Does early medical intervention have a role in the management of intracerebral haemorrhage?

Assessment of Hemodynamic Alterations in Cerebral Veins in Patients With Intracerebral Hemorrhage Using Duplex Color-Coded Sonography

OBJECTIVES

To investigate the contributions of hemodynamic alterations in cerebral veins to the prognosis of patients with primary intracerebral hemorrhage (ICH).

METHODS

Duplex color-coded sonography was performed on 87 ICH patients between July 2016 and October 2017. The time-averaged peak velocity, the time-averaged mean velocity (TAMV), the blood flow volume (BFV) of bilateral internal jugular veins (IJVs) and vertebral veins (VVs), and the mean velocities of bilateral basal veins of Rosenthal, straight sinus, and bilateral transverse sinuses were calculated to understand the relationship of hemodynamic data with prognosis in patients with ICH.

RESULTS

The study revealed that the time-averaged peak velocities, TAMVs and BFVs of both right IJV and VV in ICH patients with good clinical outcomes were higher than those of the left IJV and VV, whereas statistically significant differences were not found in the mean velocity of bilateral veins of Rosenthal. The perihematomal edema volume, time-averaged peak velocities, TAMVs, and BFVs of the bilateral IJVs and right VV and the TAMV of the left VV were associated with the prognosis of ICH patients in the univariate analysis. However, the TAMV of the right IJV and BFV of the left IJV were the independent factors that predicted prognosis in multivariate analysis. Partial correlation showed that there was a linear dependence between the differences in TAMV and BFV between bilateral IJVs.

CONCLUSIONS

The presence of hemodynamic changes in cerebral veins in patients with ICH has an impact on prognosis.

Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage

Background:

Spontaneous intracerebral hemorrhage (SICH) is a form of cerebrovascular accident with a very high rate of morbidity and mortality. The determinants of prognosis include the demographic, clinical, laboratory, and radiologic factors. It is long known that the hematoma size has a negative impact on the outcome in SICH. The influence of perihematomal edema (PHE) is not established to the extent same as that of hematoma volume. Hence, we planned this study to determine as to what role does PHE plays in the outcome in SICH.

Aim of the Study:

To evaluate the prognostic influence of absolute and relative edema (ratio of absolute edema to hematoma volume) in the patients of SICH.

Materials and Methods:

This is a prospective case-controlled study. A total of 44 patients were enrolled after excluding the confounding factors. The patients were evaluated and their disability was assessed using modified Rankin scale (MRS). The imaging was done in the interval between 24 and 72 h and the hematoma volume, absolute edema volume, and the relative edema were calculated. The outcome was reassessed at 12 weeks and defined as favorable if MRS < 3.

Results:

A total of 69 patients were found to be having SICH on imaging; however, 25 patients were excluded as they had one of the criterion for exclusion. Hence, only 44 patients were included in the study. On univariate analysis, none of the demographic characteristics of the patients, vascular risk factors, presenting complaints, blood pressure, Glasgow coma scale, and MRS at admission, laboratory parameters were not significantly different in the two outcome groups. The hematoma volume was significantly higher in the poor outcome group (P < 0.0001) and the relative edema was associated with a favorable outcome at 12 weeks (P < 0.0001). On multivariate logistic regression, the hematoma volume and relative edema were found to have effect on the outcome similar to that seen on univariate analysis.

Conclusion:

In SICH, a larger hematoma volume is a predictor of poor outcome and a relative edema is associated with a better functional status.

Acute Statin Treatment Improves Recovery after Experimental Intracerebral Hemorrhage

BACKGROUND AND PURPOSE

We have previously demonstrated that 2-week treatment of experimental intracerebral hemorrhage (ICH) with a daily dose of 2 mg/kg statin starting 24 hours post-injury exerts a neuroprotective effect. The present study extends our previous investigation and tests the effect of acute high-dose (within 24 hours) statin therapy on experimental ICH.

MATERIAL AND METHODS

Fifty-six male Wistar rats were subjected to ICH by stereotactic injection of 100 μl of autologous blood into the striatum. Rats were divided randomly into seven groups: saline control group (n = 8); 10, 20 and 40 mg/kg simvastatin-treated groups (n = 8); and 10, 20 and 40 mg/kg atorvastatin-treated groups (n = 8). Simvastatin or atorvastatin were administered orally at 3 and 24 hours after ICH. Neurological functional outcome was evaluated using behavioral tests (mNSS and corner turn test) at multiple time points after ICH. Animals were sacrificed at 28 days after treatment, and histological studies were completed.

RESULTS

Acute treatment with simvastatin or atorvastatin at doses of 10 and 20 mg/kg, but not at 40 mg/kg, significantly enhanced recovery of neurological function starting from 2 weeks post-ICH and persisting for up to 4 weeks post ICH. In addition, at doses of 10 mg/kg and 20 mg/kg, histological evaluations revealed that simvastatin or atorvastatin reduced tissue loss, increased cell proliferation in the subventricular zone and enhanced vascular density and synaptogenesis in the hematoma boundary zone when compared to saline-treated rats.

CONCLUSIONS

Treatment with simvastatin or atorvastatin at doses of 10 and 20 mg/kg significantly improves neurological recovery after administration during the first 24 hours after ICH. Decreased tissue loss, increased cell proliferation and vascularity likely contribute to improved functional recovery in rats treated with statins after ICH.

History and mechanism for treatment of intracerebral hemorrhage with scalp acupuncture

Intracerebral hemorrhage (ICH) is an important public health problem with high rates of mortality, morbidity, and disability, but no clinically proven treatment strategy is available to date. Scalp acupuncture (SA) refers to a therapy for treating diseases by needling and stimulating the specific areas of the scalp. The evidence from clinical studies suggested that SA therapy may produce significant benefits for patients with acute ICH. However, the therapeutic mechanisms are yet not well addressed. Therefore, in this paper, we provide a comprehensive overview on the history and mechanisms of SA therapy on acute ICH. Although SA has been practiced for thousands of years in China and could date back to 5 BC, SA therapy for acute ICH develops only in the recent 30 years. The possible mechanisms associated with the therapeutic effects of SA on ICH include the influence on hematoma, brain edema, and blood brain barrier, the products released from haematoma, the immune and inflammatory reaction, focal perihemorrhagic hypoperfusion and hemorheology, neuroelectrophysiology, and so on. At last, the existence of instant effect of SA on acute ICH and its possible mechanisms are presented.