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Marchina S, Yeatts SD, Foster LD, Janis S, Shoamanesh A, Khatri P, Bernstein K, Perlmutter A, Stever C, Heistand EC, Broderick JP, Greenberg SM, Leira EC, Rosand J, Lioutas VA, Salman RAS, Tirschwell D, Marti-Fabregas J, Selim M. Rationale and Design of the Statins Use in Intracerebral Hemorrhage Patients (SATURN) Trial. Cerebrovasc Dis 2024:000538195. [PMID: 38493765 PMCID: PMC11403066 DOI: 10.1159/000538195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION The benefits and risks of HMG-CoA reductase inhibitor (statin) drugs in survivors of intracerebral hemorrhage (ICH) are unclear. Observational studies suggest an association between statin use and increased risk of lobar ICH, particularly in patients with apolipoprotein-E (APOE) ε2 and ε4 genotypes. There are no randomized controlled trials (RCTs) addressing the effects of statins after ICH leading to uncertainty as to whether statins should be used in patients with lobar ICH who are at high risk for ICH recurrence. The SATURN trial aims to evaluate the effects of continuation versus discontinuation of statin on the risk of ICH recurrence and ischemic major adverse cerebro-cardio-vascular events (MACCE) in patients with lobar ICH. Secondary aims include the assessment of whether the APOE genotype modifies the effects of statins on ICH recurrence, functional and cognitive outcomes and quality of life. METHODS The SATURN trial is a multi-center, pragmatic, prospective, randomized, open-label, Phase III clinical trial with blinded end-point assessment. A planned total of 1456 patients with lobar ICH will be recruited from 140 sites in the United States, Canada and Spain. Patients presenting within seven days of a spontaneous lobar ICH that occurred while taking a statin, will be randomized (1:1) to continuation (control) vs. discontinuation (intervention) of the same statin drug and dose that they were using at ICH onset. The primary outcome is the time to recurrent symptomatic ICH within a two-year follow-up period. The primary safety outcome is the occurrence of ischemic MACCE. CONCLUSION The results will help to determine the best strategy for statin use in survivors of lobar ICH and may help to identify if there is a subset of patients who would benefit from statins.
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Puppala GK, Gorthi SP, Chandran V, Gandeti R, Rao SS. Prevalence of Cognitive Impairment and Dementia After Intracerebral Hemorrhage. Ann Indian Acad Neurol 2023; 26:952-957. [PMID: 38229634 PMCID: PMC10789433 DOI: 10.4103/aian.aian_731_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 01/18/2024] Open
Abstract
Objective To study the prevalence of cognitive impairment in survivors of intracerebral hemorrhage (ICH). Methods Survivors of spontaneous ICH were followed up in the neurology outpatient department when they reported for follow-up after 6 months. Neuroimaging records at the onset and at follow-up visits are studied for the location of ICH, volume of ICH, intraventricular extension, and hydrocephalus. The volume of ICH is calculated by ABC/2 method on a CT scan. All patients underwent cognitive assessment with Addenbrooke's cognitive examination ACE III and were categorized as patients having cognitive impairment (or) no cognitive impairment. Results A total of 120 patients were studied, out of which 77 (64%) are males and 43 (36%) are females with age groups ranging from 26 to 75 years. In the study population, the mean age was found to be 62.3 years. Specifically, the mean age for males was 56.9 years, while for females it was 63.4 years. Cognitive impairment was noted in 34 of 120 patients (28%) during 6 to 12 months of examination, of which 11 of 19 were in lobar location, 21 of 94 were in sub-cortical location, and 2 of 7 were in infratentorial location. Conclusion It was found that 28% of survivors of ICH were cognitively impaired. Hence, it is essential to assess cognition in post-ICH patients during follow-up, so that suitable adjustments can be made in their employment, and also in educating family members in providing a good quality of life.
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Affiliation(s)
- Goutham Kumar Puppala
- D.M Neurology Assistant Professor of Neurology, Kakatiya Medical College, Warangal, Telangana, India
| | - Sankar Prasad Gorthi
- D.M Neurology Professor and HOD of Neurology, Bhartiya Vidya Peet, Pune, Maharashtra, India
| | - Vijay Chandran
- D.M Neurology Associate Professor of Neurology, Kasturba Medical College, Manipal, Udupi, Karnataka, India
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Morita Y, Yoshikawa T, Takahashi M. Long working hours and risk of hypertensive intracerebral haemorrhage among Japanese workers claiming compensation for overwork-related intracerebral haemorrhage: an unmatched case-control study. BMJ Open 2023; 13:e074465. [PMID: 37739464 PMCID: PMC10533741 DOI: 10.1136/bmjopen-2023-074465] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES Overwork-related cerebrovascular and cardiovascular diseases (CCVDs) constitute a major occupational and public health issue worldwide. However, to our knowledge, few studies have reported the underlying pathophysiological mechanisms. We aimed to determine whether patients with extreme workload have a greater risk of developing hypertensive intracerebral haemorrhage (ICH) located in the deep brain areas than patients without extreme workload. We also determined the association between the number of hours of overtime work and the risk of developing hypertensive ICH. DESIGN Unmatched case-control study. SETTING Database of patients claiming compensation for overwork-related CCVDs in Japan. PARTICIPANTS A total of 1215 patients who claimed overwork-related ICH in Japan, of whom 621 had their compensation claim approved (patients with extreme workload) and 622 did not. PRIMARY AND SECONDARY OUTCOME MEASURES Logistic regression analysis was performed to calculate the risk of developing hypertensive ICH in patients with extreme workload compared with those without extreme workload, adjusted for confounders such as age, occupation, smoking status, alcohol consumption and medical history. We also calculated the risk of developing hypertensive ICH in compensated patients by average monthly overtime working hours. RESULTS Patients with extreme workloads had a significantly higher odds ratio (OR) for developing hypertensive ICH (1.44, 95% CI: 1.10 to 1.88) than those without extreme workloads. ORs for developing hypertensive ICH according to overtime working hours showed a dose-response relationship; an overtime of 100 hours/month was associated with a significantly higher OR (1.31, 95% CI: 0.89 to 1.91; 1.41, 95% CI: 0.95 to 2.11; and 1.50, 95% CI: 1.01 to 2.22 for 60-79.9, 80-99.9 and≥100 hours/month, respectively) than that for workloads of less than 60 hours/month. CONCLUSIONS Regarding Japanese workers, overtime work could be associated with the risk of developing hypertensive ICH, and hypertension may play an important role in overwork-related ICH.
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Affiliation(s)
- Yusaku Morita
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Kawasaki, Japan
| | - Toru Yoshikawa
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Kawasaki, Japan
| | - Masaya Takahashi
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Kawasaki, Japan
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Amano Y, Yamaguchi Y, Osato T, Watanabe T, Kamiyama K, Nakamura H. Long insular artery damage might be a key sign for predicting functional prognosis of putaminal hemorrhage. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:221-227. [PMID: 36775739 DOI: 10.1016/j.neucie.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/21/2022] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage. METHODS We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores≥3 and related factors. RESULTS Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores≥3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores≥3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores≥3 than group B (p=0.00). CONCLUSION In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage.
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Affiliation(s)
- Yuki Amano
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
| | - Yohei Yamaguchi
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | | | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
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Amano Y, Yamaguchi Y, Osato T, Watanabe T, Kamiyama K, Nakamura H. Long insular artery damage might be a key sign for predicting functional prognosis of putaminal hemorrhage. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wang N, Lin W, Zhu X, Tu Q, Zhu D, Qu S, Yang J, Ruan L, Zhuge Q. Conventional craniotomy versus conservative treatment in patients with minor spontaneous intracerebral hemorrhage in the basal ganglia. Chin Neurosurg J 2022; 8:26. [PMID: 35986426 PMCID: PMC9389702 DOI: 10.1186/s41016-022-00288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background The treatment for spontaneous intracerebral hemorrhage (ICH) is still controversial, especially for hematomas in the basal ganglia. A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the basal ganglia. Methods We retrospectively collected the data of consecutive patients with minor basal ganglia hemorrhage from January 2018 to August 2019. We compared clinical outcomes of two groups using propensity score matching. The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at a 12-month follow-up was used as the primary outcome measure. According to a previous prognosis algorithm, patients were divided into good and poor prognosis groups to obtain a dichotomized (favorable or unfavorable) outcome as the primary outcome. Secondary outcomes included hospitalized complications, mortality, and modified Rankin score at 12 months. Results A total of 54 patients were analyzed, and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched. The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group (81% vs 44%; OR 1.833, 95% CI 1.159–2.900; P=0.005). The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group (P=0.005). Conclusions It is not recommended to undertake conventional craniotomy for patients with a minor hematoma (25–40 ml) in the basal ganglia. An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.
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Gon Y, Kabata D, Mochizuki H. Association between kidney function and intracerebral hematoma volume. J Clin Neurosci 2022; 96:101-106. [PMID: 35032897 DOI: 10.1016/j.jocn.2021.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/11/2021] [Accepted: 12/20/2021] [Indexed: 12/20/2022]
Abstract
Renal dysfunction has been reported to be associated with larger hematoma volume in intracerebral hemorrhage (ICH) due to concomitant nutritional imbalances and platelet dysfunction; however, this association remains controversial. This study analyzed the association between potential risk factors and hematoma volume in patients with ICH. This retrospective cohort study used data from 456 patients with ICH at a single comprehensive stroke center. We assessed the association of estimated glomerular filtration rate (eGFR) and Controlling Nutritional Status score with hematoma volume using multivariable non-linear regression models. The effect of the use of antithrombotic agents on hematoma volume was analyzed using outcome-adaptive double/debiased machine learning approach, considering many covariates. The median and interquartile range of age and eGFR were 64 (54-75) years and 56.1 (39.3-66.7) mL/min/1.73 m2, respectively. The multivariable non-linear regression model showed that (1) eGFR and hematoma volume had a positive linear association, which was not statistically significant, and (2) nutritional status was positively associated with hematoma volume, although not significantly. Outcome-adaptive double/debiased machine learning revealed that patients receiving antithrombotic agents did not present with significantly larger hematoma volume than those who were not receiving antithrombotic agents (estimated mean difference of hematoma volume [95% confidence interval] = 15.32 [-6.02 to 36.65]). Our analysis shows no statistically or clinically significant relationship between renal function and hematoma volume; however, nutritional status and the use of antithrombotic agents showed an increasing tendency of the degree of hematoma in patients with ICH.
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Affiliation(s)
- Yasufumi Gon
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Advanced Interdisciplinary Studies, The University of Tokyo Graduate School of Engineering, Tokyo, Japan.
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
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The Burden and Risks Factors for Intracerebral Hemorrhage in a Southeast Asian Population. Clin Neurol Neurosurg 2022; 214:107145. [DOI: 10.1016/j.clineuro.2022.107145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
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Kitano T, Hirano T, Okazaki S, Itotagawa E, Yagita Y, Morita Y, Watanabe A, Takahashi D, Sakaguchi M, Fujiwara H, Todo K, Sasaki T, Kumanogoh A, Mochizuki H. Heterogeneity of Stroke in Patients with Systemic Lupus Erythematosus. Intern Med 2022; 61:3045-3052. [PMID: 36244734 PMCID: PMC9646340 DOI: 10.2169/internalmedicine.9228-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The underlying pathophysiology varies according to stroke subtype. However, stroke heterogeneity among patients with systemic lupus erythematosus (SLE) remains unstudied. We hypothesized that the contribution of SLE to stroke might vary according to its subtype and investigated the associations of SLE and various stroke subtypes. Methods Diagnostic codes and electronic medical records were used to identify 70 patients with SLE who developed acute cerebral infarction or intracerebral hemorrhaging at four tertiary referral hospitals between 2008 and 2018. Intracerebral hemorrhaging was classified as lobar or deep, while cerebral infarction was classified according to the SSS-TOAST criteria. Physician notes were used to identify SLE activity, and their prevalences were compared among stroke subtypes. Outcomes were collected from the patients' medical records. Results The most common stroke subtype in patients with SLE was that of undetermined causes (31%), followed by small artery occlusion (16%), cardioaortic embolism (13%), other causes (11%), lobar hemorrhaging (10%), deep hemorrhaging (10%), and large artery atherosclerosis (9%). Stroke onset occurred during a period of high SLE activity in 21 patients (30%). The proportion of patients with high SLE activity varied according to stroke subtype (p=0.039) and was highest for cerebral infarction with undetermined causes. Stroke recurrence or death was observed in 40% of patients within 5 years after the initial stroke onset. Conclusion The contributions of SLE to stroke varied significantly according to the stroke subtype. Given the unfavorable prognosis, close stroke subtype-specific observation by rheumatologists and stroke specialists is recommended after stroke events.
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Affiliation(s)
- Takaya Kitano
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Toru Hirano
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Japan
| | - Shuhei Okazaki
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Eri Itotagawa
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Japan
| | | | | | | | | | - Hiroshi Fujiwara
- Division of Rheumatology and Allergy, Osaka General Medical Center, Japan
| | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Tsutomu Sasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
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Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, Quindós B, Forcelledo L, Vizcaino D, Martín L, Salgado E, Viña L. Clinico-radiological related to early brain death factors. Med Intensiva 2021; 46:1-7. [PMID: 34802992 DOI: 10.1016/j.medine.2021.11.005] [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: 10/31/2019] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h. DESIGN A retrospective cohort study was made covering the period 2015-2017. SETTING An adult Intensive Care Unit (ICU). PATIENTS/METHODS Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - I Astola
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Balboa
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Leoz
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Á Meilan
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - C Del Busto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Quindós
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - D Vizcaino
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Martín
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Salgado
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Viña
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
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Shen J, Guo F, Yang P, Xu F. Influence of hypertension classification on hypertensive intracerebral hemorrhage location. J Clin Hypertens (Greenwich) 2021; 23:1992-1999. [PMID: 34608743 PMCID: PMC8630601 DOI: 10.1111/jch.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023]
Abstract
The authors sought to explore whether hypertension classification was risk factor for lobar and non‐lobar hypertensive intracerebral hemorrhage (HICH) and the prognosis in patients with hematoma. This retrospective cohort study was conducted on HICH patients admitted at the First Affiliated Hospital of Soochow University. Observations with first‐ever intracerebral hemorrhage (ICH) were recruited. The authors divided the brain image into three groups according to the location of ICH to predict whether there were significant differences between lobar and non‐lobar ICH. A Mann‐Whitney U test was used and this retrospective trial also compared the operation and mortality rates. Our cohort included 209 patients (73.7% male; median age:60.5±16.7). The overall incidence of lobar HICH was less than non‐lobar HICH (24.4% vs. 68.4%), 7.2% cases of mixed HICH was included in this analysis. In a Mann‐Whitney U test analyze, it indicated that there were significant differences in hypertension classification between lobar and non‐lobar HICH (Z = ‐3.3, p<.05). And the percentage of hematoma in lobar areas with relatively slightly high blood pressure (BP) (high normal and grade 1 hypertension) accounts for 52.9% versus 30.1% in non‐lobar areas. The increasing trends of the prevalent rate of lobar ICH with BP rising were not remarkable. The non‐lobar HICH showed a sharper increase in the condition of grade 3 hypertension compared with lobar HICH. During the period of research, the fatality of lobar hemorrhage was 2.9% versus 7.7% (non‐lobar). Besides, the fatality incidence of HICH with relatively slightly high BP (high normal and grade 1 hypertension) was lower than poorly controlled hypertensive patients (grade 2 and grade 3 hypertension). (8.0% vs. 15.7%). The increase of hypertension classification will aggravate the occurrence of non‐lobar ICH and positively corrected with BP, but not in lobar areas. It is essential to understand the distinction influence of hypertension classification between lobar and non‐lobar ICH.
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Affiliation(s)
- Jun Shen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - FengBao Guo
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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Nakamura K, Sasaki T, Minami K, Take Y, Kimura K, Haraguchi Y, Sasaki W, Kishi S, Yoshimura S, Nakatani Y, Miki Y, Goto K, Kaseno K, Yamashita E, Koyama K, Funabashi N, Naito S. Symptomatic and asymptomatic intracerebral hemorrhages detected by magnetic resonance imaging after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2021; 64:443-454. [PMID: 34432185 DOI: 10.1007/s10840-021-01051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Symptomatic intracerebral hemorrhages (ICHs) are a rare complication after atrial fibrillation (AF) catheter ablation, while the incidence of asymptomatic ICHs detected by magnetic resonance (MR) imaging remains unclear. This study aimed to investigate the incidence, characteristics, and predictors of new-onset ICHs on MR imaging after AF ablation. METHODS We retrospectively studied 1257 consecutive AF ablation procedures in 1201 patients who underwent MR imaging on the day after the procedure. Repeat MR imaging within 3 months post-ablation was available in 352 procedures. RESULTS Old ICHs on the initial MR imaging were observed in 28 procedures (2.2%). Post-ablation new ICHs were observed in 14 procedures (4.0%), including one symptomatic (0.3%) and 13 (3.7%) asymptomatic ICHs. One patient had a new ICH on the initial MR imaging, while the remaining 13 had such on the repeat MR imaging. A univariate analysis revealed that a previous ischemic stroke or transient ischemic attack (TIA) and the CHA2DS2-VASc score were positive predictors of new ICHs (odds ratios, 5.502 and 1.435; P = 0.004 and 0.044). The lesion diameter did not significantly differ between the old and new ICHs (median, 6.1 mm vs. 8.0 mm, P = 0.281), while the predominant location differed (lobar areas, 22.6% vs. 53.3%; cerebellum, 22.6% vs. 20.0%; others, 54.8% vs. 26.7%; P = 0.026). CONCLUSIONS A few asymptomatic ICHs may occur after AF ablation. Most of the post-ablation new ICHs occurred a few days or later after the procedure. A previous ischemic stroke/TIA and the CHA2DS2-VASc score may be risk factors for post-ablation ICHs.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kentaro Minami
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Koki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yumiko Haraguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Keiko Koyama
- Division of Radiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Nobusada Funabashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
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Li Y, Wu DX, Liu JF, Li H, Wang JW, Li YX, Guo H, Liu W, Ji L, Chen LY, Zhang WH, Jing SQ, Xu LF, Wang ZF, Li CH. Analysis of the curative effect and influencing factors of stereotactic aspiration in the treatment of primary brainstem haemorrhage. J Clin Neurosci 2021; 89:122-127. [PMID: 34119254 DOI: 10.1016/j.jocn.2021.04.014] [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: 01/16/2021] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
Primary brainstem haemorrhage (PBH) is characterized by acute onset, rapid deterioration, many complications, and poor prognosis. Its treatment has been controversial. This study aimed to explore the clinical risk factors of postoperative survival and neurological function recovery of stereotactic aspiration in the treatment of PBH. The clinical data of 65 patients with severe brainstem haemorrhage from February 2019 to February 2020 in the First Hospital of Hebei Medical University were reviewed. All patients were treated with stereotactic haematoma aspiration. We determined the survival status of patients at 30 days after the operation and the recovery of neurological function at 90 days. The modified Rankin Scale score (mRS) was used to assess the survival status. The 30-day mortality rate was 23.1% (15 patients). The proportion of patients with good neurological recovery at 90 days after the operation was 32.3% (21 patients). According to the multivariate logistic regression analysis, the haematoma classification was an independent risk factor for postoperative survival (OR = 0.197, 95% CI: 0.016-0.385, p = 0.046) and recovery of neurological function 90 days after surgery (OR = 0.019, 95% CI: 0.001-0.267, p = 0.003). The haematoma classification is an independent risk factor for 30-day mortality and recovery of neurological function 90 days after surgery. Massive and basal-tegmental haematomas were associated with higher mortality. The prognosis of patients with unilateral and bilateral tegmental haematoma was better than that of patients with other haematoma types.
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Affiliation(s)
- Yan Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dong-Xue Wu
- Department of Radiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian-Feng Liu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ji-Wei Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Xiong Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hao Guo
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Liu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Le Ji
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling-You Chen
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Hua Zhang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shan-Quan Jing
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li-Feng Xu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zi-Feng Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cong-Hui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, China.
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Zhao J, Yang F, Song C, Li L, Yang X, Wang X, Yu L, Guo J, Wang K, Fu F, Jiang W. Glibenclamide Advantage in Treating Edema After Intracerebral Hemorrhage (GATE-ICH): Study Protocol for a Multicenter Randomized, Controlled, Assessor-Blinded Trial. Front Neurol 2021; 12:656520. [PMID: 33986719 PMCID: PMC8110908 DOI: 10.3389/fneur.2021.656520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/25/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: Brain edema after acute intracerebral hemorrhage (ICH) plays a critical role in the secondary injury of ICH and may heighten the potential for a poor outcome. This trial aims to explore the efficacy of small doses of oral glibenclamide in perihematomal edema (PHE) and the prognosis of patients with ICH. Methods and Analysis: The GATE-ICH trial is a multicenter randomized, controlled, assessor-blinded trial. A total of 220 adult patients with acute primary ICH in 28 study centers in China will be randomized to the glibenclamide group (glibenclamide plus guideline-recommended ICH management) or the control group (guideline-recommended ICH management). Multivariate logistic regression will be used to analyze the relationship between the treatments and primary outcome. Study Outcomes: The primary efficacy outcome is the proportion of poor functional outcomes (modified Rankin Scale ≥3) at 90 days after enrollment. The secondary efficacy outcomes include changes in the volume of ICH and PHE between the baseline and follow-up computed tomography scans as well as the clinical scores between the baseline and follow-up assessments. Discussion: The GATE-ICH trial will assess the effects of small doses of oral glibenclamide in reducing the PHE after ICH and improving the 90-day prognosis of patients. Clinical Trial Registration: www.clinicaltrials.gov., NCT03741530. Registered on November 8, 2018. Trial Status: Protocol version: May 6, 2019, Version 5. Recruitment and follow-up of patients is currently ongoing. This trial will be end in the second quarter of 2021.
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Affiliation(s)
- Jingjing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Changgeng Song
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Li Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Xiai Yang
- Department of Neurology, Ankang Central Hospital, Ankang, China
| | - Xiaofeng Wang
- Department of Neurosurgery, The PLA 987 Hospital, Baoji, China
| | - Liping Yu
- Department of Neurology, The First Peoples Hospital of Xianyang, Xianyang, China
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Kangjun Wang
- Department of Neurology, Hanzhong Central Hospital, Hanzhong, China
| | - Feng Fu
- Department of Neurology, 215 Hospital of Shaanxi NI, Xianyang, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
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15
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Stanton R, Demel SL, Flaherty ML, Antzoulatos E, Gilkerson LA, Osborne J, Behymer TP, Moomaw CJ, Sekar P, Langefeld C, Woo D. Risk of intracerebral haemorrhage from hypertension is greatest at an early age. Eur Stroke J 2021; 6:28-35. [PMID: 33817332 DOI: 10.1177/2396987321994296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/17/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction The risk of intracerebral haemorrhage (ICH) associated with hypertension (HTN) is well documented. While the prevalence of HTN increases with age, the greatest odds ratio (OR) for HTN as a risk for ischemic stroke is at an early age. We sought to evaluate if the risk for ICH from HTN was higher in the youngest patients of each race. Patients and methods The Ethnic/Racial Variations of ICH (ERICH) study is a prospective multicenter case-control study of ICH among whites, blacks, and Hispanics. Participants were divided into age groups based on race-specific quartiles. Cases in each race/age group were compared to controls using logistic regression (i.e., cases and controls unmatched). The probability of ICH among cases and controls for each race were compared against independent variables of HTN, quartile of age and interaction of quartile and age also using logistic regression. Results Overall, 2033 non-lobar ICH cases and 2060 controls, and 913 lobar ICH cases with 927 controls were included. ORs were highest in the youngest age quartile for non-lobar haemorrhage for blacks and Hispanics and highest in the youngest quartile for lobar haemorrhage for all races. The formal test of interaction between age and HTN was significant in all races for all locations with the exception of lobar ICH in whites (p = 0.2935). Discussion Hypertension is a strong independent risk factor for ICH irrespective of location among persons of younger age, consistent with the hypothesis that first exposure to HTN is a particularly sensitive time for all locations of ICH.
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Affiliation(s)
- Robert Stanton
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Stacie L Demel
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Matthew L Flaherty
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Eleni Antzoulatos
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Lee A Gilkerson
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Jennifer Osborne
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Tyler P Behymer
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Charles J Moomaw
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Padmini Sekar
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
| | - Carl Langefeld
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Daniel Woo
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, OH, USA
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16
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Kleitsch J, Nistal DA, Romano Spica N, Alkayyali M, Song R, Chada D, Reilly K, Lay C, Reynolds AS, Fifi JT, Bederson JB, Mocco J, Liang JW, Kellner CP, Dangayach NS. Interhospital Transfer of Intracerebral Hemorrhage Patients Undergoing Minimally Invasive Surgery: The Experience of a New York City Hospital System. World Neurosurg 2021; 148:e390-e395. [PMID: 33422715 DOI: 10.1016/j.wneu.2020.12.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of interhospital transfer (IHT) on outcomes of patients with intracerebral hemorrhage (ICH) has not been well studied. We seek to describe the protocolized IHT and systems of care approach of a New York City hospital system, where ICH patients undergoing minimally invasive surgery (MIS) are transferred to a dedicated ICH center. METHODS We retrospectively reviewed 100 consecutively admitted patients with spontaneous ICH. We gathered information on demographics, variables related to IHT, clinical and radiographic characteristics, and details about the clinical course and outpatient follow-up. We grouped patients into 2 cohorts: those admitted through IHT and those directly admitted through the emergency department. Primary outcome was good functional outcome at 6 months, defined as modified Rankin Scale score 0-3. RESULTS Of 100 patients, 89 underwent IHT and 11 were directly admitted. On multivariable analysis, there were no significant differences in 6-month functional outcome between the 2 cohorts. All transfers were managed by a system-wide transfer center and 24/7 hotline for neuroemergencies. An ICH-specific IHT protocol was followed, in which a neurointensivist provided recommendations for stabilizing patients for transfer. Average transfer time was 199.7 minutes and average distance travelled was 13.6 kilometers. CONCLUSIONS In our hospital system, a centralized approach to ICH management and a dedicated ICH center increased access to specialist services, including MIS. Most patients undergoing MIS were transferred from outside hospitals, which highlights the need for additional studies and descriptions of experiences to further elucidate the impact of and best protocols for the IHT of ICH patients.
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Affiliation(s)
- Julianne Kleitsch
- State University of New York Downstate College of Medicine, Brooklyn, New York, USA; Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Dominic A Nistal
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | | | - Miryam Alkayyali
- Icahn School of Medicine at Mount Sinai (Beth Israel/Mount Sinai West), Department of Neurology, New York, New York, USA
| | - Rui Song
- State University of New York Downstate College of Medicine, Brooklyn, New York, USA
| | - Deeksha Chada
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Kaitlin Reilly
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Cappi Lay
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Alexandra S Reynolds
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Johanna T Fifi
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Joshua B Bederson
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - J Mocco
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - John W Liang
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Christopher P Kellner
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA
| | - Neha S Dangayach
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
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17
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Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, Quindós B, Forcelledo L, Vizcaino D, Martín L, Salgado E, Viña L. Clinico-radiological related to early brain death factors. Med Intensiva 2020; 46:S0210-5691(20)30249-7. [PMID: 32873408 DOI: 10.1016/j.medin.2020.06.019] [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: 10/31/2019] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 hours. DESIGN A retrospective cohort study was made covering the period 2015-2017. SETTING An adult Intensive Care Unit (ICU). PATIENTS/METHODS Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD >24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD >24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD >24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España.
| | - I Astola
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - S Balboa
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - B Leoz
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - Á Meilan
- Sección de Neurorradiología, Servicio de Radiología. Hospital Universitario Central de Asturias, Oviedo, España
| | - C Del Busto
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - B Quindós
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Forcelledo
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - D Vizcaino
- Sección de Neurorradiología, Servicio de Radiología. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Martín
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - E Salgado
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Viña
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
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18
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Chen LH, Li FJ, Zhang HT, Chen WJ, Sun K, Xu RX. The microsurgical treatment for primary hypertensive brainstem hemorrhage: Experience with 52 patients. Asian J Surg 2020; 44:123-130. [PMID: 32600922 DOI: 10.1016/j.asjsur.2020.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/31/2019] [Accepted: 04/05/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to investigate the effect of minimal invasive microsurgery in treating primary hypertensive brainstem hemorrhage (PHBH). METHODS 52 patients of PHBH (≥3.5 ml) who have taken the minimal invasive microsurgery with neuronavigation guidance were included between Jan. 2011 and Dec. 2018. The volume/location/type of hematoma, preoperative Glasgow Coma Scale (GCS), postoperative Glasgow Outcome Scale (GOS) and hemorrhagic dilatation of the fourth ventricle were analyzed during the follow-up period ranged from 3 to 57 months. RESULTS Among all the patients, 18 achieved complete hematoma evacuation (≥95%), 31 achieved subtotal evacuation (≥90%), 3 achieved premodinantly evacuation (>75%). No rebleeding during or after surgery within 24 h were found. 45 patients survived after 3 months, the mean preoperative hematoma volume decreased from 7.1 ± 2.6 ml-0.9 ml (p < 0.05), 19 patients got GOS Grade V/Ⅳ. It is shown the volume less than 10 ml always led to better outcome while massive and bilateral hematoma were related with poor prognosis. CONCLUSION The microsurgical hematoma evacuation under neuronavigation assistance is a rapid, effective, and safe technique for the removal of PHBH, especially for the volume less than 10 ml.
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Affiliation(s)
- Li-Hua Chen
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Fang-Jia Li
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Hong-Tian Zhang
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Wen-Jin Chen
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Kai Sun
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Ru-Xiang Xu
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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19
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Kimura Y, Miwa K, Takasugi J, Oyama N, Todo K, Sakaguchi M, Mochizuki H, Sasaki T. Total small vessel disease score and functional outcomes following acute intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:105001. [PMID: 32689644 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Individual cerebral small vessel disease (SVD) markers are independent predictors for poor prognosis following intracerebral hemorrhage (ICH), however, the impact of the cumulative SVD burden on outcomes remains unclear. We aimed to investigate the association between the global SVD burden and functional outcomes following ICH. METHODS We retrospectively evaluated a consecutive cohort of patients with ICH who underwent brain magnetic resonance imaging and magnetic resonance angiography, from a prospective registry. We identified the presence and severity of the SVD markers (cerebral microbleeds, lacunar infarctions, periventricular hyperintensities, and deep white matter hyperintensities) and summed them to obtain the modified total SVD score (0-4). Poor functional outcomes were defined as a modified Rankin Scale score at discharge ≥ 3. A multivariate logistic regression model was used to assess the association between patient outcomes and the SVD score. RESULTS A total of 144 patients were included (65.0 ± 12.2 years, 67.4% male). The modified total SVD score was potentially associated with poor functional outcomes (odds ratio [OR] 1.72, 95% confidence interval [CI] 0.97-3.03) after adjustment for age, sex, history of stroke, chronic kidney disease, prior use of antithrombotic agents, the National Institutes of Health Stroke Scale score on admission, the non-lobar location of ICH, and hematoma volume on admission. Moreover, among older patients (≥ 65 years), the SVD score was associated with poor outcomes (OR 3.11, 95% CI 1.01-9.55). Among those with supratentorial ICH, the score remained significant (OR 2.06, 95% CI 1.11-3.83). CONCLUSIONS The modified total SVD score may have predictive value for poor functional outcomes following ICH.
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Affiliation(s)
- Yoko Kimura
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, Japan.
| | - Junji Takasugi
- Department of Stroke Medicine, Japan Community Health care Organization Hoshigaoka Medical Center, Osaka, Japan.
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
| | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Manabu Sakaguchi
- Department of Neurology, Osaka General Medical Center, Osaka, Japan.
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tsutomu Sasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
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20
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Singh SD, Brouwers HB, Senff JR, Pasi M, Goldstein J, Viswanathan A, Klijn CJM, Rinkel GJE. Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review. J Neurol Neurosurg Psychiatry 2020; 91:82-87. [PMID: 31848229 DOI: 10.1136/jnnp-2019-321461] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/27/2019] [Accepted: 11/11/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Guidelines regarding recommendations for surgical treatment of spontaneous cerebellar intracerebral haemorrhage (ICH) differ. We aimed to systematically review the literature to assess treatment strategies and outcomes. METHODS We searched PubMed and Embase between 1970 and 2019 for randomised or otherwise controlled studies and observational cohort studies. We included studies according to predefined selection criteria and assessed their quality according to the Newcastle-Ottawa Scale (NOS) and risk of bias according to a predefined scale. We assessed case fatality and functional outcome in patients treated conservatively or with haematoma evacuation. Favourable functional outcome was defined as a modified Rankin Scale score of 0-2 or a Glasgow Outcome Scale score of 4-5. RESULTS We included 41 observational cohort studies describing 2062 patients (40% female) with spontaneous cerebellar ICH. A total of 1171 patients (57%) underwent haematoma evacuation. Ten studies described a cohort of surgically treated patients (n=533) and 31 cohorts with both surgically and conservatively treated patients (n=638 and n=891, respectively). There were no randomised clinical trials nor studies comparing outcome between the groups after adjustment for differences in baseline characteristics. The median NOS score (IQR) was 5 (4-6) out of 8 points and the bias score was 2 (1-3) out of 8, indicative of high risk of bias. Case fatality at discharge was 21% (95% CI 17% to 25%) after conservative treatment and 24% (95% CI 19% to 29%) after haematoma evacuation. At ≥6 months after conservative treatment, case fatality was 30% (95% CI 25% to 30%) and favourable functional outcome was 45% (95% CI 40% to 50%) and after haematoma evacuation, case fatality was 34% (95% CI 30% to 38%) and 42% (95% CI 37% to 47%). CONCLUSIONS Controlled studies on the effect of neurosurgical treatment in patients with spontaneous cerebellar ICH are lacking, and the risk of bias in published series is high. Due to substantial differences in patient characteristics between conservatively and surgically treated patients, and high variability in treatment indications, a meaningful comparison in outcomes could not be made. There is no good published evidence to support treatment recommendations and controlled, preferably randomised studies are warranted in order to formulate evidence-based treatment guidelines for patients with cerebellar ICH.
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Affiliation(s)
- Sanjula Dhillon Singh
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, Netherlands.,Department of Neurology and Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Hens Bart Brouwers
- Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, Netherlands
| | - Jasper Rudolf Senff
- Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, Netherlands
| | - Marco Pasi
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology and Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Goldstein
- Department of Neurology and Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology and Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Catharina J M Klijn
- Department of Neurology, Radboud University Nijmegen, Nijmegen, Netherlands.,Center for Neuroscience, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, Netherlands
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Fallenius M, Skrifvars MB, Reinikainen M, Bendel S, Curtze S, Sibolt G, Martinez-Majander N, Raj R. Spontaneous Intracerebral Hemorrhage. Stroke 2019; 50:2336-2343. [PMID: 31311464 DOI: 10.1161/strokeaha.118.024560] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background and Purpose- We compared clinical and radiological predictors of long-term mortality in patients with spontaneous intracerebral hemorrhage (ICH) needing intensive care. Methods- A retrospective multicenter study of adult ICH patients treated in Finnish tertiary hospital's intensive care units during 2003 to 2013. We created 3 multivariable models (clinical, radiological, and combined clinical-radiological) for 12-month mortality prediction and compared their areas under receiver operating characteristic curves (AUCs). We analyzed supratentorial and infratentorial ICHs separately. Results- Of 972 patients (796 supratentorial ICH, 176 infratentorial ICH) included, 43% died within 12 months (42% supratentorial ICH, 49% infratentorial ICH). For all patients, the clinical model (AUC, 0.83; 95% CI, 0.81-0.86) outperformed the radiological model (AUC, 0.73; 95% CI, 0.70-0.77; P<0.001), yet the combined model (AUC, 0.85; 95% CI, 0.83-0.88) outperformed both condensed models (P<0.001). For supratentorial ICH, the combined model outperformed both the clinical and radiological models (AUC, 0.84; 95% CI, 0.81-0.87 versus AUC, 0.82; 95% CI, 0.79-0.85 and AUC, 0.73; 95% CI, 0.69-0.77; P<0.001 for all). For infratentorial ICH patients, the combined model significantly outperformed the radiological model but not the clinical model (AUC, 0.92; 95% CI, 0.88-0.96 versus AUC, 0.76; 95% CI, 0.69-0.83 versus AUC, 0.91; 95% CI, 0.87-0.95; P<0.001 and P=0.433, respectively). Conclusions- Clinical factors were more important than objective radiological factors for 12-month mortality prediction in intensive care unit-treated ICH patients. The effect of clinical and radiological factors on outcome was different for supratentorial and infratentorial ICHs stressing that these should not be treated as one entity.
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Affiliation(s)
- Marika Fallenius
- From the Department of Anesthesiology and Intensive Care (M.F., M.B.S.), Helsinki University Hospital, University of Helsinki, Finland
| | - Markus B Skrifvars
- From the Department of Anesthesiology and Intensive Care (M.F., M.B.S.), Helsinki University Hospital, University of Helsinki, Finland.,Department of Emergency Care and Services (M.B.S.), Helsinki University Hospital, University of Helsinki, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland (M.R., S.B.)
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland (M.R., S.B.)
| | - Sami Curtze
- Department of Neurology (S.C., G.S., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology (S.C., G.S., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland
| | - Nicolas Martinez-Majander
- Department of Neurology (S.C., G.S., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery (R.R.), Helsinki University Hospital, University of Helsinki, Finland
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Chen R, Wang X, Anderson CS, Robinson T, Lavados PM, Lindley RI, Chalmers J, Delcourt C. Infratentorial Intracerebral Hemorrhage. Stroke 2019; 50:1257-1259. [DOI: 10.1161/strokeaha.118.023766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ruiqi Chen
- From the Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu (R.C.)
| | - Xia Wang
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.W., C.S.A., R.I.L., J.C., C.D.)
| | - Craig S. Anderson
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.W., C.S.A., R.I.L., J.C., C.D.)
- George Institute China at Peking University Medical Science Center, Beijing (C.S.A.)
| | - Thompson Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.R.)
| | - Pablo M. Lavados
- Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago (P.M.L.)
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile (P.M.L.)
| | - Richard I. Lindley
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.W., C.S.A., R.I.L., J.C., C.D.)
| | - John Chalmers
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.W., C.S.A., R.I.L., J.C., C.D.)
| | - Candice Delcourt
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.W., C.S.A., R.I.L., J.C., C.D.)
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Ironside N, Chen CJ, Dreyer V, Christophe B, Buell TJ, Connolly ES. Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage. Int J Stroke 2019; 15:90-102. [PMID: 30747614 DOI: 10.1177/1747493019830589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction. METHODS Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0-2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. RESULTS The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence (p = 0.008) and mortality (p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3-9 = 2 points; 10-13 = 1 point), volume-location (lobar:≥24 mL=2 points, 21-24 mL=1 point; deep:≥8 mL=2 points, 7-8 mL=1 point; brainstem:≥6 mL=2 points, 3-6 mL=1 point; cerebellum:≥24 mL=2 points, 12-24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score. CONCLUSIONS The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume-location relationship plays an important role in ICH outcome prediction.
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Affiliation(s)
- Natasha Ironside
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Victoria Dreyer
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Brandon Christophe
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Zhou H, Chen L, He H. Intraoperative and postoperative effects of TEG-guided platelet transfusion on antiplatelet drug-related intracerebral hemorrhage patients. Exp Ther Med 2019; 17:2263-2267. [PMID: 30783485 PMCID: PMC6364191 DOI: 10.3892/etm.2019.7169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022] Open
Abstract
Intraoperative and postoperative effects of platelet transfusion on antiplatelet drug-related intracerebral hemorrhage (ICH) patients were investigated. A retrospective study on 82 ICH patients undergoing emergency surgical treatment caused by antiplatelet drugs was conducted. Among them, 51 patients treated with platelet transfusion served as the observation group and 31 patients without platelet transfusion as the control group. The intraoperative and postoperative bleeding volume, blood transfusion volume and the rate of secondary bleeding were compared between observation and control group under the guidance of thromboelastography (TEG). The coagulation routine examination results of the two groups before surgery were in the normal range, but TEG indicated an excessive inhibition of platelet function (platelet inhibition rate >89%). The platelet number after treatment increased significantly in the two groups of patients and it was significantly higher in observation group than that in control group (P<0.05). The intraoperative bleeding volume in observation group was significantly lower than that in control group. The total blood transfusion volume in observation group was significantly lower than that in control group (Z=2.681, P=0.036), the postoperative hematoma residual volume in observation group was significantly lower than that in control group (t=2.145, P=0.035), and the drainage volume in observation group was significantly lower than that in control group (t=2.401, P=0.019). Only 3.92% of the patients in observation group and 19.35% in control group had secondary surgery, and the difference of the recurrence rate of secondary bleeding between the two groups was statistically significant (χ2=3.610, P=0.048). TEG detection indicator can more comprehensively and accurately evaluate the preoperative coagulation function of patients. This study suggests that preoperative platelet transfusion can improve the intraoperative and postoperative bleeding of ICH patients after antiplatelet therapy to some extent, reducing the blood transfusion volume and the secondary bleeding rate.
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Affiliation(s)
- Hao Zhou
- Department of Blood Transfusion, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Li Chen
- Department of Blood Transfusion, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Hongtian He
- Department of Blood Transfusion, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
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Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci 2019; 398:54-66. [PMID: 30682522 DOI: 10.1016/j.jns.2019.01.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/22/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost. The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event. Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients. Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.
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Affiliation(s)
- João Pinho
- Neurology Department, Hospital de Braga, Portugal.
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
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26
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Yang JH, Lee HD, Kwak SY, Byun KH, Park SH, Yang D. Mechanism of cognitive impairment in chronic patients with putaminal hemorrhage: A diffusion tensor tractography. Medicine (Baltimore) 2018; 97:e11035. [PMID: 30024496 PMCID: PMC6086472 DOI: 10.1097/md.0000000000011035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
It is not clear whether the fornix and cingulum are involved in cognition after putaminal hemorrhage (PH). We investigated structural changes and differences of the neural tracts, and the relationship between the integrity of the neural tracts and cognition not only at the affected but also at the unaffected side.Sixteen patients with left chronic putaminal hemorrhage and 20 healthy volunteers were enrolled. Using diffusion tensor tractography (DTT), we compared fiber number (FN), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the neural tracts between patient and control groups. The relationship between the neural tract parameters and neuropsychological results was also analyzed.The left fornix FN was significantly lower than the right fornix FN in the patient group. Except for the cingulum FA, the neural tracts parameters for both the affected and unaffected hemispheres differed significantly between the groups. The fornix FA and ADC at the affected side were significantly correlated with intelligence quotient (IQ), mini-mental status examination (MMSE), and short-term memory. Interestingly, the fornix ADC at the unaffected side was significantly correlated with MMSE. However, none of the cingulum parameters was correlated with neuropsychological results.The fornix integrity is critical for cognitive impairment after putaminal hemorrhage.
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Affiliation(s)
- Jeong-Hee Yang
- Division of Brain Fusion Research, Biomedical Research Center, Ulsan University Hospital
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu
| | - So Young Kwak
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu
| | - Ki Hyun Byun
- Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine
| | - Sung Ho Park
- Department of Neurosurgery, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine
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27
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Béjot Y, Blanc C, Delpont B, Thouant P, Chazalon C, Daumas A, Osseby GV, Hervieu-Bègue M, Ricolfi F, Giroud M, Cordonnier C. Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors. Neurology 2018; 90:e2017-e2024. [DOI: 10.1212/wnl.0000000000005633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/09/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH).MethodsAll patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985–1993, 1994–2002, and 2003–2011). Multivariable ordinal and logistic regression models were applied.ResultsFive hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87–3.23, p = 0.124 for 1994–2002; and OR 1.97, 95% CI, 1.08–3.60, p = 0.027 for 2003–2011 vs 1985–1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16–3.82, p = 0.014 for 1994–2002; and OR 2.73; 95% CI 1.54–4.84, p = 0.001 for 2003–2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24–0.99, p = 0.048 for 1994–2002; and OR 0.32, 95% CI 0.16–0.64, p = 0.001 for 2003–2011).ConclusionThe decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.
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Abstract
OBJECTIVE To assess the risks and benefits of surgical treatment (Open Craniotomy) of Intra-cerebral hematoma (ICH). METHODS Twenty seven patients of ICH who underwent surgical treatment at Neurosurgical department of Sheikh Zayed Hospital, Rahim Yar Khan, from 1st January 2015 to 31st December 2015 were included in this study. The primary outcome measured was death and improvement in GCS Status among survivor's at three months. RESULTS Mean age of the patients was 58.4±10.7 and majority of patients (48.1%) were in the age range of 60-70 years. There were22.2% patients with ICH volume of >50 ml. Six (6) patients had 8 GCS with 50ml volume, who later died in ICU. Three of the patients who expired developed post-operative pneumothorax. These patients also acquired RTI resulting in deterioration of GCS. The rest of the expired patients showed deterioration in their GCS associated with oedma on brain CT scan. One patient died as a result of re-bleed. Twenty one (21) patients were discharged from hospital, two of these patients were lost in second follow up. Rest of the patients showed a gradual improvement in GCS touching 15/15 by 2nd follow up visit. CONCLUSION Surgical prognosis of ICH depends on the patients GCS received and size of hemorrhage at the time of presentation. Urgent surgical evacuation in patients with rapid deterioration carries good outcome, hence should be considered.
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Affiliation(s)
- Waqar Aziz Rehman
- Dr. Waqar Aziz Rehman, FCPS General Surgery, FCPS neurosurgery Resident, Assistant Professor, Department of Neurosurgery, Sheikh Zayed Medical College/Hospital, Rahim Yaar Khan, Pakistan
| | - Muhammad Sohaib Anwar
- Dr. Muhammad Sohaib Anwar, FCPS Neurosurgery, Assistant Professor, Department of Neurosurgery, Sheikh Zayed Medical College/Hospital, Rahim Yaar Khan, Pakistan
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Shimamura N, Kakuta K, Wang L, Naraoka M, Uchida H, Wakao S, Dezawa M, Ohkuma H. Neuro-regeneration therapy using human Muse cells is highly effective in a mouse intracerebral hemorrhage model. Exp Brain Res 2016; 235:565-572. [PMID: 27817105 DOI: 10.1007/s00221-016-4818-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
A novel type of non-tumorigenic pluripotent stem cell, the Muse cell (multi-lineage, differentiating stress enduring cell), resides in the connective tissue and in cultured mesenchymal stem cells (MSCs) and is reported to differentiate into multiple cell types according to the microenvironment to repair tissue damage. We examined the efficiency of Muse cells in a mouse intracerebral hemorrhage (ICH) model. Seventy μl of cardiac blood was stereotactically injected into the left putamen of immunodeficient mice. Five days later, 2 × 105 of human bone marrow MSC-derived Muse cells (n = 6) or cells other than Muse cells in MSCs (non-Muse, n = 6) or the same volume of PBS (n = 11) was injected into the ICH cavity. Water maze and motor function tests were implemented for 68 days, and immunohistochemistry for NeuN, MAP2 and GFAP was done. The Muse group showed impressive recovery: Recovery was seen in the water maze after day 19, and motor functions after 5 days was compared with the other two groups, with a significant statistical difference (p < 0.05). The survival rate of the engrafted cells in the Muse group was significantly higher than in the non-Muse group (p < 0.05) at day 69, and those cells showed positivity for NeuN (~57%) and MAP-2 (~41.6%). Muse cells could remain in the ICH brain, differentiate into neural-lineage cells and restore functions without inducing them into neuronal cells by gene introduction and cytokine treatment prior to transplantation. A simple collection of Muse cells and their supply to the brain in naïve state facilitates regenerative therapy in ICH.
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Affiliation(s)
- Norihito Shimamura
- Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki, Aomori, 036-8562, Japan.
| | - Kiyohide Kakuta
- Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki, Aomori, 036-8562, Japan
| | - Liang Wang
- Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki, Aomori, 036-8562, Japan
| | - Masato Naraoka
- Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki, Aomori, 036-8562, Japan
| | - Hiroki Uchida
- Department of Stem Cell Biology and Histology, Tohoku University School of Medicine, Sendai, Japan
| | - Shohei Wakao
- Department of Stem Cell Biology and Histology, Tohoku University School of Medicine, Sendai, Japan
| | - Mari Dezawa
- Department of Stem Cell Biology and Histology, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki, Aomori, 036-8562, Japan
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30
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Obesity is associated with better survival and functional outcome after acute intracerebral hemorrhage. J Neurol Sci 2016; 370:140-144. [DOI: 10.1016/j.jns.2016.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/28/2016] [Accepted: 09/19/2016] [Indexed: 11/21/2022]
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Sacco S, Ornello R, Degan D, Tiseo C, Pistoia F, Carolei A. Declining incidence of intracerebral hemorrhage over two decades in a population-based study. Eur J Neurol 2016; 23:1627-1634. [DOI: 10.1111/ene.13099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- S. Sacco
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - R. Ornello
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - D. Degan
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - C. Tiseo
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - F. Pistoia
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - A. Carolei
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
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Knockout of ho-1 protects the striatum from ferrous iron-induced injury in a male-specific manner in mice. Sci Rep 2016; 6:26358. [PMID: 27198537 PMCID: PMC4873828 DOI: 10.1038/srep26358] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/29/2016] [Indexed: 02/06/2023] Open
Abstract
Men have worse survival than premenopausal women after intracerebral hemorrhage (ICH). After ICH, overproduction of iron associated with induction of heme oxygenase-1 (HO-1) in brain was observed. Rodent ICH model using ferrous citrate (FC)-infusion into the striatum to simulate iron overload, showed a higher degree of injury severity in males than in females. However, the participation of HO-1 in sex-differences of iron-induced brain injury remains unknown. The present results showed a higher level of HO-1 expression associated with more severe injury in males compared with females after FC-infusion. Estradiol (E2) contributed to lower levels of FC-induced HO-1 expression in females compared with males. Heterozygote ho-1 KO decreased the levels of FC-induced injury severity, histological lesions, behavioral deficits, autophagy and autophagic cell death in the striatum of males but not in females. Moreover, ho-1 deficiency enhanced the neuroprotection by E2 only in males. These results suggested that over induction of HO-1 plays a harmful role in FC-induced brain injury in a male-specific manner. Suppression of HO-1 combined with E2 exhibits a synergistic effect on neuroprotection against FC-induced striatal injury in males. These findings open up the prospect for male-specific neuroprotection targeting HO-1 suppression for patients suffering from striatal iron overload.
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Hsieh JT, Ang BT, Ng YP, Allen JC, King NKK. Comparison of Gender Differences in Intracerebral Hemorrhage in a Multi-Ethnic Asian Population. PLoS One 2016; 11:e0152945. [PMID: 27050549 PMCID: PMC4822850 DOI: 10.1371/journal.pone.0152945] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) accounts for 10-15% of all first time strokes and with incidence twice as high in the Asian compared to Western population. This study aims to investigate gender differences in ICH patient outcomes in a multi-ethnic Asian population. METHOD Data for 1,192 patients admitted for ICH were collected over a four-year period. Multivariate logistic regression was used to identify independent predictors and odds ratios were computed for 30-day mortality and Glasgow Outcome Scale (GOS) comparing males and females. RESULT Males suffered ICH at a younger age than females (62.2 ± 13.2 years vs. 66.3 ± 15.3 years; P<0.001). The occurrence of ICH was higher among males than females at all ages until 80 years old, beyond which the trend was reversed. Females exhibited increased severity on admission as measured by Glasgow Coma Scale compared to males (10.9 ± 4.03 vs. 11.4 ± 4.04; P = 0.030). No difference was found in 30-day mortality between females and males (F: 30.5% [155/508] vs. M: 27.0% [186/688]), with unadjusted and adjusted odds ratio (F/M) of 1.19 (P = 0.188) and 1.21 (P = 0.300). At discharge, there was a non-statistically significant but potentially clinically relevant morbidity difference between the genders as measured by GOS (dichotomized GOS of 4-5: F: 23.7% [119/503] vs. M: 28.7% [194/677]), with unadjusted and adjusted odds ratio (F/M) of 0.77 (P = 0.055) and 0.87 (P = 0.434). CONCLUSION In our multi-ethnic Asian population, males developed ICH at a younger age and were more susceptible to ICH than women at all ages other than the beyond 80-year old age group. In contrast to the Western population, neurological status of female ICH patients at admission was poorer and their 30-day mortality was not reduced. Although the study was not powered to detect significance, female showed a trend toward worse 30-day morbidity at discharge.
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Affiliation(s)
- Justin T. Hsieh
- School of Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
- * E-mail:
| | - Beng Ti Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Yew Poh Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - John C. Allen
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Nicolas K. K. King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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Zheng J, Li H, Zhao HX, Guo R, Lin S, Dong W, Ma L, Fang Y, Tian M, Liu M, You C. Surgery for Patients With Spontaneous Deep Supratentorial Intracerebral Hemorrhage: A Retrospective Case-Control Study Using Propensity Score Matching. Medicine (Baltimore) 2016; 95:e3024. [PMID: 26986116 PMCID: PMC4839897 DOI: 10.1097/md.0000000000003024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Spontaneous intracerebral hemorrhage (sICH) is one of the most dangerous cerebrovascular diseases, especially when in deep brain. The treatment of spontaneous deep supratentorial intracerebral hemorrhage is still controversial. We conducted a retrospective case-control study using propensity score matching to compare the efficacy of surgery and conservative treatment for patients with deep surpatentorial hemorrhage. We observed the outcomes of consecutive patients with spontaneous deep supratentorial hemorrhage retrospectively from December 2008 to July 2013. Clinical outcomes of surgery and conservative treatments were compared in patients with deep sICH using propensity score matching method. The primary outcome was neurological function status at 6 months post ictus. The second outcomes included mortality at 30 days and 6 months, and the incidence of complications. Subgroup analyses of 6-month outcome were conducted. Sixty-three (22.66%) of the 278 patients who received surgery had a favorable neurological function status at 6 months, whereas in the conservative group, 66 of 278 (23.74%) had the same result (P = 0.763). The 30-day mortality in the surgical group was 19.06%, whereas 30.58% in the conservative group (P = 0.002). There was significant difference in the mortality at 6 months after ictus as well (23.38% vs 36.33%, P = 0.001). The subgroup analyses showed significantly better outcomes for the surgical group when hematoma was >40 mL (13.33% vs 0%, P = 0.005) or complicated with intraventricular hemorrhage (16.67% vs 7.27%, P = 0.034). For complications, the risk of pulmonary infection, gastrointestinal hemorrhage, urinary infection, pulmonary embolus, and need for tracheostomy/long term ventilation in the surgical group was higher than the conservative group (31.29% vs 15.47%, P < 0.001; 6.83% vs 3.96%, P = 0.133; 2.88% vs 1.80%, P = 0.400; 1.80% vs 1.08%, P = 0.476; 32.73% vs 23.38%, P = 0.014). Surgery could reduce the short-term mortality as well as long-term mortality in patients with spontaneous deep supratentorial hemorrhage. Moreover, surgery might improve the functional outcome in patients with large hematoma or with IVH compared with conservative treatment. Surgery might be a beneficial choice for part of the patients with spontaneous deep supratentorial hemorrhage, but further detailed research is still needed.
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Affiliation(s)
- Jun Zheng
- From the Department of Neurosurgery (JZ, HL, H-XZ, RG, SL, WD, LM, YF, MT, CY); and Department of Neurology (ML), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Xiong L, Reijmer YD, Charidimou A, Cordonnier C, Viswanathan A. Intracerebral hemorrhage and cognitive impairment. Biochim Biophys Acta Mol Basis Dis 2015; 1862:939-44. [PMID: 26692171 DOI: 10.1016/j.bbadis.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/05/2015] [Accepted: 12/10/2015] [Indexed: 02/01/2023]
Abstract
Vascular cognitive impairment and vascular dementia are composed of cognitive deficits resulted from a range of vascular lesions and pathologies, including both ischemic and hemorrhagic. However the contribution of spontaneous intracerebral hemorrhage presumed due to small vessel diseases on cognitive impairment is underestimated, in contrast to the numerous studies about the role of ischemic vascular disorders on cognition. In this review we summarize recent findings from clinical studies and appropriate basic science research to better elucidate the role and possible mechanisms of intracerebral hemorrhage in cognitive impairment and dementia. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- Li Xiong
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Neurology Department, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.
| | - Yael D Reijmer
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Andreas Charidimou
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Charlotte Cordonnier
- Department of Neurology and Stroke Unit, Hôpital Roger Salengro, Lille University Hospital, Lille Cedex 59037, France.
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Barker-Collo S, Bennett DA, Krishnamurthi RV, Parmar P, Feigin VL, Naghavi M, Forouzanfar MH, Johnson CO, Nguyen G, Mensah GA, Vos T, Murray CJL, Roth GA. Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013. Neuroepidemiology 2015; 45:203-14. [PMID: 26505984 PMCID: PMC4632242 DOI: 10.1159/000441103] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/15/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Accurate information on stroke burden in men and women are important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality rates were greater in men. However, sex differences in various metrics of stroke burden on a global scale have not been a subject of comprehensive and comparable assessment for most regions of the world, nor have sex differences in stroke burden been examined for trends over time. METHODS Stroke incidence, prevalence, mortality, disability-adjusted life years (DALYs) and healthy years lost due to disability were estimated as part of the Global Burden of Disease (GBD) 2013 Study. Data inputs included all available information on stroke incidence, prevalence and death and case fatality rates. Analysis was performed separately by sex and 5-year age categories for 188 countries. Statistical models were employed to produce globally comprehensive results over time. All rates were age-standardized to a global population and 95% uncertainty intervals (UIs) were computed. FINDINGS In 2013, global ischemic stroke (IS) and hemorrhagic stroke (HS) incidence (per 100,000) in men (IS 132.77 (95% UI 125.34-142.77); HS 64.89 (95% UI 59.82-68.85)) exceeded those of women (IS 98.85 (95% UI 92.11-106.62); HS 45.48 (95% UI 42.43-48.53)). IS incidence rates were lower in 2013 compared with 1990 rates for both sexes (1990 male IS incidence 147.40 (95% UI 137.87-157.66); 1990 female IS incidence 113.31 (95% UI 103.52-123.40)), but the only significant change in IS incidence was among women. Changes in global HS incidence were not statistically significant for males (1990 = 65.31 (95% UI 61.63-69.0), 2013 = 64.89 (95% UI 59.82-68.85)), but was significant for females (1990 = 64.892 (95% UI 59.82-68.85), 2013 = 45.48 (95% UI 42.427-48.53)). The number of DALYs related to IS rose from 1990 (male = 16.62 (95% UI 13.27-19.62), female = 17.53 (95% UI 14.08-20.33)) to 2013 (male = 25.22 (95% UI 20.57-29.13), female = 22.21 (95% UI 17.71-25.50)). The number of DALYs associated with HS also rose steadily and was higher than DALYs for IS at each time point (male 1990 = 29.91 (95% UI 25.66-34.54), male 2013 = 37.27 (95% UI 32.29-45.12); female 1990 = 26.05 (95% UI 21.70-30.90), female 2013 = 28.18 (95% UI 23.68-33.80)). INTERPRETATION Globally, men continue to have a higher incidence of IS than women while significant sex differences in the incidence of HS were not observed. The total health loss due to stroke as measured by DALYs was similar for men and women for both stroke subtypes in 2013, with HS higher than IS. Both IS and HS DALYs show an increasing trend for both men and women since 1990, which is statistically significant only for IS among men. Ongoing monitoring of sex differences in the burden of stroke will be needed to determine if disease rates among men and women continue to diverge. Sex disparities related to stroke will have important clinical and policy implications that can guide funding and resource allocation for national, regional and global health programs.
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Lee AY, Choi BY, Kim SH, Chang CH, Jung YJ, Jang SH. Difference of injury of the corticospinal tract according to surgical or conservative treatment in patients with putaminal hemorrhage. Int J Neurosci 2015; 126:429-35. [PMID: 26000805 DOI: 10.3109/00207454.2015.1026966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigated difference of injury of the corticospinal tract (CST) according to surgical or conservative treatment in patients with putaminal hemorrhage (PH), using diffusion tensor tractography (DTT). METHODS Forty-six patients with PH (hematoma volume on the brain CT: 20-40 ml) were recruited. Patients were classified as the surgical treatment group and the conservative treatment group. The hematoma volume on the initial brain CT (median 2 hours after onset; range 1-14 hours) and volumes of the hematoma, the total lesion and the peri-hematomal edema volume on the follow-up brain magnetic resonance imaging (MRI) (median 23.5 days after onset; range 12-46 days) were estimated. Diffusion tensor imaging was performed and we defined the injury of the CST in terms of the configuration or abnormal DTT parameters. RESULTS In the conservative treatment group, the total lesion volume on the brain MRI was increased compared with the hematoma volume on the initial brain CT (p < 0.05). On brain MRI, the hematoma volume, peri-hematomal edema volume, and total lesion volume were larger in the conservative treatment group than in the surgical treatment group (p < 0.05). Twelve patients (60%) in the surgical treatment group and 24 patients (92%) in the conservative treatment group had injury of the CST. CONCLUSION Injury of the CST was less prevalent in the surgical treatment group than in the conservative treatment group in patients with PH. Therefore, it appears that surgical treatment could be helpful in prevention of injury of the CST in patients with PH.
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Affiliation(s)
- Ah Young Lee
- a Department of Physical Medicine and Rehabilitation, College of Medicine , Yeungnam University , Daegu , Republic of Korea
| | - Byung Yun Choi
- b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea
| | - Seong Ho Kim
- b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea
| | - Chul Hoon Chang
- b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea
| | - Young Jin Jung
- b Department of Neurosurgery, College of Medicine , Yeungnam University , Daegu , Republic of Korea
| | - Sung Ho Jang
- a Department of Physical Medicine and Rehabilitation, College of Medicine , Yeungnam University , Daegu , Republic of Korea
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Male-Specific Alleviation of Iron-Induced Striatal Injury by Inhibition of Autophagy. PLoS One 2015; 10:e0131224. [PMID: 26147959 PMCID: PMC4492841 DOI: 10.1371/journal.pone.0131224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/30/2015] [Indexed: 02/03/2023] Open
Abstract
Men exhibit a worse survival rate than premenopausal women after intracerebral hemorrhage (ICH), however, no sex-specific management has been concerned. In a rat model involving infusion of ferrous citrate (FC) that simulates iron accumulation after hemorrhage, a higher degree of autophagy associated with higher injury severity was observed in striatum of males than in females. Since the imbalance between the levels of autophagy and energy demand may lead to cell death, we proposed that FC-induced autophagy is detrimental in a male specific manner and autophagy modulation affects injury severity in a sex-dependent manner. Rapamycin, an autophagy inducer, and conditional knockout gene of autophagy-related protein 7 (Atg7) in dopamine receptor D2 (DRD2) neurons were used to test our hypothesis using a mouse model with striatal FC infusion. The result showed that the levels of autophagic cell death and injury severity were higher in male than in female mice. Pre-treatment of FC-infused females with rapamycin increased the FC-induced behavioral deficit and DRD2 neuron death. However, DRD2 neuron-specific knockout of Atg7 decreased FC-induced injury severity and the number of TUNEL(+) DRD2 neurons in males. These results suggest that autophagy in FC-infusion males is overactive with maladaptive consequences and inhibition of autophagy decreases the severity of FC-induced striatal injury in males. These findings present prospects for male-specific therapeutic strategy that targets autophagy in patients suffering from iron overload.
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Abstract
Management of patients with an indication for long-term oral antithrombotic therapy who have an intracerebral hemorrhage (ICH) presents a therapeutic dilemma. Should antithrombotic therapy be resumed, and if so, when, using what agent, and for whom? There is no consensus for answers to these questions. In the absence of randomized trials, management of antithrombotic therapy after ICH is based on a combination of observational data, pathophysiologic concepts, and decision analysis. At the heart of the decision is an assessment of the individual patient's risk of thromboembolism off antithrombotic therapy versus risk of ICH recurrence on antithrombotic therapy.
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Affiliation(s)
- Allyson Zazulia
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St Louis, MO 63110, USA.
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Gokhale S, Caplan LR, James ML. Sex Differences in Incidence, Pathophysiology, and Outcome of Primary Intracerebral Hemorrhage. Stroke 2015; 46:886-92. [DOI: 10.1161/strokeaha.114.007682] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sankalp Gokhale
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Louis R. Caplan
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Michael L. James
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
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Samarasekera N, Fonville A, Lerpiniere C, Farrall AJ, Wardlaw JM, White PM, Smith C, Al-Shahi Salman R. Influence of intracerebral hemorrhage location on incidence, characteristics, and outcome: population-based study. Stroke 2015; 46:361-8. [PMID: 25586833 DOI: 10.1161/strokeaha.114.007953] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The characteristics of intracerebral hemorrhage (ICH) may vary by ICH location because of differences in the distribution of underlying cerebral small vessel diseases. Therefore, we investigated the incidence, characteristics, and outcome of lobar and nonlobar ICH. METHODS In a population-based, prospective inception cohort study of ICH, we used multiple overlapping sources of case ascertainment and follow-up to identify and validate ICH diagnoses in 2010 to 2011 in an adult population of 695 335. RESULTS There were 128 participants with first-ever primary ICH. The overall incidence of lobar ICH was similar to nonlobar ICH (9.8 [95% confidence interval, 7.7-12.4] versus 8.6 [95% confidence interval, 6.7-11.1] per 100 000 adults/y). At baseline, adults with lobar ICH were more likely to have preceding dementia (21% versus 5%; P=0.01), lower Glasgow Coma Scale scores (median, 13 versus 14; P=0.03), larger ICHs (median, 38 versus 11 mL; P<0.001), subarachnoid extension (57% versus 5%; P<0.001), and subdural extension (15% versus 3%; P=0.02) than those with nonlobar ICH. One-year case fatality was lower after lobar ICH than after nonlobar ICH (adjusted odds ratio for death at 1 year: lobar versus nonlobar ICH 0.21; 95% confidence interval, 0.07-0.63; P=0.006, after adjustment for known predictors of outcome). There were 4 recurrent ICHs, which occurred exclusively in survivors of lobar ICH (annual risk of recurrent ICH after lobar ICH, 11.8%; 95% confidence interval, 4.6%-28.5% versus 0% after nonlobar ICH; log-rank P=0.04). CONCLUSIONS The baseline characteristics and outcome of lobar ICH differ from other locations.
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Affiliation(s)
- Neshika Samarasekera
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Arthur Fonville
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Christine Lerpiniere
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Andrew J Farrall
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Joanna M Wardlaw
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Philip M White
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Colin Smith
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.)
| | - Rustam Al-Shahi Salman
- From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (N.S., A.F., C.L., A.J.F., J.M.W., C.S., R.A.-S.S.), Brain Research Imaging Centre (A.J.F., J.M.W.), and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, Edinburgh, United Kingdom; and Newcastle University Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom (P.M.W.).
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LoPresti MA, Bruce SS, Camacho E, Kunchala S, Dubois BG, Bruce E, Appelboom G, Connolly ES. Hematoma volume as the major determinant of outcomes after intracerebral hemorrhage. J Neurol Sci 2014; 345:3-7. [DOI: 10.1016/j.jns.2014.06.057] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/21/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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Yoo JS, Choi BY, Chang CH, Jung YJ, Kim SH, Jang SH. Characteristics of injury of the corticospinal tract and corticoreticular pathway in hemiparetic patients with putaminal hemorrhage. BMC Neurol 2014; 14:121. [PMID: 24903632 PMCID: PMC4096439 DOI: 10.1186/1471-2377-14-121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/06/2014] [Indexed: 01/25/2023] Open
Abstract
Background No study on the characteristics of injury of the corticospinal tract (CST) or corticoreticular pathway (CRP) in patients with putaminal hemorrhage has been reported. In this study, using diffusion tensor tractography, we attempted to investigate the characteristics of injury of the CST and CRP in hemiparetic patients with putaminal hemorrhage. Method Fifty seven consecutive patients with putaminal hemorrhage and 57 healthy control subjects were recruited for this study. Diffusion tensor imaging was performed during the early period (8 ~ 30 days) after onset. We defined injury of the CST or CRP in terms of the configuration (discontinuation of a neural tract) or abnormal DTT parameters (the fractional anisotrophy value or fiber number was more than two standard deviations lower than that of normal control subjects). The Motricity Index, the modified Brunnstrom Classification, and the Functional Ambulation Categories were used for evaluation of motor function. Results Among 57 patients, injury of the CST was found in 41 patients (71.9%) and injury of the CRP was found in 50 patients (87.8%), respectively, and 37 patients (64.9%) had injury of both the CST and CRP. All three motor functions of patients with injury of both the CST and CRP were significantly lower than those of patients with injury of either the CST or CRP (p < 0.05). Conclusion Our results indicate that the putaminal hemorrhage frequently accompanies injury of both the CST and CRP, and the CRP appears to be more vulnerable to putaminal hemorrhage than the CST. These findings suggest the necessity for evaluation of both the CRP and the CST in patients with putaminal hemorrhage.
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Affiliation(s)
| | | | | | | | | | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu 705-717, Republic of Korea.
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Kwon HG, Choi BY, Kim SH, Chang CH, Jung YJ, Lee HD, Jang SH. Injury of the cingulum in patients with putaminal hemorrhage: a diffusion tensor tractography study. Front Hum Neurosci 2014; 8:366. [PMID: 24910606 PMCID: PMC4039026 DOI: 10.3389/fnhum.2014.00366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/13/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives: Little is known about the pathophysiological mechanisms of cognitive impairment in patients with putaminal hemorrhage (PH). Using diffusion tensor tractography, we investigated injury of the cingulum in patients with PH. Methods: We recruited 63 patients with PH, who were classified according to three groups, based on integrity of the cingulum to the lower portion of the genu of the corpus callosum: group A; preserved integrity, group B; discontinuation of integrity in the affected hemisphere, and group C; discontinuation of integrity in both hemispheres. Results: Thirty four patients (54.0%) belonged to group A, 16 patients (25.4%) to group B, and the remaining 13 patients (20.6%) to group C. Regarding the Mini-Mental State Examination, significant differences were observed between group A and group C, and between group B and group C without significant difference between group A and group B (p < 0.05). In terms of the volume of hematoma, significant differences were observed among the three groups (p < 0.05). Regarding the most anterior point of the hematoma, significant differences were observed between group A and groups B and C (p < 0.05); in contrast, regarding the most point of hematoma, significant differences were observed between group C and groups A and B, respectively (p < 0.05). Conclusion: We found that the anterior cingulum is vulnerable to PH. Therefore, our results suggest the necessity for evaluation of the cingulum in patients with PH particularly if the hematoma is large or close to the anterior margin or midline of the brain.
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Affiliation(s)
- Hyeok Gyu Kwon
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Daegu, South Korea
| | - Byung Yeon Choi
- Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Daegu, South Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Daegu, South Korea
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Zis P, Leivadeas P, Michas D, Kravaritis D, Angelidakis P, Tavernarakis A. Predicting 30-day case fatality of primary inoperable intracerebral hemorrhage based on findings at the emergency department. J Stroke Cerebrovasc Dis 2014; 23:1928-33. [PMID: 24784015 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Early survival of patients with intracerebral hemorrhage (ICH) depends on several factors, including the location and size of the hematoma and the level of consciousness on admission. The aim of our study was to estimate the case fatality of primary inoperable ICH 30 days after the event in our hospital and to identify clinical and laboratory characteristics, recordable at the Emergency Department (ED), which could predict death at 30 days. METHODS Clinical and laboratory data on all patients with primary ICH admitted to our hospital were retrospectively collected. RESULTS Between January 2011 and June 2013 191 patients with primary ICH were admitted to our hospital. The 30-day case fatality rate was estimated to be 31.9%, as 61 patients died within 30 days after the ICH. Five variables were independently associated with 30-day case fatality: each decreased point at the Glasgow Coma Scale (GCS) is associated with a 1.3-fold increase in the odds of death at 30 days; infratentorial location and intraventricular extension are associated with a 5.5-fold and a 4.7-fold increase in the odds of death at 30 days, respectively; each centimeter of the maximum diameter of the hematoma and each point increase of the international normalized ratio (INR) are associated with a 1.9-fold and a 3.5-fold increase in the odds of death at 30 days, respectively. CONCLUSIONS GCS score on admission, infratentorial location of the hematoma, intraventricular extension of the hematoma, INR on admission, and maximum diameter of the hematoma are the 5 variables that are independently associated with 30-day case fatality of primary inoperable ICH. EDICH is introduced as a new grading scale, which includes laboratory and clinical findings at the ED and has predicting value of the 30-day case fatality.
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Affiliation(s)
- Panagiotis Zis
- Department of Neurology, Evangelismos General Hospital, Athens, Greece.
| | - Pavlos Leivadeas
- Department of Neurology, Evangelismos General Hospital, Athens, Greece
| | - Dimitrios Michas
- Department of Neurology, Evangelismos General Hospital, Athens, Greece
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Plasma brain natriuretic peptide is elevated in the acute phase of intracerebral hemorrhage. J Clin Neurosci 2014; 21:221-4. [DOI: 10.1016/j.jocn.2013.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/22/2012] [Accepted: 02/23/2013] [Indexed: 11/18/2022]
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Yasaka M, Lip GY. Impact of Non-Vitamin K Antagonist Oral Anticoagulants on Intracranial Bleeding in Asian Patients With Non-Valvular Atrial Fibrillation. Circ J 2014; 78:2367-72. [DOI: 10.1253/circj.cj-14-0720] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization, Kyushu Medical Center
| | - Gregory Y.H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital
- Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University
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Gotoh S, Hata J, Ninomiya T, Hirakawa Y, Nagata M, Mukai N, Fukuhara M, Ikeda F, Shikata K, Kamouchi M, Kitazono T, Kiyohara Y. Trends in the incidence and survival of intracerebral hemorrhage by its location in a Japanese community. Circ J 2013; 78:403-9. [PMID: 24270733 DOI: 10.1253/circj.cj-13-0811] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND No previous population-based studies have examined secular trends in the incidence of intracerebral hemorrhage (ICH) by its location. METHODS AND RESULTS We established 3 cohorts consisting of residents of Hisayama, Japan, aged ≥40 years without a history of stroke or myocardial infarction in 1961 (the first cohort, n=1,618), in 1974 (the second cohort, n=2,038), and in 1988 (the third cohort, n=2,637). Each cohort was followed for 13 years. The age- and sex-adjusted incidence of ICH significantly declined from the first to the second cohort and showed no further change in the third cohort. With regard to the ICH location, the incidence of putaminal hemorrhage decreased steadily, mainly in subjects aged 60-69 years, whereas the incidence of thalamic hemorrhage increased, especially in those aged ≥70 years. Both hypertension and alcohol intake were strong risk factors for ICH in the first cohort, but their influence declined with time. Blood pressure levels in hypertensive subjects decreased significantly, and the proportion of current drinkers decreased slightly over the study period. CONCLUSIONS Our findings suggest that the ICH incidence steeply declined from the 1960s to the 1970s in Japan as a result of the reduced influence of hypertension and alcohol intake, but that this decline has leveled off since then, probably because of the increased incidence of thalamic hemorrhage in the elderly in recent years.
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Affiliation(s)
- Seiji Gotoh
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University
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The incidence, hospital expenditure, and, 30 day and 1 year mortality rates of spontaneous intracerebral hemorrhage in Taiwan. J Clin Neurosci 2013; 21:91-4. [PMID: 24090518 DOI: 10.1016/j.jocn.2013.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/14/2013] [Accepted: 03/18/2013] [Indexed: 11/22/2022]
Abstract
The risks of morbidity and mortality are high in patients with spontaneous intracerebral hemorrhage (sICH). The medical care resources associated with sICH are also substantial. This study aimed to evaluate the medical expenditure for sICH patients in Taiwan. We analyzed the National Health Insurance Research Database from 2005 to 2010. The inclusion criterion was first-event sICH; traumatic ICH patients were excluded. Student's t-test, multiple linear regression and the chi-squared test were employed as the statistical methods. Our results showed that the incidence of sICH was 40.77 patients per 100,000 of population per year in Taiwan. The incidence increased with age and was greater in men than women. The mean hospital length of stay (LOS) of first-event sICH patients was 31.8 days; the mean LOS in the intensive care unit was 7.9 days; and the mean survival time was 60.4 months. The mortality rate within 30 days and within 1 year was 19.8 and 29.6%, respectively. The mean hospital expenditure of first-event sICH patients was USD $7572, and was highly correlated with LOS. In conclusion, the incidence of sICH in Taiwan is higher than that in white and black populations of northern America and some European countries and lower than that in the Asian populations of Japan and China. The features of male and female sICH patients differ. Our findings suggest that the hospital expenditure and mortality rate of sICH patients in Taiwan are comparable with those of other countries.
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Tveiten A, Ljøstad U, Mygland Å, Naess H. Leukoaraiosis is Associated with Short- and Long-term Mortality in Patients with Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2013; 22:919-25. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 11/30/2022] Open
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