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Luo B, Li L, Song XD, Chen HX, Yun DB, Wang L, Zhang Y. MicroRNA-7 attenuates secondary brain injury following experimental intracerebral hemorrhage via inhibition of NLRP3. J Stroke Cerebrovasc Dis 2024; 33:107670. [PMID: 38438086 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND PURPOSE The pathophysiological mechanisms underlying brain injury resulting from intracerebral hemorrhage (ICH) remain incompletely elucidated, and efficacious therapeutic interventions to enhance the prognosis of ICH patients are currently lacking. Previous research indicates that MicroRNA-7 (miR-7) can suppress the expression of Nod-like receptor protein 3 (NLRP3), thereby modulating neuroinflammation in Parkinson's disease pathogenesis. However, the potential regulatory effects miR-7 on NLRP3 inflammasome after ICH are yet to be established. This study aims to ascertain whether miR-7 mitigates secondary brain injury following experimental ICH by inhibiting NLRP3 and to investigate the underlying mechanisms. METHODS An ICH model was established by stereotaxically injecting 100 μL of autologous blood into the right basal ganglia of Sprague-Dawley (SD) rats. Subsequently, these rats were allocated into three groups: sham, ICH + Vehicle, and ICH + miR-7, each comprising 18 animals. Twelve hours post-modeling, rats received intraventricular injections of 10 μL physiological saline, 10 μL phosphate, and 10 μL phosphate-buffered saline solution containing 0.5 nmol of miR-7 mimics, respectively. Neurological function was assessed on day three post-modeling, followed by euthanasia for brain tissue collection. Brain water content was determined using the dry-wet weight method. The expression of inflammatory cytokines in cerebral tissues surrounding the hematoma was analyzed through immunohistochemistry and Western blot assays. These cytokines were re-evaluated using Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Moreover, bioinformatics tools were employed to predict miR-7's binding to NLRP3. A wild-type luciferase reporter gene vector and a corresponding mutant vector were constructed, followed by transfection of miR-7 mimics into HEK293T cells to assess luciferase activity. RESULTS Our study demonstrates that the administration of miR-7 mimics markedly reduced neurological function scores and attenuated brain edema in rats following ICH. A significant upregulation of NLRP3 expression in microglia/macrophage adjacent to the hematoma was observed, substantially reduced after the treatment with miR-7 mimics. Furthermore, this intervention ameliorated neurodegenerative changes and effectively decreased the protein and mRNA levels of pro-inflammatory cytokines, namely TNF-α, IL-1β, IL-6, and Caspase1, in the cerebral tissues proximate to the hematomas. In addition, miR-7 mimics distinctly inhibited the luciferase activity associated with the wild-type reporter gene, an effect not mirrored in its mutant variant. CONCLUSIONS The miR-7 suppressed NLRP3 expression in microglia/macrophage to reduce the production of inflammatory cytokines, leading to conducting certain neuroprotection post-ICH in rats.
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Affiliation(s)
- Bo Luo
- Department of Neurosurgery, Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District 637000, Nanchong, Sichuan Province, PR China
| | - Lin Li
- Department of Neurosurgery, Chongqing Cancer Hospital, No.181 Hanyu Road, Shapingba District 400000, Chongqing City, PR China
| | - Xu-Dong Song
- Department of Neurosurgery, Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District 637000, Nanchong, Sichuan Province, PR China
| | - Hua-Xuan Chen
- Department of Neurosurgery, Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District 637000, Nanchong, Sichuan Province, PR China
| | - De-Bo Yun
- Department of Neurosurgery, Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District 637000, Nanchong, Sichuan Province, PR China
| | - Lin Wang
- Department of Neurosurgery, Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District 637000, Nanchong, Sichuan Province, PR China
| | - Yuan Zhang
- Department of Neurosurgery, Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District 637000, Nanchong, Sichuan Province, PR China.
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Talmasov D, Kelly S, Ecker S, Olivera A, Lord A, Gurin L, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Relationship Between Hemorrhage Type and Development of Emotional and Behavioral Dyscontrol After Hemorrhagic Stroke. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230114. [PMID: 38650464 DOI: 10.1176/appi.neuropsych.20230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Emotional and behavioral dyscontrol (EBD), a neuropsychiatric complication of stroke, leads to patient and caregiver distress and challenges to rehabilitation. Studies of neuropsychiatric sequelae in stroke are heavily weighted toward ischemic stroke. This study was designed to compare risk of EBD following intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) and to identify risk factors for EBD following hemorrhagic stroke. METHODS The authors conducted a prospective cohort study of patients hospitalized for nontraumatic hemorrhagic stroke between 2015 and 2021. Patients or legally authorized representatives completed the Quality of Life in Neurological Disorders (Neuro-QOL) EBD short-form inventory 3 months after hospitalization. Univariable and multivariable analyses identified risk factors for EBD after hemorrhagic stroke. RESULTS The incidence of EBD was 21% (N=15 of 72 patients) at 3 months after hemorrhagic stroke. Patients with ICH were more likely to develop EBD; 93% of patients with EBD (N=14 of 15) had ICH compared with 56% of patients without EBD (N=32 of 57). The median Glasgow Coma Scale (GCS) score at hospital admission was lower among patients who developed EBD (13 vs. 15 among those without EBD). Similarly, admission scores on the National Institutes of Health Stroke Scale (NIHSS) and the Acute Physiology and Chronic Health Evaluation II (APACHE II) were higher among patients with EBD (median NIHSS score: 7 vs. 2; median APACHE II score: 17 vs. 11). Multivariable analyses identified hemorrhage type (ICH) and poor admission GCS score as predictors of EBD 3 months after hemorrhagic stroke. CONCLUSIONS Patients with ICH and a low GCS score at admission are at increased risk of developing EBD 3 months after hemorrhagic stroke and may benefit from early intervention.
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Affiliation(s)
- Daniel Talmasov
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Sean Kelly
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Sarah Ecker
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Anlys Olivera
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Aaron Lord
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Lindsey Gurin
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Koto Ishida
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Kara Melmed
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Jose Torres
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Cen Zhang
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Jennifer Frontera
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Ariane Lewis
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
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Fang M, Xia F, Wang J, Wang C, Teng B, You S, Li M, Chen X, Hu X. The NLRP3 inhibitor, OLT1177 attenuates brain injury in experimental intracerebral hemorrhage. Int Immunopharmacol 2024; 131:111869. [PMID: 38492343 DOI: 10.1016/j.intimp.2024.111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND PURPOSE It has been reported activation of NLRP3 inflammasome after intracerebral hemorrhage (ICH) ictus exacerbates neuroinflammation and brain injury. We hypothesized that inhibition of NLRP3 by OLT1177 (dapansutrile), a novel NLRP3 inflammasome inhibitor, could reduce brain edema and attenuate brain injury in experimental ICH. METHODS ICH was induced by injection of autologous blood into basal ganglia in mice models. Sixty-three C57Bl/6 male mice were randomly grouped into the sham, vehicle, OLT1177 (Dapansutrile, 200 mg/kg intraperitoneally) and treated for consecutive three days, starting from 1 h after ICH surgery. Behavioral test, brain edema, brain water content, blood-brain barrier integrity and vascular permeability, cell apoptosis, and NLRP3 and its downstream protein levels were measured. RESULTS OLT1177 significantly reduced cerebral edema after ICH and contributed to the attenuation of neurological deficits. OLT1177 could preserve blood-brain barrier integrity and lessen vascular leakage. In addition, OLT1177 preserved microglia morphological shift and significantly inhibited the activation of caspase-1 and release of IL-1β. We also found that OLT1177 can protect against neuronal loss in the affected hemisphere. CONCLUSIONS OLT1177 (dapansutrile) could significantly attenuate the brain edema after ICH and effectively alleviate the neurological deficit. This result suggests that the novel NLRP3 inhibitor, OLT1177, might serve as a promising candidate for the treatment of ICH.
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Affiliation(s)
- Mei Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiayan Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengyang Wang
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Bang Teng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shenglan You
- Animal Imaging Core Facilities, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Manrui Li
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Xiameng Chen
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China.
| | - Xin Hu
- Animal Imaging Core Facilities, West China Hospital, Sichuan University, Chengdu 610041, China.
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Kim M, Kim JH, Park W, Park JC, Ahn JS, Kwun BD, Lee SG, Hwang S, Kim M, Lee S. Risk of Cerebral Aneurysm Rupture After Liver Transplantation: Development and Validation of a Hemorrhagic Stroke Scoring Model. J Korean Med Sci 2024; 39:e88. [PMID: 38469964 PMCID: PMC10927392 DOI: 10.3346/jkms.2024.39.e88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) patients appear to be more prone to neurological events compared to individuals undergoing other types of solid-organ transplantation. The aims of the present study were to analyze the prevalence of unruptured intracranial aneurysms (UIAs) in patients undergoing liver transplantation (LT) and to examine the perioperative occurrence of subarachnoid hemorrhage (SAH). Also, it intended to systematically identify the risk factors of SAH and hemorrhagic stroke (HS) within a year after LT and to develop a scoring system which involves distinct clinical features of LT patients. METHODS Patients who underwent LT from January 2012 to March 2022 were analyzed. All included patients underwent neurovascular imaging within 6 months before LT. We conducted an analysis of prevalence and radiological features of UIA and SAH. The clinical factors that may have an impact on HS within one year of LT were also reviewed. RESULTS Total of 3,487 patients were enrolled in our study after applying inclusion and exclusion criteria. The prevalence of UIA was 5.4%. The incidence of SAH and HS within one year following LT was 0.5% and 1.6%, respectively. We developed a scoring system based on multivariable analysis to predict the HS within 1-year after LT. The variables were a poor admission mental status, the diagnosis of UIA, serum ammonia levels, and Model for End-stage Liver Disease (MELD) scores. Our model showed good discrimination among the development (C index, 0.727; 95% confidence interval [CI], 0.635-0.820) and validation (C index, 0.719; 95% CI, 0.598-0.801) cohorts. CONCLUSION The incidence of UIA and SAH was very low in LT patients. A poor admission mental status, diagnosis of UIA, serum ammonia levels, and MELD scores were significantly associated with the risk of HS within one year after LT. Our scoring system showed a good discrimination to predict the HS in LT patients.
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Affiliation(s)
- Minwoo Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Shen J, Xue X, Yuan H, Song Y, Wang J, Cui R, Ke K. Deubiquitylating Enzyme OTUB1 Facilitates Neuronal Survival After Intracerebral Hemorrhage Via Inhibiting NF-κB-triggered Apoptotic Cascades. Mol Neurobiol 2024; 61:1726-1736. [PMID: 37775718 DOI: 10.1007/s12035-023-03676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
The deubiquitylase OTU domain-containing ubiquitin aldehyde-binding protein 1 (OTUB1) has been implicated in the pathogenesis of various human diseases. However, the molecular mechanism by which OTUB1 participates in the pathogenesis of intracerebral hemorrhage (ICH) remains elusive. In the present study, we established an autologous whole blood fusion-induced ICH model in C57BL/6 J mice. We showed that the upregulation of OTUB1 contributes to the attenuation of Nuclear factor kappa B (NF-κB) and its downstream apoptotic signaling after ICH. OTUB1 directly associates with NF-κB precursors p105 and p100 after ICH, leading to attenuated polyubiquitylation of p105 and p100. Moreover, we revealed that NF-κB signaling was modestly activated both in ICH tissues and hemin-exposed HT-22 neuronal cells, accompanied with the activation of NF-κB downstream pro-apoptotic signaling. Notably, overexpression of OTUB1 strongly inhibited hemin-induced NF-κB activation, whereas interference of OTUB1 led to the opposite effect. Finally, we revealed that lentiviral transduction of OTUB1 markedly ameliorated hemin-induced apoptotic signaling and HT-22 neuronal death. Collectively, these findings suggest that the upregulation of OTUB1 serves as a neuroprotective mechanism in antagonizing neuroinflammation-induced NF-κB signaling and neuronal death, shed new light on manipulating intracellular deubiquitylating pathways as novel interventive approaches against ICH-induced secondary neuronal damage and death.
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Affiliation(s)
- Jiabing Shen
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Xiaoli Xue
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China
- Department of Neurology, Qidong People's Hospital, Qidong, Jiangsu, People's Republic of China
| | - Huimin Yuan
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China
- Department of Neurology, Qidong People's Hospital, Qidong, Jiangsu, People's Republic of China
| | - Yan Song
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Jinglei Wang
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China
- Department of Neurology, Affiliated Hai'an Hospital of Nantong University and Hai'an People's Hospital, Hai'an, People's Republic of China
| | - Ronghui Cui
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China.
| | - Kaifu Ke
- Department of Neurology, Affiliated Hospital and Medical School of Nantong University, Nantong, 226001, People's Republic of China.
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Fu H, Novak A, Robert D, Kumar S, Tanamala S, Oke J, Bhatia K, Shah R, Romsauerova A, Das T, Espinosa A, Grzeda MT, Narbone M, Dharmadhikari R, Harrison M, Vimalesvaran K, Gooch J, Woznitza N, Salik N, Campbell A, Khan F, Lowe DJ, Shuaib H, Ather S. AI assisted reader evaluation in acute CT head interpretation (AI-REACT): protocol for a multireader multicase study. BMJ Open 2024; 14:e079824. [PMID: 38346874 PMCID: PMC10862304 DOI: 10.1136/bmjopen-2023-079824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION A non-contrast CT head scan (NCCTH) is the most common cross-sectional imaging investigation requested in the emergency department. Advances in computer vision have led to development of several artificial intelligence (AI) tools to detect abnormalities on NCCTH. These tools are intended to provide clinical decision support for clinicians, rather than stand-alone diagnostic devices. However, validation studies mostly compare AI performance against radiologists, and there is relative paucity of evidence on the impact of AI assistance on other healthcare staff who review NCCTH in their daily clinical practice. METHODS AND ANALYSIS A retrospective data set of 150 NCCTH will be compiled, to include 60 control cases and 90 cases with intracranial haemorrhage, hypodensities suggestive of infarct, midline shift, mass effect or skull fracture. The intracranial haemorrhage cases will be subclassified into extradural, subdural, subarachnoid, intraparenchymal and intraventricular. 30 readers will be recruited across four National Health Service (NHS) trusts including 10 general radiologists, 15 emergency medicine clinicians and 5 CT radiographers of varying experience. Readers will interpret each scan first without, then with, the assistance of the qER EU 2.0 AI tool, with an intervening 2-week washout period. Using a panel of neuroradiologists as ground truth, the stand-alone performance of qER will be assessed, and its impact on the readers' performance will be analysed as change in accuracy (area under the curve), median review time per scan and self-reported diagnostic confidence. Subgroup analyses will be performed by reader professional group, reader seniority, pathological finding, and neuroradiologist-rated difficulty. ETHICS AND DISSEMINATION The study has been approved by the UK Healthcare Research Authority (IRAS 310995, approved 13 December 2022). The use of anonymised retrospective NCCTH has been authorised by Oxford University Hospitals. The results will be presented at relevant conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT06018545.
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Affiliation(s)
- Howell Fu
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Novak
- Emergency Medicine Research Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Jason Oke
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kanika Bhatia
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruchir Shah
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Tilak Das
- Department of Clinical Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Abdalá Espinosa
- Emergency Medicine Research Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Mark Harrison
- Emergency Department, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - Kavitha Vimalesvaran
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Gooch
- College of Health, Psychology & Social Care, University of Derby, Derby, UK
| | - Nicholas Woznitza
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | | | - Alan Campbell
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farhaan Khan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Haris Shuaib
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarim Ather
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Gu T, Pan J, Chen L, Li K, Wang L, Zou Z, Shi Q. Association of inflammatory cytokines expression in cerebrospinal fluid with the severity and prognosis of spontaneous intracerebral hemorrhage. BMC Neurol 2024; 24:7. [PMID: 38167007 PMCID: PMC10759732 DOI: 10.1186/s12883-023-03487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To investigate the potential diagnostic and prognostic implications of inflammatory cytokine levels in the cerebrospinal fluid (CSF) of patients with spontaneous intracerebral hemorrhage (SICH) upon their initial hospital admission. METHODS Our cohort included 100 patients diagnosed with acute SICH, presenting to the Department of Neurosurgery. Additionally, we recruited 50 individuals without central nervous system (CNS) pathology, treated concurrently at our facility, as controls. CSF samples, collected upon hospital entry, were quantitatively assessed for 10 inflammatory cytokines using the Mesoscale Discovery Platform (MSD, Rockville, MD, USA) electrochemiluminescence technology, followed by validation through enzyme-linked immunosorbent assay (ELISA). RESULTS We observed a marked elevation of IL-6, IL-8, IL-10, and TNF-α in the CSF of the SICH subgroup compared to controls. Higher Glasgow Coma Scale (GCS) scores in SICH patients corresponded with lower CSF concentrations of IL-6, IL-8, IL-10, and TNF-α, indicating an inverse relationship. Notably, CSF inflammatory cytokine levels were consistently higher in SICH patients with hydrocephalus than in those without. Increases in IL-6, IL-8, IL-10, and TNF-α in the CSF were notably more pronounced in the poor prognosis group (Glasgow Outcome Scale, GOS 1-3) compared to those with a favorable prognosis (GOS 4-5). The AUC values for these cytokines in predicting SICH prognosis were 0.750, 0.728, 0.717, and 0.743, respectively. CONCLUSIONS Initial CSF levels of IL-6, IL-8, IL-10, and TNF-α upon admission provide significant insights into the severity of neural damage and are robust indicators for prognosis in SICH patients.
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Affiliation(s)
- Tianyan Gu
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Jingyu Pan
- Medical College of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - Ling Chen
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Kai Li
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Li Wang
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Zhihao Zou
- Department of Neurosurgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China.
| | - Qinghai Shi
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China.
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Fleming V, Prasad A, Ge C, Crawford S, Meraj S, Hough CL, Lo B, Carson SS, Steingrub J, White DB, Muehlschlegel S. Prevalence and predictors of shared decision-making in goals-of-care clinician-family meetings for critically ill neurologic patients: a multi-center mixed-methods study. Crit Care 2023; 27:403. [PMID: 37865797 PMCID: PMC10590503 DOI: 10.1186/s13054-023-04693-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Shared decision-making is a joint process where patients, or their surrogates, and clinicians make health choices based on evidence and preferences. We aimed to determine the extent and predictors of shared decision-making for goals-of-care discussions for critically ill neurological patients, which is crucial for patient-goal-concordant care but currently unknown. METHODS We analyzed 72 audio-recorded routine clinician-family meetings during which goals-of-care were discussed from seven US hospitals. These occurred for 67 patients with 72 surrogates and 29 clinicians; one hospital provided 49/72 (68%) of the recordings. Using a previously validated 10-element shared decision-making instrument, we quantified the extent of shared decision-making in each meeting. We measured clinicians' and surrogates' characteristics and prognostic estimates for the patient's hospital survival and 6-month independent function using post-meeting questionnaires. We calculated clinician-family prognostic discordance, defined as ≥ 20% absolute difference between the clinician's and surrogate's estimates. We applied mixed-effects regression to identify independent associations with greater shared decision-making. RESULTS The median shared decision-making score was 7 (IQR 5-8). Only 6% of meetings contained all 10 shared decision-making elements. The most common elements were "discussing uncertainty"(89%) and "assessing family understanding"(86%); least frequent elements were "assessing the need for input from others"(36%) and "eliciting the context of the decision"(33%). Clinician-family prognostic discordance was present in 60% for hospital survival and 45% for 6-month independent function. Univariate analyses indicated associations between greater shared decision-making and younger clinician age, fewer years in practice, specialty (medical-surgical critical care > internal medicine > neurocritical care > other > trauma surgery), and higher clinician-family prognostic discordance for hospital survival. After adjustment, only higher clinician-family prognostic discordance for hospital survival remained independently associated with greater shared decision-making (p = 0.029). CONCLUSION Fewer than 1 in 10 goals-of-care clinician-family meetings for critically ill neurological patients contained all shared decision-making elements. Our findings highlight gaps in shared decision-making. Interventions promoting shared decision-making for high-stakes decisions in these patients may increase patient-value congruent care; future studies should also examine whether they will affect decision quality and surrogates' health outcomes.
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Affiliation(s)
- Victoria Fleming
- Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abhinav Prasad
- Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Departments of Anesthesia/Critical Care, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Connie Ge
- Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sybil Crawford
- Tan Chingfen University of Massachusetts Graduate School of Nursing, Worcester, MA, USA
| | - Shazeb Meraj
- Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bernard Lo
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shannon S Carson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Jay Steingrub
- Division of Pulmonary Medicine and Critical Care Medicine, Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
| | - Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Departments of Anesthesia/Critical Care, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Departments of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Phipps 455, Baltimore, MD, 21287, USA.
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9
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Olivera A, Ecker S, Lord A, Gurin L, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Factors Associated With Anxiety After Hemorrhagic Stroke. J Neuropsychiatry Clin Neurosci 2023; 36:36-44. [PMID: 37667629 DOI: 10.1176/appi.neuropsych.20220218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE A significant number of patients develop anxiety after stroke. The objective of this study was to identify risk factors for anxiety after hemorrhagic stroke that may facilitate diagnosis and treatment. METHODS Patients admitted between January 2015 and February 2021 with nontraumatic hemorrhagic stroke (intracerebral [ICH] or subarachnoid [SAH] hemorrhage) were assessed telephonically 3 and 12 months after stroke with the Quality of Life in Neurological Disorders Anxiety Short Form to evaluate the relationships between poststroke anxiety (T score >50) and preclinical social and neuropsychiatric history, systemic and neurological illness severity, and in-hospital complications. RESULTS Of 71 patients who completed the 3-month assessment, 28 (39%) had anxiety. There was a difference in Glasgow Coma Scale (GCS) scores on admission between patients with anxiety (median=14, interquartile range [IQR]=12-15) and those without anxiety (median=15, IQR=14-15) (p=0.034), and the incidence of anxiety was higher among patients with ICH (50%) than among those with SAH (20%) (p=0.021). Among patients with ICH, anxiety was associated with larger median ICH volume (25 cc [IQR=8-46] versus 8 cc [IQR=3-13], p=0.021) and higher median ICH score (2 [IQR=1-3] versus 1 [IQR=0-1], p=0.037). On multivariable analysis with GCS score, hemorrhage type, and neuropsychiatric history, only hemorrhage type remained significant (odds ratio=3.77, 95% CI=1.19-12.05, p=0.024). Of the 39 patients who completed the 12-month assessment, 12 (31%) had anxiety, and there was a difference in mean National Institutes of Health Stroke Scale scores between patients with (5 [IQR=3-12]) and without (2 [IQR=0-4]) anxiety (p=0.045). There was fair agreement (κ=0.38) between the presence of anxiety at 3 and 12 months. CONCLUSIONS Hemorrhage characteristics and factors assessed with neurological examination on admission are associated with the development of poststroke anxiety.
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Affiliation(s)
- Anlys Olivera
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Sarah Ecker
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Aaron Lord
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Lindsey Gurin
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Koto Ishida
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Kara Melmed
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Jose Torres
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Cen Zhang
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Jennifer Frontera
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Ariane Lewis
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
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10
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Taleb S, Lee JJH, Duncan P, Cramer SC, Bahr-Hosseini M, Su M, Starkman S, Avila G, Hochberg A, Hamilton S, Conwit RA, Saver JL. Essential information for neurorecovery clinical trial design: trajectory of global disability in first 90 days post-stroke in patients discharged to acute rehabilitation facilities. BMC Neurol 2023; 23:239. [PMID: 37340330 DOI: 10.1186/s12883-023-03251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Many stroke recovery interventions are most beneficial when started 2-14d post-stroke, a time when patients become eligible for inpatient rehabilitation facilities (IRF) and neuroplasticity is often at its peak. Clinical trials focused on recovery need to expand the time from this plasticity to later outcome timepoints. METHODS The disability course of patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) enrolled in Field Administration of Stroke Therapy Magnesium (FAST-MAG) Trial with moderate-severe disability (modified Rankin Scale [mRS] 3-5) on post-stroke day4 who were discharged to IRF 2-14d post-stroke were analyzed. RESULTS Among 1422 patients, 446 (31.4%) were discharged to IRFs, including 23.6% within 2-14d and 7.8% beyond 14d. Patients with mRS 3-5 on day4 discharged to IRFs between 2-14d accounted for 21.7% (226/1041) of AIS patients and 28.9% (110/381) of ICH patients, (p < 0.001). Among these AIS patients, age was 69.8 (± 12.7), initial NIHSS median 8 (IQR 4-12), and day4 mRS = 3 in 16.4%, mRS = 4 in 50.0%, and mRS = 5 in 33.6%. Among these ICH patients, age was 62.4 (± 11.7), initial NIHSS median 9 (IQR 5-13), day 4 mRS = 3 in 9.4%, mRS = 4 in 45.3%, and mRS = 5 in 45.3% (p < 0.01 for AIS vs ICH). Between day4 to day90, mRS improved ≥ 1 levels in 72.6% of AIS patients vs 77.3% of ICH patients, p = 0.3. For AIS, mRS improved from mean 4.17 (± 0.7) to 2.84 (± 1.5); for ICH, mRS improved from mean 4.35 (± 0.7) to 2.75 (± 1.3). Patients discharged to IRF beyond day14 had less improvement on day90 mRS compared with patients discharged between 2-14d. CONCLUSIONS In this acute stroke cohort, nearly 1 in 4 patients with moderate-severe disability on post-stroke day4 were transferred to IRF within 2-14d post-stroke. ICH patients had nominally greater mean improvement on mRS day90 than AIS patients. This course delineation provides a roadmap for future rehabilitation intervention studies.
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Affiliation(s)
- Shayandokht Taleb
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, USA.
- Department of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.
| | - Jenny Ji-Hyun Lee
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Steven C Cramer
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Michael Su
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Sidney Starkman
- Departments of Emergency Medicine and Neurology, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Gilda Avila
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Scott Hamilton
- Department of Neurology, Stanford University, Stanford, USA
| | - Robin A Conwit
- National Institute of Neurological Disorders and Stroke, Bethesda, USA
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, USA
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11
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Sun T, Zhao YY, Xiao QX, Wu M, Luo MY. Deferoxamine in intracerebral hemorrhage: Systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 227:107634. [PMID: 36857886 DOI: 10.1016/j.clineuro.2023.107634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a stroke with a high morbidity and mortality rate. Deferoxamine (DFX) is thought to be effective in treating Intracerebral Hemorrhage. In our study, we performed a meta-analysis to evaluate the treatment effects of DFX. METHODS We systematically searched PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and Chinese Biomedical Literature Database in Jan 2022 for studies on DFX for ICH patients. Outcome measures included relative hematoma volume, relative edema volume, good neurological functional outcome and adverse events. Odds risk (OR) and weighted mean difference (WMD) were used to evaluate clinical outcomes. RESULTS After searching 636 articles, 4 RCTs, 2 NRCTs, and 1cohort study were included. We found that DFX was effective in hematoma absorption on day 7 after onset, but the difference was not significant on day 14. DFX could suppress edema expansion on days 3, 7, and 14 after onset. DFX did not contribute to better outcomes after 3 and 6 months when used the modified Rankin Scale and the Glasgow Outcome Scale to evaluate neurological prognosis. The pooled results showed no statistically significant difference in Serious adverse events between the experimental and control groups. CONCLUSIONS DFX could limit edema expansion on days 3, 7, and 14 after commencement and facilitate hematoma absorption at week 1 without significantly increasing the risk of adverse events, but it did not improve neurological prognosis.
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Affiliation(s)
- Tao Sun
- The First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yang-Yang Zhao
- The First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qiu-Xiang Xiao
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Meng Wu
- The First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Mu-Yun Luo
- Department of Neurosurgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
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12
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Videla C, Plou P, Valencia Chicue L, Yampolsky C, Ajler P, Ciarrocchi N. A minimal invasive drainage of intracerebral hemorrhage. A South American experience with MISTIE procedure. World Neurosurg 2022:S1878-8750(22)01385-7. [PMID: 36184041 DOI: 10.1016/j.wneu.2022.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/20/2022]
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13
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Gil-Garcia CA, Alvarez EF, Garcia RC, Mendoza-Lopez AC, Gonzalez-Hermosillo LM, Garcia-Blanco MDC, Valadez ER. Essential topics about the imaging diagnosis and treatment of Hemorrhagic Stroke: a comprehensive review of the 2022 AHA guidelines. Curr Probl Cardiol 2022; 47:101328. [PMID: 35870549 DOI: 10.1016/j.cpcardiol.2022.101328] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe stroke with a high death rate (40 % mortality). The prevalence of hemorrhagic stroke has increased globally, with changes in the underlying cause over time as anticoagulant use and hypertension treatment have improved. The fundamental etiology of ICH and the mechanisms of harm from ICH, particularly the complex interaction between edema, inflammation, and blood product toxicity, have been thoroughly revised by the American Heart Association (AHA) in 2022. Although numerous trials have investigated the best medicinal and surgical management of ICH, there is still no discernible improvement in survival and functional tests. Small vessel diseases, such as cerebral amyloid angiopathy (CAA) or deep perforator arteriopathy (hypertensive arteriopathy), are the most common causes of spontaneous non-traumatic intracerebral hemorrhage (ICH). Even though ICH only causes 10-15% of all strokes, it contributes significantly to morbidity and mortality, with few acute or preventive treatments proven effective. Current AHA guidelines acknowledge up to 89% sensitivity for unenhanced brain CT and 81% for brain MRI. The imaging findings of both methods are helpful for initial diagnosis and follow-up, sometimes necessary a few hours after admission, especially for detecting hemorrhagic transformation or hematoma expansion. This review summarized the essential topics on hemorrhagic stroke epidemiology, risk factors, physiopathology, mechanisms of injury, current management approaches, findings in neuroimaging, goals and outcomes, recommendations for lifestyle modifications, and future research directions ICH. A list of updated references is included for each topic.
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Affiliation(s)
| | | | | | | | | | | | - Ernesto-Roldan Valadez
- Directorado de investigación, Hospital General de Mexico "Dr. Eduardo Liceaga," 06720, CDMX, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia.
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14
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Lee S, Kim DY, Kim MK, Kim HJ. Intracerebral Hemorrhage Caused by Thrombosis of a Developmental Venous Anomaly with an Unusual Structure: A Case Report. Taehan Yongsang Uihakhoe Chi 2022; 83:199-205. [PMID: 36237365 PMCID: PMC9238210 DOI: 10.3348/jksr.2021.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/06/2021] [Accepted: 04/24/2021] [Indexed: 06/16/2023]
Abstract
Developmental venous anomalies (DVAs) are common intracranial vascular malformations and they are generally do not cause clinical complications. In cases showing DVA and hemorrhage, the hemorrhage is usually associated with adjacent cavernous malformations. Very few cases of intracerebral hemorrhage (ICH) caused by thrombosis in DVA have been reported in the literature. In this case report, we present an interesting case of a large ICH caused by thrombosis within a DVA with an unusual structure that may have potentiated the thrombosis.
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15
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Zhu X, Long Z, Bao T, Liu L, Yang K. Exploring the mechanism of Radix Rhei Et Rhizome intervention in intracerebral hemorrhage based on systematic pharmacology and proteomics strategy. Biosci Rep 2021; 41:226101. [PMID: 32803256 PMCID: PMC7955106 DOI: 10.1042/bsr20201910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To explore the mechanism of Radix Rhei Et Rhizome (Dahuang, DH) intervention in intracerebral hemorrhage (ICH) based on systematic pharmacology and proteomics strategy. METHODS The systematic pharmacological strategies were utilized to find the bioactive compounds of Radix Rhei Et Rhizome, predict its potential targets, and collect ICH's disease genes; then, the Cytoscape 3.7.1 software was applied for network construction and network topology analysis. After that, in-depth analysis of the proteomics data of Radix Rhei Et Rhizome intervention in ICH was performed to complement and validate the results of systematic pharmacological predictions. RESULTS A total of three major networks were constructed in the present study: (1) compound-compound target network of Radix Rhei Et Rhizome, (2) DH-ICH PPI network, (3) proteomics proteins' PPI network. These three major networks have been analyzed by network topology, and several small networks derived (such as signaling pathway networks). The enrichment analysis showed that Radix Rhei Et Rhizome can intervene in several biological process (such as inflammation, smooth muscle proliferation, platelet activation, blood pressure regulation, angiogenesis, hypoxia, and inflammatory response of leukocytes), signaling pathway (such as FoxO signaling pathway, complement and coagulation cascades, cGMP-PKG signaling pathway, and Rap1 signaling pathway), and reactome pathway (such as signaling by interleukins, interleukin-4 and interleukin-13 signaling, nuclear receptor transcription pathway, and platelet activation). CONCLUSION Radix Rhei Et Rhizome may intervene in ICH-related biological process, signaling pathway, and reactome pathway found in this research so as to achieve the effect of treating ICH related injuries.
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Affiliation(s)
- Xiaofei Zhu
- Institute of Integrative Medicine, Department of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhiyong Long
- Shantou University Medical College, Shantou, Guangdong Province, China
- Department of Physical Medicine and Rehabilitation, Guangdong General Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Tingting Bao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Clinical Medicine (Xiyuan Hospital), Beijing University of Chinese Medicine, Beijing, China
| | - Liang Liu
- People’s Hospital of Ningxiang City, Ningxiang 410600, Hunan Province, China
- Correspondence: Liang Liu (, ) or Kailin Yang ()
| | - Kailin Yang
- Graduate College, Capital Medical University, Beijing, China
- Correspondence: Liang Liu (, ) or Kailin Yang ()
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16
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Mishra S, Choueka M, Wang Q, Hu C, Visone S, Silver M, Stein EG, Levine SR, Wang QT. Intracranial Hemorrhage in COVID-19 Patients. J Stroke Cerebrovasc Dis 2021; 30:105603. [PMID: 33484980 PMCID: PMC7831866 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105603] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients. Methods Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed. Results Of 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively. Conclusions COVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.
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Affiliation(s)
- Sanskriti Mishra
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Murray Choueka
- Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Qiang Wang
- Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Chloe Hu
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States.
| | - Stephanie Visone
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States.
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, United States.
| | - Evan G Stein
- Department of Radiology, Maimonides Medical Center, Brooklyn, NY, United States.
| | - Steven R Levine
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States.
| | - Qingliang T Wang
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Surgery/Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
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Dawoud F, Lucke-Wold B, Trejo-Lopez J, Yachnis A, Rahman M. An Unusual Cause of Intracerebral Hemorrhage: Clinical Pearls Regarding Primary Angiitis of the Central Nervous System. Neurol Sci Neurosurg 2020; 1:10.47275/2692-093x-109. [PMID: 33205146 PMCID: PMC7668556 DOI: 10.47275/2692-093x-109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary angiitis of the central nervous system (PACNS) is a rare form of vasculitis. It is a diagnosis of exclusion and often diagnosed post mortem on pathologic evaluation. Cerebral angiography can be suggestive, but biopsy is required. Symptoms can vary from headache to focal cranial nerve deficits. On the more severe spectrum, patients can present with ischemic and vary rarely hemorrhagic stroke. We present in this case report key clinical pearls regarding suspected diagnosis. Younger patients with cortical hemorrhages may have PACNS instead of the more common cerebral amyloid angiopathy. Early suspicion may aid in initiating effective treatment as we highlight in the discussion.
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Affiliation(s)
- Fakhry Dawoud
- Quillen College of Medicine, East Tennessee State University, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, United States
- Correspondence to: Brandon Lucke-Wold, Department of Neurosurgery, University of Florida, United States;
| | | | - Anthony Yachnis
- Department of Pathology, University of Florida, United States
| | - Maryam Rahman
- Department of Neurosurgery, University of Florida, United States
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18
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Almaghrabi TS, McDonald MM, Cai C, Rahbar MH, Choi HA, Lee K, Naval NS, Grotta JC, Chang TR. Cocaine Use is Associated with More Rapid Clot Formation and Weaker Clot Strength in Acute Stroke Patients. Int J Cerebrovasc Dis Stroke 2019; 2:110. [PMID: 31681912 PMCID: PMC6824539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION 1.1.Cocaine use is a known risk factor for stroke and has been associated with worse outcomes. Cocaine may cause an altered coagulable state by a number of different proposed mechanisms, including platelet activation, endothelial injury, and tissue factor expression. This study analyzes the effect of cocaine use on Thrombelastography (TEG) in acute stroke patients. PATIENT AND METHODS 1.2.Patients presenting with Acute Ischemic Stroke (AIS) and spontaneous Intracerebral Hemorrhage (ICH) to a single academic center between 2009 and 2014 were prospectively enrolled. Blood was collected for TEG analysis at the time of presentation. Patient demographics and baseline TEG values were compared between two groups: cocaine and non-cocaine users. Multivariable Quantile regression models were used to compare the median TEG components between groups after controlling for the effect of confounders. RESULTS 1.3.91 patients were included, 53 with AIS and 38 with ICH. 8 (8.8%) patients were positive for cocaine, 4 (50%) with AIS, and 4 (50%) with ICH. There were no significant differences in age, blood pressure, platelet count, or PT/PTT between the cocaine positive and cocaine negative group. Following multivariable analysis, and adjusting for factors known to influence TEG including stroke subtype, cocaine use was associated with shortened median R time (time to initiate clotting) of 3.8 minutes compared to 4.8 minutes in non-cocaine users (p=0.04). Delta (thrombin burst) was also earlier among cocaine users (0.4 minutes) compared with non-cocaine users (0.5 min, p=0.04). The median MA and G (measurements of final clot strength) were reduced in cocaine users (MA=62.5 mm, G=7.8 dynes/cm2) compared to non-cocaine users (MA=66.5 mm, G=10.1 dynes/cm2; p=0.047, p=0.04, respectively). CONCLUSION 1.4.Cocaine users demonstrate more rapid clot formation but reduced overall clot strength based on admission TEG values.
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Affiliation(s)
- Tareq S Almaghrabi
- Department of Internal Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Mark M McDonald
- Department of Neurology, University of Virginia School of Medicine, Virginia, USA
| | - Chunyan Cai
- Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA
| | - Mohammed H Rahbar
- Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA
| | - H Alex Choi
- Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA
| | - Kiwon Lee
- Department of Neurology, Robert Wood Johnson Medical School, New Jersey, USA
| | - Neeraj S Naval
- Department of Neurosurgery, Baptist Medical Center, Florida, USA
| | - James C Grotta
- Department of Neurology, Memorial Hermann Hospital, Texas, USA
| | - Tiffany R Chang
- Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA
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19
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Vafaee F, Zarifkar A, Emamghoreishi M, Namavar MR, Shahpari M, Zarifkar AH. Effect of Recombinant Insulin-like Growth Factor-2 Injected into the Hippocampus on Memory Impairment Following Hippocampal Intracerebral Hemorrhage in Rats. Galen Med J 2018; 7:e1353. [PMID: 34466449 PMCID: PMC8344085 DOI: 10.22086/gmj.v0i0.1353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 09/28/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Insulin-like growth factor 2 (IGF-2) is a growth factor and an anti-inflammatory cytokine that plays a pivotal role in memory. In this study, we examined the effect of recombinant IGF-2 on memory impairment due to intracerebral hemorrhage (ICH). Avoidance and recognition memory, locomotor activity, neurological deficit score (NDS), and the level of the IGF-2 gene expression were evaluated. MATERIALS AND METHODS To induce ICH, 100 μL of autologous blood was injected into the left hippocampus of male Sprague Dawley rats. Recombinant IGF-2 was injected into the damaged hippocampus 30 minutes after the induction of ICH. Then, over two weeks, NDS, locomotor activity, passive avoidance, and novel object recognition (NOR) test were evaluated. Finally, the level of IGF-2 gene expression was evaluated by using the real-time polymerase chain reaction technique. RESULT Our results indicated that recombinant IGF-2 injection significantly increased step-through latency (P<0.001) and total time spent in the dark box (P<0.01). However, no significant difference was seen in recognition memory and NDS. Locomotor activity did not significantly change in any group. A significantly reduced level of IGF-2 was observed after two weeks (P<0.05). CONCLUSION The results of this study show that a single dose of recombinant IGF-2 injection can influence hippocampus-dependent memories. Importantly, IGF-2 did not change locomotor activity and NDS after two weeks, which probably represents its specific function in memory.
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Affiliation(s)
- Farzaneh Vafaee
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asadollah Zarifkar
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Emamghoreishi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Namavar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Histomorphometry and Stereology Research center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Anatomical Sciences, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Shahpari
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Hossein Zarifkar
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Yadegari S, Aghsaei-Fard M, Akbari M, Mirmohammad-Sadeghi A. "Eight and a half" and "nine syndrome" rare presentation of pontine lesions; case reports and review of literature. Iran J Neurol 2018; 17:189-191. [PMID: 31210904 PMCID: PMC6555881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Eight-and-a-half syndrome (EHS) is one-and-a-half syndrome [(conjugated horizontal gaze palsy and internuclear ophthalmoplegia (INO)] plus ipsilateral fascicular seventh cranial nerve palsy. Involvement of lower pontine tegmentum including the abducens nucleus, the ipsilateral medial longitudinal fasciculus (MLF), and the adjacent facial colliculus contribute to the clinical findings of EHS. Recently, nine syndrome with addition of hemiparesis or hemianesthesia to EHS (due to involvement of adjacent corticospinal tract or medial lemniscus) is suggested. Methods: Consecutive patients with presentation of EHS or nine syndrome were reviewed from referral neuro-ophthalmology and strabismus clinics. Results: Three cases of EHS were identified with different etiologies of intracerebral hemorrhage (ICH), demyelination, and neuromyelitis optica spectrum disorder. Moreover, one case of "nine syndrome" due to ICH was described. Brain magnetic resonance imaging (MRI) in all of them revealed lesion in lower tegmentum of pons. Conclusion: Apart from different etiologies, recognition of EHS or nine syndrome allows precise localization of the lesion to lower pontine tegmentum ipsilaterally.
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Affiliation(s)
- Samira Yadegari
- Department of Neuro-Ophthalmology and Strabismus, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Aghsaei-Fard
- Department of Neuro-Ophthalmology and Strabismus, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Akbari
- Department of Neuro-Ophthalmology and Strabismus, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Mirmohammad-Sadeghi
- Department of Neuro-Ophthalmology and Strabismus, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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21
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Lane K, Keita M, Avadhani R, Dlugash R, Mayo S, Thompson RE, Awad I, McBee N, Ziai W, Hanley DF. African American Screening and Enrollment in (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III) CLEAR III. Clin Res (Alex) 2018; 32:https://www.acrpnet.org/2018/08/14/african-american-screening-and-enrollment-in-the-clear-iii-trial/. [PMID: 30221183 PMCID: PMC6138411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Under-enrolling minority patients in clinical trials reduces generalizability. CLEAR III, a randomized controlled trial, presented an opportunity to assess African American (AA) participation. METHODS AA enrollment was compared to U.S. population and NINDS trial data then stratified by region; census data for 42 recruitment cities were compared to screening and randomization percentages, using simple linear regression. RESULTS AAs were 25% of screens and 45.1% of enrollments (n=370), more than twice the 19.8% participation rate reported by the 2011 NINDS Advisory Panel on Health Disparities Research and triple the projected 13.9% 2014 U.S. population. Conversion rates were (AA vs. non-AA): overall (8.7% vs. 3.4%, p<0.001); Northeast (7.7% vs. 2.9%, p<0.001); South (8.2% vs. 4.0%, p<0.001); Midwest (10.3% vs. 3.6%, p<0.01); and West (8.9% vs. 3.8%, p=0.02). AA enrollments ranged from 0% to 100% (mean: 40.4%). AA screening ranged from 0% to 63.7% (mean: 23.2%). AA city census ranged from 1.3% to 82.7% (mean: 28.0%); higher census was associated with higher screening (p<0.0001) and enrollment (p=0.004). CONCLUSIONS AAs were willing to enroll in an acute stroke trial. AA city census rates should be considered when selecting enrollment centers and setting recruitment goals. Factors leading to successful AA recruitment should be further investigated, as population-based participation is a goal in all trials.
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Affiliation(s)
- Karen Lane
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maningbe Keita
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Radhika Avadhani
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Dlugash
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Mayo
- Emissary International, LLC, Austin, TX, USA
| | | | - Issam Awad
- University of Chicago Medicine and Biological Sciences, Chicago, IL, USA 60637
| | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Ziai
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Lehtola H, Hartikainen J, Hartikainen P, Kiviniemi T, Nuotio I, Palomäki A, Ylitalo A, Airaksinen KEJ, Mustonen P. How do anticoagulated atrial fibrillation patients who suffer ischemic stroke or spontaneous intracerebral hemorrhage differ? Clin Cardiol 2018; 41:608-614. [PMID: 29745996 DOI: 10.1002/clc.22935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 02/23/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) increases risk of ischemic stroke, and oral anticoagulation (OAC) increases risk of intracerebral hemorrhage (ICH). This study aimed to compare OAC-treated AF patients with an ischemic stroke/transient ischemic attack (TIA) or spontaneous ICH as their first lifetime cerebrovascular event, especially focusing on patients with therapeutic international normalized ratio (INR). HYPOTHESIS We assumed that in AF patients suffering ischemic stroke/TIA or ICH, patient characteristics could be different in patients with therapeutic INR than in patients with warfarin. METHODS FibStroke is a multicenter, retrospective registry collating details of AF patients with ischemic stroke/TIA or intracranial hemorrhage in 2003-2012. This substudy included AF patients on OAC with first lifetime ischemic stroke/TIA or spontaneous ICH. RESULTS A total of 1457 patients with 1290 ischemic strokes/TIAs and 167 ICHs were identified. Of these, 553 (42.9%) strokes/TIAs and 96 (57.5%) ICHs occurred in patients with INR within therapeutic range. During OAC with therapeutic INR, congestive heart failure (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.18-4.58) and hypercholesterolemia (OR: 2.52, 95% CI: 1.51-4.19) were more common in patients with ischemic stroke/TIA, whereas a history of bleeding (OR: 0.30, 95% CI: 0.11-0.82) was less common when compared with patients with ICH. In the whole cohort, renal impairment (OR: 1.86, 95% CI: 1.23-2.80) and mechanical valve prosthesis (OR: 4.41, 95% CI: 1.32-14.7) were overrepresented in patients with stroke/TIA, whereas aspirin use (OR: 0.52, 95% CI: 0.30-0.91) and high INR (OR: 0.40, 95% CI: 0.33-0.48) were overrepresented in patients with ICH. CONCLUSIONS In anticoagulated AF patients with therapeutic INR and first lifetime cerebrovascular event, congestive heart failure and hypercholesterolemia were associated with ischemic stroke/TIA and history of bleeding with ICH.
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Affiliation(s)
- Heidi Lehtola
- Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland.,Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | | | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilpo Nuotio
- Department of Acute Internal Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Ylitalo
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Satakunta Central Hospital, Pori, Finland
| | | | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland
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23
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Hao S, Wang B. Editorial: Review on Intracerebral Haemorrhage: Multidisciplinary Approaches to the Injury Mechanism Analysis and Therapeutic Strategies. Curr Pharm Des 2017; 23:2159-2160. [PMID: 28703081 DOI: 10.2174/1381612823999170307150448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Shilei Hao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China
| | - Bochu Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China
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24
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Babadjouni RM, Radwanski RE, Walcott BP, Patel A, Durazo R, Hodis DM, Emanuel BA, Mack WJ. Neuroprotective strategies following intraparenchymal hemorrhage. J Neurointerv Surg 2017; 9:1202-1207. [PMID: 28710084 DOI: 10.1136/neurintsurg-2017-013197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 12/23/2022]
Abstract
Intracerebral hemorrhage and, more specifically, intraparenchymal hemorrhage, are devastating disease processes with poor clinical outcomes. Primary injury to the brain results from initial hematoma expansion while secondary hemorrhagic injury occurs from blood-derived products such as hemoglobin, heme, iron, and coagulation factors that overwhelm the brains natural defenses. Novel neuroprotective treatments have emerged that target primary and secondary mechanisms of injury. Nonetheless, translational application of neuroprotectants from preclinical to clinical studies has yet to show beneficial clinical outcomes. This review summarizes therapeutic agents and neuroprotectants in ongoing clinical trials aimed at targeting primary and secondary mechanisms of injury after intraparenchymal hemorrhage.
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Affiliation(s)
- Robin Moshe Babadjouni
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ryan E Radwanski
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brian P Walcott
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arati Patel
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ramon Durazo
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Drew M Hodis
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Benjamin A Emanuel
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Mack
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Gioia L, Klahr A, Kate M, Buck B, Dowlatshahi D, Jeerakathil T, Emery D, Butcher K. The intracerebral hemorrhage acutely decreasing arterial pressure trial II (ICH ADAPT II) protocol. BMC Neurol 2017; 17:100. [PMID: 28525977 PMCID: PMC5437568 DOI: 10.1186/s12883-017-0884-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Aggressively lowering blood pressure (BP) in acute intracerebral hemorrhage (ICH) may improve outcome. Although there is no evidence that BP reduction changes cerebral blood flow, retrospective magnetic resonance imaging (MRI) studies have demonstrated sub-acute ischemic lesions in ICH patients. The primary aim of this study is to assess ischemic lesion development in patients randomized to two different BP treatment strategies. We hypothesize aggressive BP reduction is not associated with ischemic injury after ICH. Methods The Intracerebral Hemorrhage Acutely Decreasing Blood Pressure Trial II (ICH ADAPT II) is a phase II multi-centre randomized open-label, blinded-endpoint trial. Acute ICH patients (N = 270) are randomized to a systolic blood pressure (SBP) target of <140 or <180 mmHg. Acute ICH patients within 6 h of onset and two SBP measurements ≥140 mmHg recorded >2 mins apart qualify. SBP is managed with a pre-defined treatment protocol. Patients undergo MRI at 48 h, Days 7 and 30, with clinical assessment at Day 30 and 90. The primary outcome is diffusion weighted imaging (DWI) lesion frequency at 48 h. Secondary outcomes include cumulative DWI lesion rate frequency within 30 days, absolute hematoma growth, prediction of DWI lesion incidence, 30-day mortality rates, day 90 functional outcome, and cognitive status. Discussion This trial will assess the impact of hypertensive therapies on physiological markers of ischemic injury. The findings of this study will provide evidence for the link, or lack thereof, between BP reduction and ischemic injury in ICH patients. Trial registration This study is registered with clinicaltrials.gov (NCT02281838, first received October 29, 2014). Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0884-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Gioia
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Ana Klahr
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Mahesh Kate
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | | | - Thomas Jeerakathil
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada
| | - Derek Emery
- Department of Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Kenneth Butcher
- Division of Neurology, University of Alberta, 7th Floor Clinical Sciences Building, 11350-83rd Avenue, Edmonton, AB, T6G 2B7, Canada.
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26
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Boulouis G, Morotti A, Goldstein JN, Charidimou A. Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 2017; 88:339-345. [PMID: 28214798 DOI: 10.1136/jnnp-2016-315346] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/25/2017] [Accepted: 02/01/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION It is unclear whether intensive lowering of blood pressure (BP) at the acute phase of intracerebral haemorrhage (ICH) is beneficial. We performed a meta-analysis of randomised controlled trials (RCTs) to assess whether intensive BP lowering in patients with acute ICH is safe and effective in improving clinical outcomes. METHODS We searched PubMed, EMBASE and the Cochrane databases for relevant RCTs and calculated pooled OR for 3-month mortality (safety outcome) and 3-month death or dependency (modified Rankin Scale (mRs) ≥3;efficacy outcome), in patients with acute ICH randomised to either intensive BP-lowering or standard BP-lowering treatment protocols. We also investigated the association between treatment arm and ICH expansion at 24 hours. Random effects models with DerSimonian-Laird weights were used. RESULTS Five eligible studies including 4360 patients with acute ICH were pooled in meta-analysis. The risk of 3-month mortality was similar between patients randomised to intensive BP-lowering treatment and standard BP-lowering treatment (OR: 0.99; 95% CI: 0.82 to 1.20, p=0.909). Intensive BP-lowering treatment showed a (non-significant) trend for an association with lower 3-month death or dependency risk compared with standard treatment (OR: 0.91; 95% CI: 0.80 to 1.02), p=0.106). Intensive BP reduction was associated with a trend for lower risk of significant ICH expansion compared with standard treatment (OR: 0.82; 95% CI: 0.68 to 1.00, p=0.056), especially in larger RCTs. CONCLUSIONS For patients with acute ICH similar to those included in RCTs and without contraindication to acute BP treatment, intensive acute BP lowering is safe, but does not seem to provide an incremental clinical benefit in terms of functional outcomes. The effect of intensive BP lowering on significant haematoma expansion at 24 hours warrants further investigation.
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Affiliation(s)
- Gregoire Boulouis
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Université Paris-Descartes, INSERM UMR 894, Paris, France
| | - Andrea Morotti
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, Massachusetts, USA .,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Bivard A, Cheng X, Lin LT, Levi C, Spratt N, Kleinig T, O'Brien B, Butcher K, Lou M, Zhang JF, Sylaja PN, Cao WJ, Jannes J, Dong Q, Parsons M. Global White Matter Hypoperfusion on CT Predicts Larger Infarcts and Hemorrhagic Transformation after Acute Ischemia. CNS Neurosci Ther 2016; 22:238-43. [PMID: 26775830 DOI: 10.1111/cns.12491] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/09/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis. AIM We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. METHODS Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h. RESULTS Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R(2) = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R(2) = 0.341, P = 0.034), very low CBV volume (R(2) = 0.249, P = 0.026), and severely delayed perfusion (Tmax>14 second R(2) = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). CONCLUSION White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.
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Affiliation(s)
- Andrew Bivard
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Long-Ting Lin
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher Levi
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Neil Spratt
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Tim Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, NSW, Australia
| | - Billy O'Brien
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Kenneth Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jing-Fen Zhang
- Department of Neurology, Baotou Central Hospital, Baotou, China
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Wen-Jie Cao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jim Jannes
- Department of Neurology, The Queen Elizabeth Hospital, Adelaide, NSW, Australia
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mark Parsons
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
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Bakhshayesh B, Hosseininezhad M, Seyed Saadat SM, Hajmanuchehri M, Kazemnezhad E, Ghayeghran AR. Predicting in-hospital mortality in Iranian patients with spontaneous intracerebral hemorrhage. Iran J Neurol 2014; 13:231-6. [PMID: 25632336 PMCID: PMC4300799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/19/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is the most fatal subtype of stroke. Despite limited effective therapy, there is no accepted clinical grading scale to predict in-hospital mortality, especially in developing nations. The purpose of this study was to assess the predictors of in-hospital mortality among a sample of Iranian patients with spontaneous ICH for use at the time of the first evaluation. METHODS This prospective study was carried from January 2010 to the end of January 2011. Demographic, clinical, and laboratory data of ICH patients were collected. Hematoma volume and perihematoma edema (PHE) were measured on brain computed tomography scan using ABC/2 formula. Logistic regression analysis was performed to determine independent variables contributing to in-hospital mortality. RESULTS Of a total 167 consecutive ICH patients, 98 patients met inclusion criteria. Mean ± standard deviation age of patients was 70.16 ± 12.52. After multivariate analysis, five variables remained as independent predictors of in-hospital mortality included: age [odds ratio (OR) = 1.12, 95% confidence interval (CI) = 1.03-1.23, P = 0.009], diabetes mellitus (OR = 10.86, 95% CI = 1.08-109.24, P = 0.009), National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.41, 95% CI = 1.08-1.68, P ≤ 0.001), as well as volume of hematoma (OR = 1.1, 95% CI = 1.03-1.17, P = 0.003), and PHE (OR = 0.75, 95% CI = 0.60-0.93, P = 0.010). CONCLUSION Our results indicate that older age, diabetes mellitus, higher NIHSS, as well as larger volume of hematoma, and smaller PHE on admission are important predictors of in-hospital mortality in our ICH patients.
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Affiliation(s)
- Babak Bakhshayesh
- Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mozaffar Hosseininezhad
- Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | - Ehsan Kazemnezhad
- Department of Biostatistics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir-Reza Ghayeghran
- Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Moghtaderi A, Sanei-Sistani S, Abdollahi G, Dahmardeh H. Comparison of intima-media thickness of common and internal carotid arteries of patients with ischemic stroke and intracerebral hemorrhage. Iran J Neurol 2014; 13:226-30. [PMID: 25632335 PMCID: PMC4300798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 08/30/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Role of atherosclerosis in the pathogenesis of ischemic and hemorrhagic infarctions is still matter of debate. Intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA) are markers of atherosclerosis. The aim of this study was to compare CCA IMT and ICA IMT of patients with ischemic and hemorrhagic infarction. METHODS Two equal groups of 80 patients with small and large vessel ischemic stroke and 80 patients with non-traumatic intracerebral hemorrhage (ICH) who referred to our central teaching hospital of Zahedan were assessed in this descriptive study. IMT of four arteries (right and left CCA and ICA) were measured, and collected data were analysis using Student's t-test. RESULTS There were 137 males (57.1%) and 103 (42.9%) female with mean age of 62.7 ± 11.7. Mean right CCA IMT of patients with small vessel diseases (SVD), large vessel diseases (LVD), and ICH were 0.564 ± 0.130, 0.623 ± 0.150, and 0.580 ± 0.140 mm, respectively (P = 0.032). Mean left CCA IMT of patients with SVD, LVD, and ICH were 0.569 ± 0.120, 0.618 ± 0.120, and 0.573 ± 0.130 mm, respectively (P = 0.039). The above findings for right ICA were 0.572 ± 0.120, 0.569 ± 0.140, and 0.522 ± 0.130 mm, respectively (P = 0.145). Those findings for left ICA IMT were 0.525 ± 0.110, 0.554 ± 0.120, and 0.527 ± 0.120 mm, respectively (P = 0.257). CONCLUSION Our findings showed that by using CCA IMT, differentiation between small and large vessel infarctions and hemorrhagic infarctions can be made.
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Affiliation(s)
- Ali Moghtaderi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sharareh Sanei-Sistani
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ghassem Abdollahi
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamid Dahmardeh
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Koh EJ, Kim SK, Wang KC, Chai JY, Chong S, Park SH, Cheon JE, Phi JH. The return of an old worm: cerebral paragonimiasis presenting with intracerebral hemorrhage. J Korean Med Sci 2012; 27:1428-32. [PMID: 23166429 PMCID: PMC3492682 DOI: 10.3346/jkms.2012.27.11.1428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 07/05/2012] [Indexed: 11/20/2022] Open
Abstract
Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.
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Affiliation(s)
- Eun Jung Koh
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Diagnostic Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
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Hwang SK, Kim JS, Kim JH, Hong CK, Yang KH. Antihypertensive treatment of acute intracerebral hemorrhage by intravenous nicardipine hydrochloride: prospective multi-center study. J Korean Med Sci 2012; 27:1085-90. [PMID: 22969257 PMCID: PMC3429828 DOI: 10.3346/jkms.2012.27.9.1085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/19/2012] [Indexed: 11/23/2022] Open
Abstract
The authors performed a multicenter prospective study to evaluate the feasibility and safety of intravenous nicardipine hydrochloride for acute hypertension in patients with intracerebral hemorrhage (ICH). This study included 88 patients (mean age: 58.3 yr, range 26-87 yr) with ICH and acute hypertension in 5 medical centers between August 2008 and November 2010, who were treated using intravenous nicardipine. Administration of nicardipine resulted in a decrease from mean systolic blood pressure (BP) (175.4 ± 33.7 mmHg) and diastolic BP (100.8 ± 22 mmHg) at admission to mean systolic BP (127.4 ± 16.7 mmHg) and diastolic BP (67.2 ± 12.9 mmHg) in 6 hr after infusion (P < 0.001, mixed-effect linear models). Among patients who underwent follow-up by computed tomography, hematoma expansion at 24 hr (more than 33% increase in hematoma size at 24 hr) was observed in 3 (3.4%) of 88 patients. Neurological deterioration (defined as a decrease in initial Glasgow coma scale ≥ 2) was observed in 2 (2.2%) of 88 patients during the treatment. Aggressive nicardipine treatment of acute hypertension in patients with ICH can be safe and effective with a low rate of neurological deterioration and hematoma expansion.
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Affiliation(s)
- Sung-Kyun Hwang
- Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, Korea.
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Abstract
The factors related to death and functional recovery after primary pontine hemorrhage (PPH) in Koreans has not been well defined. The authors sought to identify independent predictors of death and functional recovery after PPH using data obtained at a single institute. Data were collected retrospectively on 281 patients with PPH admitted to the Stroke Unit at our hospital between January 1, 2000 and December 31, 2009. Multivariate logistic regression analysis was used to evaluate the associations between selected variables and 30-day mortality and 90-day functional recovery after PPH. One-hundred and ten patients (39.1%) died within 30 days of PPH and 27 patients (9.6%) achieved functional recovery within 90 days. By multivariate analysis, unconsciousness, dilated pupils, abnormal respiration, systolic blood pressure < 100 mmHg, hydrocephalus, and conservative treatment were found to be predictors of 30-day mortality, whereas consciousness, intact motor function, no history of hypertension or diabetes mellitus, intact eye movement, a hematoma volume of < 5 mL, no ventricular hemorrhage, and normally sized ventricle were found to be predictors of 90-day functional recovery. The present findings suggest that systolic hypotension of less than 100 mmHg may predict 30-day mortality and a history of underlying hypertension and diabetes mellitus may predict 90-day functional recovery.
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Affiliation(s)
- Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yun Gyu Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Togha M, Gheini MR, Ahmadi B, Khashaiar P, Razeghi S. Lipid profile in cerebrovascular accidents. Iran J Neurol 2011; 10:1-4. [PMID: 24250834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 11/11/2010] [Indexed: 10/27/2022]
Abstract
BACKGROUND Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke. Their role in intra-cerebral hemorrhage, however, is not clear. The present study was designed to evaluate the lipid profile levels of patients who had experienced an acute stroke during the first 24-hour and to compare these levels in different patients suffering from the stroke, either hemorrhagic or ischemic, and healthy individuals. METHODS In this cross-sectional study, 258 consecutive patients with acute stroke admitted to the neurology department of our center during September 2006 and September 2007 were studied. As for the control group, 187 apparently healthy subjects living in the same community and matched for age and sex were selected. Lipid profile was measured and compared between the three groups. RESULTS In the patients' group, 65 suffered from hemorrhagic stroke (group 1) and the other 193 had ischemic stroke (group 2). Except for TG values, there was no significant difference among the ischemic and hemorrhagic lipid profile. Age, cholesterol, and LDL influenced the risk of developing an ischemic stroke; TG was not reported as a risk factor or a protective one. While the comparison of data retrieved from patients suffering from hemorrhagic strokes with the controls, revealed LDL as the risk factor contributing to the development of ICH whereas TG was reported as a protective factor. CONCLUSION It could be concluded that LDL level can be considered as a risk factor for both ischemic and hemorrhagic cerebral events.
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Ali Mousavi S, Khorvash F, Hoseini T. The efficacy of citroline in the treatment of ischemic stroke and primary hypertensive intracereral hemorrhage; a review article. ARYA Atheroscler 2010; 6:122-5. [PMID: 22577428 PMCID: PMC3347821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 08/19/2010] [Indexed: 11/06/2022]
Abstract
Stroke is a medical emergency with a mortality rate higher than most forms of cancer. It is the second leading cause of death in developed countries and the most common cause of serious, long-term disability in adults.Primary intracerebral hemorrhage (ICH) is a major clinical problem that accounts for 15% of all acute stroke hospitalizations. Currently, there is no medical therapy available for these patients, with options being limited to supportive care or invasive neurosurgical evacuation. The damage induced by an ICH appears to be related to a combination of different factors. In addition to direct mechanical disruption from the hematoma, surrounding injury secondary to edema formation and ischemia are contributing factors for brain injury following ICH. Citicoline (cytidine-5-diphosphocholine) is an essential precursor for the synthesis of phosphatidylcholine that is key component of cell membranes. Citicoline is a naturally occurring endogenous compound. For clinical use, the sodium salt of this compound usually utilized. During ischemia, phosphatidylcholine is broken down into free fatty acids, which in turn are used to generate free radicals that potentiate ischemic injury. Citicoline is a neuroprotectant drug with some beneficial effects in human ischemic stroke and primary intracerebral hemorrhage (ICH) with an excellent safety profile.In the current paper, we review published papers regarding use of citicoline in the treatment of human ischemic stroke and primary intracerebral hemorrhage (ICH).
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Affiliation(s)
- Seyed Ali Mousavi
- MD, Associate Professor of Neurology, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence To: Seyed Ali Mousavi,
| | - Fariborz Khorvash
- MD, Assistant Professor of Neurology, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Hoseini
- Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Lee SH, Lim YJ, Choi SK, Kim TS, Rhee BA. Radiosurgical considerations in the treatment of large cerebral arteriovenous malformations. J Korean Neurosurg Soc 2009; 46:378-84. [PMID: 19893730 DOI: 10.3340/jkns.2009.46.4.378] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 10/06/2009] [Accepted: 10/06/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In order to establish the role of Gamma Knife radiosurgery (GKS) in large intracranial arteriovenous malformations (AVMs), we analyzed clinical characteristics, radiological features, and radiosurgical outcomes. METHODS Between March 1992 and March 2005, 28 of 33 patients with large AVMs (> 10 cm(3) in nidus-volume) who were treated with GKS underwent single session radiosurgery (RS), and the other 5 patients underwent staged volumetric RS. Retrospectively collected data were available in 23 cases. We analyzed treatment outcomes in each subdivided groups and according to the AVM sizes. We compared the estimated volume, defined as primarily estimated nidus volume using MR images, with real target volume after excluding draining veins and feeding arteries embedded into the nidus. RESULTS Regarding those patients who underwent single session RS, 44.4% (8/18) had complete obliteration; regarding staged volumetric RS, the obliteration rate was 40% (2/5). The complete obliteration rate was 60% (6/10) in the smaller nidus group (10-15 cm(3) size), and 25% (2/8) in the larger nidus group (over 15 cm(3) size). One case of cerebral edema and two cases (8.7%) of hemorrhage were seen during the latent period. The mean real target volume for 18 single sessions of RS was 17.1 cm(3) (10.1-38.4 cm(3)), in contrast with the mean estimated volume of 20.9 cm(3) (12.0-45.0 cm(3)). CONCLUSION The radiosurgical treatment outcomes of large AVMs are generally poor. However, we presume that the recent development in planning software and imaging devices aid more accurate measurement of the nidus volume, therefore improving the treatment outcome.
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Affiliation(s)
- Sung Ho Lee
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
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