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Zhang L, Zhang Y, Wang X, Zhao Y. Correlation of levels of lactic acid and glucose in cerebrospinal fluid of cerebral hemorrhage patients with the occurrence of postoperative intracranial infection and clinical prognosis. J Med Biochem 2024; 43:36-42. [PMID: 38496025 PMCID: PMC10943468 DOI: 10.5937/jomb0-44058] [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: 03/21/2023] [Accepted: 06/11/2023] [Indexed: 03/19/2024] Open
Abstract
Background Cerebral haemorrhage is a critical condition that often requires surgical treatment, and postoperative intracranial infection can significantly impact patient outcomes. The aim of the study was to examine the relationship between the levels of lactic acid and glucose in cerebrospinal fluid (CSF) of patients with cerebral haemorrhage and their postoperative intracranial infection and clinical prognosis. Methods The study selected the clinical data of 324 patients with cerebral haemorrhage who underwent surgical treatment in our hospital from March 2020 to March 2022 for retrospective analysis and divided these patients into the intracranial infection group (Group A, n=22, leukocyte values in CSF>5×106/L) and the non-intracranial infection group (Group B, n=302, leukocyte values in CSF 5×106/L) according to the occurrence of postoperative intracranial infection in patients to detect the levels of lactic acid and glucose in CSF at different times in the two groups. Pearson method was adopted to analyze the correlation of the levels of lactic acid and glucose in CSF of patients with intracranial infection, and the Glasgow Outcome Scale (GOS) was used to assess the clinical prognosis of patients. According to their scores, these patients were divided into the good prognosis group (GPG, scores of 4-5 points, n=178) and the poor prognosis group (PPG, scores of 1-3 points, n=146). The levels of lactic acid and glucose in the CSF of patients in the two groups were measured, and the Pearson method was adopted to analyze the relationship between these levels and clinical prognosis.
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Affiliation(s)
- Lei Zhang
- Dongying Peoples Hospital, Department of Emergency Critical Care Medicine, Dongying, China
| | - Yan Zhang
- Dongying Peoples Hospital, Department of Emergency Critical Care Medicine, Dongying, China
| | - Xiaotian Wang
- Dongying Peoples Hospital, Department of Emergency Critical Care Medicine, Dongying, China
| | - Yun Zhao
- Dongying Peoples Hospital, Administration Department of Nosocomial Infection Dongying, China
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Ponce D, Ramírez-Guerrero G, Balbi AL. The role of peritoneal dialysis in the treatment of acute kidney injury in neurocritical patients: a retrospective Brazilian study. Perit Dial Int 2024:8968608231223385. [PMID: 38265013 DOI: 10.1177/08968608231223385] [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] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. AKI and its treatment, including acute kidney replacement therapy, can expose patients to a secondary greater brain injury. This study aimed to explore the role of peritoneal dialysis (PD) in neurocritical AKI patients in relation to metabolic and fluid control, complications related to PD and outcome. METHODS Neurocritical AKI patients were treated by PD (prescribed Kt/V = 0.40/session) using a flexible catheter and a cycler and lactate as a buffer. RESULTS A total of 58 patients were included. The mean age was 61.8 ± 13.2 years, 65.5% were in the intensive care unit, 68.5% needed intravenous inotropic agents, 72.4% were on mechanical ventilation, APACHE II was 16 ± 6.67 and the main neurological diagnoses were stroke (25.9%) and intracerebral haemorrhage (31%). Ischaemic acute tubular necrosis (iATN) was the most common cause of AKI (51.7%), followed by nephrotoxic ATN AKI (25.8%). The main dialysis indications were uraemia and hypervolemia. Blood urea and creatinine levels stabilised after four sessions at around 48 ± 11 mg/dL and 2.9 ± 0.4 mg/dL, respectively. Negative fluid balance and ultrafiltration increased progressively and stabilised around 2.1 ± 0.4 L /day. Weekly delivered Kt/V was 2.6 ± 0.31. The median number of high-volume PD sessions was 6 (4-10). Peritonitis and mechanical complications were not frequent (8.6% and 10.3%, respectively). Mortality rate was 58.6%. Logistic regression identified as factors associated with death in neurocritical AKI patients: age (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.09-2.16, p = 0.001), nephrotoxic AKI (OR = 0.78, 95% CI = 0.69- 0.95, p = 0.03), mechanical ventilation (OR = 1.54, 95% CI = 1.17-2.46, p = 0.01), intracerebral haemorrhage as main neurological diagnoses (OR = 1.15, 95% CI = 1.09-2.11, p = 0.03) and negative fluid balance after two PD sessions (OR = 0.94, 95% CI = 0.74-0.97, p = 0.009). CONCLUSION Our study suggests that careful prescription may contribute to providing adequate treatment for most neurocritical AKI patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious, mechanical and metabolic complications. Mechanical ventilation, positive fluid balance and intracerebral haemorrhage were factors associated with mortality, while patients with nephrotoxic AKI had lower odds of mortality compared to those with septic and ischaemic AKI. Further studies are needed to investigate better the role of PD in neurocritical patients with AKI.
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Affiliation(s)
- Daniela Ponce
- Internal Medicine Department, Botucatu School of Medicine, University of Sao Paulo State - UNESP, Brazil
- Internal Medicine Department, Clinical Hospital of Botucatu School of Medicine, Brazil
| | - Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - André Luis Balbi
- Internal Medicine Department, Botucatu School of Medicine, University of Sao Paulo State - UNESP, Brazil
- Internal Medicine Department, Clinical Hospital of Botucatu School of Medicine, Brazil
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Ebaid NY, Mouffokes A, Yasen NS, Elrosasy AM, Philip KG, Assy MM, Alsowey AM. Diagnostic accuracy of dual-energy computed tomography in the diagnosis of neurological complications after endovascular treatment of acute ischaemic stroke: a systematic review and meta-analysis. Br J Radiol 2024; 97:73-92. [PMID: 38263833 PMCID: PMC11027317 DOI: 10.1093/bjr/tqad007] [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: 05/27/2023] [Revised: 09/28/2023] [Accepted: 10/22/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate dual-energy computed tomography's (DECT) diagnostic performance in detecting neurological complications following endovascular therapy (EVT) of acute ischaemic stroke (AIS). METHODS We performed the literature search using Web of Science, Scopus, PubMed, EBSCO, and Science Direct databases for published related studies. The selected studies estimated the validity of DECT in the detection of neurological complications after EVT for AIS. Study quality assessment was performed utilizing the Quality of Diagnostic Accuracy Studies-2 Tool. Our meta-analysis calculated the pooled sensitivity, negative likelihood ratio, specificity, and positive likelihood ratio for each detected complication. The summary receiver operating characteristics (sROC) curve was utilized to estimate the area under the curve (AUC). RESULTS Of 22 studies, 21 were included in the quantitative synthesis. In the detection of intracerebral haemorrhage (ICH), DECT pooled overall sensitivity and specificity were 69.9% (95% CI, 44.5%-86.8%) and 100% (95% CI, 92.1%-100%); whereas, in the detection of ischaemia, they were 85.9% (95% CI, 80.4%-90%) and 90.7% (95% CI, 87%-93.5%), respectively. On the sROC curve, AUC values of 0.954 and 0.952 were recorded for the detection of ICH and ischaemia, respectively. CONCLUSIONS DECT demonstrated high accuracy and specificity in the detection of neurological complications post-endovascular treatment of AIS. However, further prospective studies with a standardized reference test and a larger sample size are recommended to support these findings. ADVANCES IN KNOWLEDGE DECT is a rapid and valid imaging tool for the prediction of ICH and cerebral ischaemia after the EVT of AIS.
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Affiliation(s)
- Noha Yahia Ebaid
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
- Medical Research Group of Egypt, Cairo 11511, Egypt
| | - Adel Mouffokes
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran 31020, Algeria
| | - Noha S Yasen
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Applied Medical Sciences, Misr University for Science and Technology, Cairo 11511, Egypt
| | - Amr M Elrosasy
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, Cairo University, Cairo 11511, Egypt
| | - Kerollos George Philip
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, Sohag University, Sohag 82511, Egypt
| | - Mostafa Mohamad Assy
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
| | - Ahmed Mohamed Alsowey
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
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Storti B, Canavero I, Gabriel MM, Capozza A, Rifino N, Stanziano M, Tagliabue L, Bersano A. Iatrogenic cerebral amyloid angiopathy: An illustrative case of a newly introduced disease. Eur J Neurol 2023; 30:3397-3399. [PMID: 37494007 DOI: 10.1111/ene.15997] [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: 06/22/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND AND PURPOSE Iatrogenic cerebral amyloid angiopathy (iCAA) is a specific type of cerebral amyloid angiopathy which is becoming increasingly diagnosed. It has been hypothesized that iCAA might arise as a late consequence of past neurosurgical interventions involving dural patch grafts. Positron emission tomography (PET) scans with amyloid tracers and the assay of beta-amyloid levels in cerebrospinal fluid (CSF) are auxiliary criteria, however, definite diagnosis remains histopathologically determined. METHODS Case report. RESULTS We present a 48-year-old patient who suffered multiple lobar cerebral haemorrhages from the age of 47. The patient had undergone surgery for remolval of hemangioblastoma with lyophilized dural graft at the age of 11, in 1987. Brain MRI, amiloid PET and CSF analysis led to a diagnosis of probable iCAA. CONCLUSION It is necessary to increase the awareness of iCAA, in order to avoid overlooking the potential causal involvement of surgical procedures which took place far back in time. Moreover, the diagnostic relevance of amyloid PET and beta-amyloid levels in CSF must be emphasised.
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Affiliation(s)
- Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Magdalena Gabriel
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Antonella Capozza
- Nuclear Medicine Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Nicola Rifino
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Luca Tagliabue
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Chabros J, Kayhanian S, Timofeev I, Kolias A, Helmy AE, Anwar F, Hutchinson PJ. Cycling-related cranio-spinal injuries admitted to a Major Trauma Centre in the cycling capital of the UK. Br J Neurosurg 2023:1-11. [PMID: 37698133 DOI: 10.1080/02688697.2023.2255280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND The increased popularity of cycling is leading to an anticipated increase in cycling-related traffic accidents and a need to better understand the demographics and epidemiology of craniospinal injuries in this vulnerable road user group. This study aims to systematically investigate and characterise cycling-related head and spine injuries seen in the Major Trauma Centre for the Eastern region, which has the highest cycling rates in the UK. METHODS We performed a retrospective cohort study comparing the incidence, patterns, and severity of head and spine injuries in pedal cyclists presenting to the Major Trauma Centre in Cambridge between January 2012 and December 2020. Comparisons of injury patterns, characteristics, and associations were made according to mechanism of injury, helmet use, patient age and gender. RESULTS A total of 851 patients were admitted after being involved in cycling-related collisions over the study period, with 454 (53%) sustaining head or spine injuries. The majority of victims (80%) were male and in mid-adulthood (median age 46 years). Head injuries were more common than spine injuries, with the most common head injuries being intracranial bleeds (29%), followed by skull fractures (12%), and cerebral contusions (10%). The most common spine injuries were cervical segment fractures, particularly C6 (9%), C7 (9%), and C2 (8%). Motorised collisions had a higher prevalence of spine fractures at each segment (p < 0.001) and were associated with a higher proportion of multi-vertebral fractures (p < 0.001). These collisions were also associated with impaired consciousness at the scene and more severe systemic injuries, including a lower Glasgow coma scale (R = -0.23, p < 0.001), higher injury severity score (R = 0.24, p < 0.001), and longer length of stay (R = 0.21, p < 0.001). Helmet use data showed that lack of head protection was associated with more severe injuries and poorer outcomes. CONCLUSION As cycling rates continue to increase, healthcare providers may expect to see an increase in bicycle-related injuries in their practice. The insights gained from this study can inform the treatment of these injuries while highlighting the need for future initiatives aimed at increasing road safety and accident prevention.
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Affiliation(s)
- Jeremi Chabros
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Saeed Kayhanian
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Angelos Kolias
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Adel E Helmy
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Fahim Anwar
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Kam JKP, Dodds JM, Kam JKT, Dawes BH, Ghani M. Outcomes after inter-hospital transfer of intensive care patients with haemorrhagic stroke: a 5-year retrospective review. ANZ J Surg 2023; 93:1957-1963. [PMID: 36947603 DOI: 10.1111/ans.18426] [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: 10/27/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Inter-hospital transfer (IHT) of intensive care patients is a limited resource. We assessed the outcomes of patients with haemorrhagic stroke requiring IHT and intensive care and aimed to identify early prognostic factors of poor neurological outcome. METHODS We conducted a retrospective observational cohort study of patients admitted to a single tertiary intensive care unit (ICU) with haemorrhagic stroke after IHT between January 2014 and December 2018. Primary outcome was poor neurological outcome (modified Rankin Scale ≥4 at time of discharge from hospital or rehabilitation unit). Secondary outcomes were mortality rate, rate of intervention, rate of organ donation surgery (ODS) and potentially avoidable transfer (PAT). PAT was defined as transfer where the patient did not receive an intervention and had a poor neurological outcome. RESULTS Ninety patients were included in this study, 48 with intracerebral haemorrhage (ICH) and 42 with subarachnoid haemorrhage (SAH). Fifty-one (56.7%) patients had a poor neurological outcome, including 30 (33%) who died. Factors significantly associated with poor neurological outcome included age > 80 years, lower presenting Glasgow Coma Score (GCS) and bilaterally fixed and dilated pupils. Stepwise logistic regression demonstrated history of hypertension as significantly associated with poor neurological outcome in patients with ICH (P = 0.021). Seven (7.8%) patients had ODS. Sixty-four (71.1%) patients received intervention and 20 (22.2%) transfers were potentially avoidable. CONCLUSIONS Patients in this cohort are at high risk of poor neurological outcome. Prognostic factors identified in this study may help referring, retrieval and receiving clinicians to discuss futility prior to pursuing IHT.
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Affiliation(s)
- Jeffrey K P Kam
- Department of Intensive Care Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Jarron M Dodds
- Department of Intensive Care Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jeremy K T Kam
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Bryden H Dawes
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Manisa Ghani
- Department of Intensive Care Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Hu N, An R, Yu K, Chang Y, Gao W. PF4 induces inflammatory response through NF-kB signal pathway in rats with intra cerebral haemorrhage. Folia Neuropathol 2023; 61:379-386. [PMID: 38174673 DOI: 10.5114/fn.2023.130449] [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] [Indexed: 01/05/2024] Open
Abstract
Intracerebral haemorrhage (ICH) is a lethal cerebrovascular disorder with a high mortality and morbidity. Although it is a major public health problem, there is no effective treatment for ICH. After ICH, the primary and secondary mechanisms are mentioned when discussing brain injury. The transcription factor, nuclear factor-kappa B (NF-kB), is an important regulator of inflammatory responses. The role of platelet factor 4 (PF4) in ICH is unclear. To study the effect of PF4 on inflammatory response of rats in ICH, a rat model of striatum ICH was established by injecting autologous blood from the autogenous femoral artery into the right striatum of rats. Forty-eight hours after ICH, the expression of PF4, NF-kB (P-P65) and inflammatory changes in rats were determined with WB and ELISA. Heme was used to induce PC12 cell damage, simulate the ICH model in vitro, and detect PF4, P-P65 and striatal inflammatory changes. Short hairpin RNA (shRNA-PF4) was used to knock-down the expression of PF4 in PC12 cells to detect changes in inflammatory factors. The results showed that 48 hours after surgery, the behavioural score of cerebral haemorrhage was the lowest. The expression of PF4 and P-P65 in the striatum of the ICH group was significantly higher compared with the sham surgery group. The expression of interleukin (IL)-6 and IL-1b in the ICH group was also greatly improved. After inhibiting NF-kB expression, PF4 expression was decreased. In short, ICH enhances the expression of PF4, which induces an inflammatory response in rats with cerebral haemorrhage through the NF-kB signalling pathway. Reducing the expression of PF4 can attenuate the inflammatory response.
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Affiliation(s)
- Na Hu
- Hebei Normal University Biology Postdoctoral Research Station, College of Life Science, Hebei Normal University, China
- Hebei University of Chinese Medicine, China
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, China
| | - Ran An
- Hebei University of Chinese Medicine, China
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, China
| | - Kun Yu
- Hebei University of Chinese Medicine, China
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, China
| | - Yanzhong Chang
- Hebei Normal University Biology Postdoctoral Research Station, College of Life Science, Hebei Normal University, China
- College of Life Sciences, Hebei Normal University, China
| | - Weijuan Gao
- Hebei University of Chinese Medicine, China
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, China
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Neri S, Gasparini S, Pascarella A, Santangelo D, Cianci V, Mammì A, Lo Giudice M, Ferlazzo E, Aguglia U. Epilepsy in Cerebrovascular Diseases: A Narrative Review. Curr Neuropharmacol 2023; 21:1634-1645. [PMID: 35794769 PMCID: PMC10514540 DOI: 10.2174/1570159x20666220706113925] [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: 01/14/2022] [Revised: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epilepsy is a common comorbidity of cerebrovascular disease and an increasing socioeconomic burden. OBJECTIVE We aimed to provide an updated comprehensive review on the state of the art about seizures and epilepsy in stroke, cerebral haemorrhage, and leukoaraiosis. METHODS We selected English-written articles on epilepsy, stroke, and small vessel disease up until December 2021. We reported the most recent data about epidemiology, pathophysiology, prognosis, and management for each disease. RESULTS The main predictors for both ES and PSE are the severity and extent of stroke, the presence of cortical involvement and hemorrhagic transformation, while PSE is also predicted by younger age at stroke onset. Few data exist on physiopathology and seizure semiology, and no randomized controlled trial has been performed to standardize the therapeutic approach to post-stroke epilepsy. CONCLUSION Some aspects of ES and PSE have been well explored, particularly epidemiology and risk factors. On the contrary, few data exist on physiopathology, and existing evidence is mainly based on studies on animal models. Little is also known about seizure semiology, which may also be difficult to interpret by non-epileptologists. Moreover, the therapeutic approach needs standardization as regards indications and the choice of specific ASMs. Future research may help to better elucidate these aspects.
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Affiliation(s)
- Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Domenico Santangelo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Michele Lo Giudice
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
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Gürbüz H, Topçu H, Topcu H. Estimating the Outcomes of Intra cerebral Haemorrhage with Intracerebral Haemorrhage Score and Acute Physiology and Chronic Health Evaluation-II Score: A Multicentre Study. Turk J Anaesthesiol Reanim 2022; 50:410-415. [PMID: 36511489 PMCID: PMC9885778 DOI: 10.5152/tjar.2022.21422] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Spontaneous intracerebral haemorrhage causes mortality or leads to permanent disability in most of the survivors. Thus, determining the severity of the disease to predict mortality and morbidity is important. This study aimed to evaluate Acute Physiology and Chronic Health Evaluation-II and Intracerebral Haemorrhage scores in spontaneous intracerebral haemorrhage patients treated in intensive care units. METHODS This multicenter study was conducted in 2 tertiary care hospitals' general intensive care units. Short- (in-hospital) and long-term (1-year) mortality and functional outcomes at discharge were evaluated using the Intracerebral Haemorrhage and Acute Physiology and Chronic Health Evaluation-II scores. RESULTS Of the 35 spontaneous intracerebral haemorrhage patients analysed, the modified Ranking Scale was <4 in 10 (28.6%) patients and ≥4 in 25 (71.4%) patients. The in-hospital mortality was 51.4%, and 1-year mortality was 60%. The discriminative power of Acute Physiology and Chronic Health Evaluation-II was excellent (area under the curve ≥0.9), and Intracerebral Haemorrhage Score was fair (area under the curve ≥0.7) for both in-hospital mortality and poor outcomes at discharge. The area under the curve of Acute Physiology and Chronic Health Evaluation-II was significantly higher than the area under the curve of Intracerebral Haemorrhage score. CONCLUSION Acute Physiology and Chronic Health Evaluation-II score is a better model with high sensitivity and specificity than the Intracerebral Haemorrhage score in predicting the in-hospital mortality and functional outcomes at the discharge of spontaneous intracerebral haemorrhage patients. However, the Acute Physiology and Chronic Health Evaluation-II score lacks the neuroradiologic features that are crucial for spontaneous intracerebral haemorrhage. Therefore, the Intracerebral Haemorrhage score can be used as an indicator of neurological status combined with the Acute Physiology and Chronic Health Evaluation-II score rather than as a predictive model of outcomes.
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Affiliation(s)
- Hande Gürbüz
- Department of Anaesthesiology and Reanimation, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey,Corresponding author: Hande Gürbüz, e-mail:
| | - Hülya Topçu
- Department of Anaesthesiology and Reanimation, Hitit University, Erol Olçok Training and Research Hospital, Çorum, Turkey
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Wilson MH, Ashworth E, Hutchinson PJ. A proposed novel traumatic brain injury classification system - an overview and inter-rater reliability validation on behalf of the Society of British Neurological Surgeons. Br J Neurosurg 2022; 36:633-638. [PMID: 35770478 DOI: 10.1080/02688697.2022.2090509] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The measurement of traumatic brain injury (TBI) 'severity' has traditionally been based on the earliest Glasgow Coma Score (GCS) recorded, however, the underlying parenchymal pathology is highly heterogonous. This heterogeneity renders prediction of outcome on an individual patient level inaccurate and makes comparison between patients both in clinical practice and research difficult. The complexity of this heterogeneity has resulted in generic all encompassing 'traumatic brain injury protocols'. Early management and studies of neuro-protectants are often done irrespective of TBI type, yet it may well be that a specific treatment may be beneficial in a subset of TBI pathologies. METHODS A simple CT-based classification system rating the recognised types of blunt TBI (extradural, subdural, subarachnoid haemorrhage, contusions/intracerebral haematoma and diffuse axonal injury) as mild (1), moderate (2) or severe (3) is proposed. Hypoxic brain injury, a common secondary injury following TBI, is also included. Scores can be combined to reflect concomitant types of TBI and predominant location of injury is also recorded. To assess interrater reliability, 50 patient CT images were assessed by 5 independent clinicians of varying experience. Interrater reliability was calculated using overall agreement through Cronbach's alpha including confidence intervals for intra-class coefficients. RESULTS Interrater reliability scores showed strong agreement for same score and same injury for TBIs with blood on CT and Cronbach's alpha co-efficient (range 0.87-0.93) demonstrated excellent correlation between raters. Cronbach's alpha was not affected when individual raters were removed. CONCLUSIONS The proposed simple CT classification system has good inter-rater reliability and hence potentially could enable better individual prognostication and targeted treatments to be compared while also accounting for multiple intracranial injury types. Further studies are proposed and underway.
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Affiliation(s)
- Mark H Wilson
- Imperial Neurotrauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Biomedical Research Centre, Imperial College, The Bays, 2 South Wharf Road, London, UK
| | - Emily Ashworth
- Imperial Neurotrauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Biomedical Research Centre, Imperial College, The Bays, 2 South Wharf Road, London, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
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11
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Lorman-Carbó B, Clua-Espuny JL, Muria-Subirats E, Ballesta-Ors J, González-Henares MA, Pallejà-Millán M, Martín-Luján FM. Adjusted Morbidity Groups and Intra cerebral Haemorrhage: A Retrospective Primary Care Cohort Study. Int J Environ Res Public Health 2021; 18:13320. [PMID: 34948927 DOI: 10.3390/ijerph182413320] [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: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
Background: Intracerebral haemorrhage rates are increasing among highly complex, elderly patients. The main objective of this study was to identify modifiable risk factors of intracerebral haemorrhage. Methods: Multicentre, retrospective, community-based cohort study was conducted, including patients in the Adjusted Morbidity Group 4 with no history of intracerebral haemorrhage. Cases were obtained from electronic clinical records of the Catalan Institute of Health and were followed up for five years. The primary outcome was the occurrence of intracerebral haemorrhage during the study period. Demographic, clinical and pharmacological variables were included. Logistic regression analyses were carried out to detect prognostic variables for intracerebral haemorrhage. Results: 4686 subjects were included; 170 (3.6%) suffered an intracerebral haemorrhage (85.8/10,000 person–year [95% CI 85.4 to 86.2]). The HAS-BLED score for intracerebral haemorrhage risk detection obtained the best AUC (0.7) when used in the highest complexity level (cut-off point ≥3). Associated independent risk factors were age ≥80 years, high complexity and use of antiplatelet agents. Conclusions: The Adjusted Morbidity Group 4 is associated with a high risk of intracerebral haemorrhage, particularly for highly complex patients and the use of antiplatelet agents. The risk of bleeding in these patients must be closely monitored.
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12
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Bachmann H, Cambron M, Casselman JW, Van Driessche V, Van Haute E, Van Hijfte L, Kelderman T, Hemelsoet D, Laureys G. Alemtuzumab in multiple sclerosis: A retrospective analysis of occult hemorrhagic magnetic resonance imaging lesions and risk factors. Eur J Neurol 2021; 28:4209-4213. [PMID: 34374173 DOI: 10.1111/ene.15054] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/16/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Alemtuzumab, a monoclonal CD52 antibody, is a high-efficacy disease-modifying-therapy in relapsing-remitting multiple sclerosis (RRMS). Recently, intracerebral hemorrhage (ICH) was reported as a possible treatment-related adverse event. Arterial hypertension during infusion was suggested as a potential cause, although platelet or endothelial dysfunction may also contribute. This study aimed to screen for occult hemorrhagic cerebral lesions after alemtuzumab treatment and to further elucidate risk factors. METHODS We included 30 RRMS patients who received alemtuzumab treatment at Ghent University Hospital or Sint-Jan Bruges Hospital. Retrospective data concerning vital signs, adverse effects and thrombocyte levels during treatment were collected. The occurrence of occult intracranial hemorrhagic lesions was assessed by magnetic resonance imaging with susceptibility-weighted imaging (SWI). RESULTS The mean (standard deviation [SD]) systolic blood pressure (SBP) during the morning, afternoon and evening was 120 (3.38) mmHg during first administration and 114 (4.40) mmHg during second administration (N = 13). There was no significant increase in SBP when comparing morning, afternoon and evening per day, nor was there a significant difference in daily mean SBP between consecutive administration days. Thrombocyte count during treatment cycles ranged between 107 × 109 /L and 398 × 109 /L, with a mean (SD) absolute reduction of 59.3 × 109 /L (50.65) or a mean (SD) relative reduction of 25.0 (12.84)% (N = 20). No patient had ICH, nor did SWI show any cerebral microbleeds or other hemorrhagic lesions post-treatment (N = 23). CONCLUSIONS In our patient population, alemtuzumab treatment was not associated with arterial hypertension, ICH or occult microbleeds. Possible differences in administration regimen (ambulatory vs. in-hospital setting) and patient population (cardiovascular risk) might explain an increased risk in different populations.
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13
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Tay MRJ. Hospital readmission in stroke survivors one year versus three years after discharge from inpatient rehabilitation: Prevalence and associations in an Asian cohort. J Rehabil Med 2021; 53:jrm00208. [PMID: 34096610 PMCID: PMC8814857 DOI: 10.2340/16501977-2849] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the prevalence and risk factors for readmission after inpatient rehabilitation in stroke survivors, in a developed multi-ethnic Southeast Asian country. METHODS A retrospective cohort study of 1,235 stroke survivors who completed inpatient rehabilitation in a tertiary rehabilitation centre. RESULTS A total of 296 (24.0%) patients with stroke were readmitted within the first year, and 87 (7.0%) patients were readmitted 1-3 years after stroke. Significant risk factors for readmission of patients in the first year post-stroke were older age (p = 0.027), lower admission Functional Independence Measure (FIM) motor (p = 0.001) and cognition scores (p = 0.025), a Charlson Comorbidity Index (CCI) ≥1 (p < 0.001) and the presence of at least 1 medical complication during initial hospitalization (p < 0.001), while FIM gain was found to be protective (p < 0.001). Looking at readmission after 1 year post-stroke, a CCI≥1 (p < 0.001) and the presence of medical complications during initial hospitalization (p < 0.001) were risk factors for readmission, while FIM gain (p = 0.001) was protective. Common causes for readmission include recurrent stroke and falls. CONCLUSION There is a high readmission rate in stroke survivors, even after the first year post-stroke. Interventions, such as fall risk assessments, vaccinations, meticulous catheter care, intensified secondary risk factors interventions and continued post-discharge rehabilitation, may hold promise for reducing readmission rates.
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14
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Sun F, Liu H, Fu HX, Zhang S, Qian XD, Li JJ, Zhu YB, Zhang XX, Zhang J, Qiu HP, Kang LL, Hu YJ, Zhao L, Mi YJ, Gao YJ, Dou ZJ, Ma Z. Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction. J Int Med Res 2021; 48:300060519895352. [PMID: 32357116 PMCID: PMC7221219 DOI: 10.1177/0300060519895352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/21/2022] Open
Abstract
Objective Cerebral infarction has a poor prognosis and causes a serious burden on
families and society. Recombinant tissue plasminogen activator (rt-PA) and
urokinase (UK) are commonly used thrombolytic agents in the clinic. However,
direct and powerful clinical trial evidence to determine the therapeutic
effect of rt-PA and UK on intravenous thrombolysis is lacking. Methods In this study, 180 patients with acute cerebral infarction were treated with
rt-PA or UK. The National Institutes of Health Stroke Scale (NIHSS) scores,
Barthel index, bleeding complications, and biomarkers were evaluated. Results No significant differences in NIHSS or Barthel scores were found between the
groups. However, UK increased the risk of intracranial haemorrhage compared
with rt-PA. rt-PA had increased activity in reducing serum levels of MMP-9
than UK. Conclusion Intravenous thrombolysis with rt-PA and UK in the time window of acute
cerebral infarction can achieve similar therapeutic effects, but rt-PA can
further reduce the risk of cerebral haemorrhage and is relatively safer than
UK.
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Affiliation(s)
- Fan Sun
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Heng Liu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Hui-Xiao Fu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Shuo Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xu-Dong Qian
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jia-Jia Li
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yun-Bo Zhu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xiao-Xuan Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jian Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Hai-Peng Qiu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Ling-Ling Kang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Ya-Jun Hu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Liang Zhao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan-Juan Mi
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan-Jun Gao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhi-Jie Dou
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zheng Ma
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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15
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Lange KS, Taieb G, Lepretre P, De La Cruz E, Arquizan C, Gaillard N. A rare cause of midbrain haemorrhage. Eur J Neurol 2020; 28:e22-e24. [PMID: 33332693 DOI: 10.1111/ene.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kristin S Lange
- Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Guillaume Taieb
- Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Pierre Lepretre
- Department of Neuroradiology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Elisa De La Cruz
- Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
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16
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Damien C, Cisse F, Ligot N, Toure ML, Konaté M, Barry SD, Saw M, Naeije G. Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study. Trop Med Int Health 2020; 26:166-172. [PMID: 33159424 DOI: 10.1111/tmi.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. METHODS Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. RESULTS Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. CONCLUSIONS Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.
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Affiliation(s)
- C Damien
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - F Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - N Ligot
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M L Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - M Konaté
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - S D Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - M Saw
- Centre de Diagnostic Caisse Nationale de Sécurité Sociale, Conakry, Guinea
| | - G Naeije
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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17
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Zaouak Y, Sadeghi N, Sarbu N, Ligot N, Lubicz B. Differentiation between Cerebral Hemorrhage and Contrast Extravasation Using Dual Energy Computed Tomography after Intra-Arterial Neuro Interventional Procedures. J Belg Soc Radiol 2020; 104:70. [PMID: 33283150 DOI: 10.5334/jbsr.2083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the value of dual-energy computed tomography (DECT) in differentiating cerebral hemorrhage from blood brain barrier (BBB) disruption after neuro-interventional procedures with intra-arterial injection of iodinated contrast material. Material and methods: This prospective study was approved by the local ethics committee, and informed consent was obtained for all patients. Thirty five patients with acute ischemic stroke or un-ruptured brain aneurysm who had received intra-arterial administration of iodinated contrast material were evaluated using DECT at 80 and 150 kV immediately after the procedure. A three-material decomposition algorithm was used to obtain virtual non-contrast (VNC) images and iodine overlay maps (IOM). A follow-up examination (brain magnetic resonance imaging MRI or conventional CT) was used as the standard of reference for hemorrhage, defined as a persistant hyperdensity on a conventional CT or T2* hypo-intensity on brain MRI. The diagnostic values of DECT in differentiating hemorrhage and iodinated contrast material were obtained. Results: Mixed images obtained with DECT showed intra-parenchymal or subarachnoid hyperattenuation in 18/35 patients. Among these, 16 were classified (according to VNC images and IOM) as contrast extravasations and two with a mixture of hemorrhage and contrast material. On follow-up imaging, there were two patients with hemorrhage. The sensitivity, specificity, and accuracy of DECT in the identifying hemorrhage was calculated as 67% (2/3), 100% (32/32) and 97% (32/33) respectively. Conclusion: DECT allows an early and accurate differentiation between cerebral hemorrhage and BBB disruption after intra-arterial neuro-interventional procedures.
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18
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Campanella W, Pedrini R, Vestito L, Marinelli L, Trompetto C, Mori L. Transcranial Direct Current Stimulation in the Treatment of Subacute Post-Stroke Thalamic Aphasia. Eur J Case Rep Intern Med 2020; 7:001794. [PMID: 33194851 DOI: 10.12890/2020_001794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background Although many studies have demonstrated the effectiveness of transcranial direct current stimulation (tDCS) in improving speech recovery in post-stroke aphasia, as far as we know patients affected by thalamic aphasia have never been investigated. Patient and method A 65-year-old man with severe non-fluent aphasia due to a left thalamic haemorrhagic stroke underwent intensive daily speech therapy combined with tDCS. Results The patient showed progressive improvement with almost complete recovery of his speech disorder, behavioural disinhibition and apathy. Conclusions Our findings suggest that tDCS with concurrent speech therapy can be useful in patients with subcortical stroke lesions. LEARNING POINTS The thalamus has a central role in the development of the higher functions, such as memory, regulation of behaviour and emotions, and language elaboration.Transcranial direct current stimulation (tDCS) applied to the cerebral cortex is a promising tool for improving language recovery in patients with post-stroke aphasia.Combined treatment with tDCS and speech and language therapy (SLT) was effective in a patient with subacute thalamic aphasia, who showed improvement in all aspects of linguistic and behavioural communication.
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Affiliation(s)
- William Campanella
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Riccardo Pedrini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | | | - Lucio Marinelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Laura Mori
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
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19
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Stösser S, Ullrich L, Kassubek J, Ludolph AC, Schocke M, Neugebauer H. Recent silent infarcts do not increase the risk of haemorrhage after intravenous thrombolysis. Eur J Neurol 2020; 27:2483-2490. [PMID: 32702146 DOI: 10.1111/ene.14453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Haemorrhagic transformation (HT) is one of the main risks of intravenous thrombolysis (IVT) for acute ischaemic stroke. Contraindications serve to exclude patients at high risk of HT after IVT. One of these contraindications is a stroke within the preceding 3 months. It is unclear if this contraindication should include recent clinically silent infarcts (RSIs). The aim of this study was to investigate whether RSIs are associated with a higher risk of HT and a worse clinical outcome after IVT for acute ischaemic stroke. METHODS In a retrospective monocentric cohort study, all patients who received IVT for acute ischaemic stroke based on magnetic resonance imaging were assessed over 5 years. RSIs were defined as lesions with diffusion restriction and positive signal on fluid attenuated inversion recovery sequences. Patients with RSIs (RSI+) were compared to patients without RSIs (RSI-) regarding HT after IVT and clinical outcome. RESULTS In all, 981 patients who had received IVT for acute ischaemic stroke demonstrated by magnetic resonance imaging were identified. RSIs were detected in 115 patients (11.5%). HT after IVT was observed in 32 (28.3%) RSI+ and 56 (25.8%) RSI- patients (P = 0.624). Symptomatic intracerebral haemorrhage was noted in two (1.8%) RSI+ and five (2.3%) RSI- patients (P = 1.000). No differences in clinical outcome were observed. CONCLUSIONS The detection of RSIs in patients treated with IVT for acute ischaemic stroke was not associated with a higher risk of HT or a worse clinical outcome. The results of this study argue against considering RSIs as a contraindication for IVT.
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Affiliation(s)
- S Stösser
- Department of Neurology, University of Ulm, Ulm, Germany
| | - L Ullrich
- Department of Neurology, University of Ulm, Ulm, Germany
| | - J Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - A C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany
| | - M Schocke
- Department of Radiology, University and Rehabilitation Hospital Ulm, Ulm, Germany
| | - H Neugebauer
- Department of Neurology, University of Ulm, Ulm, Germany
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20
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Alvarez-Perez FJ, Paiva F, Lino CA. Intraventricular hemorrhage as clinical presentation of herpes simplex virus encephalitis. A case report and review of the literature. Int J Neurosci 2020; 131:1254-1259. [PMID: 32597277 DOI: 10.1080/00207454.2020.1787409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Herpes simplex virus encephalitis (HSVE) represents the most common cause of sporadic encephalitis in humans. The development of intracerebral hematomas is rare and late during the course of HSVE. To report a case of a patient with HSVE who initially presented a diffuse intracranial hemorrhage with predominant intraventricular bleeding. CASE REPORT A 66-year-old man was admitted to the Emergency Department with acute headache. Antecedents: alcohol consumption and ethylic hepatopathy. The brain computed tomography showed acute tetraventricular hemorrhage and hydrocephalus. The blood analysis showed pancytopenia and alteration of all hepatic parameters. After external drainage of cerebrospinal fluid the patient presented a worsening of headache, disorientation, mild left hemiparesis, neck stiffness and temperature of 37.6 °C. The cerebrospinal fluid was hemorrhagic, with 3 lymphocytes/mm3, 60 mg/dL of proteins and PCR positive for Herpes simplex virus type 1. The patient improved with intravenous acyclovir, however he experienced several medical complications which caused his dead. DISCUSSION The patient presented an atypical cerebral bleeding related to HSVE because the development of hematoma was early and the topography of hemorrhage was basically intraventricular. Probably, both atypical characteristics were related to thrombocytopenia and severe coagulation disorder. This case expands the spectrum of cerebrovascular disorders associated with HSVE.
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Affiliation(s)
- F J Alvarez-Perez
- Stroke Unit, Cova da Beira University Hospital, Covilhã, Portugal.,Health Sciences Research Center, Medicine Department, Health Sciences Faculty, Beira Interior University, Covilhã, Portugal
| | - F Paiva
- Stroke Unit, Cova da Beira University Hospital, Covilhã, Portugal
| | - C A Lino
- Stroke Unit, Cova da Beira University Hospital, Covilhã, Portugal
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21
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Tsivgoulis G, Katsanos AH, Seiffge DJ, Paciaroni M, Wilson D, Koga M, Macha K, Cappellari M, Kallmünzer B, Polymeris AA, Toyoda K, Caso V, Werring DJ, Engelter ST, De Marchis GM. Fatal intracranial haemorrhage occurring after oral anticoagulant treatment initiation for secondary stroke prevention in patients with atrial fibrillation. Eur J Neurol 2020; 27:1612-1617. [PMID: 32333493 DOI: 10.1111/ene.14280] [Citation(s) in RCA: 8] [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: 03/15/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE In this pooled analysis of seven multicentre cohorts potential differences were investigated in the incidence, characteristics and outcomes between intracranial haemorrhages (ICHs) associated with the use of non-vitamin K antagonist oral anticoagulants (NOAC-ICH) or with vitamin K antagonists (VKA-ICH) in ischaemic stroke patients after oral anticoagulant treatment initiation for atrial fibrillation (AF). METHODS Data from 4912 eligible AF patients who were admitted in a stroke unit with ischaemic stroke or transient ischaemic attack and who were treated with either VKAs or NOACs within 3 months post-stroke were included. Fatal ICH was defined as death occurring during the first 30 days after ICH onset. A meta-analysis of available observational studies reporting 30-day mortality rates from NOAC-ICH or VKA-ICH onset was additionally performed. RESULTS During 5970 patient-years of follow-up 71 participants had an ICH, of whom 20 were NOAC-ICH and 51 VKA-ICH. Patients in the two groups had comparable baseline characteristics, except for the higher prevalence of kidney disease in VKA-ICH patients. There was a non-significant higher number of fatal ICH in patients with VKAs (11 events per 3385 patient-years) than in those with NOACs (three events per 2623 patient-years; hazard ratio 0.32, 95% confidence interval 0.09-1.14). Three-month functional outcomes were similar (P > 0.2) in the two groups. The meta-analysis showed a lower 30-day mortality risk for patients with NOAC-ICH compared to VKA-ICH (relative risk 0.70, 95% confidence interval 0.51-0.95). CONCLUSIONS Non-vitamin K oral anticoagulants for intracranial haemorrhages and VKA-ICH occurring during secondary stroke prevention of AF patients have comparable baseline characteristics and outcomes except for the risk of fatal ICH within 30 days, which might be greater in VKA-ICH.
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Affiliation(s)
- G Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens School of Medicine, Attikon' University Hospital, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - A H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - D J Seiffge
- Neurology and Stroke Center, University Hospital and University of Basel, Basel, Switzerland.,Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - D Wilson
- Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - M Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - K Macha
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Cappellari
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - B Kallmünzer
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A A Polymeris
- Neurology and Stroke Center, University Hospital and University of Basel, Basel, Switzerland
| | - K Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - V Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - D J Werring
- Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - S T Engelter
- Neurology and Stroke Center, University Hospital and University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland
| | - G M De Marchis
- Neurology and Stroke Center, University Hospital and University of Basel, Basel, Switzerland
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Ling W, Cui Y, Gao J, Li R, Jiang X, Tian Y, Wang K, Cui J. Antcin C ameliorates neuronal inflammation due to cerebral haemorrhage by inhibiting the TLR-4 pathway. Folia Neuropathol 2020; 58:317-23. [PMID: 33480236 DOI: 10.5114/fn.2020.102434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study investigated the protective effects of antcin C against cerebral haemorrhage injury. MATERIAL AND METHODS Cerebral haemorrhage was treated with antcin C 100 mg/kg i.p. at 60 min after the induction of cerebral injury. Neurological scores and volumes of cerebral injury were assessed to determine the effects of antcin C, based on oxidative stress and serum mediators of inflammation by ELISA. qRT-PCR was used to estimate the mRNA expression of Toll-like receptor 4 (TLR-4) and interleukin-1 receptor-associated kinase 4 (IRAK4) proteins in the cerebral tissue of rats with cerebral haemorrhage. Western blot assay and histopathology were also performed. RESULTS The findings suggest that treatment with antcin C reduced the neurological scores and volumes of cerebral injury in cerebral injured rats. Parameters of oxidative stress and cytokine levels were reduced in the serum of the antcin C-treated group compared with the negative control group. Treatment with antcin C ameliorated the expression of TLR-4, IRAK4, and zonula occludens-1 (ZO-1) proteins in the cerebral tissue of cerebral injured rats. CONCLUSIONS The results revealed that treatment with antcin C protected against cerebral haemorrhage damage by controlling microglia inflammation through the TLR-4 pathway.
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Howes A, Hilditch C, Keir A. What clinical practice strategies have been shown to decrease incidence rates of intraventricular haemorrhage in preterm infants? J Paediatr Child Health 2019; 55:1269-1278. [PMID: 31629388 DOI: 10.1111/jpc.14613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 01/23/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022]
Abstract
AIM To answer the clinical question 'In infants about to be delivered and admitted to neonatal units, what clinical practice strategies, compared to standard care, have been shown to decrease incidence rates of intraventricular haemorrhage (IVH)?' METHODS MEDLINE via Ovid (1943 to 5 January 2018), Embase via Ovid (1974 to 5 January 2018) and the Cochrane Library (5 January 2018) were searched for relevant articles. RESULTS A total of 478 articles, after the removal of duplicates, were found and screened by title and abstract. Forty full-text articles were subsequently reviewed, and 19 were included as relevant to the structured clinical question. An additional article was included based on expert advice. CONCLUSION There are various levels of research evidence for clinical practice strategies to decrease the incidence rates of IVH. Higher-quality evidence suggests that antenatal corticosteroids decrease the rates of IVH, and multiple evidence-based intervention bundles implemented in the neonatal unit are associated with decreased rates of IVH.
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Affiliation(s)
- Alexander Howes
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Cathie Hilditch
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Obstetrics and Gynaecology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Keir
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Obstetrics and Gynaecology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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24
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Pana TA, Wood AD, Perdomo-Lampignano JA, Tiamkao S, Clark AB, Kongbunkiat K, Bettencourt-Silva JH, Sawanyawisuth K, Kasemsap N, Mamas MA, Myint PK. Impact of heart failure on stroke mortality and recurrence. Heart Asia 2019; 11:e011139. [PMID: 31244914 DOI: 10.1136/heartasia-2018-011139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 11/03/2022]
Abstract
Objective We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. Methods We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. Results 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). Conclusions HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.
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Affiliation(s)
- Tiberiu A Pana
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Adrian D Wood
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jesus A Perdomo-Lampignano
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Somsak Tiamkao
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kannikar Kongbunkiat
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Kittisak Sawanyawisuth
- Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narongrit Kasemsap
- North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand.,Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Yanhua X, Suxian Z. Cerebral Haemorrhage in a Young Patient With Atypical Werner Syndrome Due to Mutations in LMNA. Front Endocrinol (Lausanne) 2018; 9:433. [PMID: 30123186 PMCID: PMC6085819 DOI: 10.3389/fendo.2018.00433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/13/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction: Werner syndrome is a rare genetic disorder; classical Werner syndrome is caused by mutations in the WRN gene. However, recent research has shown that LMNA gene mutations can also cause premature ageing syndromes such as atypical Werner syndrome (AWS). AWS usually manifests as muscular damage, defects in the cardiac conduction system, lipoatrophy, diabetes, atherosclerosis, and premature ageing. Clinical presentation: A 24-year-old man presented with severe abdominal aortic and peripheral artery disease and cerebral haemorrhage. He was prescribed once-daily 20 mg atorvastatin. Another large cerebral haemorrhage occurred 8 months after discharge. Although he underwent minimally invasive intracranial haematoma surgery, paralysis set in. Molecular studies showed a missense mutation within exon 5 (c.898G>C) that caused amino acid aspartate 300 to be replaced by histidine (p.Asp300His) in the LMNA gene. The patient was diagnosed with AWS. Conclusions: Haemorrhagic stroke and progeroid features may be manifestations of LMNA-linked AWS. In such cases, the patient's family history and genetic background should be investigated. WRN and LMNA gene testing of the proband and the immediate family should be considered. This case report provides a deeper understanding of the role of LMNA mutations in AWS.
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Affiliation(s)
- Xiao Yanhua
- Affiliated Hospital of Guilin Medical College, Guilin, China
- Guilin People's Hospital, Guilin, China
| | - Zhou Suxian
- Affiliated Hospital of Guilin Medical College, Guilin, China
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26
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Ciszek B, Jóźwiak R, Sobieszczuk E, Przelaskowski A, Skadorwa T. Stroke Bricks - spatial brain regions to assess ischaemic stroke localisation. Folia Morphol (Warsz) 2017; 76:568-573. [PMID: 28353303 DOI: 10.5603/fm.a2017.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/30/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
Computer-aided analysis of non-contrast computed tomography (NCCT) images for rapid diagnosis of ischaemic stroke is based on the augmented visualisation of evolving ischaemic lesions. Computerised support of NCCT often leads to overinterpretation of ischaemic areas, thus it is of great interest to provide neurologically verified regions in order to improve accuracy of subsequent radiological assessment. We propose Stroke Bricks (StBr) as an arbitrary spatial division of brain tissue into the regions associated with specific clinical symptoms of ischaemic stroke. Neurological stroke deficit is formally translated into respective areas of possible ischaemic lesions. StBr were designed according to formalised mapping of neurological symptoms and were attributed to the uniquely defined areas of impaired blood supply. StBr concept may be useful for an integrated radiological CT-based assessment of suspected stroke cases or can be included into computer-aided tools to optimise the evaluation of stroke site and its extent. These data in turn are appropriable for further diagnosis, predicting the therapeutic outcome as well as for patients' qualification for an appropriate form of reperfusion therapy. The usefulness of StBr was illustrated in the case studies.
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Affiliation(s)
- B Ciszek
- Department of Descriptive and Clinical Anatomy, Centre of Biostructure Research, Medical University of Warsaw Chałubińskiego 5, 02-004 Warsaw Department of Neurosurgery, Bogdanowicz Memorial Hospital, Niekłańska 4/24, 03-924 Warsaw.
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27
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Giner-Soriano M, Roso-Llorach A, Vedia Urgell C, Castells X, Capellà D, Ferreira-González I, Elorza-Ricart JM, Casajuana M, Troncoso Mariño A, Diògene E, Bolíbar B, Violan C, Morros R. Effectiveness and safety of drugs used for stroke prevention in a cohort of non-valvular atrial fibrillation patients from a primary care electronic database. Pharmacoepidemiol Drug Saf 2016; 26:97-107. [PMID: 27868275 DOI: 10.1002/pds.4137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 03/22/2016] [Revised: 10/04/2016] [Accepted: 10/25/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to assess effectiveness and safety of antithrombotics for stroke prevention in non-valvular atrial fibrillation in real-use conditions. METHODS We used a population-based retrospective cohort study. Information emerges from SIDIAP, a database containing anonymized information from electronic health records from 274 primary healthcare centres of the Catalan Health Institute, Catalonia (Spain), with a reference population of 5 835 000 people. Population includes all adults with a new diagnosis of non-valvular atrial fibrillation registered in SIDIAP from 2007 to 2012. The main outcome of antithrombotics' effectiveness was stroke. The main outcomes of safety were cerebral and gastrointestinal haemorrhages. We also estimated all-cause mortality. We used multivariable Cox proportional hazard models to examine association between antithrombotic treatment and main outcomes. RESULTS We included 22 205 subjects with non-valvular atrial fibrillation; 40.8% initiated on vitamin K antagonists (VKA), 33.4% on antiplatelets and 25.8% untreated. We found stroke-risk reduction with VKA, hazard ratio (HR) 0.72 (95% confidence interval (CI), 0.58-0.91), also seen in patients with CHADS2 ≥ 2, HR 0.65 (95%CI, 0.49-0.86), and CHA2 DS2 -VASc ≥ 2, HR 0.66 (95%CI, 0.52-0.84). We observed a higher risk of digestive bleeding with antiplatelets, HR 1.32 (95%CI, 1.01-1.73). Both VKA and antiplatelets were associated with reduction of all-cause mortality risk; HR 0.55 (95%CI, 0.49-0.62) and HR 0.89 (95%CI, 0.80-0.97), respectively. CONCLUSIONS This study found a stroke-risk reduction associated with VKA and an increased risk of gastrointestinal bleeding associated with platelet-aggregation inhibitors in comparison with untreated patients. Both antithrombotic groups showed a reduction in all-cause mortality. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Albert Roso-Llorach
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Cristina Vedia Urgell
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Unitat de farmàcia, Servei d'Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Spain
| | - Xavier Castells
- Translab Research Group, Unitat de Farmacologia Clínica, Departament de Ciències Mèdiques, Facultat de Medicina, UdG, Girona, Spain
| | - Dolors Capellà
- Translab Research Group, Unitat de Farmacologia Clínica, Departament de Ciències Mèdiques, Facultat de Medicina, UdG, Girona, Spain
| | - Ignacio Ferreira-González
- Unidad de Epidemiología del Servicio de Cardiología, Hospital Vall d'Hebron y CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Marc Casajuana
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Amelia Troncoso Mariño
- Unitat de Coordinació i Estratègia del Medicament, Institut Català de la Salut, Barcelona, Spain
| | - Eduard Diògene
- Servei de Farmacologia, Hospital Vall d'Hebron, Barcelona, Spain
| | - Bonaventura Bolíbar
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Concepció Violan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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Budts W, Laenens D, Van Calenbergh F, Vermeersch P, De Potter T, Aminian A, Benit E, Stammen F, Kefer J. Left atrial appendage occlusion with the Amplatzer Cardiac Plug could improve survival and prevent thrombo-embolic and major bleeding events in atrial fibrillation patients with increased bleeding risk. Acta Cardiol 2016; 71:135-43. [PMID: 27090034 DOI: 10.2143/ac.71.2.3141842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIMS Literature suggests a beneficial effect of percutaneous left atrial appendage occlusion (LAAO) to prevent thrombo-embolic events in patients with non-rheumatic atrial fibrillation (AF). We compared outcome of LAAO versus ‘suboptimal standard’ treatment in AF patients with high bleeding risk. METHODS AND RESULTS Patients with sufficient follow-up data (n = 125) who underwent LAAO with the Amplatzer Cardiac Plug (ACP) were selected from the Belgian ACP database. AF patients who survived intracranial haemorrhage were recruited from the Leuven Neurosurgical Registry (LNR, n = 113). After propensity score adjustment, the outcome of both groups was compared for the combined end point (death, stroke, transient ischaemic attack, systemic emboli, and major bleeding event). The LAAO group did not differ from the LNR group for mean age and gender (74 ± 7 versus 75 ± 10 years, P = 0.29; female 39% versus 48%, P = 0.18). However, the CHA2DS2-VASc and HAS-BLED scores were both higher in the LAAO group (4.8 ± 1.7 versus 3.9 ± 1.7, P = 0.0001; 3.5 ± 1.4 versus 3.2 ± 1.4, P = 0.036). After propensity score adjustment, the risk for the primary end point was significantly higher for the LNR group (HR 2.012, 95% CI 1.113-3.638). CONCLUSION LAAO with ACP seems to improve the combination of survival and the prevention of thrombo-embolic and major bleeding events in patients with atrial fibrillation and increased bleeding risk.
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Abstract
The use of antithrombotic medicines in patients who have a history of intracerebral haemorrhage is widely perceived as being contraindicated. However, many patients with intracerebral haemorrhage may suffer from conditions for which antithrombotic medicines are indicated. Such scenarios represent a therapeutic dilemma whereby treating infers an increased risk of recurrent intracerebral haemorrhage, but not treating infers an increase of thrombotic complications. Despite the importance of this dilemma, there is very little guidance for prescribers. This perspective review considered previous systematic reviews that addressed this issue, together with recently published research findings from the Tayside Stroke Cohort. Systematic reviews of experimental and observational studies have concluded that there is a marked lack of data on which to judge the safety of oral anticoagulant agents following intracerebral haemorrhage. In addition, the limited data available regarding the use of antiplatelet medicines following intracerebral haemorrhage provide no evidence that they are harmful, and again further data are required. In the absence of such data, a decision analysis approach has been proposed. This considers the findings of other studies to infer the likely impact of using antithrombotic agents in patients with intracerebral haemorrhage. The success of this approach is contingent on the availability of reliable data that describe the rate of recurrent intracerebral haemorrhage; however, published data on this varies widely. There are a number of factors that conspire against researchers addressing this issue. The current paucity of evidence to guide prescribers faced with this therapeutic dilemma seems likely to remain for some time.
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Affiliation(s)
- Robert Flynn
- Medicines Monitoring Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Alexander Doney
- Centre for Cardiovascular & Lung Biology, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Kallmünzer B, Tauchi M, Schlachetzki JC, Machold K, Schmidt A, Winkler J, Schwab S, Kollmar R. Granulocyte colony-stimulating factor does not promote neurogenesis after experimental intra cerebral haemorrhage. Int J Stroke 2013; 9:783-8. [PMID: 24920160 DOI: 10.1111/ijs.12217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hematopoietic growth factors have been suggested to induce neuroprotective and regenerative effects in various animal models of cerebral injury. However, the pathways involved remain widely unexplored. AIMS This study aimed to investigate effects of local and systemic administration of granulocyte colony-stimulating factor on brain damage, functional recovery, and cerebral neurogenesis in an intracerebral haemorrhage whole blood injection model in rats. METHODS Eight-week-old male Wistar rats (n = 100) underwent induction of striatal intracerebral haemorrhage by autologous whole blood injection or sham procedure and were randomly assigned to either (a) systemic treatment with granulocyte colony-stimulating factor (60 μg/kg) for five-days; (b) single intracerebral injection of granulocyte colony-stimulating factor (60 μg/kg) into the cavity; or (c) application of vehicle for five-days. Bromodeoxyuridine-labelling and immunohistochemistry were used to analyze proliferation and survival of newly born cells in the sub-ventricular zone and the hippocampal dentate gyrus. Moreover, functional deficits and lesion volume were assessed until day 42 after intracerebral haemorrhage. RESULTS Differences in lesion size or hemispheric atrophy between granulocyte colony-stimulating factor-treated and control groups did not reach statistical significance. Neither systemic, nor local granulocyte colony-stimulating factor administration induced neurogenesis within the dentate gyrus or the sub-ventricular zone. The survival of newborn cells in these regions was prevented by intracerebral granulocyte colony-stimulating factor application. A subtle benefit in functional recovery at day 14 after intracerebral haemorrhage induction was observed after granulocyte colony-stimulating factor treatment. CONCLUSION There was a lack of neuroprotective or neuroregenerative effects of granulocyte colony-stimulating factor in the present rodent model of intracerebral haemorrhage. Conflicting results from functional outcome assessment require further research.
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Affiliation(s)
- Bernd Kallmünzer
- Department of Neurology, University Medical Center Erlangen, Germany
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Abstract
The objective of this study was to evaluate clinical symptoms and findings on cranial ultrasound (CUS) in preterm infants with cerebellar haemorrhage through retrospective analysis of all preterm infants with a postnatal CUS or MRI diagnosis of cerebellar haemorrhage admitted in a tertiary care centre between January 2002 and June 2009. Fifteen infants were identified; median gestational age was 25 2/7 weeks and median birth weight 730 g. We discerned six types of haemorrhage: subarachnoid (n = 3), folial (n = 1), lobar (n = 9, of which 4 bilateral), giant lobar (n = 1, including vermis) and contusional (n = 1). Especially in infants with lobar cerebellar haemorrhage, CUS showed preceding or concurrent lateral ventricle dilatation, mostly without intraventricular haemorrhage (IVH). Thirteen infants suffered from notable, otherwise unexplained motor agitation in the days preceding the diagnosis. In conclusion, motor agitation may be a presenting symptom of cerebellar haemorrhage in preterm infants. Unexplained ventriculomegaly can be a first sign of cerebellar haemorrhage and should instigate sonographic exploration of the cerebellum.
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Affiliation(s)
- Ginette M. Ecury-Goossen
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Sophia Children’s Hospital Erasmus MC, dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
| | - Jeroen Dudink
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Sophia Children’s Hospital Erasmus MC, dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
| | - Maarten Lequin
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Monique Feijen-Roon
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Sandra Horsch
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Abstract
The global burden of stroke, the undisputed success of intravenous thrombolysis in the management of myocardial infarction and subsequent evidence from animal models of cerebral infarction have all fuelled intense interest in the potential role for thrombolytic agents in the acute management of stroke in clinical practice. Before any clinical treatment is introduced universally its safety and efficacy must be demonstrated in the routine clinical environment and not just within the ideal conditions of controlled clinical trials. Similarly, the cost effectiveness of a new treatment modality is an essential consideration before its use is promulgated. This paper reviews the current scientific evidence for thrombolysis in stroke with reference to issues of safety, efficacy and cost effectiveness.
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Zahuranec DB, Gonzales NR, Brown DL, Lisabeth LD, Longwell PJ, Eden SV, Smith MA, Garcia NM, Hoff JT, Morgenstern LB. Presentation of intra cerebral haemorrhage in a community. J Neurol Neurosurg Psychiatry 2006; 77:340-4. [PMID: 16484640 PMCID: PMC2077701 DOI: 10.1136/jnnp.2005.077164] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND Studies on intracerebral haemorrhage (ICH) from tertiary care centres may not be an accurate representation of the true spectrum of disease presentation. OBJECTIVE To describe the clinical and imaging presentation of ICH in a community devoid of the referral bias of an academic medical centre; and to investigate factors associated with lower Glasgow coma scale (GCS) score at presentation, as GCS is crucial to early clinical decision making. METHODS The study formed part of the BASIC project (Brain Attack Surveillance in Corpus Christi), a population based stroke surveillance study in a bi-ethnic Texas community. Cases of first non-traumatic ICH were identified from years 2000 to 2003, using active and passive surveillance. Clinical data were collected from medical records by trained abstractors, and all computed tomography (CT) scans were reviewed by a study physician. Multivariable linear regression was used to identify clinical and CT predictors of a lower GCS score. RESULTS 260 cases of non-traumatic ICH were identified. Median ICH volume was 11 ml (interquartile range 3 to 36) with hydrocephalus noted in 45%. Median initial GCS score was 12.5 (7 to 15). Hydrocephalus score (p = 0.0014), ambient cistern effacement (p = 0.0002), ICH volume (p = 0.014), and female sex (p = 0.024) were independently associated with lower GCS score at presentation, adjusting for other variables. CONCLUSIONS ICH has a wide range of severity at presentation. Hydrocephalus is a potentially reversible cause of a lower GCS score. Since early withdrawal of care decisions are often based on initial GCS, recognition of the important influence of hydrocephalus on GCS is warranted before withdrawal of care decisions are made.
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Affiliation(s)
- D B Zahuranec
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI 48109-0316, USA
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