negatively correlated with the number of subcortical lobar microbleeds (P = 0.018). CAA and cortical amyloid deposition are more strongly associated with strictly intracortical/juxtacortical microbleeds than subcortical lobar microbleeds. Categorization of lobar microbleeds based on anatomical location may help differentiate the underlying microangiopathy and potentially improve the accuracy of current neuroimaging criteria for cerebral small vessel disease.
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Affiliation(s)
- Pin-Yan Kuo
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Pu-Tien Chiang
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Chia-Ju Liu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
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Perez CM, Gong Z, Yoo C, Roy D, Deoraj A, Felty Q. Inhibitor of DNA Binding Protein 3 (ID3) and Nuclear Respiratory Factor 1 (NRF1) Mediated Transcriptional Gene Signatures are Associated with the Severity of Cerebral Amyloid Angiopathy. Mol Neurobiol 2024; 61:835-882. [PMID: 37668961 DOI: 10.1007/s12035-023-03541-2] [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: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is a degenerative vasculopathy. We have previously shown that transcription regulating proteins- inhibitor of DNA binding protein 3 (ID3) and the nuclear respiratory factor 1 (NRF1) contribute to vascular dysregulation. In this study, we have identified sex specific ID3 and NRF1-mediated gene networks in CAA patients diagnosed with Alzheimer's Disease (AD). High expression of ID3 mRNA coupled with low NRF1 mRNA levels was observed in the temporal cortex of men and women CAA patients. Low NRF1 mRNA expression in the temporal cortex was found in men with severe CAA. High ID3 expression was found in women with the genetic risk factor APOE4. Low NRF1 expression was also associated with APOE4 in women with CAA. Genome wide transcriptional activity of both ID3 and NRF1 paralleled their mRNA expression levels. Sex specific differences in transcriptional gene signatures of both ID3 and NRF1 were observed. These findings were further corroborated by Bayesian machine learning and the GeNIe simulation models. Dynamic machine learning using a Monte Carlo Markov Chain (MCMC) gene ordering approach revealed that ID3 was associated with disease severity in women. NRF1 was associated with CAA and severity of this disease in men. These findings suggest that aberrant ID3 and NRF1 activity presumably plays a major role in the pathogenesis and severity of CAA. Further analyses of ID3- and NRF1-regulated molecular drivers of CAA may provide new targets for personalized medicine and/or prevention strategies against CAA.
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Affiliation(s)
- Christian Michael Perez
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Zhenghua Gong
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Changwon Yoo
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Deodutta Roy
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Alok Deoraj
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Quentin Felty
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
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Oh TK, Kim S, Song IA. Joblessness, decreased income, and disability in intensive care unit survivors of nontraumatic intracranial hemorrhage in South Korea. J Stroke Cerebrovasc Dis 2024; 33:107459. [PMID: 38000111 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107459] [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: 06/30/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To examine the proportions of unemployment, decreased household income, and newly acquired disability, and their impact on long-term mortality after intensive care unit (ICU) admission due to nontraumatic intracranial hemorrhage (IH). MATERIALS AND METHODS This nationwide population-based retrospective cohort study enrolled adult patients admitted to the ICU because of nontraumatic IH between 2010 and 2018 in South Korea. Patients who were alive ≥365 days after ICU admission were defined as nontraumatic IH survivors. RESULTS In total, 104,086 nontraumatic IH survivors were included in the final analysis. Among them, 7,225 (6.9 %) experienced job loss, 25,709 (24.7 %) experienced decreased household income, and 20,938 (20.1 %) had newly acquired disabilities, of whom 14,188 (13.6 %) had newly acquired brain disabilities. Male sex, increased duration of intensive care unit stay, comorbid status, hospital admission through the emergency room, nontraumatic intracerebral hemorrhage, receipt of surgery, mechanical ventilatory support, and increased total cost of hospitalization were associated with job loss, decreased household income, and newly acquired disabilities. However, these changes were not significantly associated with 2-year all-cause mortality (adjusted hazard ratio: 1.00, 95 % confidence interval: 0.95, 1.06; P = 0.997). CONCLUSIONS Many nontraumatic IH survivors experienced unemployment, decreased household income, and newly acquired disability one year after ICU admission in South Korea. Some factors were potential risk factors for these changes, but the changes were not associated with 2-year all-cause mortality.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Saeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
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Wilkinson CM, Kalisvaart AC, Kung TF, Abrahart AH, Khiabani E, Colbourne F. Tissue Compliance and Intracranial Pressure Responses to Large Intracerebral Hemorrhage in Young and Aged Spontaneously Hypertensive Rats. Hypertension 2024; 81:151-161. [PMID: 37909235 PMCID: PMC10734784 DOI: 10.1161/hypertensionaha.123.21628] [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: 06/08/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND After a large intracerebral hemorrhage (ICH), the hematoma and swelling cause intracranial pressure (ICP) to increase, sometimes causing brain herniation and death. This is partly countered by widespread tissue compliance, an acute decrease in tissue volume distal to the stroke, at least in young healthy animals. Intracranial compensation dynamics seem to vary with age, but there is no data on old animals or those with hypertension, major factors influencing ICH risk and outcome. METHODS We assessed hematoma volume, edema, ICP, and functional deficits in young and aged spontaneously hypertensive rats (SHRs) and young normotensive control strains after collagenase-induced ICH. Macroscopic and microscopic brain volume fractions, such as contralateral hemisphere volume, cortical thickness, and neuronal morphology, were assessed via histological and stereological techniques. RESULTS Hematoma volume was 52% larger in young versus aged SHRs; surprisingly, aged SHRs still experienced proportionally worse outcomes following ICH, with 2× greater elevations in edema and ICP relative to bleed volume and 3× the degree of tissue compliance. Aged SHRs also experienced equivalent neurological deficits following ICH compared with their younger counterparts, despite the lack of significant age-related behavioral effects. Importantly, tissue compliance occurred across strains and age groups and was not impaired by hypertension or old age. CONCLUSIONS Aged SHRs show considerable capacity for tissue compliance following ICH and seem to rely on such mechanisms more heavily in settings of elevated ICP. Therefore, the ICP compensation response to ICH mass effect varies across the lifespan according to risk factors such as chronic hypertension.
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Affiliation(s)
- Cassandra M. Wilkinson
- Department of Psychology (C.M.W., A.C.J.K., T.F.C.K., A.H.A., E.K., F.C.), University of Alberta, Edmonton, Canada
| | - Anna C.J. Kalisvaart
- Department of Psychology (C.M.W., A.C.J.K., T.F.C.K., A.H.A., E.K., F.C.), University of Alberta, Edmonton, Canada
| | - Tiffany F.C. Kung
- Department of Psychology (C.M.W., A.C.J.K., T.F.C.K., A.H.A., E.K., F.C.), University of Alberta, Edmonton, Canada
| | - Ashley H. Abrahart
- Department of Psychology (C.M.W., A.C.J.K., T.F.C.K., A.H.A., E.K., F.C.), University of Alberta, Edmonton, Canada
| | - Elmira Khiabani
- Department of Psychology (C.M.W., A.C.J.K., T.F.C.K., A.H.A., E.K., F.C.), University of Alberta, Edmonton, Canada
| | - Frederick Colbourne
- Department of Psychology (C.M.W., A.C.J.K., T.F.C.K., A.H.A., E.K., F.C.), University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute (F.C.), University of Alberta, Edmonton, Canada
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Lee CC, Huang APH, Chen CC, Liu ZH, Yeap MC, Chen KT, Hsu PW, Wei KC, Chen CT, Wang YC, Chang TW, Chuang CC. Minimally invasive endoscopic evacuation with the novel, portable Axonpen neuroendoscopic system for spontaneous intracerebral hemorrhage. J Clin Neurosci 2024; 119:93-101. [PMID: 37992420 DOI: 10.1016/j.jocn.2023.11.003] [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: 08/02/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
Minimally invasive surgeries have shown potential to improve mortality and clinical outcomes of spontaneous intracerebral hemorrhage (ICH). The present study assessed the first-in-human outcomes of a novel, portable neuroendoscopic system for ICH evacuation at our single center. This neuroendoscopic system integrates real-time visualization into a handpiece which has controllable suction, irrigation, and coagulation to allow a neurosurgeon to conduct minimally invasive ICH evacuation independently with bimanual dexterity. Pre- and postoperative data of ten patients who had spontaneous basal ganglia hemorrhage (mean: 46.5 ± 12.2 mL) and underwent evacuation with the specified neuroendoscopic system were collected prospectively. The mean time to receive surgery was 12.1 ± 7.6 h. Mean operative time was 3.4 ± 0.9 h. The mean hematoma volume decreased to 6.0 ± 3.9 mL at postoperative 6 h, resulting in a mean volume reduction of 86.0 ± 11.2% (P = 0.005). The median length of intensive care unit stay was 3 days (IQR, 3-4 days). At discharge, the median Glasgow Coma Scale (GCS) score significantly improved to 11.5 (IQR, 11-15; P = 0.016), and the median modified Rankin Scale (mRS) score was 4 (IQR, 4-5). Six patients (60%) showed a favorable mRS score of ≤ 3 on their last return visit. Neither death nor rebleeding occurred during the follow-up periods. Integrated design of the innovative device is valuable to optimize minimally invasive endoscopic ICH evacuation procedure. Further studies are needed to clarify long-term benefits from such type of the innovative device to early intervention of ICH.
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Affiliation(s)
- Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan, ROC; Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan, ROC
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan, ROC
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Neurosurgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan, ROC
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ting-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Neurosurgery, Xiamen Chang Gung Hospital, Xiamen, China.
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Kishida K, Maruyama D, Kotani S, Murakami N, Hashimoto N. Clinical Significance of Stiffness during Endoscopic Surgery for Intracerebral Hemorrhage: A Retrospective Study. Neurol Med Chir (Tokyo) 2023; 63:563-570. [PMID: 37940569 PMCID: PMC10788487 DOI: 10.2176/jns-nmc.2023-0043] [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: 05/31/2023] [Accepted: 08/28/2023] [Indexed: 11/10/2023] Open
Abstract
Studies regarding hematoma stiffness and removal difficulty are scarce. This study explored the association between hematoma stiffness and surgical results of endoscopic hematoma removal for intracerebral hemorrhage. It also aimed to clarify factors associated with hematoma stiffness. We classified intracerebral hematoma as either soft or firm stiffness by retrospectively evaluating operative videos by two neurosurgeons. The interobserver reliability of the classification was assessed by calculating the κ values. We investigated the relationship between hematoma stiffness and surgical results. Favorable hematoma removal (FHR) was defined as a residual hematoma volume of ≤15 mL or removal rate of ≥70%. Furthermore, we compared the background characteristics, imaging findings, and laboratory data between the two groups. Forty patients were included in this study. The mean baseline hematoma volume was 69.9 mL (range, 41.3-97.6 mL). FHR was accomplished in 35 cases (87.5%). Thirty-four patients (85%) were in the soft hematoma group (group S). Six patients (15%) were in the firm hematoma group (group F). Classification of hematoma stiffness demonstrated an excellent degree of interobserver agreement (κ score = 0.91). Patients in group S had a high FHR rate (p = 0.018) and short endoscopic procedure times (p = 0.00034). The island sign was present in group S (p = 0.030). Patients in group F had significantly high fibrinogen levels (p = 0.049) and low serum total calcium (p = 0.032), hemoglobin (p = 0.041), and hematocrit (p = 0.011) levels. Hematoma stiffness during endoscopic surgery for intracerebral hemorrhage correlates with surgical results, including the endoscopic procedure time and accomplishing rate of FHR.
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Affiliation(s)
- Kengo Kishida
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Daisuke Maruyama
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Saki Kotani
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Nobukuni Murakami
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
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Huang J, Shao F, Chen B, Zheng G, Shen J, Qiu S. Serum Secreted Protein Acidic and Rich in Cysteine-Like 1 as a Biochemical Predictor for Prognosticating Clinical Outcomes After Acute Supratentorial Intracerebral Hemorrhage: A Prospective Cohort Study. Neuropsychiatr Dis Treat 2023; 19:2709-2728. [PMID: 38077240 PMCID: PMC10710246 DOI: 10.2147/ndt.s444671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/28/2023] [Indexed: 06/04/2024] Open
Abstract
Background Secreted protein acidic and rich in cysteine-like 1 (SPARCL1) regulates synaptic stability and is up-regulated during axonal regeneration. Here, serum SPARCL1 was determined for estimating severity and prognosticating early neurological deterioration (END) and functional outcomes of acute intracerebral hemorrhage (ICH). Methods In this prospective observational cohort study of 156 patients with supratentorial ICH, blood samples of 53 were acquired not only at admission but also ad days 1, 3, 5, 7 and 10. Another group of 53 healthy controls were recruited. The modified Rankin Scale (mRS) scores of 3-6 at poststroke six months were regarded as poor prognosis. Results As opposed to controls, serum SPARCL1 levels were markedly elevated during the early ten days after ICH, with the highest levels at days 1 and 3. Admission serum SPARCL1 levels were independently correlated with National Institutes of Health Stroke Scale scores and hematoma volume, were significantly increased in the order of six-month mRS scores from 0 to 6 and were independently correlated with six-month mRS scores. Serum SPARCL1 levels were linearly related to risks of poor six-month prognosis and END under restricted cubic spline, had significant efficiency under receiver operating characteristic (ROC) curve and were independently associated with END and poor prognosis. Subgroup analysis confirmed that no interactions existed for associations of serum SPARCL1 levels with other variables, such as age, gender and some specific vascular risk factors. END and poor prognosis prediction models integrating serum SPARCL1 were displayed using the two nomograms. The poor prognosis prediction model, but END prediction model not, performed well under calibration curve, decision curve and ROC curve. Conclusion A substantial elevation of serum SPARCL1 levels during the early period after ICH is independently related to illness severity and poor neurological outcomes, thus signifying that serum SPARCL1 may appear as a prognostic biomarker of ICH.
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Affiliation(s)
- Jianjun Huang
- Department of Neurosurgery, The First People’s Hospital of Fuyang District of Hangzhou City, Hangzhou, People’s Republic of China
| | - Fangping Shao
- Emergency Department, The First People’s Hospital of Fuyang District of Hangzhou City, Hangzhou, People’s Republic of China
| | - Bin Chen
- Department of Neurosurgery, The First People’s Hospital of Fuyang District of Hangzhou City, Hangzhou, People’s Republic of China
| | - Guanrong Zheng
- Department of Neurosurgery, The First People’s Hospital of Fuyang District of Hangzhou City, Hangzhou, People’s Republic of China
| | - Jia Shen
- Department of Neurosurgery, The First People’s Hospital of Fuyang District of Hangzhou City, Hangzhou, People’s Republic of China
| | - Shenzhong Qiu
- Department of Neurosurgery, The First People’s Hospital of Fuyang District of Hangzhou City, Hangzhou, People’s Republic of China
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Gregson BA, Metcalfe S, Iqbal A, Rowan E, Prasad M, Bhattathiri P, Gholkar A, Mitchell P, Haley MD, Mendelow AD. Volume reduction with surgery for ICH: when is it effective? Analysis of the CT scans from the STICH II trial. Br J Neurosurg 2023; 37:1635-1642. [PMID: 37161757 DOI: 10.1080/02688697.2023.2207643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The surgical trial of lobar intracerebral haemorrhage (STICH II) was a randomised controlled trial evaluating early surgical removal of a clot. This paper investigates volume change in both arms of the trial with respect to Extended Glasgow Outcome Scale (GOSE) groups. METHODS Patients randomised into STICH II had an initial diagnostic CT and a second CT 5 days after randomisation. Each scan was anonymously assessed by at least two central readers. An analysis of agreement between the two readers was conducted using kappa tests and intraclass correlation. The change in volume in both the early surgery (ES) and the initial conservative treatment (ICT) arms were analysed with respect to the six-month GOSE outcome. RESULTS Of the 597 patients randomised in the trial there were 582 pre-randomisation scans and 566 5-day scans available for analysis of agreement. There was good agreement between the assessors for the radiological inclusion criteria including volume (ICC = 0.87) and this was better than the agreement between the assessor and local investigator (ICC = 0.73). There were 526 patients with two scans available for analysis of change in volume measurement. The median percentage change in volume for the ES group was a reduction of 92.4% (IQR 75.6%, 99.0%) while for the ICT group, in which some cases crossed over to delayed surgery, it was only 5.7% (IQR 16.4% increase, 29.5% reduction). ES patients with almost complete removal (99-100%) had the best outcome with only 30% dead or lower severely disabled. For the ICT group outcome was related to the final volume: the smaller the final volume the better the outcome. CONCLUSIONS This analysis provides evidence for central assessments of scans in exploratory analyses and further information regarding the potential advantage of early and more complete clot removal on outcome in ICH and should inform the planning of future trials.Clinical trials registration: ISRCTN22153967.
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Affiliation(s)
- Barbara A Gregson
- Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ahmed Iqbal
- Neuroradiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Elise Rowan
- Health Research Group, Lincoln University, Lincoln, UK
| | | | | | - Anil Gholkar
- Neuroradiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Patrick Mitchell
- Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, UK
| | - Mark D Haley
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A David Mendelow
- Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, UK
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Song M, Jin Z, Wang P, Zhang X. Th17/Treg imbalance in peripheral blood from patients with intracranial aneurysm. J Neurosurg Sci 2023; 67:733-739. [PMID: 34647716 DOI: 10.23736/s0390-5616.21.05567-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spontaneous subarachnoid hemorrhage (SAH) is highly associated with ruptured intracranial aneurysm (IA), which dramatically increases neurological disabilities or mortality in patients. The balance between T helper cells (Th17) and regulatory T cells (Treg) plays a crucial role in regulating immune-inflammatory response. In the current study, we aim to obtain a better understanding of the role of Th17 and Treg cells in patients with IA. METHODS 138 patients total participated in this study, including ruptured aneurysms group (Ruptured IA, RIA, N.=70 cases) and unruptured aneurysms group (Unruptured IA, URIA, N.=68 cases). Additionally, 76 cases of healthy subjects were selected as control group. The frequencies of Th17 and Treg cells were determined using flow cytometry. The serum levels of cytokines including IL-17, IL-23, IL-10, and TGF-β1 were determined using ELISA. mRNA was isolated from the whole blood. FOXP3 and RCRc mRNA expressions were detected using RT-qPCR. RESULTS The percentage of Th17 cells in peripheral blood from RIA patients was higher than URIA patients (P<0.01), whereas the percentage of Treg cells in peripheral blood from RIA was significantly lower when compared with URIA patients (P<0.001). The serum levels of IL-17 (P<0.01) and IL-23 (P<0.05) were markedly increased while the levels of IL-10 (P<0.01) and TGF-β1 (P<0.05) were decreased in RIA patients when compared with URIA patients. Lastly, the mRNA level of RCRc was significantly increased in RIA vs. URIA patients (P<0.001). By contrast, FOXP3 mRNA level was significantly decreased in RIA vs. URIA patients (P<0.001). CONCLUSIONS In the current study, we demonstrated the imbalance of Th17/Treg in patients with IA, and the frequencies of Th17 cells were positively correlated with the severity of IA-induced SAH. These results provided data to support that targeting Th17/Treg could act as an effective approach for the management of IA.
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Affiliation(s)
- Miaomiao Song
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou, China -
| | - Zhibin Jin
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou, China
| | - Peng Wang
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou, China
| | - Xiang Zhang
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou, China
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Dou X, Dong W, Gu Y, Zhang T, Zhang J. Significance of serum sestrin2 as a biomarker of severity and functional outcome in acute intracerebral hemorrhage: a prospective observational longitudinal study. BMC Neurol 2023; 23:424. [PMID: 38031041 PMCID: PMC10685503 DOI: 10.1186/s12883-023-03470-6] [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: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Sestrin2 is a highly conserved stress-inducible protein with neuroprotective properties. Herein, we investigated the prognostic significance of serum sestrin2 in human intracerebral hemorrhage (ICH). METHODS In this prospective observational longitudinal study, we enrolled 126 patients with supratentorial ICH as cases together with 126 healthy individuals as controls. Severity indicators were National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Prognostic parameters were early neurologic deterioration (END) and post-stroke 6-month poor prognosis [modified Rankin Scale (mRS) scores of 3-6]. Multivariate analysis was performed to assess relations of serum sestrin2 levels to severity and prognosis. RESULTS Patients had statistically significantly higher serum sestrin2 levels than controls. Serum sestrin2 levels of patients were independently correlated with NIHSS scores and hematoma volume, as well as were substantially elevated in order of mRS scores from 0 to 6. Serum sestrin2 was identified as an independent predictor of END and poor prognosis. Based on the receiver operating characteristic curve, serum sestrin2 had a similar predictive ability for END and poor prognosis, as compared to NIHSS scores and hematoma volume. Prediction models of END and poor prognosis, in which serum sestrin2, NIHSS scores and hematoma volume were integrated, were visually described via nomogram, were reliable and stable under calibration curve and were of clinical benefit using decision curve analysis. Also, prediction model of poor prognosis showed dramatically higher discriminatory efficiency than any of NIHSS scores, hematoma volume and serum sestrin2. CONCLUSION Serum sestrin2 levels, which are obviously increased following acute ICH, are independently related to illness severity and poor clinical outcomes, substantializing serum sestrin2 as a clinically valuable prognostic biomarker of ICH.
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Affiliation(s)
- Xianghong Dou
- Department of Neurology, Donghai County People's Hospital, Lianyungang, 222300, Jiangsu, China
| | - Wensheng Dong
- Department of Neurosurgery, The Second People's Hospital of Lianyungang, Lianyungang, 222000, Jiangsu, China
| | - Yanmei Gu
- Department of Neurosurgery, The Second People's Hospital of Lianyungang, Lianyungang, 222000, Jiangsu, China
| | - Tingting Zhang
- Department of Neurology, Ganyu District Traditional Chinese Medicine Hospital of Lianyungang, Lianyungang, 222100, Jiangsu, China
| | - Jianhua Zhang
- Department of Neurosurgery, The Second People's Hospital of Lianyungang, Lianyungang, 222000, Jiangsu, China.
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Wolf D, Payer T, Lisson CS, Lisson CG, Beer M, Götz M, Ropinski T. Self-supervised pre-training with contrastive and masked autoencoder methods for dealing with small datasets in deep learning for medical imaging. Sci Rep 2023; 13:20260. [PMID: 37985685 PMCID: PMC10662445 DOI: 10.1038/s41598-023-46433-0] [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: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Deep learning in medical imaging has the potential to minimize the risk of diagnostic errors, reduce radiologist workload, and accelerate diagnosis. Training such deep learning models requires large and accurate datasets, with annotations for all training samples. However, in the medical imaging domain, annotated datasets for specific tasks are often small due to the high complexity of annotations, limited access, or the rarity of diseases. To address this challenge, deep learning models can be pre-trained on large image datasets without annotations using methods from the field of self-supervised learning. After pre-training, small annotated datasets are sufficient to fine-tune the models for a specific task. The most popular self-supervised pre-training approaches in medical imaging are based on contrastive learning. However, recent studies in natural image processing indicate a strong potential for masked autoencoder approaches. Our work compares state-of-the-art contrastive learning methods with the recently introduced masked autoencoder approach "SparK" for convolutional neural networks (CNNs) on medical images. Therefore, we pre-train on a large unannotated CT image dataset and fine-tune on several CT classification tasks. Due to the challenge of obtaining sufficient annotated training data in medical imaging, it is of particular interest to evaluate how the self-supervised pre-training methods perform when fine-tuning on small datasets. By experimenting with gradually reducing the training dataset size for fine-tuning, we find that the reduction has different effects depending on the type of pre-training chosen. The SparK pre-training method is more robust to the training dataset size than the contrastive methods. Based on our results, we propose the SparK pre-training for medical imaging tasks with only small annotated datasets.
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Affiliation(s)
- Daniel Wolf
- Visual Computing Research Group, Institute of Media Informatics, Ulm University, Ulm, Germany.
- Experimental Radiology Research Group, Department for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany.
| | - Tristan Payer
- Visual Computing Research Group, Institute of Media Informatics, Ulm University, Ulm, Germany
| | - Catharina Silvia Lisson
- Experimental Radiology Research Group, Department for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Christoph Gerhard Lisson
- Experimental Radiology Research Group, Department for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Meinrad Beer
- Experimental Radiology Research Group, Department for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Michael Götz
- Experimental Radiology Research Group, Department for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Timo Ropinski
- Visual Computing Research Group, Institute of Media Informatics, Ulm University, Ulm, Germany
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Zhou J, Yang C, Xv Q, Wang L, Shen L, Lv Q. Usefulness of Serum Translocator Protein as a Potential Predictive Biochemical Marker of Three-Month Cognitive Impairment After Acute Intracerebral Hemorrhage: A Prospective Observational Cohort Study. Int J Gen Med 2023; 16:5389-5403. [PMID: 38021045 PMCID: PMC10674616 DOI: 10.2147/ijgm.s438503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Translocator protein (TSPO) is a biomarker of neuroinflammation and brain injury. This study aimed to ascertain the potential of serum TSPO as a predictor of cognitive impairment after acute intracerebral hemorrhage (ICH). Methods In this prospective observational cohort study, 276 patients with supratentorial ICH were randomly assigned to two groups (184 patients in the study group and 92 in the validation group) in a 2:1 ratio. Serum TSPO levels were gauged at admission, and cognitive status was assessed using the Montreal Cognitive Assessment Scale (MoCA) post-stroke 3 months. A MoCA score of < 26 was considered indicative of cognitive impairment. Results Serum TSPO levels were inversely correlated with MoCA scores (ρ=-0.592; P<0.001). Multivariate linear regression analysis showed that serum TSPO levels were independently associated with MoCA scores (β, -0.934; 95% confidence interval (CI), -1.412--0.455; VIF, 1.473; P<0.001). Serum TSPO levels were substantially higher in patients with cognitive impairment than in the remaining patients (median, 2.7 versus 1.6 ng/mL; P<0.001). Serum TSPO levels were linearly correlated with the risk of cognitive impairment under a restricted cubic spline (P=0.325) and independently predicted cognitive impairment (odds ratio, 1.589; 95% CI, 1.139-2.216; P=0.016). Subgroup analysis showed that the relationship between serum TSPO levels and cognitive impairment was not markedly influenced by other parameters, such as age, sex, drinking, smoking, hypertension, diabetes mellitus, body mass index, and dyslipidemia (all P for interaction > 0.05). The model, which contained serum TSPO, National Institutes of Health Stroke Scale scores and hematoma volume, performed well under the receiver operating characteristic curve, calibration curve and decision curve, and using the Hosmer-Lemeshow test. This model was validated in the validation group. Conclusion Serum TSPO level upon admission after ICH was independently associated with cognitive impairment, substantializing serum TSPO as a reliable predictor of post-ICH cognitive impairment.
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Affiliation(s)
- Jing Zhou
- Department of Neurosurgery, Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang, People’s Republic of China
| | - Chunsong Yang
- Department of Neurosurgery, Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang, People’s Republic of China
| | - Qichen Xv
- Department of Neurosurgery, Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang, People’s Republic of China
| | - Liyun Wang
- Department of Neurosurgery, Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang, People’s Republic of China
| | - Liangjun Shen
- Department of Neurosurgery, Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang, People’s Republic of China
| | - Qingwei Lv
- Department of Neurosurgery, Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang, People’s Republic of China
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Li H, Ghorbani S, Zhang R, Ebacher V, Stephenson EL, Keough MB, Yong VW, Xue M. Prominent elevation of extracellular matrix molecules in intracerebral hemorrhage. Front Mol Neurosci 2023; 16:1251432. [PMID: 38025264 PMCID: PMC10658787 DOI: 10.3389/fnmol.2023.1251432] [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: 07/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Intracerebral hemorrhage (ICH) is the predominant type of hemorrhagic stroke with high mortality and disability. In other neurological conditions, the deposition of extracellular matrix (ECM) molecules is a prominent obstacle for regenerative processes and an enhancer of neuroinflammation. Whether ECM molecules alter in composition after ICH, and which ECM members may inhibit repair, remain largely unknown in hemorrhagic stroke. Methods The collagenase-induced ICH mouse model and an autopsied human ICH specimen were investigated for expression of ECM members by immunofluorescence microscopy. Confocal image z-stacks were analyzed with Imaris 3D to assess the association of immune cells and ECM molecules. Sections from a mouse model of multiple sclerosis were used as disease and staining controls. Tissue culture was employed to examine the roles of ECM members on oligodendrocyte precursor cells (OPCs). Results Among the lectican chondroitin sulfate proteoglycan (CSPG) members, neurocan but not aggrecan, versican-V1 and versican-V2 was prominently expressed in perihematomal tissue and lesion core compared to the contralateral area in murine ICH. Fibrinogen, fibronectin and heparan sulfate proteoglycan (HSPG) were also elevated after murine ICH while thrombospondin and tenascin-C was not. Confocal microscopy with Imaris 3D rendering co-localized neurocan, fibrinogen, fibronectin and HSPG molecules to Iba1+ microglia/macrophages or GFAP+ astrocytes. Marked differentiation from the multiple sclerosis model was observed, the latter with high versican-V1 and negligible neurocan. In culture, purified neurocan inhibited adhesion and process outgrowth of OPCs, which are early steps in myelination in vivo. The prominent expression of neurocan in murine ICH was corroborated in human ICH sections. Conclusion ICH caused distinct alterations in ECM molecules. Among CSPG members, neurocan was selectively upregulated in both murine and human ICH. In tissue culture, neurocan impeded the properties of oligodendrocyte lineage cells. Alterations to the ECM in ICH may adversely affect reparative outcomes after stroke.
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Affiliation(s)
- Hongmin Li
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, China
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Samira Ghorbani
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ruiyi Zhang
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, China
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Vincent Ebacher
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB, Canada
| | - Erin L. Stephenson
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael B. Keough
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - V. Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, China
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Shentu HS, Chen YH, Cheng ZY, Fu B, Fu YH, Zheng SF, Li C. A Prospective Cohort Study of Inter-Alpha-Trypsin Inhibitor Heavy Chain 4 as a Serologic Marker in Relation to Severity and Functional Outcome of Acute Intracerebral Hemorrhage. Neuropsychiatr Dis Treat 2023; 19:2363-2379. [PMID: 37954033 PMCID: PMC10637248 DOI: 10.2147/ndt.s433264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
Background The inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) may regulate immunity and inflammation. The current study was conducted to determine its role as a biomarker for reflecting the severity and predicting outcomes of intracerebral hemorrhage (ICH). Methods In this prospective cohort study, 185 patients with supratentorial ICH were enrolled, among whom 62 had blood obtained not only at admission but also on days 1, 3, 5, 7, 10, and 14. In addition, 62 healthy controls underwent blood collection at the start of the study. The serum ITIH4 levels were then quantified. We recorded early neurological deterioration (END) and poor prognosis (modified Rankin Scale [mRS] scores of 3-6]) six months after ICH. Results Serum ITIH4 levels decreased prominently in the early phase after ICH, continued to decline until day 5, then gradually increased until day 14, and were significantly lower during 14 days in patients than in controls. Serum ITIH4 levels on admission were independently associated with serum C-reactive protein levels, National Institutes of Health Stroke Scale (NIHSS) scores and hematoma volume. Admission serum ITIH4 levels were independently associated with mRS scores, END, and poor prognosis. No substantial differences existed in the areas under the receiver operating characteristic curve of END and poor prognosis prediction between the serum ITIH4 levels, NIHSS scores, and hematoma volume. Prediction models, in which serum ITIH4 levels, NIHSS scores, and hematoma volume were integrated, were relatively reliable and stable using a series of statistical methods. In addition, the prediction model of poor prognosis had a higher discriminatory ability than the NIHSS scores and hematoma volume alone. Conclusion A dramatic decline in serum ITIH4 levels during the early period following ICH is independently related to the inflammatory response, stroke severity, and poor neurologic outcomes, suggesting that serum ITIH4 may be a useful prognostic biomarker of ICH.
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Affiliation(s)
- Hua-Song Shentu
- Department of Neurosurgery, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
| | - Yi-Hua Chen
- Department of Neurosurgery, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
| | - Zhen-Yu Cheng
- Department of Neurosurgery, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
| | - Bin Fu
- Department of Neurosurgery, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
| | - Yuan-Hao Fu
- Department of Neurosurgery, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
| | - Shu-Feng Zheng
- Department of Endocrinology, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
| | - Chan Li
- Department of Neurosurgery, Jinhua People’s Hospital, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, People’s Republic of China
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Chen C, Xie Y, Pu M, Deng L, Li Z, Yang T, Yin H, Zhang Z, Lv X, Liu X, Cheng J, Li Q. Age-related differences in risk factors, clinical characteristics, and outcomes for intracerebral hemorrhage. Front Aging Neurosci 2023; 15:1264124. [PMID: 38020784 PMCID: PMC10655109 DOI: 10.3389/fnagi.2023.1264124] [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: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Intracerebral hemorrhage (ICH) is a severe form of stroke that remains understudied in the young adults. We aimed to investigate the clinical presentation, and risk factors associated with ICH in this age group and compare them to older patients. Methods Our study included ICH patients admitted between March 2016 and December 2021 in the First Affiliated Hospital of Chongqing Medical University from our ongoing prospective cohort database. Demographic characteristics, etiology, risk factors, and clinical outcomes were compared between elderly and young patients. Furthermore, logistic regression analysis was employed to explore risk factors associated with the functional outcome at 3-months. Results We selected 1,003 patients (mean age, 59.9 ±13.8 years old), 746 (74.4%) patients were aged >50 years. The logistic regression analysis showed young patients have a higher proportion of secondary ICH, higher white blood cell count and higher body mass index (BMI), but less diabetes mellitus. Of all patients, predictors of 3-month functional independence was first-ever ICH and age ≤50 years. The history of nephropathy and stroke, higher baseline NIHSS score, larger hematoma volume, and the presence of hydrocephalus were associated with poor outcomes. And the white blood cell count could significantly influence the prognosis among young ICH patients. Three-month functional outcome based on modified Rankin scale score was better in young patients than the elderly (OR, 1.232; 95% CI, 1.095-1.388; p < 0.001). Conclusions The highest incidence of ICH occurs in the age groups of 50-59 and 60-69. ICH in young adults had higher white blood cell and BMI compared to the elderly, and differs in etiological distribution. The young patients also had similar short-term mortality but more favorable functional outcomes than the elderly. Furthermore, NIHSS score and larger hematoma volumes were associated with poor outcome in all patients.
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Affiliation(s)
- Chu Chen
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanfang Xie
- Department of Neurology, Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Mingjun Pu
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Deng
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zuoqiao Li
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tiannan Yang
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Yin
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhehao Zhang
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinni Lv
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueyun Liu
- Department of Neurology, Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Jing Cheng
- Department of Neurology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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