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Shimoni Z, Danilov V, Hadar S, Froom P. Head Computed Tomography Scans in Elderly Patients with Low Velocity Head trauma after a Fall. Isr Med Assoc J 2021; 23:359-363. [PMID: 34155849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Recommendations for a head computed tomography (CT) scan in elderly patients without a loss of consciousness after a traumatic brain injury and without neurological findings on admission and who are not taking oral anticoagulant therapy, are discordant. OBJECTIVES To determine variables associated with intracranial hemorrhage (ICH) and the need for neurosurgery in elderly patients after low velocity head trauma. METHODS In a regional hospital, we retrospectively selected 206 consecutive patients aged ≥ 65 years with head CT scans ordered in the emergency department because of low velocity head trauma. Outcome variables were an ICH and neurological surgery. Independent variables included age, sex, disability, neurological findings, facial fractures, mental status, headache, head sutures, loss of consciousness, and anticoagulation therapy. RESULTS Fourteen patients presented with ICH (6.8%, 3.8-11.1%) and three (1.5%, 0.3-4.2%) with a neurosurgical procedure. One patient with a coma (0.5, 0.0-2.7) died 2 hours after presentation. All patients who required surgery or died had neurological findings. Reducing head CT scans by 97.1% (93.8-98.9%) would not have missed any patient with possible surgical utility. Twelve of the 14 patients (85.7%) with an ICH had neurological findings, post-trauma loss of consciousness or a facial fracture were not present in 83.5% (95% confidence interval 77.7-88.3) of the cohort. CONCLUSIONS None of our patients with neurological findings required neurosurgery. Careful palpation of the facial bones to identify facial fractures might aid in the decision whether to perform a head CT scan.
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Affiliation(s)
- Zvi Shimoni
- Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Vendi Danilov
- Department of Neurology, Laniado Hospital, Netanya, Israel
| | - Shoshana Hadar
- Department of Neurology, Laniado Hospital, Netanya, Israel
| | - Paul Froom
- Department of Clinical Utility, Laniado Hospital, Netanya, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mahmood A, Needham K, Shakur-Still H, Harris T, Jamaluddin SF, Davies D, Belli A, Mohamed FL, Leech C, Lotfi HM, Moss P, Lecky F, Hopkins P, Wong D, Boyle A, Wilson M, Darwent M, Roberts I. Effect of tranexamic acid on intracranial haemorrhage and infarction in patients with traumatic brain injury: a pre-planned substudy in a sample of CRASH-3 trial patients. Emerg Med J 2021; 38:270-278. [PMID: 33262252 PMCID: PMC7982942 DOI: 10.1136/emermed-2020-210424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early tranexamic acid (TXA) treatment reduces head injury deaths after traumatic brain injury (TBI). We used brain scans that were acquired as part of the routine clinical practice during the CRASH-3 trial (before unblinding) to examine the mechanism of action of TXA in TBI. Specifically, we explored the potential effects of TXA on intracranial haemorrhage and infarction. METHODS This is a prospective substudy nested within the CRASH-3 trial, a randomised placebo-controlled trial of TXA (loading dose 1 g over 10 min, then 1 g infusion over 8 hours) in patients with isolated head injury. CRASH-3 trial patients were recruited between July 2012 and January 2019. Participants in the current substudy were a subset of trial patients enrolled at 10 hospitals in the UK and 4 in Malaysia, who had at least one CT head scan performed as part of the routine clinical practice within 28 days of randomisation. The primary outcome was the volume of intraparenchymal haemorrhage (ie, contusion) measured on a CT scan done after randomisation. Secondary outcomes were progressive intracranial haemorrhage (post-randomisation CT shows >25% of volume seen on pre-randomisation CT), new intracranial haemorrhage (any haemorrhage seen on post-randomisation CT but not on pre-randomisation CT), cerebral infarction (any infarction seen on any type of brain scan done post-randomisation, excluding infarction seen pre-randomisation) and intracranial haemorrhage volume (intraparenchymal + intraventricular + subdural + epidural) in those who underwent neurosurgical haemorrhage evacuation. We planned to conduct sensitivity analyses excluding patients who were severely injured at baseline. Dichotomous outcomes were analysed using relative risks (RR) or hazard ratios (HR), and continuous outcomes using a linear mixed model. RESULTS 1767 patients were included in this substudy. One-third of the patients had a baseline GCS (Glasgow Coma Score) of 3 (n=579) and 24% had unilateral or bilateral unreactive pupils. 46% of patients were scanned pre-randomisation and post-randomisation (n=812/1767), 19% were scanned only pre-randomisation (n=341/1767) and 35% were scanned only post-randomisation (n=614/1767). In all patients, there was no evidence that TXA prevents intraparenchymal haemorrhage expansion (estimate=1.09, 95% CI 0.81 to 1.45) or intracranial haemorrhage expansion in patients who underwent neurosurgical haemorrhage evacuation (n=363) (estimate=0.79, 95% CI 0.57 to 1.11). In patients scanned pre-randomisation and post-randomisation (n=812), there was no evidence that TXA reduces progressive haemorrhage (adjusted RR=0.91, 95% CI 0.74 to 1.13) and new haemorrhage (adjusted RR=0.85, 95% CI 0.72 to 1.01). When patients with unreactive pupils at baseline were excluded, there was evidence that TXA prevents new haemorrhage (adjusted RR=0.80, 95% CI 0.66 to 0.98). In patients scanned post-randomisation (n=1431), there was no evidence of an increase in infarction with TXA (adjusted HR=1.28, 95% CI 0.93 to 1.76). A larger proportion of patients without (vs with) a post-randomisation scan died from head injury (38% vs 19%: RR=1.97, 95% CI 1.66 to 2.34, p<0.0001). CONCLUSION TXA may prevent new haemorrhage in patients with reactive pupils at baseline. This is consistent with the results of the CRASH-3 trial which found that TXA reduced head injury death in patients with at least one reactive pupil at baseline. However, the large number of patients without post-randomisation scans and the possibility that the availability of scan data depends on whether a patient received TXA, challenges the validity of inferences made using routinely collected scan data. This study highlights the limitations of using routinely collected scan data to examine the effects of TBI treatments. TRIAL REGISTRATION NUMBER ISRCTN15088122.
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Affiliation(s)
- Abda Mahmood
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Kelly Needham
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Haleema Shakur-Still
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Tim Harris
- Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - David Davies
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Caroline Leech
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Hamzah Mohd Lotfi
- Emergency Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Phil Moss
- Clinical Research Unit, Emergency Department, Saint George's University Hospitals NHS Foundation Trust, London, UK
| | - Fiona Lecky
- Accident & Emergency, Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip Hopkins
- Emergency Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Darin Wong
- Emergency Department, Penang General Hospital, Georgetown, Malaysia
| | - Adrian Boyle
- Emergency Department, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Wilson
- Neurosurgeries, Emergencies & Trauma, Division of Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Melanie Darwent
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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3
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Menacho ST, Grandhi R, Delic A, Anadani M, Ziai WC, Awad IA, Hanley DF, de Havenon A. Impact of Intracranial Pressure Monitor-Guided Therapy on Neurologic Outcome After Spontaneous Nontraumatic Intracranial Hemorrhage. J Stroke Cerebrovasc Dis 2021; 30:105540. [PMID: 33360250 PMCID: PMC8080544 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105540] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/05/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Intracranial pressure (ICP) monitors have been used in some patients with spontaneous intracranial hemorrhage (ICH) to provide information to guide treatment without clear evidence for its use in this population. We assessed the impact of ICP monitor placement, including external ventricular drains and intraparenchymal monitors, on neurologic outcome in this population. MATERIALS AND METHODS In this secondary analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III trial, the primary outcome was poor outcome (modified Rankin Scale score 4-6) and the secondary outcome was death, at 1 year from onset. We compared outcomes in patients with or without an ICP monitor using unadjusted and adjusted logistic regression models. The analyses were repeated in a balanced cohort created with propensity score matching. RESULTS Seventy patients underwent ICP monitor placement and 424 did not. Poor outcome was seen in 77.1% of patients in the ICP-monitor subgroup compared with 53.8% in the no-monitor subgroup (p<0.001). Of patients in the ICP-monitor subgroup, 31.4% died, compared with 21.0% in the no-monitor subgroup (p=0.053). In multivariate models, ICP monitor placement was associated with a >2-fold greater risk of poor outcome (odds ratio 2.76, 95% CI 1.30-5.85, p=0.008), but not with death (p=0.652). Our findings remained consistent in the propensity score-matched cohort. CONCLUSION These results question whether ICP monitor-guided therapy in patients with spontaneous nontraumatic ICH improves outcome. Further work is required to define the causal pathway and improve identification of patients that might benefit from invasive ICP monitoring.
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Affiliation(s)
- Sarah T Menacho
- Departments of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
| | - Ramesh Grandhi
- Departments of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Alen Delic
- Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Mohammad Anadani
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Wendy C Ziai
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Issam A Awad
- Department of Neurosurgery, The University of Chicago School of Medicine, Chicago, IL, USA
| | - Daniel F Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam de Havenon
- Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
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4
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Chan YQ, Lee ZM, Tan SL. Laparoscopic splenic artery ligation in a patient with immune thrombocytopenia with intracranial haemorrhage (two clips that stopped a timebomb). Med J Malaysia 2020; 75:433-435. [PMID: 32724010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intracranial haemorrhage (ICH) in a patient with relapse of idiopathic thrombocytopaenic purpura (ITP) can be lethal. The site of haemorrhage, compounded by low platelets in this disease, makes its management extremely challenging, especially when a neurosurgical procedure is warranted. We report a case report of an unconventional way of increasing platelet counts in ITP rapidly in an emergency setting.
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Affiliation(s)
- Y Q Chan
- Hospital Tengku Ampuan Rahimah, Department of General Medicine, Klang, Selangor, Malaysia.
| | - Z M Lee
- Hospital Tengku Ampuan Rahimah, Department of General Medicine, Klang, Selangor, Malaysia
| | - S L Tan
- Hospital Tengku Ampuan Rahimah, Department of General Medicine, Haematology Unit, Klang, Selangor, Malaysia
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Kaiser EE, Waters ES, Fagan MM, Scheulin KM, Platt SR, Jeon JH, Fang X, Kinder HA, Shin SK, Duberstein KJ, Park HJ, West FD. Characterization of tissue and functional deficits in a clinically translational pig model of acute ischemic stroke. Brain Res 2020; 1736:146778. [PMID: 32194080 PMCID: PMC10671789 DOI: 10.1016/j.brainres.2020.146778] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022]
Abstract
The acute stroke phase is a critical time frame used to evaluate stroke severity, therapeutic options, and prognosis while also serving as a major tool for the development of diagnostics. To further understand stroke pathophysiology and to enhance the development of treatments, our group developed a translational pig ischemic stroke model. In this study, the evolution of acute ischemic tissue damage, immune responses, and functional deficits were further characterized. Stroke was induced by middle cerebral artery occlusion in Landrace pigs. At 24 h post-stroke, magnetic resonance imaging revealed a decrease in ipsilateral diffusivity, an increase in hemispheric swelling resulting in notable midline shift, and intracerebral hemorrhage. Stroke negatively impacted white matter integrity with decreased fractional anisotropy values in the internal capsule. Like patients, pigs showed a reduction in circulating lymphocytes and a surge in neutrophils and band cells. Functional responses corresponded with structural changes through reductions in open field exploration and impairments in spatiotemporal gait parameters. Characterization of acute ischemic stroke in pigs provided important insights into tissue and functional-level assessments that could be used to identify potential biomarkers and improve preclinical testing of novel therapeutics.
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Affiliation(s)
- Erin E Kaiser
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Elizabeth S Waters
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Madison M Fagan
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Kelly M Scheulin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Simon R Platt
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - Julie H Jeon
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| | - Xi Fang
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| | - Holly A Kinder
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Soo K Shin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States; Department of Pharmaceutical and Biomedical Sciences, Interdisciplinary Toxicology Institute, University of Georgia, Athens, GA, United States
| | - Kylee J Duberstein
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Hea J Park
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States; Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States; Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States.
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6
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Csecsei P, Tarkanyi G, Bosnyak E, Szapary L, Lenzser G, Szolics A, Buki A, Hegyi P, Abada A, Molnar T. Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry. J Stroke Cerebrovasc Dis 2020; 29:104851. [PMID: 32402722 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/18/2020] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intracranial hemorrhages (ICH) are classified as symptomatic or asymptomatic according to the presence of clinical deterioration. Here, we aimed to find predictive factors of symptomatic intracranial bleeding in a registry-based stroke research. METHODS Data of consecutive patients with acute ischemic stroke (AIS) were extracted from the prospective STAY ALIVE stroke registry. Analysis of the total population and treatment sugroups such as endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or their combination (IVT+EVT) were also done. Outcome measures were ICH, 30- and 90-day clinical outcome based on the modified Rankin Scale (mRS:0-2 as favorable outcome). The hemorrhage was captured by a non-enhanced CT of the skull within 24 h after procedure. RESULTS A total of 355 patients (mean age: 68±11; female N=177 (49.9%); EVT n=131 (36.9%); IVT n=157 (44.2%); IVT+EVT n=67 (18.9%) were included in the analysis. The total number of ICH was 47 (13%), symptomatic (sICH) 12 (3.4%) and asymptomatic (aICH) 35 (9.9%) in the whole population. NIHSS ≥15.5 at 24 post stroke hours predicted sICH with a sensitivity of 100% and a specificity of 92% (p<0.001). Furthermore, lower age, good collateral circulation on initial CT angiography and lower NIHSS score measured at 24 h independently associated with a favorable 90-day outcome, whereas baseline NIHSS and ASPECT score were not. CONCLUSION Although partial recanalization, ASPECT< 6, and poor collaterals were significantly associated with sICH, the only independent predictor was NIHSS ≥15.5 at 24 post stroke hours. This suggests a careful evaluation of patients with worsening NIHSS despite an adequate therapy.
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Affiliation(s)
- Peter Csecsei
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary.
| | - Gabor Tarkanyi
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary
| | - Edit Bosnyak
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary
| | - Laszlo Szapary
- Department of Neurology, University of Pecs, Medical School, Ifjusag u. 13., Pecs 7623, Hungary
| | - Gabor Lenzser
- Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary
| | - Alex Szolics
- Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary
| | - Andras Buki
- Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary
| | - Peter Hegyi
- Institute for Translational Medicine, University of Pecs, Medical School, Pecs, Hungary
| | - Alan Abada
- Department of Anaesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
| | - Tihamer Molnar
- Department of Anaesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary
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Yaghmoor BE, Alotaibi SM, Enani MZ, AlQudsi HS, Aljehani MA, Althomali MH, Hisan FM, Sindi GJ, Alshoaibi NA, Sabbagh AJ. Electrocardiographic changes following intracranial haemorrhage: a retrospective cohort study. Neurosciences (Riyadh) 2020; 25:104-111. [PMID: 32351247 PMCID: PMC8015531 DOI: 10.17712/nsj.2020.2.20190109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To improve the understanding of the association between electrocardiographic (ECG) abnormalities and clinical outcomes of patients with all types of intracranial hemorrhage (ICH). METHODS A retrospective cohort study was conducted in a tertiary healthcare hospital on patients with ICH without cardiac disease or renal disease requiring dialysis. Demographic and clinical data were collected from hospital records. ECG record were obtained within 24 hours of presentation and prior to treatment. Records were interpreted for this study by a cardiologist blinded to other data. RESULTS Assessment of 291 patients (228 adults and 63 children) showed that subdural hemorrhage was the most common type of ICH (31.6%) followed by intraparenchymal hemorrhage (23.0%). ECG records were available for 98 patients. ECG abnormalities were most commonly nonspecific ST-segment changes (32.6%). In adults, history of neurological disease was associated with atrioventricular block (p=.004) and QTc prolongation (p=.041). Pediatric patients exhibited associations between ST-segment changes (p=.045) and sinus tachycardia (p=.027) and type of ICH. However, ECG changes were not statistically associated with clinical outcomes in adults or children. CONCLUSION Significant ECG changes frequently occurred in patients with all types of ICH but did not consistently predict the outcome in this study. Close observation of patients is still recommended to detect ECG changes that could affect the treatment.
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Affiliation(s)
- Bassam E Yaghmoor
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail:
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8
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Pande SD, Win MM, Khine AA, Zaw EM, Manoharraj N, Lolong L, Tin AS. Haemorrhagic transformation following ischaemic stroke: A retrospective study. Sci Rep 2020; 10:5319. [PMID: 32210323 PMCID: PMC7093519 DOI: 10.1038/s41598-020-62230-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/05/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to identify the prevalence of haemorrhagic transformation (HT) in patients with ischaemic stroke, and evaluate its association with medical comorbidities, stroke subtypes, premorbid medication, and long-term survival. To achieve this, we performed a retrospective analysis of 527 consecutive stroke rehabilitation patients. Of these, 102 (19.4%) developed HT. Older patients, and those with large artery strokes, had a higher risk of HT. Forty-one patients received alteplase (rtPA), of which 15 (36.6%) developed HT. A total of 129 (24.5%) patients were taking aspirin prior to their stroke and, of these, 39 (30.2%) developed HT. Twenty-three (4.36%) patients were taking vitamin k antagonists, prior to stroke, of which 14 (60.9%) developed HT. There were 102 patients (19.35%) with underlying atrial fibrillation, of whom 55 (53.9%) developed HT. Patients with known ischaemic heart disease had an increased risk of HT, and patients with HT had significantly lower total cholesterol levels (4.96 vs. 5.34) and lower LDL cholesterol levels (3.20 vs. 3.5). In conclusion, older age, atrial fibrillation, treatment with oral anticoagulants and antiplatelet medications prior to stroke, low total and LDL cholesterol, and rtPA use, are all associated with HT. Survival was not affected by the presence of HT.
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Affiliation(s)
- S D Pande
- Department of Rehabilitation medicine, Changi General Hospital, Singapore, Singapore.
| | - M M Win
- Department of Rehabilitation medicine, Changi General Hospital, Singapore, Singapore
| | - A A Khine
- Department of Rehabilitation medicine, Changi General Hospital, Singapore, Singapore
| | - E M Zaw
- Department of Rehabilitation medicine, Changi General Hospital, Singapore, Singapore
| | - N Manoharraj
- Department of Rehabilitation medicine, Changi General Hospital, Singapore, Singapore
| | - L Lolong
- Department of Rehabilitation medicine, Changi General Hospital, Singapore, Singapore
| | - A S Tin
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
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9
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Abstract
The origin of secondary brainstem hemorrhages following an acute expansive hemispheric lesion has been attributed to Henri Duret, who proposed that hemorrhaging was caused by a shock wave through the cerebral spinal fluid. However, other experiments have shown important findings correlating brainstem hemorrhages to arterial hemorrhages. Animal studies found that the rapidity of expansion of a lesion would be crucial in producing these lesions, but there was no consistent correlation with paratentorial grooving so commonly seen with increased intracranial pressure. This historical perspective studies the different experimentalists who paved the way for the discovery of these secondary brainstem hemorrhages-often named after Duret-and now known not to be invariably associated with poor outcome.
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Affiliation(s)
- Eelco F M Wijdicks
- Division of Neurocritical Care and Hospital Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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10
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Cucci MD, Benken ST. Blood pressure variability in the management of hypertensive emergency: A narrative review. J Clin Hypertens (Greenwich) 2019; 21:1684-1692. [PMID: 31553128 PMCID: PMC8030327 DOI: 10.1111/jch.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/09/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022]
Abstract
Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta-analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage. This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.
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Affiliation(s)
| | - Scott T. Benken
- University of Illinois Medical CenterUniversity of Illinois‐Chicago College of PharmacyChicagoIllinois
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de Havenon A, Fino NF, Johnson B, Wong KH, Majersik JJ, Tirschwell D, Rost N. Blood Pressure Variability and Cardiovascular Outcomes in Patients With Prior Stroke: A Secondary Analysis of PRoFESS. Stroke 2019; 50:3170-3176. [PMID: 31537194 PMCID: PMC6817411 DOI: 10.1161/strokeaha.119.026293] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Every year in the United States, almost 185 000 ischemic strokes occur in patients with a prior stroke. Recurrent stroke has significantly higher morbidity and mortality. Among modifiable risk factors for recurrent stroke, hypertension is the most prevalent. Reducing systolic blood pressure is standard of care for secondary stroke prevention. Recent literature suggests that increased blood pressure variability (BPV) is associated with primary stroke, although studies have not convincingly shown that it is associated with recurrent stroke, which was the goal of this analysis. Methods- We conducted a secondary analysis of 17 916 patients in the PRoFESS (Prevention Regimen for Effectively Avoiding Second Strokes) trial, which is the largest trial of patients with potential recurrent stroke. We calculated BPV and evaluated its effect on recurrent stroke (composite and stratified by ischemic or hemorrhagic stroke), major cardiovascular events (death from cardiovascular causes, recurrent stroke, myocardial infarction, or new or worsening heart failure), and all-cause death. Results- Both systolic and diastolic BPV were associated with recurrent stroke, major cardiovascular events, and all-cause death. The association with stroke was significant for ischemic, but not hemorrhagic, stroke. For every 10-point increase in BPV (systolic SD, range =0-54.2), the hazard ratio for a recurrent ischemic stroke was 1.15 (95% CI, 1.02-1.32; P=0.02), for major cardiovascular events was 1.19 (95% CI, 1.09-1.31; P<0.001), and for all-cause death was 1.24 (95% CI, 1.10-1.39; P<0.001). Conclusions- Our study adds to the growing body of literature suggesting that BPV is an important and potentially modifiable risk factor for ischemic stroke, cardiovascular events, and all-cause death. Specifically, it is the first study to demonstrate that increased BPV is associated with recurrent ischemic stroke and that diastolic BPV can be as important as systolic BPV. Future work should focus on evaluating whether actively reducing BPV, using widely available and inexpensive antihypertensive medications, reduces the risk of cardiovascular disease.
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Affiliation(s)
- Adam de Havenon
- From the Department of Neurology (A.d.H., B.J., K.-H.W., J.J.M.), University of Utah, Salt Lake City
| | - Nora F Fino
- Division of Epidemiology, Department of Internal Medicine (N.F.F.), University of Utah, Salt Lake City
| | - Brian Johnson
- From the Department of Neurology (A.d.H., B.J., K.-H.W., J.J.M.), University of Utah, Salt Lake City
| | - Ka-Ho Wong
- From the Department of Neurology (A.d.H., B.J., K.-H.W., J.J.M.), University of Utah, Salt Lake City
| | - Jennifer J Majersik
- From the Department of Neurology (A.d.H., B.J., K.-H.W., J.J.M.), University of Utah, Salt Lake City
| | - David Tirschwell
- Department of Neurology, University of Washington, Seattle (D.T.)
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Boston (N.R.)
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12
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Curtis E, Constantinescu D, Fitchett E, Smitaman E, Curtis B. Intracranial migration of silicone oil: a mimic of intracranial hemorrhage. Intern Emerg Med 2019; 14:1005-1007. [PMID: 31175531 DOI: 10.1007/s11739-019-02123-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Eric Curtis
- Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - David Constantinescu
- Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Evan Fitchett
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | - Edward Smitaman
- Division of Musculoskeletal Radiology, University of California San Diego Health System, 408 Dickinson Street, San Diego, CA, 92103, USA
| | - Brian Curtis
- VHA National Teleradiology Program, 1001 Sneath Lane Suite #100, San Bruno, CA, 94066, USA.
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13
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Abstract
A 5-year-old girl presented to paediatric emergency with fever and seizures for a short duration. At first, meningitis was suspected and management was started empirically. There was no improvement in the clinical condition of the patient and investigations revealed spontaneous intracranial haemorrhage (ICH) secondary to factor XIII deficiency. The child was transfused cryoprecipitate and managed conservatively for ICH. She became asymptomatic and was kept on monthly cryoprecipitate transfusions. This case report summarises factor XIII deficiency in ICH which was not suspected initially, but diagnosed later on after CT scan head and factor XIII assay. This report also highlights events occurring during its management.
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Affiliation(s)
- Muzamil Ejaz
- Pediatrics, Dow Medical College, Dow University of Health Sciences, Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan
| | - Ayesha Saleem
- Pediatrics, Dow Medical College, Dow University of Health Sciences, Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan
| | - Nimrah Ali
- Pediatrics, Dow Medical College, Dow University of Health Sciences, Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan
| | - Fizza Tariq
- Pediatrics, Dow Medical College, Dow University of Health Sciences, Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan
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14
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Tuteja G, Uppal A, Strong J, Nguyen T, Pope K, Jenkins R, Al Rebh H, Gatz D, Chang WT, Tran QK. Interventions affecting blood pressure variability and outcomes after intubating patients with spontaneous intracranial hemorrhage. Am J Emerg Med 2018; 37:1665-1671. [PMID: 30528041 DOI: 10.1016/j.ajem.2018.11.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Spontaneous intracranial hemorrhage (sICH) that increases intracranial pressure (ICP) is a life-threatening emergency often requiring intubation in Emergency Departments (ED). A previous study of intubated ED patients found that providing ≥5 interventions after initiating mechanical ventilation (pMVI) reduced mortality rate. We hypothesized that pMVIs would lower blood pressure variability (BPV) in patients with sICH and thus improve survival rates and neurologic outcomes. METHOD We performed a retrospective study of adults, who were transferred to a quaternary medical center between 01/01/2011 and 09/30/2015 for sICH, received an extraventricular drain during hospitalization. They were identified by International Classification of Diseases, version 9 (430.XX, 431.XX), and procedure code 02.21. Outcomes were BPV indices, death, and being discharged home. RESULTS We analyzed records from 147 intubated patients transferred from 40 EDs. Forty-one percent of patients received ≥5 pMVIs and was associated with lower median successive variation in systolic blood pressure (BPSV) (31,[IQR 18-45) compared with those receiving 4 or less pMVIs (38[IQR 16-70]], p = 0.040). Three pMVIs, appropriate tidal volume, sedative infusion, and capnography were significantly associated with lower BPV. In addition to clinical factors, BPSV (OR 26; 95% CI 1.2, >100) and chest radiography (OR 0.3; 95% CI 0.09, 0.9) were associated with mortality rate. Use of quantitative capnography (OR 8.3; 95%CI, 4.7, 8.8) was associated with increased likelihood of being discharged home. CONCLUSIONS In addition to disease severity, individual pMVIs were significantly associated with BPV and patient outcomes. Emergency physicians should perform pMVIs more frequently to prevent BPV and improve patients' outcomes.
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Affiliation(s)
- Gurshawn Tuteja
- John Hopkins University, Baltimore, MD, United States of America.
| | - Angad Uppal
- John Hopkins University, Baltimore, MD, United States of America.
| | - Jonathan Strong
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Tina Nguyen
- University of Maryland at College Park, College Park, MD, United States of America.
| | - Kanisha Pope
- University of Maryland at College Park, College Park, MD, United States of America
| | - Ryne Jenkins
- R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Heba Al Rebh
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Wan-Tsu Chang
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States of America.
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15
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Shkirkova K, Saver JL, Starkman S, Wong G, Weng J, Hamilton S, Liebeskind DS, Eckstein M, Stratton S, Pratt F, Conwit R, Sanossian N. Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke: Exploratory Analysis of the FAST-MAG Randomized Clinical Trial. JAMA Neurol 2018; 75:1364-1374. [PMID: 30039165 PMCID: PMC6248118 DOI: 10.1001/jamaneurol.2018.1893] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/17/2018] [Indexed: 12/17/2022]
Abstract
Importance Studies of neurological deterioration in stroke have focused on the subacute period, but stroke treatment is increasingly migrating to the prehospital setting, where the neurological course has not been well delineated. Objective To describe the frequency, predictors, and outcomes of neurological deterioration among patients in the ultra-early period following ischemic stroke or intracranial hemorrhage. Design, Settings, and Participants Exploratory analysis of the prehospital, randomized Field Administration of Stroke Therapy-Magnesium (FAST-MAG) Trial conducted from 2005 to 2013 within 315 ambulances and 60 stroke patient receiving hospitals in Southern California. Participants were consecutively enrolled patients with suspected acute stroke who were transported by ambulance within 2 hours of stroke onset. Main Outcomes and Measures The main outcome was neurological deterioration, defined as a worsening of 2 or more points on the Glasgow Coma Scale (GCS), a level of consciousness scale ranging from 3 to 15, with higher scores indicating more alertness. Imaging outcomes were ischemic or hemorrhagic injury extent identified during the first brain imaging scan. Outcomes at 3 months included global disability level (assessed using the modified Rankin Scale [mRS]; range, 0-6, with higher numbers indicating greater disability) and mortality. Results Among the 1690 patients (99.4%), the mean (SD) age was 69.4 (13.5) years, and 43% were female. Final diagnoses were acute cerebral ischemia in 1237 patients (73.2%), intracranial hemorrhage in 386 patients (22.8%), and neurovascular mimic in 67 patients (4.0%). The median (interquartile range [IQR]) minutes between the last well-known time and GCS assessments were 23 (14-42) minutes for prehospital, 58 (46-79) minutes for ED arrival, and 149 (120-180) minutes for early ED course assessments. From prehospital to early postarrival, ultra-early neurological deterioration (U-END) occurred in 200 of 1690 patients (11.8%), more often among patients with intracranial hemorrhage than among those with acute cerebral ischemia (119 of 386 [30.8%] vs 75 of 1237 [6.1%], P < .001). Patterns of U-END were prehospital U-END without early recovery in 30 of 965 patients (3.1%), stable prehospital course but early ED deterioration in 49 of 965 patients (5.1%), and continuous deterioration in both prehospital and early ED phases in 27 of 965 patients (2.8%). Ultra-early neurological deterioration was associated with worse 3-month outcomes, including increased global disability (mRS score, 4.6 vs 2.4; P < .001), reduced functional independence (mRS score 0-2, 32 of 200 [16.0%] vs 844 of 1490 [56.6%]; P < .001), and increased mortality (87 of 200 [43.5%] vs 176 of 1490 [11.8%]; P < .001). Conclusions and Relevance Ultra-early neurological deterioration occurs in 1 in 8 ambulance-transported patients with acute cerebrovascular disease, including 1 in 3 patients with intracranial hemorrhage and 1 in 16 patients with acute cerebral ischemia, and is associated with markedly reduced functional independence and increased mortality. Averting U-END may be a target for future prehospital therapeutics. Trial Registration ClinicalTrials.gov Identifier: NCT00059332.
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Affiliation(s)
- Kristina Shkirkova
- Stroke Center, Department of Neurology, University of California, Los Angeles
| | - Jeffrey L. Saver
- Stroke Center, Department of Neurology, University of California, Los Angeles
| | - Sidney Starkman
- Department of Emergency Medicine, University of California, Los Angeles
| | - Gregory Wong
- Department of Emergency Medicine, University of California, Los Angeles
| | - Julius Weng
- Department of Emergency Medicine, University of California, Los Angeles
| | - Scott Hamilton
- Department of Neurology, Stanford University, Stanford, California
| | - David S. Liebeskind
- Stroke Center, Department of Neurology, University of California, Los Angeles
| | - Marc Eckstein
- Department of Emergency Medicine, University of Southern California, Los Angeles
- Los Angeles Fire Department, Los Angeles, California
| | - Samuel Stratton
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Los Angeles
- Los Angeles EMS Agency, Los Angeles, California
- Orange County EMS Agency, Orange County, California
| | - Frank Pratt
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Robin Conwit
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Nerses Sanossian
- Department of Neurology, University of Southern California, Los Angeles
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16
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Williamson MR, Wilkinson CM, Dietrich K, Colbourne F. Acetazolamide Mitigates Intracranial Pressure Spikes Without Affecting Functional Outcome After Experimental Hemorrhagic Stroke. Transl Stroke Res 2018; 10:428-439. [PMID: 30225552 PMCID: PMC6647499 DOI: 10.1007/s12975-018-0663-6] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 01/31/2023]
Abstract
Increased intracranial pressure (ICP) after stroke can lead to poor outcome and death. Novel treatments to combat ICP rises are needed. The carbonic anhydrase inhibitor acetazolamide diminishes cerebrospinal fluid (CSF) production, reduces ICP in healthy animals, and is beneficial for idiopathic intracranial hypertension patients. We tested whether acetazolamide mitigates ICP elevations by presumably decreasing CSF volume after collagenase-induced striatal hemorrhage in rats. We confirmed that acetazolamide did not adversely affect hematoma formation in this model or physiological variables, such as temperature. Then, we assessed the effects of acetazolamide on ICP. Lastly, we tested the effects of acetazolamide on behavioral and histological outcome. Acetazolamide reduced the magnitude and occurrence of short-timescale ICP spikes, assessed as disproportionate increases in ICP (sudden ICP increases > 10 mmHg), 1-min peak ICP, and the magnitude of spikes > 20 mmHg. However, mean ICP was unaffected. In addition, acetazolamide reduced ICP variability, reflecting improved intracranial compliance. Compliance measures were strongly correlated with high peak and mean ICP, whereas ipsilateral hemisphere water content was not correlated with ICP. Despite effects on ICP, acetazolamide did not improve behavioral function or affect lesion size. In summary, we show that intracerebral hemorrhage creates an impaired compliance state within the cranial space that can result in large, transient ICP spikes. Acetazolamide ameliorates intracranial compliance and mitigates ICP spikes, but does not improve functional outcome, at least for moderate-severity ICH in rats.
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Affiliation(s)
- Michael R Williamson
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Cassandra M Wilkinson
- P217 Biological Sciences Building, Department of Psychology, University of Alberta, Edmonton, AB, T6G 2E9, Canada
| | - Kristen Dietrich
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Frederick Colbourne
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.
- P217 Biological Sciences Building, Department of Psychology, University of Alberta, Edmonton, AB, T6G 2E9, Canada.
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17
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Codari M, Papini GDE, Melazzini L, Pluchinotta FR, Secchi F, Carminati M, Frigiola A, Chessa M, Sardanelli F. Does Tetralogy of Fallot affect brain aging? A proof-of-concept study. PLoS One 2018; 13:e0202496. [PMID: 30130369 PMCID: PMC6103512 DOI: 10.1371/journal.pone.0202496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/04/2018] [Indexed: 02/06/2023] Open
Abstract
The impact of congenital heart disease on brain aging has not been extensively investigated. We evaluated cerebral microbleeds and white matter hyperintensities on brain magnetic resonance imaging in adult patients with tetralogy of Fallot (ToF). Ten ToF patients (6 women, 4 men; aged 21–58 years; New York Heart Association [NYHA] class 1–2) were prospectively enrolled and underwent a T1-weighted, a T2-weighted dark fluid, and a T2*-weighted scans. Ten age- and sex-matched controls were prospectively recruited and subjected to the same acquisition protocol. Cerebral microbleeds (CMBs) were manually counted while white matter hyperintensities (WMHs) were segmented using ITK-Snap. Wilcoxon signed-rank test, Spearman correlation, and Bland-Altman statistics were used. The median (interquartile range [IQR]) age was 45.0 (30.5–49.5) years in ToF patients and 46.0 (30.5–49.8) years in controls. The median (IQR) of the number of CMBs was 6.0 (4.0–7.8) in ToF patients and 0 (0.0–0.0) in controls (p = 0.002). The WMHs burden was 2,506 (1,557–2,900) mm3 for ToF patients and 2,212 (1,860–2,586) mm3 for controls (p = 0.160). Moreover, a positive significant correlation was found between the WMHs burden and the NYHA class (ρ = 0.80, p = 0.005). Inter-operator concordance rate for the presence/absence of CMBs was 90%; the reproducibility for the WMHs burden was 77%. In conclusion, we found more cerebral microbleeds and a higher WMHs burden in adult ToF patients than in controls. This preliminary comparison supports the hypothesis of an early brain aging in ToF patients. Larger studies are warranted.
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Affiliation(s)
- Marina Codari
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- * E-mail:
| | | | - Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Milan, Italy
| | - Francesca Romana Pluchinotta
- Unit of Pediatric and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mario Carminati
- Unit of Pediatric and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alessandro Frigiola
- Unit of Pediatric and Adult Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimo Chessa
- Unit of Pediatric and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Milan, Italy
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18
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McDermott B, O’Halloran M, Porter E, Santorelli A. Brain haemorrhage detection using a SVM classifier with electrical impedance tomography measurement frames. PLoS One 2018; 13:e0200469. [PMID: 30001401 PMCID: PMC6042738 DOI: 10.1371/journal.pone.0200469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022] Open
Abstract
Brain haemorrhages often require urgent treatment with a consequent need for quick and accurate diagnosis. Therefore, in this study, we investigate Support Vector Machine (SVM) classifiers for detecting brain haemorrhages using Electrical Impedance Tomography (EIT) measurement frames. A 2-layer model of the head, along with a series of haemorrhages, is designed as both numerical models and physical phantoms. EIT measurement frames, taken from an electrode array placed on the head surface, are used to train and test linear SVM classifiers. Various scenarios are implemented on both platforms to examine the impact of variables such as noise level, lesion location, lesion size, variation in electrode positioning, and variation in anatomy, on the classifier performance. The classifier performed well in numerical models (sensitivity and specificity of 90%+) with signal-to-noise ratios of 60 dB+, was independent of lesion location, and could detect lesions reliably down to the tested minimum volume of 5 ml. Slight variations in electrode layout did not affect performance. Performance was affected by variations in anatomy however, emphasising the need for large training sets covering different anatomies. The phantom models proved more challenging, with maximal sensitivity and specificity of 75% when used with the linear SVM. Finally, the performance of two more complex classifiers is briefly examined and compared to the linear SVM classifier. These results demonstrate that a radial basis function (RBF) SVM classifier and a neural network classifier can improve detection accuracy. Classifiers applied to EIT measurement frames is a novel approach for lesion detection and may offer an effective diagnostic tool clinically. A challenge is to translate the strong results from numerical models into real world phantoms and ultimately human patients, as well as the selection and development of optimal classifiers for this application.
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Affiliation(s)
- Barry McDermott
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
- * E-mail:
| | - Martin O’Halloran
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
| | - Emily Porter
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
| | - Adam Santorelli
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
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19
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Karadan U, Supreeth RN, Manappallil RG, Jayakrishnan C. Twenty-Four Syndrome: An Untold Presentation of Pontine Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:e73-e74. [PMID: 29325920 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 11/18/2022] Open
MESH Headings
- Aged
- Facial Paralysis/diagnosis
- Facial Paralysis/etiology
- Facial Paralysis/physiopathology
- Facial Paralysis/therapy
- Female
- Fixation, Ocular
- Hearing
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Hearing Loss, Sensorineural/therapy
- Hearing Loss, Unilateral/diagnosis
- Hearing Loss, Unilateral/etiology
- Hearing Loss, Unilateral/physiopathology
- Hearing Loss, Unilateral/therapy
- Horner Syndrome/diagnosis
- Horner Syndrome/etiology
- Horner Syndrome/physiopathology
- Horner Syndrome/therapy
- Humans
- Intracranial Hemorrhages/complications
- Intracranial Hemorrhages/diagnostic imaging
- Intracranial Hemorrhages/physiopathology
- Intracranial Hemorrhages/therapy
- Pons/blood supply
- Recovery of Function
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Ummer Karadan
- Baby Memorial Hospital, Calicut, Kerala 673004, India
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20
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Iacoviello L, Bonaccio M, Cairella G, Catani MV, Costanzo S, D'Elia L, Giacco R, Rendina D, Sabino P, Savini I, Strazzullo P. Diet and primary prevention of stroke: Systematic review and dietary recommendations by the ad hoc Working Group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis 2018; 28:309-334. [PMID: 29482962 DOI: 10.1016/j.numecd.2017.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and haemorrhagic strokes. The present review was conducted in the framework of the work carried out through 2015 and 2016 for the preparation of the Italian Guidelines for the Prevention and Treatment of Stroke, 8th Edition, by ISO-SPREAD (Italian Stroke Organization and the Stroke Prevention and Educational Awareness Diffusion). METHODS AND RESULTS Systematic review of articles focused on primary prevention of stroke published between January 2013 to May 2016 through an extensive search of the literature using MEDLINE/PUBMED, EMBASE and the Cochrane Library. Articles were ranked according to the SIGN methodology while the GRADE system was used to establish the strength of recommendations. As a result of our literature search, we examined 87 meta-analyses overall (mainly of prospective studies), a few isolated more recent prospective studies not included in the meta-analyses, and a smaller number of available randomized controlled trials and case-control studies. Based on the analysis of the above articles, 36 Syntheses of the available evidence and 36 Recommendations were eventually prepared. The present document was developed by organizing the available evidence into three individual areas (nutrients, food groups and dietary patterns) to provide a systematic and user-friendly overview of the available evidence on the relationship between nutrition and primary prevention of stroke. Yet analysis of foods and food patterns allowed translating the information about nutrients in a tool more amenable to use in daily life also in the light of the argument that people eat foods rather than nutrients. CONCLUSIONS The present literature review and dietary recommendations provide healthcare professionals and all interested readers with a useful overview for the reduction of the risk of total, ischemic and haemorrhagic stroke through dietary modifications.
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Affiliation(s)
- L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy; Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100, Varese, Italy.
| | - M Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy
| | - G Cairella
- Servizio Igiene Alimenti e Nutrizione, ASL Rome B, Italy
| | - M V Catani
- Department of Experimental Medicine & Surgery, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - S Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy
| | - L D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - R Giacco
- Institute of Food Science, National Research Council, 83100, Avellino, Italy
| | - D Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - P Sabino
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - I Savini
- Department of Experimental Medicine & Surgery, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - P Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy.
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21
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Abstract
PURPOSE OF REVIEW This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks. RECENT FINDINGS Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population. Finally, the FDA-approved left atrial appendage closure (LAAC) with the WATCHMAN device provides an option without the need for life-long anticoagulation. In this review, we introduce the concept of preventing both ischemic and hemorrhagic strokes in AF patients through accurate AF diagnosis and stratification of both embolic and ICH risks. LAAC can be considered in patients at higher hemorrhagic risks while warfarin/DOAC use should be individualized in the majority of AF patients at a low risk of bleeding.
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Affiliation(s)
- Elif Gokcal
- Department of Neurology, Bezmialem University, Istanbul, Turkey
| | - Marco Pasi
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
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Wang G, Zhang YP, Gao Z, Shields LBE, Li F, Chu T, Lv H, Moriarty T, Xu XM, Yang X, Shields CB, Cai J. Pathophysiological and behavioral deficits in developing mice following rotational acceleration-deceleration traumatic brain injury. Dis Model Mech 2018; 11:dmm030387. [PMID: 29208736 PMCID: PMC5818073 DOI: 10.1242/dmm.030387] [Citation(s) in RCA: 18] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/16/2017] [Indexed: 01/22/2023] Open
Abstract
Abusive head trauma (AHT) is the leading cause of death from trauma in infants and young children. An AHT animal model was developed on 12-day-old mice subjected to 90° head extension-flexion sagittal shaking repeated 30, 60, 80 and 100 times. The mortality and time until return of consciousness were dependent on the number of repeats and severity of the injury. Following 60 episodes of repeated head shakings, the pups demonstrated apnea and/or bradycardia immediately after injury. Acute oxygen desaturation was observed by pulse oximetry during respiratory and cardiac suppression. The cerebral blood perfusion was assessed by laser speckle contrast analysis (LASCA) using a PeriCam PSI system. There was a severe reduction in cerebral blood perfusion immediately after the trauma that did not significantly improve within 24 h. The injured mice began to experience reversible sensorimotor function at 9 days postinjury (dpi), which had completely recovered at 28 dpi. However, cognitive deficits and anxiety-like behavior remained. Subdural/subarachnoid hemorrhage, damage to the brain-blood barrier and parenchymal edema were found in all pups subjected to 60 insults. Proinflammatory response and reactive gliosis were upregulated at 3 dpi. Degenerated neurons were found in the cerebral cortex and olfactory tubercles at 30 dpi. This mouse model of repetitive brain injury by rotational head acceleration-deceleration partially mimics the major pathophysiological and behavioral events that occur in children with AHT. The resultant hypoxia/ischemia suggests a potential mechanism underlying the secondary rotational acceleration-deceleration-induced brain injury in developing mice.
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Affiliation(s)
- Guoxiang Wang
- Department of Spine Surgery, Orthopedics Hospital affiliated to the Second Bethune Hospital, Jilin University, Changchun 130041, China
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Zhongwen Gao
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Fang Li
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Neurological Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Tianci Chu
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Huayi Lv
- Eye Center of the Second Bethune Hospital, Jilin University, Changchun 130041, China
| | - Thomas Moriarty
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Xiao-Ming Xu
- Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Xiaoyu Yang
- Department of Spine Surgery, Orthopedics Hospital affiliated to the Second Bethune Hospital, Jilin University, Changchun 130041, China
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Jun Cai
- Department of Spine Surgery, Orthopedics Hospital affiliated to the Second Bethune Hospital, Jilin University, Changchun 130041, China
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Uccelli A, Gattorno M. Neurological manifestations in autoinflammatory diseases. Clin Exp Rheumatol 2018; 36 Suppl 110:61-67. [PMID: 29742058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 06/08/2023]
Abstract
Autoinflammatory diseases (AIDs) are a distinct group of diseases characterised by a dysregulation of the innate immune response leading to systemic inflammation. The clinical spectrum of these conditions is extremely variable and possibly every system and tissue can be involved, including the central nervous system (CNS). Indeed, neurological manifestations may dominate the clinical picture from disease onset in some rare conditions. However, the involvement of the CNS in AIDs is not a disease in itself, but represents a rare complication which is consequent to a systemic or local immune response, mainly involving cells of the innate immunity. This review will describe neurological manifestations associated with AIDs, including: chronic aseptic meningitis and brain atrophy, sensori-neural hearing loss, early-onset haemorrhagic and ischaemic strokes, mental retardation, cerebellitis, and ataxia, and severe encephalopathy with brain calcifications.
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Affiliation(s)
- Antonio Uccelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa; Ospedale Policlinico San Martino, IRCCS, Genoa; and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
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24
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Gurol ME. Nonpharmacological Management of Atrial Fibrillation in Patients at High Intracranial Hemorrhage Risk. Stroke 2018; 49:247-254. [PMID: 29203684 PMCID: PMC5847291 DOI: 10.1161/strokeaha.117.017081] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 12/17/2022]
Affiliation(s)
- M Edip Gurol
- From the Department of Neurology, Massachusetts General Hospital, Boston.
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25
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Abstract
The cerebrovascular time constant (τ) theoretically estimates how fast the cerebral arterial bed is filled by blood volume after a sudden change in arterial blood pressure during one cardiac cycle. The aim of this study was to assess the time constant of the cerebral arterial bed in patients with traumatic brain injury (TBI) with and without intracranial hematomas (IH). We examined 116 patients with severe TBI (mean 35 ± 15 years, 61 men, 55 women). The first group included 58 patients without IH and the second group included 58 patients with epidural (7), subdural (48), and multiple (3) hematomas. Perfusion computed tomography (PCT) was performed 1-12 days after TBI in the first group and 2-8 days after surgical evacuation of the hematoma in the second group. Arteriovenous amplitude of regional cerebral blood volume oscillation was calculated as the difference between arterial and venous blood volume in the "region of interest" of 1 cm(2). Mean arterial pressure was measured and the flow rate of the middle cerebral artery was recorded with transcranial Doppler ultrasound after PCT. The time constant was calculated by the formula modified by Kasprowicz. The τ was shorter (p = 0.05) in both groups 1 and 2 in comparison with normal data. The time constant in group 2 was shorter than in group 1, both on the side of the former hematoma (р = 0.012) and on the contralateral side (р = 0.044). The results indicate failure of autoregulation of cerebral capillary blood flow in severe TBI, which increases in patients with polytrauma and traumatic IH.
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MESH Headings
- Adolescent
- Adult
- Aged
- Arterial Pressure
- Cerebrovascular Circulation
- Female
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/physiopathology
- Hematoma, Subdural, Intracranial/diagnostic imaging
- Hematoma, Subdural, Intracranial/physiopathology
- Humans
- Intracranial Hemorrhages/diagnostic imaging
- Intracranial Hemorrhages/physiopathology
- Male
- Middle Aged
- Middle Cerebral Artery/diagnostic imaging
- Middle Cerebral Artery/physiopathology
- Perfusion Imaging
- Time Factors
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Transcranial
- Vascular Resistance
- Young Adult
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Affiliation(s)
- Alex Trofimov
- Department of Polytrauma and Critical Care, Regional Hospital named after N.A. Semashko, 190, Rodionov str, Nizhny Novgorod, 603126, Russian Federation.
- Department of Neurosurgery, Nizhniy Novgorod State Medical Academy, Nizhniy Novgorod, Russian Federation.
| | - George Kalentiev
- Department of Critical Care, Regional Hospital named after N.A. Semashko, 190, Rodionov str, Nizhniy Novgorod, Russian Federation
| | - Alexander Gribkov
- Department of Critical Care, Regional Hospital named after N.A. Semashko, 190, Rodionov str, Nizhniy Novgorod, Russian Federation
| | - Oleg Voennov
- Department of Critical Care, Regional Hospital named after N.A. Semashko, 190, Rodionov str, Nizhniy Novgorod, Russian Federation
| | - Vera Grigoryeva
- Department of Neurosurgery, Nizhniy Novgorod State Medical Academy, Nizhniy Novgorod, Russian Federation
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Qi BX, Yao H, Shang L, Sheng LP, Wang XC, Zhu L, Zhang XX, Wang JP, Fang DH. Evaluation of the role of 8-iso-PGF levels at multiple sites during intracranial hemorrhage in pediatric patients. Eur Rev Med Pharmacol Sci 2017; 21:4153-4160. [PMID: 29028082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The present study was planned to explore the role of 8-isomeric-prostaglandinF2α (8-iso-PGF2α) levels at the multiple sites of cerebrospinal fluid in children with intracranial hemorrhage. PATIENTS AND METHODS 90 children with intracranial hemorrhage were admitted to Surgery Intensive Care Unit (SICU) of our hospital from January to December 2013 and were selected as study subjects. They were divided into group A (n=30), group B (n=30) and group C (n=30). The group A was given conventional treatment, the group B was treated with minimally invasive puncture and the group C was treated with cerebrospinal fluid decompression. After 1 d, 2 d, 3 d, and 7 d of hospitalization, enzyme-linked immunosorbent assay (ELISA) was used to detect the 8-iso-PGF2α levels in peripheral blood of children in all groups. On the day of admission and 10 d after treatment, 3 groups of children were implemented with brain nuclear magnetic resonance spectroscopy for metabolite analyses. RESULTS On the day of admission there were no significant differences in the 8-iso-PGF2α levels among group A, B and C. Further, after 1 d, 3 d, 7 d of hospital stay, the 8-iso-PGF2α levels in peripheral blood showed a gradual downward trend, and decline range of the group C was greater than that of group A and B (p < 0.05). After 10 days of treatment, there were significant differences in the bilateral temporal lobe and hippocampal NAA/Creatinine (Cr), Cho/Cr, mI/Cr and NAA/mI among group A, B, and C. The survival rate of group C was higher than that of group A and B (p < 0.05). On the other hand, the prevalence of sequelae was significantly lower than that of group A and B (p < 0.05). The amount of blood loss in children with intracranial hemorrhage was positively correlated with the levels of 8-iso-PGF2α in peripheral blood (r = 0.546, p < 0.05) as observed by Spearman correlation analysis. CONCLUSIONS 8-iso-PGF2α plays an important role in the pathogenesis of intracranial hemorrhage, and could be utilized as a biomarker of oxidative stress in children with intracranial hemorrhage. Further, cerebrospinal fluid decompression is a better method of treatment for intracranial hemorrhage.
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Affiliation(s)
- B-X Qi
- Departments of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu Province, China.
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Mistry EA, Mistry AM, Nakawah MO, Khattar NK, Fortuny EM, Cruz AS, Froehler MT, Chitale RV, James RF, Fusco MR, Volpi JJ. Systolic Blood Pressure Within 24 Hours After Thrombectomy for Acute Ischemic Stroke Correlates With Outcome. J Am Heart Assoc 2017; 6:JAHA.117.006167. [PMID: 28522673 PMCID: PMC5524120 DOI: 10.1161/jaha.117.006167] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Current guidelines suggest treating blood pressure above 180/105 mm Hg during the first 24 hours in patients with acute ischemic stroke undergoing any form of recanalization therapy. Currently, no studies exist to guide blood pressure management in patients with stroke treated specifically with mechanical thrombectomy. We aimed to determine the association between blood pressure parameters within the first 24 hours after mechanical thrombectomy and patient outcomes. Methods and Results We retrospectively studied a consecutive sample of adult patients who underwent mechanical thrombectomy for acute ischemic stroke of the anterior cerebral circulation at 3 institutions from March 2015 to October 2016. We collected the values of maximum, minimum, and average values of systolic blood pressure, diastolic blood pressure, and mean arterial pressures in the first 24 hours after mechanical thrombectomy. Primary and secondary outcomes were patients’ functional status at 90 days measured on the modified Rankin scale and the incidence and severity of intracranial hemorrhages within 48 hours. Associations were explored using an ordered multivariable logistic regression analyses. A total of 228 patients were included (mean age 65.8±14.3; 104 males, 45.6%). Maximum systolic blood pressure independently correlated with a worse 90‐day modified Rankin scale and hemorrhagic complications within 48 hours (adjusted odds ratio=1.02 [1.01–1.03], P=0.004; 1.02 [1.01–1.04], P=0.002; respectively) in multivariable analyses, after adjusting for several possible confounders. Conclusions Higher peak values of systolic blood pressure independently correlated with worse 90‐day modified Rankin scale and a higher rate of hemorrhagic complications. Further prospective studies are warranted to identify whether systolic blood pressure is a therapeutic target to improve outcomes.
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Affiliation(s)
- Eva A Mistry
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX
| | | | | | - Nicolas K Khattar
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY
| | - Enzo M Fortuny
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY
| | - Aurora S Cruz
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY
| | - Michael T Froehler
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN
| | - Rohan V Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN
| | - Robert F James
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY
| | - Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
- Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN
| | - John J Volpi
- Department of Neurology, Houston Methodist Neurological Institute, Houston, TX
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28
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Kumar R, Suri JC, Manocha R. Study of association of severity of sleep disordered breathing and functional outcome in stroke patients. Sleep Med 2017; 34:50-56. [PMID: 28522098 DOI: 10.1016/j.sleep.2017.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/13/2017] [Accepted: 02/17/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Sleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome. METHODS Patients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea-hypopnea index was respectively calculated as AHI3% and AHI4%. Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (<80 = functional dependence; ≥80 = functional independence) and modified Rankins Scale (>2 = poor outcome; ≤2 = good outcome). RESULTS A total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI4% of >5/h, 23 (46%) had an AHI4% of >15/h, and 9 (18%) had an AHI4% of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04-1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76-0.96, p = 0.009) were significant risk factors for predicting SDB (AHI4% > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI4% (OR = 1.20; 95% CI 1.01-1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI4% (OR = 1.14; 95% CI 1.03-1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59-0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used. CONCLUSION In conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient ischemic attack patients may be warranted.
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Affiliation(s)
- Rohit Kumar
- Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjang Hosptial, New Delhi, India.
| | - Rajesh Manocha
- Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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29
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Kober SE, Schweiger D, Reichert JL, Neuper C, Wood G. Upper Alpha Based Neurofeedback Training in Chronic Stroke: Brain Plasticity Processes and Cognitive Effects. Appl Psychophysiol Biofeedback 2017; 42:69-83. [PMID: 28197747 PMCID: PMC5344963 DOI: 10.1007/s10484-017-9353-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
In the present study, we investigated the effects of upper alpha based neurofeedback (NF) training on electrical brain activity and cognitive functions in stroke survivors. Therefore, two single chronic stroke patients with memory deficits (subject A with a bilateral subarachnoid hemorrhage; subject B with an ischemic stroke in the left arteria cerebri media) and a healthy elderly control group (N = 24) received up to ten NF training sessions. To evaluate NF training effects, all participants performed multichannel electroencephalogram (EEG) resting measurements and a neuropsychological test battery assessing different cognitive functions before and after NF training. Stroke patients showed improvements in memory functions after successful NF training compared to the pre-assessment. Subject B had a pathological delta (0.5-4 Hz) and upper alpha (10-12 Hz) power maximum over the unaffected hemisphere before NF training. After NF training, he showed a more bilateral and "normalized" topographical distribution of these EEG frequencies. Healthy participants as well as subject A did not show any abnormalities in EEG topography before the start of NF training. Consequently, no changes in the topographical distribution of EEG activity were observed in these participants when comparing the pre- and post-assessment. Hence, our results show that upper alpha based NF training had on the one hand positive effects on memory functions, and on the other hand led to cortical "normalization" in a stroke patient with pathological brain activation patterns, which underlines the potential usefulness of NF as neurological rehabilitation tool.
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Affiliation(s)
- Silvia Erika Kober
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, Graz, 8010 Austria
| | - Daniela Schweiger
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
| | | | - Christa Neuper
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, Graz, 8010 Austria
- Institute of Neural Engineering, Laboratory of Brain-Computer Interfaces, Graz University of Technology, Stremayrgasse 16, Graz, 8010 Austria
| | - Guilherme Wood
- Department of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, Graz, 8010 Austria
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30
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Weiwei L, Bing X, Yiming D, Zhen Z, Yifeng D. Therapeutic effect of minimally invasive interventional treatment of brain hematoma. Pak J Pharm Sci 2016; 29:1829-1832. [PMID: 28476710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To investigate the therapeutic effect of minimally invasive interventional treatment of brain hematoma, 128 patients with brain hematoma were randomly divided into two groups, including observation group (64 cases) and control group (64 cases). The observation group was performed with minimally invasive interventional therapy and drug conservative therapy was used in the control group. Clinical curative effect, treatment of neural function defect score, and quality of life score were recorded. Total effective rate in observation group was significantly higher (p<0.05) than that in control group (90.6% vs 62.5%). And the mortality in observation group was significantly lower (p<0.05) than that in control group (3.1% vs 9.4%). National Institute of Health stroke scale (NIHSS) and Quality of Life (QOL) of the two groups after treatment were improved significantly (p<0.05) compared with those with treatment before; and the improved level of concept in observation group was significantly higher (p<0.05) than that of control group. Therefore, minimally invasive interventional brain hematoma surgery can effectively remove the hematoma in the brain, improve the nerve function of patients caused by trauma and improve the quality of life.
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Affiliation(s)
- Lin Weiwei
- Neurology Shandong Provincial Hospital affiliated to Shandong University Jinan, Shandong, People's Republic of China
| | - Xing Bing
- Neurosurgery Beijing Union Medical College Hospital Beijing, People's Republic of China
| | - Deng Yiming
- Neurology Beijing Tian Tan Hospital, Capital Medical University Beijing, People's Republic of China
| | - Zhang Zhen
- Neurosurgery Shandong Provincial Hospital affiliated to Shandong University Jinan, Shandong, People's Republic of China
| | - Du Yifeng
- Neurology Shandong Provincial Hospital affiliated to Shandong University Jinan, Shandong, People's Republic of China
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Abstract
PURPOSE While a healthy lifestyle has been associated with reduced risk of developing ischemic stroke, less is known about its effect on stroke severity. METHODS We performed a prospective cohort study among 37,634 women without stroke or missing risk factor data at baseline. The healthy lifestyle index was composed of smoking, physical activity, body mass index, alcohol consumption, and diet (range 0-20, with 20 representing healthiest lifestyle). Possible functional outcomes were no stroke or stroke with modified Rankin Scale score of 0-1 (mild), 2-3 (moderate), or 4-6 (severe). Multinomial logistic regression was used to analyze the association between healthy lifestyle and functional outcomes from stroke. RESULTS Over 17.2 years of follow-up, 867 total strokes were confirmed. Compared with the lowest category (0-4), the highest category (17-20) was associated with reductions in risk of total stroke with mild (odds ratio [OR] 0.43; 95% confidence interval [CI], 0.20-0.90), moderate (OR 0.53; 95% CI, 0.27-1.06), and severe (OR 0.48; 95% CI, 0.20-1.18) functional outcomes. Even a modest healthy lifestyle index (5-8 points) was associated with significant decreases in total stroke with severe and moderate functional outcomes. Similar results were seen for ischemic but not hemorrhagic strokes. CONCLUSIONS Highest vs lowest scores on the healthy lifestyle index were associated with reductions in risk of total and ischemic strokes with mild, moderate, and severe functional outcomes among women. The evidence that even modest healthy lifestyle index scores reduced risks of total and ischemic stroke with moderate and severe functional outcomes suggests modest lifestyle changes may reduce risk of disabling stroke events.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Carlos S Kase
- Department of Neurology, Boston University School of Medicine, Mass
| | - Tobias Kurth
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass; Institute of Public Health, Charité Universitätzmedizin, Berlin, Germany
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Solodov AA, Petrikov SS, Krylov VV. [POSITIVE END-EXPIRATORY PRESSURE (PEEP) INFLUENCES ON INTRACRANIAL PRESSURE, SYSTEMIC HEMODYNAMICS AND PULMONARY GAS EXCHANGE IN PATIENTS WITH INTRACRANIAl HEMORRHAGE IN CRITICAL STATE]. Anesteziol Reanimatol 2016; 61:115-120. [PMID: 27468501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Positive end-expiratory pressure is one of the main parameters of respiratory support influencing the gas exchange. However, despite the number ofpositive effects, PEEP can compromise venous outflow from the cranial cavity, increased intracranial pressure, decreased venous return and cardiac output and, consequently, reduced blood pressure and cerebral perfusion. The article presents the results of a survey of 39 patients with intracranial hemorrhage in critical state, undergoing respiratory support with different levels of positive end-expiratory pressure. Increasing of PEEP to 15 cm H2O had no adverse effect on mean arterial pressure, heart rate and cerebral perfusion pressure and led only to an clinical insignificant increase (maximum on 2.4 +/- 5.1 mmHg) in intracranial pressure. The greatest hemodynamic changes were observed with increasing PEEP up to 20 cm H2O in patients with preserved compliance ofthe respiratory system. The instability of cerebral perfusion and intracranial pressure associated with a decrease in cardiac output and preload and the exhaustion of compensatory mechanism of peripheral vascular resistance. High levels of PEEP despite the trend towards Cstat reduction will not lead to an increase in the content of extravascular lung water Thus a gradual increase of PEEP to 15 cm H2O can be safe and effective method of improving pulmonary gas exchange in patients with intracranial hemorrhage in critical state.
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Flores JJ, Klebe D, Rolland WB, Lekic T, Krafft PR, Zhang JH. PPARγ-induced upregulation of CD36 enhances hematoma resolution and attenuates long-term neurological deficits after germinal matrix hemorrhage in neonatal rats. Neurobiol Dis 2016; 87:124-33. [PMID: 26739391 PMCID: PMC4724557 DOI: 10.1016/j.nbd.2015.12.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/11/2015] [Accepted: 12/25/2015] [Indexed: 12/11/2022] Open
Abstract
Germinal matrix hemorrhage remains the leading cause of morbidity and mortality in preterm infants in the United States with little progress made in its clinical management. Survivors are often afflicted with long-term neurological sequelae, including cerebral palsy, mental retardation, hydrocephalus, and psychiatric disorders. Blood clots disrupting normal cerebrospinal fluid circulation and absorption after germinal matrix hemorrhage are thought to be important contributors towards post-hemorrhagic hydrocephalus development. We evaluated if upregulating CD36 scavenger receptor expression in microglia and macrophages through PPARγ stimulation, which was effective in experimental adult cerebral hemorrhage models and is being evaluated clinically, will enhance hematoma resolution and ameliorate long-term brain sequelae using a neonatal rat germinal matrix hemorrhage model. PPARγ stimulation (15d-PGJ2) increased short-term PPARγ and CD36 expression levels as well as enhanced hematoma resolution, which was reversed by a PPARγ antagonist (GW9662) and CD36 siRNA. PPARγ stimulation (15d-PGJ2) also reduced long-term white matter loss and post-hemorrhagic ventricular dilation as well as improved neurofunctional outcomes, which were reversed by a PPARγ antagonist (GW9662). PPARγ-induced upregulation of CD36 in macrophages and microglia is, therefore, critical for enhancing hematoma resolution and ameliorating long-term brain sequelae.
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Affiliation(s)
- Jerry J Flores
- Department of Physiology & Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Damon Klebe
- Department of Physiology & Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - William B Rolland
- Department of Physiology & Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Tim Lekic
- Department of Physiology & Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Paul R Krafft
- Department of Physiology & Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - John H Zhang
- Department of Physiology & Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA; Departments of Anesthesiology and Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
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Andrikopoulou M, Vintzileos AM. Sawtooth fetal heart rate pattern due to in utero fetal central nervous system injury. Am J Obstet Gynecol 2016; 214:403.e1-4. [PMID: 26672681 DOI: 10.1016/j.ajog.2015.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/29/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Maria Andrikopoulou
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, NY.
| | - Anthony M Vintzileos
- Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, NY
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Mathieson S, Rennie J, Livingstone V, Temko A, Low E, Pressler RM, Boylan GB. In-depth performance analysis of an EEG based neonatal seizure detection algorithm. Clin Neurophysiol 2016; 127:2246-56. [PMID: 27072097 PMCID: PMC4840013 DOI: 10.1016/j.clinph.2016.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 11/26/2022]
Abstract
A novel method for in-depth analysis of neonatal seizure detection algorithms is proposed. The analysis estimated how seizure features are exploited by automated detectors. This method led to significant improvement of the ANSeR algorithm.
Objective To describe a novel neurophysiology based performance analysis of automated seizure detection algorithms for neonatal EEG to characterize features of detected and non-detected seizures and causes of false detections to identify areas for algorithmic improvement. Methods EEGs of 20 term neonates were recorded (10 seizure, 10 non-seizure). Seizures were annotated by an expert and characterized using a novel set of 10 criteria. ANSeR seizure detection algorithm (SDA) seizure annotations were compared to the expert to derive detected and non-detected seizures at three SDA sensitivity thresholds. Differences in seizure characteristics between groups were compared using univariate and multivariate analysis. False detections were characterized. Results The expert detected 421 seizures. The SDA at thresholds 0.4, 0.5, 0.6 detected 60%, 54% and 45% of seizures. At all thresholds, multivariate analyses demonstrated that the odds of detecting seizure increased with 4 criteria: seizure amplitude, duration, rhythmicity and number of EEG channels involved at seizure peak. Major causes of false detections included respiration and sweat artefacts or a highly rhythmic background, often during intermediate sleep. Conclusion This rigorous analysis allows estimation of how key seizure features are exploited by SDAs. Significance This study resulted in a beta version of ANSeR with significantly improved performance.
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Affiliation(s)
- S Mathieson
- Academic Research Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom; Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Ireland.
| | - J Rennie
- Academic Research Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom; Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Ireland
| | - V Livingstone
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Ireland
| | - A Temko
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Ireland; Department of Electrical and Electronic Engineering, University College Cork, Ireland
| | - E Low
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Ireland
| | - R M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, United Kingdom
| | - G B Boylan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Ireland
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Hoffmann A, Kunze R, Helluy X, Milford D, Heiland S, Bendszus M, Pham M, Marti HH. High-Field MRI Reveals a Drastic Increase of Hypoxia-Induced Microhemorrhages upon Tissue Reoxygenation in the Mouse Brain with Strong Predominance in the Olfactory Bulb. PLoS One 2016; 11:e0148441. [PMID: 26863147 PMCID: PMC4749302 DOI: 10.1371/journal.pone.0148441] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 01/18/2016] [Indexed: 11/19/2022] Open
Abstract
Human pathophysiology of high altitude hypoxic brain injury is not well understood and research on the underlying mechanisms is hampered by the lack of well-characterized animal models. In this study, we explored the evolution of brain injury by magnetic resonance imaging (MRI) and histological methods in mice exposed to normobaric hypoxia at 8% oxygen for 48 hours followed by rapid reoxygenation and incubation for further 24 h under normoxic conditions. T2*-, diffusion-weighted and T2-relaxometry MRI was performed before exposure, immediately after 48 hours of hypoxia and 24 hours after reoxygenation. Cerebral microhemorrhages, previously described in humans suffering from severe high altitude cerebral edema, were also detected in mice upon hypoxia-reoxygenation with a strong region-specific clustering in the olfactory bulb, and to a lesser extent, in the basal ganglia and cerebral white matter. The number of microhemorrhages determined immediately after hypoxia was low, but strongly increased 24 hours upon onset of reoxygenation. Histologically verified microhemorrhages were exclusively located around cerebral microvessels with disrupted interendothelial tight junction protein ZO-1. In contrast, quantitative T2 and apparent-diffusion-coefficient values immediately after hypoxia and after 24 hours of reoxygenation did not show any region-specific alteration, consistent with subtle multifocal but not with regional or global brain edema.
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Affiliation(s)
- Angelika Hoffmann
- Department of Neuroradiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
- * E-mail: (AH); (HHM)
| | - Reiner Kunze
- Institute of Physiology and Pathophysiology, University of Heidelberg, 69120, Heidelberg, Germany
| | - Xavier Helluy
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - David Milford
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Hugo H. Marti
- Institute of Physiology and Pathophysiology, University of Heidelberg, 69120, Heidelberg, Germany
- * E-mail: (AH); (HHM)
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Schmidt B, Lezaic V, Weinhold M, Plontke R, Schwarze J, Klingelhöfer J. Is Impaired Autoregulation Associated with Mortality in Patients with Severe Cerebral Diseases? Acta Neurochir Suppl 2016; 122:181-185. [PMID: 27165903 DOI: 10.1007/978-3-319-22533-3_37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cerebral autoregulation (CA) is a mechanism that compensates for variations in cerebral perfusion pressure (CPP) by changes in cerebral blood flow resistance to keep the cerebral blood flow constant. In this study, the relationship between lethal outcome during hospitalisation and the autoregulation-related indices PRx and Mx was investigated. MATERIALS AND METHODS Thirty patients (aged 18-77 years, mean 53 ± 16 years) with severe cerebral diseases were studied. Cerebral blood flow velocity (CBFV), arterial blood pressure (ABP) and intracranial pressure (ICP) were repeatedly recorded. CA indices were calculated as the averaged correlation between CBFV and CPP (Mx) and between ABP and ICP (PRx). Positive index values indicated impairment of CA. RESULTS Six patients died in hospital. In this group both PRx and Mx were significantly higher than in the group of survivors (PRx: 0.41 ± 0.33 vs 0.09 ± 0.25; Mx: 0.28 ± 0.40 vs 0.03 ± 0.21; p = 0.01 and 0.04, respectively). PRx and Mx correlated significantly with Glasgow Outcome Scale (GOS) score (PRx: R = -0.40, p < 0.05; Mx: R = -0.54, p < 0.005). PRx was the only significant risk factor for mortality (p < 0.05, logistic regression). CONCLUSION Increased PRx and Mx were associated with risk of death in patients with severe cerebral diseases. The relationship with mortality was more pronounced in PRx, whereas Mx showed a better correlation with GOS score.
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MESH Headings
- Adolescent
- Adult
- Aged
- Brain Diseases/mortality
- Brain Diseases/physiopathology
- Brain Injuries, Traumatic/mortality
- Brain Injuries, Traumatic/physiopathology
- Cerebral Hemorrhage/mortality
- Cerebral Hemorrhage/physiopathology
- Cerebrovascular Circulation/physiology
- Encephalitis/mortality
- Encephalitis/physiopathology
- Female
- Homeostasis
- Humans
- Hypoxia, Brain/mortality
- Hypoxia, Brain/physiopathology
- Infarction, Middle Cerebral Artery/mortality
- Infarction, Middle Cerebral Artery/physiopathology
- Intracranial Hemorrhages/mortality
- Intracranial Hemorrhages/physiopathology
- Intracranial Pressure/physiology
- Male
- Middle Aged
- Middle Cerebral Artery/diagnostic imaging
- Middle Cerebral Artery/physiopathology
- Monitoring, Physiologic
- Prognosis
- Retrospective Studies
- Sinus Thrombosis, Intracranial/mortality
- Sinus Thrombosis, Intracranial/physiopathology
- Subarachnoid Hemorrhage/mortality
- Subarachnoid Hemorrhage/physiopathology
- Subarachnoid Hemorrhage, Traumatic/mortality
- Subarachnoid Hemorrhage, Traumatic/physiopathology
- Ultrasonography, Doppler, Transcranial
- Young Adult
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Affiliation(s)
- Bernhard Schmidt
- Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany.
| | - Vesna Lezaic
- Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany
| | - Marco Weinhold
- Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany
| | - Ronny Plontke
- Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany
| | - Jens Schwarze
- Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany
| | - Jürgen Klingelhöfer
- Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany
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Abstract
Intracranial hemorrhage is a serious cause of morbidity and mortality in the neonate. Subgaleal, subdural, subarachnoid, and intraventricular hemorrhage have varying pathophysiology, but each can have serious long-term consequences. This article reviews the pathophysiology, presentation, and outcomes for intracranial hemorrhage in the newborn, as well as potential therapeutic interventions.
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Içme F, Erel Ö, Avci A, Satar S, Gülen M, Acehan S. The relation between oxidative stress parameters, ischemic stroke, and hemorrhagic stroke. Turk J Med Sci 2015; 45:947-53. [PMID: 26422872 DOI: 10.3906/sag-1402-96] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aims of this study were to investigate the significance of oxidative stress parameters in the pathogenesis of ischemic stroke and hemorrhagic stroke and to investigate their effects on stroke severity using the National Institutes of Health Stroke Scale (NIHSS). MATERIALS AND METHODS A total of 92 patients, including 74 with ischemic stroke and 18 with hemorrhagic stroke, and 75 volunteers were enrolled in the study. Total oxidant status (TOS), total antioxidant status (TAS), paraoxonase, stimulating paraoxonase, arylesterase, and thiol levels were measured in both the patient and volunteer groups. NIHSS and oxidative stress index (OSI) scores were calculated. RESULTS TOS and OSI levels were significantly higher in the ischemia and hemorrhagic stroke groups than in the control group (P < 0.05). Arylesterase and thiol levels were significantly lower in the ischemia group than the control group (P < 0.05). No significant correlation was found between NIHSS score and TAS, TOS, OSI, paraoxonase, arylesterase, stimulated paraoxonase, and thiol levels (P > 0.05). CONCLUSION Oxidative stress may play a role in the pathogenesis of both ischemic stroke and hemorrhagic stroke in terms of oxidants. We do not think that oxidative stress has any effect in determining stroke severity in either type of stroke.
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40
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Candefjord S, Winges J, Yu Y, Rylander T, McKelvey T. Microwave technology for localization of traumatic intracranial bleedings-a numerical simulation study. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:1948-51. [PMID: 24110096 DOI: 10.1109/embc.2013.6609909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem worldwide. Intracranial bleedings represents the most serious complication of TBI and need to be surgically evacuated promptly to save lives and mitigate injury. Microwave technology (MWT) is promising as a complement to computed tomography (CT) to be used in road and air ambulances for early detection of intracranial bleedings. In this study, we perform numerical simulations to investigate if a classification algorithm based on singular value decomposition can distinguish between bleedings at different positions adjacent to the skull bone for a similar but simplified problem. The classification accuracy is 94-100% for all classes, a result that encourages us to pursue our efforts with MWT for more realistic scenarios. This indicates that MWT has potential for localizing a detected bleeding, which would increase the diagnostic value of this technique.
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Mouhieddine TH, Itani MM, Nokkari A, Ren C, Daoud G, Zeidan A, Mondello S, Kobeissy FH. Nanotheragnostic applications for ischemic and hemorrhagic strokes: improved delivery for a better prognosis. Curr Neurol Neurosci Rep 2015; 15:505. [PMID: 25394858 DOI: 10.1007/s11910-014-0505-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Stroke is the second leading cause of death worldwide and a major cause of long-term severe disability representing a global health burden and one of the highly researched medical conditions. Nanostructured material synthesis and engineering have been recently developed and have been largely integrated into many fields including medicine. Recent studies have shown that nanoparticles might be a valuable tool in stroke. Different types, shapes, and sizes of nanoparticles have been used for molecular/biomarker profiling and imaging to help in early diagnosis and prevention of stroke and for drug/RNA delivery for improved treatment and neuroprotection. However, these promising applications have limitations, including cytotoxicity, which hindered their adoption into clinical use. Future research is warranted to fully develop and effectively and safely translate nanoparticles for stroke diagnosis and treatment into the clinic. This work will discuss the emerging role of nanotheragnostics in stroke diagnosis and treatment applications.
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Affiliation(s)
- Tarek H Mouhieddine
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
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42
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Kirwan L. Starting out--A case that made me stronger. Nurs Child Young People 2015; 27:15. [PMID: 26156610 DOI: 10.7748/ncyp.27.6.15.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Lisa Kirwan
- Great Ormond Street Hospital for Children in London
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43
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Zhou H, Mu Z, Chen X, Shi Z, Zha Z, Liu Y, Xu Z. HAEC in the treatment of brain hemorrhage: a preliminary observation in rabbits. Int J Clin Exp Pathol 2015; 8:6772-6778. [PMID: 26261561 PMCID: PMC4525895] [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] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study aimed to evaluate the therapeutic potential of human amniotic epithelial cell (HAEC) transplantation in the management of brain hemorrhage in an animal model. METHODS New Zealand white rabbits were induced to develop cerebral hemorrhage through autologous blood injection. Animals with confirmed brain hemorrhage were randomized to receive transplantation of, respectively, vehicle (n=15) and primary HAECs (n=15) that were expressing embryonic stem cell- and neuron-specific markers and were transfected with a retroviral vector carrying the green fluorescent protein (GFP). Behavioral and histological changes, survival of transplanted HAECs, and expression of glial fibrillary acidic protein (GFAP) and MAP-2 in transplanted perifocal tissue were assessed at various time points after transplantation. RESULTS At 2-3 weeks after transplantation, walking, body weight-supporting and movement coordinating capacities of limbs were improved mostly level II-III hemorrhage lesion cases in HAEC transplantation group but mostly in level I-II hemorrhage lesion cases in the vehicle control group. The Tarlov scores were significantly difference between the two groups (P<0.05). GFAP- and MAP-2-positive cells were observed in the neural tissue in animals transplanted with hAECs but not in animals in the control group (P<0.05). CONCLUSION These preliminary observations suggest that hAEC transplantation possess both embryonic stem cell features and a neuron differentiation potential and thus may offer a promising treatment for hemorrhage-associated neurological damage.
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Affiliation(s)
- Heping Zhou
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical UniversityAnqing 246003, Anhui Province, PR China
| | - Zhaohui Mu
- Department of Neurosurgery, The First People’s Hospital of TaizhouTaizhou, Zhejiang province, PR China
| | - Xinsheng Chen
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical UniversityAnqing 246003, Anhui Province, PR China
| | - Zhengsheng Shi
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical UniversityAnqing 246003, Anhui Province, PR China
| | - Zhengjiang Zha
- Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical UniversityAnqing 246003, Anhui Province, PR China
| | - Yanfei Liu
- Department of Neurosurgery, Mudu People’s Hospital of SuzhouSuzhou, Jiangsu province, PR China
| | - Zheng Xu
- Department of Neurosurgery, Changzheng Hospital of Shanghai, Second Military Medical UniversityShanghai, PR China
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Hsu JC, Hsieh CY, Yang YHK, Lu CY. Net clinical benefit of oral anticoagulants: a multiple criteria decision analysis. PLoS One 2015; 10:e0124806. [PMID: 25897861 PMCID: PMC4405347 DOI: 10.1371/journal.pone.0124806] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 03/19/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND This study quantitatively evaluated the comparative efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, and apizaban) and warfarin for treatment of nonvalvular atrial fibrillation. We also compared these agents under different scenarios, including population with high risk of stroke and for primary vs. secondary stroke prevention. METHODS We used multiple criteria decision analysis (MCDA) to assess the benefit-risk of these medications. Our MCDA models contained criteria for benefits (prevention of ischemic stroke and systemic embolism) and risks (intracranial and extracranial bleeding). We calculated a performance score for each drug accounting for benefits and risks in comparison to treatment alternatives. RESULTS Overall, new agents had higher performance scores than warfarin; in order of performance scores: dabigatran 150 mg (0.529), rivaroxaban (0.462), apixaban (0.426), and warfarin (0.191). For patients at a higher risk of stroke (CHADS2 score≥3), apixaban had the highest performance score (0.686); performance scores for other drugs were 0.462 for dabigatran 150 mg, 0.392 for dabigatran 110 mg, 0.271 for rivaroxaban, and 0.116 for warfarin. Dabigatran 150 mg had the highest performance score for primary stroke prevention, while dabigatran 110 mg had the highest performance score for secondary prevention. CONCLUSIONS Our results suggest that new oral anticoagulants might be preferred over warfarin. Selecting appropriate medicines according to the patient's condition based on information from an integrated benefit-risk assessment of treatment options is crucial to achieve optimal clinical outcomes.
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Affiliation(s)
- Jason C. Hsu
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yang Hsieh
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
- Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, MA, United States of America
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Mirendil H, Thomas EA, De Loera C, Okada K, Inomata Y, Chun J. LPA signaling initiates schizophrenia-like brain and behavioral changes in a mouse model of prenatal brain hemorrhage. Transl Psychiatry 2015; 5:e541. [PMID: 25849980 PMCID: PMC4462599 DOI: 10.1038/tp.2015.33] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 12/13/2022] Open
Abstract
Genetic, environmental and neurodevelopmental factors are thought to underlie the onset of neuropsychiatric disorders such as schizophrenia. How these risk factors collectively contribute to pathology is unclear. Here, we present a mouse model of prenatal intracerebral hemorrhage--an identified risk factor for schizophrenia--using a serum-exposure paradigm. This model exhibits behavioral, neurochemical and schizophrenia-related gene expression alterations in adult females. Behavioral alterations in amphetamine-induced locomotion, prepulse inhibition, thigmotaxis and social interaction--in addition to increases in tyrosine hydroxylase-positive dopaminergic cells in the substantia nigra and ventral tegmental area and decreases in parvalbumin-positive cells in the prefrontal cortex--were induced upon prenatal serum exposure. Lysophosphatidic acid (LPA), a lipid component of serum, was identified as a key molecular initiator of schizophrenia-like sequelae induced by serum. Prenatal exposure to LPA alone phenocopied many of the schizophrenia-like alterations seen in the serum model, whereas pretreatment with an antagonist against the LPA receptor subtype LPA1 prevented many of the behavioral and neurochemical alterations. In addition, both prenatal serum and LPA exposure altered the expression of many genes and pathways related to schizophrenia, including the expression of Grin2b, Slc17a7 and Grid1. These findings demonstrate that aberrant LPA receptor signaling associated with fetal brain hemorrhage may contribute to the development of some neuropsychiatric disorders.
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Affiliation(s)
- H Mirendil
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
| | - E A Thomas
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
| | - C De Loera
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
| | - K Okada
- Advanced Medical Research Laboratories, Research Division, Mitsubishi Tanabe Pharma Corporation, Toda-shi, Saitama, Japan
| | - Y Inomata
- Pharmacology Research Laboratories I, Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | - J Chun
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
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Yougbaré I, Lang S, Yang H, Chen P, Zhao X, Tai WS, Zdravic D, Vadasz B, Li C, Piran S, Marshall A, Zhu G, Tiller H, Killie MK, Boyd S, Leong-Poi H, Wen XY, Skogen B, Adamson SL, Freedman J, Ni H. Maternal anti-platelet β3 integrins impair angiogenesis and cause intracranial hemorrhage. J Clin Invest 2015; 125:1545-56. [PMID: 25774504 DOI: 10.1172/jci77820] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/05/2015] [Indexed: 01/09/2023] Open
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a life-threatening disease in which intracranial hemorrhage (ICH) is the major risk. Although thrombocytopenia, which is caused by maternal antibodies against β3 integrin and occasionally by maternal antibodies against other platelet antigens, such as glycoprotein GPIbα, has long been assumed to be the cause of bleeding, the mechanism of ICH has not been adequately explored. Utilizing murine models of FNAIT and a high-frequency ultrasound imaging system, we found that ICH only occurred in fetuses and neonates with anti-β3 integrin-mediated, but not anti-GPIbα-mediated, FNAIT, despite similar thrombocytopenia in both groups. Only anti-β3 integrin-mediated FNAIT reduced brain and retina vessel density, impaired angiogenic signaling, and increased endothelial cell apoptosis, all of which were abrogated by maternal administration of intravenous immunoglobulin (IVIG). ICH and impairment of retinal angiogenesis were further reproduced in neonates by injection of anti-β3 integrin, but not anti-GPIbα antisera. Utilizing cultured human endothelial cells, we found that cell proliferation, network formation, and AKT phosphorylation were inhibited only by murine anti-β3 integrin antisera and human anti-HPA-1a IgG purified from mothers with FNAIT children. Our data suggest that fetal hemostasis is distinct and that impairment of angiogenesis rather than thrombocytopenia likely causes FNAIT-associated ICH. Additionally, our results indicate that maternal IVIG therapy can effectively prevent this devastating disorder.
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MESH Headings
- Animals
- Antibody Specificity
- Antigens, Human Platelet/immunology
- Apoptosis
- Autoantigens/immunology
- Blood Platelets/immunology
- Brain/blood supply
- Brain/embryology
- Disease Models, Animal
- Female
- Fetal Blood/immunology
- Human Umbilical Vein Endothelial Cells
- Humans
- Immune Sera/toxicity
- Immunity, Maternally-Acquired
- Immunoglobulin G/immunology
- Immunoglobulins, Intravenous/therapeutic use
- Integrin beta3/genetics
- Integrin beta3/immunology
- Intracranial Hemorrhages/embryology
- Intracranial Hemorrhages/etiology
- Intracranial Hemorrhages/immunology
- Intracranial Hemorrhages/physiopathology
- Male
- Maternal-Fetal Exchange
- Mice
- Mice, Knockout
- Neovascularization, Pathologic/etiology
- Neovascularization, Physiologic/immunology
- Platelet Glycoprotein GPIb-IX Complex/genetics
- Platelet Glycoprotein GPIb-IX Complex/immunology
- Pregnancy
- Proto-Oncogene Proteins c-akt/physiology
- Retinal Vessels/embryology
- Retinal Vessels/pathology
- Thrombocytopenia, Neonatal Alloimmune/embryology
- Thrombocytopenia, Neonatal Alloimmune/immunology
- Thrombocytopenia, Neonatal Alloimmune/prevention & control
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Ngamolane A, Molobe LT, Mojela K, Silava C, Cainelli F, Vento S. Brain hemorrhage as presenting feature of Takayasu's arteritis in an African girl. Isr Med Assoc J 2015; 17:196-197. [PMID: 25946777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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48
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Miyagi T, Koga M, Yamagami H, Okuda S, Okada Y, Kimura K, Shiokawa Y, Nakagawara J, Furui E, Hasegawa Y, Kario K, Arihiro S, Sato S, Minematsu K, Toyoda K. Reduced estimated glomerular filtration rate affects outcomes 3 months after intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. J Stroke Cerebrovasc Dis 2014; 24:176-82. [PMID: 25440328 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 07/19/2014] [Accepted: 08/13/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The effect of renal dysfunction on intracerebral hemorrhage (ICH) remains unclear. We investigated associations of renal dysfunction assessed by estimated glomerular filtration rate (eGFR) with clinical courses and outcomes in ICH patients. METHODS From a prospective, multicenter, observational study, 203 patients who had supratentorial ICH within 3 hours of onset were included. Patients were classified into 3 groups based on eGFR: Group 1 (eGFR < 60 mL/minute/m(2)), Group 2 (60-89), and Group 3 (≥ 90). Outcomes included neurologic deterioration within 72 hours, hematoma expansion (> 33% in volume) at 24 hours, and favorable (modified Rankin Scale [mRS] ≤ 2) or unfavorable (mRS ≥ 5) outcome at 3 months. RESULTS Thirty-seven patients (16 women, 74.6 ± 13.2 years) were assigned to Group 1, 99 (34 women, 65.2 ± 11.4 years) to Group 2, and 67 (30 women, 61.3 ± 9.4 years) to Group 3. Significant differences were found in age (P < .001) and initial systolic blood pressure among the groups (208.4 ± 18.0, 201.9 ± 15.1, and 198.1 ± 14.2 mm Hg for Group 1, 2, and 3, respectively; P = .006). Similar rates of neurologic deterioration (14%, 6%, and 6%) and hematoma expansion (16%, 14%, and 18%) were observed among the groups. However, in Group 1, favorable outcome was less frequent (17%, 48%, and 42%; P = .002) and unfavorable outcome was more frequent (24%, 7%, and 6%; P = .013) than in the other groups. After adjustment for confounders, eGFR < 60 mL/minute/m(2) was independently associated with both favorable outcome (odds ratio [OR], .21; 95% CI, .07-.54) and unfavorable outcome (OR, 5.64; 95% CI, 1.80-18.58). CONCLUSIONS Renal dysfunction (eGFR < 60 mL/minute/m(2)) was associated with poor clinical outcome after ICH.
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Affiliation(s)
- Tetsuya Miyagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Hiroshi Yamagami
- Department of Neurology, Stroke Center, Kobe City General Hospital, Kobe, Japan
| | - Satoshi Okuda
- Department of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiaki Shiokawa
- Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan
| | - Jyoji Nakagawara
- Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan
| | - Eisuke Furui
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Shoji Arihiro
- Department of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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49
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Arzu J, Muqueet MA, Sweety SA, Iqbal AM, Kabir FI, Mahmood M. Haemorrhagic stroke after thrombolysis with streptokinase. Mymensingh Med J 2014; 23:818-820. [PMID: 25481610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 54 years old male presented with central chest pain for five hours in a local hospital, Comilla. He was diagnosed as a case of acute STEMI (Extensive Anterior) and was thrombolized with Streptokinase 1.5 million IU. His pain was relieved, ST segment was depressed by >50% after thrombolysis. While in hospital, he developed weakness of his left limbs with gradually deteriorating level of consciousness. A CT scan of brain showed haemorrhage in the right frontoparietal region. This is a rare case of haemorrhagic stroke after thrombolysis with streptokinase.
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Affiliation(s)
- J Arzu
- Dr Jahanara Arzu, Assistant Professor, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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50
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Gulwani H, Garg N. A 40-year-old woman with intracranial bleed and osteomalacia. Brain Pathol 2014; 24:419-20. [PMID: 25083537 DOI: 10.1111/bpa.12155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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