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Sample records for massive intracerebral hemorrhage

  1. Massive intracerebral hemorrhage associated with Wegener granulomatosis.

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    Ceri, Mevlut; Ortabozkoyun, Levent; Unverdi, Selman; Kirac, Mustafa; Duranay, Murat

    2012-06-01

    Wegener granulomatosis (WG) is a necrotizing granulomatous vasculitis that predominantly affects airways and kidneys. But central nervous system involvement (7-11%) is an uncommon. Massive ICH may occur in the course of WG, and this serious condition is related with high risk of mortality. Therefore, the new treatment strategies may be considered in addition to classical practices in serious organ involvement and recurrent attack. Here, we present an adult patient with WG whose disease was complicated by a massive intracerebral hemorrhage (ICH), which subsequently led to death.

  2. Recurrent intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Shen jinsong; Lu jianhong

    2000-01-01

    Objective: In order to study the clinical manifestation and risk factor of recurrent intracerebral hemorrhage(ICH).Methods:The 256 patients were analysed who admitted to our hospital for intracerebral hemorrhage between 1995 and 1997.The 15(5 .86%)patients had a recurrent ICH.There were 9 men and 6 women and the mean age of the patients was 63.5 ± 6.4years at the first bleeding episode and 67.8± 8. 5 years at the second. The mean interval between the two bleeding episodes was 44.6 ± 12.5 months. The 73.3%patients were hypertensive .′The site of the first hemorrhage was ganglionic in 8 patients , ]ohar in six paients and brainstem in one .The recurrent hemorrhage occurred at a different location from the previous ICH.The most common pattern of recurrence was “ganglionic -ganglionic” (7 patients), lobar - ganglionic (3 patients), lobar-lobar(three patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor. By comparison with 24 patients followed up to average 47.5± 18.7 months with isolated ICH without recurrence .Only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanism of recurrence of ICH were multiple(hypertension, cerebral amyloid angiopathy).Contral of blood pressure and good living habit after the first hemorrhage may prevent ICH recurrences.

  3. Multiple simultaneous intracerebral hemorrhages following accidental massive lumbar cerebrospinal fluid drainage: Case report and literature review

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    Ruiz-Sandoval Jose

    2006-01-01

    Full Text Available Multiple simultaneous intracerebral hemorrhages (ICH are uncommon. We report the case of an 80-year-old woman with previous diagnosis of normal pressure hydrocephalus and who was brought to our hospital with altered mental status and urinary incontinence. Medical history of hypertension, hematological disorders or severe head trauma was absent. Platelet count and coagulation profile were unremarkable. An initial head computed tomography (CT showed sulcal enlargement and ventricular dilatation, but no evidence of ICH. A tap test indicated as a guide to case selection for shunt surgery accidentally resulted in cerebrospinal fluid (CSF overdrainage. The patient presented sudden neurological deterioration, with sluggishly responsive pupils and generalized tonic-clonic seizures. A new head CT demonstrated multiple supra and infratentorial ICH. The patient became comatose and had a fatal course. Hence, CSF overdrainage may either cause or precipitate multiple simultaneous ICHs, affecting both the infratentorial and supratentorial regions.

  4. Statins and intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Zheng Haiping; Hu Zhiping; Lu Wei

    2014-01-01

    Objective To briefly review the literature regarding the impact of statins on the prevention and treatment of stroke,especially on intracerebral hemorrhage (ICH).We described statins' effects,mechanism of ICH,serum total cholesterol and ICH,and the relationship between statins and ICH.Data sources All articles used in this review were mainly searched from the PubMed database with no limitations of language and year of publication.Study selection Randomized controlled studies,prospective cohort studies,animal experiments,and meta-analysis articles related to this topic in the past decade were selected.Results Statins play an important role in the primary and secondary prevention of cardiovascular diseases and also have an impact on the treatment of vascular diseases.There still exist controversies about the relationship between statins and ICH.More clinical and experimental trials indicate that statins do not increase the risk of ICH.Conclusion A low or a regular dose of statins would not increase the risk of ICH.

  5. Quantitative Intracerebral Hemorrhage Localization

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    Muschelli, John; Ullman, Natalie L.; Sweeney, Elizabeth M.; Eloyan, Ani; Martin, Neil; Vespa, Paul; Hanley, Daniel F.; Crainiceanu, Ciprian M.

    2015-01-01

    Background and Purpose The location of intracerebral hemorrhage (ICH) is currently described in a qualitative way; we provide a quantitative framework for estimating ICH engagement and its relevance to stroke outcomes. Methods We analyzed 111 patients with ICH from the MISTIE II clinical trial. We estimated ICH engagement at a population level using image registration of CT scans to a template and a previously labeled atlas. Predictive regions of NIHSS and GCS stroke severity scores, collected at enrollment, were estimated. Results The percent coverage of the ICH by these regions strongly outperformed the reader-labeled locations. The adjusted R2 almost doubled from 0.129 (reader-labeled model) to 0.254 (quantitative-location model) for NIHSS and more than tripled from 0.069 (reader-labeled model) to 0.214 (quantitative-location model). A permutation test confirmed that the new predictive regions are more predictive than chance: p<.001 for NIHSS and p<.01 for GCS. Conclusions Objective measures of ICH location and engagement using advanced CT imaging processing provide finer, objective, and more quantitative anatomic information than that provided by human readers. PMID:26451031

  6. Intracerebral hemorrhage and cognitive impairment.

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    Xiong, Li; Reijmer, Yael D; Charidimou, Andreas; Cordonnier, Charlotte; Viswanathan, Anand

    2016-05-01

    Vascular cognitive impairment and vascular dementia are composed of cognitive deficits resulted from a range of vascular lesions and pathologies, including both ischemic and hemorrhagic. However the contribution of spontaneous intracerebral hemorrhage presumed due to small vessel diseases on cognitive impairment is underestimated, in contrast to the numerous studies about the role of ischemic vascular disorders on cognition. In this review we summarize recent findings from clinical studies and appropriate basic science research to better elucidate the role and possible mechanisms of intracerebral hemorrhage in cognitive impairment and dementia. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.

  7. Delayed Intracerebral Hemorrhage Secondary to Ventriculoperitoneal Shunt

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    Ma, Li; Chen, Yi-Li; Yang, Shu-Xu; Wang, Yi-Rong

    2015-01-01

    Abstract The ventriculoperitoneal (VP) shunt is a routine procedure for cerebrospinal fluid (CSF) diversion, and is associated with many complications. A delayed hemorrhage after the VP shunt surgery, however, is quite rare. In this study, we report a case involving late-onset hemorrhage. The 67-year-old male patient with a history of head trauma and brain surgery underwent a VP shunt placement for hydrocephalus. The surgery course was uneventful and no bleeding was revealed in the first computed tomographic (CT) scan after the procedure. However, a massive intraparenchymal and intraventricular hemorrhage occurred 8 h following adjustment of the valve system on the 8th day after surgery. Erosion of the vasculature by catheter cannulation and a sudden reduction of CSF pressure after downregulation of the valve could be one of the possible causes of the intracerebral hemorrhage (ICH). PMID:26632700

  8. Glycemia in Spontaneous Intracerebral Hemorrhage: Clinical Implications

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    Alvis-Miranda Hernando

    2014-10-01

    Full Text Available Spontaneous cerebral hemorrhage or intracranial hemorrhage accounts for 10-15% of all strokes. Intracranial hemorrhage is much less common than ischemic stroke, but has higher mortality and morbidity, one of the leading causes of severe disability. Various alterations, among these the endocrine were identified when an intracerebral hemorrhage, these stress-mediated mechanisms exacerbate secondary injury. Deep knowledge of the injuries which are directly involved alterations of glucose, offers insight as cytotoxicity, neuronal death and metabolic dysregulations alter the prognosis of patients with spontaneous intracerebral hemorrhage.

  9. Tamoxifen treatment for intracerebral hemorrhage.

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    Xie, Qing; Guan, Jian; Wu, Gang; Xi, Guohua; Keep, Richard F; Hua, Ya

    2011-01-01

    Tamoxifen is a selective estrogen receptor modulator. In this study we investigated whether or not tamoxifen reduces intracerebral hemorrhage (ICH)-induced brain injury in rats. In all experiments, adult male Sprague-Dawley rats received an injection of 100 μL autologous whole blood into the right basal ganglia. In the first set of experiments, rats were treated with tamoxifen (2.5 mg/kg or 5 mg/kg, i.p.) or vehicle 2 and 24 h after ICH and were killed at day 3 for brain edema measurement. In the second set of experiments, rats were treated with tamoxifen (5 mg/kg) or vehicle and magnetic resonance imaging (MRI), and behavior tests were performed at days 1, 7, 14 and 28. Rats were killed at day 28 for brain histology. We found that tamoxifen at 5 but not at 2.5 mg/kg reduced perihematomal brain edema at day 3 (ptamoxifen reduced caudate atrophy at day 28 (pTamoxifen also improved functional outcome (ptamoxifen-treated rats. However, two out of five rats treated with tamoxifen developed hydrocephalus. These results suggest that tamoxifen has neuroprotective effects in ICH, but the cause of hydrocephalus development following tamoxifen treatment needs to be examined further.

  10. Clinical features of multiple spontaneous intracerebral hemorrhages

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    Tao CHANG

    2016-01-01

    Full Text Available Objective To analyze the clinical features of multiple spontaneous intracerebral hemorrhages (MICH. Methods Conservative therapy, puncture and drainage, hematoma removal and/or decompressive craniectomy were used in the treatment of 630 intracerebral hemorrhage (ICH patients, who were divided into 2 groups: 30 cases with MICH and another 600 cases with solitary intracerebral hemorrhage (SICH. Three months after onset, modified Rankin Scale (mRS was used to evaluate the prognosis of all cases. Results Compared with patients in SICH group, the occurrence rate of hypertension > 5 years (P = 0.008, diabetes mellitus (P = 0.024, hypercholesterolemia (P = 0.050 and previous ischemic stroke (P = 0.026 were all significantly higher in MICH group. The mean arterial pressure (MAP level (P = 0.002 and the incidence of limb movement disorder (P = 0.000 were significantly higher in patients with MICH than those with SICH. Basal ganglia and thalamus were the predilection sites of hematoma (P = 0.001. Patients with MICH had worse prognosis compared to those with SICH 3 months after onset (P = 0.006. Conclusions Hypertension > 5 years, diabetes mellitus, hypercholesterolemia and ischemic stroke were identified to be the pathophysiological basis of MICH in this study. All patients with MICH had more serious clinical manifestations after onset and worse prognosis. DOI: 10.3969/j.issn.1672-6731.2016.01.008

  11. Massive antenatal fetomaternal hemorrhage

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    Dziegiel, Morten Hanefeld; Koldkjaer, Ole; Berkowicz, Adela

    2005-01-01

    Massive fetomaternal hemorrhage (FMH) can lead to life-threatening anemia. Quantification based on flow cytometry with anti-hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO-compatible fetus allows an estimation...

  12. Nonbacterial thrombotic endocarditis presenting as intracerebral hemorrhage.

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    Wigger, Olivier; Windecker, Stephan; Bloechlinger, Stefan

    2016-12-01

    Nonbacterial thrombotic endocarditis is a rare cause of valvular heart disease, most commonly associated with advanced malignancy. The morbidity of this kind of endocarditis lies in its tendency to embolize, while the valve function is usually preserved. The central nervous system is the most common site of embolization, leading to ischemic stroke. We report a case of nonbacterial thrombotic endocarditis complicated by intracerebral hemorrhage as the first manifestation of adenocarcinoma of the lung. The endocarditis led to severe aortic regurgitation. In view of the advanced stage of lung cancer, the patient refused further therapy. He passed away 3 weeks after first diagnosis of the adenocarcinoma.

  13. Treatment of intracerebral hemorrhage: the clinical evidences.

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    Sterzi, R; Vidale, S

    2004-03-01

    Of all strokes 10% to 15% are intracerebral hemorrhage, primary ICH accounting for more than 75% of cases. A correct evaluation and management must start in the emergency room, in particular for patients who rapidly deteriorate. The diffusion of organized care for stroke patients and the availability of the stroke units in Italian hospitals, may represent a further opportunity to improve the outcome of patients with ICH. Despite the bulk of evidences coming from the randomized clinical therapeutic trials for acute ischemic stroke, the available data for randomized surgical trials are scanty. In these small randomized studies, neither surgical nor medical treatment has conclusively been shown to benefit patients with ICH. Surgical techniques are improving but it is important to find out the time window during which surgical evacuation is most effective with respect to the long-term outcome. The use of thrombolytic therapy to promote the resolution of ventricular blood clots appears to be promising.

  14. Hyponatremia in Patients with Spontaneous Intracerebral Hemorrhage

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    Jaime Robenolt Gray

    2014-11-01

    Full Text Available Hyponatremia is the most frequently encountered electrolyte abnormality in critically ill patients. Hyponatremia on admission has been identified as an independent predictor of in-hospital mortality in patients with spontaneous intracerebral hemorrhage (sICH. However, the incidence and etiology of hyponatremia (HN during hospitalization in a neurointensive care unit following spontaneous intracerebral hemorrhage (sICH remains unknown. This was a retrospective analysis of consecutive patients admitted to Detroit Receiving Hospital for sICH between January 2006 and July 2009. All serum Na levels were recorded for patients during the ICU stay. HN was defined as Na <135 mmol/L. A total of 99 patients were analyzed with HN developing in 24% of sICH patients. Patients with HN had an average sodium nadir of 130 ± 3 mmol/L and an average time from admission to sodium <135 mmol/L of 3.9 ± 5.7 days. The most common cause of hyponatremia was syndrome of inappropriate antidiuretic hormone (90% of HN patients. Patients with HN were more likely to have fever (50% vs. 23%; p = 0.01, infection (58% vs. 28%; p = 0.007 as well as a longer hospital length of stay (14 (8–25 vs. 6 (3–9 days; p < 0.001. Of the patients who developed HN, fifteen (62.5% patients developed HN in the first week following sICH. This shows HN has a fairly high incidence following sICH. The presence of HN is associated with longer hospital length of stays and higher rates of patient complications, which may result in worse patient outcomes. Further study is necessary to characterize the clinical relevance and treatment of HN in this population.

  15. History of Preclinical Models of Intracerebral Hemorrhage

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    Ma, Qingyi; Khatibi, Nikan; Chen, Hank; Zhang, John H.

    2013-01-01

    In order to understand a disease process, effective modeling is required that can assist scientists in understanding the pathophysiological processes that take place. Intracerebral hemorrhage (ICH), a devastating disease representing 15% of all stroke cases, is just one example of how scientists have developed models that can effectively mimic human clinical scenarios. Currently there are three models of hematoma injections that are being used to induce an ICH in subjects. They include the microballoon model introduced in 1987 by Dr. David Mendelow, the bacterial collagenase injection model introduced in 1990 by Dr. Gary Rosenberg, and the autologous blood injection model introduced by Dr. Guo-Yuan Yang in 1994. These models have been applied on various animal models beginning in 1963 with canines, followed by rats and rabbits in 1982, pigs in 1996, and mice just recently in 2003. In this review, we will explore in detail the various injection models and animal subjects that have been used to study the ICH process while comparing and analyzing the benefits and disadvantages of each. PMID:21725723

  16. The Frequency of Recurrence in Primary Hypertensive Intracerebral Hemorrhage

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    SA Mousavi

    2006-01-01

    Full Text Available Background: Primary intracerebral Hemorrhage (PICH is a devasting illness with high early mortality which causes 10 -12 percent of stroke cases. Survivors of PICH are at risk for recurrence of hemorrhage. We wanted to determine the frequency of recurrence of ICH in patients with PICH at Alzahra and Noor hospital Isfahan, Iran. Methods: A descriptive retrospective study was did on the hospital records of patients with a discharge diagnosis of intracerebral hemorrhage to identify the cases. Data were gathered by means of a check list and were analysed by using SPSS statistical software. Results: A total number of 660 cases were identified by computer search. After abstraction, 400 patients with primary hypertensive intracerebral hemorrhage were identified. Widespread distribution of recurrence of ICH were 65 cases which 33 cases of them were men and 32 cases were women. Conclusion: Totally, 16 .25 percent of patients had recurrence which is greater risk of recurrence in comparison to other studies. Key Words: Intracerebral Hemorrhage, hypertension, recurrence of Intracerebral Hemorrhage

  17. Intracerebral hemorrhage location and outcome among INTERACT2 participants

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    Delcourt, C; Sato, S.; Zhang, S.; Sandset, E.C.; Zheng, D.; Chen, X.; Hackett, M.L.; Arima, H.; Hata, J.; Heeley, E.; Salman, R.A.; Robinson, T.; Davies, L.; Lavados, P.M.; Lindley, R.I.; Stapf, C.; Chalmers, J.; Anderson, C.S.; Klijn, C.J.M.

    2017-01-01

    OBJECTIVE: To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS: Associations between ICH sites and poor outcomes (death [6] or maj

  18. Intracerebral hemorrhage caused by varicella-induced thrombocytopenia.

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    Lizarazo, Jairo; Castellanos, María Fernanda; Omaña, Claudia Rosa; Chaín, Miguel; Villamizar, Sergio

    2016-02-16

    We present the case of a previously healthy 44-years-old man with chickenpox, severe thrombocytopenia, mucosal hemorrhage, and intracerebral hemorrhage in the right hemisphere. The patient was treated with platelets and high doses of steroids. He recovered although with persistent left homonymous hemianopsia and epilepsy, which were controlled with medication.

  19. Intravenous tranexamic acid for hyperacute primary intracerebral hemorrhage

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    Sprigg, Nikola; Robson, Katie; Bath, Philip

    2016-01-01

    RATIONALE: Outcome after intracerebral hemorrhage remains poor. Tranexamic acid is easy to administer, readily available, inexpensive, and effective in other hemorrhagic conditions. AIM: This randomized trial aims to test the hypothesis that intravenous tranexamic acid given within 8 h of spontan...

  20. Spreading depolarizations in patients with spontaneous intracerebral hemorrhage

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    Helbok, Raimund; Schiefecker, Alois Josef; Friberg, Christian;

    2017-01-01

    Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke......, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography...... patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema...

  1. Hypoxic preconditioning enhances neural stem cell transplantation therapy after intracerebral hemorrhage in mice.

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    Wakai, Takuma; Narasimhan, Purnima; Sakata, Hiroyuki; Wang, Eric; Yoshioka, Hideyuki; Kinouchi, Hiroyuki; Chan, Pak H

    2016-12-01

    Previous studies have shown that intraparenchymal transplantation of neural stem cells ameliorates neurological deficits in animals with intracerebral hemorrhage. However, hemoglobin in the host brain environment causes massive grafted cell death and reduces the effectiveness of this approach. Several studies have shown that preconditioning induced by sublethal hypoxia can markedly improve the tolerance of treated subjects to more severe insults. Therefore, we investigated whether hypoxic preconditioning enhances neural stem cell resilience to the hemorrhagic stroke environment and improves therapeutic effects in mice. To assess whether hypoxic preconditioning enhances neural stem cell survival when exposed to hemoglobin, neural stem cells were exposed to 5% hypoxia for 24 hours before exposure to hemoglobin. To study the effectiveness of hypoxic preconditioning on grafted-neural stem cell recovery, neural stem cells subjected to hypoxic preconditioning were grafted into the parenchyma 3 days after intracerebral hemorrhage. Hypoxic preconditioning significantly enhanced viability of the neural stem cells exposed to hemoglobin and increased grafted-cell survival in the intracerebral hemorrhage brain. Hypoxic preconditioning also increased neural stem cell secretion of vascular endothelial growth factor. Finally, transplanted neural stem cells with hypoxic preconditioning exhibited enhanced tissue-protective capability that accelerated behavioral recovery. Our results suggest that hypoxic preconditioning in neural stem cells improves efficacy of stem cell therapy for intracerebral hemorrhage.

  2. Pharmacogenomic effects of apolipoprotein e on intracerebral hemorrhage.

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    James, Michael L; Sullivan, Patrick M; Lascola, Christopher D; Vitek, Michael P; Laskowitz, Daniel T

    2009-02-01

    The purpose of the study was to evaluate the effect of APOE genotype and the feasibility of administering an apolipoprotein E-mimetic therapeutic to modify outcomes in a murine model of intracerebral hemorrhage. Intracerebral hemorrhage was induced via stereotactic injection of 0.1 U Clostridial collagenase into the left basal ganglia of wild-type and apolipoprotein-E targeted-replacement mice, consisting of either homozygous 3/3 or 4/4 genotypes. Animals were randomized to receive either vehicle or apolipoprotein E-mimetic peptide. Outcomes included functional neurological tests (21-point neuroseverity score and Rotorod latency) over the initial 7 days after injury, radiographic and histological hemorrhage size at 3 and 7 days, brain water content for cerebral edema at 24 hours, and quantitative polymerase chain reaction for inflammatory markers at 6, 24, and 48 hours. Apolipoprotein-E targeted-replacement mice consisting of homozygous 3/3 demonstrated superior neuroseverity scores and Rotorod latencies over the first 3 days after intracerebral hemorrhage, decreased cerebral edema at 24 hours, and reduced upregulation of IL-6 and endothelial nitric oxide synthase at 6 hours when compared to their apolipoprotein-E targeted-replacement mice consisting of homozygous 4/4 counterparts. After intravenous administration of 1 mg/kg apolipoprotein E-mimetic peptide, both wild-type and apolipoprotein-E targeted-replacement mice consisting of homozygous 4/4 exhibited improved functional outcomes over 7 days after intracerebral hemorrhage, less edema at 24 hours, and reduced upregulation of IL-6 and endothelial nitric oxide synthase when compared to mice that did not receive the peptide. Our data indicate that APOE genotype influences neurological outcome after intracerebral hemorrhage in a murine model. In particular APOE4 is associated with poor functional outcome and increased cerebral edema. Additionally, this outcome can be modified by the addition of an apolipoprotein E

  3. Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage

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    Krishnan, Kailash; Scutt, Polly; Woodhouse, Lisa

    2016-01-01

    BACKGROUND AND PURPOSE: More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH...

  4. Prior Cannabis Use Is Associated with Outcome after Intracerebral Hemorrhage

    NARCIS (Netherlands)

    Napoli, M. Di; Zha, A.M.; Godoy, D.A.; Masotti, L.; Schreuder, F.H.B.M.; Popa-Wagner, A.; Behrouz, R.

    2016-01-01

    OBJECTIVE: Recent evidence suggests that a potential harmful relationship exists between cannabis use and ischemic stroke. The purpose of this study was to determine the implications of cannabis use in intracerebral hemorrhage (ICH) patients. METHODS: An analysis of an international, multicenter, ob

  5. Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Parry-Jones, A.R.; Napoli, M. Di; Goldstein, J.N.; Schreuder, F.H.; Tetri, S.; Tatlisumak, T.; Yan, B.; Nieuwenhuizen, K.M.; Dequatre-Ponchelle, N.; Lee-Archer, M.; Horstmann, S.; Wilson, D.; Pomero, F.; Masotti, L.; Lerpiniere, C.; Godoy, D.A.; Cohen, A.S.; Houben, R.; Al-Shahi Salman, R.; Pennati, P.; Fenoglio, L.; Werring, D.; Veltkamp, R.; Wood, E.; Dewey, H.M.; Cordonnier, C.; Klijn, C.J.M.; Meligeni, F.; Davis, S.M.; Huhtakangas, J.; Staals, J.; Rosand, J.; Meretoja, A.

    2015-01-01

    OBJECTIVE: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different

  6. Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Parry-Jones, Adrian R.; Di Napoli, Mario; Goldstein, Joshua N.; Schreuder, Floris H B M; Tetri, Sami; Tatlisumak, Turgut; Yan, Bernard; Van Nieuwenhuizen, Koen M.; Dequatre-Ponchelle, Nelly; Lee-Archer, Matthew; Horstmann, Solveig; Wilson, Duncan; Pomero, Fulvio; Masotti, Luca; Lerpiniere, Christine; Godoy, Daniel Agustin; Cohen, Abigail S.; Houben, Rik; Al-Shahi Salman, Rustam; Pennati, Paolo; Fenoglio, Luigi; Werring, David; Veltkamp, Roland; Wood, Edith; Dewey, Helen M.; Cordonnier, Charlotte; Klijn, Catharina J M; Meligeni, Fabrizio; Davis, Stephen M.; Huhtakangas, Juha; Staals, Julie; Rosand, Jonathan; Meretoja, Atte

    2015-01-01

    Objective There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different

  7. Genetic variants in CETP increase risk of intracerebral hemorrhage

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    Anderson, Christopher D.; Falcone, Guido J.; Phuah, Chia Ling; Radmanesh, Farid; Brouwers, H. Bart; Battey, Thomas W K; Biffi, Alessandro; Peloso, Gina M.; Liu, Dajiang J.; Ayres, Alison M.; Goldstein, Joshua N.; Viswanathan, Anand; Greenberg, Steven M.; Selim, Magdy; Meschia, James F.; Brown, Devin L.; Worrall, Bradford B.; Silliman, Scott L.; Tirschwell, David L.; Flaherty, Matthew L.; Kraft, Peter; Jagiella, Jeremiasz M.; Schmidt, Helena; Hansen, Björn M.; Jimenez-Conde, Jordi; Giralt-Steinhauer, Eva; Elosua, Roberto; Cuadrado-Godia, Elisa; Soriano, Carolina; van Nieuwenhuizen, Koen M.; Klijn, Catharina J M; Rannikmae, Kristiina; Samarasekera, Neshika; Salman, Rustam Al Shahi; Sudlow, Catherine L.; Deary, Ian J.; Morotti, Andrea; Pezzini, Alessandro; Pera, Joanna; Urbanik, Andrzej; Pichler, Alexander; Enzinger, Christian; Norrving, Bo; Montaner, Joan; Fernandez-Cadenas, Israel; Delgado, Pilar; Roquer, Jaume; Lindgren, Arne; Slowik, Agnieszka; Schmidt, Reinhold; Kidwell, Chelsea S.; Kittner, Steven J.; Waddy, Salina P.; Langefeld, Carl D.; Abecasis, Goncalo; Willer, Cristen J.; Kathiresan, Sekar; Woo, Daniel; Rosand, Jonathan

    2016-01-01

    Objective: In observational epidemiologic studies, higher plasma high-density lipoprotein cholesterol (HDL-C) has been associated with increased risk of intracerebral hemorrhage (ICH). DNA sequence variants that decrease cholesteryl ester transfer protein (CETP) gene activity increase plasma HDL-C;

  8. Clinical characteristics and outcome of intracerebral hemorrhage in young adults

    NARCIS (Netherlands)

    Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Dijk, E.J. van; Leeuw, F.E. de

    2014-01-01

    Data on determinants of prognosis after intracerebral hemorrhage (ICH) in young adults are scarce. Our aim was to identify clinical determinants of prognosis after ICH in adults aged 18-50. We investigated 98 consecutive patients with an ICH, aged 18-50 years, admitted to our hospital between 1980 a

  9. Previously undiagnosed hemophilia patient with intracerebral hemorrhage

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    Eray Atalay

    2015-09-01

    Full Text Available Intracranial bleeding in hemophilia patients is a rare but a mortal complication. Diagnosis of hemophilia in adulthood is an uncommon occurrence. In this case report an adult patient with intracranial hemorrhage is presented.

  10. Delayed Intracerebral Hemorrhage Secondary to Ventriculoperitoneal Shunt: A Case Report and Literature Review.

    Science.gov (United States)

    Ma, Li; Chen, Yi-Li; Yang, Shu-Xu; Wang, Yi-Rong

    2015-11-01

    The ventriculoperitoneal (VP) shunt is a routine procedure for cerebrospinal fluid (CSF) diversion, and is associated with many complications. A delayed hemorrhage after the VP shunt surgery, however, is quite rare. In this study, we report a case involving late-onset hemorrhage. The 67-year-old male patient with a history of head trauma and brain surgery underwent a VP shunt placement for hydrocephalus. The surgery course was uneventful and no bleeding was revealed in the first computed tomographic (CT) scan after the procedure. However, a massive intraparenchymal and intraventricular hemorrhage occurred 8 h following adjustment of the valve system on the 8th day after surgery.Erosion of the vasculature by catheter cannulation and a sudden reduction of CSF pressure after downregulation of the valve could be one of the possible causes of the intracerebral hemorrhage (ICH).

  11. Hypereosinophilia with Multiple Thromboembolic Cerebral Infarcts and Focal Intracerebral Hemorrhage

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    Lee, Eun Ju; Lee, Young Jun; Lee, Seung Ro; Park, Dong Woo; Kim, Hyun Young [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2009-10-15

    We report a case of hypereosinophilia causing multiple areas of cerebral infarcts. A 52-year-old Korean man presented with dysarthria and weakness in both arms. A brain MRI revealed multiple acute infarcts in the distal border zone with focal intracerebral hemorrhage, whereas a cerebral angiogram was not remarkable. The eosinophil count was 5,500/{mu}L and was accompanied by elevated cardiac enzyme levels. The pattern of cerebral infarcts and laboratory results suggest a thromboembolic infarction associated with hypereosinophilia.

  12. Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients.

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    Naganuma, Toshihide; Takemoto, Yoshiaki; Shoji, Tetsuo; Ishimura, Eiji; Okamura, Mikio; Nakatani, Tatsuya

    2015-08-01

    In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients. Cranial MRI, including T2*-weighted magnetic resonance imaging, was performed on 179 hemodialysis patients with no past history of cerebrovascular events. The patients were followed prospectively until death or renal transplantation. We used the Cox proportional hazards model with inverse probability of treatment weighting using the propensity score to compare the event-free survivals of patients with/without CMBs. For sensitivity analyses, stratification by propensity score quintile and regression adjustment were used. CMBs were detected in 45 of the 179 patients. During a median follow-up period of 5.0 years, stroke occurred in 24 patients, including 12 with intracerebral hemorrhage and 12 with cerebral infarctions. Cox proportional hazards analysis with inverse probability of treatment weighting using the propensity score revealed that the presence of CMBs was a strong and significant predictor of intracerebral hemorrhage (hazard ratio, 26.53; 95% confidence interval, 2.88-244.90) but not cerebral infarction (hazard ratio, 0.91; 95% confidence interval, 0.25-3.34). Sensitivity analyses yielded similar results. This study showed that the presence of CMBs was an independent and strong predictor of intracerebral hemorrhage in stroke-free hemodialysis patients, indicating that hemodialysis patients with CMBs should be carefully monitored for future onset of intracerebral hemorrhage. © 2015 American Heart Association, Inc.

  13. Mortality Prediction in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

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    Alexis Suárez Quesada

    2016-03-01

    Full Text Available Background: spontaneous intracerebral hemorrhage is the deadliest, most disabling, and least treatable form of stroke. No therapy has proven to improve its outcome or reduce its mortality. Objective: to identify predictors of mortality in patients with spontaneous supratentorial intracerebral hemorrhage. Methods: a single cohort study was conducted involving 176 patients admitted consecutively to the stroke ward of the Carlos Manuel de Céspedes Provincial General Hospital with neuroimaging and clinical diagnosis of spontaneous supratentorial intracerebral hemorrhage from January 2013 to November 2015. Independent predictors were obtained using multivariable logistic regression. Results: seventy four point four percent of the patients were hypertensive. The median age among those who died was 67.45 ± 14.84 years. Forty three point eight percent of the patients under study died. Subjects with fatal outcome had lower score on the Glasgow Coma Scale (10.00 ± 3.47 vs. 14.00 ± 1.93, higher hematoma volume expressed in cubic centimeters (26.27 ± 36.86 vs. 6.19 ± 19.59, and displacement of the midline structures (2.00 ± 5.95 vs. 0.00 ± 4.49. The following predictors were identified: Glasgow score ≤ 10 points (Exp (B: 10.74; 95 % CI=4.69 to 24.59, hematoma volume ≥ 20 cm3 (Exp (B: 4.44; 95 % CI= 1.95 to 10.06, and pulse pressure ≥ 60 mmHg (Exp (B: 2.42, 95 % CI=1.10 to 5.33. The area under the ROC curve was 0.85. Conclusions: the Glasgow Coma Scale is the most significant independent variable to predict mortality in patients with spontaneous intracerebral hemorrhage.

  14. A case of repeated intracerebral hemorrhages secondary to ventriculoperitoneal shunt

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    Jinbing Zhao

    2015-03-01

    Full Text Available Ventriculoperitoneal shunt is a routinely performed treatment in neurosurgical department. Intracerebral hemorrhage, as a complication after shunt catheterization, is really rare but with high mortality. In this study, we reported a case of a 74-year-old man who suffered from repeated intracerebral hemorrhage after ventriculoperitoneal shunt. The first hemorrhage happened 63 h after the 1st surgery, and most hematomas were located in the ipsilateral occipital lobe and intraventricles, along the ventricular catheter. Fresh blood clot casts blocked the external ventricular draining catheter, which was inserted into the right front horn during the 3rd surgery, indicating new intraventricular bleeding happened. A large hematoma in ipsilateral frontal lobe was detected on the 3rd day after the removal of external ventricular draining catheter. Different hemorrhagic locations and time points were encountered on the same case. We discussed the possible causes of repeated hemorrhage for this case, and the pre-operative preparation including risk evaluation in future clinical work.

  15. Correlative research between homocysteine,cystatin C and patients with essential hypertension and hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    孙屿

    2014-01-01

    Objective To investigate the correlation between homocysteine(Hcy),cystatin C(Cys C)and patients with essential hypertension and hypertensive intracerebral hemorrhage.Methods Subjects were divided into hypertensive intracerebral hemorrhage group(108 cases),essential hypertension group(100 cases)and control group(100 cases),and their cystatin C,homocysteine and total cholesterol(TC)and triglycerides(TG)were surveyed.Results The patients with hypertensive intracerebral hemorrhage and essential hypertension had higher

  16. Early MR abnormality indicating functional recovery from spontaneous intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Fumeya, Hiroshi; Hideshima, Hiroshi (Hideshima Hospital, Musashino, Tokyo (Japan))

    1991-10-01

    Magnetic resonance (MR) imaging as an indicator of recovery from hemiparesis was evaluated in 60 patients with spontaneous intracerebral hemorrhage. T{sub 2}-weighted MR images revealed early MR abnormality (EMA) of the corticospinal tract within 1 week of ictus. Most patients without EMA recovered beyond Brunnstrom's Recovery Stage 3 while only a few patients with EMA did so. Patients with EMA cannot regain motor function because EMA is almost always followed by complete tract degeneration. EMA in the brainstem and poor motor function recovery are closely correlated. (author).

  17. How I treat patients with massive hemorrhage

    DEFF Research Database (Denmark)

    Johansson, Pär I; Stensballe, Jakob; Oliveri, Roberto

    2014-01-01

    Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids and red blood cells (RBC) in the early phase, and plasma and platelets in...

  18. Perioperative Antihypertensive Treatment in Patients With Spontaneous Intracerebral Hemorrhage.

    Science.gov (United States)

    Zheng, Jun; Li, Hao; Lin, Sen; Ma, Junpeng; Guo, Rui; Ma, Lu; Fang, Yuan; Tian, Meng; Liu, Ming; You, Chao

    2017-01-01

    Studies on antihypertensive treatment for surgical patients with spontaneous intracerebral hemorrhage are insufficient. This pilot study was conducted to investigate the safety of the perioperative intensive blood pressure lowering in surgical patients with spontaneous intracerebral hemorrhage. This study was a prospective, parallel, randomized, assessor-blinded trial. Patients allocated to the intensive group received perioperative intensive antihypertensive treatment aiming to achieve a target systolic blood pressure between 120 and 140 mm Hg, whereas the patients in the conservative group received conservative treatment aiming to achieve a target systolic blood pressure between 140 and 180 mm Hg for 7 days. The primary outcome was the rate of rehemorrhage at 7 days after surgery. Rehemorrhage was noted in 11 patients (11%) in the intensive group and 14 (14%) in the conservative group (P=0.689). There was no significant difference in mortality at 7 days (4.0% versus 10.0%; P=0.164), 30 days (10.4% versus 17.2%; P=0.247), and 90 days (13.5% versus 18.2%; P=0.490) between the 2 groups. Perioperative intensive blood pressure lowering was not associated with a reduced incidence of rehemorrhage, death, or other serious adverse events. URL: http://www.chictr.org.cn/. Unique identifier: ChiCTR-TRC-13004304. © 2016 American Heart Association, Inc.

  19. Diagnostic usefulness of periIesional edema around intracerebral hemorrhage in predicting underlying causes

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Nam Yeol; Seo, Jeong Jin; Yoon, Woong; Shin, Sang Soo; Lim, Hyo Soon; Chung, Tae Woong; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Hospital, Gwangju (Korea, Republic of)

    2004-07-01

    We attempted to evaluate the diagnostic usefulness of the degree of perilesional edema around intracerebral hematoma in predicting the underlying cause. This study included 54 patients with intracerebral hematoma for whom the underlying cause was confirmed by biopsy, radiological or clinical methods. Cases of subarachnoid hemorrhage, hemorrhagic transformation of cerebral infarction and intraventricular hemorrhage were excluded. The lesion size was defined as the average value of the longest axis and the axis perpendicular to this. The size of the perilesional edema was defined as the longest width of the edema. In all cases, the sizes of the lesion and edema were measured on the T2 weighted image. We defined the edema ratio as the edema size divided by the lesion size. 23 cases were diagnosed as intracerebral hemorrhage due to neoplastic conditions, such as metastasis (n=17), glioblastoma (n=5), hemangioblastoma (n=1). 31 cases were caused by non-neoplastic conditions, such as spontaneous hypertensive hemorrhage (n=23), arteriovenous malformation (n=4), cavernous angioma (n=3), and moya-moya disease (n=1). In fourteen cases, which were confirmed as malignant intracerebral hemorrhage, the edema ratio was more than 100%. Of the other cases, only 8 were confirmed as malignant intracerebral hemorrhage. It was found that the larger the edema ratio, the more malignant the intracerebral hemorrhage, and this result was statistically significant (p<0.001). Measurement of perilesional edema and the intracerebral hematoma ratio may be useful in predicting the underlying causes.

  20. Putative role of prostaglandin receptor in intracerebral hemorrhage

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    Shekher eMohan

    2012-10-01

    Full Text Available Each year, approximately 795,000 people experience a new or recurrent stroke. Of all strokes, 84% are ischemic, 13% are intracerebral hemorrhage (ICH strokes and 3% are subarachnoid hemorrhage (SAH strokes. Despite the decreased incidence of ischemic stroke, there has been no change in the incidence of hemorrhagic stroke in the last decade. ICH is a devastating disease 37-38% of patients between the ages of 45-64 die within 30 days. In an effort to prevent ischemic and hemorrhagic strokes we and others have been studying the role of prostaglandins and their receptors. Prostaglandins are bioactive lipids derived from the metabolism of arachidonic acid. They sustain homeostatic functions and mediate pathogenic mechanisms, including the inflammatory response. Most prostaglandins are produced from specific enzymes and act upon cells via distinct G-protein coupled receptors. The presence of multiple prostaglandin receptor’s cross-reactivity and coupling to different signal transduction pathways allow differentiated cells to respond to prostaglandins in a unique manner. Due to the number of prostaglandin receptors, prostaglandin-dependent signaling can function either to promote neuronal survival or injury following acute excitotoxicity, hypoxia, and stress induced by ICH. To better understand the mechanisms of neuronal survival and neurotoxicity mediated by prostaglandin receptors, it is essential to understand downstream signaling. Several groups including ours have discovered unique roles for prostaglandin receptors in rodent models of ischemic stroke, excitotoxicity, and Alzheimer disease, highlighting the emerging role of prostaglandin receptor signaling in hemorrhagic stroke with a focus on cyclic-adenosine monophosphate (cAMP and calcium (Ca2+ signaling. We review current ICH data and discuss future directions notably on prostaglandin receptors, which may lead to the development of unique therapeutic targets against hemorrhagic stroke and

  1. Management of intracerebral hemorrhage – use of statins

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    Van Matre ET

    2016-04-01

    Full Text Available Edward T Van Matre,1 Deb S Sherman,2 Tyree H Kiser1,21Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 2Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USAAbstract: Intracerebral hemorrhage (ICH is a neurologic injury resulting in significant morbidity and mortality. Statins play a significant role in primary and secondary prevention of cardiovascular and cerebrovascular ischemic events. Despite clear benefits of statins in ischemic stroke, post hoc analyses of some studies suggest there may be a link between statin therapy and development of ICH. Direct pharmacologic effects of decreased serum levels of total cholesterol and low-density lipoproteins in conjunction with pleiotropic effects are thought to be linked to this possible increase in ICH risk. In the face of the potential of statins to increase the risk of ICH, recent evidence suggests that statins may also have beneficial effects on patient outcomes when continued or initiated following an ICH. This discordance in findings and the overall lack of well-designed prospective clinical trials increase the complexity of clinical decision making when utilizing statin therapy in patients with, or at risk for, ICH. This review evaluates the pharmacologic effects of statin therapy and describes how these effects translate to both risks and benefits in ICH. The current literature regarding the effects of statin therapy on clinical outcomes in ICH is evaluated to help guide clinicians with decisions regarding initiation, continuation, or discontinuation of statin therapy in patients with ICH.Keywords: intracerebral hemorrhage, statin pharmacology, intracranial hemorrhage, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, pleiotropic effects

  2. Colony stimulating factor 1 receptor inhibition eliminates microglia and attenuates brain injury after intracerebral hemorrhage.

    Science.gov (United States)

    Li, Minshu; Li, Zhiguo; Ren, Honglei; Jin, Wei-Na; Wood, Kristofer; Liu, Qiang; Sheth, Kevin N; Shi, Fu-Dong

    2017-07-01

    Microglia are the first responders to intracerebral hemorrhage, but their precise role in intracerebral hemorrhage remains to be defined. Microglia are the only type of brain cells expressing the colony-stimulating factor 1 receptor, a key regulator for myeloid lineage cells. Here, we determined the effects of a colony-stimulating factor 1 receptor inhibitor (PLX3397) on microglia and the outcome in the context of experimental mouse intracerebral hemorrhage. We show that PLX3397 effectively depleted microglia, and the depletion of microglia was sustained after intracerebral hemorrhage. Importantly, colony-stimulating factor 1 receptor inhibition attenuated neurodeficits and brain edema in two experimental models of intracerebral hemorrhage induced by injection of collagenase or autologous blood. The benefit of colony-stimulating factor 1 receptor inhibition was associated with reduced leukocyte infiltration in the brain and improved blood-brain barrier integrity after intracerebral hemorrhage, and each observation was independent of lesion size or hematoma volume. These results demonstrate that suppression of colony-stimulating factor 1 receptor signaling ablates microglia and confers protection after intracerebral hemorrhage.

  3. Necrostatin-1 Reduces Neurovascular Injury after Intracerebral Hemorrhage

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    Melanie D. King

    2014-01-01

    Full Text Available Intracerebral hemorrhage (ICH is the most common form of hemorrhagic stroke, accounting for 15% of all strokes. ICH has the highest acute mortality and the worst long-term prognosis of all stroke subtypes. Unfortunately, the dearth of clinically effective treatment options makes ICH the least treatable form of stroke, emphasizing the need for novel therapeutic targets. Recent work by our laboratory identified a novel role for the necroptosis inhibitor, necrostatin-1, in limiting neurovascular injury in tissue culture models of hemorrhagic injury. In the present study, we tested the hypothesis that necrostatin-1 reduces neurovascular injury after collagenase-induced ICH in mice. Necrostatin-1 significantly reduced hematoma volume by 54% at 72 h after-ICH, as compared to either sham-injured mice or mice administered an inactive, structural analogue of necrostatin-1. Necrostatin-1 also limited cell death by 48%, reduced blood-brain barrier opening by 51%, attenuated edema development to sham levels, and improved neurobehavioral outcomes after ICH. These data suggest a potential clinical utility for necrostatin-1 and/or novel necroptosis inhibitors as an adjunct therapy to reduce neurological injury and improve patient outcomes after ICH.

  4. Oxidative Stress in Intracerebral Hemorrhage: Sources, Mechanisms, and Therapeutic Targets

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    Xin Hu

    2016-01-01

    Full Text Available Intracerebral hemorrhage (ICH is associated with the highest mortality and morbidity despite only constituting approximately 10–15% of all strokes. Complex underlying mechanisms consisting of cytotoxic, excitotoxic, and inflammatory effects of intraparenchymal blood are responsible for its highly damaging effects. Oxidative stress (OS also plays an important role in brain injury after ICH but attracts less attention than other factors. Increasing evidence has demonstrated that the metabolite axis of hemoglobin-heme-iron is the key contributor to oxidative brain damage after ICH, although other factors, such as neuroinflammation and prooxidases, are involved. This review will discuss the sources, possible molecular mechanisms, and potential therapeutic targets of OS in ICH.

  5. Causes and clinical characteristics of spontaneous intracerebral hemorrhage in children

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    Yan-ju MENG

    2014-01-01

    Full Text Available In this study, clinical data of 31 patients in childhood with spontaneous intracerebral hemorrhage (SICH were retrospectively analyzed. According to various imaging examinations (CT, MRI, CTA, MRA and DSA, 22 cases (70.97% had definite causes, including 9 cases (29.03% with intracranial arteriovenous malformation, 6 cases (19.35% with cavernous hemangioma, 3 cases (9.68% with hematopathy, 2 cases (6.45% with tumor apoplexy, one case (3.23% with intracranial aneurysm and one case (3.23% with moyamoya disease; 9 cases (29.03% had unclear causes. All cases were timely diagnosed and treated. Among all the patients, 23 cases (74.19% were cured with good prognosis, 6 cases (19.35% improved, and the other 2 cases (6.45% died. Therefore, primary diseases should be timely treated as hematoma was removed.

  6. Idarucizumab as Antidote to Intracerebral Hemorrhage under Treatment with Dabigatran

    Science.gov (United States)

    Held, Valentin; Eisele, Philipp; Eschenfelder, Christoph C.; Szabo, Kristina

    2016-01-01

    Background and Purpose Non-vitamin K anticoagulants (NOAC) such as dabigatran have become important therapeutic options for the prevention of stroke. Until recently, there were only nonspecific agents to reverse their anticoagulant effects in a case of emergency. Idarucizumab, an antibody fragment targeting dabigatran, is the first specific antidote for a NOAC to be approved, but real-world experience is limited. Methods We report two cases of patients on dabigatran with acute intracerebral hemorrhage who received idarucizumab. Results In both cases, idarucizumab promptly reversed the anticoagulant effect of dabigatran and there was no hematoma expansion in follow-up imaging. Conclusions In addition to clinical and preclinical studies, our cases add to the experience regarding the safety and efficacy of idarucizumab. They show that idarucizumab may be an important safety option for patients on dabigatran in emergency situations. PMID:27920714

  7. Current management of massive hemorrhage in trauma

    DEFF Research Database (Denmark)

    Johansson, Pär I; Stensballe, Jakob; Ostrowski, Sisse R

    2012-01-01

    ABSTRACT: Hemorrhage remains a major cause of potentially preventable deaths. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution, and consumption of clotting factors and platelets. Concepts of damage control surgery have evolved...

  8. Intracerebral Hemorrhage. A Case Presentation Hemorragia intracerebral. Presentación de un caso

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    Inti Santana Carballosa

    Full Text Available A 70 year-old female patient suffering from a cerebrovascular disease intracerebral hemorrhage type and presented as Le Roux 2 cerebromeningeal hemorrhage subtype with factors for a bad prognosis of neurologic causes and, for diverse complications which evolved in the clinical intensive care service at the University hospital ¨Dr. Gustavo Aldereguia Lima¨ in Cienfuegos city. According to the management stated in the clinical practice guideline of the protocol intervention of this health institution an achievement was obtained when the patient passed from a Rankin 5 state at the admission of the hospital to a Rankin 3 state at the time of discharging from the institution. The survival rate at the time of the last evolution was a Rankin 2.
    Se presenta el caso de una paciente femenina, de 70 años de edad, portadora de enfermedad cerebrovascular tipo hemorragia intracerebral y forma de presentación como subtipo hemorragia cerebromeníngea Le Roux 2, con factores agravantes para mal pronóstico de causa neurológica y por diversas complicaciones, que evolucionó en el servicio de Terapia Intensiva Clínica del Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos. Con la conducta asumida según guías de prácticas clínicas por protocolo de actuación de la citada institución asistencial se logró que de un estado por escala de Rankin de 5, al ingreso, egresara con Rankin 3 y una supervivencia hasta el momento con última evaluación de Rankin 2.

  9. Diagnosis of chronic myeloid leukemia from acute intracerebral hemorrhage: A case report

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    Chakroun-Walha Olfa

    2015-08-01

    Full Text Available Intracerebral hemorrhage (ICH is frequent pathology in emergency departments. Coagulopathies leading to ICH are rare. We describe here the case of diagnosis of a chronic myeloid leukemia from ICH in emergencies.

  10. Predictors of tracheostomy in patients with spontaneous intracerebral hemorrhage.

    Science.gov (United States)

    Yaghi, Shadi; Moore, Page; Ray, Bappaditya; Keyrouz, Salah G

    2013-06-01

    One third of patients with intracerebral hemorrhage (ICH) require mechanical ventilation; in most, tracheostomy may be necessary. Limited data exist about predictors of tracheostomy in ICH. The aim of our study is to identify predictors of tracheostomy in ICH. We reviewed medical records of patients seen in our institution between 2005 and 2009, using ICD-9 codes for ICH, for admission clinical and radiological parameters. A stepwise logistic regression model was used to identify tracheostomy predictors. Ninety patients with ICH were included in the analysis, eleven of which required tracheostomy. Patients requiring a tracheostomy were more likely to have a large hematoma volume (≥30mL) (63.4% vs. 29.1%, p=0.037), intraventricular hemorrhage (81.8% vs. 27.8%, pintubation≥14 days (54.5% vs. 1.27%, pintubation days (OR=87.49, ppredictors. We could potentially predict the need for tracheostomy early in the course of ICH based on the admission GCS score; duration of intubation is another predictor for tracheostomy. Early tracheostomy could decrease the time, and therefore risks of prolonged endotracheal intubation and length of hospital stay. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Incident Cerebral Microbleeds in a Cohort of Intracerebral Hemorrhage.

    Science.gov (United States)

    Pasquini, Marta; Benedictus, Marije R; Boulouis, Grégoire; Rossi, Costanza; Dequatre-Ponchelle, Nelly; Cordonnier, Charlotte

    2016-03-01

    We aimed to identify prognostic and associated factors of incident cerebral microbleeds (CMBs) in intracerebral hemorrhage (ICH) survivors. Observational prospective cohort of 168 ICH survivors who underwent 1.5T magnetic resonance imaging at ICH onset and during follow-up (median scan interval, 3.4; interquartile range, 1.4-4.7) years. We used logistic regression adjusted for age, sex, and scan interval. Analyses were stratified according to the index ICH location (58 lobar ICH, 103 nonlobar ICH, excluding patients with multiple or unclassifiable ICH). Eighty-nine (53%) patients had CMBs at ICH onset, and 80 (48%) exhibited incident CMBs during follow-up. Predictors of incident CMBs at ICH onset were ≥1 CMBs (adjusted odds ratio [aOR], 2.27; 95% confidence interval [CI], 1.18-4.35), old radiological macrohemorrhage (aOR, 6.78; 95% CI, 2.76-16.68), and CMBs in mixed location (aOR, 3.73; 95% CI, 1.67-8.31). When stratifying by ICH location, incident CMBs were associated in nonlobar ICH with incident lacunes (aOR, 2.86; 95% CI, 1.04-7.85) and with the use of antiplatelet agents (aOR, 2.89; 95% CI, 1.14-7.32). In lobar ICH, incident CMBs were associated with incident radiological macrohemorrhage (aOR, 9.76; 95% CI, 1.07-88.77). Prognostic and associated factors of incident CMBs differed according to the index ICH location. Whereas in lobar ICH, incident CMBs were associated with hemorrhagic biomarkers, in nonlobar ICH, ischemic burden also increased. CMBs may be interesting biomarkers to monitor in randomized trials on restarting antithrombotic drugs after ICH. © 2016 American Heart Association, Inc.

  12. Brain perihematoma genomic profile following spontaneous human intracerebral hemorrhage.

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    Anna Rosell

    Full Text Available BACKGROUND: Spontaneous intracerebral hemorrhage (ICH represents about 15% of all strokes and is associated with high mortality rates. Our aim was to identify the gene expression changes and biological pathways altered in the brain following ICH. METHODOLOGY/PRINCIPAL FINDINGS: Twelve brain samples were obtained from four deceased patients who suffered an ICH including perihematomal tissue (PH and the corresponding contralateral white (CW and grey (CG matter. Affymetrix GeneChip platform for analysis of over 47,000 transcripts was conducted. Microarray Analysis Suite 5.0 was used to process array images and the Ingenuity Pathway Analysis System was used to analyze biological mechanisms and functions of the genes. We identified 468 genes in the PH areas displaying a different expression pattern with a fold change between -3.74 and +5.16 when compared to the contralateral areas (291 overexpressed and 177 underexpressed. The top genes which appeared most significantly overexpressed in the PH areas codify for cytokines, chemokines, coagulation factors, cell growth and proliferation factors while the underexpressed codify for proteins involved in cell cycle or neurotrophins. Validation and replication studies at gene and protein level in brain samples confirmed microarray results. CONCLUSIONS: The genomic responses identified in this study provide valuable information about potential biomarkers and target molecules altered in the perihematomal regions.

  13. Microglial Responses after Ischemic Stroke and Intracerebral Hemorrhage

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    Roslyn A. Taylor

    2013-01-01

    Full Text Available Stroke is a leading cause of death worldwide. Ischemic stroke is caused by blockage of blood vessels in the brain leading to tissue death, while intracerebral hemorrhage (ICH occurs when a blood vessel ruptures, exposing the brain to blood components. Both are associated with glial toxicity and neuroinflammation. Microglia, as the resident immune cells of the central nervous system (CNS, continually sample the environment for signs of injury and infection. Under homeostatic conditions, they have a ramified morphology and phagocytose debris. After stroke, microglia become activated, obtain an amoeboid morphology, and release inflammatory cytokines (the M1 phenotype. However, microglia can also be alternatively activated, performing crucial roles in limiting inflammation and phagocytosing tissue debris (the M2 phenotype. In rodent models, microglial activation occurs very early after stroke and ICH; however, their specific roles in injury and repair remain unclear. This review summarizes the literature on microglial responses after ischemic stroke and ICH, highlighting the mediators of microglial activation and potential therapeutic targets for each condition.

  14. The factors affecting mortality in patients with intracerebral hemorrhage

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    Serpil Demirci

    2011-12-01

    Full Text Available Objectives: Intracerebral hemorrhage (ICH occurs usually from the rupture of vessels into the brain parenchyma and accounts for approximately 10% of all strokes. ICH occurs more commonly in Turkey than in other western countries and carries a significantly high mortality than ischemic strokeMaterials and methods: We evaluated 86 consecutive patients with ICH who were admitted to Neurology Clinics of SDU University Medical Faculty. The factors studied were age, gender, risk factors, electrocardiography results, blood pressure, fever, blood cells, biochemistry, hematoma volume and localization, clinical findings, and demographic characteristics.Results: ICH is a 30-day mortality rate between approximately 50%, with half of the deaths occurring within 48 hour from the onset.Conclusion: It was found that age, site and volume of hematoma, initial level of consciousness and drainage of hematoma into the ventricular cavity have significant effects on the prognosis. The prognosis of ICH remains frequently poor despite the best medical management, control of vital functions and infections. J Clin Exp Invest 2011; 2 (4: 404-407

  15. Rare Coding Variation and Risk of Intracerebral Hemorrhage

    Science.gov (United States)

    Radmanesh, Farid; Falcone, Guido J.; Anderson, Christopher D.; McWilliams, David; Devan, William J.; Brown, W Mark; Battey, Thomas W. K.; Ayres, Alison M.; Raffeld, Miriam R.; Schwab, Kristin; Sun, Guangyun; Deka, Ranjan; Viswanathan, Anand; Goldstein, Joshua N.; Greenberg, Steven M.; Tirschwell, David L.; Silliman, Scott L.; Selim, Magdy; Meschia, James F.; Brown, Devin L.; Worrall, Bradford B.; Langefeld, Carl D.; Woo, Daniel; Rosand, Jonathan

    2015-01-01

    Background and Purpose Intracerebral hemorrhage (ICH) has a substantial genetic component. We performed a preliminary search for rare coding variants associated with ICH. Methods 757 cases and 795 controls were genotyped using the Illumina HumanExome Beadchip (Illumina, Inc. San Diego, CA, USA). Meta-analyses of single-variant and gene-based association were computed. Results No rare coding variants were associated with ICH. Three common variants on chromosome 19q13 at an established susceptibility locus, encompassing TOMM40, APOE, and APOC1 met genome-wide significance (p<5e-08). After adjusting for the APOE epsilon alleles, this locus was no longer convincingly associated with ICH. No gene reached genome-wide significance level in gene-based association testing. Conclusions While no coding variants of large effect were detected, this study further underscores a major challenge for the study of genetic susceptibility loci – large sample sizes are required for sufficient power except for loci with large effects. PMID:26111891

  16. Management of intracerebral hemorrhage--use of statins.

    Science.gov (United States)

    Van Matre, Edward T; Sherman, Deb S; Kiser, Tyree H

    2016-01-01

    Intracerebral hemorrhage (ICH) is a neurologic injury resulting in significant morbidity and mortality. Statins play a significant role in primary and secondary prevention of cardiovascular and cerebrovascular ischemic events. Despite clear benefits of statins in ischemic stroke, post hoc analyses of some studies suggest there may be a link between statin therapy and development of ICH. Direct pharmacologic effects of decreased serum levels of total cholesterol and low-density lipoproteins in conjunction with pleiotropic effects are thought to be linked to this possible increase in ICH risk. In the face of the potential of statins to increase the risk of ICH, recent evidence suggests that statins may also have beneficial effects on patient outcomes when continued or initiated following an ICH. This discordance in findings and the overall lack of well-designed prospective clinical trials increase the complexity of clinical decision making when utilizing statin therapy in patients with, or at risk for, ICH. This review evaluates the pharmacologic effects of statin therapy and describes how these effects translate to both risks and benefits in ICH. The current literature regarding the effects of statin therapy on clinical outcomes in ICH is evaluated to help guide clinicians with decisions regarding initiation, continuation, or discontinuation of statin therapy in patients with ICH.

  17. APOE polymorphisms influence longitudinal lipid trends preceding intracerebral hemorrhage

    Science.gov (United States)

    Phuah, Chia-Ling; Raffeld, Miriam R.; Ayres, Alison M.; Gurol, M. Edip; Viswanathan, Anand; Greenberg, Steven M.; Biffi, Alessandro; Rosand, Jonathan

    2016-01-01

    Objective: We sought to determine whether APOE genotype influences a previously observed decline in serum total cholesterol (TC) and low-density lipoprotein (LDL) levels preceding primary intracerebral hemorrhage (ICH), as a potential demonstration of nonamyloid mechanisms of APOE in ICH risk. Methods: We performed a single-center retrospective longitudinal analysis using patients with known APOE genotype drawn from an ongoing cohort study of ICH. Serum lipid measurements for TC, triglycerides (TGs), LDL, and high-density lipoprotein (HDL) collected within 2 years before and after index ICH were extracted from electronic medical records. Piecewise linear mixed-effects models were used to compare APOE allele–specific effects on temporal serum lipid trends in ICH. Demographics, medical history, medications, and health maintenance data were included as fixed effects. Inter- and intraindividual variations in lipid levels were modeled as random effects. Results: A total of 124 ICH cases were analyzed. APOE ε4 carriers had greater rates of decline in serum TC and LDL within 6 months preceding ICH (TC: −7.30 mg/dL/mo, p = 0.0035; LDL: −8.44 mg/dL/mo, p = 0.0001). Conversely, serum TC and LDL levels in APOE ε2 carriers were unchanged within the same time period. APOE genotype had no associations with serum HDL or TG trends. Conclusions: APOE allele status predicts serum TC and LDL changes preceding acute ICH. Our results have implications for ongoing efforts in dissecting the role of dyslipidemia in cerebrovascular disease risk. APOE genotype–specific influence on lipid trends provides a clue for one mechanism by which APOE may influence risk of ICH. Further characterization of the metabolic roles of APOE is needed to improve the understanding of APOE biology in cerebrovascular disease risk. PMID:27433544

  18. Fate of diffusion restricted lesions in acute intracerebral hemorrhage.

    Directory of Open Access Journals (Sweden)

    Yuan-Hsiung Tsai

    Full Text Available Diffusion-restricted lesions on diffusion-weighted imaging (DWI are detected in patients with intracerebral hemorrhage (ICH. In this study, we aimed to determine the fate of DWI lesions in ICH patients and whether the presence of DWI lesions is associated with functional outcome in patients with ICH.This prospective study enrolled 153 patients with acute ICH. Baseline MRI scans were performed within 2 weeks after ICH to detect DWI lesions and imaging markers for small vessel disease (SVD. Follow-up MRI scans were performed at 3 months after ICH to assess the fate of the DWI lesions. We analyzed the associations between the characteristics of DWI lesions with clinical features and functional outcome.Seventeen of the 153 patients (11.1% had a total of 25 DWI lesions. Factors associated with DWI lesions were high initial systolic and mean arterial blood pressure (MAP at the emergency room, additional lowering of MAP within 24 hours, and the presence of white matter hyperintensity and cerebral microbleeds. Thirteen of the 25 DWI lesions (52% were not visible on follow-up T2-weighted or fluid-attenuated inversion recovery images and were associated with high apparent diffusion coefficient value and a sharper decease in MAP. The regression of DWI lesions was associated with good functional outcome.More than half of the DWI lesions in the ICH patients did not transition to visible, long-term infarction. Only if the DWI lesion finally transitioned to final infarction was a poor functional outcome predicted. A DWI lesion may be regarded as an ischemic change of SVD and does not always indicate certain cerebral infarction or permanent tissue injury.

  19. NLRP3 inflammasome contributes to inflammation after intracerebral hemorrhage.

    Science.gov (United States)

    Ma, Qingyi; Chen, Sheng; Hu, Qin; Feng, Hua; Zhang, John H; Tang, Jiping

    2014-02-01

    The NLRP3 (NALP3, cryopyrin) inflammasome, a key component of the innate immune system, facilitates caspase-1 and interleukin (IL)-1β processing, which amplifies the inflammatory response. Here, we investigated whether NLRP3 knockdown decreases neutrophil infiltration, reduces brain edema, and improves neurological function in an intracerebral hemorrhage (ICH) mouse model. We also determined whether mitochondrial reactive oxygen species (ROS) governed by mitochondrial permeability transition pores (mPTPs) would trigger NLRP3 inflammasome activation following ICH. ICH was induced by injecting autologous arterial blood (30μl) into a mouse brain. NLRP3 small interfering RNAs were administered 24 hours before ICH. A mPTP inhibitor (TRO-19622) or a specific mitochondria ROS scavenger (Mito-TEMPO) was coinjected with the blood. In naive animals, rotenone, which is a respiration chain complex I inhibitor, was applied to induce mitochondrial ROS production, and followed by TRO-19622 or Mito-TEMPO treatment. Neurological deficits, brain edema, enzyme-linked immunosorbent assay, Western blot, in vivo chemical cross-linking, ROS assay, and immunofluorescence were evaluated. ICH activated the NLRP3 inflammasome. NLRP3 knockdown reduced brain edema and decreased myeloperoxidase (MPO) levels at 24 hours, and improved neurological functions from 24 to 72 hours following ICH. TRO-19622 or Mito-TEMPO reduced ROS, NLRP3 inflammasome components, and MPO levels following ICH. In naive animals, rotenone administration induced mPTP formation, ROS generation, and NLRP3 inflammasome activation, which were then reduced by TRO-19622 or Mito-TEMPO. The NLRP3 inflammasome amplified the inflammatory response by releasing IL-1β and promoting neutrophil infiltration following ICH. Mitochondria ROS may be a major trigger of NLRP3 inflammasome activation. The results of our study suggest that the inhibition of the NLRP3 inflammasome may effectively reduce the inflammatory response following ICH

  20. CD163 Expression in Neurons After Experimental Intracerebral Hemorrhage.

    Science.gov (United States)

    Liu, Ran; Cao, Shenglong; Hua, Ya; Keep, Richard F; Huang, Yining; Xi, Guohua

    2017-05-01

    CD163, a receptor for hemoglobin, is involved in hemoglobin clearance after intracerebral hemorrhage (ICH). In contrast to microglial/macrophage CD163, neuronal CD163 hemoglobin has not been well studied. This study examined the expression of neuronal CD163 in a pig model of ICH and in vitro rat cortical neurons and the impact of deferoxamine on that expression. There were 2 parts to this study. In the in vivo part, piglets had injection of autologous blood into the right frontal lobe. The time course of CD163 expression and the effect of deferoxamine on the expression of CD163 after ICH were determined in the grey matter. In the in vitro part, the levels of CD163 and neuronal death and the effect of deferoxamine were examined in rat cortical neurons culture treated with hemoglobin. CD163-positive cells were found, and the CD163 protein levels were upregulated in the ipsilateral grey matter after ICH. The CD163 levels peaked at days 1 and 3. The CD163-positive cells were colocated with NeuN-positive, heme oxygenase-2-positive, and terminal deoxynucleatidyl transferase dUTP nick end labeling-positive cells. Deferoxamine treatment attenuated ICH-induced CD163 upregulation and significantly reduced both brain CD163 and hemoglobin levels at day 3. Treating neuronal cultures with hemoglobin for 24 hours resulted in CD163 upregulation and increased cell death. Deferoxamine significantly attenuated the hemoglobin-induced neuronal death and CD163 upregulation. CD163 is expressed in neurons and upregulated after ICH. Deferoxamine reduced ICH-induced CD163 upregulation and brain cell death in vivo and hemoglobin-induced CD163 upregulation and neuronal death in vitro. © 2017 American Heart Association, Inc.

  1. Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis.

    Science.gov (United States)

    Zand, Ramin; Tsivgoulis, Georgios; Singh, Mantinderpreet; McCormack, Michael; Goyal, Nitin; Ishfaq, Muhammad Fawad; Shahripour, Reza Bavarsad; Nearing, Katherine; Elijovich, Lucas; Alexandrov, Anne W; Liebeskind, David S; Alexandrov, Andrei V

    2017-03-01

    Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9). Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Predicting Early Awakening from Coma after Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Diana eGoodman

    2013-10-01

    Full Text Available Introduction – Given the high morbidity and mortality associated with intracerebral hemorrhage (ICH, family members and healthcare providers base early supportive management decisions, at least in part, on expected prognosis. In the comatose patient with ICH, this short-term prognosis is most overtly characterized by regaining of consciousness.Methods – A retrospective consecutive cohort of 51 patients admitted to a neuroICU with ICH and admission Glasgow Coma Scale score ≤ 8 was identified. Logistic regression was performed to assess the association of baseline characteristics and treatment parameters associated with awakening.Results – Awakening from coma was observed in 53% of ICH patients: 83% with an initial GCS score of 7-8, 43% with an initial score of 5-6, and 20% with an initial score of 3-4. Awakening from coma in the cohort of 27 patients who regained consciousness occurred in 59% of patients by day 2, 89% by day 7, and 96% by day 9. In multivariable analysis, only higher admission GCS score was associated with a greater likelihood of awakening from coma (OR 4.9 [95%CI 1.9–13] per 2-point category, p=0.001. DNR status during the first 24 hours was not associated with awakening but was at later time points.Conclusion – GCS score is the predominant initial predictor of early awakening in patients who present in coma after ICH. Patients who regained consciousness typically did so within the first 9 days of hospital admission.

  3. CD163 promotes hematoma absorption and improves neurological functions in patients with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Wen-jing Xie; Hong-quan Yu; Yu Zhang; Qun Liu; Hong-mei Meng

    2016-01-01

    Clinical outcomes are positively associated with hematoma absorption. The monocyte-macrophage scavenger receptor, CD163, plays an important role in the metabolism of hemoglobin, and a soluble form of CD163 is present in plasma and other tissue lfuids;therefore, we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage. Patients with intracerebral hemorrhage were divided into high-and low-level groups according to the average CD163 level (1,977.79 ± 832.91 ng/mL). Compared with the high-level group, the low-level group had a signiifcantly slower hematoma absorption rate, and signiifcantly increased National Institutes of Health Stroke Scale scores and modiifed Rankin Scale scores. These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.

  4. CD163 promotes hematoma absorption and improves neurological functions in patients with intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Wen-jing Xie

    2016-01-01

    Full Text Available Clinical outcomes are positively associated with hematoma absorption. The monocyte-macrophage scavenger receptor, CD163, plays an important role in the metabolism of hemoglobin, and a soluble form of CD163 is present in plasma and other tissue fluids; therefore, we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage. Patients with intracerebral hemorrhage were divided into high- and low-level groups according to the average CD163 level (1,977.79 ± 832.91 ng/mL. Compared with the high-level group, the low-level group had a significantly slower hematoma absorption rate, and significantly increased National Institutes of Health Stroke Scale scores and modified Rankin Scale scores. These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.

  5. CD163 promotes hematoma absorption and improves neurological functions in patients with intracerebral hemorrhage.

    Science.gov (United States)

    Xie, Wen-Jing; Yu, Hong-Quan; Zhang, Yu; Liu, Qun; Meng, Hong-Mei

    2016-07-01

    Clinical outcomes are positively associated with hematoma absorption. The monocyte-macrophage scavenger receptor, CD163, plays an important role in the metabolism of hemoglobin, and a soluble form of CD163 is present in plasma and other tissue fluids; therefore, we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage. Patients with intracerebral hemorrhage were divided into high- and low-level groups according to the average CD163 level (1,977.79 ± 832.91 ng/mL). Compared with the high-level group, the low-level group had a significantly slower hematoma absorption rate, and significantly increased National Institutes of Health Stroke Scale scores and modified Rankin Scale scores. These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.

  6. Peri-Hemorrhagic Edema and Secondary Hematoma Expansion after Intracerebral Hemorrhage: From Benchwork to Practical Aspects

    Science.gov (United States)

    Babi, Marc-Alain; James, Michael L.

    2017-01-01

    Spontaneous intracerebral hemorrhage (SICH) is the most lethal type of stroke. Half of these deaths occur within the acute phase. Frequently observed deterioration during the acute phase is often due to rebleeding or peri-hematomal expansion. The exact pathogenesis that leads to rebleeding or peri-hemorrhagic edema remains under much controversy. Numerous trials have investigated potential predictor of peri-hemorrhagic edema formation or rebleeding but have yet to come with consistent results. Unfortunately, almost all of the “classical” approaches have failed to show a significant impact in regard of significant clinical outcome in randomized clinical trials. Current treatment strategies may remain “double-edged swords,” for inherent reasons to the pathophysiology of sICH. Therefore, the right balance and possibly the combination of current accepted strategies as well as the evaluation of future approaches seem urgent. This article reviews the role of disturbed autoregulation following SICH, surgical and non-surgical approaches in management of SICH, peri-hematoma edema, peri-hematoma expansion, and future therapeutic trends. PMID:28154550

  7. [Prognosis of intracerebral hemorrhage with coma in a neurological critical care unit in the tropics].

    Science.gov (United States)

    Sène Diouf, F; Mapoure, N Y; Ndiaye, M; Mbatchou Ngahane, H B; Touré, K; Thiam, A; Mboup, B; Doumbe, J N; Diop, A G; Ndiaye, M M; Ndiaye, I P

    2008-12-01

    Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.

  8. Perihematoma Damage at Different Time Points in Experimental Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The damage degree of neurons in perilesion at different time points was observed in order to explore the optimal operation occasion. Piglet lobar hematomas were produced by pressure-controlled infusions of 2.5 mL autonomous blood into the right frontal hemispheric white matter over 15 min, and the metabolic changes were ambulatorily detected with MRS at 3rd, 12th, 24th and 48th h after hematoma induction. Brain tissues of perihematoma were also obtained at different time points. The transcription level of Bax gene was detected by in situ hybridization and apoptosis by TUNEL technique, and the pathologic change of neurons was observed under an electron microscope. The results showed that the number of Bax positive cells reached the peak at 24 h (79.00±4. 243/5 fields). There was no significant difference in A values between 3 h and 6 h, 12 h (P>0.05), but there significant difference between 24 h and 3 h, 6 h, 12 h (P<0.05). The number of apoptotic cells reached the peak at 24 h (P<0. 001), and there was no significant difference betw een 3 h and 6 h (P=0. 999). The area of the apoptotic cells showed no significant difference between 3 h and 6 h or among 3 h, 6 h and 6 h (P>0.05). Lac peak mainly occurred at 24 h and 48 h, while on the healthy side, no Lac peak was detectable. The ratio of NAA/Cr presented a descent tendency, but there was no significant difference among the groups before 12 h (P>0.05), there was very significant difference between 3, 6 and 24, 48 h (P<0.01). Under electronic microscopy, the neuronal damage surrounding hematoma in 3 to 6 h was milder than in 24 h to 48 h. It was concluded that the secondary apoptosis, damage and metabolic disturbance of the neurons surround ing hematoma was milder in 3-6 h in acute intracerebral hemorrhage, while obviously aggravated in 24-48 h. An effective intervention is needed to reduce secondary damage as soon as possible.

  9. Genetic variants in CETP increase risk of intracerebral hemorrhage

    Science.gov (United States)

    Falcone, Guido J.; Phuah, Chia‐Ling; Radmanesh, Farid; Brouwers, H. Bart; Battey, Thomas W. K.; Biffi, Alessandro; Peloso, Gina M.; Liu, Dajiang J.; Ayres, Alison M.; Goldstein, Joshua N.; Viswanathan, Anand; Greenberg, Steven M.; Selim, Magdy; Meschia, James F.; Brown, Devin L.; Worrall, Bradford B.; Silliman, Scott L.; Tirschwell, David L.; Flaherty, Matthew L.; Kraft, Peter; Jagiella, Jeremiasz M.; Schmidt, Helena; Hansen, Björn M.; Jimenez‐Conde, Jordi; Giralt‐Steinhauer, Eva; Elosua, Roberto; Cuadrado‐Godia, Elisa; Soriano, Carolina; van Nieuwenhuizen, Koen M.; Klijn, Catharina J. M.; Rannikmae, Kristiina; Samarasekera, Neshika; Salman, Rustam Al‐Shahi; Sudlow, Catherine L.; Deary, Ian J.; Morotti, Andrea; Pezzini, Alessandro; Pera, Joanna; Urbanik, Andrzej; Pichler, Alexander; Enzinger, Christian; Norrving, Bo; Montaner, Joan; Fernandez‐Cadenas, Israel; Delgado, Pilar; Roquer, Jaume; Lindgren, Arne; Slowik, Agnieszka; Schmidt, Reinhold; Kidwell, Chelsea S.; Kittner, Steven J.; Waddy, Salina P.; Langefeld, Carl D.; Abecasis, Goncalo; Willer, Cristen J.; Kathiresan, Sekar; Woo, Daniel; Rosand, Jonathan

    2016-01-01

    Objective In observational epidemiologic studies, higher plasma high‐density lipoprotein cholesterol (HDL‐C) has been associated with increased risk of intracerebral hemorrhage (ICH). DNA sequence variants that decrease cholesteryl ester transfer protein (CETP) gene activity increase plasma HDL‐C; as such, medicines that inhibit CETP and raise HDL‐C are in clinical development. Here, we test the hypothesis that CETP DNA sequence variants associated with higher HDL‐C also increase risk for ICH. Methods We performed 2 candidate‐gene analyses of CETP. First, we tested individual CETP variants in a discovery cohort of 1,149 ICH cases and 1,238 controls from 3 studies, followed by replication in 1,625 cases and 1,845 controls from 5 studies. Second, we constructed a genetic risk score comprised of 7 independent variants at the CETP locus and tested this score for association with HDL‐C as well as ICH risk. Results Twelve variants within CETP demonstrated nominal association with ICH, with the strongest association at the rs173539 locus (odds ratio [OR] = 1.25, standard error [SE] = 0.06, p = 6.0 × 10−4) with no heterogeneity across studies (I 2 = 0%). This association was replicated in patients of European ancestry (p = 0.03). A genetic score of CETP variants found to increase HDL‐C by ∼2.85mg/dl in the Global Lipids Genetics Consortium was strongly associated with ICH risk (OR = 1.86, SE = 0.13, p = 1.39 × 10−6). Interpretation Genetic variants in CETP associated with increased HDL‐C raise the risk of ICH. Given ongoing therapeutic development in CETP inhibition and other HDL‐raising strategies, further exploration of potential adverse cerebrovascular outcomes may be warranted. Ann Neurol 2016;80:730–740 PMID:27717122

  10. Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Mani Gupta

    2014-01-01

    Full Text Available Background: Spontaneous intracerebral hemorrhage (SICH is a form of cerebrovascular accident with a very high rate of morbidity and mortality. The determinants of prognosis include the demographic, clinical, laboratory, and radiologic factors. It is long known that the hematoma size has a negative impact on the outcome in SICH. The influence of perihematomal edema (PHE is not established to the extent same as that of hematoma volume. Hence, we planned this study to determine as to what role does PHE plays in the outcome in SICH. Aim of the Study: To evaluate the prognostic influence of absolute and relative edema (ratio of absolute edema to hematoma volume in the patients of SICH. Materials and Methods : This is a prospective case-controlled study. A total of 44 patients were enrolled after excluding the confounding factors. The patients were evaluated and their disability was assessed using modified Rankin scale (MRS. The imaging was done in the interval between 24 and 72 h and the hematoma volume, absolute edema volume, and the relative edema were calculated. The outcome was reassessed at 12 weeks and defined as favorable if MRS < 3. Results: A total of 69 patients were found to be having SICH on imaging; however, 25 patients were excluded as they had one of the criterion for exclusion. Hence, only 44 patients were included in the study. On univariate analysis, none of the demographic characteristics of the patients, vascular risk factors, presenting complaints, blood pressure, Glasgow coma scale, and MRS at admission, laboratory parameters were not significantly different in the two outcome groups. The hematoma volume was significantly higher in the poor outcome group (P < 0.0001 and the relative edema was associated with a favorable outcome at 12 weeks (P < 0.0001. On multivariate logistic regression, the hematoma volume and relative edema were found to have effect on the outcome similar to that seen on univariate analysis. Conclusion: In

  11. Cerebral venous thrombosis presenting with intracerebral hemorrhage in a patient with paroxysmal nocturnal hemoglobinuria

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    Gentle Sunder Shrestha

    2016-01-01

    Full Text Available Cerebral venous thrombosis (CVT is an uncommon cause of stroke. Paroxysmal nocturnal hemoglobinuria (PNH is a rare type of hemolytic anemia, frequently associated with thrombophilia. PNH may rarely present with CVT. Approximately, one-third of the patients with CVT develop cerebral hemorrhage. Here, we present a rare combination of CVT presenting with intracerebral hemorrhage in a patient with PNH. High index of suspicion is needed to avoid misdiagnosis. Patient was successfully managed with anticoagulation therapy.

  12. Gene polymorphisms of intracerebral hemorrhage in Chinese population: a systematic review

    Institute of Scientific and Technical Information of China (English)

    谭贤佩

    2014-01-01

    Objective To assess the genes polymorphisms associated with intracerebral hemorrhage(ICH)in Chinese quantitatively or qualitatively by searching all case control studies related comprehensively.Methods Odds ratio(OR)and 95%confidence intervals(95%CI)were determined for each polymorphism using fixed or random model with Revman 5.1.Results Statistically significant associations with ICH were

  13. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Steiner, Thorsten; Al-Shahi Salman, Rustam; Beer, Ronnie

    2014-01-01

    BACKGROUND: Intracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has upd...

  14. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review

    DEFF Research Database (Denmark)

    Thompson, B B; Béjot, Y; Caso, V

    2010-01-01

    Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH....

  15. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review

    DEFF Research Database (Denmark)

    Thompson, B B; Béjot, Y; Caso, V

    2010-01-01

    Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH....

  16. Blood pressure levels and the risk of intracerebral hemorrhage after ischemic stroke

    NARCIS (Netherlands)

    Hilkens, N.A.; Greving, J.P.; Algra, A.; Klijn, C.J.M.

    2017-01-01

    OBJECTIVE: To investigate the association between blood pressure (BP) levels and risk of intracerebral hemorrhage (ICH) after ischemic stroke. METHODS: We performed a post hoc analysis of data from the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, a randomized clinical

  17. Two cases of asymptomatic massive fetomaternal hemorrhage.

    Science.gov (United States)

    Peedin, Alexis R; Mazepa, Marshall A; Park, Yara A; Weimer, Eric T; Schmitz, John L; Raval, Jay S

    2015-04-01

    Evaluation of fetomaternal hemorrhage (FMH) in the immediate postpartum period is critical for the timely administration of Rh immunoglobulin (RhIG) prophylaxis to minimize the risk of alloimmunization in D-negative mothers of D-positive newborns. We report a series of two clinically-unsuspected cases of massive FMHs identified at our university medical center. Retrospective records of two cases of massive FMH were investigated using the electronic medical record. After positive fetal bleed screens, flow cytometric analysis for hemoglobin F was performed to quantify the volume of the hemorrhages in both cases. Flow cytometric enumeration with anti-D was also performed in one case. The two patients had 209.5 and 75 mL of fetal blood in circulation, resulting in 8 and 4 doses of RhIG administered, respectively. For the former patient, flow cytometric analysis with anti-D ruled out hereditary persistence of fetal hemoglobin and supported the fetal origin of the red cells. Due to the clinically-silent nature of both hemorrhages, further evaluation of the newborns' blood was not performed. These cases highlight the importance of rapidly obtaining accurate measurements of fetal blood loss via flow cytometric analysis in cases of FMH, particularly in clinically-unsuspected cases, to ensure timely administration of adequate immunoprophylaxis to D-negative mothers.

  18. THE EXPERIMENTAL STUDY ON THE CELL APOPTOSIS AND EXPRESSION OF BCL-2 PROTEIN IN INTRACEREBRAL HEMORRHAGE IN MODEL OF RATS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Intra-cerebral hemorrhage is a common clinicaldisease,with a high mortality and morbidity.So itis one of the clinical hot topics.It has been foundinrecent years that there is a close relationship bet weenthe cell apoptosis and the course or prognosis of in-tra-cerebral hemorrhage.Bcl-2,as the apoptosis-adjusted gene,plays ani mportant role in the courseof cell apoptosis,but the mechanis min the cell ap-optosis in intra-cerebral hemorrhage remains un-clear.In this experi ment,with the model buildingof the in...

  19. Relationship of cerebral microbleeds with hematoma growth in elderly patients with acute hypertensive intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Shou-feng LIU

    2015-01-01

    Full Text Available Objective To investigate whether cerebral microbleeds (CMBs can predict hematoma growth in elderly patients with acute hypertensive intracerebral hemorrhage.  Methods The clinical records of 98 elderly patients with acute hypertensive intracerebral hemorrhage who underwent initial CT within 6 h and repeated CT and susceptibility-weighted imaging (SWI within 24 h of onset were analyzed. Based on the performance of SWI, patients were divided into microbleeds group and non-microbleeds group. Forward multivariate Logistic regression analysis was used to evaluate the predicting value of CMBs on the growth of intracerebral hematoma.  Results Among 98 patients, hematoma growth was found in 25 cases in the second CT scan. The ratio in microbleeds group was significantly higher than that in non-microbleeds group (43.75% vs 16.67%; χ2 = 8.319, P = 0.004. Multivariate Logistic regression showed that CMBs was independent risk factor for intracerebral hematoma (OR = 0.241, 95%CI: 0.065-0.861; P = 0.017.  Conclusions CMBs in patients with acute intracerebral hematoma can predict high risk of hemotoma growth, and effective treatment should be taken to improve the prognosis of patients. DOI: 10.3969/j.issn.1672-6731.2015.01.012

  20. Damage control resuscitation for massive hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Osaree Akaraborworn

    2014-01-01

    Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival.Damage control resuscitation is a new paradigm for patients with massive bleeding.It consists of permissive hypotension,hemostatic resuscitation and transfusion strategies,and damage control surgery.Permissive hypotension seems to have better results before the bleeding is controlled.The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of fresh frozen plasma to packed red cells.Damage control surgery is done when the patient's condition is unfit for definitive surgery.Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.

  1. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Mayer, Stephan A; Brun, Nikolai C; Begtrup, Kamilla;

    2008-01-01

    patients with intracerebral hemorrhage to receive placebo (268 patients), 20 microg of rFVIIa per kilogram of body weight (276 patients), or 80 microg of rFVIIa per kilogram (297 patients) within 4 hours after the onset of stroke. The primary end point was poor outcome, defined as severe disability...... or death according to the modified Rankin scale 90 days after the stroke. RESULTS: Treatment with 80 microg of rFVIIa per kilogram resulted in a significant reduction in growth in volume of the hemorrhage. The mean estimated increase in volume of the intracerebral hemorrhage at 24 hours was 26......% in the placebo group, as compared with 18% in the group receiving 20 microg of rFVIIa per kilogram (P=0.09) and 11% in the group receiving 80 microg (P

  2. Effects of dexamthasone with different doses on aquaporin-4 in brain of intracerebral hemorrhage rats

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To determine the relationship between the expression of aquaporin-4(AQP4) after intracerebral hemorrhage and dexamethasone treated. Methods:Collagenase Ⅶ was injected in caudate nucleus in a stereotaxis frame to establish the intracerebral hemorrhage(ICH) animal models. The intracerebral hemorrhage(ICH) rats were randomly divided into four groups: the sham group (group A), the ICH group(group B), low dosertreated group(group C), moderate dose group(group D) and high dose group(group E). The groups were respectively received an intraperitoneal dexamethasone injection with 1 mg/kg, 15 mg/kg, 30 mg/kg, twice a day for three days. The brain water content(BWC), the permeability of blood-brain barrier(BBB) and the expression of AQP4 were observed. Results:Both the BBB disruption and AQP4 expression decreased in treated groups, and the AQP4 expression had a dose-dependent manner in the dexamethasone treatment. And it seemed that low dose dexamethasone was in favor of brain swelling elimination, but the higher dosage had not similar effect. Conclusion:Dexamethesone may play a critical role on expression of AQP4 in the physiopathology of hemorrhagic edema.

  3. Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

    Science.gov (United States)

    Safatli, Diaa A.; Günther, Albrecht; Schlattmann, Peter; Schwarz, Falko; Kalff, Rolf; Ewald, Christian

    2016-01-01

    Background: Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts. Methods: We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical parameters. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. Results: From 342 patients (mean age: 67 years, mean Glasgow Coma Scale [GCS] on admission: 9, mean ICH volume: 62.19 ml, most common hematoma location: basal ganglia [43.9%]), 102 received surgical and 240 conservative treatment. The 30-day mortality was 25.15%. In a multivariate analysis, GCS (Odds ratio [OR] =0.726, 95% confidence interval [CI] =0.661–0.796, P 32 ml supratentorially or 21 ml infratentorially. Using Pearson correlation, we found a correlation of 0.986 between ICH score and 30-day mortality (P < 0.001), 0.853 between FUNC score and 30-day mortality (P = 0.001), and 0.924 between ICH-GS and 30-day mortality (P = 0.001). Conclusions: GCS score on admission together with the baseline volume and localization of the hemorrhage are strong predictors for 30-day mortality in patients with spontaneous primary intracerebral hemorrhage, and by relying on them it is possible to identify high-risk patients with poor short-term outcome. The ICH score and the ICH-GS accurately predict the 30-day mortality. PMID:27583176

  4. Pattern and location of intracerebral hemorrhage in Enugu, South ...

    African Journals Online (AJOL)

    2015-10-16

    Oct 16, 2015 ... (ICH) is the second most common subtype of stroke with a worldwide ... hemorrhage (DCH) (including brain stem and cerebellar). Pattern and location .... hemoglobinopathies such as sickle cell disease which are common in ...

  5. Low-density lipoprotein receptor-related protein-1 facilitates heme scavenging after intracerebral hemorrhage in mice.

    Science.gov (United States)

    Wang, Gaiqing; Manaenko, Anatol; Shao, Anwen; Ou, Yibo; Yang, Peng; Budbazar, Enkhjargal; Nowrangi, Derek; Zhang, John H; Tang, Jiping

    2017-04-01

    Heme-degradation after erythrocyte lysis plays an important role in the pathophysiology of intracerebral hemorrhage. Low-density lipoprotein receptor-related protein-1 is a receptor expressed predominately at the neurovascular interface, which facilitates the clearance of the hemopexin and heme complex. In the present study, we investigated the role of low-density lipoprotein receptor-related protein-1 in heme removal and neuroprotection in a mouse model of intracerebral hemorrhage. Endogenous low-density lipoprotein receptor-related protein-1 and hemopexin were increased in ipsilateral brain after intracerebral hemorrhage, accompanied by increased hemoglobin levels, brain water content, blood-brain barrier permeability and neurological deficits. Exogenous human recombinant low-density lipoprotein receptor-related protein-1 protein reduced hematoma volume, brain water content surrounding hematoma, blood-brain barrier permeability and improved neurological function three days after intracerebral hemorrhage. The expression of malondialdehyde, fluoro-Jade C positive cells and cleaved caspase 3 was increased three days after intracerebral hemorrhage in the ipsilateral brain tissues and decreased with recombinant low-density lipoprotein receptor-related protein-1. Intracerebral hemorrhage decreased and recombinant low-density lipoprotein receptor-related protein-1 increased the levels of superoxide dismutase 1. Low-density lipoprotein receptor-related protein-1 siRNA reduced the effect of human recombinant low-density lipoprotein receptor-related protein-1 on all outcomes measured. Collectively, our findings suggest that low-density lipoprotein receptor-related protein-1 contributed to heme clearance and blood-brain barrier protection after intracerebral hemorrhage. The use of low-density lipoprotein receptor-related protein-1 as supplement provides a novel approach to ameliorating intracerebral hemorrhage brain injury via its pleiotropic neuroprotective effects.

  6. Need for Continued Use of Anticoagulants After Intracerebral Hemorrhage.

    Science.gov (United States)

    Estol, Conrado J.; Kase, Carlos S.

    2003-07-01

    One of the unsolved dilemmas in cerebrovascular disease is the ideal timing to restart anticoagulant therapy (ACT) safely in patients who have suffered an intracranial hemorrhage and have an indication to continue ACT. No randomized studies with evidence-based data are available to settle this issue. Only a few reports have been published; their shortcomings include small numbers of patients evaluated retrospectively, a broad spectrum of indications for ACT, different types of hemorrhage, and variable methods of reversing and restarting ACT. Despite this variability, most reports agree that 1) ACT has to be immediately reversed to decrease the risk of hemorrhage progression; 2) a period between 1 and 2 weeks appears sufficient to allow for management and monitoring of the hemorrhage off ACT; and 3) ACT can be safely restarted after the period off of treatment. A physician confronting a patient with intracranial hemorrhage and the need for ACT faces a situation of individually focused clinical decision making. The problem rests in balancing the risks of a worsening or recurring hemorrhage on one side, and the risk of thromboembolism on the other. From available information and personal experience, an unvalidated risk stratification can be proposed to categorize patients in low- and high-risk groups for hemorrhagic complications and embolic phenomena, assigning them to 5 or 15 days off ACT, respectively. Intermediate-risk patients can have ACT restarted in 5 to 15 days from the onset of the intracranial hemorrhage. Anticoagulation should be immediately reversed. Fresh frozen plasma is the standard treatment in most institutions. Prothrombin complex concentrate is an alternative, but issues of availability make its use impractical. The use of recombinant factor VIIa is an attractive new option.

  7. The return of an old worm: cerebral paragonimiasis presenting with intracerebral hemorrhage.

    Science.gov (United States)

    Koh, Eun Jung; Kim, Seung-Ki; Wang, Kyu-Chang; Chai, Jong-Yil; Chong, Sangjoon; Park, Sung-Hye; Cheon, Jung-Eun; Phi, Ji Hoon

    2012-11-01

    Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.

  8. [Brain metastasis from papillary thyroid carcinoma with acute intracerebral hemorrhage: a surgical case report].

    Science.gov (United States)

    Chonan, Masashi; Mino, Masaki; Yoshida, Masahiro; Sakamoto, Kazuhiro

    2012-05-01

    We report a rare case of brain metastasis from papillary thyroid carcinoma with intracerebral hemorrhage. A 79-year-old woman presented with sudden headache and monoplegia of the right upper limb 10 years after diagnosis of thyroid papillary adenocarcinoma. Despite the known metastatic lesions in the cervical lymph nodes and lungs, she had been well for 10 years since thyroidectomy, focal irradiation and internal radiation of 131I. CT demonstrated intracerebral hemorrhage in the left temporal lobe. Magnetic resonance imaging showed marked signal heterogeneity. She underwent radical surgery on the day of the onset and the histological diagnosis was metastatic brain tumor of thyroid papillary carcinoma. Postoperative course was uneventful, and the monoplegia was improved. Papillary thyroid carcinoma has a relatively benign course, and surgical removal of the brain metastasis is able to contribute to longer survival times for patients.

  9. Benign Sphenoid Wing Meningioma Presenting with an Acute Intracerebral Hemorrhage – A Case Report

    Science.gov (United States)

    Frič, Radek; Hald, John K.; Antal, Ellen-Ann

    2016-01-01

    BACKGROUND AND STUDY OBJECT We report an unusual case of a benign lateral sphenoid wing meningioma that presented with, and was masked by, an acute intracerebral hemorrhage. CASE REPORT A 68-year-old woman was admitted after sudden onset of coma. Computed tomography (CT) revealed an intracerebral hemorrhage, without any underlying vascular pathology on CT angiography. During the surgery, we found a lateral sphenoid wing meningioma with intratumoral bleeding that extended into the surrounding brain parenchyma. RESULTS We removed the hematoma and resected the tumor completely in the same session. The histopathological classification of the tumor was a WHO grade I meningothelial meningioma. The patient recovered very well after surgery, without significant neurological sequelae. CONCLUSIONS: Having reviewed the relevant references from the medical literature, we consider this event as an extremely rare presentation of a benign sphenoid wing meningioma in a patient without any predisposing medical factors. The possible mechanisms of bleeding from this tumor type are discussed. PMID:27127413

  10. Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature.

    Science.gov (United States)

    Tanaka, Toshihide; Kato, Naoki; Hasegawa, Yuzuru; Murayama, Yuichi

    2014-01-01

    Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.

  11. Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Toshihide Tanaka

    2014-01-01

    Full Text Available Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.

  12. Intracerebral Hemorrhage; towards physiological imaging of hemorrhage risk in acute and chronic bleeding.

    Directory of Open Access Journals (Sweden)

    Raphael eJakubovic

    2012-05-01

    Full Text Available Despite improvements in management and prevention of intracerebral hemorrhage (ICH, there has been little improvement in mortality over the last 30 years. Hematoma expansion, primarily during the first few hours is highly predictive of neurological deterioration, poor functional outcome and mortality. For each 10% increase in ICH size, there is a 5% increase in mortality and an additional 16% chance of poorer functional outcome. As such, both the identification and prevention of hematoma expansion are attractive therapeutic targets in ICH. Previous studies suggest that contrast extravasation seen on CT Angiography (CTA, MRI, and digital subtraction angiography correlates with hematoma growth, indicating ongoing bleeding. Contrast extravasation on the arterial phase of a CTA has been coined the CTA Spot Sign. These easily identifiable foci of contrast enhancement have been identified as independent predictors of hematoma growth, mortality and clinical outcome in primary ICH. The Spot Sign score, developed to stratify risk of hematoma expansion, has shown high inter-observer agreement. Post-contrast leakage or delayed CTA Spot Sign, on post contrast CT following CTA or delayed CTA respectively are seen in an additional ~8% of patients and explain apparently false negative observations on early CTA imaging in patients subsequently undergoing hematoma expansion. CT perfusion provides an opportunity to acquire dynamic imaging and has been shown to quantify rates of contrast extravasation. Intravenous recombinant factor VIIa(rFVIIa within 4 hours of ICH onset has been shown to significantly reduce hematoma growth. However, clinical efficacy has yet to be proven. There is compelling evidence that cerebral amyloid angiopathy (CAA may precede the radiographic evidence of vascular disease and as such contribute to microbleeding. The interplay between microbleeding, CAA,CTA Spot Sign and genetic composition (ApoE genotype may be crucial in developing a

  13. Perioperative antihypertensive treatment in patients of spontaneous intracerebral hemorrhage (PATICH): a clinical trial protocol.

    Science.gov (United States)

    Zheng, Jun; Lin, Sen; Li, Hao; Ma, Junpeng; Guo, Rui; Fang, Yuan; Ma, Lu; Liu, Wenke; Liu, Ming; You, Chao

    2014-09-01

    The management of perioperative period for patients with spontaneous intracerebral hemorrhage affects the prognosis. Elevated blood pressure is common in the patients with spontaneous intracerebral hemorrhage and related to a poor outcome. However, study on antihypertensive treatment for surgical patients with spontaneous intracerebral hemorrhage is insufficient. To determine if the intensive antihypertensive treatment improves the prognosis compared with the conservative antihypertensive treatment followed guidelines in perioperative period for patients with spontaneous intracerebral hemorrhage. PATICH is a prospective, parallel, randomized, assessor-blinded trial. Two hundred eligible patients will be assigned to the intensive group and conservative group randomly. Patients allocated to the intensive group will receive an intensive antihypertensive treatment aiming to achieve a target systolic blood pressure of between 120 mmHg and 140 mmHg while the patients in the conservative group will receive conservative antihypertensive treatment as recommended by guidelines for 7 days. Operation will be conducted by well-trained surgeons and the best medical treatment will be given in all patients. Patients will be followed up at 7 days, 30 days, and 90 days. Primary outcome of this study is the rate of rehemorrhage in 7 days after surgery. Secondary outcomes include death and dependency at 90 days incidence of ischemic stroke, separate rate of death and dependency at 90 days, health related quality of life (HRQoL) at 90 days, incidence of other vascular events, and days of hospitalization. Dependency is defined by a score of 3-5 based on the modified Rankin Scale (mRS). Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage: characteristics, risk factors and impact on management.

    Science.gov (United States)

    Wan, Xueyan; Fan, Ting; Wang, Sheng; Zhang, Suojun; Liu, Shengwen; Yang, Hongkuan; Shu, Kai; Lei, Ting

    2017-02-01

    Progressive hemorrhagic injury (PHI) is a common occurrence in clinical practice; however, how PHI affects clinical management remains unclear. We attempt to evaluate the characteristics and risk factors of PHI and also investigate how PHI influences clinical management in traumatic intracerebral hemorrhage (TICH) patients. This retrospective study included a cohort of 181 patients with TICH who initially underwent conservative treatment and they were dichotomized into a PHI group and a non-PHI group. Clinical data were reviewed for comparison. Multivariate logistic regression analysis was applied to identify predictors of PHI and delayed operation. Overall, 68 patients (37.6%) experienced PHI and 27 (14.9%) patients required delayed surgery. In the PHI group, 17 patients needed late operation; in the non-PHI group, 10 patients received decompressive craniectomy. Compared to patients with non-PHI, the PHI group was more likely to require late operation (P = 0.005, 25.0 vs 8.8%), which took place within 48 h (P = 0.01, 70.6 vs 30%). Multivariate logistic regression identified past medical history of hypertension (odds ratio [OR] = 4.56; 95% confidence interval [CI] = 2.04-10.45), elevated international normalized ratio (INR) (OR = 20.93; 95% CI 7.72-71.73) and linear bone fracture (OR = 2.11; 95% CI = 1.15-3.91) as independent risk factors for PHI. Hematoma volume of initial CT scan >5 mL (OR = 3.80; 95% CI = 1.79-8.44), linear bone fracture (OR = 3.21; 95% CI = 1.47-7.53) and PHI (OR = 3.49; 95% CI = 1.63-7.77) were found to be independently associated with delayed operation. Past medical history of hypertension, elevated INR and linear bone fracture were predictors for PHI. Additionally, the latter was strongly predictive of delayed operation in the studied cohort.

  15. Morphine-sensitive paroxysmal sympathetic storm in pontine intracerebral hemorrhage.

    Science.gov (United States)

    Ko, Sang-Bae; Kim, Chi Kyung; Lee, Seung-Hoon; Bae, Hee-Joon; Yoon, Byung-Woo

    2010-11-01

    Paroxysmal sympathetic storm (PSS) is a rare complication of severe traumatic brain injury or cerebrovascular disease. Various medications have been tried in patients with PSS, but the clinical responses of the patients were variable. We report a classic case of PSS after spontaneous pontine hemorrhage in which the patient's fluctuating blood pressure and body temperature were dramatically stabilized using morphine.

  16. Influence of Hypertension, Lipometabolism Disorders, Obesity and Other Lifestyles on Spontaneous Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    JUN-FU ZHOU; JI-YUE WANG; YAN-ER LUO; HUAI-HONG CHEN

    2003-01-01

    To investigate whether hypertension, abnormal lipometabolism, obesity, cigarette smoking and alcohol drinking affect the intracerebral hemorrhagic volumes (IHV) in patients with spontaneous intracerebral hemorrhage (SIHP), and to explore the roles of these factors in spontaneous intracerebral hemorrhage (SIH). Methods Five hundred patients with acute SIH and 200 healthy adult volunteers (HAV) were enrolled in a study of independently randomized controlled design, in which the levels of systolic pressure (SP) and diastolic pressure (DP), and total cholesterol (TCH),triacylglycerols (triglycerides, TG), high density lipoprotein cholesterol (HDL-CH), low density lipoprotein cholesterol (LDL-CH) in serum as well as the level of erythrocytic membrane cholesterol (EM-CH) were measured, and the body mass index (BMI), daily cigarette smoking consumption (DCSC) and daily pure alcohol consumption (DPAC) were calculated. Results Compared with the average parameters in the HAV group, those of SP, DP, TG, LDL-CH and BMI in the SIHP group were significantly increased (P<0.0001), while those of HDL-CH and EM-CH were significantly decreased (P<0.0001). The linear regression and correlation analysis showed that with increased SP, DP,LDL-CH, BMI, DCSC, DPAC and aging as well as decreased HDL-CH and EM-CH, the IHV levels in SIHP were increased gradually (P<0.0001-0.01). The linear stepwise regression analysis suggested that there existed a close correlation among the values of SP, DP, TCH, TG, HDL-CH, LDL-CH,EM-CH, BMI, DCSC, DPAC, age and IHV of the SIH patients, and that Y = - 12.4583 + 0.1127SP -1.1977EM-CH + 0.9788LDL-CH + 0.2477BMI + 0.0382DCSC + 0.0248DP, P<0.0001~ 0.05.Conclusions The findings in the present study suggest that significantly increased systolic and diastolic pressure, low density lipoprotein cholesterol, body mass index and daily cigarette smoking consumption, and significantly decreased erythrocytic membrane cholesterol may be likely the main factors

  17. Risk stratification for prognosis in intracerebral hemorrhage: A decision tree model and logistic regression

    Directory of Open Access Journals (Sweden)

    Gang WU

    2016-01-01

    Full Text Available Objective  To analyze the risk factors for prognosis in intracerebral hemorrhage using decision tree (classification and regression tree, CART model and logistic regression model. Methods  CART model and logistic regression model were established according to the risk factors for prognosis of patients with cerebral hemorrhage. The differences in the results were compared between the two methods. Results  Logistic regression analyses showed that hematoma volume (OR-value 0.953, initial Glasgow Coma Scale (GCS score (OR-value 1.210, pulmonary infection (OR-value 0.295, and basal ganglia hemorrhage (OR-value 0.336 were the risk factors for the prognosis of cerebral hemorrhage. The results of CART analysis showed that volume of hematoma and initial GCS score were the main factors affecting the prognosis of cerebral hemorrhage. The effects of two models on the prognosis of cerebral hemorrhage were similar (Z-value 0.402, P=0.688. Conclusions  CART model has a similar value to that of logistic model in judging the prognosis of cerebral hemorrhage, and it is characterized by using transactional analysis between the risk factors, and it is more intuitive. DOI: 10.11855/j.issn.0577-7402.2015.12.13

  18. Diffusion weighted EPI in early cerebral infarction and intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Susumu; Cho, Keiichi; Hosaka, Sumio; Ito, Koichiro; Tajima, Natsuki; Kobayashi, Shiro [Nippon Medical School (Japan). Chiba-Hokuso Hospital; Kumazaki, Tatsuo; Takahashi, Yoshiyuki

    1997-11-01

    Fifteen cases of early cerebral infarction and 14 cases of cerebral hemorrhage underwent diffusion weighted echo planar imaging. Increased intensity area was detected only 2 in 5 cases less than 3 hours from ictus, whereas infarction was correctly diagnosed in all cases over 3 hours. Infarcted area was increased on the follow-up study in 2 cases. Hematoma showed mixed intensity in hyper acute phase, very hypo in acute, mixed in subacute and very hyper in the chronic stage. High intensity area surrounded the hematoma. (author)

  19. Outcome assessment of hemiparesis due to intracerebral hemorrhage using diffusion tensor fractional anisotropy.

    Science.gov (United States)

    Koyama, Tetsuo; Marumoto, Kohei; Uchiyama, Yuki; Miyake, Hiroji; Domen, Kazuhisa

    2015-04-01

    This study aimed to evaluate the prognostic efficacy of magnetic resonance diffusion tensor fractional anisotropy (FA) for patients with hemiparesis due to intracerebral hemorrhage. Diffusion tensor FA brain images were acquired 14-21 days after putaminal and/or thalamic hemorrhage. The ratio of FA values within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated for each patient (n = 40) and assessed for correlation with Brunnstrom stage (BRS, 1-6), motor component of the functional independence measure (FIM-motor, 13-91), and the total length of stay (LOS) until discharge from rehabilitation (P hemiparesis due to putaminal and/or thalamic hemorrhage, particularly hand function recovery. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Influence of different hematoma clearance rates on patients with hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Cheng Zhong; Jing-Zhu Shi; Yu Liu; Tao Ou; Guo-Jing Liu; Bin Wang

    2016-01-01

    Objective:To evaluate the influence of different hematoma clearance rates patients with hypertensive intracerebral hemorrhage.Methods: A total of 94 cases with hypertensive intracerebral hemorrhage treated with operation from June 2012 to June 2015 were selected. According to theirhematoma clearance rates, they were divided into groups A (50%-70%, 28 cases), B (70%-90%,48 cases) and C (90%, 18 cases). The recovery and perioperative levels of serum neuron-specific enolase (NSE) and soluble S-100 protein of the three groups were compared.Results: The perioperative mortality and the rates of postoperative rebleeding, intracranial infection and other complications of the three groups showed no statistical significant difference (P>0.05). With the increase of the hematoma clearance rate, the drainage tube removal time and hematoma complete absorption time reduced significantly (P<0.05). In the groups B and C, the grade levels of ADL in postoperative 3 months were significantly superior to those in the group A (P<0.05). The levels of serum NSE and S-100 in the three groups increased in the initial stage and then declined after surgery. In the group B and C, the serum levels of NSE and S-100 were significantly higher than those in the group A on the 7th day after surgery (P<0.05). With the increase of the hematoma clearance rate, the serum levels of NSE and S-100 were significantly reduced on the 14th day after surgery (P<0.05). Conclusions:High level of hematoma clearance rate can help to increase the operation efficacy and prognosis of patients with hypertensive intracerebral hemorrhage.

  1. Xenon neuroprotection in experimental stroke: interactions with hypothermia and intracerebral hemorrhage.

    Science.gov (United States)

    Sheng, Siyuan P; Lei, Beilei; James, Michael L; Lascola, Christopher D; Venkatraman, Talaignair N; Jung, Jin Yong; Maze, Mervyn; Franks, Nicholas P; Pearlstein, Robert D; Sheng, Huaxin; Warner, David S

    2012-12-01

    Xenon has been proven to be neuroprotective in experimental brain injury. The authors hypothesized that xenon would improve outcome from focal cerebral ischemia with a delayed treatment onset and prolonged recovery interval. Rats were subjected to 70 min temporary focal ischemia. Ninety minutes later, rats were treated with 0, 15, 30, or 45% Xe for 20 h or 0 or 30% Xe for 8, 20, or 44 h. Outcome was measured after 7 days. In another experiment, after ischemia, rats were maintained at 37.5° or 36.0°C for 20 h with or without 30% Xe. Outcome was assessed 28 days later. Finally, mice were subjected to intracerebral hemorrhage with or without 30% Xe for 20 h. Brain water content, hematoma volume, rotarod function, and microglial activation were measured. Cerebral infarct sizes (mean±SD) for 0, 15, 30, and 45% Xe were 212±27, 176±55, 160±32, and 198±54 mm, respectively (P=0.023). Neurologic scores (median±interquartile range) followed a similar pattern (P=0.002). Infarct size did not vary with treatment duration, but neurologic score improved (P=0.002) at all xenon exposure durations (8, 20, and 44 h). Postischemic treatment with either 30% Xe or subtherapeutic hypothermia (36°C) had no effect on 28-day outcome. Combination of these interventions provided long-term benefit. Xenon improved intracerebral hemorrhage outcome measures. Xenon improved focal ischemic outcome at 7, but not 28 days postischemia. Xenon combined with subtherapeutic hypothermia produced sustained recovery benefit. Xenon improved intracerebral hemorrhage outcome. Xenon may have potential for clinical stroke therapy under carefully defined conditions.

  2. Repetitive hyperbaric oxygen treatment increases insulin sensitivity in diabetes patients with acute intracerebral hemorrhage

    Science.gov (United States)

    Xu, Qian; Wei, Yi-ting; Fan, Shuang-bo; Wang, Liang; Zhou, Xiao-ping

    2017-01-01

    Aim The role of hyperbaric oxygen therapy (HBOT) in the treatment of acute ischemic stroke is controversial. This study aims to investigate whether the peripheral insulin sensitivity of type 2 diabetes patients suffering from intracerebral hemorrhage can be increased after HBOT. Methods Fifty-two type 2 diabetes participants were recruited after being diagnosed with intracerebral hemorrhage in our hospital. Insulin sensitivity was measured by the glucose infusion rate during a hyperinsulinemic euglycemic clamp (80 mU m−2 min−1) at baseline and 10 and 30 days after HBOT sessions. Serum insulin, fasting glucose, and hemoglobin A1C were measured in fasting serum at baseline and after HBOT sessions. In addition, early (∼10 days after onset) and late (1 month after onset) outcomes (National Institutes of Health Stroke Scale, NIHSS scores) and efficacy (changes of NIHSS scores) of HBOT were evaluated. Results In response to HBOT, the glucose infusion rate was increased by 37.8%±5.76% at 1 month after onset compared with baseline. Reduced serum insulin, fasting glucose, and hemoglobin A1C were observed after HBOT. Both early and late outcomes of the HBOT group were improved compared with baseline (P<0.001). In the control group, there was significant difference only in the late outcome (P<0.05). In the assessment of efficacy, there were statistically significant differences between the groups when comparing changes in NIHSS scores at 10 days and 1 month after onset (P<0.05). Conclusion Peripheral insulin sensitivity was increased following HBOT in type 2 diabetes patients with intracerebral hemorrhage. The HBOT used in this study may be effective for diabetes patients with acute stroke and is a safe and harmless adjunctive treatment. PMID:28228657

  3. Effect of Decompressive Craniectomy on Perihematomal Edema in Patients with Intracerebral Hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christian Fung

    Full Text Available Perihematomal edema contributes to secondary brain injury in the course of intracerebral hemorrhage. The effect of decompressive surgery on perihematomal edema after intracerebral hemorrhage is unknown. This study analyzed the course of PHE in patients who were or were not treated with decompressive craniectomy.More than 100 computed tomography images from our published cohort of 25 patients were evaluated retrospectively at two university hospitals in Switzerland. Computed tomography scans covered the time from admission until day 100. Eleven patients were treated by decompressive craniectomy and 14 were treated conservatively. Absolute edema and hematoma volumes were assessed using 3-dimensional volumetric measurements. Relative edema volumes were calculated based on maximal hematoma volume.Absolute perihematomal edema increased from 42.9 ml to 125.6 ml (192.8% after 21 days in the decompressive craniectomy group, versus 50.4 ml to 67.2 ml (33.3% in the control group (Δ at day 21 = 58.4 ml, p = 0.031. Peak edema developed on days 25 and 35 in patients with decompressive craniectomy and controls respectively, and it took about 60 days for the edema to decline to baseline in both groups. Eight patients (73% in the decompressive craniectomy group and 6 patients (43% in the control group had a good outcome (modified Rankin Scale score 0 to 4 at 6 months (P = 0.23.Decompressive craniectomy is associated with a significant increase in perihematomal edema compared to patients who have been treated conservatively. Perihematomal edema itself lasts about 60 days if it is not treated, but decompressive craniectomy ameliorates the mass effect exerted by the intracerebral hemorrhage plus the perihematomal edema, as reflected by the reduced midline shift.

  4. Top 100 most-cited articles on Spontaneous Intracerebral Hemorrhage: A bibliometric analysis.

    Science.gov (United States)

    Nasir, Syed Ali Raza; Gilani, Jaleed Ahmed; Fatima, Kaneez; Faheem, Urooba; Kazmi, Omar; Siddiqi, Javed; Khosa, Faisal

    2017-09-21

    A bibliometric uses the citation count of an article to determine its impact on the clinical world. There is a paucity of literature concerning top article citations on spontaneous intracerebral hemorrhage (ICH). The main objective of this investigation was to bridge this gap and to provide understanding of the trends on the most influential articles written on this subject. Scopus Library database was searched to determine the citations of all published spontaneous ICH articles. Articles that focused on other forms of ICH, such as trauma-related hemorrhages, sub-arachnoid hemorrhages, hemorrhages due to anti-coagulation, vascular malformations or cavernomas were excluded from our list. Our articles were divided into two groups; 'Specific' articles, that focused specifically on spontaneous ICH, and 'Generalized' articles that were about ICH in general, including spontaneous as well as other forms of ICH. We did not apply any time or study-type restriction in our search. The top 100 cited articles were selected and analyzed by 2 independent investigators. Broderick J was the author with most publications in the list (n=21). The largest subset of the spontaneous ICH articles was published in the 5-year periods from 1996 to 2000 and 2001 to 2005 (n=27 each). United States had the highest number of articles (n=49). The journal with the highest number of top 100 cited articles was Stroke with 39, followed by 16 in Neurology. In conclusion, our study identifies the trends related to the subject of spontaneous intracerebral hemorrhage by analyzing the citation frequency of the most cited articles in the field. Copyright © 2017. Published by Elsevier Inc.

  5. Protection of Momordica charantia polysaccharide against intracerebral hemorrhage-induced brain injury through JNK3 signaling pathway.

    Science.gov (United States)

    Duan, Zhen-Zhen; Zhou, Xiao-Ling; Li, Yi-Hang; Zhang, Feng; Li, Feng-Ying; Su-Hua, Qi

    2015-01-01

    It has been well documented that Momordica charantia polysaccharide (MCP) has multiple biological effects such as immune enhancement, anti-oxidation and anti-cancer. However, the potential protective effects of MCP on stroke damage and its relative mechanisms remain unclear. Our present study demonstrated that MCP could scavenge reactive oxygen species (ROS) in intra-cerebral hemorrhage damage, significantly attenuating the neuronal death induced by thrombin in primary hippocampal neurons. Furthermore, we found that MCP prevented the activation of the c-Jun N-terminal protein kinase (JNK3), c-Jun and caspase-3, which was caused by the intra-cerebral hemorrhage injury. Taken together, our study demonstrated that MCP had a neuroprotective effect in response to intra-cerebral hemorrhage and its mechanisms involved the inhibition of JNK3 signaling pathway.

  6. Review of Preclinical and Clinical Studies of Bone Marrow-Derived Cell Therapies for Intracerebral Hemorrhage

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    Paulo Henrique Rosado-de-Castro

    2016-01-01

    Full Text Available Stroke is the second leading cause of mortality worldwide, causing millions of deaths annually, and is also a major cause of disability-adjusted life years. Hemorrhagic stroke accounts for approximately 10 to 27% of all cases and has a fatality rate of about 50% in the first 30 days, with limited treatment possibilities. In the past two decades, the therapeutic potential of bone marrow-derived cells (particularly mesenchymal stem cells and mononuclear cells has been intensively investigated in preclinical models of different neurological diseases, including models of intracerebral hemorrhage and subarachnoid hemorrhage. More recently, clinical studies, most of them small, unblinded, and nonrandomized, have suggested that the therapy with bone marrow-derived cells is safe and feasible in patients with ischemic or hemorrhagic stroke. This review discusses the available evidence on the use of bone marrow-derived cells to treat hemorrhagic strokes. Distinctive properties of animal studies are analyzed, including study design, cell dose, administration route, therapeutic time window, and possible mechanisms of action. Furthermore, clinical trials are also reviewed and discussed, with the objective of improving future studies in the field.

  7. Review of Preclinical and Clinical Studies of Bone Marrow-Derived Cell Therapies for Intracerebral Hemorrhage

    Science.gov (United States)

    de Carvalho, Felipe Gonçalves; de Freitas, Gabriel Rodriguez

    2016-01-01

    Stroke is the second leading cause of mortality worldwide, causing millions of deaths annually, and is also a major cause of disability-adjusted life years. Hemorrhagic stroke accounts for approximately 10 to 27% of all cases and has a fatality rate of about 50% in the first 30 days, with limited treatment possibilities. In the past two decades, the therapeutic potential of bone marrow-derived cells (particularly mesenchymal stem cells and mononuclear cells) has been intensively investigated in preclinical models of different neurological diseases, including models of intracerebral hemorrhage and subarachnoid hemorrhage. More recently, clinical studies, most of them small, unblinded, and nonrandomized, have suggested that the therapy with bone marrow-derived cells is safe and feasible in patients with ischemic or hemorrhagic stroke. This review discusses the available evidence on the use of bone marrow-derived cells to treat hemorrhagic strokes. Distinctive properties of animal studies are analyzed, including study design, cell dose, administration route, therapeutic time window, and possible mechanisms of action. Furthermore, clinical trials are also reviewed and discussed, with the objective of improving future studies in the field. PMID:27698671

  8. Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou, China

    Institute of Scientific and Technical Information of China (English)

    Yun-zhen HU; Jian-wen WANG; Ben-yan LUO

    2013-01-01

    Ethnicity and socioeconomic factors can influence disease susceptibility,clinical presentation,and outcome.We investigated the clinical characteristics (age,sex,seasonal variation,lesion site,symptoms,complications,prognosis,and sequelae) and risk factors for intracerebral hemorrhage (ICH) in 266 cases treated at our hospital in Hangzhou City,China,from January 2011 to December 2011.Risk of ICH increased dramatically with age; only 4.3%of cases were <30 years old,while 44.4% were >60 years of age.Men outnumbered women by 2:1 (67.3% vs.32.7%).Single hemorrhage was most often located in the cerebral lobes (37.2% of cases),basal ganglia (34.2%),thalamus (8.3%),cerebellum (6.8%),ventricle (1.5%),and brainstem (1.1%),while 10.9% of cases exhibited hemorrhages at multiple sites.Hypertension was also a major risk factor for ICH,as 47% of all patients were hypertensive and the percentage increased with age.In hypertensive patients,the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia.In patients with leukemia (all forms),most hemorrhages were lobar.Warfarin-and encephalic operation-associated ICHs were all lobar.Headache was the major symptom of occipital,temporal,and frontal lobe hemorrhage.Dizziness,nausea,and vomiting were the major symptoms of cerebellum hemorrhage.Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage.Disturbed level of consciousness was the major symptom in multisite,ventricular,parietal lobe,and brainstem hemorrhage.Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage.Hospital mortality was 24.4% (n=65) with a mean delay from presentation to death of (10.5±18.5) d.The majority of fatalities were cerebral hernia cases (58.5%) and these patients also had the shortest time to death [(2.9±3.5) d].Mortality was 100%in brainstem ICH and hemorrhagic conversion of cerebral infarct

  9. The Injury and Therapy of Reactive Oxygen Species in Intracerebral Hemorrhage Looking at Mitochondria

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    Jie Qu

    2016-01-01

    Full Text Available Intracerebral hemorrhage is an emerging major health problem often resulting in death or disability. Reactive oxygen species (ROS have been identified as one of the major damaging factors in ischemic stroke. However, there is less discussion about ROS in hemorrhage stroke. Metabolic products of hemoglobin, excitatory amino acids, and inflammatory cells are all sources of ROS, and ROS harm the central nervous system through cell death and structural damage, especially disruption of the blood-brain barrier. We have considered the antioxidant system of the CNS itself and the drugs aiming to decrease ROS after ICH, and we find that mitochondria are key players in all of these aspects. Moreover, when the mitochondrial permeability transition pore opens, ROS-induced ROS release, which leads to extensive liberation of ROS and mitochondrial failure, occurs. Therefore, the mitochondrion may be a significant target for elucidating the problem of ROS in ICH; however, additional experimental support is required.

  10. Magnetic Resonance Imaging Profile of Blood–Brain Barrier Injury in Patients With Acute Intracerebral Hemorrhage

    Science.gov (United States)

    Aksoy, Didem; Bammer, Roland; Mlynash, Michael; Venkatasubramanian, Chitra; Eyngorn, Irina; Snider, Ryan W.; Gupta, Sandeep N.; Narayana, Rashmi; Fischbein, Nancy; Wijman, Christine A. C.

    2013-01-01

    Background Spontaneous intracerebral hemorrhage (ICH) is associated with blood–brain barrier (BBB) injury, which is a poorly understood factor in ICH pathogenesis, potentially contributing to edema formation and perihematomal tissue injury. We aimed to assess and quantify BBB permeability following human spontaneous ICH using dynamic contrast‐enhanced magnetic resonance imaging (DCE MRI). We also investigated whether hematoma size or location affected the amount of BBB leakage. Methods and Results Twenty‐five prospectively enrolled patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were examined using DCE MRI at 1 week after symptom onset. Contrast agent dynamics in the brain tissue and general tracer kinetic modeling were used to estimate the forward leakage rate (Ktrans) in regions of interest (ROI) in and surrounding the hematoma and in contralateral mirror–image locations (control ROI). In all patients BBB permeability was significantly increased in the brain tissue immediately adjacent to the hematoma, that is, the hematoma rim, compared to the contralateral mirror ROI (P30 mL) had higher Ktrans values than small hematomas (P<0.005). Ktrans values of lobar hemorrhages were significantly higher than the Ktrans values of deep hemorrhages (P<0.005), independent of hematoma volume. Higher Ktrans values were associated with larger edema volumes. Conclusions BBB leakage in the brain tissue immediately bordering the hematoma can be measured and quantified by DCE MRI in human ICH. BBB leakage at 1 week is greater in larger hematomas as well as in hematomas in lobar locations and is associated with larger edema volumes. PMID:23709564

  11. Prophylactic heparin in acute intracerebral hemorrhage: a propensity score-matched analysis of the INTERACT2 study.

    Science.gov (United States)

    Muñoz-Venturelli, Paula; Wang, Xia; Lavados, Pablo M; Stapf, Christian; Robinson, Thompson; Lindley, Richard; Heeley, Emma; Delcourt, Candice; Chalmers, John; Anderson, Craig S

    2016-07-01

    Indication and timing of pharmacological venous thromboembolism prophylaxis in intracerebral hemorrhage patients is controversial. To determine whether use of subcutaneous heparin during the first 7 days after spontaneous intracerebral hemorrhage increases risks of death and disability. Data are from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) study. Patients with acute intracerebral hemorrhage (propensity score matched analysis were used to determine associations of heparin use on death and disability (modified Rankin scale) at 90 days. In 2525 patients with available data, there were 465 (22.5%) who received subcutaneous heparin. They had higher death or major disability at 90 days in crude (odds ratio 2.29, 95% confidence interval 1.85-2.84; p propensity score matched (odds ratio 2.06, 95% confidence interval 1.53-2.77; p propensity score matched analysis, heparin-treated patients had significant lower mortality (odds ratio 0.55, 95% CI 0.35-0.87; p = 0.01) but greater major disability (odds ratio 1.68, 95% confidence interval 1.25-2.28; p risk, we recommend careful consideration of the need for venous thromboembolism prophylaxis with heparin in intracerebral hemorrhage patients. http://www.clinicaltrials.gov NCT00716079. © 2016 World Stroke Organization.

  12. Plasma 8-iso-Prostaglandin F2α concentrations and outcomes after acute intracerebral hemorrhage.

    Science.gov (United States)

    Du, Quan; Yu, Wen-Hua; Dong, Xiao-Qiao; Yang, Ding-Bo; Shen, Yong-Feng; Wang, Hao; Jiang, Li; Du, Yuan-Feng; Zhang, Zu-Yong; Zhu, Qiang; Che, Zhi-Hao; Liu, Qun-Jie

    2014-11-01

    Higher plasma 8-iso-Prostaglandin F2α concentrations have been associated with poor outcome of severe traumatic brain injury. We further investigated the relationships between plasma 8-iso-Prostaglandin F2α concentrations and clinical outcomes in patients with acute intracerebral hemorrhage. Plasma 8-iso-Prostaglandin F2α concentrations of 128 consecutive patients and 128 sex- and gender-matched healthy subjects were measured by enzyme-linked immunosorbent assay. We assessed their relationships with disease severity and clinical outcomes including 1-week mortality, 6-month mortality and unfavorable outcome (modified Rankin Scale score>2). Plasma 8-iso-Prostaglandin F2α concentrations were substantially higher in patients than in healthy controls. Plasma 8-iso-Prostaglandin F2α concentrations were positively associated with National Institutes of Health Stroke Scale (NIHSS) scores and hematoma volume using a multivariate linear regression. It emerged as an independent predictor for clinical outcomes of patients using a forward stepwise logistic regression. ROC curves identified the predictive values of plasma 8-iso-Prostaglandin F2α concentrations, and found its predictive value was similar to NIHSS scores and hematoma volumes. However, it just numerically added the predictive values of NIHSS score and hematoma volume. Increased plasma 8-iso-Prostaglandin F2α concentrations are associated with disease severity and clinical outcome after acute intracerebral hemorrhage. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth.

    Science.gov (United States)

    Hubbard, Dena; Tobias, Joseph D

    2006-11-01

    In infants, intracerebral hemorrhage (ICH) is most likely the result of trauma or disturbances of coagulation function. Routine and standard care of the newborn includes the administration of vitamin K to prevent hemorrhagic disease of the newborn. We present two infants, the products of home deliveries, who did not receive vitamin K at birth. Both infants developed ICH at 5 weeks of age and presented with signs and symptoms of increased IC pressure. In both cases, recombinant factor VIIa was administered to correct coagulation function and allow immediate surgical intervention which included craniotomy and hematoma evacuation in one patient and placement of a ventriculostomy in the other to treat increased IC pressure. Despite this therapy, both infants were left with severe neurologic sequelae. These two cases illustrate that hemorrhagic disease of the newborn can occur when prophylactic vitamin K is not administered and that it can have devastating consequences. Given these issues, the routine administration of vitamin K to all infants is mandatory and should not be considered optional.

  14. Debulking from within: a robotic steerable cannula for intracerebral hemorrhage evacuation.

    Science.gov (United States)

    Burgner, Jessica; Swaney, Philip J; Lathrop, Ray A; Weaver, Kyle D; Webster, Robert J

    2013-09-01

    New approaches to intracerebral hemorrhage management are motivated by its high incidence and 40% mortality rate. Surgery is sometimes attempted to decompress the brain, although patient outcomes are similar regardless of whether surgery occurs. We hypothesize that surgical decompression is not more effective because current open surgical techniques disrupt healthy brain tissue to access the clot formed by the hemorrhage, offsetting the benefits of surgery. To address this, we propose a less invasive needle-based approach in which the clot is debulked from within using a superelastic, precurved aspiration cannula that is deployed from a needle. The tip of this aspiration cannula is controlled by coordinated insertion and retraction of the cannula and needle, as well as axial rotation of the cannula. We describe the design of a sterilizable and biocompatible robot that can control the three degrees of freedom of the needle and cannula. Image guidance is achieved by adapting an approach originally developed for brain biopsy. We provide an optimization method for the selection of the precurvatures of one or more sequentially used aspiration cannulas to maximize hemorrhage evacuation, based on preoperative medical image data. In vitro experiments demonstrate the feasibility of evacuating 83-92% of hemorrhage volume, depending on the number of tubes and deployment method used.

  15. High Morphologic Plasticity of Microglia/Macrophages Following Experimental Intracerebral Hemorrhage in Rats

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    Shu-Sheng Yang

    2016-07-01

    Full Text Available As current efforts have limited effects on the clinical outcome of intracerebral hemorrhage (ICH, the mechanisms including microglia/macrophages that involved inflammation need further investigation. Here, 0.4 units of collagenase VII were injected into the left caudate putamen (CPu to duplicate ICH rat models. In the brains of ICH rats, microglia/macrophages, the nearest cells to the hemorrhagic center, were observed as ameboid and Prussian-blue positive. Furthermore, the ameboid microglia/macrophages were differentiation (CD 68 and interleukin-1β (IL-1β positive, and neither CD206 nor chitinase3-like 3 (Ym1 positive, suggesting their strong abilities of phagocytosis and secretion of IL-1β. According to the distance to the hemorrhagic center, we selected four areas—I, II, III, and IV—to analyze the morphology of microglia/macrophages. The processes decreased successively from region I to region IV. Microglia/macrophages in region IV had no processes. The processes in region I were radially distributed, however, they showed obvious directivity towards the hemorrhagic center in regions II and III. Region III had the largest density of compactly arrayed microglia/macrophages. All these in vivo results present the high morphologic plasticity of microglia/macrophages and their functions in the pathogenesis of ICHs.

  16. Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

    Science.gov (United States)

    Rimpau, C.; Nickel, C. H.; Baier, P.

    2017-01-01

    The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient's survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes. PMID:28255471

  17. Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

    Directory of Open Access Journals (Sweden)

    M. Kirsch

    2017-01-01

    Full Text Available The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.

  18. Early treatment of hypertension in acute ischemic and intracerebral hemorrhagic stroke: progress achieved, challenges, and perspectives.

    Science.gov (United States)

    Feldstein, Carlos A

    2014-03-01

    Hypertension is the leading risk factor for ischemic and intracerebral hemorrhagic subtypes of stroke. Additionally, high blood pressure (BP) in the acute cerebrovascular event is associated with poor outcome, and a high percentage of stroke survivors have inadequate control of hypertension. The present is a systematic review of prospective, randomized, and controlled trials carried out on safety and efficacy of antihypertensive treatment of both subtypes of acute stroke. Six trials involving 7512 patients were included, which revealed controversies on the speed and the goals of treatment. These controversies could be due at least in part, from the fact that some studies analyzed the results of antihypertensive treatment in ischemic and intracerebral hemorrhagic subtypes of acute stroke together, and from a different prevalence of past-stroke in the randomized groups. Further research is necessary to establish whether standard antihypertensive treatment provides greater benefit than simple observation in patients with ischemic acute stroke and Stage 2 hypertension of JNC 7, albeit they were not candidates for acute reperfusion. In that case, the target reduction in BP could be 10% to 15% within 24 hours. The recently published INTERACT 2 has provided evidence that patients with hemorrhagic stroke may receive intensive antihypertensive treatment safely with the goal of reducing systolic BP to levels no lower than 130 mm Hg. It is important to take into account that marked BP lowering in acute stroke increases the risk of poor outcome by worsening cerebral ischemia from deterioration of cerebral blood flow autoregulation. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  19. Intracerebral Hemorrhage

    Science.gov (United States)

    ... Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke Treatment Caregiver and Patient Resources Home » Patients & Families » About Stroke » ... Families Warning Signs Reducing Your Risk Information for Caregivers Find a Trial ... & Conferences Guidelines & Consensus Statements Education What ...

  20. Pheochromocytoma complicated by intracerebral hemorrhage - a case report; Feocromocitoma complicado com acidente vascular encefalico hemorragico - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, Aline Silva; Marchiori, Edson; Almeida, Fabiola Assuncao de; Martins, Renata Romano; Sales, Anderson Ribeiro; Santos, Tereza Cristina C.R.S. dos; Reis, Simone Teixeira [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia; Silveira, Sonia Marcelino T. da

    1999-06-01

    The authors report a case of pheochromocytoma that was complicated by intracerebral hemorrhage in a 17-year-old female patient. Computed tomography showed a solid mass, heterogeneous, on the right adrenal. The patient underwent a right adrenalectomy. She is being observed by our out-patients clinic, presenting normal blood pressure levels and a left hemiparesis. (author)

  1. Case of granulomatosis with polyangiitis (Wegener's granulomatosis) manifested with asymptomatic intracerebral hemorrhage.

    Science.gov (United States)

    Takaoka, Hirokazu; Hashimoto, Atsushi; Nogi, Shinichi; Iwata, Kanako; Futami, Hidekazu; Arinuma, Yoshiyuki; Shimada, Kota; Nakayama, Hisanori; Komiya, Akiko; Furukawa, Hiroshi; Matsui, Toshihiro; Tohma, Shigeto

    2013-01-01

    A 46-year-old man, who had had sinusitis, developed bilateral omalgia, petechiae on his lower extremities and a congested right eye. A blood test detected elevated serum C-reactive protein level. Computed tomography incidentally found an acute lesion of thalamic hemorrhage without neurological symptoms and no specific therapy was given at the time. Thereafter, he developed vertigo, vomiting and pneumonia for which antibiotics were ineffective. He was referred and admitted to our hospital. Further, aural and renal lesions, and presence of serum proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) confirmed his diagnosis of granulomatosis with polyangiitis (Wegener's) (GPA). With corticosteroid and cyclophosphamide therapy, his symptoms disappeared in two months along with faded PR3-ANCA. Afterward he showed neither new cerebral lesion nor symptom. This is a rare case of GPA manifested with asymptomatic intracerebral hemorrhage. It should be noted that GPA could cause various manifestations in central nervous system such as a fatal or an asymptomatic hemorrhagic lesion, which might respond to immunosuppressive therapy.

  2. Intrastriatal injection of autologous blood or clostridial collagenase as murine models of intracerebral hemorrhage.

    Science.gov (United States)

    Lei, Beilei; Sheng, Huaxin; Wang, Haichen; Lascola, Christopher D; Warner, David S; Laskowitz, Daniel T; James, Michael L

    2014-07-03

    Intracerebral hemorrhage (ICH) is a common form of cerebrovascular disease and is associated with significant morbidity and mortality. Lack of effective treatment and failure of large clinical trials aimed at hemostasis and clot removal demonstrate the need for further mechanism-driven investigation of ICH. This research may be performed through the framework provided by preclinical models. Two murine models in popular use include intrastriatal (basal ganglia) injection of either autologous whole blood or clostridial collagenase. Since, each model represents distinctly different pathophysiological features related to ICH, use of a particular model may be selected based on what aspect of the disease is to be studied. For example, autologous blood injection most accurately represents the brain's response to the presence of intraparenchymal blood, and may most closely replicate lobar hemorrhage. Clostridial collagenase injection most accurately represents the small vessel rupture and hematoma evolution characteristic of deep hemorrhages. Thus, each model results in different hematoma formation, neuroinflammatory response, cerebral edema development, and neurobehavioral outcomes. Robustness of a purported therapeutic intervention can be best assessed using both models. In this protocol, induction of ICH using both models, immediate post-operative demonstration of injury, and early post-operative care techniques are demonstrated. Both models result in reproducible injuries, hematoma volumes, and neurobehavioral deficits. Because of the heterogeneity of human ICH, multiple preclinical models are needed to thoroughly explore pathophysiologic mechanisms and test potential therapeutic strategies.

  3. Resveratrol Attenuates Neurodegeneration and Improves Neurological Outcomes after Intracerebral Hemorrhage in Mice

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    Frederick Bonsack

    2017-08-01

    Full Text Available Intracerebral hemorrhage (ICH is a devastating type of stroke with a substantial public health impact. Currently, there is no effective treatment for ICH. The purpose of the study was to evaluate whether the post-injury administration of Resveratrol confers neuroprotection in a pre-clinical model of ICH. To this end, ICH was induced in adult male CD1 mice by collagenase injection method. Resveratrol (10 mg/kg or vehicle was administered at 30 min post-induction of ICH and the neurobehavioral outcome, neurodegeneration, cerebral edema, hematoma resolution and neuroinflammation were assessed. The Resveratrol treatment significantly attenuated acute neurological deficits, neurodegeneration and cerebral edema after ICH in comparison to vehicle treated controls. Further, Resveratrol treated mice exhibited improved hematoma resolution with a concomitant reduction in the expression of proinflammatory cytokine, IL-1β after ICH. Altogether, the data suggest the efficacy of post-injury administration of Resveratrol in improving acute neurological function after ICH.

  4. From discharge planner to "concierge": recommendations for hospital social work by clients with intracerebral hemorrhage.

    Science.gov (United States)

    Linton, Kristen F; Ing, Marissa M; Vento, Megan A; Nakagawa, Kazuma

    2015-01-01

    The Affordable Care Act and budget cuts have changed the role of hospital social workers by placing pressure on them to conduct speedy discharges and decrease readmission rates. This qualitative study aimed to assess if hospital social work is meeting the needs of clients in the hospital and postdischarge. Semistructured interviews with 10 clients with intracerebral hemorrhage (ICH) and 11 caregivers were conducted. Participants reported that social work services were not meeting their needs. Clients with ICH and their caregivers expressed needs from social workers that surpassed their roles as discharge planners, including counseling, help with finances and insurance, and advocacy. Participants wanted social work services to begin early in acute treatment with continuity postdischarge. Social workers should conduct ethical social work by meeting clients where they are, addressing needs as prioritized by the client, and advocating individually and organizationally for clients.

  5. Gastrointestinal bleeding after intracerebral hemorrhage: a retrospective review of 808 cases.

    Science.gov (United States)

    Yang, Tie-Cheng; Li, Jian-Guo; Shi, Hong-Mei; Yu, Dong-Ming; Shan, Kai; Li, Li-Xia; Dong, Xiao-Yan; Ren, Tian-Hua

    2013-10-01

    This study examined the incidence and risk factors for gastrointestinal (GI) bleeding after spontaneous intracerebral hemorrhage (ICH). The available medical records of patients with ICH admitted from June 2008 to December 2009 for any episode of GI bleeding, possible precipitating factors and administration of ulcer prophylaxis were reviewed. The prevalence of GI bleeding was 26.7%, including 3 cases of severe GI bleeding (0.35%). Patients with GI bleeding had significantly longer hospital stay and higher in-hospital mortality compared with patients without GI bleeding. Multivariate logistic regression analyses showed that age, Glasgow Coma Scale scores, sepsis and ICH volume were independent predictors of GI bleeding. About 63.4% of patients with ICH received stress ulcer prophylaxis. GI bleeding occurred frequently after ICH, but severe events were rare. Age, Glasgow Coma Scale score, sepsis and ICH volume were independent predictors of GI bleeding occurring after ICH.

  6. Primary report of noninvasive impedance monitoring of cerebral hematoma and edema in patients with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Xia Yi Lu; Dong Wei-Wei; Yang Hao; Long Men; Yang Hua

    2000-01-01

    Background and Objective Brain edema is one of the most important clinical process in many diseases. Tissue impedance monitoring offers a non-invasive, bedside, rapid, and reliable technique for the monitoring of the brain edema. Methods We use a bioelectrical impedance(BEI) monitoring unit to record the brain impedance in the healthy volunteer and the patients with intracerebral hemorrhage. Percent of BEI variations were calculation. Results and Conclusions Brain BEI haven f any difference between both hemispheres in normal ones. In 48hrs, BEI value at hematoma-side was obviously decreased; after 48hrs, BEI value was obviously increased and continue to tenth day. Brain bioelectrical impedance monitoring, particularly noninvasively, is a first time in this field. The primary results show brain BEI could reflect the evolution of cerebral hematoma and edema.

  7. Activation of endogenous neural stem cells in experimental intracerebral hemorrhagic rat brains

    Institute of Scientific and Technical Information of China (English)

    唐涛; 黎杏群; 武衡; 罗杰坤; 张花先; 罗团连

    2004-01-01

    Background Many researchers suggest that adult mammalian central nervous system (CNS) is incapable of completing self-repair or regeneration. And there are accumulating lines of evidence which suggest that endogenous neural stem cells (NSCs) are activated in many pathological conditions, including stroke in the past decades, which might partly account for rehabilitation afterwards. In this study, we investigated whether there was endogenous neural stem cell activation in intracerebral hemorrhagic (ICH) rat brains.Methods After ICH induction by stereotactical injection of collagenase type Ⅶ into globus pallidus, 5-Bromo-2 Deoxyuridine (BrdU) was administered intraperitoneally to label newborn cells. Immunohistochemical method was used to detect Nestin, a marker for neural stem cells, and BrdU.Results Nestin-positive or BrdU-Labeled cells were predominantly located at 2 sites: basal ganglion around hemotoma, ependyma and nearby subventricular zone (SVZ). No positive cells for the 2 markers were found in the 2 sites of normal control group and sham group, as well as in non-leisoned parenchyma, both hippocampi and olfactory bulbs in the 4 groups. Nestin+ cells presented 4 types of morphology, and BrdU+ nucleus were polymorphologic. Postive cell counting around hemotoma showed that at day 2, Nestin+ cells were seen around hemotoma in model group , the number of which increased at day 4, day 7(P<0.01), peaked at day 14(P<0.05), and reduced significantly by day 28(P<0.01).Conclusion Endogenous neural stem cells were activated in experimental intracerebral hemorrhagic rat brains.

  8. The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study protocol.

    Science.gov (United States)

    Woo, Daniel; Rosand, Jonathan; Kidwell, Chelsea; McCauley, Jacob L; Osborne, Jennifer; Brown, Mark W; West, Sandra E; Rademacher, Eric W; Waddy, Salina; Roberts, Jamie N; Koch, Sebastian; Gonzales, Nicole R; Sung, Gene; Kittner, Steven J; Birnbaum, Lee; Frankel, Michael; Testai, Fernando Daniel; Hall, Christiana E; Elkind, Mitchell S V; Flaherty, Matthew; Coull, Bruce; Chong, Ji Y; Warwick, Tanya; Malkoff, Marc; James, Michael L; Ali, Latisha K; Worrall, Bradford B; Jones, Floyd; Watson, Tiffany; Leonard, Anne; Martinez, Rebecca; Sacco, Ralph I; Langefeld, Carl D

    2013-10-01

    Epidemiological studies of intracerebral hemorrhage (ICH) have consistently demonstrated variation in incidence, location, age at presentation, and outcomes among non-Hispanic white, black, and Hispanic populations. We report here the design and methods for this large, prospective, multi-center case-control study of ICH. The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multi-center, prospective case-control study of ICH. Cases are identified by hot-pursuit and enrolled using standard phenotype and risk factor information and include neuroimaging and blood sample collection. Controls are centrally identified by random digit dialing to match cases by age (±5 years), race, ethnicity, sex, and metropolitan region. As of March 22, 2013, 1655 cases of ICH had been recruited into the study, which is 101.5% of the target for that date, and 851 controls had been recruited, which is 67.2% of the target for that date (1267 controls) for a total of 2506 subjects, which is 86.5% of the target for that date (2897 subjects). Of the 1655 cases enrolled, 1640 cases had the case interview entered into the database, of which 628 (38%) were non-Hispanic black, 458 (28%) were non-Hispanic white, and 554 (34%) were Hispanic. Of the 1197 cases with imaging submitted, 876 (73.2%) had a 24 hour follow-up CT available. In addition to CT imaging, 607 cases have had MRI evaluation. The ERICH study is a large, case-control study of ICH with particular emphasis on recruitment of minority populations for the identification of genetic and epidemiological risk factors for ICH and outcomes after ICH.

  9. Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials.

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    Jia-Wei Wang

    Full Text Available BACKGROUND: A wealth of evidence based on the randomized controlled trials (RCTs has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH. METHODS: According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection. RESULTS: Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR: 0.80, 95% confidence interval (CI: 0.69-0.93; P = 0.004 and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26-0.74; P = 0.002 compared to craniotomy with no significant heterogeneity among the study results. CONCLUSIONS: The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration.

  10. Evaluation of the Efficiency of Treatment for Massive Obstetric Hemorrhage

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    S. V. Barinov

    2014-01-01

    Full Text Available Objective: to evaluate the efficiency of therapy for massive obstetric hemorrhage, by applying thromboelastography (TEG. Subjects and methods. Sixty six patients with massive obstetric hemorrhage who were divided into two groups: a study (A; n=37 and comparison (B; n=29 groups were examined. A control group (C; n=30 comprised women with physiological blood loss during labor. The efficiency of TEG was evaluated from the volume of blood loss and the frequency of hysterectomy.Results. Fibrin clot density, MA have the highest prognostic capacity to identify the risk of massive obstetric hemorrhage [AUC=0.83 (95% CI 0.79—0.87; р=0.001]. A therapeutic and diagnostic set for massive obstetric hemorrhage, by applying TEG, can reduce the number of hysterectomies by 3. 1 times (p=0.02, the volume of blood loss by 1.3 times (p=0.03, and the use of fresh frozen plasma by 2.0 times (p=0.01. Conclusion. Rapid evaluation of the blood coagulation system, by using a TEG® 5000 device (Haemoscope Corp., USA makes it possible to perform timely pathogenetic sound therapy, to prevent a critical condition, and to implement organ-sparing tactics.  

  11. Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage: The Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies.

    Science.gov (United States)

    Qiu, Miaoyan; Sato, Shoichiro; Zheng, Danni; Wang, Xia; Carcel, Cheryl; Hirakawa, Yoichiro; Sandset, Else C; Delcourt, Candice; Arima, Hisatomi; Wang, Jiguang; Chalmers, John; Anderson, Craig S

    2016-06-01

    Faster heart rate predicts higher mortality in coronary heart disease and acute ischemic stroke, but its prognostic significance in intracerebral hemorrhage remains uncertain. We aimed to determine the effect of admission heart rate on clinical and imaging outcomes in patients with intracerebral hemorrhage. A post hoc pooled analysis of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT 1 and 2). Clinical outcomes were mortality and modified Rankin Scale score at 90 days; and imaging outcome was absolute growth in hematoma volume during the initial 24 hours. Patients were divided into 4 categories according to baseline heart rate (heart rate group as the reference. Of 3185 patients with available data, higher admission heart rate was associated with both mortality and worse modified Rankin Scale score: adjusted hazard ratio for heart rate (≥85 versus heart rate and absolute growth in hematoma volume (P-trend, 0.196). Higher admission heart rate is independently associated with death and poor functional outcome after acute intracerebral hemorrhage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079. © 2016 American Heart Association, Inc.

  12. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update

    Science.gov (United States)

    An, Sang Joon; Kim, Tae Jung; Yoon, Byung-Woo

    2017-01-01

    Intracerebral hemorrhage (ICH) is the second most common subtype of stroke and a critical disease usually leading to severe disability or death. ICH is more common in Asians, advanced age, male sex, and low- and middle-income countries. The case fatality rate of ICH is high (40% at 1 month and 54% at 1 year), and only 12% to 39% of survivors can achieve long-term functional independence. Risk factors of ICH are hypertension, current smoking, excessive alcohol consumption, hypocholesterolemia, and drugs. Old age, male sex, Asian ethnicity, chronic kidney disease, cerebral amyloid angiopathy (CAA), and cerebral microbleeds (CMBs) increase the risk of ICH. Clinical presentation varies according to the size and location of hematoma, and intraventricular extension of hemorrhage. Patients with CAA-related ICH frequently have concomitant cognitive impairment. Anticoagulation related ICH is increasing recently as the elderly population who have atrial fibrillation is increasing. As non-vitamin K antagonist oral anticoagulants (NOACs) are currently replacing warfarin, management of NOAC-associated ICH has become an emerging issue. PMID:28178408

  13. A qualitative study of transportation challenges among intracerebral hemorrhage survivors and their caregivers.

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    Ing, Marissa M; Vento, Megan A; Nakagawa, Kazuma; Linton, Kristen F

    2014-11-01

    Post-discharge barriers of hemorrhagic stroke survivors in Hawai'i have not been extensively studied. The purpose of this qualitative study was to identify common driving and transportation barriers among patients with intracerebral hemorrhage (ICH) and their caregivers in the Honolulu community. Semi-structured interviews were conducted with ICH patients (n = 10) and caregivers (n = 11) regarding their driving and transportation barriers. Inductive content analysis was used to analyze the interviews. Participants reported that they needed transportation to attend to their recovery and remain safe. Informal transportation was desired, yet not always available to patients. A local paratransit service for people with disabilities was the most common form of alternative transportation used by patients; however, they reported difficulty obtaining this method of transportation. Participants with no other option used costly, private transportation. Most ICH survivors expressed great challenges with the available transportation services that are essential to their reintegration into the community after hospitalization. Greater effort to provide transportation options and eligibility information to the ICH patients and their caregivers may be needed to improve their post-discharge care.

  14. Intracerebral Hemorrhage with Intraventricular Extension—Getting the Prognosis Right Early

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    Christoph Stretz

    2017-08-01

    Full Text Available BackgroundEarly accurate outcome prognostication for patients with intracerebral hemorrhage (ICH and accompanying intraventricular hemorrhage (IVH is often challenging (1. Acute hydrocephalus often contributes to a poor clinical exam (2 and can portend significant morbidity and mortality (3. Accordingly, the inpatient neurologist may feel inclined to recommend limitations of care for an ICH patient admitted with a large IVH burden and poor exam.Case presentationWe present a patient with significant IVH and minimal ICH who deteriorated rapidly to coma after presentation. Despite this exam, an initially non-functioning diversion of cerebrospinal fluid (CSF and temporary halt of further attempts of CSF diversion in the setting of an early “do not resuscitate order,” our patient gradually improved and, with supportive ICU care and rehabilitation, was able to communicate and ambulate with assistance at 12 weeks.ConclusionPatients with ICH with IVH do have the capacity to improve dramatically even with relatively conservative management. Unless previous limitations of care exist, we recommend that early judgments of prognosis for patients with ICH and/or IVH should be delayed for at least 72 h until the patient’s clinical trajectory over time is better understood.

  15. Intracerebral hemorrhage for the palliative care provider: what you need to know.

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    Simmons, B Brent; Parks, Susan M

    2008-12-01

    Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant comorbidities. The process of withdrawing ventilatory support can differ greatly from that of a medical intensive care unit (ICU) patient. Most ICH patients die within 24 hours following extubation. Symptoms of dyspnea and pain warrant use of opioids before and after terminal extubation. In addition, treating death rattle and postextubation stridor are important interventions. Family meetings are a vital intervention to help explain prognosis, establish a plan of care, and to get all family members on the same page. Family meetings can have a rapid effect, with 66% of families opting for withdrawal of life support to decide within 24 hours of such a meeting.

  16. Outcomes from intracerebral hemorrhage among patients pre-treated with statins

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    Flávio Ramalho Romero

    2011-06-01

    Full Text Available OBJECTIVE: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA reductase inhibitors, or statins, have been associated with improved clinical outcomes after ischemic stroke and subarachnoid hemorrhage, but with an increased risk of incidental spontaneous intracerebral hemorrhage (ICH. We investigated whether the statin use before ICH, was associated with functional independence, 90 days after treatment. METHOD: We analyzed 124 consecutive ICH patients with 90-day outcome data who were enrolled in a prospective cohort study between 2006 and 2009. Eighty-three patients were included in this study. Among ICH survivors, univariate Cox regression models and Kaplan-Meier plots were used to determine subject characteristics that were associated with an increased risk of recurrence. Statin usage was determined through interviewing the patient at the time of ICH and confirmed by reviewing their medical records. Independent status was defined as Glasgow Outcome Scale grades 4 or 5. RESULTS: Statins were used by 20 out of 83 patients (24% before ICH onset. There was no effect from pre-ICH statin use on functional independence rates (28% versus 29%, P=0.84 or mortality (46% versus 45%, P=0.93. CONCLUSION: Pre-ICH statin use is not associated with changes to ICH functional outcome or mortality.

  17. Neuroprotective pentapeptide CN-105 improves functional and histological outcomes in a murine model of intracerebral hemorrhage.

    Science.gov (United States)

    Lei, Beilei; James, Michael L; Liu, Ji; Zhou, Guanen; Venkatraman, Talaignair N; Lascola, Christopher D; Acheson, Shawn K; Dubois, Laura G; Laskowitz, Daniel T; Wang, Haichen

    2016-10-07

    Presently, no pharmacological treatments have been demonstrated to improve long-term functional outcomes following intracerebral hemorrhage (ICH). Clinical evidence associates apolipoprotein E (apoE) genotype with ICH incidence and outcome. While apoE modifies neuroinflammatory responses through its adaptive role in glial downregulation, intact apoE holoprotein is too large to cross the blood-brain barrier (BBB). Therefore, we developed a 5-amino acid peptide - CN-105 - that mimics the polar face of the apoE helical domain involved in receptor interactions. In the current study, we investigated the therapeutic potential of CN-105 in a mouse model of ICH. Three doses of CN-105 (0.05 mg/kg) was administered by tail vein injection within 24 hours after ICH induction. Functional assessment showed durable improvement in vestibulomotor performance after CN-105 treatment, as quantified by increased Rotarod latencies on Days 1-5 post-ICH, and long-term improvement in neurocognitive performance, as quantified by reduced Morris water maze latencies on Days 29-32 post-ICH. Further, brain water content was significantly reduced, neuroinflammation was decreased and hippocampal CA3 neuronal survival was increased, although hemorrhage volume was not affected by CN-105. We concluded, therefore, that pentapeptide CN-105 improved short- and long-term neurobehavioral outcomes in a murine model of ICH, suggesting therapeutic potential for patients with acute ICH.

  18. T lymphocytes infiltration promotes blood-brain barrier injury after experimental intracerebral hemorrhage.

    Science.gov (United States)

    Zhang, Xuan; Liu, Wei; Yuan, Jichao; Zhu, Haitao; Yang, Yang; Wen, Zexian; Chen, Yaxing; Li, Lan; Lin, Jiangkai; Feng, Hua

    2017-09-01

    T lymphocytes migrate into the brain after intracerebral hemorrhage (ICH) and promote cerebral inflammation, thus exacerbating neuronal injury. However, the relationship between of T lymphocytes infiltration and blood-brain barrier (BBB) injury after ICH has not been clarified. In this study, we investigated the spatial-temporal distribution of infiltrating T lymphocytes after ICH in C57BL/6 mice by immunofluorescence and flow cytometry, and the accompanying change rules of BBB permeability were detected by Evans blue dye leakage and tight junction protein expression. Furthermore, T lymphocyte-deficient nude mice and T lymphocyte-decreased C57BL/6 mice treated with fingolimod were used to verify the relationship between T lymphocytes infiltration and BBB leakage after ICH. Here, we reported that brain-infiltrating T lymphocytes in the hemorrhagic hemisphere began to accumulate on the first day and peaked on the fifth day after ICH; BBB leakage also at peaked on the fifth day. Moreover, T lymphocyte-deficient nude mice showed minor BBB leakage after ICH compared with C57BL/6 control mice. Similarly, fingolimod treatment can significantly decrease T lymphocyte infiltration and promote BBB integrity compared with a vehicle control. Overall, our results suggested that suppression of T lymphocyte infiltration may be a novel way to improve BBB integrity after ICH. Copyright © 2017. Published by Elsevier B.V.

  19. Number of cerebral microbleeds and risk of intracerebral hemorrhage after intravenous thrombolysis.

    Science.gov (United States)

    Dannenberg, Steffen; Scheitz, Jan F; Rozanski, Michal; Erdur, Hebun; Brunecker, Peter; Werring, David J; Fiebach, Jochen B; Nolte, Christian H

    2014-10-01

    Cerebral microbleeds (CMBs) are found in a substantial proportion of patients with ischemic stroke eligible for treatment with intravenous thrombolysis. Until now, there is limited data on the impact of multiple CMBs on occurrence of intracerebral hemorrhage (ICH) after intravenous thrombolysis. Between 2008 and 2013, all patients receiving MRI-based intravenous thrombolysis were identified within our prospective thrombolysis register. Number of CMBs was rated on pretreatment T2*-weighted MRI by a rater blinded to clinical data and follow-up. Outcomes of interest were occurrence of symptomatic ICH (sICH) and parenchymal hemorrhage (PH). Among 326 included patients, 52 patients had a single CMB (16.0%), 19 had 2 to 4 CMBs (5.8%), and 10 had ≥5 CMBs (3.1%). Frequency of sICH/PH was 1.2%/5.7% in patients without CMBs, 3.8%/3.8% in patients with a single CMB, 10.5%/21.1% in patients with 2 to 4 CMBs, and 30.0%/30.0% in patients with ≥5 CMBs, respectively (each P for trendCMBs, both patients with 2 to 4 CMBs (P=0.02/P=0.02) and patients with ≥5 CMBs (PCMBs are present, with a graded relationship to increasing baseline CMB number. © 2014 American Heart Association, Inc.

  20. Baicalein Promotes Neuronal and Behavioral Recovery After Intracerebral Hemorrhage Via Suppressing Apoptosis, Oxidative Stress and Neuroinflammation.

    Science.gov (United States)

    Wei, Ning; Wei, Yinghai; Li, Binru; Pang, Linlin

    2017-01-21

    Intracerebral hemorrhage (ICH) is an important public health problem in neurology, which is not only associated with high mortality but also leading to disability. Yet no satisfactory treatment has been developed. The secondary injury that resulted from a number of self-destructive processes such as neuroinflammation, apoptosis and oxidative stress, is the key factor contributing to ICH-induced brain damage. Baicalein has been proved to improve neuronal functional recovery in rat model of subarachnoid hemorrhage and ischemic brain damage. To investigate the effect of baicalein on ICH and its underlying mechanism, a collagenase-induced ICH rat model was performed. Baicalein treatment significantly decreased neurological severity score at day 1 and 3 after ICH injury. Our results showed that the lesion volume, the brain water content, the expression levels of four pro-inflammatory cytokines (IL-1β, IL-4 and IL-6 and TNF-α) and the numbers of apoptotic cells were reduced significantly in ICH rats receiving baicalein treatment, especially in 50 mg/kg baicalein-treated group. Moreover, baicalein increased SOD and GSH-Px activities and down-regulated MDA level of brain tissues in rats. These results suggested that the therapeutic efficacy of baicalein on repairing brain damage is probably caused by suppressing apoptosis, oxidative stress and neuroinflammation. Baicalein could be developed into a novel drug for clinical treatment of ICH and ICH-related brain injuries.

  1. Expression of thrombin and its associated protein in cerebellum of human and rat after intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhi-yi; QI Ji-ping; ZHU Hong; SONG Yue-jia; WU He; JIA Ying; ZHANG Guang-mei

    2010-01-01

    Background Intracerebral hemorrhage (ICH) can cause brain damage through a number of pathways.The purpose of the study was to explore the effect of thrombin, protease nexin-1 (PN-1) and protease activated receptor-1 (PAR-1) in rat and human cerebellum after ICH.Methods A model of ICH was produced in adult Sprague-Dawley rats by direct injection of autologous blood (50 μl) into caudate nucleus.Patients with injured hemorrhage were also enrolled in this study.Different expressions of thrombin,PAR-1, PN-1 were detected in rat and human cerebellum by immunohistochemistry and in situ hybridization.Results In rat cerebellum, thrombin protein significantly increased at 6 hours and reached the maximum 2 days afterICH.The expression of PAR-1 protein reached the maximum at 24-48 hours, and then began to decrease.The expression of PN-1 protein reached the maximum at 3 hours, decreased somewhat after that and increased a little at 5days after ICH.While in human cerebellum, the changing tendency of thrombin, PAR-1 and PN-1 was almost conform to the rat.Conclusion In cerebellum, thrombin can activate PAR-1 expression after ICH, and PN-1 appears quickly after ICH in order to control the deleterious effect of thrombin.

  2. Moyamoya disease manifested as multiple simultaneous intracerebral hemorrhages: A case report and literature review

    Science.gov (United States)

    Yu, Jinlu; Yuan, Yongjie; Li, Wei; Xu, Kan

    2016-01-01

    Multiple simultaneous intracerebral hemorrhages (MSIH) caused by Moyamoya disease (MMD) is extremely rare. To date, the clinical manifestations, imaging characteristics and mechanism of MMD-induced MSIH have not yet been elucidated. In order to improve the understanding on such cases, the present study described a rare case of MSIH caused by MMD. A 40-year-old female patient with no history of hypertension or diabetes mellitus experienced a sudden headache followed by coma. Cranial computed tomography (CT) examination revealed MSIH in the left frontal area, temporal lobe and basal ganglia. CT angiography and digital subtraction angiography examinations revealed typical characteristics of MMD. Subsequent to excluding disorders of the blood system and blood coagulation, we concluded that the present case of MSIH was caused by MMD. Hematoma evacuation and decompressive craniectomy were performed with satisfactory results. In addition, after reviewing previous MSIH cases in the literature, potential mechanisms of MMD-mediated MSIH were considered. In conclusion, MMD should be considered as a possible cause of MSIH during diagnosis and treatment. MMD can lead to pathological changes in the fragility of small arteries; therefore, rupture and hemorrhage at one site may induce a transient increase in blood pressure, causing the rupture of small arteries at other sites, and thus leading to MSIH. Hematoma evacuation and decompression should be conducted in selective cases of MMD-induced MSIH in order to achieve a good prognosis. PMID:27588064

  3. Evacuation of intracerebral hemorrhages by neuroendoscopy with transparent sheath. Experimental study

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    Alvaro Otero-Rodriguez

    2015-03-01

    Full Text Available Objectives: Endoscopic evacuation of intracerebral hemorrhage (ICH has been developed in order to reduce the tissue injury that conventional craniotomy could generate. Experimental studies are important to assess the effectiveness of the technique and its modifications. The objectives of this study are to develop in pig an experimental model of endoscopic evacuation of ICHs, to assess effectiveness of surgical evacuation, and to evaluate a new transparent sheath as complement to the endoscopy. Methods: Autologous blood was infused into the frontal lobe white matter in 16 pigs. In the problem group, endoscopic evacuation was performed with the aid of a new transparent sheath, which has outer and inner sheaths with blunt and closed finals. Pigs were sacrificed at 4 h, 24 h and 5 days. The volumes of hematoma and histopathological features were determined. Results: Residual volume of the problem group was significantly 70.09% lower than in control group, without significant differences in injected volumes, in percentage of subarachnoid hemorrhage, and in time interval from hematoma induction to pig´s death. The vital reaction after hemorrhage was similar in both groups. Conclusions: The experimental model developed is useful to assess endoscopic evacuation of ICHs. The endoscopy is an effective technique in the treatment of ICHs, without increasing the vital reaction secondary to hematoma. The new transparent sheath increases the visualization of surgical field and allows a continuous visual control since the beginning of the procedure. Its closed final prevents unwanted injury of the brain by the instruments used to remove the hematoma.

  4. CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage

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    Fainardi, Enrico; Borrelli, Massimo; Saletti, Andrea; Ceruti, Stefano; Tamarozzi, Riccardo [Azienda Ospedaliera Universitaria, Neuroradiology Unit, Department of Neuroscience, Ferrara (Italy); Schivalocchi, Roberta; Cavallo, Michele [Azienda Ospedaliera Universitaria, Neurosurgery Unit, Department of Neuroscience, Ferrara (Italy); Azzini, Cristiano [Azienda Ospedaliera Universitaria, Neurology Unit, Department of Neuroscience, Ferrara (Italy); Chieregato, Arturo [Ospedale M. Bufalini, Neurocritical Care Unit, Cesena (Italy)

    2008-08-15

    We sought to quantify perfusion changes associated to acute spontaneous intracerebral hemorrhage (SICH) by means of computed tomography perfusion (CTP) imaging. We studied 89 patients with supratentorial SICH at admission CT by using CTP scanning obtained within 24 h after symptom onset. Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV) and mean transit time (rMTT) levels were measured in four different regions of interest manually outlined on CT scan: (1) hemorrhagic core; (2) perihematomal low-density area; (3) 1 cm rim of normal-appearing brain tissue surrounding the perilesional area; and (4) a mirrored area, including the clot and the perihematomal region, located in the non-lesioned contralateral hemisphere. rCBF, rCBV, and rMTT mean levels showed a centrifugal distribution with a gradual increase from the core to the periphery (p < 0.0001). Perfusion absolute values were indicative of ischemia in hemorrhagic core, oligemia in perihematomal area, and hyperemia in normal-appearing and contralateral areas. Perihematomal rCBF and rCBV mean levels were higher in small ({<=}20 ml) than in large (>20 ml) hematomas (p<0.01 and p <0.02, respectively). Multi-parametric CTP mapping of acute SICH indicates that perfusion values show a progressive improvement from the core to the periphery. In the first 24 h, perihemorrhagic region was hypoperfused with CTP values which were not suggestive of ischemic penumbra destined to survive but more likely indicative of edema formation. These findings also argue for a potential influence of early amounts of bleeding on perihematomal hemodynamic abnormalities. (orig.)

  5. Sex-Specific Effects of Progesterone on Early Outcome of Intracerebral Hemorrhage.

    Science.gov (United States)

    Hsieh, Justin T; Lei, Beilei; Sheng, Huaxin; Venkatraman, Talagnair; Lascola, Christopher D; Warner, David S; James, Michael L

    2016-01-01

    Preclinical evidence suggests that progesterone improves recovery after intracerebral hemorrhage (ICH); however, gonadal hormones have sex-specific effects. Therefore, an experimental model of ICH was used to assess recovery after progesterone administration in male and female rats. ICH was induced in male and female Wistar rats via stereotactic intrastriatal injection of clostridial collagenase (0.5 U). Animals were randomized to receive vehicle or 8 mg/kg progesterone intraperitoneally at 2 h, then subcutaneously at 5, 24, 48, and 72 h after injury. Outcomes included relevant physiology during the first 3 h, hemorrhage and edema evolution over the first 24 h, proinflammatory transcription factor and cytokine regulation at 24 h, rotarod latency and neuroseverity score over the first 7 days, and microglial activation/macrophage recruitment at 7 days after injury. Rotarod latency (p = 0.001) and neuroseverity score (p = 0.01) were improved in progesterone-treated males, but worsened in progesterone-treated females (p = 0.028 and p = 0.008, respectively). Progesterone decreased cerebral edema (p = 0.04), microglial activation/macrophage recruitment (p < 0.001), and proinflammatory transcription factor phosphorylated nuclear factor-x03BA;B p65 expression (p = 0.0038) in males but not females, independent of tumor necrosis factor-α, interleukin-6, and toll-like receptor-4 expression. Cerebral perfusion was increased in progesterone-treated males at 4 h (p = 0.043) but not 24 h after injury. Hemorrhage volume, arterial blood gases, glucose, and systolic blood pressure were not affected. Progesterone administration improved early neurobehavioral recovery and decreased secondary neuroinflammation after ICH in male rats. Paradoxically, progesterone worsened neurobehavioral recovery and did not modify neuroinflammation in female rats. Future work should isolate mechanisms of sex-specific progesterone effects after ICH. © 2015 S. Karger AG, Basel.

  6. A change in injured corticospinal tract originating from the premotor cortex to the primary motor cortex in a patient with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Sang Seok Yeo; Sung Ho Jang

    2012-01-01

    Many studies have attempted to elucidate the motor recovery mechanism of stroke, but the majority of these studies focus on cerebral infarct and relatively little is known about the motor recovery mechanism of intracerebral hemorrhage. In this study, we report on a patient with intracerebral hemorrhage who displayed a change in injured corticospinal tract originating from the premotor cortex to the primary motor cortex on diffusion tensor imaging. An 86-year-old woman presented with complete paralysis of the right extremities following spontaneous intracerebral hemorrhage in the left frontoparietal cortex. The patient showed motor recovery, to the extent of being able to extend affected fingers against gravity and to walk independently on even ground at 5 months after onset. Diffusion tensor imaging showed that the left corticospinal tract originated from the premotor cortex at 1 month after intracerebral hemorrhage and from the left primary motor cortex and premotor cortex at 5 months after intracerebral hemorrhage. The change of injured corticospinal tract originating from the premotor cortex to the primary motor cortex suggests motor recovery of intracerebral hemorrhage.

  7. Changes of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage.

    Science.gov (United States)

    Wang, Zhi; Wang, Chao; Zhang, Weiguang; Wang, Laizang; Lei, Ting

    2008-02-01

    In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups: group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1 alpha and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups (Phypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1 alpha could provide the basis for diagnosis of postoperative hypertensive crisis.

  8. The Reliability and Sensitivity of the National Institutes of Health Stroke Scale for Spontaneous Intracerebral Hemorrhage in an Uncontrolled Setting

    OpenAIRE

    Specogna, Adrian V.; Patten, Scott B; Tanvir C Turin; Hill, Michael D

    2013-01-01

    BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure neurologic function and guide treatment after spontaneous intracerebral hemorrhage (ICH) in routine stroke clinics. We evaluated its reliability and sensitivity to detect change with consecutive and unique rater combinations in a real-world setting. METHODS: Conservative measures of interrater reliability (unweighted Kappa (κ), Intraclass Correlation Coefficient (ICC1,1) and sensitivity ...

  9. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke.

    Science.gov (United States)

    Liu, Ning; Cadilhac, Dominique A; Andrew, Nadine E; Zeng, Lingxia; Li, Zongfang; Li, Jin; Li, Yan; Yu, Xuewen; Mi, Baibing; Li, Zhe; Xu, Honghai; Chen, Yangjing; Wang, Juan; Yao, Wanxia; Li, Kuo; Yan, Feng; Wang, Jue

    2014-12-01

    Mechanisms, acute management, and outcomes for patients who experience intracerebral hemorrhage may differ from patients with ischemic stroke. Studies of very early rehabilitation have been mainly undertaken in patients with ischemic stroke, and it is unknown if benefits apply to those with intracerebral hemorrhage. We hypothesized that early rehabilitation, within 48 hours of stroke, would improve survival and functional outcomes in patients with intracerebral hemorrhage. This was a multicenter, randomized controlled study, with blinded assessment of outcome at 3 and 6 months. Eligible patients were randomized to receive standard care or standard care plus early rehabilitation. Primary outcome includes survival. Secondary outcomes includes health-related quality of life using the 36-item Short Form Questionnaire, function measured with the modified Barthel Index, and anxiety measured with the Zung Self-Rated Anxiety Scale. Two hundred forty-three of 326 patients were randomized (mean age, 59 years; 56% men). At 6 months, patients receiving standard care were more likely to have died (adjusted hazard ratio, 4.44; 95% confidence interval [CI], 1.24-15.87); for morbidity outcomes, a 6-point difference in the Physical Component Summary score of the 36-item Short Form Questionnaire (95% CI, 4.2-8.7), a 7-point difference for the Mental Component Summary score (95% CI, 4.5-9.5), a 13-point difference in Modified Barthel Index scores (95% CI, 6.8-18.3), and a 6-point difference in Self-Rating Anxiety Scale scores (95% CI, 4.4-8.3) was reported in favor of the intervention groups. For the first time, we have shown that commencing rehabilitation within 48 hours of intracerebral hemorrhage improves survival and functional outcomes at 6 months after stroke in hospitalized patients in China. http://www.chictr.org/en. Unique identifier: ChiCTR-TRC-13004039. © 2014 American Heart Association, Inc.

  10. Clinical efficacy and effect of mNGF on inflammatory factor and oxidative stress in patients with severe intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Fang Li; Lu Wang; Mutalifu-Maihemuti; Dong Xiao

    2016-01-01

    Objective:To investigate the effect of mouse nerve growth factor (mNGF) on inflammatory factors and oxidative stress in patients with severe intracerebral hemorrhage.Methods:A total of 84 severe intracerebral hemorrhage patients were randomly divided into observation group (42 cases) and control group (42 cases). The two groups were given the conventional therapy of controlling intracranial pressure and glucose, and the observation group was additionally given mNGF. The efficacy in the two groups was observed. The levels of inflammatory factors including hs-CRP, IL-8 and TNF-α and oxidative stress indicators including malondialdehyde (MDA) and superoxide dismutase (SOD) were tested before and after treatment and compared in the two groups. Results:Total effective rate was significantly increased after treatment in observation group; compared with before treatment, the levels of hs-CRP, IL-8 and TNF-ααwere significantly reduced after treatment in the two groups, and more significantly decreased in the observation group; compared with before treatment, the levels of MDA and SO were significantly reduced after treatment in the two groups, and more significantly decreased in the observation group.Conclusion:The mNGF treatment has reliable curative effect in severe intracerebral hemorrhage patients, which can improve inflammatory response and oxidative stress.

  11. Perihematomal Perfusion Typing and Spot Sign of Acute Intracerebral Hemorrhage with Multimode Computed Tomography:A Preliminary Study

    Institute of Scientific and Technical Information of China (English)

    Xin-yi Hou; Pei-yi Gao

    2014-01-01

    Objective To explore the perihematomal perfusion typing and spot sign on computed tomography angiography (CTA) source images in order to assist in individualizing therapeutic decisions for patients with intracerebral hemorrhage by possibly forecasting perihematomal ischemia and hematoma enlargement. Methods We examined 58 patients with spontaneous intracerebral hemorrhage by computed tomography perfusion and CTA within 6 hours after symptom onset. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images. The perfusion of hematoma region and perihematoma region was evaluated for presence or absence of the perihematomal penumbra. Three kinds of perihematoma perfusion typing were defined according to the perfusion of hematoma region and perihematoma region. CTA source images was reviewed to make sure presence or absence of the spot sign. Results Finally, 53 patients (34 males, 19 females) were enrolled in our study according to exclusion criteria. Finally, 21 patients were classified into the normal group, 23 patients were classified into the mild group, and 9 patients were classified into the severe group. There were significant differences in hematoma size between the presence and absence of the perihematomal penumbra group (P Conclusion In acute intracerebral hemorrhage patients, the perihematoma perfusion typing and CTA spot sign provide more radiological information that might assist in individualizing therapeutic decisions for patients by possibly forecasting perihematomal ischemia and hematoma enlargement.

  12. Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage.

    Science.gov (United States)

    Tan, Ge; Hao, Zilong; Lei, Chunyan; Chen, Yanchao; Yuan, Ruozhen; Xu, Mangmang; Liu, Ming

    2016-10-01

    Whether subclinical change of liver function is associated with outcome of spontaneous intracerebral hemorrhage remains to be an open question. A total of 639 patients of spontaneous intracerebral hemorrhage within 7 days from stroke onset were finally enrolled. Liver function indicators, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin (BIL), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), albumin (ALB), and international normalized ratio (INR), were collected and collapsed into quartiles. The main outcomes were 30-day death, 90-day death, and 90-day poor outcome (modified Rankin Scale score of 3-6). Two adjusted model, Model 1 and Model 2 (Model 1 plus GCS score), were established to identify independent association between liver function indicators and ICH outcomes. The mortality rate was 19.9 % (127/639) at 30 days and 21.3 % (136/639) at 90 days. Rate of 90-day poor outcome was 51.5 % (329/639). Among liver function indicators, AST and ALP were associated with all the three outcomes, which did not alter significantly when adjusted by Model 1. After adjusted by Model 2, ALP was still associated with outcomes. Association between AST and outcomes was, however, weakened significantly by GCS score. In conclusions, among liver function indicators, AST and ALP were associated with outcomes after spontaneous intracerebral hemorrhage.

  13. Effects of minocycline on apoptosis and angiogenesis-related protein expression in a rat model of intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Ruizhi Wang; Dongning Hao; Wei Shi; Jingnan Pu; Zizhang Wang

    2012-01-01

    In the present study, a rat model of non-traumatic intracerebral hemorrhage was established by type IV collagenase injection into the right globus pallidus. Bax and Bcl-2 expression in tissues surrounding hematomas was significantly increased within 14 days after injury, and it then gradually decreased. Vascular endothelial growth factor, Flk-1 and Flt-1 mRNA expression gradually increased over time. After intraperitoneal injection with minocycline, Bax expression was decreased 1 day after intracerebral hemorrhage. Flk-1 and Flt-1 mRNA expression was decreased after minocycline injection, but Bcl-2 expression was increased, and vascular endothelial growth factor mRNA expression was decreased between 4-14 days. These results indicated that protective effects of minocycline on nerve tissues were associated with increased Bcl-2 expression and decreased Bax expression in the early stage after intracerebral hemorrhage. In the late stage, minocycline downregulated vascular endothelial growth factor and its receptor expression to inhibit brain tissue self-repair.

  14. Factors associated with in-hospital mortality following intracerebral hemorrhage: a three-year study in Tehran, Iran

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    Bakhtavar Khadigeh

    2004-06-01

    Full Text Available Abstract Background Primary intracerebral hemorrhage (ICH is one of the common vascular insults with a relatively high rate of mortality. The aim of the current study was to determine the mortality rate and to evaluate the influence of various factors on the mortality of patients with intracerebral hemorrhage (ICH. Demographic characteristics along with clinical features and neuroimaging information on 122 patients with primary ICH admitted to Sina Hospital between 1999–2002 were assessed by multivariate analysis. Results Of 122 patients diagnosed with intracerebral hemorrhage, 70 were men and 52 were women. Sixtynine percent of subjects were between 60 to 80 years of age. A history of hypertension was the primary cause in 67.2% of participants and it was found more frequent compared to other cardiovascular risk factors such as a history of ischemic heart disease (17.2%, diabetes mellitus (18% and cigarette smoking (13.1%. The overall mortality rate among ICH patients admitted to the hospital was 46.7%. About one third of the deaths occurred within the first two days after brain injury. Factor independently associated with in-hospital mortality were Glasgow Coma Scale (GCS score (≤ 8, diabetes mellitus disease, volume of hematoma and and intraventricular hematoma. Conclusion Higher rate of mortality were observed during the first two weeks of hospitalization following ICH. Neuroimaging features along with GCS score can help the clinicians in developing their prognosis.

  15. Functional independence: A comparison of the changes during neurorehabilitation between patients with non-traumatic subarachnoid hemorrhage and intracerebral hemorrhage or acute ischemic stroke

    DEFF Research Database (Denmark)

    Stabel, Henriette Holm; Pedersen, Asger Roer; Johnsen, Søren Paaske

    2017-01-01

    Objective To compare the changes in functional independence measured by the FIM after specialized neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage (SAH) and patients with intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS). Design Historical cohort study......) comprised patients with a first-time nontraumatic SAH (n=212) and age-matched patients with a first-time ICH/AIS (n=448). Interventions Not applicable. Main Outcome Measures Crude and adjusted comparisons of FIM (total and item by item) measured at baseline and at discharge. Results Patients...

  16. Pathomorphological changes of lungs and functional biochemical parameters of respiratory function in patients with intracerebral hemorrhages

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    S. I. Tertyishniy

    2013-08-01

    Full Text Available Pulmonary complications and closely related with them systemic functional-biochemical abnormalities are the most common complications of cerebral stroke. The purpose of the work was to research functional-biochemical parameters of respiratory function and to find it’s association with morphological changes in the lungs because of intracerebral hemorrhage. 37 sectional observations in patients who die of intracerebral hemorrhage were analized. It was conducted analysis of morphological transformations and retrospective analysis of functional-biochemical findings of respiratory functions, in order to detect changes of systemic hemodynamics, oxygen balance and ion-osmotic one and acid-alkaline status. The results of the study. The changes of blood gas composition and acid-alkaline status are registered in the lungs in the background of microcirculation disturbance from the first hours of development of intracerebral hemorrhage. During the first days of the onset of disease the partial oxygen pressure in arterial blood (РаО2 decreased 50,88% in comparison with the calculated normative findings. Partial pressure of carbon dioxide (РаСО2 in the arterial blood rosed by 52,17%. Without conducting artificial lung ventilation PO2 in venous blood decreased by 45,9%, and PCO2 increased by 40%. I has been marked a decrease in the oxygen capacity of the blood, due to the reduction of hemoglobin content in the blood to 103,7 minus 2 g/l and the concomitant decline in hematocrit up to 0,24-0,3. Deficit of the foundations has averaged from -6 to -10 mmol/l. These changes have led to a impression of the respiratory and metabolic acidosis, with a significant increase in the concentration of hydrogen ions. In the first day after the development of the disease with a rapid growing marks of swelling of the brain with concomitant dislocation of the brain stem, blood pH was 7,28 minus 0,02. It has been histologically determined interstitial edema, that

  17. Fucoidan from Fucus vesiculosus Fails to Improve Outcomes Following Intracerebral Hemorrhage in Mice.

    Science.gov (United States)

    Burchell, Sherrefa R; Iniaghe, Loretta O; Zhang, John H; Tang, Jiping

    2016-01-01

    Intracerebral hemorrhage (ICH) is the most fatal stroke subtype, with no effective therapies. Hematoma expansion and inflammation play major roles in the pathophysiology of ICH, contributing to primary and secondary brain injury, respectively. Fucoidan, a polysaccharide from the brown seaweed Fucus vesiculosus, has been reported to activate a platelet receptor that may function in limiting bleeding, and to exhibit anti-inflammatory effects. As such, the aim of the present study was to examine the effects of fucoidan on hemorrhaging and neurological outcomes after ICH. Male CD-1 mice were subjected to experimental ICH by infusion of bacterial collagenase. Animals were randomly divided into the following groups: sham, ICH + vehicle, ICH + 25 mg/kg fucoidan, ICH + 75 mg/kg fucoidan, and ICH + 100 mg/kg fucoidan. Brain water content, neurobehavioral outcomes, and hemoglobin content were evaluated at 24 h post ICH. Our findings show that fucoidan failed to attenuate the ICH-induced increase in BWC. The neurological deficits that result from ICH also did not differ in the treatment groups at all three doses. Finally, we found that fucoidan had no effect on the hemoglobin content after ICH. We postulate that fucoidan treatment did not improve the measured outcomes after ICH because we used crude fucoidan, which has a high molecular weight, in our study. High-molecular-weight fucoidans are reported to have less therapeutic potential than low molecular weight fucoidans. They have been shown to exhibit anti-coagulant and pro-apoptotic properties, which seem to outweigh their anti-inflammatory and potential procoagulant abilities. We propose that using a low-molecular-weight fucoidan, or fractionating the crude polysaccharide, may be effective in treating ICH. Future studies are needed to confirm this.

  18. Localized hypothermia aggravates bleeding in the collagenase model of intracerebral hemorrhage.

    Science.gov (United States)

    John, Roseleen F; Williamson, Michael R; Dietrich, Kristen; Colbourne, Frederick

    2015-03-01

    Animal studies testing whether therapeutic hypothermia is neuroprotective after intracerebral hemorrhage (ICH) have been inconclusive. In rodents, ICH is often produced in the striatum by infusing collagenase, which causes prolonged hemorrhaging from multiple vessels. Our previous data shows that this bleeding (hematoma) is worsened by systemic hypothermia given soon after collagenase infusion. In this study we hypothesized that localized brain hypothermia would also aggravate bleeding in this model (0.2 U of collagenase in 1.2 μL of saline). We also evaluated cooling after intrastriatal thrombin infusion (1 U in 30 μL of saline)-a simplified model of ICH thought to cause bleeding. Focal hypothermia was achieved by flushing cold water through an implanted cooling device attached to the skull underneath the temporalis muscle of adult rats. Previous work and data at this time shows this method cools the striatum to ∼33°C, whereas the body remains normothermic. In comparison to normothermic groups, cooling significantly worsened bleeding when instituted at 6 hours (∼94 vs. 42 μL, p=0.018) and 12 hours (79 vs. 61 μL, p=0.042) post-ICH (24-hour survival), but not after a 24-hour delay (36-hour survival). Rats were cooled until euthanasia when hematoma size was determined by a hemoglobin-based spectrophotometry assay. Cooling did not influence cerebral blood volume after just saline or thrombin infusion. The latter is explained by the fact that thrombin did not cause bleeding beyond that caused by saline infusion. In summary, local hypothermia significantly aggravates bleeding many hours after collagenase infusion suggesting that bleeding may have confounded earlier studies with hypothermia. Furthermore, these findings serve as a cautionary note on using cooling even many hours after cerebral bleeding.

  19. Utility of Early MRI in the Diagnosis and Management of Acute Spontaneous Intracerebral Hemorrhage

    Science.gov (United States)

    Wijman, Christine A.C.; Venkatasubramanian, Chitra; Bruins, Sara; Fischbein, Nancy; Schwartz, Neil

    2010-01-01

    Background The optimal diagnostic evaluation for spontaneous intracerebral hemorrhage (ICH) remains controversial. In this retrospective study, we assessed the utility of early magnetic resonance imaging (MRI) in ICH diagnosis and management. Methods Eighty-nine (72%) of 123 patients with spontaneous ICH underwent a brain CT and MRI within 30 days of ICH onset. Seventy patients with a mean age of 62 ± 15 years were included. A stroke neurologist and a general neurologist, each blinded to the final diagnosis, independently reviewed the admission data and the initial head CT and then assigned a presumed ICH cause under 1 of 9 categories. ICH cause was potentially modified after subsequent MRI review. The final ‘gold standard’ ICH etiology was determined after review of the complete medical record by an independent investigator. Change in diagnostic category and confidence and the potential impact on patient management were systematically recorded. Results Mean time to MRI was 3 ± 5 days. Final ICH diagnosis was hypertension or cerebral amyloid angiopathy (CAA) in 50% of patients. After MRI review the stroke neurologist changed diagnostic category in 14%, diagnostic confidence in an additional 23% and management in 20%, and the general neurologist did so in 19, 21 and 21% of patients, respectively. MRI yield was highest in ICH secondary to ischemic stroke, CAA, vascular malformations and neoplasms, and did not differ by age, history of hypertension, hematoma location or the presence of intraventricular hemorrhage. Conclusions The results of this study suggest potential additive clinical benefit of early MRI in patients with spontaneous ICH. PMID:20733299

  20. CLINICAL AND NEUROIMAGING STUDIES IN PATIENTS WITH ACUTE SPONTANEOUS INTRACEREBRAL HEMORRHAGE.

    Directory of Open Access Journals (Sweden)

    Мaya P. Danovska

    2014-03-01

    Full Text Available Objective: To define the prognostic value of clinical and neuroimaging parameters on the 30-th day mortality and clinical outcome after spontaneous intracerebral hemorrhage (sICH. Materials and methods: we examined 88 patients with sICH admitted to Neurology Clinic, UMHAT Pleven within 48 hours after clinical symptoms onset. Glasgow Coma Scale (GCS score was used to assess the primary stroke severity; neurological deficit on admission was assessed by National Institute of Health Stroke Scale (NIHSS; clinical outcome at discharge was evaluated by modified Rankin Scale (mRS and by Glasgow Outcome Scale (GOS on the 30-th day after sICH onset. Hematoma volume was measured by the formula of Kothari: AxBxC/2 in ml. The statistical analysis was performed by SPSS 19.0 and Statgraphics plus 4.1 for Windows. Results: Initial assessment of primary stroke severity and neurological deficit by GCS и NIHSS, hematoma localization and volume were found strongly correlated with the clinical outcome on the 30-th day after the sICH onset. Age and vascular risk factors did not correlate with the clinical outcome. Male patients had better survival on the 30-th day compared with the female ones. Discussion: Neurological deficit on admission, hematoma localization and volume were found reliable predictors of the 30-th day clinical outcome that could serve for early stratification of patients and optimal choice of therapeutic approach.

  1. Patient-tailored multimodal neuroimaging, visualization and quantification of human intra-cerebral hemorrhage

    Science.gov (United States)

    Goh, Sheng-Yang M.; Irimia, Andrei; Vespa, Paul M.; Van Horn, John D.

    2016-03-01

    In traumatic brain injury (TBI) and intracerebral hemorrhage (ICH), the heterogeneity of lesion sizes and types necessitates a variety of imaging modalities to acquire a comprehensive perspective on injury extent. Although it is advantageous to combine imaging modalities and to leverage their complementary benefits, there are difficulties in integrating information across imaging types. Thus, it is important that efforts be dedicated to the creation and sustained refinement of resources for multimodal data integration. Here, we propose a novel approach to the integration of neuroimaging data acquired from human patients with TBI/ICH using various modalities; we also demonstrate the integrated use of multimodal magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) data for TBI analysis based on both visual observations and quantitative metrics. 3D models of healthy-appearing tissues and TBIrelated pathology are generated, both of which are derived from multimodal imaging data. MRI volumes acquired using FLAIR, SWI, and T2 GRE are used to segment pathology. Healthy tissues are segmented using user-supervised tools, and results are visualized using a novel graphical approach called a `connectogram', where brain connectivity information is depicted within a circle of radially aligned elements. Inter-region connectivity and its strength are represented by links of variable opacities drawn between regions, where opacity reflects the percentage longitudinal change in brain connectivity density. Our method for integrating, analyzing and visualizing structural brain changes due to TBI and ICH can promote knowledge extraction and enhance the understanding of mechanisms underlying recovery.

  2. Gender Differences in Patients with Intracerebral Hemorrhage: A Hospital-Based Multicenter Prospective Study

    Directory of Open Access Journals (Sweden)

    Monique Bueno Alves

    2012-10-01

    Full Text Available Gender differences are well described for patients with ischemic stroke. Conversely, sex disparities in stroke presentation, risk factors, treatment, and outcomes for intracerebral hemorrhage (ICH were not previously studied. Our objective was to compare the frequency of risk factors, management patterns, symptoms at presentation, complication rates, and outcomes between genders in patients with ICH in Fortaleza, Brazil. Methods: Data were prospectively collected from patients admitted to 19 hospitals in Fortaleza with a diagnosis of ICH by trained research coordinators from June 2009 to October 2010. Daily visits to the selected hospitals were performed, and all patients admitted with a diagnosis of ICH were prospectively evaluated. Results: We evaluated 364 patients, 47.5% of whom were women. Men were younger (59.3 ± 14.58 years vs. 66.3 ± 14.6 years, p Conclusion: Overall risk factors for ICH in men and women were similar in our series. Men had a higher frequency of alcohol abuse and smoking. Women were older, had an increased time length from symptoms onset to hospital admission and had a worse prognosis at discharge. A better understanding of the gender disparities in patients with ICH will hopefully lead to better outcomes in both sexes in the future.

  3. Intracerebral hemorrhage and deep microbleeds associated with cnm-positive Streptococcus mutans; a hospital cohort study.

    Science.gov (United States)

    Tonomura, Shuichi; Ihara, Masafumi; Kawano, Tomohiro; Tanaka, Tomotaka; Okuno, Yoshinori; Saito, Satoshi; Friedland, Robert P; Kuriyama, Nagato; Nomura, Ryota; Watanabe, Yoshiyuki; Nakano, Kazuhiko; Toyoda, Kazunori; Nagatsuka, Kazuyuki

    2016-02-05

    Oral infectious diseases are epidemiologically associated with stroke. We previously showed that oral Streptococcus mutans with the cnm gene encoding a collagen-binding Cnm protein induced intracerebral hemorrhage (ICH) experimentally and was also associated with cerebral microbleeds (CMBs) in our population-based cohort study. We therefore investigated the roles of cnm-positive Streptococcus mutans in this single hospital-based, observational study that enrolled 100 acute stroke subjects. The cnm gene in Streptococcus mutans isolated from saliva was screened using PCR techniques and its collagen-binding activities examined. CMBs were evaluated on T2* gradient-recalled echo MRI. One subject withdrew informed consent and 99 subjects (63 males) were analyzed, consisting of 67 subjects with ischemic stroke, 5 with transient ischemic attack, and 27 with ICH. Eleven cases showed Streptococcus mutans strains positive for cnm. The presence of cnm-positive Streptococcus mutans was significantly associated with ICH [OR vs. ischemic stroke, 4.5; 95% CI, 1.17-19.1] and increased number of deep CMBs [median (IQR), 3 (2-9) vs. 0 (0-1), p = 0.0002]. In subjects positive for Streptococcus mutans, collagen binding activity was positively correlated with the number of deep CMBs (R(2) = 0.405; p < 0.0001). These results provide further evidence for the key role of oral health in stroke.

  4. Morphological and histochemical changes in the brain stem in case of experimental hemispheric intracerebral hemorrhage

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    S. I. Tertishniy

    2015-10-01

    Full Text Available Aim. Investigation of the extent of morphological changes and activity of biogenic amines (according to the intensity of luminescence in the neurons of the brain stem in intracerebral hemorrhage (ICH. Methods and results. ICH was designed on 29 white rats of Vistar line by the administration of autologous blood in the cerebral hemisphere. It was revealed that increased luminescence intensity by 18.4±5.5% was registered in monoaminergic neurons in 1–6 hours after experimental ICH. After 12 hours – 1 day development of dislocation syndrome leads to mosaic focal ischemic neuronal injuries with maximum reduction in the level of catecholamines by 29.5±5.0% compared with control cases. Three–6 days after ICH on a background of selective neuronal necrosis in substantial number of neurons in the nuclei of the brainstem the level of catecholamines is significantly reduced. Conclusion. Disclosed observations reflect significant functional pathology of neurons responsible for the regulation of cardiorespiratory function and may underlie disturbances of integrative activity in the brain stem in general.

  5. Mast cell blocking reduces brain edema and hematoma volume and improves outcome after experimental intracerebral hemorrhage.

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    Strbian, Daniel; Tatlisumak, Turgut; Ramadan, Usama Abo; Lindsberg, Perttu J

    2007-04-01

    Intracerebral hemorrhage (ICH) is associated with high mortality and disability, and there is no widely approved clinical therapy. Poor outcome after ICH results mostly from a mass effect owing to enlargement of the hematoma and brain swelling, leading to displacement and disruption of brain structures. Cerebral mast cells (MC) are resident inflammatory cells that are located perivascularly and contain potent vasoactive, proteolytic, and fibrinolytic substances. We previously found pharmacological MC stabilization and genetic MC deficiency to be associated with up to 50% reduction of postischemic brain swelling in rats. Here, we studied the role of MC and MC stabilization in ICH using in vivo magnetic resonance imaging and ex vivo digital imaging for calculating brain edema and hematoma volume. In a rat ICH model of autologous blood injection into the basal ganglia, four groups of Wistar rats received either saline or sodium cromoglycate (MC stabilizer, two groups) or compound 48/80 (MC degranulator). Evaluated 24 h later, MC stabilization had resulted in highly significantly better neurologic scores (Pbrain swelling (Pbrain swelling (P<0.05), and smaller hematoma growth (P<0.05) than WT. The role of MC deserves a close evaluation as a potential target in the development of novel forms of ICH therapy.

  6. PGE2-EP3 signaling exacerbates intracerebral hemorrhage outcomes in 24-mo-old mice.

    Science.gov (United States)

    Leclerc, Jenna L; Lampert, Andrew S; Diller, Matthew A; Doré, Sylvain

    2016-06-01

    With the population aging at an accelerated rate, the prevalence of stroke and financial burden of stroke-related health care costs are expected to continue to increase. Intracerebral hemorrhage (ICH) is a devastating stroke subtype more commonly affecting the elderly population, who display increased mortality and worse functional outcomes compared with younger patients. This study aimed to investigate the contribution of the prostaglandin E2 (PGE2) E prostanoid (EP) receptor subtype 3 in modulating anatomical outcomes and functional recovery following ICH in 24-mo-old mice. EP3 is the most abundant EP receptor in the brain and we have previously shown that signaling through the PGE2-EP3 axis exacerbates ICH outcomes in young mice. Here, we show that EP3 receptor deletion results in 17.9 ± 6.1% less ICH-induced brain injury (P EP3-mediated neurotoxicity. Identified mechanisms include reduced blood accumulation and modulation of angiogenic and astroglial responses. Using this aged cohort of mice, we have confirmed and extended our previous results in young mice demonstrating the deleterious role of the PGE2-EP3 signaling axis in modulating brain injury and functional recovery after ICH, further supporting the notion of the EP3 receptor as a putative therapeutic avenue for the treatment of ICH. Copyright © 2016 the American Physiological Society.

  7. Does Antiplatelet Therapy during Bridging Thrombolysis Increase Rates of Intracerebral Hemorrhage in Stroke Patients?

    Science.gov (United States)

    Broeg-Morvay, Anne; Mordasini, Pasquale; Slezak, Agnieszka; Liesirova, Kai; Meisterernst, Julia; Schroth, Gerhard; Arnold, Marcel; Jung, Simon; Mattle, Heinrich P; Gralla, Jan; Fischer, Urs

    2017-01-01

    Symptomatic intracerebral hemorrhage (sICH) after bridging thrombolysis for acute ischemic stroke is a devastating complication. We aimed to assess whether the additional administration of aspirin during endovascular intervention increases bleeding rates. We retrospectively compared bleeding complications and outcome in stroke patients who received bridging thrombolysis with (tPA+ASA) and without (tPA-ASA) aspirin during endovascular intervention between November 2008 and March 2014. Furthermore, we analyzed bleeding complications and outcome in antiplatelet naïve patients with those with prior or acute antiplatelet therapy. Baseline characteristics, previous medication, and dosage of rtPA did not differ between 50 tPA+ASA (39 aspirin naïve, 11 preloaded) and 181 tPA-ASA patients (p>0.05). tPA+ASA patients had more often internal carotid artery (ICA) occlusion (p0.1). There were no differences in bleeding complications and mortality among 112 bridging patients with antiplatelet therapy (62 preloaded, 39 acute administration, 11 both) and 117 antiplatelet naïve patients. In a logistic regression analysis, aspirin administration during endovascular procedure was not a predictor of sICH. Antiplatelet therapy before or during bridging thrombolysis in patients with acute ischemic stroke did not increase the risk of bleeding complications and had no impact on outcome. This finding has to be confirmed in larger studies.

  8. A combination of serum iron, ferritin and transferrin predicts outcome in patients with intracerebral hemorrhage.

    Science.gov (United States)

    Yang, Guang; Hu, Rong; Zhang, Chao; Qian, Christopher; Luo, Qian-Qian; Yung, Wing-Ho; Ke, Ya; Feng, Hua; Qian, Zhong-Ming

    2016-02-22

    Association of a high-serum ferritin with poor outcome showed that iron might play a detrimental role in the brain after intracerebral hemorrhage (ICH). Here, we investigated changes in serum iron, ferritin, transferrin (Tf) and ceruloplasmin (CP) in patients with ICH (n = 100) at day 1 (admission), 3, 7, 14 and 21 and those in control subjects (n = 75). The hematoma and edema volumes were also determined in ICH-patients on admission and at day 3. The Modified Rankin Scale (mRS) of 59 patients was ≥3 (poor outcome) and 41 Serum ferritin was significantly higher and serum iron and Tf markedly lower in patients with poor-outcome than the corresponding values in patients with good-outcome at day 1 to 7 and those in the controls. There was a significant positive correlation between serum ferritin and relative edema volume or ratio at day 1 and 3 and hematoma volume at day 1 (n = 28), and a negative correlation between serum iron or Tf and hematoma volume at day 1 (n = 100). We concluded that not only increased serum ferritin but also reduced serum iron and Tf are associated with outcome as well as hematoma volume.

  9. Changes of vasoactive polypeptides during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi; WANG Xue-feng; WANG Chao; LUAN Wen-zhong

    2007-01-01

    Background Hypertensive crisis could be found after operation in patients with hypertensive intracerebral hemorrhage (HICH).The aim of this study was to explore the changes and the roles of some vasoactive polypeptides during postoperative hypertensive crisis in patients with HICH.Methods A total of 31 patients,who were admitted for craniotomy,were enrolled into this study.After the operation,the patients were divided into three groups.Group Ⅰ consisted of 9 patients with postoperative hypertensive crisis,and group Ⅱ was composed of 13 patients without postoperative hypertensive crisis.Nine patients,who denied history of hypertension or HICH,were set as group Ⅲ.The levels of some vasoactivators in the three groups were measured before and after the operation.The differences in the results among the groups were analyzed using the ANOVA.The data collected before and after the operation in the group Ⅰ was compared by Wilcoxon test.Results The concentration of endothelin in group Ⅰ was significantly higher than that in group Ⅲ (P0.05).Conclusions Postoperative hypertensive crisis may be due to the increased thromboxane A2 and relatively inadequate prostacyclin,especially 6-keto-PGF1α.The increased level of endothelin and intraoperative stimulation also play a certain role in the development of postoperative hypertensive crisis.

  10. [Behavioral change and cell proliferation in the subventricular zone in adult rats after intracerebral hemorrhage].

    Science.gov (United States)

    Sun, Jianjun; Liu, Yong; Zhang, Pengbo; Chen, Xinlin; Guo, Zhenyu; Zhang, Jianshui; Yang, Pengbo

    2009-03-01

    To investigate the relationship between behavioral changes and cell proliferation in subventricular zone (SVZ) after intracerebral hemorrhage (ICH) in adult rats. Forty male Sprague-Dawley rats were randomly assigned into a behavioral test group (n = 19) and a bromodeoxyuridine (Brdu) immunohistochemical staining group (n = 21). ICH was induced by stereotactial injection of collagenase type VII into straitum. Proliferating cells were labeled by injection intrapenitoneally of bromodeoxyuridine in a pulse protocal. Rats were killed on day 2, 7, 14, and 28 after the ICH. Behavioral test and bromodeoxyuridine immunohistochemical staining were performed.Behavioral change was tested by forelimb placing test, Berderson's grade and corner turn test in rats. Cell counting of bromodeoxyuridine immunoreactive cells in SVZ was performed. There were marked neurological deficits by day 2 after the ICH, with progressive recovery of function over 4 weeks. A significant increase in the number of bromodeoxyuridine immunoreactive cells in the ipsilateral and cortralateral SVZ was observed from 2 to 14 days with a peak at day 7 after the ICH compared with the sham group.The bromodeoxyuridine immunoreactive cells decreased to control level 28 days after the ICH. Proliferation of cells in SVZ corresponds well with behavioral recovery after the ICH, which indicates SVZ cells may be involved in the repairing process after the ICH.

  11. CD163/Hemoglobin Oxygenase-1 Pathway Regulates Inflammation in Hematoma Surrounding Tissues after Intracerebral Hemorrhage.

    Science.gov (United States)

    Liu, BaoHua; Hu, BeiLei; Shao, ShengMin; Wu, Wei; Fan, LiuBo; Bai, GuangHui; Shang, Ping; Wang, XiaoTong

    2015-12-01

    The aim of the present study was to investigate changes in the expression of CD163 and hemoglobin oxygenase-1 (HO-1) in brain tissue surrounding hematomas after intracerebral hemorrhage (ICH), and correlations with other factors. Brain tissues in the close surrounding of ICH hematomas (n = 27, ICH group) were collected at 6 hours or less, 6-24 hours, 24-72 hours, and more than 72 hours after bleeding onset, and more distant tissues (n = 12, control group) were histologically analyzed with hematoxylin and eosin staining and transmission electron microscopy. Interleukin (IL)-1, IL-10, and tumor necrosis factor-alpha, as well as the expression of CD163 and HO-1, were assessed using immunochemistry, Western blotting, and reverse transcription-polymerase chain reaction. Apoptosis rates were determined with terminal deoxynucleotidyl transferase dUTP nick end labeling assays. The expressions of the inflammatory cytokines IL-1 and tumor necrosis factor-alpha were increased at 6-24 hours (P CD163 and HO-1 expressions gradually increased from 6 to 24 hours to peaks at more than 72 hours after ICH onset (P CD163 and HO-1 expressions reached peaks and inflammatory cytokine expressions dropped. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. The absence of the CD163 receptor has distinct temporal influences on intracerebral hemorrhage outcomes

    DEFF Research Database (Denmark)

    Leclerc, Jenna L; Lampert, Andrew S; Loyola Amador, Claudia

    2017-01-01

    Hemoglobin (Hb) toxicity precipitates secondary brain damage following intracerebral hemorrhage (ICH). CD163 is an anti-inflammatory Hb scavenger receptor and CD163-positive macrophages/microglia locally accumulate post-bleed, yet no studies have investigated the role of CD163 after ICH. ICH...... was induced in wildtype and CD163(-/-) mice and various anatomical and functional outcomes were assessed. At 3 d, CD163(-/-) mice have 43.4 ± 5.0% (p = 0.0002) and 34.8 ± 3.4% (p = 0.0003) less hematoma volume and tissue injury, respectively. Whereas, at 10 d, CD163(-/-) mice have 49.2 ± 15.0% larger lesions...... (p = 0.0385). An inflection point was identified, where CD163(-/-) mice perform better on neurobehavioral testing and have less mortality before 4 d, but increased mortality and worse function after 4 d (p = 0.0389). At 3 d, CD163(-/-) mice have less Hb, iron, and blood-brain barrier dysfunction...

  13. Correlation of Cerebral Microbleed Distribution to Amyloid Burden in Patients with Primary Intracerebral Hemorrhage

    Science.gov (United States)

    Tsai, Hsin-Hsi; Tsai, Li-Kai; Chen, Ya-Fang; Tang, Sung-Chun; Lee, Bo-Ching; Yen, Ruoh-Fang; Jeng, Jiann-Shing

    2017-01-01

    The underlying pathology of cerebral microbleeds (CMBs) with mixed lobar and deep distribution remains contentious. The aim of this study was to correlate CMBs distribution to β-amyloid burden in patients with primary intracerebral hemorrhage (ICH). Fourty-seven ICH patients underwent magnetic resonance susceptibility-weighted imaging and 11C-Pittsburgh Compound B positron emission tomography. The amyloid burden was expressed as standardized uptake value ratio with reference to cerebellum, and presented as median (interquartile range). Patients were categorized into the lobar, mixed (both lobar and deep regions), and deep types of CMB. Comparing the lobar (17%), mixed (59.6%) and deep (23.4%) CMB types, the global amyloid burden was significantly higher in the mixed type than the deep type (1.10 [1.03–1.25] vs 1.00 [0.97–1.09], p = 0.011), but lower than in the lobar type (1.48 [1.18–1.50], p = 0.048). On multivariable analysis, the ratio of lobar to deep CMB number was positively correlated with global (p = 0.028) and occipital (p = 0.031) amyloid burden. In primary ICH, patients with lobar and mixed CMB types are associated with increased amyloid burden than patients with deep type. The ratio of lobar to deep CMB number is an independent indicator of cerebral β-amyloid deposition. PMID:28303922

  14. Cerebral Microbleeds on Magnetic Resonance Imaging and Anticoagulant-Associated Intracerebral Hemorrhage Risk

    Science.gov (United States)

    Charidimou, Andreas; Shakeshaft, Clare; Werring, David J.

    2012-01-01

    The increasing use of antithrombotic drugs in an aging population [including anticoagulants to prevent future ischemic stroke in individuals with atrial fibrillation (AF)] has been associated with a dramatic increase in the incidence of intracerebral hemorrhage (ICH) in users of antithrombotic drugs. Several lines of evidence suggest that cerebral small vessel disease (particularly sporadic cerebral amyloid angiopathy) is a risk factor for this rare but devastating complication of these commonly used treatments. Cerebral microbleeds (CMBs) have emerged as a key MRI marker of small vessel disease and a potentially powerful marker of future ICH risk, but adequately powered, high quality prospective studies of CMBs and ICH risk on anticoagulation are not available. Further data are urgently needed to determine how neuroimaging and other biomarkers may contribute to individualized risk prediction to make anticoagulation as safe and effective as possible. In this review we discuss the available evidence on cerebral small vessel disease and CMBs in the context of antithrombotic treatments, especially regarding their role as a predictor of future ICH risk after ischemic stroke, where risk-benefit judgments can be a major challenge for physicians. We will focus on patients with AF because these are frequently treated with anticoagulation. We briefly describe the rationale and design of a new prospective observational inception cohort study (Clinical Relevance of Microbleeds in Stroke; CROMIS-2) which investigates the value of MRI markers of small vessel disease (including CMBs) and genetic factors in assessing the risk of oral anticoagulation-associated ICH. PMID:23015806

  15. Intracerebral hemorrhage and deep microbleeds associated with cnm-positive Streptococcus mutans; a hospital cohort study

    Science.gov (United States)

    Tonomura, Shuichi; Ihara, Masafumi; Kawano, Tomohiro; Tanaka, Tomotaka; Okuno, Yoshinori; Saito, Satoshi; Friedland, Robert P.; Kuriyama, Nagato; Nomura, Ryota; Watanabe, Yoshiyuki; Nakano, Kazuhiko; Toyoda, Kazunori; Nagatsuka, Kazuyuki

    2016-01-01

    Oral infectious diseases are epidemiologically associated with stroke. We previously showed that oral Streptococcus mutans with the cnm gene encoding a collagen-binding Cnm protein induced intracerebral hemorrhage (ICH) experimentally and was also associated with cerebral microbleeds (CMBs) in our population-based cohort study. We therefore investigated the roles of cnm-positive Streptococcus mutans in this single hospital-based, observational study that enrolled 100 acute stroke subjects. The cnm gene in Streptococcus mutans isolated from saliva was screened using PCR techniques and its collagen-binding activities examined. CMBs were evaluated on T2* gradient-recalled echo MRI. One subject withdrew informed consent and 99 subjects (63 males) were analyzed, consisting of 67 subjects with ischemic stroke, 5 with transient ischemic attack, and 27 with ICH. Eleven cases showed Streptococcus mutans strains positive for cnm. The presence of cnm-positive Streptococcus mutans was significantly associated with ICH [OR vs. ischemic stroke, 4.5; 95% CI, 1.17–19.1] and increased number of deep CMBs [median (IQR), 3 (2–9) vs. 0 (0–1), p = 0.0002]. In subjects positive for Streptococcus mutans, collagen binding activity was positively correlated with the number of deep CMBs (R2 = 0.405; p < 0.0001). These results provide further evidence for the key role of oral health in stroke. PMID:26847666

  16. Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation (Mi SPACE for Intracerebral Hemorrhage

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    Benjamin Ritsma

    2014-01-01

    Full Text Available Background. Spontaneous intracerebral hemorrhage (ICH is common and causes significant mortality and morbidity. To date, optimal medical and surgical intervention remains uncertain. A lack of definitive benefit for operative management may be attributable to adverse surgical effect, collateral tissue injury. This is particularly relevant for ICH in dominant, eloquent cortex. Minimally invasive surgery (MIS offers the potential advantage of reduced collateral damage. MIS utilizing a parafascicular approach has demonstrated such benefit for intracranial tumor resection. Methods. We present a case of dominant hemisphere spontaneous ICH evacuated via the minimally invasive subcortical parafascicular transsulcal access clot evacuation (Mi SPACE model. We use this report to introduce Mi SPACE and to examine the application of this novel MIS paradigm. Case Presentation. The featured patient presented with a left temporal ICH and severe global aphasia. The hematoma was evacuated via the Mi SPACE approach. Postoperative reassessments showed significant improvement. At two months, bedside language testing was normal. MRI tractography confirmed limited collateral injury. Conclusions. This case illustrates successful application of the Mi SPACE model to ICH in dominant, eloquent cortex and subcortical regions. MRI tractography illustrates collateral tissue preservation. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.

  17. Association between cerebral microbleeds and the first onset of intracerebral hemorrhage - a 3.0 T MR study

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    Sun, Shengjun; Gao, Peiyi; Sui, Binbin; Xue, Jing; Wang, Hui; Wang, Qiong; Jing, Lina (Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing (China)); Zhai, Renyou (Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing (China)), Email: ryzhai219@hotmail.com

    2012-03-15

    Background. Cerebral microbleeds (CMBs) detected by gradient-echo MRI have been proven to be a potential risk factor for further bleeding, while the association between CMBs and the first onset of intracerebral hemorrhage has not been well investigated. Purpose. To analyze the association between CMBs and the first onset of primary intracerebral hemorrhage (pICH). Material and Methods. Two hundred and two consecutive inpatients with ICH and 234 consecutive outpatients without ICH as control group were enrolled in this study. MR imaging including T2-GRE, T{sub 1}W, T{sub 2}W and fluid attenuated inversion recovery (FLAIR) sequences were performed to detect CMBs and other abnormalities. Prevalence, distribution, and grades of CMBs, as well as the location and size of the intracerebral hematoma were analyzed, respectively. Comparison was made between pICH and control group. Logistic analysis was performed to evaluate the association between CMBs and ICH. The correlation between hematoma size and CMBs grade/numbers was analyzed. Results. CMBs were detected in 140 patients in pICH (69.3%) group and 62 patients in control group (26.5%). The incidence of CMBs in pICH group was significantly higher than that in control group (P < 0.0001). As the logistic regression analysis results, CMBs was the risk factor associated with ICH, with modulation OR value of 8.363 (95% CI 5.210-13.421). The volume of ICH with CMBs was 12.57 +- 17.23 mL, and the volume of ICH without CMBs was 17.77 +- 26.97 mL. Negative correlation was demonstrated between CMBs number and ICH volume (rs = -0.1769, P = 0.0118), as well as between CMBs grade and hematoma volume (rs = -0.1185, P = 0.1557). Conclusion CMBs may be an independent risk factor for the first onset of intracerebral hemorrhage

  18. Prognostic comparison of operative and non-operative therapies for intracerebral hemorrhage in a local hospital: Case retrospection

    Institute of Scientific and Technical Information of China (English)

    Deming Zhao; Zenghong Jiang; Bin Wang

    2006-01-01

    BACKGROUND: At present, it is satisfactory for micro-trauma craniopuncture therapy for cerebral hemor rhage to treat spontaneous intracerebral hemorrhage (ICH). Surgical treatment can decrease fatality rate of ICH patients; however, some reports suggest that there are no obvious differences of therapeutic effects between surgical treatment and medical therapy because of various states, operative indications, contraindi cations and operative styles.OBJECTIVE: To observe the effect of surgical treatment on ICH prognosis, especially on fatality rate. DESIGN: Retrospective-case study.SETTING: Huaibei People's Hospital. PARTICIPANTS: ① A total of 241 ICH patients selected from Huaibei People's Hospital from January 1988 to May 1989 were regarded as group A. They were all coincidence with Diagnostic Criteria of Intracerebral Hemorrhage in the National Cerebrovascular Disease Academic Meeting. There were 154 males and 87 females aged 34-94 years, and among them, 230 patients were older than 50 years (95.4%). Hemorrhage sites: Among 142 patients, 85 cases had internal capsule hemorrhage, 18 external capsule hemorrhage, 15 thalamic hemorrhage, 9 cerebellar hemorrhage, 7 brain stem hemorrhage, 7 cerebral lobe hemorrhage, and 1 corpus callosum hemorrhage. Hemorrhage volume: Among 89 clear records, 44 cases had of 1-10 mL, 35 of 11-30 mL, 5 of 31-40 mL, and 5 of 41-80 mL. Except 2 patients, other ones were treated with medical operation. ② A total of 203 ICH patients selected from the same hospital from January 2003 to December 2005 were regarded as group B. Among them, 72 cases were treated with operation, but other 131 ones were treated with non-operation. They were all diagnosed with CT. There were 113 males and 90 females aged 30-88 years, and among them, 183 patients were older than 50 years (90.1%). Hemorrhage sites: Among 203 patients, 104 cases had internal capsule hemorrhage, 17 external capsule hemorrhage, 19 thalamic hemorrhage, 9 cerebellar hemorrhage, 12 brain

  19. Interleukin-4 ameliorates the functional recovery of intracerebral hemorrhage through the alternative activation of microglia/macrophage

    Directory of Open Access Journals (Sweden)

    Jianjing eYang

    2016-03-01

    Full Text Available Neuro-inflammation plays an important role in the recovery of brain injury after stroke. Microglia/macrophage is the major executor in the neuro-inflammation, which can be polarized into two distinct phenotypes: injurious/toxic classical activation (M1 phenotype and protective alternative activation (M2 phenotype. Here, we investigated whether intracerebral administration of interleukin-4 (IL-4 at an early stage could affect the activation of microglia/macrophage and the corresponding outcome after intracerebral hemorrhage (ICH. The neuro-behavior was recorded between different groups in the rat ICH model. The M1 and M2 markers were then determined by qRT-PCR, western blotting, ELISA and immunofluorescence, respectively. We observed aberrant activation of microglia/macrophage after ICH. After intracerebral injection of IL-4, M1 activation was greatly inhibited while M2 activation was enhanced, along with improving neurobehavioral recovery from deficits after ICH. Our study showed that early intracerebral injection of IL-4 potentially promotes neuro-functional recovery, probably through enhancing the alternative activation of microglia/macrophage.

  20. MRI characteristics of spontaneous intracerebral hemorrhage; Das kernspintomographische Erscheinungsbild der spontanen intrazerebralen Blutung

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    Felber, S.; Schocke, M. [Innsbruck Univ. (Austria). Klinik fuer Radiologie; Innsbruck Univ. (Austria). Inst. fuer Magnetresonanztomographie und Spektroskopie; Auer, A.; Golaszewski, S.; Amort, B. [Innsbruck Univ. (Austria). Inst. fuer Magnetresonanztomographie und Spektroskopie; Nedden, D. zur [Innsbruck Univ. (Austria). Klinik fuer Radiologie

    1999-10-01

    We review the signal characteristics of intracerebral hematomas (ICH) on magnetic resonance imaging (MRI), with special emphasis on the diagnosis of intracerebral hemorrhage within the first hours after stroke. The detection of peracute ICH was evaluated in 42 patients of a prospective, MR randomized stroke trial. These patients underwent a protocol of T1 and T2 weighted sequences, diffusion weighted sequences and MR - angiography within 6 hours after onset of acute hemiparesis. The signal behaviour of ICH in any stage after bleeding was additionally reviewed in a retrospective series of 63 patients, who were submitted for MRI over a 12 months period because of known ICH. MRI correctly identified 4 hyperacute ICH in the prospective group and 4 hyperacute ICH in the retrospective group. These ICHs had high signal on T2 weighted images, were isointense in T1 weighted images and had signal voids on the diffusion weighted sequences. The signal intensities of acute, subacute and chronic ICHs correlated to previous experiences as reported in the literature. In conclusion, MRI reliably identified all hematomas even in the hyperacute stage. Diffusion weighted images were most sensitive to the presence of deoxyhemoglobine and helpful for the differentiation and characterization of acute ischemia. Therefore, MRI at 1.5 T can be employed as an alternative to CT for the emergency diagnosis of acute stroke. (orig.) [German] In dieser Uebersicht wird das kernspintomographische (KST) Erscheinungsbild der intrazerebralen Blutung (IZB) anhand eigener Erfahrungen und der Literatur diskutiert. Besonderes Gewicht wurde auf den KST Nachweis der hyperakuten IZB innerhalb der ersten Stunden gelegt. Es wurden einerseits die Befunde von 42 Patienten einer prospektiven, KST randomisierten Schlaganfallstudie ausgewertet, bei denen die KST als Erstuntersuchung innerhalb von 6 Stunden durchgefuehrt worden war. Andererseits werteten wir retrospektiv jene KST Untersuchungen aus, die im Jahr 1998

  1. Comparison of quantitative estimation of intracerebral hemorrhage and infarct volumes after thromboembolism in an embolic stroke model

    DEFF Research Database (Denmark)

    Eriksen, Nina; Rasmussen, Rune Skovgaard; Overgaard, Karsten

    2014-01-01

    . AIMS: We evaluated different methods for estimating the volume of infarcts, hemorrhages, after embolic middle cerebral artery occlusion with or without thrombolysis. METHODS: An experimental thromboembolytic rat model was used in this study. The rats underwent surgery and were placed in two groups...... of the infarct and intracerebral hemorrhage. RESULTS: No differences were observed in the infarct volume or amount of bleeding when comparing the three methods of volume estimation. Although semiautomated computer estimation and manual erythrocyte counting provided similar results as the stereological...... measurements, the stereological method was the most efficient and advantageous. CONCLUSIONS: We found that stereology was the superior method for quantification of hemorrhagic volume, especially for rodent petechial bleeding, which is otherwise difficult to measure. Our results suggest the possibility...

  2. Brain edema after intracerebral hemorrhage in rats: The role of inflammation

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    Zhang Xiangjian

    2006-01-01

    Full Text Available Background: Intracerebral hemorrhage (ICH results in secondary brain edema and injury that may lead to death and disability. ICH also causes inflammation. It is unclear whether inflammation contributes to brain edema and neuron injury or functions in repairing the brain tissue. Aims: To understand the effect of inflammation in ICH, we have carried out an investigation on the various aspects and the dynamic changes of inflammation. Settings and Design: An ICH model was generated by injecting 50 ml autologous tail artery blood stereotactically into the right caudate nucleus of 30 rats, which were randomly divided into five ICH groups. Similarly, five Sham control groups were generated by inserting the needle to the right caudate nucleus of rats. Materials and Methods: Rat behavior was evaluated over the time course (6 h, 24 h, 48 h, 72 h and 7 d in each group. The rats were then killed by administering an overdose of pentobarbital. Following the euthanasia, the brain water content, neuronal loss, glia proliferation, inflammatory infiltration and brain morphology of the rats were measured. Additionally, the expression of TNF-a,IL-6, ICAM-1, VEGF, NF-kB, C3 and CR2 was analyzed by immunohistochemistry. Statistical Analysis: The data were analyzed by student′s t test. Results: Rat brain water content increased progressively over the time course and reached its peak at 48h followed ICH. The maximum of inflammatory infiltrate (especially neutrophils and immunopositive cells of TNF-a, IL-6 and NF-kB, were at 48h. The expression of C3 and CR2 reached their peaks at 48-72h, while the expression ICAM-1 and VEGF were at maximum at 72h followed ICH. Conclusions: The results suggested that the inflammatory cytokines, complement system and VEGF may have a function in the development of the brain edema and neuron injury followed ICH.

  3. Gender and age interact to affect early outcome after intracerebral hemorrhage.

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    Odera Umeano

    Full Text Available BACKGROUND: Intracerebral hemorrhage (ICH is a common and devastating form of cerebrovascular disease. In ICH, gender differences in outcomes remain relatively understudied but have been examined in other neurological emergencies. Further, a potential effect of age and gender on outcomes after ICH has not been explored. This study was designed to test the hypothesis that age and gender interact to modify neurological outcomes after ICH. METHODS: Adult patients admitted with spontaneous primary supratentorial ICH from July 2007 through April 2010 were assessed via retrospective analysis of an existing stroke database at Duke University. Univariate analysis of collected variables was used to compare gender and outcome. Unfavorable outcome was defined as discharge to hospice or death. Using multivariate regression, the combined effect of age and gender on outcome after ICH was analyzed. RESULTS: In this study population, women were younger (61.1+14.5 versus 65.8+17.3 years, p=0.03 and more likely to have a history of substance abuse (35% versus 8.9%, p<0.0001 compared to men. Multivariable models demonstrated that advancing age had a greater effect on predicting discharge outcome in women compared to men (p=0.02. For younger patients, female sex was protective; however, at ages greater than 60 years, female sex was a risk factor for discharge to hospice or death. CONCLUSION: While independently associated with discharge to hospice or death after ICH, the interaction effect between gender and age demonstrated significantly stronger correlation with early outcome after ICH in a single center cohort. Prospective study is required to verify these findings.

  4. Mendelian Genes and Risk of Intracerebral Hemorrhage and Small-Vessel Ischemic Stroke in Sporadic Cases.

    Science.gov (United States)

    Chong, Michael; O'Donnell, Martin; Thijs, Vincent; Dans, Antonio; López-Jaramillo, Patricio; Gómez-Arbeláez, Diego; Mondo, Charles; Czlonkowska, Anna; Skowronska, Marta; Oveisgharan, Shahram; Yusuf, Salim; Paré, Guillaume

    2017-08-01

    Mendelian strokes are rare genetic disorders characterized by early-onset small-vessel stroke. Although extensively studied among families with syndromic features, whether these genes affect risk among sporadic cases is unknown. We sequenced 8 genes responsible for Mendelian stroke in a case-control study of sporadic stroke cases (≤70 years). Participants included 1251 primary stroke cases of small-vessel pathology (637 intracerebral hemorrhage and 614 small-vessel ischemic stroke cases) and 1716 controls from the INTERSTROKE study (Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World). Overall, the prevalence of canonical disease-causing mutations was 0.56% in cases and 0.23% in controls (odds ratio=1.89; 95% confidence interval, 0.54-7.57; P=0.33). CADASIL (Cerebral Autosomal Dominant Arteriopathies with Subcortical Infarcts and Leukoencephalopathies) mutations were more frequent among cases (0.48%) than controls (0.23%) but were not significantly associated with stroke risk (odds ratio=2.03; 95% confidence interval, 0.58-8.02; P=0.27). Next, we included all rare nonsynonymous mutations to investigate whether other types of mutations may contribute to stroke risk. Overall, 13.5% of cases and 14.2% of controls were carriers of at least one rare nonsynonymous mutation among the 8 Mendelian stroke genes. Mutation carriers were not at elevated risk of stroke (odds ratio=0.93; 95% confidence interval, 0.75-1.16; P=0.55). In the absence of syndromic features and family history of stroke, screening for Mendelian mutations among small-vessel stroke patients is unlikely to have high diagnostic utility. © 2017 American Heart Association, Inc.

  5. CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery.

    Science.gov (United States)

    Brouwers, H Bart; Raffeld, Miriam R; van Nieuwenhuizen, Koen M; Falcone, Guido J; Ayres, Alison M; McNamara, Kristen A; Schwab, Kristin; Romero, Javier M; Velthuis, Birgitta K; Viswanathan, Anand; Greenberg, Steven M; Ogilvy, Christopher S; van der Zwan, Albert; Rinkel, Gabriel J E; Goldstein, Joshua N; Klijn, Catharina J M; Rosand, Jonathan

    2014-09-02

    To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH). In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association between spot sign and active intraoperative bleeding, postoperative rebleeding, and residual ICH volumes was evaluated using univariable and multivariable logistic regression. A total of 95 patients met inclusion criteria: 44 lobar, 17 deep, 33 cerebellar, and 1 brainstem ICH; ≥1 spot sign was identified in 32 patients (34%). The spot sign was the only independent marker of active bleeding during surgery (odds ratio [OR] 3.4; 95% confidence interval [CI] 1.3-9.0). Spot sign (OR 4.1; 95% CI 1.1-17), female sex (OR 6.9; 95% CI 1.7-37), and antiplatelet use (OR 4.6; 95% CI 1.2-21) were predictive of postoperative rebleeding. Larger residual hematomas and postoperative rebleeding were associated with higher discharge case fatality (OR 3.4; 95% CI 1.1-11) and a trend toward increased case fatality at 3 months (OR 2.9; 95% CI 0.9-8.8). The CTA spot sign is associated with more intraoperative bleeding, more postoperative rebleeding, and larger residual ICH volumes in patients undergoing hematoma evacuation for spontaneous ICH. The spot sign may therefore be useful to select patients for future surgical trials. © 2014 American Academy of Neurology.

  6. Oxfordshire Community Stroke Project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage.

    Science.gov (United States)

    Sung, Sheng-Feng; Chen, Solomon Chih-Cheng; Lin, Huey-Juan; Chen, Chih-Hung; Tseng, Mei-Chiun; Wu, Chi-Shun; Hsu, Yung-Chu; Hung, Ling-Chien; Chen, Yu-Wei

    2014-03-01

    The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance. We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI). In a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST. Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.

  7. Evolving use of seizure medications after intracerebral hemorrhage: A multicenter study.

    Science.gov (United States)

    Naidech, Andrew M; Beaumont, Jennifer; Jahromi, Babak; Prabhakaran, Shyam; Kho, Abel; Holl, Jane L

    2017-01-03

    Prophylactic medications can be a source of preventable harm, potentially affecting large numbers of patients. Few data exist about how clinicians change prescribing practices in response to new data and revisions to guidelines about preventable harm from a prophylactic medication. We sought to determine the changes in prescribing practice of seizure medications for patients with intracerebral hemorrhage (ICH) across a metropolitan area before and after new outcomes data and revised prescribing guidelines were published. We conducted an observational study using electronic medical record data from 4 academic medical centers in a large US metropolitan area. A total of 3,422 patients with ICH, diagnosed between 2007 and 2012, were included. In 2009, after a publication found an association of phenytoin with higher odds of dependence or death, the use of phenytoin declined from 9.6% in 2009 to 2.2% in 2012 (p < 0.00001). Conversely, the use of levetiracetam more than doubled, from 15.1% in 2007 to 35% in 2012 (p < 0.00001). Use of levetiracetam varied among the 4 institutions from 6.7% to 29.8% (p < 0.00001). New data that led to revised prescribing guidelines for prophylactic seizure medications for patients with ICH were temporally associated with a significant decrease in use of the medication, potentially reducing adverse outcomes. However, a corresponding increase in the use of an alternative medication, levetiracetam, occurred despite limited knowledge about its potential effects on outcomes. Future guideline changes should anticipate and address alternatives. © 2016 American Academy of Neurology.

  8. Genetic Associations of Angiotensin-Converting Enzyme with Primary Intracerebral Hemorrhage: A Meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yuhao Sun

    Full Text Available A number of studies have reported an association of angiotensin-converting enzyme (ACE gene polymorphism with primary intracerebral hemorrhage (PICH, however the reports have demonstrated inconclusive results. To clarify this conflict, we updated the previously performed meta-analysis by Peck et al., which revealed negative results, by investigating the ACE polymorphism and its correlation to PICH.PubMed and Embase databases (through Dec 2012 were searched for English articles on the relationship of the I/D polymorphism in ACE with PICH in humans. Summary odds ratios (ORs were estimated and potential sources of heterogeneity and bias were explored.A total of 805 PICH cases and 1641 control cases obtained from 8 case-control studies were included. The results suggest that in dominant genetic models, the ACE I/D polymorphic variant was associated with a 58% increase in susceptibility risk of PICH (OR = 1.58; 95% CI = 1.07-2.35 for DD vs. DI+II. However, in the subgroup analysis based on race, a significant increased risk was found in Asian DD homozygote carriers (OR = 1.76 and 95% CI = 1.16-2.66 for DD vs. DI+II, but not in Caucasian DD homozygote carriers (OR = 1.18, 95% CI = 0.36-3.88, P = 0.784 for DD vs. DI+II. The heterogeneity between studies was remarkable, and its major sources of heterogeneity were due to the year in which the study was published. No potential publication bias was observed in dominant genetic models.These data demonstrated evidence of a positive association between ACE I/D polymorphism with PICH, and suggested that the ACE gene is a PICH susceptible gene in Asian populations.

  9. Association Between Serum Calcium Level and Extent of Bleeding in Patients With Intracerebral Hemorrhage.

    Science.gov (United States)

    Morotti, Andrea; Charidimou, Andreas; Phuah, Chia-Ling; Jessel, Michael J; Schwab, Kristin; Ayres, Alison M; Romero, Javier M; Viswanathan, Anand; Gurol, M Edip; Greenberg, Steven M; Anderson, Christopher D; Rosand, Jonathan; Goldstein, Joshua N

    2016-11-01

    Calcium is a key cofactor of the coagulation cascade and may play a role in the pathophysiology of intracerebral hemorrhage (ICH). To investigate whether a low serum calcium level is associated with an increase in the extent of bleeding in patients with ICH as measured by baseline hematoma volume and risk of hematoma expansion. Prospective cohort study of 2103 consecutive patients with primary ICH ascertained during the period between 1994 and 2015 at an academic medical center. The statistical analysis was performed in January 2016. Total calcium level was measured on admission, and hypocalcemia was defined as a serum calcium level of less than 8.4 mg/dL. Baseline and follow-up hematoma volumes, detected by noncontrast computed tomography, were measured using a computer-assisted semiautomatic analysis. Hematoma expansion was defined as an increase of more than 30% or 6 mL from baseline ICH volume. Associations between serum calcium level and baseline hematoma volume and between serum calcium level and ICH expansion were investigated in multivariable linear and logistic regression models, respectively. A total of 2123 patients with primary ICH were screened, and 2103 patients met the inclusion criteria (mean [SD] age, 72.7 [12.5] years; 54.3% male patients), of whom 229 (10.9%) had hypocalcemia on admission. Hypocalcemic patients had a higher median baseline hematoma volume than did normocalcemic patients (37 mL [IQR, 15-72 mL] vs 16 mL [IQR, 6-44 mL]; P bleeding in patients with ICH. A low calcium level may be associated with a subtle coagulopathy predisposing to increased bleeding and might therefore be a promising therapeutic target for acute ICH treatment trials.

  10. Electroacupuncture Exerts Neuroprotection through Caveolin-1 Mediated Molecular Pathway in Intracerebral Hemorrhage of Rats

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    Hui-Qin Li

    2016-01-01

    Full Text Available Spontaneous intracerebral hemorrhage (ICH is one of the most devastating types of stroke. Here, we aim to demonstrate that electroacupuncture on Baihui (GV20 exerts neuroprotection for acute ICH possibly via the caveolin-1/matrix metalloproteinase/blood-brain barrier permeability pathway. The model of ICH was established by using collagenase VII. Rats were randomly divided into three groups: Sham-operation group, Sham electroacupuncture group, and electroacupuncture group. Each group was further divided into 4 subgroups according to the time points of 6 h, 1 d, 3 d, and 7 d after ICH. The methods were used including examination of neurological deficit scores according to Longa’s scale, measurement of blood-brain barrier permeability through Evans Blue content, in situ immunofluorescent detection of caveolin-1 in brains, western blot analysis of caveolin-1 in brains, and in situ zymography for measuring matrix metalloproteinase-2/9 activity in brains. Compared with Sham electroacupuncture group, electroacupuncture group has resulted in a significant improvement in neurological deficit scores and in a reduction in Evans Blue content, expression of caveolin-1, and activity of matrix metalloproteinase-2/9 at 6 h, 1 d, 3 d, and 7 d after ICH (P<0.05. In conclusion, the present results suggested that electroacupuncture on GV20 can improve neurological deficit scores and reduce blood-brain barrier permeability after ICH, and the mechanism possibly targets caveolin-1/matrix metalloproteinase/blood-brain barrier permeability pathway.

  11. Validation of a novel claims-based stroke severity index in patients with intracerebral hemorrhage

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    Ling-Chien Hung

    2017-01-01

    Full Text Available Background: Stroke severity is an important outcome predictor for intracerebral hemorrhage (ICH but is typically unavailable in administrative claims data. We validated a claims-based stroke severity index (SSI in patients with ICH in Taiwan. Methods: Consecutive ICH patients from hospital-based stroke registries were linked with a nationwide claims database. Stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS, and functional outcomes, assessed using the modified Rankin Scale (mRS, were obtained from the registries. The SSI was calculated based on billing codes in each patient's claims. We assessed two types of criterion-related validity (concurrent validity and predictive validity by correlating the SSI with the NIHSS and the mRS. Logistic regression models with or without stroke severity as a continuous covariate were fitted to predict mortality at 3, 6, and 12 months. Results: The concurrent validity of the SSI was established by its significant correlation with the admission NIHSS (r = 0.731; 95% confidence interval [CI], 0.705–0.755, and the predictive validity was verified by its significant correlations with the 3-month (r = 0.696; 95% CI, 0.665–0.724, 6-month (r = 0.685; 95% CI, 0.653–0.715 and 1-year (r = 0.664; 95% CI, 0.622–0.702 mRS. Mortality models with NIHSS had the highest area under the receiver operating characteristic curve, followed by models with SSI and models without any marker of stroke severity. Conclusions: The SSI appears to be a valid proxy for the NIHSS and an effective adjustment for stroke severity in studies of ICH outcome with administrative claims data.

  12. Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage.

    Science.gov (United States)

    Scherer, Moritz; Cordes, Jonas; Younsi, Alexander; Sahin, Yasemin-Aylin; Götz, Michael; Möhlenbruch, Markus; Stock, Christian; Bösel, Julian; Unterberg, Andreas; Maier-Hein, Klaus; Orakcioglu, Berk

    2016-11-01

    ABC/2 is still widely accepted for volume estimations in spontaneous intracerebral hemorrhage (ICH) despite known limitations, which potentially accounts for controversial outcome-study results. The aim of this study was to establish and validate an automatic segmentation algorithm, allowing for quick and accurate quantification of ICH. A segmentation algorithm implementing first- and second-order statistics, texture, and threshold features was trained on manual segmentations with a random-forest methodology. Quantitative data of the algorithm, manual segmentations, and ABC/2 were evaluated for agreement in a study sample (n=28) and validated in an independent sample not used for algorithm training (n=30). ABC/2 volumes were significantly larger compared with either manual or algorithm values, whereas no significant differences were found between the latter (Pcorrelation coefficient 0.95 [lower 95% confidence interval 0.91]) and superior to ABC/2 (concordance correlation coefficient 0.77 [95% confidence interval 0.64]). Validation confirmed agreement in an independent sample (algorithm concordance correlation coefficient 0.99 [95% confidence interval 0.98], ABC/2 concordance correlation coefficient 0.82 [95% confidence interval 0.72]). The algorithm was closer to respective manual segmentations than ABC/2 in 52/58 cases (89.7%). An automatic segmentation algorithm for volumetric analysis of spontaneous ICH was developed and validated in this study. Algorithm measurements showed strong agreement with manual segmentations, whereas ABC/2 exhibited its limitations, yielding inaccurate overestimations of ICH volume. The refined, yet time-efficient, quantification of ICH by the algorithm may facilitate evaluation of clot volume as an outcome predictor and trigger for surgical interventions in the clinical setting. © 2016 American Heart Association, Inc.

  13. The absence of the CD163 receptor has distinct temporal influences on intracerebral hemorrhage outcomes.

    Science.gov (United States)

    Leclerc, Jenna L; Lampert, Andrew S; Loyola Amador, Claudia; Schlakman, Brandon; Vasilopoulos, Terrie; Svendsen, Pia; Moestrup, Søren K; Doré, Sylvain

    2017-01-01

    Hemoglobin (Hb) toxicity precipitates secondary brain damage following intracerebral hemorrhage (ICH). CD163 is an anti-inflammatory Hb scavenger receptor and CD163-positive macrophages/microglia locally accumulate post-bleed, yet no studies have investigated the role of CD163 after ICH. ICH was induced in wildtype and CD163(-/-) mice and various anatomical and functional outcomes were assessed. At 3 d, CD163(-/-) mice have 43.4 ± 5.0% (p = 0.0002) and 34.8 ± 3.4% (p = 0.0003) less hematoma volume and tissue injury, respectively. Whereas, at 10 d, CD163(-/-) mice have 49.2 ± 15.0% larger lesions (p = 0.0385). An inflection point was identified, where CD163(-/-) mice perform better on neurobehavioral testing and have less mortality before 4 d, but increased mortality and worse function after 4 d (p = 0.0389). At 3 d, CD163(-/-) mice have less Hb, iron, and blood-brain barrier dysfunction, increased astrogliosis and neovascularization, and no change in heme oxygenase 1 (HO1) expression. At 10 d, CD163(-/-) mice have increased iron and VEGF immunoreactivity, but no significant change in HO1 or astrogliosis. These novel findings reveal that CD163 deficiency has distinct temporal influences following ICH, with early beneficial properties but delayed injurious effects. While it is unclear why CD163 deficiency is initially beneficial, the late injurious effects are consistent with the key anti-inflammatory role of CD163 in the recovery phase of tissue damage.

  14. Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk Updated meta-analysis.

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    Charidimou, Andreas; Shoamanesh, Ashkan; Wilson, Duncan; Gang, Qiang; Fox, Zoe; Jäger, H Rolf; Benavente, Oscar R; Werring, David J

    2015-09-15

    We performed a systematic review and meta-analysis to assess whether the presence of cerebral microbleeds (CMBs) on pretreatment MRI scans of patients with acute ischemic stroke treated with thrombolysis is associated with an increased risk of symptomatic intracerebral hemorrhage (ICH). We searched PubMed for relevant studies and calculated pooled odds ratios (ORs) for symptomatic ICH, using the Mantel–Haenszel fixed-effects method, among individuals with vs without CMBs on pretreatment MRI scans. To minimize potential bias, sensitivity analysis was performed including studies providing data on patients treated only with IV thrombolysis. Ten eligible studies including 2,028 patients were pooled in meta-analysis. The overall prevalence of CMBs was 23.3%. Among patients with CMBs, 40 of 472 (8.5%; 95%confidence interval [CI]: 6.1%–11.4%) experienced a symptomatic ICH after thrombolysis compared with 61 of 1,556 patients (3.9%; 95% CI: 3%–5%) without CMBs. The pooled OR of ICH across all studies was 2.26 (95%CI: 1.46–3.49; p , 0.0001). Eight studies, including 1,704 patients (n 5 401 with CMBs), provided data on patients treated with IV thrombolysis only; OR for the presence of CMBs and the development of symptomatic ICH was 2.87 (95%CI: 1.76–4.69; p , 0.0001). Our meta-analysis of the available published data demonstrates an increased risk of symptomatic ICH after thrombolysis for acute ischemic stroke in patients with CMBs. However, we cannot fully exclude bias or confounding, so our results should be considered hypothesis generating. Detecting CMBs should not prevent thrombolytic treatment based on present evidence. Further analyses, taking into account CMB number and location, as well as measures of functional outcome, are needed.

  15. Development of a mechanics-based model of brain deformations during intracerebral hemorrhage evacuation

    Science.gov (United States)

    Narasimhan, Saramati; Weis, Jared A.; Godage, Isuru S.; Webster, Robert; Weaver, Kyle; Miga, Michael I.

    2017-03-01

    Intracerebral hemorrhages (ICHs) occur in 24 out of 100,000 people annually and have high morbidity and mortality rates. The standard treatment is conservative. We hypothesize that a patient-specific, mechanical model coupled with a robotic steerable needle, used to aspirate a hematoma, would result in a minimally invasive approach to ICH management that will improve outcomes. As a preliminary study, three realizations of a tissue aspiration framework are explored within the context of a biphasic finite element model based on Biot's consolidation theory. Short-term transient effects were neglected in favor of steady state formulation. The Galerkin Method of Weighted Residuals was used to solve coupled partial differential equations using linear basis functions, and assumptions of plane strain and homogeneous isotropic properties. All aspiration models began with the application of aspiration pressure sink(s), calculated pressures and displacements, and the use of von Mises stresses within a tissue failure criterion. With respect to aspiration strategies, one model employs an element-deletion strategy followed by aspiration redeployment on the remaining grid, while the other approaches use principles of superposition on a fixed grid. While the element-deletion approach had some intuitive appeal, without incorporating a dynamic grid strategy, it evolved into a less realistic result. The superposition strategy overcame this, but would require empirical investigations to determine the optimum distribution of aspiration sinks to match material removal. While each modeling framework demonstrated some promise, the superposition method's ease of computation, ability to incorporate the surgical plan, and better similarity to existing empirical observational data, makes it favorable.

  16. Changes of ferrous iron and its transporters after intracerebral hemorrhage in rats.

    Science.gov (United States)

    Wang, Gaiqing; Shao, Anwen; Hu, Weimin; Xue, Fang; Zhao, Hongping; Jin, Xiaojie; Li, Guanglai; Sun, Zhitang; Wang, Li

    2015-01-01

    Ferrous iron is a major source inducing oxidative stress after intracerebral hemorrhage (ICH). Divalent metal transporter1 (DMT1) is the important and well-known plasma membrane transport protein which was proved to be involved in the transport of free ferrous iron in mammals. Ferroportin 1 (FPN1) is the unique exporter of ferrous iron from mammalian cells. The role of DMT1 and FPN1 in brain after ICH is still not elucidated. Therefore, we measure the expression of DMT1 and FPN1, to explore the correlations between ferrous iron and its specific transporters after ICH. Ninety-six Sprague-Dawley rats received intra-striatal infusions of 0.5 U type IV collagenase to establish ICH model. Ferrous iron content in brain was determined using Turnbull's method. DMT1 and FPN1 expression were examined by immunohistochemical staining and Real-Time quantitative polymerase chain reaction (RT-PCR). With the use of confocal laser microscopy, we determined the colocalization of DMT1 and FPN1 at 1, 3, 7 and 14 days after ICH. Ferrous iron deposition was shown in the perihematomal zone as early as 1 day after ICH; it reached a peak after 7 days and was not elevated within 14 days following ICH. The expression of the DMT1 upregulated and reached to peak at day 7 after ICH. FPN1 reached a plateau at 3 days post-ICH. Expression levels of DMT1 and FPN1 were in parallel with ferrous iron deposition. There was a positive correlation between FPN1 and DMT1. DMT1 mainly localized in the cytoplasm of glias and neurons. FPN1 were mostly distributed on the membrane of endothelial cells and glias. Confocal microscope showed that DMT1 colocalized with FPN1. DMT1 and FPN1 are positively influenced by ferrous iron status in brain after ICH. DMT1 and FPN1 attenuate iron overload after ICH via increasing transmembrane iron export.

  17. Common variants within oxidative phosphorylation genes influence risk of ischemic stroke and intracerebral hemorrhage.

    Science.gov (United States)

    Anderson, Christopher D; Biffi, Alessandro; Nalls, Michael A; Devan, William J; Schwab, Kristin; Ayres, Alison M; Valant, Valerie; Ross, Owen A; Rost, Natalia S; Saxena, Richa; Viswanathan, Anand; Worrall, Bradford B; Brott, Thomas G; Goldstein, Joshua N; Brown, Devin; Broderick, Joseph P; Norrving, Bo; Greenberg, Steven M; Silliman, Scott L; Hansen, Björn M; Tirschwell, David L; Lindgren, Arne; Slowik, Agnieszka; Schmidt, Reinhold; Selim, Magdy; Roquer, Jaume; Montaner, Joan; Singleton, Andrew B; Kidwell, Chelsea S; Woo, Daniel; Furie, Karen L; Meschia, James F; Rosand, Jonathan

    2013-03-01

    Previous studies demonstrated association between mitochondrial DNA variants and ischemic stroke (IS). We investigated whether variants within a larger set of oxidative phosphorylation (OXPHOS) genes encoded by both autosomal and mitochondrial DNA were associated with risk of IS and, based on our results, extended our investigation to intracerebral hemorrhage (ICH). This association study used a discovery cohort of 1643 individuals, a validation cohort of 2432 individuals for IS, and an extension cohort of 1476 individuals for ICH. Gene-set enrichment analysis was performed on all structural OXPHOS genes, as well as genes contributing to individual respiratory complexes. Gene-sets passing gene-set enrichment analysis were tested by constructing genetic scores using common variants residing within each gene. Associations between each variant and IS that emerged in the discovery cohort were examined in validation and extension cohorts. IS was associated with genetic risk scores in OXPHOS as a whole (odds ratio [OR], 1.17; P=0.008) and complex I (OR, 1.06; P=0.050). Among IS subtypes, small vessel stroke showed association with OXPHOS (OR, 1.16; P=0.007), complex I (OR, 1.13; P=0.027), and complex IV (OR, 1.14; P=0.018). To further explore this small vessel association, we extended our analysis to ICH, revealing association between deep hemispheric ICH and complex IV (OR, 1.08; P=0.008). This pathway analysis demonstrates association between common genetic variants within OXPHOS genes and stroke. The associations for small vessel stroke and deep ICH suggest that genetic variation in OXPHOS influences small vessel pathobiology. Further studies are needed to identify culprit genetic variants and assess their functional consequences.

  18. Systemic administration of urocortin after intracerebral hemorrhage reduces neurological deficits and neuroinflammation in rats

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    Liew Hock-Kean

    2012-01-01

    Full Text Available Abstract Background Intracerebral hemorrhage (ICH remains a serious clinical problem lacking effective treatment. Urocortin (UCN, a novel anti-inflammatory neuropeptide, protects injured cardiomyocytes and dopaminergic neurons. Our preliminary studies indicate UCN alleviates ICH-induced brain injury when administered intracerebroventricularly (ICV. The present study examines the therapeutic effect of UCN on ICH-induced neurological deficits and neuroinflammation when administered by the more convenient intraperitoneal (i.p. route. Methods ICH was induced in male Sprague-Dawley rats by intrastriatal infusion of bacterial collagenase VII-S or autologous blood. UCN (2.5 or 25 μg/kg was administered i.p. at 60 minutes post-ICH. Penetration of i.p. administered fluorescently labeled UCN into the striatum was examined by fluorescence microscopy. Neurological deficits were evaluated by modified neurological severity score (mNSS. Brain edema was assessed using the dry/wet method. Blood-brain barrier (BBB disruption was assessed using the Evans blue assay. Hemorrhagic volume and lesion volume were assessed by Drabkin's method and morphometric assay, respectively. Pro-inflammatory cytokine (TNF-α, IL-1β, and IL-6 expression was evaluated by enzyme-linked immunosorbent assay (ELISA. Microglial activation and neuronal loss were evaluated by immunohistochemistry. Results Administration of UCN reduced neurological deficits from 1 to 7 days post-ICH. Surprisingly, although a higher dose (25 μg/kg, i.p. also reduced the functional deficits associated with ICH, it is significantly less effective than the lower dose (2.5 μg/kg, i.p.. Beneficial results with the low dose of UCN included a reduction in neurological deficits from 1 to 7 days post-ICH, as well as a reduction in brain edema, BBB disruption, lesion volume, microglial activation and neuronal loss 3 days post-ICH, and suppression of TNF-α, IL-1β, and IL-6 production 1, 3 and 7 days post

  19. THE EXPERIMENTAL STUDY ON THE CELL APOPTOSIS AND EXPRESSION OF BCL-2 PROTEIN IN INTRACEREBRAL HEMORRHAGE IN MODEL OF RATS

    Institute of Scientific and Technical Information of China (English)

    Bao Gang; Guo Ning; Zhang Zhonglin; Chen Wei; Bao Dehu

    2006-01-01

    Otjective To study whether there is the apoptosis of neural cells and the expressionof Bcl-2 protein in intracerebral hemorrhage (ICH) in model of rats, for the further understanding the mechanism of the delayed damage of the neural cells around the hematoma after ICH. Methods Fifty SD rats were randomly divided into 5 groups, ten in each. With the Group A as the control, the rest 40 were used to set up intracerebral hemorrhage model. The brains were taken out at 12th, 24th, 48th and 72th hours, respectively. Apoptosis cells were detected with terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL), and the expression of Bcl-2 protein was detected with immunochemical stainging methed (SP). Results In the control group, no apoptosis cells and Bcl-2protein were detected. In rest groups, the apoptosis cells and Bcl-2 protein were expressed in different degree.Apoptosis rates verified and corresponded with the time after ICH, with the peak at 48th -72th hour after hemorrhage.The peak rate of apoptosis cells was (24. 50± 2.69)% and Bcl-2 protein expression was (20. 76 ± 1.97)% . There was significant difference between the experimental groups and control (P<0.05), and no linear relationship between the apoptosis rate and the expression of Bcl-2 protein. Conclusion Apoptosis may be an important factor in the secondary trauma of ICH. There is a time leg after hemorrhage. All this is instructive to clinical treatment in time. Bcl-2 protein keeps increasing in a certain time after hemorrhage, but not synchronize with the cell apoptosis. This indicates that bcl-2 has the effect to reduce the apoptosis of neural cells.

  20. Effects of basic fibroblast growth factor on superoxide dismutase activity and malondialdehyde content in the rat brain following intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Hongqiao Wei; Juen Huang; Junjie Huang; Bing Li; Qianming Li

    2008-01-01

    BACKGROUND: Studies have confirmed that basic fibroblast growth factor (bFGF) promotes neuronal survival and neurite outgrowth. OBJECTIVE: To compare and verify the effects of bFGF on superoxide dismutase activity and malondialdehyde content in rat brain tissues surrounding a hemorrhagic lesion, as well as the hippocampus at the hemorrhagic side. DESIGN, TIME AND SETTING: The randomized, controlled, neurobiological study was performed at the Science Experimental Center and Research Laboratory, Guangxi Medical University, China, from September to December 2006. MATERIALS: Ninety-two adult, healthy, Wistar rats of equal gender were used to establish intraeerebral hemorrhage by infusing type VII collagenase into the left internal capsule. Type Ⅶ collagenase (Sigma, USA), superoxide dismutase and malondialdehyde kits (Jiancheng, China), and bFGF (Institute of Bioengineering, Ji'nan University, China) were used for this study. METHODS: Ninety successfully lesioned rats were equally and randomly divided into three groups. Rats in the bFGF group were intramuscularly injected daily with bFGF (8μg/kg). Rats in the saline control group received an equal volume of saline. The rats in the model group did not receive other interventions. Superoxide dismutase activity was measured using the xanthine oxidase method. Malondialdehyde contents were detected using the thiobarbituric acid method. MAIN OUTCOME MEASURES: At 1, 3, and 7 days following intracerebral hemorrhage, superoxide dismutase and malondialdehyde were determined in the brain tissue surrounding the hematoma and in the hippocampus in the affected hemisphere. RESULTS: In brain tissue surrounding the hematoma, superoxide dismutase activity was significantly increased in the bFGF group at 3 and 7 days after intracerebral hemorrhage compared with the saline control group, whereas malondialdehyde content was significantly decreased (P 0.05). CONCLUSION: Increased superoxide dismutase activity and decreased

  1. Graphite furnace atomic absorption spectrophotometry--a novel method to quantify blood volume in experimental models of intracerebral hemorrhage.

    Science.gov (United States)

    Kashefiolasl, Sepide; Foerch, Christian; Pfeilschifter, Waltraud

    2013-02-15

    Intracerebral hemorrhage (ICH) accounts for 10% of all strokes and has a significantly higher mortality than cerebral ischemia. For decades, ICH has been neglected by experimental stroke researchers. Recently, however, clinical trials on acute blood pressure lowering or hyperacute supplementation of coagulation factors in ICH have spurred an interest to also design and improve translational animal models of spontaneous and anticoagulant-associated ICH. Hematoma volume is a substantial outcome parameter of most experimental ICH studies. We present graphite furnace atomic absorption spectrophotometric analysis (AAS) as a suitable method to precisely quantify hematoma volumes in rodent models of ICH. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome

    Directory of Open Access Journals (Sweden)

    Denchai Laiwattana

    2014-05-01

    Full Text Available Background: Primary multiple simultaneous intracerebral hemorrhages (MSICHs are quite rare. Although occasional reports have been found, there have been no systematic reviews. The published case reports and case series contain overlapping data, leading to erroneous information about MSICHs. This is the first extensive review of accessible studies published in English on MSICHs. Our primary objective was to analyze the demographic data on age, sex, outcome and prognosis with regard to primary MSICHs. Summary: A PubMed search without language restriction for articles with results from human studies and registered between January 1950 and September 2013 yielded 677 articles. The following inclusion criteria were applied: (1 reported case(s or case series on primary MSICHs; (2 text partly or fully in English, and (3 text contains identifiable data on age, sex and outcome of patients. A total of 24 articles met all the inclusion criteria. The reference lists of these 24 articles were inspected for additional relevant articles, which yielded another 20 articles. In all, 248 cases were identified; 143 cases were excluded for various reasons: 52 duplicate cases, 18 cases of multiple nonsimultaneous intracerebral hemorrhages, 25 cases of secondary MSICHs, and 48 cases with incomplete data on age, sex and outcome. The remaining 105 cases were analyzed. MSICHs were found to be more common in bilateral cases (53.33%: there were bilateral basal ganglia hemorrhages (33.33%, bilateral thalamic hemorrhages (18.10%, bilateral lobar hemorrhages (0.95% and bilateral cerebellar hemorrhages (0.95%. Nonbilateral MSICHs were found in 46.67% of the cases. The hematomas were commonly distributed in the basal ganglia (45.83%, thalamus (30.56% and cerebellum (10.19%. MSICHs were more frequently encountered in males (60.95%; average age: 59.13 ± 12.49 years. The average age of the female patients was higher (63.89 ± 13.11 years. Patients with primary MSICHs had a

  3. [Anesthetic management of massive endobronchial hemorrhage after pulmonary embolectomy].

    Science.gov (United States)

    Nakayama, Shin; Miyabe, Masayuki; Tabata, Kouya; Toyooka, Hidenori

    2003-08-01

    We report a case of massive endobronchial hemorrhage after pulmonary embolectomy. A 63-year-old woman underwent emergency pulmonary embolectomy with cardiopulmonary bypass (CPB). During partial CPB, we found massive blood gushing out from the endotracheal tube. Approximately 2,000 ml of blood was aspirated in 10 minutes. To ensure adequate oxygenation, emergent percutaneous cardiopulmonary support system (PCPS) was started. After neutralization of heparin and the institution of 10 cmH2O of positive end-expiratory pressure, the bleeding diminished. Institution of PCPS allows performance of unhurried bronchoscopy to identify the actual bleeding point and to lavage the airway. In addition to this management, we administrated steroids and neutrophil elastase inhibitor to stabilize pulmonary capillary membrane. Without complications, the patient was extubated 2 days after operation and the following course was uneventful. Immediate institution of PEEP and pharmacological interventions to reduce pulmonary blood pressure were beneficial in arresting hemorrhage. The bleeding begins usually at the time of discontinuation of CPB. We should recognize the possible occurrence of endobronchial bleeding after pulmonary embolectomy and prepare to protect the airway and to maintain oxygenation and cardiac function.

  4. Prevention of Rh isoimmunization after spontaneous, massive fetomaternal hemorrhage.

    Science.gov (United States)

    Graham, E M; Freedman, L J; Forouzan, I; Morgan, M A

    1996-09-01

    Massive fetomaternal hemorrhage has been associated with numerous risk factors and can occur spontaneously. The risk is probably greater when a woman who is Rh negative has an ABO-compatible fetus. We report the case of a gravid, A-negative unsensitized patient who came to the hospital at term complaining of decreased fetal movement over the previous 24 hours. During evaluation, the fetal heart rate was found to have decreased beat-to-beat variability and repetitive late decelerations, and the mother was delivered of a 3,005 gA-positive neonate (by cesarean section) with a hemoglobin level of 2.9 g/dL. An acid elution test showed 400 mL of fetal blood in the maternal circulation, and the patient received 23 ampules (6,900 micrograms) of Rh immune globulin postpartum. The patient's condition was observed for 156 days after delivery; she did not become sensitized to the Rh factor. A massive fetomaternal hemorrhage can occur without any antecedent risk factors, with a risk of subsequent morbidity to the neonate. Sensitization can be prevented by prompt administration of adequate amounts of Rh immune globulin.

  5. Hemorragia intracerebral espontânea: estudo retrospectivo de 72 casos operados Primary intracerebral hemorrhage: retrospective study of 72 operated cases

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    JOSÉ CORREIA DE FARIAS BRITO

    2000-06-01

    Full Text Available Realizamos estudo retrospectivo de 72 casos de hemorragia intracerebral espontânea (HICE operados no período de 1970 a 1999. Foram excluídos do grupo os casos de hemorragias cerebrais decorrentes de traumatismos cranianos, tumores, malformações vasculares e doenças hematológicas. A idade variou de 20 a 81 anos com média de 58,2 anos. A maioria dos pacientes era do gênero masculino e de cor branca. Em um terço deles, a pressão arterial estava elevada, e os hematomas lobares ocorreram em maior número de vezes que os ganglionares. A sintomatologia dominante resultou do aumento da pressão intracraniana e das lesões cerebrais focais. Em 52 (72,7% casos, foi possível realizar tomografia computadorizada de crânio. A avaliação dos resultados cirúrgicos foi dirigida para cada década, em separado, mostrando taxas de mortalidade com significativas diferenças.We analysed 72 cases of primary intracranial hemorrhage surgically treated from 1970 to 1999. The hemorrhages were diagnosed by computerized axial tomography in 52 pacients. Most hematomas were situated in the cerebral hemispheres (30 percent in thalamus-basal ganglia region and 50 percent in the subcortical matter. There were 10 patients with cerebellar hemorrhage. Hypertension (based in blood pressure recordings in the hospital and history was found in 24 patients (33 percent. The most frequent findings were coma, intracranial hypertension and hemimotor deficit. The death rate registred was 27.7 percent; however, it was found a significant difference in the mortality index when considering the 70-79 decade (62.7 percent and the 90-99 decade (20.7 percent. A critical analysis was made about depth hematomas, consciousness state and intracranial hypertension with herniation related to surgical procedure.

  6. Use of a condom to control massive postpartum hemorrhage.

    Science.gov (United States)

    Akhter, Sayeba; Begum, Mosammat Rashida; Kabir, Zakia; Rashid, Maliha; Laila, Tarafder Runa; Zabeen, Fahmida

    2003-09-11

    To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive postpartum hemorrhage (PPH). This prospective study was done in the Obstetrics and Gynecology Department of Dhaka Medical College and Hospital, Bangladesh, between July 2001 and December 2002. During the study period, 152 cases of PPH were identified; 109 were managed medically; 20 were managed using the B-Lynch procedure, and 23 were managed using the condom catheter. Patients were selected for intervention with the condom catheter when PPH that occurred as a result of atonicity or morbid adhesion (accreta) could not be controlled by uterotonics or a surgical procedure. In patients who were in shock due to massive hemorrhage, a condom catheter was introduced immediately without prior medical management. With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 mL normal saline, according to need. The condom catheter was kept for 24-48 hours, depending upon the initial intensity of blood loss, and gradually deflated when bleeding ceased. (1) Ability of condom catheter to stop bleeding; (2) time required to stop bleeding after the tamponade was applied; (3) subsequent morbidity in terms of severe infection, despite use of prophylactic antibiotics. In all 23 cases in which the condom catheter was used, bleeding stopped within 15 minutes. No patient needed further intervention. No patient went into irreversible shock. There was no intrauterine infection as documented by clinical signs and symptoms and culture and sensitivity of high vaginal swab. The hydrostatic condom catheter can control PPH quickly and effectively. It is simple to use, inexpensive, and safe. In developing countries where PPH remains a primary cause of maternal mortality, any healthcare provider involved in delivery may use this procedure for controlling massive PPH to save the lives of patients.

  7. Cost effectiveness of recombinant factor VIIa for treatment of intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Eckman Mark H

    2008-05-01

    Full Text Available Abstract Background Phase I/II placebo-controlled clinical trials of recombinant Factor VIIa (rFVIIa suggested that administration of rFVIIa within 4 hours after onset of intracerebral hemorrhage (ICH is safe, limits ICH growth, and improves outcomes. We sought to determine the cost-effectiveness of rFVIIa for acute ICH treatment, using published Phase II data. We hypothesized that rFVIIa would have a low marginal cost-effectiveness ratio (mCER given the poor neurologic outcomes after ICH with conventional management. Methods We performed an incremental cost-effectiveness analysis from the societal perspective, considering conventional management vs. 80 ug/kg rFVIIa treatment for acute ICH cases meeting Phase II inclusion criteria. The time frame for the analysis was 1. 25 years: data from the Phase II trial was used for 90 day outcomes and rFVIIa complications – arterial thromboembolic events (ATE. We assumed no substantial cost differences in care between the two strategies except: 1 cost of rFVIIa (for an 80 mcg/kg dose in an 80 kg patient, assumed cost of $6,408; 2 cost of ATE side effects from rFVIIa (which also decrease quality of life and increase the chance of death; and 3 differential monetary costs of outcomes and their impact on quality of life, including disposition (home vs. nursing home, and outpatient vs. inpatient rehabilitation. Sensitivity analyses were performed to explore uncertainty in parameter estimates, impact of rFVIIa cost, direct cost of neurologic outcomes, probability of ATE, and outcomes after ATE. Results In the "base case", treating ICH with rFVIIa dominates the usual care strategy by being more effective and less costly. rFVIIa maintained a mCER Conclusion Based on data from preliminary trials, treating selected ICH patients with rFVIIa results in lower cost and improved clinical outcomes. This potential cost-effectiveness must be considered in light of the Phase III trial results.

  8. Recombinant-activated factor Ⅶ and neuronal apoptosis in a rat model of intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Qiang Li; Wei Li; Suju Ding; Jianping Tang; Jing Fang; Benqiang Deng; Tao Wu

    2009-01-01

    BACKGROUND:Activated clotting factor Ⅶ has been demonstrated to exhibit obvious anti-apoptosis effects.OBJECTIVE:To observe the effect of activated clotting factor Ⅶ on neuronal apoptosis at different time points following rat intracerebral hemorrhage (ICH).DESIGN,TIME AND SETTING:A randomized,controlled,animal experiment was performed at the Neurobiological Laboratory of Second Military Medical University from October 2005 to April 2006.MATERIALS:Recombinant-activated clotting factor Vlla (rFⅧa) was purchased from Danish Novo Nordisk,Denmark.In situ cell death detection kit-POD kit was purchased from Roche,Switzerland.Caspase-3 activity determination kit from Biovision,USA.METHODS:A total of 72 healthy,male,Sprague Dawley rats,aged 5-8 months,were randomly assigned to three groups (n=24):sham-operated,ICH model,and rFⅧa.In the ICH model and rFⅧa groups,80.0 μL autologous non-clotting blood from rat tails was injected into the right caudate putamen to establish the ICH.The empty microinjector was inserted into the caudate putamen in the sham-operated group.The ICH model and rFⅧa groups were subdivided into four subsets separately:6,24,72 hours and 7 clays following ICH.The rats in the rFⅧa group were injected with 160 μg/kg rFⅧa via the dorsal vein of the penis.MAIN OUTCOME MEASURES:Apoptotic cells were detected in the right caudate putamen by TUNEL;caspase-3 activity by spectrophotometry;and rat neurological function was evaluated by neurological functional impairment scales.RESULTS:Rat neurological function was deteriorated at 24,72 hours,and 7 days following ICH.The TUNEL-positive cells and caspase-3 activity in the right caudate putamen was significantly increased in the ICH rats (P<0.05);rFVlla treatment reduced the number of TUNEL-positive cells and caspase-3 activity in the right caudate putamen (P<0.05),and neurological function was significantly improved (P<0.05).CONCLUSION:rFⅧa was applied within 72 hours after ICH,which reduced

  9. Association Between Hypodensities Detected by Computed Tomography and Hematoma Expansion in Patients With Intracerebral Hemorrhage

    Science.gov (United States)

    Boulouis, Gregoire; Morotti, Andrea; Brouwers, H. Bart; Charidimou, Andreas; Jessel, Michael J.; Auriel, Eitan; Pontes-Neto, Octávio; Ayres, Alison; Vashkevich, Anastasia; Schwab, Kristin M.; Rosand, Jonathan; Viswanathan, Anand; Gurol, Mahmut E.; Greenberg, Steven M.; Goldstein, Joshua N.

    2017-01-01

    IMPORTANCE Hematoma expansion is a potentially modifiable predictor of poor outcome following an acute intracerebral hemorrhage (ICH). The ability to identify patients with ICH who are likeliest to experience hematoma expansion and therefore likeliest to benefit from expansion-targeted treatments remains an unmet need. Hypodensities within an ICH detected by noncontrast computed tomography (NCCT) have been suggested as a predictor of hematoma expansion. OBJECTIVE To determine whether hypodense regions, irrespective of their specific patterns, are associated with hematoma expansion in patients with ICH. DESIGN, SETTING, AND PARTICIPANTS We analyzed a large cohort of 784 patients with ICH (the development cohort; 55.6% female), examined NCCT findings for any hypodensity, and replicated our findings on a different cohort of patients (the replication cohort; 52.7% female). Baseline and follow-up NCCT data from consecutive patients with ICH presenting to a tertiary care hospital between 1994 and 2015 were retrospectively analyzed. Data analyses were performed between December 2015 and January 2016. MAIN OUTCOMES AND MEASURES Hypodensities were analyzed by 2 independent blinded raters. The association between hypodensities and hematoma expansion (>6 cm3 or 33% of baseline volume) was determined by multivariable logistic regression after controlling for other variables associated with hematoma expansion in univariate analyses with P ≤ .10. RESULTS A total of 1029 patients were included in the analysis. In the development and replication cohorts, 222 of 784 patients (28.3%) and 99 of 245 patients (40.4%; 321 of 1029 patients [31.2%]), respectively, had NCCT scans that demonstrated hypodensities at baseline (κ = 0.87 for interrater reliability). In univariate analyses, hypodensities were associated with hematoma expansion (86 of 163 patients with hematoma expansion had hypodensities [52.8%], whereas 136 of 621 patients without hematoma expansion had hypodensities [21

  10. Changes of TXA2 and PGI2 during Postoperative Hypertensive Crisis in Patients with Hypertensive Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Zhi WANG; Chao WANG; Weiguang ZHANG; Laizang WANG; Ting LEI

    2008-01-01

    In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to crani- otomy were divided into three groups: group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without his- tory of hypertension and hypertensive intracerebral hemorrhage. TXA2>, TXB2>, 6-keto-PGF1α and PGI2> were measured after operation in the three groups respectively. The postoperative blood pres- sure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2> and PGI2> in group A were significantly higher than those in other two groups (P<0.01). Moreover, the ratio of TXB2> to 6-keto-PGF1α in group A was significantly higher than that in other two groups (P<0.05). The increase of TXA2> and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2> to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.

  11. Change in connection between corticospinal tract and Broca's area during motor recovery in a patient with an intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Hyeok Gyu Kwon; Sung Ho Jang

    2011-01-01

    The present study reported a 42-year-old male patient who underwent conservative management for a spontaneous intracerebral hemorrhage in the left corona radiata and the basal ganglia. The patient presented with complete weakness of the right upper and lower extremities at the onset of intracerebral hemorrhage; however, he showed progressive motor recovery to the level that he was able to extent the affected extremities against some resistance at 5 weeks after onset. The corticospinal tract of the affected (left) hemisphere connected to the left Broca's area at 3 weeks after onset as shown by diffusion tensor tractography. By contrast, this connection had disappeared at 5 weeks after onset as shown by diffusion tensor tractogaphy. Transcranial magnetic stimulation study showed that no motor evoked potential was elicited from the affected (left) hemisphere at 3 weeks after onset, but motor evoked potentials were elicited at 5 weeks after onset. These findings suggest that the connection between the injured corticospinal tract and Broca's area in this patient appears to be a compensation for severe motor weakness; consequently, the connection seems to disappear with motor recovery.

  12. The impact of neuronal Notch-1/JNK pathway on intracerebral hemorrhage-induced neuronal injury of rat model.

    Science.gov (United States)

    Chen, Maohua; Sun, Jun; Lu, Chuan; Chen, Xiandong; Ba, Huajun; Lin, Qun; Cai, Jianyong; Dai, Junxia

    2016-11-08

    Notch signaling is a highly conserved pathway that regulates cell fate decisions during embryonic development. Notch activation endangers neurons by modulating NF-κB and HIF-1α pathways, however, the role of Notch signaling in activating JNK/c-Jun following intracerebral hemorrhage (ICH) has not been investigated. In this study, we used rat ICH models and thrombin-induced cell models to investigate the potential role of Notch-1/JNK signals. Our findings revealed that Notch-1 and JNK increased in hematoma-surrounding neurons tissues following ICH during ischemic conditions (all pNotch-1, p-JNK, and active caspase-3 were all up-regulated in cell viability-decreasing ICH cell models (all pNotch-1 or JNK suppressed the phosphorylation of JNK and the expression of active caspase-3, and cell viability was obviously ameliorated. In conclusion, this work suggested Notch-1 activates JNK pathway to induce the active caspase-3, leading to neuronal injury when intracerebral hemorrhage or ischemia occurred. Thus the Notch-1/JNK signal pathway has an important role in ICH process, and may be a therapeutic target to prevent brain injury.

  13. The Relationship of Hematoma Size and Mortality in Non-Traumatic Intra-Cerebral Hemorrhages in Basal Ganglia

    Directory of Open Access Journals (Sweden)

    P. Ahmadi

    2006-04-01

    Full Text Available Introduction & Objective: Among all of the neurologic diseases in adult life, the cerebrovascular disease (CVD is the most common and important ones. Intracerebral hemorrhage (ICH in basal ganglia (BG is one of the common and major types of CVD. The relations between clot size and mortality rate, in different parts of the brain, has been addressed by several researchers. It is unclear whether such a relationship is in BG. Therefore this study was designed to find a formula that predicts outcome of hemorrhage based on clot size in BG.Materials & Methods: This descriptive-comparative study that was carried out prospectively, conducted on all 63 patients who admitted to the hospital during one year, with definite diagnosis of ICH in BG. After urgent CT scanning, the size of hematoma was determined by scan images. Routine treatment was uniform for all patients. Focal signs and consciousness state were assessed in the first and last days of admission. The data were analyzed using descriptive statistics, frequency tables and chi-square and T- test. Results: 33% of patients died. Hematoma size in 70% of them was larger than 5cm and in other 30% smaller. None of the hematoma with less than 4cm size was fatal. In patients with clots of 5cm or larger, the mortality was 100%. Conclusion: The results indicated that, there was meaningful relationship between hematoma size and mortality, in BG hemorrhages. So the clot size can be used as a factor in predicting hemorrhage outcome in BG.

  14. Munchausen syndrome by proxy with massive proteinuria and gastrointestinal hemorrhage.

    Science.gov (United States)

    Ulinski, Tim; Lhopital, Caroline; Cloppet, Henri; Feït, Jean-Patrick; Bourlon, Isabelle; Morin, Denis; Cochat, Pierre

    2004-07-01

    A 5-year-old boy presented with acute abdominal pain. Massive proteinuria of 10 g/1.73 m(2) per day was detected on standard urinalysis. There was no peripheral edema. Serum concentrations of total proteins, lipids, and creatinine and immunological investigations were normal. Two kidney biopsies revealed no abnormalities. Several weeks later he was admitted for intestinal hemorrhage with significant anemia. Endoscopy of the esophagus, stomach, colon, and small bowel (via laparotomy) were normal. Electrophoresis of urine proteins revealed the unusual finding of an albumin fraction of 99.4%. During a routine check-up in the outpatient clinic fresh urine samples were obtained while the boy's mother was absent. These were all negative for protein. The mother, who was a nurse, finally confessed to adding human albumin to the urine samples.

  15. Massive Alveolar Hemorrhage During Wegener Granulomatosis: a Case Report

    Directory of Open Access Journals (Sweden)

    Gökhan Perincek

    2011-11-01

    Full Text Available This is a presentation of Wegener Granulomatosis (WG disease. Even though the lungs are rarely affected. massive alveolar hemorrhage is seen which leads to mortality. The patient was a 28 year old man. His illness was diagnosed as WG and glomerulonephritis a year previously and he was treated by administration of methylprednisolone orally. He had been treated irregularly. He applied to the emergency service with hemoptysis and asthma complaints two days earlier. After the results of his examination Hb: 3.6 gr/dl, Htc:10.3%, Üre:131 mg /dl, kreatini: 7.7 mg/dl, pH: 7.41, pO2: 55 mmHg, pCO2:33 mmHg, and being diagnosed as alveolar consolidation on lung X-ray, he was taken to the intensive care unit with a diagnosis of a massive alveolar hemorrhagei. He was intubated and attached to mechanical ventilation. He was treated with parenteral 1 mg/kg/day methylprednisolone and, siklofosfamid 2 mg/kg/day. He was extubated on the 21st day. He was taken to the chest service department on 24th day. He is still being treated.

  16. Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature.

    Science.gov (United States)

    Nieuwkamp, D J; de Gans, K; Rinkel, G J; Algra, A

    2000-02-01

    Severe intraventricular hemorrhage caused by extension from subarachnoid hemorrhage or intracerebral hemorrhage leads to hydrocephalus and often to poor outcome. We conducted a systematic review to compare conservative treatment, extraventricular drainage, and extraventricular drainage combined with fibrinolysis. We carried out a search in Medline of the literature between January 1966 and December 1998 and an additional hand-search from January 1990 to December 1998. Pharmaceutical companies were contacted to gather unpublished data. We reviewed the reference lists of all relevant articles. Two authors independently assessed eligibility of the studies and extracted data on characteristics of study design, patients, and treatment. Patients with primary intraventricular hemorrhage were excluded. Main outcome measures were death and poor outcome (defined as death or dependency) at the end of follow-up. No randomized clinical trial has yet been conducted so far, and we therefore reviewed only observational studies. The case fatality rate for conservative treatment (ten studies) was 78%. For extraventricular drainage (seven studies) it was 58% [relative risk versus conservative treatment (RR) 0.74; 95% confidence interval (CI) 0.55-0.99]. For extraventricular drainage with fibrinolytic agents (five studies) the case fatality rate was 6% (RR 0.08; 95% CI 0.02-0.24). The poor outcome rate for conservative treatment was 90%, that for extraventricular drainage 89% (RR 0.98; 95% CI 0.75-1.30) and that for extraventricular drainage with fibrinolytic agents 34% (RR 0.38; 95% CI 0.21-0.68). All RR values remained essentially the same after adjusting for age, sex, World Federation of Neurological Surgeons scale, study design, and year of publication for the studies that provided these data. Outcome is thus poor in patients with intraventricular extension of subarachnoid or intracerebral hemorrhage. This meta-analysis suggests that treatment with ventricular drainage combined

  17. Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Mortensen, Jesper; Figlewski, Krystian; Andersen, Henning

    2016-01-01

    PURPOSE: To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH). METHODS: A double......-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n = 8) or sham (n = 7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen-Taylor test (JTT). RESULTS: Both groups improved...... with the sham group, from baseline to post-assessment (p = 0.158). CONCLUSIONS: Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor...

  18. Intracerebral hemorrhage (ICH) evaluation with a novel magnetic induction sensor: a preliminary study using the Chinese head model.

    Science.gov (United States)

    Zhang, Ziyi; Liu, Peiguo; Zhou, Dongming; Zhang, Liang; Lei, Hengdong

    2014-01-01

    Biomedical magnetic induction measurement is a promising method for the detection of intracerebral hemorrhage (ICH), especially in China. Aiming at overcoming the problem of low sensitivity, a magnetic induction sensor is chosen to replace the conventional sensors. It uses a two-arm Archimedean spiral coil as the exciter and a circular coil as the receiver. In order to carry out high-fidelity simulations, the Chinese head model with real anatomical structure is introduced into this novel sensor for the first time. Simulations have been carried out upon early stage ICH measurements. By calculating the state sensitivity and time sensitivity of the perturbation phase of two types of sensors using the electromagnetic software, we conclude that the primary signal received can be largely reduced using the novel sensor, which could effectively increase the time and state sensitivity simultaneously.

  19. Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

    DEFF Research Database (Denmark)

    Ovesen, Christian; Christensen, Anders Fogh; Krieger, Derk W

    2014-01-01

    BACKGROUND AND PURPOSE: Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE. METHODS: We included consecutive patients presenting...... occurred within the first 7 to 8 hours after symptom onset. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472224....

  20. Comparison of intima-media thickness of common and internal carotid arteries of patients with ischemic stroke and intracerebral hemorrhage.

    Directory of Open Access Journals (Sweden)

    Ali Moghtaderi

    2014-12-01

    Full Text Available Role of atherosclerosis in the pathogenesis of ischemic and hemorrhagic infarctions is still matter of debate. Intima-media thickness (IMT of the common carotid artery (CCA and internal carotid artery (ICA are markers of atherosclerosis. The aim of this study was to compare CCA IMT and ICA IMT of patients with ischemic and hemorrhagic infarction.Two equal groups of 80 patients with small and large vessel ischemic stroke and 80 patients with non-traumatic intracerebral hemorrhage (ICH who referred to our central teaching hospital of Zahedan were assessed in this descriptive study. IMT of four arteries (right and left CCA and ICA were measured, and collected data were analysis using Student's t-test.There were 137 males (57.1% and 103 (42.9% female with mean age of 62.7 ± 11.7. Mean right CCA IMT of patients with small vessel diseases (SVD, large vessel diseases (LVD, and ICH were 0.564 ± 0.130, 0.623 ± 0.150, and 0.580 ± 0.140 mm, respectively (P = 0.032. Mean left CCA IMT of patients with SVD, LVD, and ICH were 0.569 ± 0.120, 0.618 ± 0.120, and 0.573 ± 0.130 mm, respectively (P = 0.039. The above findings for right ICA were 0.572 ± 0.120, 0.569 ± 0.140, and 0.522 ± 0.130 mm, respectively (P = 0.145. Those findings for left ICA IMT were 0.525 ± 0.110, 0.554 ± 0.120, and 0.527 ± 0.120 mm, respectively (P = 0.257.Our findings showed that by using CCA IMT, differentiation between small and large vessel infarctions and hemorrhagic infarctions can be made.

  1. Bipyridine, an iron chelator, does not lessen intracerebral iron-induced damage or improve outcome after intracerebral hemorrhagic stroke in rats.

    Science.gov (United States)

    Caliaperumal, Jayalakshmi; Wowk, Shannon; Jones, Sarah; Ma, Yonglie; Colbourne, Frederick

    2013-12-01

    Iron chelators, such as the intracellular ferrous chelator 2,2'-bipyridine, are a potential means of ameliorating iron-induced injury after intracerebral hemorrhage (ICH). We evaluated bipyridine against the collagenase and whole-blood ICH models and a simplified model of iron-induced damage involving a striatal injection of FeCl2 in adult rats. First, we assessed whether bipyridine (25 mg/kg beginning 12 h post-ICH and every 12 h for 3 days) would attenuate non-heme iron levels in the brain and lessen behavioral impairments (neurological deficit scale, corner turn test, and horizontal ladder) 7 days after collagenase-induced ICH. Second, we evaluated bipyridine (20 mg/kg beginning 6 h post-ICH and then every 24 h) on edema 3 days after collagenase infusion. Body temperature was continually recorded in a subset of these rats beginning 24 h prior to ICH until euthanasia. Third, bipyridine was administered (as per experiment 2) after whole-blood infusion to examine tissue loss, neuronal degeneration, and behavioral impairments at 7 days post-stroke, as well as body temperature for 3 days post-stroke. Finally, we evaluated whether bipyridine (25 mg/kg given 2 h prior to surgery and then every 12 h for 3 days) lessens tissue loss, neuronal death, and behavioral deficits after striatal FeCl2 injection. Bipyridine caused a significant hypothermic effect (maximum drop to 34.6 °C for 2-5 h after each injection) in both ICH models; however, in all experiments bipyridine-treated rats were indistinguishable from vehicle controls on all other measures (e.g., tissue loss, behavioral impairments, etc.). These results do not support the use of bipyridine against ICH.

  2. Hemorrhagic cystitis with massive bleeding from nontyphoidal Salmonella infection: A case report.

    Science.gov (United States)

    Na, Sun-Kyung; Jung, Hye-Kyung; Kim, Young Shin; Yun, Hye-Won; Chung, Jung-Wha; Jung, Ka-Young; Shim, Ki-Nam; Jung, Sung-Ae

    2013-06-01

    Hemorrhagic cystitis is defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage and is caused by viral or bacterial infection or chemotherapeutic agents. Reports of hemorrhagic cystitis caused by non-typhoidal salmonella (NTS) are extremely rare. We report a case of a 41-year-old man with hemorrhagic cystitis from NTS that caused massive bleeding and shock. The patient was hospitalized for uncontrolled diabetes and obstructive uropathy related to severe cystitis. A urine culture was positive for group D NTS. This case demonstrated that hemorrhagic cystitis in a patient with a risk factor such as diabetes can be a manifestation of local extra-intestinal NTS infection.

  3. Evaluation by computed tomography of the destruction of the internal capsule in hypertensive intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Tomita, Yukio; Ohuchi, Tadao; Yukawa, Hideki; Konno, Jyoji; Saiki, Iwao (Iwate Medical Coll., Morioka (Japan). School of Medicine)

    1983-12-01

    Seventy-five patients, 37 with putaminal hemorrhage and 38 with thalamic hemorrhage. were examined by CT immediately after the ictus and while the patients were undergoing conservative treatment. The distance was measured on every CT from the center of the pineal body to the inside edge of the hematoma in the putaminal hemorrhage and to the outside edge in the thalamic hemorrhage, by using a slice 5 cm above the orbitomeatal line on which the pineal body was clearly recognizable. At 6 months after ictus, recuperations from hemiplegia were estimated in all patients and compared with the degree of the measured distance on CT. In the group of patients who had recovered completely from hemiplegia, the degrees were more than 28 mm in the cases of putaminal hemorrhage and less than 32 mm in the cases of thalamic hemorrhage. If the degrees were under 25 mm in the putaminal hemorrhage or over 36 mm in the thalamic hemorrhage, no rehabilitation was effective for their paralytic upper extremities. Measurements of the internal capsule were also performed on three fresh brains without cerebral disease. The normal values of the distance were 34.7+-1.0 mm from the center of the pineal body to the outside edge of the posterior limb of the internal capsule and 25.0+-0.9 mm to its inside edge. Judging from these results, it is thought that the attainable limits of avoiding destruction of the posterior limb of the internal capsule by the hematoma are 28 mm in the case of a putaminal hemorrhage and 32 mm in the case of a thalamic hemorrhage. Therefore, it was considered that the internal capsule can be shifted about 7 mm to the medial or lateral side without any direct or indirect effects from the hematoma.

  4. Intraventricular Bleeding and Hematoma Size as Predictors of Infection Development in Intracerebral Hemorrhage: A Prospective Cohort Study.

    Science.gov (United States)

    Vial, Felipe; Brunser, Alejandro; Lavados, Pablo; Illanes, Sergio

    2016-11-01

    Acute intracerebral hemorrhage (ICH) is associated with increased susceptibility to bacterial infection. The physiopathology of this phenomenon is not very clear. We conducted a prospective observational study investigating the correlation and independent predictors of infections in patients with ICH. Patients admitted between April 1997 and June 2013 with ICH diagnosis were evaluated for inclusion and exclusion criteria. Two hundred twenty-two patients were included in this study. Ninety four patients (42.6%) presented with an infection during hospitalization being more common than pneumonia (30%) and urinary tract infections (14%). Intraventricular hemorrhage (IVH) (95% confidence interval [CI], 62.7% versus 39.3%; P < .001) and higher ICH score (95% CI, 2.31% versus 1.67%; P = .0014) were more common in patients who had infections. We found the following risk factors for having an infection in patients with ICH: IVH (odds ratio [OR] 2.3; 95% IC, 1.3-4.1), each point of ICH score (OR 1.3; 95% CI, 1.1-1.6), and having a hematoma volume larger than 30 cc (OR 2.0; 95% CI, 1.1-3.5). The localization of the hematoma was not found to be relevant. ICH score, size of the hematoma, and presence of IVH are independent risk factors for having an infection after ICH. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Cattle encephalon glycoside and ignotin reduced white matter injury and prevented post-hemorrhagic hydrocephalus in a rat model of intracerebral hemorrhage

    Science.gov (United States)

    Li, Rongwei; Ma, Kang; Zhao, Hengli; Feng, Zhou; Yang, Yang; Ge, Hongfei; Zhang, Xuan; Tang, Jun; Yin, Yi; Liu, Xin; Tan, Liang; Feng, Hua

    2016-01-01

    The morbidity, mortality, and disability associated with intraventricular hemorrhage (IVH) secondary to intracerebral hemorrhage (ICH) represent a global burden. To date, there is no effective therapy for ICH other than supportive care. In this study, we assessed the neuroprotective effects of Cattle encephalon glycoside and ignotin (CEGI) injection in a rat model of ICH with ventricular extension (IVH/ICH). The IVH/ICH rat model was induced via injection of type IV collagenase in the caudate nucleus of Sprague-Dawley rats. The experimental animals were randomized to receive CEGI, monosialotetrahexosyl ganglioside (GM-1), or normal saline. The modified Garcia scale, corner turn test, immunofluorescence staining for myelin basic protein (MBP) and microtubule associated protein 2 (MAP-2), transmission electron microscopy (TEM), and magnetic resonance imaging were employed to evaluate the neuroprotective effect of CEGI in the IVH/ICH rat model. CEGI treatment significantly alleviated the neurobehavioral dysfunction, reduced the lateral ventricular enlargement, promoted hematoma absorption, effectively up-regulated MBP/MAP-2 expression, and ameliorated white matter fiber damage post-ICH induction. Our results demonstrate that CEGI has significant neuroprotective effects in a rat model of IVH/ICH. Therefore, it can be used as a candidate drug for the clinical treatment of IVH/ICH. PMID:27782218

  6. Molecular, Cellular and Clinical Aspects of Intracerebral Hemorrhage: Are the Enemies Within?

    Science.gov (United States)

    Righy, Cássia; Bozza, Marcelo T.; Oliveira, Marcus F.; Bozza, Fernando A.

    2016-01-01

    Hemorrhagic stroke is a disease with high incidence and mortality rates. In addition to the mass lesions that result from hemorrhagic stroke, substances such as the blood-derived products (BDP) (hemoglobin (Hb), heme and iron) induce a potent inflammatory response and exert direct toxic effects on neurons, astrocytes, and microglia. In the present review, we discuss the mechanisms of brain injury secondary to hemorrhagic stroke, focusing on the involvement of BDP as major players of cellular redox imbalance, inflammation, and glutamate excitotoxicity. Potential natural mechanisms of protection against free Hb and heme such as haptoglobin and hemopexin, respectively, are highlighted. We finally discuss the experimental and clinical trials targeting free iron and heme scavenging as well as inflammation, as potential new therapies to minimize the devastating effects of hemorrhagic stroke on brain structure and function. PMID:26714583

  7. 463例脑出血患者的预后分析%Prognosis of patients with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    谭光林; 段文涛; 杨思芸; 李四新; 孙志勇; 郭明刚

    2010-01-01

    目的 分析脑出血患者的相关因素,指导脑出血的治疗及判断预后.方法 回顾性分析463例脑出血患者的临床资料及随访结果,应用单因素分析及Logistic多元回归分析,探讨预后的相关因素.结果 年龄、Glasgow昏迷指数、出血量、NIHSS评分、平均动脉压、出血有无破入脑室、有无中线移位、发病时随机血糖水平及并发症在两组中比较差异无统计学意义.预后不良组平均年龄71岁、平均血肿体积29 ml、平均GCS评分11.2,而预后良好组分别为65岁、15 ml、15.1,P值<0.05,差异有统计学意义.Logistic多元回归分析表明,年龄、出血量、意识障碍是脑出血发病3个月后预后不良的独立影响因素,其OR值分别为1.32、8.66、1.08.结论 ICH发病诱因较多,维持血压正常是预防ICH的重要措施.血肿体积、意识障碍、年龄可用于预测脑出血的预后.%Objective To study the related factors of patients with intracerebral hemorrhage (ICH)so as to guide treatment and predict prognosis. Methods The prognostic factors of 463 cases with intracerebral hemorrhage were analyzed with single factor and Logistic regression analyses. Results Age,Glasgow coma scale, amount of hemorrhage, NIHSS score, mean arterial blood pressure, with or without ventricular breakage, with or without midline shift and the incidence of complications at random blood glucose levels were analyzed for the correlation with the prognosis of patients. The poor prognosis group had significant differences with the good prognosis group with regards to these factors. The average age of patients with a poor prognosis was 71 years old, the average hematoma volume 29 ml and the average GCS score 11. 2versus 65 years old, 15 ml, 15. 1 for those with a good prognosis ( P < 0.05 ). Logistic regression analysis showed that age, amount of hemorrhage and disturbance of consciousness was an independent adverse prognostic factor for cerebral hemorrhage at

  8. Association of TNF-α gene with spontaneous deep intracerebral hemorrhage in the Taiwan population: a case control study

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    Chen Sien-Tsong

    2010-06-01

    Full Text Available Abstract Background Genetic factors may play a role in susceptibility to spontaneous deep intracerebral hemorrhage (SDICH. Previous studies have shown that TNF-α gene variation was associated with risks of subarachnoid hemorrhage in multiple ethnicities. The present case-control study tested the hypothesis that genetic variations of the TNF-α gene may affect the risk of Taiwanese SDICH. We examined the association of SDICH risks with four single nucleotide polymorphisms (SNPs within the TNF-α gene promoter, namely T-1031C, C-863A, C-857T, and G-308A. Methods Genotyping was determined by PCR-based restriction and electrophoresis assay for 260 SDICH patients and 368 controls. Associations were tested by logistic regression or general linear models with adjusting for multiple covariables in each gender group, and then in combined. Multiplicative terms of gender and each of the four SNPs were applied to detect the interaction effects on SDICH risks. To account for the multiple testing, permutation testing of 1,000 replicates was performed for empirical estimates. Results In an additive model, SDICH risks were positively associated with the minor alleles -1031C and -308A in men (OR = 1.9, 95% CI 1.1 to 3.4, p = 0.03 and OR = 2.6, 95% CI 1.3 to 5.3, p = 0.005, respectively but inversely associated with -863A in females (OR = 0.5, 95% CI 0.2 to 0.9, p = 0.03. There were significant interaction effects between gender and SNP on SDICH risks regarding SNPs T-1031C, C-863A, and G-308A (p = 0.005, 0.005, and 0.007, respectively. Hemorrhage size was inversely associated with -857T in males (p = 0.04. Conclusions In the Taiwan population, the associations of genetic variations in the TNF-α gene promoter with SDICH risks are gender-dependent.

  9. Prostaglandin E2 EP2 Receptor Deletion Attenuates Intracerebral Hemorrhage-Induced Brain Injury and Improves Functional Recovery

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    Jenna L. Leclerc

    2015-04-01

    Full Text Available Intracerebral hemorrhage (ICH is a devastating type of stroke characterized by bleeding into the brain parenchyma and secondary brain injury resulting from strong neuroinflammatory responses to blood components. Production of prostaglandin E2 (PGE2 is significantly upregulated following ICH and contributes to this inflammatory response in part through its E prostanoid receptor subtype 2 (EP2. Signaling through the EP2 receptor has been shown to affect outcomes of many acute and chronic neurological disorders; although, not yet explored in the context of ICH. Wildtype (WT and EP2 receptor knockout (EP2−/− mice were subjected to ICH, and various anatomical and functional outcomes were assessed by histology and neurobehavioral testing, respectively. When compared with age-matched WT controls, EP2−/− mice had 41.9 ± 4.7% smaller ICH-induced brain lesions and displayed significantly less ipsilateral hemispheric enlargement and incidence of intraventricular hemorrhage. Anatomical outcomes correlated with improved functional recovery as identified by neurological deficit scoring. Histological staining was performed to begin investigating the mechanisms involved in EP2-mediated neurotoxicity after ICH. EP2−/− mice exhibited 45.5 ± 5.8% and 41.4 ± 8.1% less blood and ferric iron accumulation, respectively. Furthermore, significantly less striatal and cortical microgliosis, striatal and cortical astrogliosis, blood–brain barrier breakdown, and peripheral neutrophil infiltration were seen in EP2−/− mice. This study is the first to suggest a deleterious role for the PGE2-EP2 signaling axis in modulating brain injury, inflammation, and functional recovery following ICH. Targeting the EP2 G protein-coupled receptor may represent a new therapeutic avenue for the treatment of hemorrhagic stroke.

  10. The Physiopathologic Mechanism of Cerebral Edema with Intracerebral Hemorrhage%脑出血后脑水肿形成的病理生理机制

    Institute of Scientific and Technical Information of China (English)

    屈洪党; 殷亮; 陈齐鸣

    2011-01-01

    Objective: To investigate the physiopathologic mechanism of cerebral edema after intracere-bral hemorrhage. Methods: To analyze the physiopathologic mechanism of cerebral edema after intracerebral hemorrhage by summarizing pertinent literatures. Results:The cerebral edema generated after intracerebral hemorrhage in the ultra - early onset. The significant factors which aggravated cerebral edema included compression of hematoma, ischemia, thrombase, hemoglobin and plasma protein, leucocytes and inflammatory cell factor. Conclusions:The physiopathologic mechanism of cerebral edema with intracerebral hemorrhage is complicated, which can provide ways and methods to treat the edema in the surrounding tissues of cerebral hematom.%目的:探讨脑出血后脑水肿形成的病理生理机制.方法:总结相关文献,分析脑出血后脑水肿形成的病理生理机制.结果:脑水肿多在脑出血后超早期发生.血肿占位效应、缺血因素、凝血酶、血红蛋白和血浆蛋白、白细胞和炎性细胞因子等在脑水肿形成的过程中具有重要作用.结论:脑出血后脑水肿形成的病理机制十分复杂,研究脑水肿的形成机制,可以为临床医师治疗血肿周围脑组织水肿提供新的途径和方法.

  11. 脑出血相关治疗指南与临床现状%Guideline and current status on prevention and treatment of intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    宋水江; 戴加勇; 汤永国

    2013-01-01

    The AHA/ASA guideline for intracerebral hemorrhage has been published nearly 2 years,however,the clinicians pay much less attention to it than the guideline of cerebral ischemia.At present there's big gaps between the status of control for intracerebral hemorrhage and guideline.Based on the analysis of current situation,comparing with the requirements of guideline,we hope to make the treatment of intracerebral hemorrhage in our country accord with the principle of guideline,making more patients benefit from the treatment.%美国心脏协会(AHA)和美国卒中学会(ASA)制定的《自发性脑出血诊疗指南》发表已逾3年,但临床医生对于脑出血指南的重视程度远不如缺血性脑血管病指南.目前有关脑出血的防治现状与指南存在较大差距.文章通过对现状的分析,对照指南的要求,希望能使中国脑出血的治疗更符合指南的精神,使更多脑出血患者从治疗中获益.

  12. The Effect of Minimally Invasive Hematoma Aspiration on the JNK Signal Transduction Pathway after Experimental Intracerebral Hemorrhage in Rats

    Science.gov (United States)

    Pei, Haitao; Jiang, Tao; Liu, Guofang; Li, Zhaoxing; Luo, Kai; An, Jingjiao; Li, Guangcheng; Guo, Yunliang

    2016-01-01

    Objective: To explore the effect of minimally invasive hematoma aspiration (MIHA) on the c-Jun NH2-terminal kinase (JNK) signal transduction pathway after intracerebral hemorrhage (ICH). Methods: In this experiment, 300 adult male Wistar rats were randomly and averagely divided into sham-operated group, ICH group and MIHA group. In each group, 60 rats were used in the detection of indexes in this experiment, while the other 40 rats were used to replace rats which reached the exclusion criteria (accidental death or operation failure). In ICH group and MIHA group, ICH was induced by injection of 70 µL of autologous arterial blood into rat brain, while only the rats in MIHA group were treated by MIHA 6 h after ICH. Rats in sham-operated group were injected nothing into brains, and they were not treated either, like rats in ICH group. In each group, six rats were randomly selected to observe their Bederson’s scales persistently (6, 24, 48, 72, 96, 120 h after ICH). According to the time they were sacrificed, the remaining rats in each group were divided into 3 subgroups (24, 72, 120 h). The change of brain water content (BWC) was measured by the wet weight to dry weight ratio method. The morphology of neurons in cortex was observed by the hematoxylin–eosin (HE) staining. The expressions of phospho-c-Jun NH2-terminal kinase (pJNK) and JNK in peri-hematomal brain tissue were determined by the immunohistochemistry (IHC) and Western blotting (WB). Results: At all time points, compared with the ICH groups, the expression of pJNK decreased obviously in MIHA groups (p < 0.05), while their Bederson’s scales and BWC declined, and neuron injury in the cortex was relieved. The expression level of JNK was not altered at different groups. The data obtained by IHC and WB indicated a high-level of consistency, which provided a certain dependability of the test results. Conclusion: The JNK signal transduction pathway could be activated after intracerebral hemorrhage, with the

  13. Cell apoptosis in perihematomal brain regions and expression of Caspase-3 protein in patients with hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Xinqing Zhang; Xiaoliang Yin; Kun Zhang; Zhimin Zhang; Hui Cai; Honglan Xu

    2006-01-01

    BACKGROUND: In patients with intracerebral hemorrhage (ICH), besides the space-occupying effect of hematoma, hematomal component also causes the pathological changes of perihematomal region, including the death of neurons and glial cells, vasogenic brain edema, the destruction of blood brain barrier and so on, which are the important factors to influence the prognosis of patients. Therefore, it is necessary to perform fur ther investigation and study on the pathological characteristics of injury and death of brain nerve cells. OBJECTIVE: To observe the pathological changes of apoptosis and Caspase-3 expression in perihe matomal brain regions in patients with hypertensive ICH (HICH) in different stages of onset, and analyze their relationship. DESIGN: Case-control observation. SETTING: Departments of Neurosurgery and Pathology of Beijing Chuiyangliu Hospital. PARTICIPANTS: Totally 19 patients with HICH, including 12 male, 7 female, aged (58.3±12.8) ranging from 49 to 78 years, whose mean volume of hemorrhage was (48.6±16.4) mL, were involved . All the cases conformed to the diagnostic criteria of intracerebral hemorrhage formulated in the 4th National Cerebrovascular Dis eases Conference and were confirmed by skull CT scanning. Informed consents of operation and specimens were obtained from the patients and relatives.METHODS; ①Patients with HICH who had undergone surgical evacuation of an intracerebral hematoma by traverse temporal lobe approach in the Department of Neurosurgery, Beijing Chuiyangliu Hospital from Jan uary 2004 to July 2005 were involved. Nineteen specimens of brain tissue from perihematomal region of HICH patients in different phases served as patient group. Five specimens were obtained from distant regions of patients in the super-early phase as the control group. According to the time from onset to operation, the 19 cases were divided into 3 groups: 6 cases in super-early phase(onset < 8 hours), 8 cases in early phase (onset about 8 to 24

  14. Increased Plasma Matrix Metalloproteinase-9 Levels Contribute to Intracerebral Hemorrhage during Thrombolysis after Concomitant Stroke and Influenza Infection

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    Sajjad Muhammad

    2016-08-01

    Full Text Available Background: Thrombolysis is the only approved therapy for acute stroke. However, life-threatening complications such as intracerebral hemorrhage (ICH can develop after intravenous administration of tissue plasminogen activator (tPA. Both infection and thrombolysis during cerebral ischemia disrupt the blood-brain barrier (BBB. tPA can induce matrix metalloproteinase-9 (MMP-9, which is known to be involved in BBB disruption. However, it has still not been investigated whether preexisting influenza virus infection during thrombolysis after acute stroke affects systemic levels of MMP-9 and its inhibitor TIMP-1 and whether increased systemic MMP-9 levels affect ICH. This study aimed to investigate the influence of influenza virus infection on plasma levels of MMP-9 and TIMP-1 after thrombolysis in acute stroke, and to determine whether the infection correlates with intracerebral bleeding. Methods: C57BL/6 mice were infected by administering 1 × 105 plaque-forming units of human influenza (H1N1 virus intranasally. After 3 days of infection the middle cerebral artery was occluded for 45 min and then reperfused. Intravenous tPA (10 mg/kg treatment was started 10 min after stroke onset. Twenty-four hours after stroke onset, mice were deeply anesthetized with ketamine, venous blood was drawn from the caval vein and centrifuged at 2,000 rpm, and the supernatant was collected and frozen at -80°C. Plasma levels of MMP-9 and TIMP-1 were quantified by using ELISA. Results: After stroke, plasma MMP-9 was significantly increased in mice with a concomitant influenza infection that were treated with tPA (9.99 ± 0.62 ng/ml, n = 7 as compared to noninfected control mice that were treated with tPA (4.74 ± 0.48 ng/ml, n = 8. Moreover, plasma levels of TIMP-1, an inhibitor of MMP-9, were also significantly increased in mice treated with tPA after concomitant infection and stroke (42.17 ± 7.02 ng/ml, n = 7 as compared to noninfected control mice that were treated

  15. Late hemorrhagic disease of the newborn as a cause of intracerebral bleeding.

    Science.gov (United States)

    Solves, P; Altés, A; Ginovart, G; Demestre, J; Fontcuberta, J

    1997-01-01

    We report a case of a 4-week-old female who presented with late hemorrhagic disease of the newborn (HDN). The newborn was previously healthy, and she received 1 mg of intramuscular vitamin K at birth. She was exclusively breast-fed. At 4 weeks she began bleeding at the umbilicus and 4 days after she suffered an intracranial hemorrhage. Coagulation studies showed a deficiency of vitamin K-dependent coagulation factors, and the normalization of all clotting studies after administration of vitamin K confirmed the diagnosis of HDN. Our conclusions are that physicians must be alert to mild bleeding in newborns and that prophylaxis with 1 mg of intramuscular vitamin K at birth may be insufficient to prevent late HDN.

  16. Efficacy of deferoxamine in animal models of intracerebral hemorrhage: a systematic review and stratified meta-analysis.

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    Han-Jin Cui

    Full Text Available Intracerebral hemorrhage (ICH is a subtype of stroke associated with high morbidity and mortality rates. No proven treatments are available for this condition. Iron-mediated free radical injury is associated with secondary damage following ICH. Deferoxamine (DFX, a ferric-iron chelator, is a candidate drug for the treatment of ICH. We performed a systematic review of studies involving the administration of DFX following ICH. In total, 20 studies were identified that described the efficacy of DFX in animal models of ICH and assessed changes in the brain water content, neurobehavioral score, or both. DFX reduced the brain water content by 85.7% in animal models of ICH (-0.86, 95% CI: -.48- -0.23; P < 0.01; 23 comparisons, and improved the neurobehavioral score by -1.08 (95% CI: -1.23- -0.92; P < 0.01; 62 comparisons. DFX was most efficacious when administered 2-4 h after ICH at a dose of 10-50 mg/kg depending on species, and this beneficial effect remained for up to 24 h postinjury. The efficacy was higher with phenobarbital anesthesia, intramuscular injection, and lysed erythrocyte infusion, and in Fischer 344 rats or aged animals. Overall, although DFX was found to be effective in experimental ICH, additional confirmation is needed due to possible publication bias, poor study quality, and the limited number of studies conducting clinical trials.

  17. The extent of the perihemorrhagic perfusion zone correlates with hematoma volume in patients with lobar intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Beseoglu, Kerim; Etminan, Nima; Steiger, Hans-Jakob; Haenggi, Daniel [Heinrich-Heine-Universitaet Duesseldorf, Department of Neurosurgery, Medical Faculty, Duesseldorf (Germany); Turowski, Bernd [Heinrich-Heine-Universitaet Duesseldorf, Department of Diagnostic and Interventional Radiology, Medical Faculty, Duesseldorf (Germany)

    2014-07-15

    Existing data on perfusion imaging assumes the perihemorrhagic zone (PHZ) in patients with intracerebral hemorrhage (ICH) to be size steady. This study investigates the size of the perihemorrhagic zone (PHZ) in patients with lobar ICH in relation to hematoma volume during the course of treatment using perfusion CT (PCT). The present analysis is based on a previously reported cohort of 20 patients undergoing surgical evacuation for lobar SICH, with pre- and early postoperative PCT scanning. Time to peak of the residue function (T{sub max}) was measured based on the 360 cortical banding method and singular value decomposition. The size of PHZ was determined before and after treatment and correlated with hematoma volume. Preoperative mean hematoma volume constituted 63.0 ml (interquartile ranges (IQR) 39.7-99.4 ml), which correlated significantly (r = 0.563, p = 0.010) with mean PHZ size (5.67 cm, IQR 5.44-8.17 cm). Following a surgical hematoma evacuation, mean hematoma volume was reduced to 2.5 ml IQR 0.0-9.5 ml, which also resulted in a significant reduction of PHZ size to 0.45 cm(IQR 0.0-1.36 cm; p < 0.001). There was no association between postoperative hematoma volume and size of the PHZ. Our findings illustrate that the extent of the PHZ cannot be generally assumed to be constant in size and that this differs significantly following hematoma reduction in patients with space occupying lobar SICH. (orig.)

  18. The reliability and sensitivity of the National Institutes of Health Stroke Scale for spontaneous intracerebral hemorrhage in an uncontrolled setting.

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    Adrian V Specogna

    Full Text Available BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS is commonly used to measure neurologic function and guide treatment after spontaneous intracerebral hemorrhage (ICH in routine stroke clinics. We evaluated its reliability and sensitivity to detect change with consecutive and unique rater combinations in a real-world setting. METHODS: Conservative measures of interrater reliability (unweighted Kappa (κ, Intraclass Correlation Coefficient (ICC1,1 and sensitivity to detect change (Minimal Detectable Difference (MDD were estimated. Sixty-one repeated ratings were completed within 1 week after ICH by physicians and nurses with no investigator intervention. RESULTS: Reliability (consistency of the NIHSS total score was good for both physicians vs. nurses and nurses vs. nurses (ICC=0.78, 95%CI: 0.58-0.89 and ICC=0.75, 95%CI: 0.55-0.87 respectively in this scenario. Reliability (agreement of items 1C and 9 were excellent (κ>=0.61 for both rater comparisons, however, reliability was poor to fair on most remaining items (κ:0.01-0.60, with item 11 being completely unreliable in this scenario (κ=10 points need to be observed for clinicians to be confident that real changes had occurred within 1 week after ICH.

  19. Corticospinal Tract Compression by Hematoma in a Patient with Intracerebral Hemorrhage: A Diffusion Tensor Tractography and Functional MRI Study

    Science.gov (United States)

    Jang, Sung-Ho; Lee, Mi Young; Ahn, Sang Ho; Kim, Joong Hwi; Jeong, Dong-Hoon; Choi, Byung Yeun; Lee, Dong Gyu

    2006-01-01

    The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract. PMID:16502496

  20. Risk of Delayed Intracerebral Hemorrhage in Anticoagulated Patients after Minor Head Trauma: The Role of Repeat Cranial Computed Tomography

    Science.gov (United States)

    Swap, Clifford; Sidell, Margo; Ogaz, Raquel; Sharp, Adam

    2016-01-01

    Context: Patients receiving anticoagulant medications who experience minor head injury are at increased risk of an intracerebral hemorrhage (ICH) developing, even after an initial computed tomography (CT) scan of the brain yields normal findings. Conflicting evidence exists regarding the frequency at which delayed bleeding occurs. Objective: To identify the frequency of delayed traumatic ICH in patients receiving warfarin or clopidogrel. Design: We performed a retrospective observational study of adult trauma encounters for anticoagulated patients undergoing head CT at 1 of 13 Kaiser Permanente Southern California Emergency Departments (EDs) between 2007 and 2011. Encounters were identified using structured data from electronic health and administrative records, and then records were individually reviewed for validation of results. Main Outcome Measures: The primary outcome measure was ICH within 60 days of an ED visit with a normal head CT result. Results: Our sample included 443 (260 clopidogrel and 183 warfarin) eligible ED encounters with normal findings of initial head CT. Overall, 11 patients (2.5%, 95% confidence interval [CI] = 1.4%–4.4%) had a delayed ICH, and events occurred at similar rates between the clopidogrel group (6/260, 2.3%, CI 1.1%–5.0%) and warfarin group (5/183, 2.7%, CI 1.2%–6.2%). Conclusion: Trauma patients in the ED who are receiving warfarin or clopidogrel have approximately a 2.5% risk of delayed ICH after an initial normal finding on a head CT. PMID:26901269

  1. Cerebroprotection by the neuronal PGE2 receptor EP2 after intracerebral hemorrhage in middle-aged mice.

    Science.gov (United States)

    Wu, He; Wu, Tao; Han, Xiaoning; Wan, Jieru; Jiang, Chao; Chen, Wenwu; Lu, Hong; Yang, Qingwu; Wang, Jian

    2017-01-01

    Inflammatory responses mediated by prostaglandins such as PGE2 may contribute to secondary brain injury after intracerebral hemorrhage (ICH). However, the cell-specific signaling by PGE2 receptor EP2 differs depending on whether the neuropathic insult is acute or chronic. Using genetic and pharmacologic approaches, we investigated the role of EP2 receptor in two mouse models of ICH induced by intrastriatal injection of collagenase or autologous arterial whole blood. We used middle-aged male mice to enhance the clinical relevance of the study. EP2 receptor was expressed in neurons but not in astrocytes or microglia after collagenase-induced ICH. Brain injury after collagenase-induced ICH was associated with enhanced cellular and molecular inflammatory responses, oxidative stress, and matrix metalloproteinase (MMP)-2/9 activity. EP2 receptor deletion exacerbated brain injury, brain swelling/edema, neuronal death, and neurobehavioral deficits, whereas EP2 receptor activation by the highly selective agonist AE1-259-01 reversed these outcomes. EP2 receptor deletion also exacerbated brain edema and neurologic deficits in the blood ICH model. These findings support the premise that neuronal EP2 receptor activation by PGE2 protects brain against ICH injury in middle-aged mice through its anti-inflammatory and anti-oxidant effects and anti-MMP-2/9 activity. PGE2/EP2 signaling warrants further investigation for potential use in ICH treatment.

  2. The effect of a neurocritical care service without a dedicated neuro-ICU on quality of care in intracerebral hemorrhage.

    Science.gov (United States)

    Burns, Joseph D; Green, Deborah M; Lau, Helena; Winter, Michael; Koyfman, Feliks; DeFusco, Christina M; Holsapple, James W; Kase, Carlos S

    2013-06-01

    Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. We retrospectively identified all patients admitted to our institution with intracerebral hemorrhage (ICH) in two 12-month periods: immediately before the arrival of the first neurointensivist ("before") and after the neurocritical care service was established ("after"). There was no nursing team, ICU housestaff/physician extender team, or physical unit dedicated to the care of patients with critical neurologic illness during either period. Using an uncontrolled before-after design, we compared clinical outcomes and performance on quality metrics between groups. We included 74 patients with primary supratentorial ICH. Mortality, length of stay (LOS), proportion of patients with modified Rankin Score 0-3, and destination on discharge did not differ between groups when adjusted for confounders. Time to first two consecutive systolic blood pressure (SBP) measurements neuro-ICU at our institution was associated with a trend toward longer ICU LOS and improvement in some key metrics of quality of care for patients with ICH.

  3. Effect of operative moment and style on postoperative daily life in hypertensive intracerebral hemorrhage%手术时机及手术方式的选择对高血压脑出血患者术后日常生活能力恢复的影响

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Rational operation in early stage was an important means to promote patients' rehabilitation.Different effects were compared to explore a reasonable classification of hypertensive intracerebral hemorrhage.

  4. Active extravasation of contrast within the hemorrhage (spot sign: a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Marcos Rosa Junior

    2013-10-01

    Full Text Available Intracerebral hemorrhage (ICH causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%, with ages varying from 33 to 89 years (median age 55 years. Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality, whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality.

  5. The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage.

    Science.gov (United States)

    James, Robert F; Palys, Viktoras; Lomboy, Jason R; Lamm, J Richard; Simon, Scott D

    2013-05-01

    New anticoagulant and antiplatelet medications have been approved and are prescribed with increased frequency. Intracranial hemorrhage is associated with the use of these medications. Therefore, neurosurgeons need to be aware of these new medications, how they are different from their predecessors, and the strategies for the urgent reversal of their effects. Utilization of intraluminal stents by endovascular neurosurgeons has resulted in the need to have a thorough understanding of antiplatelet agents. Increased use of dabigatran, rivaroxaban, and apixaban as oral anticoagulants for the treatment of atrial fibrillation and acute deep venous thrombosis has increased despite the lack of known antidotes to these medications.

  6. Aphasia caused by intracerebral hemorrhage; CT-scan findings and prognosis

    Energy Technology Data Exchange (ETDEWEB)

    Furuya, Kazuhide; Segawa, Hiromu; Shiokawa, Yoshiaki; Hasegawa, Isao; Sano, Keiji (Fuji Brain Institute and Hospital, Shizuoka (Japan))

    1992-10-01

    It is generally accepted that cases of aphasia can be divided into several groups according to verbal fluency, auditory comprehension, and repetition abilities. Although many authors have studied aphasia and its location by means of a CT scan, the primary lesion on a CT scan with regard to the subtypes of aphasia still remains controversial. In this report we present our new CT classification for the syndromes of aphasia and the prognosis. Twenty-one patients with intracerebral hematoma (ICH) were followed up for more than 3 months after onset. ICH was classified according to the mode of the horizontal extension of the hematoma on a CT scan. Four lines were decided as follows: Line (a) is between the anterior horn of the lateral ventricle and the midpoint of the third ventricle; Line (b) is the vertical line to the saggital line which originates from the midpoint of the third ventricle; Line (c) is between the trigone of the lateral ventricle and the midpoint of the third ventricle. The CT classification consisted of 4 types: in Type A, ICH was located anterior to line (a); in Type B, ICH was located between line (a) and line (b); in Type C, ICH was located between line (b) and line (c); Type B+C, was a combination of Type B and Type C. Transcortical motor aphasia belonged to the Type A group. Transcortical sensory aphasia belonged to the Type B and Type B+C groups. Wernicke's and anomic aphasia belonged to the Type C group. Conduction and global aphasia belonged to the Type B+C group. Pure Broca's aphasia could not be observed in this series. Several relationships between the syndromes of aphasia and its CT findings were evident. On the other hand, the syndromes of aphasia and the degree of recovery were not correlated, except for global aphasia. (author).

  7. Unilateral massive hemothorax in Dengue hemorrhagic fever:A unique presentation

    Institute of Scientific and Technical Information of China (English)

    Suman S Karanth; Anurag Gupta; Mukhyaprana Prabhu

    2012-01-01

    Dengue hemorrhagic fever is a more serious form of disease characterised by plasma leakage syndrome, thrombocytopenia and disseminated intravascular coagulation.We present a51 year old male who presented with fever, petechiae and acute onset of breathlessness.Emergency chest rhoentogram showed a massive right sided pleural effusion.On insertion of intercostal drain, there was a sudden gush ofblood tinged fluid suggestive of hemothorax.There was no history of trauma or bleeding tendencies.Laboratory investigations revealed a raised hematocrit and severe thrombocytopenia.DengueIgM was surprisingly positive.After aggressive supportive management the patient gradually improved and was discharged.While bilateral pleural effusion is a known occurrence in dengue hemorrhagic fever, massive hemothorax is unheard of.We report the first case in literature of dengue hemorrhagic fever presenting as unilateral massive hemothorax.A suspicion of dengue must also be borne in mind in cases of non- traumatic hemothorax especially in endemic areas.

  8. Hemorrhagic cystitis with massive bleeding from nontyphoidal Salmonella infection: A case report

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    Sun-Kyung Na

    2013-06-01

    We report a case of a 41-year-old man with hemorrhagic cystitis from NTS that caused massive bleeding and shock. The patient was hospitalized for uncontrolled diabetes and obstructive uropathy related to severe cystitis. A urine culture was positive for group D NTS. This case demonstrated that hemorrhagic cystitis in a patient with a risk factor such as diabetes can be a manifestation of local extra-intestinal NTS infection.

  9. CT Findings and Mortality in Patients with Nontraumatic Intracerebral Hemorrhage Hallazgos tomográficos y mortalidad en pacientes con hemorragias intracerebrales no traumáticas

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    Liliana Teresa Caneiro González

    2011-04-01

    Full Text Available Background: Cerebrovascular disease is among the leading causes of death in developed countries. Intracerebral hemorrhage contributes a significant number of these deaths. Objective: To establish the prognostic value of a set of demographic and tomography variables in patients with nontraumatic intracerebral hemorrhage. Methods: A descriptive case series study was conducted. The sample consisted of patients diagnosed with intraparenchymatous and intracerebral hemorrhage admitted in the General University Hospital of Cienfuegos between May 2006 and April 2007. Clinical records were analyzed. In the case of dead patients the autopsy reports were included. Patients were characterized according to demographic and tomographic variables, considered as risk factors for the type of analyzed hemorrhage. Mortality was determined as well as the behaviour of these variables in such cases. Results: 135 patients were included, being 76.3% of them over 60 years old. There were no differences according to gender. Patients with non-white skin color were predominant. Intracerebral hemorrhage was more common in patients under 60 years old while intraparenchymatous hemorrage predominated in patients from 75 on. Most voluminous hematomas were detected in intracerebral hemorrhage patients (83.3%, as well as hydrocephalus (52.2%. The risk of dying from this type of hemorrhage (94.0% was higher than from intraparenchymatous hemmorrage (about 81%. Conclusions: The highly contributing factors to mortality were: old age, non-white skin color, hydrocephalus and displacement of midline structures for more than 5 mm.Fundamento: la enfermedad vascular cerebral se encuentra entre las primeras causas de muerte en países desarrollados. La hemorragia intracerebral aporta un número importante de esas muertes. Objetivo: establecer el valor pronóstico de un grupo

  10. [Role of vascular erosion in massive colonic hemorrhage of diverticular origin. Apropos of a case].

    Science.gov (United States)

    Delattre, J F; Palot, J P; Casola, M; Baudrillard, J C; Denis, J P

    1986-01-01

    A case of massive hemorrhage from colon of diverticular origin is reported. A complete study of operative specimen allowed precise localization of diverticulum responsible and guidance of histopathologists in their search for the arterial erosion. Histology showed loss of arterial substance with total communication with diverticular lumen. A literature review emphasized vascular relations of diverticuli and the role of stercoliths in the mechanical agression responsible for the massive hemorrhage. It also illustrated the predominance of arteriography in the modern diagnostic and therapeutic approach to these lesions.

  11. Sesamin suppresses activation of microglia and p44/42 MAPK pathway, which confers neuroprotection in rat intracerebral hemorrhage.

    Science.gov (United States)

    Ohnishi, M; Monda, A; Takemoto, R; Matsuoka, Y; Kitamura, C; Ohashi, K; Shibuya, H; Inoue, A

    2013-03-01

    Thrombin plays important roles in the pathology of intracerebral hemorrhage (ICH). The recruitment of activated microglia, accompanied by thrombin-induced phosphorylation of the mitogen-activated protein kinase (MAPK) family, contributes to ICH-associated neuron loss. Here we investigated the possibility that sesamin, a lignan of sesame seed oil, is a natural candidate as an inhibitor of microglial activation and MAPK pathways under ICH insults. Sesamin (30-100 μM) suppressed thrombin-induced nitric oxide (NO) production by primary-cultured rat microglia via inhibition of inducible NO synthase (iNOS) protein expression, independently of the antioxidative effect. Sesamin selectively inhibited p44/42 MAPK phosphorylation in the MAPK family (p38 and p44/42) involved in iNOS protein expression in primary-cultured rat microglia. An in vivo rat ICH model was prepared by intrastriatal injection of 0.20U collagenase type IV unilaterally. ICH evoked the phosphorylation of p44/42 MAPK, microglial proliferation with morphological change into the activated ameboid form, and neuron loss. The phosphorylation of p44/42 MAPK was inhibited by intracerebroventricular administration of 30-nmol sesamin. Sesamin prevented ICH-induced increase of microglial cells in the perihematomal area. Notably, ramified microglia, the resting morphology, were observed in brain sections of the animals administrated sesamin. Sesamin furthermore achieved neuroprotection in the perihematomal area but not in the hematomal center. These results suggest that sesamin is a promising natural product as a novel therapeutic strategy based on the regulation of microglial activities accompanied by the activated p44/42 MAPK pathway in ICH.

  12. Inflammatory Regulation by Driving Microglial M2 Polarization: Neuroprotective Effects of Cannabinoid Receptor-2 Activation in Intracerebral Hemorrhage

    Science.gov (United States)

    Lin, Li; Yihao, Tao; Zhou, Feng; Yin, Niu; Qiang, Tan; Haowen, Zheng; Qianwei, Chen; Jun, Tang; Yuan, Zhang; Gang, Zhu; Hua, Feng; Yunfeng, Yang; Zhi, Chen

    2017-01-01

    The cannabinoid receptor-2 (CB2R) was initially thought to be the “peripheral cannabinoid receptor.” Recent studies, however, have documented CB2R expression in the brain in both glial and neuronal cells, and increasing evidence suggests an important role for CB2R in the central nervous system inflammatory response. Intracerebral hemorrhage (ICH), which occurs when a diseased cerebral vessel ruptures, accounts for 10–15% of all strokes. Although surgical techniques have significantly advanced in the past two decades, ICH continues to have a high mortality rate. The aim of this study was to investigate the therapeutic effects of CB2R stimulation in acute phase after experimental ICH in rats and its related mechanisms. Data showed that stimulation of CB2R using a selective agonist, JWH133, ameliorated brain edema, brain damage, and neuron death and improved neurobehavioral outcomes in acute phase after ICH. The neuroprotective effects were prevented by SR144528, a selective CB2R inhibitor. Additionally, JWH133 suppressed neuroinflammation and upregulated the expression of microglial M2-associated marker in both gene and protein level. Furthermore, the expression of phosphorylated cAMP-dependent protein kinase (pPKA) and its downstream effector, cAMP-response element binding protein (CREB), were facilitated. Knockdown of CREB significantly inversed the increase of M2 polarization in microglia, indicating that the JWH133-mediated anti-inflammatory effects are closely associated with PKA/CREB signaling pathway. These findings demonstrated that CB2R stimulation significantly protected the brain damage and suppressed neuroinflammation by promoting the acquisition of microglial M2 phenotype in acute stage after ICH. Taken together, this study provided mechanism insight into neuroprotective effects by CB2R stimulation after ICH. PMID:28261199

  13. Rapamycin protects against neuronal death and improves neurological function with modulation of microglia after experimental intracerebral hemorrhage in rats.

    Science.gov (United States)

    Li, D; Liu, F; Yang, T; Jin, T; Zhang, H; Luo, X; Wang, M

    2016-09-30

    Intracerebral hemorrhage (ICH) results in a devastating brain disorder with high mortality and poor prognosis and effective therapeutic intervention for the disease remains a challenge at present. The present study investigated the neuroprotective effects of rapamycin on ICH-induced brain damage and the possible involvement of activated microglia. ICH was induced in rats by injection of type IV collagenase into striatum. Different dose of rapamycin was systemically administrated by intraperitoneal injection beginning at 1 h after ICH induction. Western blot analysis showed that ICH led to a long-lasting increase of phosphorylated mTOR and this hyperactivation of mTOR was reduced by systemic administration of rapamycin. Rapamycin treatment significantly improved the sensorimotor deficits induced by ICH, and attenuated ICH-induced brain edema formation as well as lesion volume. Nissl and Fluoro-Jade C staining demonstrated that administration with rapamycin remarkably decreased neuronal death surrounding the hematoma at 7 d after ICH insult. ELISA and real-time quantitative PCR demonstrated that rapamycin inhibited ICH-induced excessive expression of TNF-α and IL-1β in ipsilateral hemisphere. Furthermore, activation of microglia induced by ICH was significantly suppressed by rapamycin administration. These data indicated that treatment of rapamycin following ICH decreased the brain injuries and neuronal death at the peri-hematoma striatum, and increased neurological function, which associated with reduced the levels of proinflammatory cytokines and activated microglia. The results provide novel insight into the neuroprotective therapeutic strategy of rapamycin for ICH insult, which possibly involving the regulation of microglial activation.

  14. Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis.

    Science.gov (United States)

    Abreu, Pedro; Nogueira, Jerina; Rodrigues, Filipe Brogueira; Nascimento, Ana; Carvalho, Mariana; Marreiros, Ana; Nzwalo, Hipólito

    2017-09-15

    Intracerebral hemorrhage (ICH) in the context of cerebral hyperperfusion syndrome (CHS) is an uncommon but potentially lethal complication after carotid revascularization for carotid occlusive disease. Information about its incidence, risk factors and fatality is scarce. Therefore, we aimed to perform a systematic review and meta-analysis focusing on the incidence, risk factors and outcomes of ICH in the context of CHS after carotid revascularization. We searched the PubMed and EBSCO hosts for all studies published in English about CHS in the context of carotid revascularization. Two reviewers independently assessed each study for eligibility based on predefined criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the PROSPERO register was made (register no. CRD42016033190), including the pre-specified protocol. Forty-one studies involving 28,956 participants were deemed eligible and included in our analysis. The overall quality of the included studies was fair. The pooled frequency of ICH in the context of CHS was 38% (95% CI: 26% to 51%, I2 = 84%, 24 studies), and the pooled case fatality of ICH after CHS was 51% (95% CI: 32% to 71%, I2 = 77%, 17 studies). When comparing carotid angioplasty with stenting (CAS) with carotid endarterectomy (CEA), post-procedural ICH in the context of CHS was less frequent in CEA. ICH following CHS occurred less often in large series and was rare in asymptomatic patients. The most common risk factors were periprocedural hypertension and ipsilateral severe stenosis. ICH as a manifestation of CHS is rare, more frequent after CAS and associated with poor prognosis. Periprocedural control of hypertension can reduce its occurrence.

  15. A functional variant in promoter region of platelet-derived growth factor-D is probably associated with intracerebral hemorrhage

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    Bai Yongyi

    2012-01-01

    Full Text Available Abstract Background Platelet-derived growth factor D (PDGF-D plays an important role in angiogenesis, vessel remodeling, inflammation and repair in response to injury. We hypothesized that genetic variation in PDGFD gene might alter the susceptibility to stroke. Findings We determined the genotypes of a single nucleotide polymorphism (SNP (-858A/C, rs3809021 in 1484 patients with stroke (654 cerebral thrombosis, 419 lacunar infarction, 411 intracerebral hemorrhage [ICH] and 1528 control subjects from an unrelated Chinese Han population and followed the stroke patients up for a median of 4.5 years. The -858AA genotype showed significantly increased risk of ICH (dominant model: odds ratio [OR] 1.29, 95% confidence interval [CI] 1.00-1.68, P = 0.05; additive model: OR 1.24, 95% CI 1.01-1.52, P = 0.04 than wild-type genotype. Further analyses showed that -858AA genotype conferred about 2-fold increase in risk of non-hypertensive ICH (dominant model: OR 2.1, 95%CI 1.34-3.29, P = 0.001; additive model: OR 1.75, 95% CI 1.24-2.46, P = 0.001. After a median follow-up of 4.5 years, -858AA genotype was associated with a reduced risk of ICH recurrence (dominant model: adjusted hazard ratio [HR] 0.09, 95%CI 0.01-0.74, P = 0.025; additive model: HR 0.21, 95% CI 0.04-1.16, P = 0.073 in non-hypertensive patients. Conclusions The -858AA genotype is probably associated with risk for non-hypertensive ICH. Further studies should be conducted to reveal the role of PDGF-D at various stages of ICH development--beneficial, or deleterious.

  16. The incidence, hospital expenditure, and, 30 day and 1 year mortality rates of spontaneous intracerebral hemorrhage in Taiwan.

    Science.gov (United States)

    Chan, Chien-Lung; Ting, Hsien-Wei; Huang, Hsin-Tsung

    2014-01-01

    The risks of morbidity and mortality are high in patients with spontaneous intracerebral hemorrhage (sICH). The medical care resources associated with sICH are also substantial. This study aimed to evaluate the medical expenditure for sICH patients in Taiwan. We analyzed the National Health Insurance Research Database from 2005 to 2010. The inclusion criterion was first-event sICH; traumatic ICH patients were excluded. Student's t-test, multiple linear regression and the chi-squared test were employed as the statistical methods. Our results showed that the incidence of sICH was 40.77 patients per 100,000 of population per year in Taiwan. The incidence increased with age and was greater in men than women. The mean hospital length of stay (LOS) of first-event sICH patients was 31.8 days; the mean LOS in the intensive care unit was 7.9 days; and the mean survival time was 60.4 months. The mortality rate within 30 days and within 1 year was 19.8 and 29.6%, respectively. The mean hospital expenditure of first-event sICH patients was USD $7572, and was highly correlated with LOS. In conclusion, the incidence of sICH in Taiwan is higher than that in white and black populations of northern America and some European countries and lower than that in the Asian populations of Japan and China. The features of male and female sICH patients differ. Our findings suggest that the hospital expenditure and mortality rate of sICH patients in Taiwan are comparable with those of other countries.

  17. A Population-Based Study of the Incidence and Case Fatality of Intracerebral Hemorrhage of Undetermined Etiology.

    Science.gov (United States)

    Qureshi, Adnan I; Afzal, Mohammad R; Malik, Ahmed A; Qureshi, Mushtaq H; Jahangir, Nauman; Suri, M Fareed K

    2015-10-01

    There is a paucity of reliable recent data regarding epidemiology of intracerebral hemorrhage (ICH) of undetermined etiology in population-based studies. To determine the incidence and case fatality of ICH of undetermined etiology using a population-based design. Medical records and neuroimaging data of all patients with ICH from Stearns and Benton Counties, Minnesota, between June 1st, 2012 and June 30th, 2014 were reviewed. Patients with a first-time diagnosis of ICH were categorized as of undetermined etiology if ICH was without features typical of hypertensive etiology with normal or no magnetic resonance imaging (MRI)/angiograms. We calculated the incidences of [1] probable and possible hypertensive ICH; [2] related to arteriovenous malformation, cavernous malformation, or aneurysmal rupture (angiographic or MRI diagnoses); [3] secondary to anticoagulation; and [4] of undetermined etiology adjusted for age and sex based on the 2010 US census. Of the 50 identified ICHs among 136,654 resident populations, seven were true incident cases of ICH of undetermined etiology in this population-based study. The age- and sex-adjusted incidence of ICH of undetermined etiology was 2.6 [95% confidence interval (CI) 0.7-4.9] per 100, 000 person-years, which was lower than probable and possible hypertensive ICH incidence of 12.8 [95% CI 8.4-17.2] per 100,000 person-years. The age-adjusted case fatality rate at 1 month was 8.14 and 0.4 per 100,000 persons for probable and possible hypertensive ICHs and ICHs of undetermined etiology, respectively. Our results should prompt further studies into identification of causes in ICH patients presently classified as ICH of undetermined etiology to reduce the incidence and case fatality of such ICHs.

  18. Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Jun; Chen, Wei-jian; Wang, Mei-hao; Li, Jian-ce; Zhang, Qian; Xia, Neng-zhi; Yang, Yun-jun [Wenzhou Medical University, Department of Radiology, First Affiliated Hospital, Wenzhou (China); Wu, Gui-yun [Cleveland Clinics Foundation, Department of Nuclear Medicine, Imaging Institute, Cleveland, OH (United States); Cheng, Jing-liang; Zhang, Yong [Zhengzhou University, Department of Radiology, First Affiliated Hospital, Zhengzhou (China); Zhuge, Qichuan [Wenzhou Medical University, Department of Neurosurgery, First Affiliated Hospital, Wenzhou (China)

    2014-11-09

    The purpose of this study was to evaluate the value of 320-detector row CT used to detect crossed cerebellar diaschisis (CCD) in patients with unilateral supratentorial spontaneous intracerebral hemorrhage (SICH). We investigated 62 of 156 patients with unilateral supratentorial SICH using 320-detector row CT scanning. Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV), mean transit time (rMTT), and time to peak (rTTP) levels were measured in different regions of interest (ROIs) that were manually outlined on computed tomography perfusion (CTP) for the cerebrum, including normal-appearing brain tissue that surrounded the perilesional low-density area (NA) and the perihematomal low-density area (PA) in all patients and the cerebellum (ipsilateral and contralateral) in CCD-positive patients. Of 62 cases, a total of 14 met the criteria for CCD due to cerebellar perfusion asymmetry on CTP maps. In the quantitative analysis, significant differences were found in the perfusion parameters between the contralateral and ipsilateral cerebellum in CCD-positive cases. No significant differences were found between the CCD-positive group and the CCD-negative group according to the hematoma volume, NIHSS scores, and cerebral perfusion abnormality (each P > 0.05). The correlation analysis of the degree of NA, PA perfusion abnormality, and the degree of CCD severity showed negative and significant linear correlations (R, -0.66∝-0.56; P < 0.05). 320-detector row CT is a robust and practicable method for the comprehensive primary imaging work-up of CCD in unilateral supratentorial SICH patients. (orig.)

  19. Which risk factors are more associated with ischemic stroke than intracerebral hemorrhage in patients with atrial fibrillation?

    Science.gov (United States)

    McGrath, Emer R; Kapral, Moira K; Fang, Jiming; Eikelboom, John W; ó Conghaile, Aengus; Canavan, Michelle; O'Donnell, Martin J

    2012-08-01

    The decision to prescribe oral anticoagulant therapy in patients with atrial fibrillation is based on an assessment of the competing risks of ischemic stroke and major bleeding, of which intracerebral hemorrhage (ICH) is the most important type. We sought to determine the comparative importance of risk factors for ischemic stroke and ICH in patients with acute stroke and atrial fibrillation with particular emphasis on risk factors common to both stroke types. Consecutive patients with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network constituted the cohort. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. Risk factors included: (1) those previously reported to be risk factors for both ischemic stroke and major bleeding (particularly ICH) ("shared" risk factors, including age, alcohol, hypertension, diabetes mellitus, renal impairment, prior stroke/transient ischemic attack and preadmission dementia); and (2) other risk factors associated with either stroke subtype alone. A total of 3197 patients presented with atrial fibrillation and acute stroke, of which 12.2% presented with ICH. Of the "shared" risk factors, age (OR, 1.19; 95% CI, 1.06-1.34 per decade) and prior stroke/transient ischemic attack (OR, 1.45; 95% CI, 1.12-1.87) were more associated with ischemic stroke than ICH, whereas a history of hypertension (OR, 0.89; 95% CI, 0.68-1.17), diabetes mellitus (OR 1.23; 95% CI, 0.92-1.64), renal impairment (OR, 1.28; 95% CI, 0.95-1.71), and alcohol intake were not more strongly associated with either stroke subtype. Of the risk factors known to be associated with both ischemic stroke and ICH in patients with atrial fibrillation, we found that none had a stronger association with ICH. Older age was more strongly associated with ischemic stroke than ICH.

  20. Tracking of Neural Stem Cells in Rats with Intracerebral Hemorrhage by the Use of 3T MRI

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    Chang, Nam Kyu; Jeong, Yong Yeon; Park, Jong Seong [Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2008-06-15

    To access the feasibility of clinically available 3T MRI to detect the migration of labeled neural stem cells (NSCs) in intracerebral hemorrhage (ICH) in a rat model. The ethics committee of our institution approved this study. ICH was induced by the injection of collagenase type IV into the right striatum of ten Sprague-Dawley rats. Human NSCs conjugated with Feridex (superparamagnetic iron oxide: SPIO) were transplanted into the left striatum one week after ICH induction. MRI was performed on a 3T scanner during the first, second, third, fourth, and sixth weeks post-transplantation. MRI was obtained using coronal T2- and T2{sup *}-weighted sequences. Two rats were sacrificed every week after in vivo MRI in order to analyze the histological findings. ICH in the right striatum was detected by MRI one and two weeks after transplantation without migration of the NSCs. There was no migration of the NSCs as seen on the histological findings one week after transplantation. The histological findings two weeks after transplantation showed a small number of NSCs along the corpus callosum. On MRI three weeks after transplantation, there was a hypointense line along the corpus callosum and decreased signal intensity in the right periventricular region. Histological findings three weeks after transplantation confirmed the presence of the hypointense line representing SPIO-labeled NSCs. MRI four and six weeks after transplantation showed a hypointense spot in the right periventricular region. The histological findings four and six weeks after transplantation showed the presence of prominent NSCs in the right periventricular region. 3T MRI can detect the migration of NSCs in rats with ICH along the corpus callosum. Therefore, 3T MRI could be feasible for detecting the migration of NSCs in the clinical setting of stem cell therapy

  1. Accuracy of the ABC/2 score for intracerebral hemorrhage: Systematic review and analysis of MISTIE, CLEAR-IVH, CLEAR III

    Science.gov (United States)

    Webb, Alastair JS; Ullman, Natalie L; Morgan, Tim C; Muschelli, John; Kornbluth, Joshua; Awad, Issam A; Mayo, Stephen; Rosenblum, Michael; Ziai, Wendy; Zuccarrello, Mario; Aldrich, Francois; John, Sayona; Harnof, Sagi; Lopez, George; Broaddus, William C; Wijman, Christine; Vespa, Paul; Bullock, Ross; Haines, Stephen J; Cruz-Flores, Salvador; Tuhrim, Stan; Hill, Michael D; Narayan, Raj; Hanley, Daniel F

    2015-01-01

    Background and Purpose The ABC/2 score estimates intracerebral hemorrhage (ICH) volume, yet validations have been limited by small samples and inappropriate outcome measures. We determined accuracy of the ABC/2 score calculated at a specialized Reading Center (RC-ABC) or local site (site-ABC) versus the reference-standard CT-based planimetry (CTP). Methods In MISTIE-II, CLEAR-IVH and CLEAR-III trials, ICH volume was prospectively calculated by CTP, RC-ABC and site-ABC. Agreement between CTP and ABC/2 was defined as an absolute difference up to 5ml and relative difference within 20%. Determinants of ABC/2 accuracy were assessed by logistic regression. Results In 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC (r2=0.93) than site-ABC (r2=0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC=15.2cm3, CTP=12.7cm3), agreement was reasonable when categorised into mild, moderate and severe ICH (kappa 0.75, p<0.001). This was consistent with overestimation of ICH volume in 6/8 previous studies. Agreement with CTP was greater for RC-ABC (84% within 5ml; 48% of scans within 20%) than for site-ABC (81% within 5ml; 41% within 20%). RC-ABC had moderate accuracy for detecting ≥ 5ml change in CTP volume between consecutive scans (sensitivity 0.76, specificity 0.86) and was more accurate with smaller ICH, thalamic haemorrhage and homogeneous clots. Conclusions ABC/2 scores at local or central sites are sufficiently accurate to categorise ICH volume and assess eligibility for the CLEAR III and MISTIE III studies, and moderately accurate for change in ICH volume. However, accuracy decreases with large, irregular or lobar clots. Clinical Trial Registration MISTIE-II NCT00224770; CLEAR-III NCT00784134; www.clinicaltrials.gov PMID:26243227

  2. Logistic regression analysis of the outcome on 90 d and associated factors in conscious patients with intracerebral hemorrhage

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    ZHEN Zhi-gang

    2013-09-01

    Full Text Available Objective To investigate the outcome on 90 d and influencing factors for the outcome in conscious patients with intracerebral hemorrhage (ICH. Methods Two hundred and twenty-five patients with ICH were admitted to our hospital within 6 h after onset and were suitable to be treated with medical conservative therapy. Patients were divided into two groups, the conscious group [Glasgow Coma Scale (GCS score ≥ 9] and the coma group (GCS score ≤ 8. Clinical features including gender, age, National Institute of Health Stroke Scale (NIHSS score, etc, were recorded. The prognosis of these patients on 90 d after onset was evaluated by the following index: survival or death; favorable prognosis [modified Rankin Scale (mRS score ≤ 2] or unfavorable prognosis (mRS score ≥ 3, death or severe disability. The difference of clinical features and prognosis between the conscious group and coma group was explored. The prognosis of the patients in conscious group was analyzed, and influencing factors for prognosis were explored. Results Multifactorial Logistic regression analysis indicated that hyperglycemia, higher NIHSS score, rehemorrhagia and hematemesis were independent risk factors for 90-day mortality. On the other hand, advanced age, higher NIHSS score, rehemorrhagia and hematemesis were independent risk factors for death or severe disability on 90-day. Conclusion In ICH patients who were conscious on admission, hyperglycemia, advanced age, higher NIHSS score, rehemorrhagia and hematemesis are strong predictors for mortality and unfavourable outcome. Controlling hyperglycemia and prevention of rehemorrhagia and hematemesis are important elements for reducing 90-day mortality and severe disability.

  3. Surgical trial in traumatic intracerebral hemorrhage (STITCH(Trauma: study protocol for a randomized controlled trial

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    Gregson Barbara A

    2012-10-01

    Full Text Available Abstract Background Intracranial hemorrhage occurs in over 60% of severe head injuries in one of three types: extradural (EDH; subdural (SDH; and intraparenchymal (TICH. Prompt surgical removal of significant SDH and EDH is established and widely accepted. However, TICH is more common and is found in more than 40% of severe head injuries. It is associated with a worse outcome but the role for surgical removal remains undefined. Surgical practice in the treatment of TICHs differs widely around the world. The aim of early surgery in TICH removal is to prevent secondary brain injury. There have been trials of surgery for spontaneous ICH (including the STICH II trial, but none so far of surgery for TICH. Methods/Design The UK National Institutes of Health Research has funded STITCH(Trauma to determine whether a policy of early surgery in patients with TICH improves outcome compared to a policy of initial conservative treatment. It will include a health economics component and carry out a subgroup analysis of patients undergoing invasive monitoring. This is an international multicenter pragmatic randomized controlled trial. Patients are eligible if: they are within 48 h of injury; they have evidence of TICH on CT scan with a confluent volume of attenuation significantly raised above that of the background white and grey matter that has a total volume >10 mL; and their treating neurosurgeon is in equipoise. Patients will be ineligible if they have: a significant surface hematoma (EDH or SDH requiring surgery; a hemorrhage/contusion located in the cerebellum; three or more separate hematomas fulfilling inclusion criteria; or severe pre-existing physical or mental disability or severe co-morbidity which would lead to poor outcome even if the patient made a full recovery from the head injury. Patients will be randomized via an independent service. Patients randomized to surgery receive surgery within 12 h. Both groups will be monitored according to

  4. Intracerebral hemorrhage associated with Sneddon's syndrome: is ischemia-related angiogenesis the cause? Case report and review of the literature

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    Aquino Gondim, F. de A.; Leacock, R.O.; Subrammanian, T.A. [Department of Neurology, Saint Louis University Hospital, 3635 Vista Avenue at Grand Blvd, MO 63110, Saint Louis, MO (United States); Cruz-Flores, S. [Department of Neurology, Saint Louis University Hospital, 3635 Vista Avenue at Grand Blvd, MO 63110, Saint Louis, MO (United States); Neurology Service, John Cochran Veterans Administration Hospital, St. Louis, MO (United States)

    2003-06-01

    Sneddon's syndrome is characterized by livedo reticularis and multiple ischemic infarcts often associated with antiphospholipid antibodies. Intracerebral hemorrhage (ICH) is unusual in Sneddon's syndrome and has not been reported as the presenting complaint. We report a 38-year-old woman with a history of two miscarriages, Raynaud's phenomenon and livedo reticularis who presented acutely with ICH. Angiography showed prominent leptomeningeal and transdural anastomoses (pseudoangiomatosis). Anticardiolipin antibodies were positive. A right frontal brain biopsy failed to reveal vasculitis and a skin biopsy was nonspecific. MRI showed residual intracerebral hemorrhage (ICH), diffuse atrophy, multiple small white matter infarcts and leptomeningeal enhancement. This is the first report of Sneddon's syndrome presenting with an ICH. It shares features with the Divry-van Bogaert syndrome. We discuss the cause of the pseudoangiomatosis pattern and its role in the genesis of the hemorrhage and suggest that cerebral angiography should be done in every patient with Sneddon's syndrome, as it could impact therapy. (orig.)

  5. Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage.

    Science.gov (United States)

    Sprügel, Maximilian I; Kuramatsu, Joji B; Gerner, Stefan T; Sembill, Jochen A; Hartwich, Julius; Giede-Jeppe, Antje; Madžar, Dominik; Beuscher, Vanessa D; Hoelter, Philip; Lücking, Hannes; Struffert, Tobias; Schwab, Stefan; Huttner, Hagen B

    2017-08-03

    Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching. Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer. Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions. © 2017 S. Karger AG, Basel.

  6. Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

    Directory of Open Access Journals (Sweden)

    Michel Lelo Tshikwela

    2012-01-01

    Full Text Available Background and Purpose: Intracerebral hemorrhage (ICH constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis. Materials and Methods: Age, sex, hypertension, type 2 diabetes mellitus (T2DM, smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models. Results: A total of 185 adults and known hypertensive patients (140 men and 45 women were examined. 30-day mortality rate was 35% (n=65. ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4, absence of coma coded 1 (1 × 2 = 2, ICH volume>25 mL coded 2 (2 × 2=4, ICH volume of ≤25 mL coded 1(1 × 2=2, left hemispheric site of ICH coded 2 (2 × 1=2, and right hemispheric site of hemorrhage coded 1(1 × 1 = 1. All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3, points were allowed as follows: Presence of coma (2 × 3 = 6, absence of coma (1 × 3 = 3, men (2 × 2 = 4, women (1 × 2 = 2, midline shift ≤7 mm (1 × 3 = 3, and midline shift >7 mm (2 × 3 = 6. Patients who died had the Kinshasa ICH score ≥16. Conclusion: In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management

  7. [Experiences with intravenous sulprostone administration in massive postpartal hemorrhage].

    Science.gov (United States)

    Schönegg, W; Wessel, J; Schmidt-Gollwitzer, K

    1987-11-01

    Forty-three patients at the University Gynecology Clinic in Charlottenburg were given the prostaglandin E2 derivative sulprostone for severe postpartal hemorrhage. It was administered intravenously in a dose of 1.7 mcg/min (100 mcg/100 ml/h), with short-term increases to three times this amount in isolated cases. The drug proved highly efficacious (rapid onset and lasting effect). In 80% of the cases there were no side effects. Rises in body temperature occurred in six patients and in one patient a venous irritation developed in the arm into which the drug was infused. An RDS occurred, though it was considered that there was not necessarily a causal connection between this and the sulprostone infusion. In the authors' experience this drug has an established place in the treatment of atonic postpartal hemorrhage emergencies.

  8. Treatment of Serious Hypertensive Intracerebral Hemorrhage with CT-location Drill-crandum Smashing-draw and Analysis of Prognosis Factors

    Institute of Scientific and Technical Information of China (English)

    Huang Panbing

    2000-01-01

    Objective: To study curative effect of CT-location drill-cranium smashing-draw and affective pregniosis factors for serious hypertensive intracerebral hemorrhage (HIH). Methods :15 cases of serious HIH(group A)were treated with CT-location drill-cranium smashing-draw ,other 15 patients treated (group B)were treated with medicine only as controls. Results: The curative rate (20%) anis improvable rate (33.3%)in group A were higher than that of (6.7% and 26.7%)in group B (P<0. 001). The mortality rate (46.7%)in group A was lower than that of (66.6%)in group B significantly (P<0.001). Conclusions: The efffect of the therapy was satisfactory The higher or lower of the mortality rate was closely related to operative time 、 m-hemorrhage 、 location and range of the hemotoma

  9. 高血压脑出血的临床特点及护理要素%Clinical features and nursing elements of hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    成杏林

    2014-01-01

    目的:分析高血压脑出血的临床特点及护理要素。方法收集高血压脑出血患者51例的临床病历资料,观察发病构成比、出血部位及危险因素。结果高血压脑出血的发病男∶女≈1.68∶1,以46岁~55岁年龄段居多(37.25%)。高血压脑出血患者出现部位以壳核部最多(41.18%),其次为丘脑部(21.57%)。吸烟、饮酒及基础性疾病为高血压脑出血的危险因素。结论高血压脑出血的发病诱因较多,临床应强化护理干预指导,严格控制基础危险因素,强化基础护理,积极预防并发症,强化心理干预指导及康复护理,以改善患者的预后。%Objective To analyze the clinical features and nursing elements of hypertensive intracerebral hemorrhage.Methods 51 cases of patients with hypertensive cerebral were chosen for the study. The incidence proportions, the bleeding site and risk factors were observed.Results The incidence of hypertensive intracerebral hemorrhage male: female was 1.68:1, and the year of 46 to 55 was the mostly (37.25%). Hypertensive cerebral hemorrhage occurs at most parts of the site of the putamen (41.18%), followed by the thalamus (21.57%). Smoking, drinking and underlying disease were the risk factors for hypertensive intracerebral hemorrhage.Conclusion The incentives incidence of hypertensive cerebral hemorrhage are more and clinical nursing interventions should strengthen the guidance, strictly controll the basis of risk factors, and strengthen primary care, actively prevent complications, strengthen psychological intervention and rehabilitation care to improve patient outcomes.

  10. Protection of Vascular Endothelial Growth Factor to Brain Edema Following Intracerebral Hemorrhage and Its Involved Mechanisms: Effect of Aquaporin-4.

    Directory of Open Access Journals (Sweden)

    Heling Chu

    Full Text Available Vascular endothelial growth factor (VEGF has protective effects on many neurological diseases. However, whether VEGF acts on brain edema following intracerebral hemorrhage (ICH is largely unknown. Our previous study has shown aquaporin-4 (AQP4 plays an important role in brain edema elimination following ICH. Meanwhile, there is close relationship between VEGF and AQP4. In this study, we aimed to test effects of VEGF on brain edema following ICH and examine whether they were AQP4 dependent. Recombinant human VEGF165 (rhVEGF165 was injected intracerebroventricularly 1 d after ICH induced by microinjecting autologous whole blood into striatum. We detected perihemotomal AQP4 protein expression, then examined the effects of rhVEGF165 on perihemotomal brain edema at 1 d, 3 d, and 7 d after injection in wild type (AQP4(+/+ and AQP4 knock-out (AQP4(-/- mice. Furthermore, we assessed the possible signal transduction pathways activated by VEGF to regulate AQP4 expression via astrocyte cultures. We found perihemotomal AQP4 protein expression was highly increased by rhVEGF165. RhVEGF165 alleviated perihemotomal brain edema in AQP4(+/+ mice at each time point, but had no effect on AQP4(-/- mice. Perihemotomal EB extravasation was increased by rhVEGF165 in AQP4(-/- mice, but not AQP4(+/+ mice. RhVEGF165 reduced neurological deficits and increased Nissl's staining cells surrounding hemotoma in both types of mice and these effects were related to AQP4. RhVEGF165 up-regulated phospharylation of C-Jun amino-terminal kinase (p-JNK and extracellular signal-regulated kinase (p-ERK and AQP4 protein in cultured astrocytes. The latter was inhibited by JNK and ERK inhibitors. In conclusion, VEGF reduces neurological deficits, brain edema, and neuronal death surrounding hemotoma but has no influence on BBB permeability. These effects are closely related to AQP4 up-regulation, possibly through activating JNK and ERK pathways. The current study may present new insights to

  11. Neovascularization and functional recovery after intracerebral hemorrhage is conditioned by the Tp53 Arg72Pro single-nucleotide polymorphism.

    Science.gov (United States)

    Rodríguez, Cristina; Sobrino, Tomás; Agulla, Jesús; Bobo-Jiménez, Verónica; Ramos-Araque, María E; Duarte, Juan J; Gómez-Sánchez, José C; Bolaños, Juan P; Castillo, José; Almeida, Ángeles

    2017-01-01

    Intracerebral hemorrhage (ICH) is a devastating subtype of stroke that lacks effective therapy and reliable prognosis. Neovascularization following ICH is an essential compensatory response that mediates brain repair and modulates the clinical outcome of stroke patients. However, the mechanism that dictates this process is unknown. Bone marrow-derived endothelial progenitor cells (EPCs) promote endothelial repair and contribute to ischemia-induced neovascularization. The human Tp53 gene harbors a common single-nucleotide polymorphism (SNP) at codon 72, which yields an arginine-to-proline amino-acidic substitution (Arg72Pro) that modulates the apoptotic activity of the p53 protein. Previously, we found that this SNP controls neuronal susceptibility to ischemia-induced apoptosis in vitro. Here, we evaluated the impact of the Tp53 Arg72Pro SNP on vascular repair and functional recovery after ICH. We first analyzed EPC mobilization and functional outcome based on the modified Rankin scale scores in a hospital-based cohort of 78 patients with non-traumatic ICH. Patients harboring the Pro allele of the Tp53 Arg72Pro SNP showed higher levels of circulating EPC-containing CD34(+) cells, EPC-mobilizing cytokines - vascular endothelial growth factor and stromal cell-derived factor-1α - and good functional outcome following ICH, when compared with the homozygous Arg allele patients, which is compatible with increased neovascularization. To assess directly whether Tp53 Arg72Pro SNP regulated neovascularization after ICH, we used the humanized Tp53 Arg72Pro knock-in mice, which were subjected to the collagenase-induced ICH. The brain endothelial cells of the Pro allele-carrying mice were highly resistant to ICH-mediated apoptosis, which facilitated cytokine-mediated EPC mobilization, cerebrovascular repair and functional recovery. However, these processes were not observed in the Arg allele-carrying mice. These results reveal that the Tp53 Arg72Pro SNP determines

  12. Effects of fentanyl on pain and motor behaviors following a collagenase-induced intracerebral hemorrhage in rats

    Directory of Open Access Journals (Sweden)

    Saine L

    2016-11-01

    Full Text Available Laurence Saine,1 Pierre Hélie,2 Pascal Vachon1 1Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, 2Department of Pathology and Microbiology, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada Purpose: Intracerebral hemorrhage (IH and cephalalgia are common consequences of traumatic brain injury. One of the primary obstacles for patient recovery is the paucity of treatments to support an appropriate analgesic protocol. The present study aimed to assess pain and motor behaviors following different doses of fentanyl on a rat model of IH. Methods: Twenty-one male Sprague Dawley rats underwent a stereotaxic surgery to produce a collagenase-induced IH in the right caudoputamen nucleus. The control group (n=6 received saline subcutaneously (SC, and experimental groups received either 5 (n=6, 10 (n=6, or 20 (n=3 µg/kg of fentanyl SC, 2 hours following surgery and on 2 subsequent days. Only 3 animals received 20 µg/kg because this dose caused catalepsy for 15–20 minutes following the injection. The rat grimace scale, a neurological examination, balance beam test, and rotarod test were performed for 5 consecutive days postoperatively to evaluate pain and motor performance. At the end of the experimentation, the brains were evaluated to determine hematoma volume, and the number of reactive astrocytes and necrotic neurons. Results: When compared to controls, the grimace scale showed that 5 µg/kg fentanyl significantly alleviated pain on day 2 only (P<0.01 and that 10 µg/kg alleviated pain on days 1 (P<0.01, 2 (P<0.001, and 3 (P<0.01. For the rotarod test, only the 10 µg/kg group showed significant decreases in performance on days 5 (P<0.05 and 6 (P<0.02. The neurological examination was not significantly different between the groups, but only the hopping test showed poor recuperation for the 5 and 10 µg/kg fentanyl group when compared to saline (P<0.01. No differences were found between the

  13. Heme activates TLR4-mediated inflammatory injury via MyD88/TRIF signaling pathway in intracerebral hemorrhage

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    Lin Sen

    2012-03-01

    Full Text Available Abstract Background Inflammatory injury plays a critical role in intracerebral hemorrhage (ICH-induced neurological deficits; however, the signaling pathways are not apparent by which the upstream cellular events trigger innate immune and inflammatory responses that contribute to neurological impairments. Toll-like receptor 4 (TLR4 plays a role in inflammatory damage caused by brain disorders. Methods In this study, we investigate the role of TLR4 signaling in ICH-induced inflammation. In the ICH model, a significant upregulation of TLR4 expression in reactive microglia has been demonstrated using real-time RT-PCR. Activation of microglia was detected by immunohistochemistry, cytokines were measured by ELISA, MyD88, TRIF and NF-κB were measured by Western blot and EMSA, animal behavior was evaluated by animal behavioristics. Results Compared to WT mice, TLR4−/− mice had restrained ICH-induced brain damage showing in reduced cerebral edema and lower neurological deficit scores. Quantification of cytokines including IL-6, TNF-α and IL-1β and assessment of macrophage infiltration in perihematoma tissues from TLR4−/−, MyD88−/− and TRIF−/− mice showed attenuated inflammatory damage after ICH. TLR4−/− mice also exhibited reduced MyD88 and TRIF expression which was accompanied by decreased NF-κB activity. This suggests that after ICH both MyD88 and TRIF pathways might be involved in TLR4-mediated inflammatory injury possibly via NF-κB activation. Exogenous hemin administration significantly increased TLR4 expression and microglial activation in cultures and also exacerbated brain injury in WT mice but not in TLR4−/− mice. Anti-TLR4 antibody administration suppressed hemin-induced microglial activation in cultures and in the mice model of ICH. Conclusions Our findings suggest that heme potentiates microglial activation via TLR4, in turn inducing NF-κB activation via the MyD88/TRIF signaling pathway, and ultimately

  14. First 5-days follow-up and correlation study between urinary cysteinyl leukotrienes and edema values in primary spontaneous supratentorial intracerebral hemorrhage

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    Dolnenec-Baneva Natalija

    2014-07-01

    Full Text Available Background: After intracerebral hemorrhage cysteinyl leukotrienes (C4, D4, E4 are synthetisized in the contact brain parenchyma-extravasated blood and participate in producing of edema formation. The study aim is a 5-days follow up (admittance/3th day/5th day of urinary cysteinyl leukotrienes, hematoma and edema volume in patients with primary spontaneous supratentorial intracerebral hemorrhage and to determine the relationship: edema/haematoma and edema/leukotrienes. Methods: An enzyme immunoassay for leukotrienes measuring in the urine samples from 62 patients with hemorrhage during the first 5 days (admittance/3th day/5th day and 80 health controls is used. Hematoma and edema volume is visualised and measured by computed-tomography. Results: Admission values of leukotrienes were significantly higher in the hemorrhagic patients (min = 268.61; max = 5787.36; mean = 1842.20 ± 1413.19 pg/ml/mg creatinine versus control subjects (min = 297.8; max = 1684.2; mean = 918.6 ± 332 (p 0.05. The edema (mean: 12.86 ± 13.52; 22.38 ± 21.10; 28.45 ± 29.41 cm3 showed very high significance (p 0.05 of moderate strength is found between edema and hematoma; and significant positive correlation (r = 0.6; p 0.05 at admittance, r = - 0.05 (p > 0. 05 on the 3th day (nonexistence of linear correlation, the sign minus presents their tendency for the opposite movement in their values and r = 0.2 (p > 0.05 on the 5th day are found (positive linear nonsignificant correlation of slight strength. Conclusion: Significant urinary leukotrienes excretion (a brain capacity for significant leukotreienes synthesis and significant edema progression versus constant haematoma are found. The edema size followed the hematoma size of moderate extent. The edema showed an inverse dependence of the leukotrienes (a tendency for opposite movement of their values, the high leukotrienes values at admittance bring to greater edema volume on the third/the fifth day, respectively. Elevated

  15. Intracerebral hemorrhage in children

    African Journals Online (AJOL)

    Ihab Zidan

    2012-04-01

    Apr 1, 2012 ... Results: Thirty patients with ICH were included in this study. ... Peer review under responsibility of Alexandria University Faculty of ... specific and include: motor deficit, sensory deficit, speech prob- ... breathing and circulation), control of the intracranial pressure, ..... prospective consecutive cohort study.

  16. Recurrent Intracerebral Hemorrhage

    DEFF Research Database (Denmark)

    Schmidt, Linnea Boegeskov; Goertz, Sanne; Wohlfahrt, Jan;

    2016-01-01

    the use of any of the investigated medicines with antithrombotic effect (ATT, SSRI's, NSAID's) and recurrent ICH. CONCLUSIONS: The substantial short-and long-term recurrence risks warrant aggressive management of hypertension following a primary ICH, particularly in patients treated surgically...... treatment and renal insufficiency were associated with increased recurrence risks (RR 1.64, 95% CI 1.39-1.93 and RR 1.72, 95% CI 1.34-2.17, respectively), whereas anti-hypertensive treatment was associated with a reduced risk (RR 0.82, 95% CI 0.74-0.91). We observed non-significant associations between...

  17. Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter

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    Nicolas Merzeau

    2017-01-01

    Full Text Available Arterioureteral fistulas (AUF are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent.

  18. Decidualized Endometriosis Causing Inversion of the Appendix, Massive Hemorrhage and Fetal Death

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    Anthony M Magliocco

    1991-01-01

    Full Text Available An extraordinary case of inversion of the appendix due to decidualized endometriosis is reported. A 35-year-old woman presented at 3 7 weeks of pregnancy with acute massive rectal hemorrhage and fetal death. A limited right hemicolectomy was performed. The cecum contained an inverted appendix with an ulcerated tip. Histologically there was decidualized endometriosis in the ulcer bed and in all layers of the appendiceal wall.

  19. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa

    NARCIS (Netherlands)

    Broekman, Evelien A.; Versteeg, Henneke; Vos, Louwerens D.; Dijksterhuis, Marja G.; Papatsonis, Dimitri N.

    2015-01-01

    Objective To evaluate the effectiveness of temporary balloon occlusion of the internal iliac artery before uterine incision to prevent massive obstetric hemorrhage during cesarean delivery among patients with anterior placenta previa. Methods In a retrospective cohort study conducted at Amphia

  20. Changes in hemeoxygenase-1 and superoxide dismutase in the peri-hematomal brain tissues of rats following intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Jiami Wu; Qingwei Meng

    2006-01-01

    BACKGROUND: The mechanism of intracerebral hemorrhage (ICH)-induced hemorrhagic brain injury is very complicated, involving the position-occupying effect of oephalophyma, ischemio factors, the toxic effect of hematoma components, the destruction of blood-brain barrier, etc. The expression and effect of hemeoxygenase-1 (HO-1) in the cerebrovascular disease has been paid close attention.OBJECTIVE: To observe the expression of HO-1 and change of superoxide dismutase (SOD) in the peri-hematomal brain tissue of rats following ICH.DESIGN: Randomized controlled animal experiment.SETTING: Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College.MATERIALS: Forty healthy male SD rats, of clean grade, weighing from 250 to 300 g, were provided by Qinglongshan Animal Farm of Nanjing. The involved 40 rats were randomized into sham-operation group (n=5) and ICH group (n =35), and ICH group was divided into 7 subgroups with 5 rats in each: ICH 6, 12, 24, 48, 72,100 and 168 hours groups. Rabbit anti-rat HO-1 immunohistochemial kit ( Boster Co., Ltd., Wuhan) and SOD kit (Jiancheng Bioengineering Institute, Nanjing)were used in this experiment.METHODS: This experiment was carried out in the Department of Neurology, Yijishan Hospital Affiliated to Wannan Medical College Between April and July 2005. In the ICH group: Autologous blood of rats was injected into the head of caudate nucleus to create ICH animal models. In the sham-operation group, the same amount of normal saline was injected into the head of caudate nucleus of rats. The brains of rats in each group were harvested at different time points. The hematoma-side brain tissue was cut open in the coronal plane taking hematomal region as center, and the posterior part was fixed with 100 g/L neutral formaldehyde. 100 mg brain tissue was taken from anterior part. The number of positive cells in HO-1 and SOD activity in peri-hematomal brain tissue at different time after ICH were detected by immunohistochemical

  1. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage.

    Science.gov (United States)

    Giede-Jeppe, Antje; Bobinger, Tobias; Gerner, Stefan T; Sembill, Jochen A; Sprügel, Maximilian I; Beuscher, Vanessa D; Lücking, Hannes; Hoelter, Philip; Kuramatsu, Joji B; Huttner, Hagen B

    2017-01-01

    Stroke-associated immunosuppression and inflammation are increasingly recognized as factors that trigger infections and thus, potentially influence the outcome after stroke. Several studies demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes in patients with ischemic stroke. However, little is known about the impact of NLR on short-term mortality in intracerebral hemorrhage (ICH). This observational study included 855 consecutive ICH-patients. Patient demographics, clinical, laboratory, and in-hospital measures as well as neuroradiological data were retrieved from institutional databases. Functional 3-months-outcome was assessed and categorized as favorable (modified Rankin Scale [mRS] 0-3) and unfavorable (mRS 4-6). We (i) studied the natural course of NLR in ICH, (ii) analyzed parameters associated with NLR on admission (NLROA), and (iii) evaluated the clinical impact of NLR on mortality and functional outcome. The median NLROA of the entire cohort was 4.66 and it remained stable during the entire hospital stay. Patients with NLR ≥4.66 showed significant associations with poorer neurological status (National Institute of Health Stroke Scale [NIHSS] 18 [9-32] vs. 10 [4-21]; p 2.606 - presented with a better clinical status (NIHSS 12 [5-21] vs. 15 [6-28]; p = 0.005), lower hematoma volumes on admission (10.6 [3.6-30.1] vs. 15.1 [5.7-42.3] mL; p = 0.004) and showed a better functional outcome (3 months mRS 0-3: 82/214 [38.3%] vs. 185/641 [28.9%]; p = 0.009). Patients associated with high NLR (≥8.508 = above 75th-percentile) showed the worst neurological status on admission (NIHSS 21 [12-32] vs. 12 [5-23]; p < 0.001), larger hematoma volumes (21.0 [8.6-48.8] vs. 12.2 [4.1-34.9] mL; p < 0.001), and higher proportions of unfavorable functional outcome at 3 months (mRS 4-6: 173/214 vs. 418/641; p < 0.001). Further, NLR was linked to more frequently occurring infectious complications (pneumonia 107/214 vs

  2. Massive fetomaternal transplacental hemorrhage as a perinatology problem, role of ABO fetomaternal compatibility--case studies.

    Science.gov (United States)

    Zizka, Z; Calda, P; Zlatohlavkova, B; Haakova, L; Cerna, M; Jirasek, J E; Fait, T; Hajek, Z; Kvasnicka, J

    2001-01-01

    Massive fetomaternal transplacental hemorrhage is not simply a problem of possible alloimunization in Rh incompatibility but also endangers the fetus (newborn) by massive anemization. Bleeding from placental vessels can occur after small trauma to the gravid uterus with mild or no clinical signs (bleeding or spotting, pain, hypertonus). The rupture of anchoring villi related to early uterine contractions is also possible. In the case of slow blood loss, the fetus reacts by adequate or inadequate compensatory reactions (hydrops fetus). Rapid and massive blood loss is followed by perinatal hypoxic damage and finally death. Our goal was to map out the diagnostic and therapeutic possibilities in regard to specific neonatal care. We evaluated four cases of fetomaternal transfusion during a 2-year period with special regard to postpartum adaptation of the newborn and the perinatal outcome. The incidence of adverse outcomes following massive fetomaternal transplacental hemorrhage was 50% (2 of 4). There was one perinatal death and one infant was affected by spastic quadriplegia. For diagnosis, it is possible to use cardiotocography (decreased variability, sinusoid pattern), ultrasound (biophysical profile) and special hematological tests for quantitative determination of fetal erythrocytes in the maternal blood. For the treatment of such cases one should consider premature termination of pregnancy or intraumbilical transfusion.

  3. C1q/Tumor Necrosis Factor-related Protein-3 Attenuates Brain Injury after Intracerebral Hemorrhage via AMPK-dependent pathway in Rat

    Directory of Open Access Journals (Sweden)

    Shaohua Wang

    2016-10-01

    Full Text Available C1q/tumor necrosis factor-related protein-3 (CTRP3 is a recently discovered adiponectin paralog with established metabolic regulatory properties. However, the role of CTRP3 in intracerebral hemorrhage (ICH is still mostly unresolved. The aim of the present report was to explore the possible neuroprotective effect of CTRP3 in an ICH rat model and to elucidate the fundamental mechanisms. ICH was induced in rats by intracerebral infusion of autologous arterial blood. The effects of exogenous CTRP3 (recombinant or lentivirus CTRP3 on brain injury were explored on day 7. Treatment with CTRP3 reduced brain edema, protected against disruption of the blood-brain barrier, improved neurological functions, and promoted angiogenesis. Furthermore, CTRP3 greatly intensified phosphorylation of AMP-activated protein kinase (AMPK in addition to expression of hypoxia inducing factor-1α (HIF-1α and vascular endothelial growth factor (VEGF. Finally, the protective effects of CTRP3 could be blocked by either AMPK or VEGF inhibitors. Our findings give the first evidence that CTRP3 is a new proangiogenic and neuroprotective adipokine, which may exert its protective effects at least partly through an AMPK/HIF-1α/ VEGF-dependent pathway, and suggest that CTRP3 may provide a new therapeutic strategy for ICH.

  4. Relationship between Interleukin-6 (−174G/C and −572C/G) Promoter Gene Polymorphisms and Risk of Intracerebral Hemorrhage: A Meta-Analysis

    Science.gov (United States)

    Kumar, Pradeep; Misra, Shubham; Kumar Yadav, Arun; Kumar, Amit; Sriwastva, Mukesh; Prasad, Kameshwar

    2016-01-01

    Background Polymorphisms of −174G/C and −572C/G in the Interleukin-6 (IL-6) promoter gene can affect both transcription and secretion of IL-6 and may be involved in the inflammatory mechanisms in early and delayed phases after intracerebral hemorrhage (ICH). The role of these polymorphisms remains unclear for the pathogenesis of ICH. Methods PubMed, EMBASE, MEDLINE and Google Scholar searches were conducted from January 1, 1950 to February 29, 2016 and were supplemented with relevant articles identified in the references. The following search terms were used: (‘interleukin-6’ or ‘IL-6’) and (‘genetic polymorphism’ or ‘single nucleotide polymorphisms’ or ‘SNP’) and (‘intracerebral hemorrhage’ or ‘ICH’) and (‘hemorrhagic stroke’ or ‘HS’). Fixed or random effects models were used to estimate the pooled odds ratios and 95% confidence intervals. Begg's funnel plot was used to assess the potential for publication bias. Results In our meta-analysis, three case-control studies involving 446 ICH cases and 2,322 controls were included. No significant association was observed for the IL-6 (-174G/C and −572C/G) gene polymorphisms with the risk of ICH under dominant, recessive and allelic models. Conclusion Our meta-analysis suggests that IL-6 gene polymorphisms are not associated with the risk of ICH. However, caution must be taken while considering the results of our meta-analysis due to the presence of small sample size. Our results cannot be extrapolated to represent the effect of entire IL-6 genetic polymorphism on stroke patients worldwide. Therefore, further well-designed studies with large sample size are warranted to validate our findings and provide a profound conclusion.

  5. Intracerebral hemorrhage: a rare late manifestation of vitamin-K deficiency in a breastfed infant. A case report.

    Science.gov (United States)

    Soylu, H; Aslan, Y; Sari, A; Erduran, E

    1997-01-01

    Late hemorrhagic disease of the newborn (HDN) is a rare complication of vitamin-K deficiency and is especially associated with intracranial hemorrhage. It may also occur in infants who received vitamin-K prophylaxis at birth. Here, we reported a case of late HDN with frontal lobe hemorrhage due to vitamin-K deficiency. This form of intracranial hemorrhage of late HDN has been reported in the literature very rarely. We conclude that the efficiency of single-dose vitamin-K prophylaxis should be revaluated.

  6. Leiomyomas and massive digestive hemorrhages: Case reports of patients diagnosed in 2004

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    Golubović Gradimir

    2007-01-01

    Full Text Available Introduction: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. Case report: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathological findings, and at the same time a definite therapeutic procedure. Discussion and conclusion: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.

  7. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    Science.gov (United States)

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Green turtle head trauma with intracerebral hemorrhage: image diagnosis and treatment Traumatismo craniano com hemorragia intracerebral em tartaruga verde: diagnóstico por imagem e tratamento

    Directory of Open Access Journals (Sweden)

    Daphne Wrobel Goldberg

    2010-11-01

    Full Text Available Sea turtles are threatened to the point of extinction. The major goal of rehabilitating injured individuals is to eventually reintroduce them back into their habitat. Sea turtles are vulnerable to anthropogenic effects, and impact traumas are a common cause of death among these animals. Carapace and skull fractures are usually related to vessel collisions or propeller impacts. However, intentional traumas inflicted by humans are also considered as a potential threat. The purpose of this article is to describe the diagnosis and rehabilitation procedures of a juvenile green turtle (Chelonia mydas after severe head trauma with brain hemorrhage. The data presented here can be used as a reference for future cases of head trauma in chelonians.Tartarugas marinhas são animais ameaçados de extinção. Por isso, o principal objetivo em reabilitar indivíduos feridos é posteriormente reintroduzi-los em seu habitat. Quelônios marinhos apresentam grande vulnerabilidade a efeitos antropogênicos, e a ocorrência de traumatismos impactantes constituem uma importante causa de óbitos entre esses animais. Fraturas de carapaça e crânio estão normalmente associadas a colisões por embarcações. No entanto, lesões intencionais provocadas por humanos também podem ser consideradas ameaças em potencial. O objetivo deste estudo é descrever o diagnóstico e a reabilitação de um indivíduo jovem de tartaruga verde (C. mydas após traumatismo craniano severo com hemorragia cerebral. Os dados apresentados poderão ser utilizados como referências para casos futuros de traumatismos afetando a região da cabeça de quelônios.

  9. The AGTR1 gene A1166C polymorphism as a risk factor and outcome predictor of primary intracerebral and aneurysmal subarachnoid hemorrhages.

    Science.gov (United States)

    Adamski, Mateusz G; Golenia, Aleksandra; Turaj, Wojciech; Baird, Alison E; Moskala, Marek; Dziedzic, Tomasz; Szczudlik, Andrzej; Slowik, Agnieszka; Pera, Joanna

    2014-01-01

    Associations between the angiotensin II type 1 receptor (AGTR1) gene A1166C polymorphism and hypertension, aortic abdominal aneurysms (as a risk factor) as well as cardiovascular disorders (as a risk factor and an outcome predictor) have been demonstrated. We aimed to investigate the role of this polymorphism as risk factors and outcome predictors in primary intracerebral hemorrhage (PICH) and aneurysmal subarachnoid hemorrhage (aSAH). We have prospectively recruited 1078 Polish participants to the study: 261 PICH patients, 392 aSAH patients, and 425 unrelated control subjects. The A1166C AGTR1 gene polymorphism was studied using the tetra-primer ARMS-PCR method. Allele and genotype frequencies were compared with other ethnically different populations. The A1166C polymorphism was not associated with the risk of PICH or aSAH. Among the aSAH patients the AA genotype was associated with a good outcome, defined by a Glasgow Outcome Scale of 4 or 5 (pAGTR1 polymorphism and outcome of aSAH patients, but not with the risk of PICH or aSAH. Copyright © 2014 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  10. [A case of fetal death resulting from a massive fetomaternal hemorrhage].

    Science.gov (United States)

    Denef, M; Capelle, X; Vanlinthout, C; Lepage, S; Emonts, P

    2015-01-01

    We report the case of a late stillbirth which unexpectedly occurred in a patient without any medical history and after a meticulous obstetrical follow up. Stillbirth is unfortunately not unusual and implies a complete etiological work up. In the present observation, the Kleihauer test and anatomoclinical examination concluded that the death was due to an acute cerebral anoxy resulting from a massive fetomaternal hemorrhage (HFM). HFM is rarely considered as the cause of a late stillbirth, but its occurrence is certainly underestimated. Yet, if HFM is identified before fetal death, an .adequate management could considerably improve the fetal prognosis and, sometines, save the child's life.

  11. 高血压性脑出血后血浆凝血酶的动态变化与脑损害的关系%The relation between the developmental change of plasma thrombin and brain damage after hypertension intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Background:After intracerebral hemorrhage,besides take part in blood coagulation,plasma thrombin also is an important neural media.It can cause cerebral edema, damage blood brain barrier,and have cytotoxicity.We analysed the amount and the release law of plasma thrombin,and their relation to brain damage on the inpatients with hypertension intracerebral hemorrhage (HCH) who came to our hospital from 1999 to 2001.

  12. Clinical Usefulness of Bakri Balloon Tamponade in the Treatment of Massive Postpartum Uterine Hemorrhage.

    Science.gov (United States)

    Nagai, Sayori; Kobayashi, Hiroaki; Nagata, Tomomi; Hiwatashi, Sayuri; Kawamura, Toshihiko; Yokomine, Daisaku; Orita, Yuji; Oki, Toshimichi; Yoshinaga, Mitsuhiro; Douchi, Tsutomu

    2016-01-01

    Intrauterine globe-shaped metreurynter tamponade has been used for some time to treat massive postpartum hemorrhage (PPH). More recently, the Bakri balloon has come into use to treat PPH. It is made of silicon, possesses a drainage lumen, and has a sausage-like spindle shape. The aim of the present study was to investigate the clinical usefulness of Bakri balloon tamponade for massive PPH. Subjects in the present study comprised 5 patients with uterine atony, 3 with placenta previa, and 2 with low-lying placenta. All patients exhibited massive PPH and resistance to conventional hemostatic managements. Bakri balloon tamponade was appliedto these 10 patients. The mean amounts of uterine bleeding (average ± SD) before and after Bakri insertion were2,732 ± 1,397 mL and 380 ± 376 mL, respectively. The median (third-first quartile ranges) volume of salineinflating the balloon was 200 mL (300-150 mL). The median (third-first quartile ranges) indwelling duration of Bakri balloon was 24 hours (24-11 hrs). The overall success rate of Bakri balloon tamponade was 90% (9/10).There were no cases of slipping out or complications regarding balloon placement. Our findings suggest that Bakri balloon tamponade may be applied to the treatment of massive PPH in uterine atony and placenta previa.The Bakri balloon appears to have the following merits: (1) easy insertion into the uterine cavity and low rate of slipping out, (2) proper conformability to the hemorrhagic area due to its spindle shape, (3) ability to monitor blood loss through the drainage lumen even after insertion.

  13. Intranasal delivery of hypoxia-preconditioned bone marrow-derived mesenchymal stem cells enhanced regenerative effects after intracerebral hemorrhagic stroke in mice.

    Science.gov (United States)

    Sun, Jinmei; Wei, Zheng Zachory; Gu, Xiaohuan; Zhang, James Ya; Zhang, Yongbo; Li, Jimei; Wei, Ling

    2015-10-01

    Intracerebral hemorrhagic stroke (ICH) causes high mortality and morbidity with very limited treatment options. Cell-based therapy has emerged as a novel approach to replace damaged brain tissues and promote regenerative processes. In this study we tested the hypothesis that intranasally delivered hypoxia-preconditioned BMSCs could reach the brain, promote tissue repair and improve functional recovery after ICH. Hemorrhagic stroke was induced in adult C57/B6 mice by injection of collagenase IV into the striatum. Animals were randomly divided into three groups: sham group, intranasal BMSC treatment group, and vehicle treatment group. BMSCs were pre-treated with hypoxic preconditioning (HP) and pre-labeled with Hoechst before transplantation. Behavior tests, including the mNSS score, rotarod test, adhesive removal test, and locomotor function evaluation were performed at varying days, up to 21days, after ICH to evaluate the therapeutic effects of BMSC transplantation. Western blots and immunohistochemistry were performed to analyze the neurotrophic effects. Intranasally delivered HP-BMSCs were identified in peri-injury regions. NeuN+/BrdU+ co-labeled cells were markedly increased around the hematoma region, and growth factors, including BDNF, GDNF, and VEGF were significantly upregulated in the ICH brain after BMSC treatment. The BMSC treatment group showed significant improvement in behavioral performance compared with the vehicle group. Our data also showed that intranasally delivered HP-BMSCs migrated to peri-injury regions and provided growth factors to increase neurogenesis after ICH. We conclude that intranasal administration of BMSC is an effective treatment for ICH, and that it enhanced neuroregenerative effects and promoted neurological functional recovery after ICH. Overall, the investigation supports the potential therapeutic strategy for BMSC transplantation therapy against hemorrhagic stroke. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Impact of proteinuria and glomerular filtration rate on risk of ischaemic and intracerebral hemorrhagic stroke: a result from the Kailuan study.

    Science.gov (United States)

    Li, Z; Wang, A; Cai, J; Gao, X; Zhou, Y; Luo, Y; Wu, S; Zhao, X

    2015-02-01

    Persons with chronic kidney disease, defined by a reduced estimated glomerular filtration rate and proteinuria, have an increased risk of cardiovascular disease including stroke. However, data from developing countries are limited. Our aim was to assess the relationship between chronic kidney disease and risk of stroke and its subtypes in a community-based population in China. The study was based on 92,013 participants (18-98 years old; 73,248 men and 18,765 women) of the Kailuan study who at baseline were free from stroke and myocardial infarction and had undergone tests for serum creatinine or proteinuria. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration formula and proteinuria by the urine dipstick result in laboratory databases. The primary outcome was the first occurrence of stroke. Data were analyzed using Cox proportional hazards models adjusted for relevant confounders and results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). During a follow-up of 4 years, 1575 stroke events (1128 ischaemic, 406 intracerebral hemorrhagic and 41 subarachnoid hemorrhagic strokes) occurred. After adjustment for variable confounders, patients with proteinuria were found to have increased HRs for the total and subtypes of stroke events (HR 1.61; 95% CI 1.35-1.92 for total stroke; HR 1.53; 95% CI 1.24-1.89 for ischaemic stroke; and HR 1.90; 95% CI 1.35-2.67 for hemorrhagic stroke). However, estimated glomerular filtration rate was not associated with incident stroke after adjustment for established cardiovascular risk factors. Proteinuria increased the risk of stroke in a general Chinese population. © 2014 EAN.

  15. Study of Risk Factors of Nosocomial Infection in Intracerebral Hemorrhage%脑出血医院感染的危险因素探讨-非条件Logistic模型

    Institute of Scientific and Technical Information of China (English)

    张旭; 李骥

    2001-01-01

    目的 探明脑出血患者并发医院感染危险因素,以及采取有效控制措施。方法 对我院1997年1月~1999年6月住院治疗的837例脑出血患者进行医院感染及其危险因素的回顾性分析。结果 脑出血并发医院感染216例,医院感染发生率为25.8%,其中以下呼吸道最多见,占39.1%,其次为泌尿道,占27.8%。老年、脑出血部位和出血量、意识障碍、 吸烟史、 血糖、 侵袭性操作、 预防性抗生素应用、住院日等9项是医院感染发生的危险因素。结论 脑出血医院感染发生率高,应引起重视,尽可能把脑出血并发医院感染控制到最低限度。%OBJECTIVE In order to explore and control the risk factors of nosocomial infection in intracerebral hemorrhage.METHODS To study prospectively in 837 hospitalized patients with intracerebral hemorrhage in our hospital from Jan.1997 to June 1999. RESULTS It was showed 215 cases of the nosocomial infection were found among 837 cases with the intracerebral hemorrhage(25.8%).Among them,nosocomial lower respiratory tract infection was the highest(39.1%),the second one was the urinary tract(27.8%).Nosocomial infection was closely related with such factors as the aging,location and volume of intracerebral hematoma,disturbance of consciousness, smoking,blood sugar,invasive operation,antibiotic prophylaxis,bed-days.Whereas serum cholesterol was a protective factor.CONCLUSIONS Nosocomial infection was still a high frequent complication in intracerebral hemorrhage and it should be paid attention.This is the most important step to control nosocomial infection of intracerebral hemorrhage in the hospital.

  16. Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Khalid Umair

    2011-04-01

    Full Text Available Abstract Background Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated. Methods An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1500 ml between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment. Results During 2008, massive postpartum hemorrhage occurred in 0.64% cases (26/4,052. No deaths were reported. The mean blood loss was 2431 ± 1817 ml (range: 1500 - 9000 ml. Emergency cesarean section was the most common mode of delivery (13/26; 50% while uterine atony was the most common cause of massive postpartum hemorrhage (14/26; 54%. B-lynch suture (24% and balloon tamponade (60% were used more commonly as compared to our previously reported experience. Cesarean hysterectomy was performed in 3 cases (12% for control of massive postpartum hemorrhage. More than 80% compliance was observed in 8 out of 10 steps of the management protocol. Initiation of blood transfusion at 1500 ml blood loss (89% and overall documentation of management (92% were favorably observed in most cases. Conclusion This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and

  17. The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database

    Directory of Open Access Journals (Sweden)

    Chien-Lung Chan

    2014-01-01

    Full Text Available Introduction. Length of stay (LOS in the intensive care unit (ICU of spontaneous intracerebral hemorrhage (sICH patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

  18. Intensive blood pressure control during the hyperacute phase of intracerebral hemorrhage in patients at risk for resistant hypertension: a retrospective cohort study.

    Science.gov (United States)

    Mohrien, Kerry M; Elijovich, Lucas; Venable, Garrett T; Taylor, Douglas R; Jones, G Morgan

    2015-04-01

    There are limited data evaluating intensive systolic blood pressure (SBP) control during the hyperacute phase of intracerebral hemorrhage (ICH) in patients with multiple risk factors for resistant hypertension. We evaluated the feasibility and safety of this intervention in a primary population that includes patients with multiple risk factors for resistant hypertension. We conducted a retrospective analysis of ICH patients for which intensive SBP control (risk factors that have been associated with resistant hypertension. Our primary objective was to determine the percentage of patients who achieved goal SBP within 1 hour of ICH diagnosis. Secondary objectives included identifying predictors of achieving goal SBP within 6 hours. Goal SBP within 1 hour was achieved in 8.1% of patients. The total number of risk factors a patient possessed was found to negatively predict ability to achieve goal SBP. For each risk factor possessed, the odds of achieving goal SBP within 6 hours are reduced by 31% (odds ratio, 0.69 [95% confidence interval, 0.54-0.89]). Intensive SBP control after ICH was difficult to achieve within 1 hour in those with risk factors for resistant hypertension. Patients' total risk factors were found to reduce the odds of achieving goal SBP within 6 hours. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. 凝血酶在脑出血中的作用机制研究进展%The Advances in Mechanism of Thrombin in the Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    丁非凡; 王朝燕; 代大伟; 代亚美

    2011-01-01

    凝血酶是一种丝氨酸蛋白酶,其主要作用是参与机体的凝血、抗凝、血栓形成和纤溶等过程.早先的研究显示在脑出血中凝血酶可以引起血脑屏障的破坏,促进脑水肿的形成,导致神经元死亡,但是新近研究显示凝血酶除了上述作用外,还有促进神经再生、血管再生及脑组织重塑等作用.%Thrombin is a serine proteinase which affects our bodys blood clotting, anticoagulation, thrombosis and f ibrinolysis. Previous studies have showed that thrombin induces blood brain barrier leakage, brain edema, and neuronal death after intracerebral hemorrhage (ICH). However, recent researches have shown that thrombin may facilitate neurogenesis, angiogenesis, plasticity after ICE

  20. The predictive accuracy of the black hole sign and the spot sign for hematoma expansion in patients with spontaneous intracerebral hemorrhage.

    Science.gov (United States)

    Yu, Zhiyuan; Zheng, Jun; Ma, Lu; Guo, Rui; Li, Mou; Wang, Xiaoze; Lin, Sen; Li, Hao; You, Chao

    2017-06-02

    In patients with spontaneous intracerebral hemorrhage (sICH), hematoma expansion (HE) is associated with poor outcome. Spot sign and black hole sign are neuroimaging predictors for HE. This study was aimed to compare the predictive value of two signs for HE. Within 6 h after onset of sICH, patients were screened for the computed tomography angiography spot sign and the non-contrast computed tomography black hole sign. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of two signs for HE prediction were calculated. The accuracy of two signs in predicting HE was analyzed by receiver-operator analysis. A total of 129 patients were included in this study. Spot sign was identified in 30 (23.3%) patients and black hole sign in 29 (22.5%) patients, respectively. Of 32 patients with HE, spot sign was observed in 19 (59.4%) and black hole sign was found in 14 (43.8%). The occurrence of black hole sign was significantly associated with spot sign (P black hole sign for predicting HE were 43.75, 84.54, 48.28, and 82.00%, respectively. The area under the curve was 0.740 for spot sign and 0.641 for black hole sign. (P = 0.228) Both spot sign and black hole sign appeared to have good predictive value for HE, and spot sign seemed to be a better predictor.

  1. N-methyl-D-aspartic acid receptor 1 (NMDAR1) aggravates secondary inflammatory damage induced by hemin-NLRP3 pathway after intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Xun Weng; Yan Tan; Xiang Chu; Xiao-Feng Wu; Rui Liu; Yue Tian; Lin Li

    2015-01-01

    Objective:Inflammation plays a critical role in secondary brain damage after intracerebral hemorrhage (ICH).However,the mechanisms of inflammatory injury following ICH are still unclear,particularly the involvement of NLRP3 inflammasome,which are crucial to sterile inflammatory responses.In this study,we aim to test the hypothesis that NLRP3 signaling pathway takes a vital position in ICH-induced secondary inflammatory damage and detect the role of N-methyl-D-aspartic acid receptor 1 (NMDAR1) in this progress.Methods:ICH was induced in mice by microinjection of hemin into the striatum.The protein levels of NMDAR1,NMDAR1 phosphorylation,NLRP3 and IL-1β were measured by Western blot.The binding of NMDAR1 to NLRP3 was detected by immunoprecipitation.Results:The expression of NMDAR1,NMDAR1 phosphorylation,NLRP3 and IL-1 β were rapidly increased after ICH.Hemin treatment enhanced NMDAR1 expression and NMDAR1 phosphorylation,as well in cultured microglial cells treated by hemin.Hemin up-regulated NLRP3 and IL-1β level,which was reversed by MK801 (NMDAR antagonist) in vitro.Hemin also promoted the binding of NMDAR1 to NLRP3.Conclusion:Our findings suggest that NMDAR1 plays a pivotal role in hemin-induced NLRP3-mediated inflammatory damage through synergistic activation.

  2. [Neuroprotector effect of human recombinant erythropoietin sorbed on polymer nanoparticles studied on model of intracerebral post-traumatic hematoma (hemorrhagic stroke)].

    Science.gov (United States)

    Balaban'ian, V Iu; Solev, I N; Elizarova, O S; Garibova, T L; Litvinova, S A; Voronina, T A

    2011-01-01

    The neuroprotective activity of recombinant human erythropoietin (r-HuEpo) sorbed on poly(butyl)cyanoacrilate nanoparticles (EPO-PBCA) and on polylactic-co-glycolic acid nanoparticles (EPO-PLGA) has been studied on Wistar rats with intracerebral post-traumatic hematoma (model of hemorrhagic stroke) (IPH-HS) in comparison to native r-HuEpo. It is established that EPO-PBCA produced a protective effect in rats after IPH-HS that was manifested by a decrease in the number of animals with neurological disorders such as circus movement, paresis, and paralysis of hind limbs; the drug also improved coordination (rotating rod test), reduced the number of lost animals, and decreased the loss weight among survived rats. In addition, EPO-PBCA optimized the research behavior of rats with IPH-HS in the open field test and prevented amnesia of passive avoidance reflex (PAR), which was caused by the IPH-HS. These effects were manifested during a two-week observation period. EPO-PLGA has a similar but much less pronounced effect on the major disorders caused by IPH-HS. The efficiency of native r-HuEpo as a neuropotective agent was insignificant and only manifested by decrease in the number of lost animals with IPH-HS.

  3. Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial.

    Science.gov (United States)

    Krishnan, Kailash; Scutt, Polly; Woodhouse, Lisa; Adami, Alessandro; Becker, Jennifer L; Cala, Lesley A; Casado, Ana M; Chen, Christopher; Dineen, Robert A; Gommans, John; Koumellis, Panos; Christensen, Hanna; Collins, Ronan; Czlonkowska, Anna; Lees, Kennedy R; Ntaios, George; Ozturk, Serefnur; Phillips, Stephen J; Sprigg, Nikola; Szatmari, Szabolcs; Wardlaw, Joanna M; Bath, Philip M

    2016-05-01

    More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P treatment groups for any secondary outcome measure, or rates of death or serious adverse events. Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Regulatory T cells ameliorate intracerebral hemorrhage-induced inflammatory injury by modulating microglia/macrophage polarization through the IL-10/GSK3β/PTEN axis.

    Science.gov (United States)

    Zhou, Kai; Zhong, Qi; Wang, Yan-Chun; Xiong, Xiao-Yi; Meng, Zhao-You; Zhao, Ting; Zhu, Wen-Yao; Liao, Mao-Fan; Wu, Li-Rong; Yang, Yuan-Rui; Liu, Juan; Duan, Chun-Mei; Li, Jie; Gong, Qiu-Wen; Liu, Liang; Yang, Mei-Hua; Xiong, Ao; Wang, Jian; Yang, Qing-Wu

    2017-03-01

    Inflammation mediated by the peripheral infiltration of inflammatory cells plays an important role in intracerebral hemorrhage (ICH) induced secondary injury. Previous studies have indicated that regulatory T lymphocytes (Tregs) might reduce ICH-induced inflammation, but the precise mechanisms that contribute to ICH-induced inflammatory injury remain unclear. Our results show that the number of Tregs in the brain increases after ICH. Inducing Tregs deletion using a CD25 antibody or Foxp3(DTR)-mice increased neurological deficient scores (NDS), the level of inflammatory factors, hematoma volumes, and neuronal degeneration. Meanwhile, boosting Tregs using a CD28 super-agonist antibody reduced the inflammatory injury. Furthermore, Tregs depletion shifted microglia/macrophage polarization toward the M1 phenotype while boosting Tregs shifted this transition toward the M2 phenotype. In vitro, a transwell co-culture model of microglia and Tregs indicated that Tregs changed the polarization of microglia, decreased the expression of MHC-II, IL-6, and TNF-α and increased CD206 expression. IL-10 originating from Tregs mediated the microglia polarization by increasing the expression of Glycogen Synthase Kinase 3 beta (GSK3β), which phosphorylates and inactivates Phosphatase and Tensin homologue (PTEN) in microglia, TGF-β did not participate in this conversion. Thus, Tregs ameliorated ICH-induced inflammatory injury by modulating microglia/macrophage polarization toward the M2 phenotype through the IL-10/GSK3β/PTEN axis.

  5. Defining Prolonged Length of Acute Care Stay for Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage: A Population-Based Analysis

    Directory of Open Access Journals (Sweden)

    Marco Stein

    2016-01-01

    Full Text Available Background. The definition of prolonged length of stay (LOS during acute care remains unclear among surgically and conservatively treated patients with intracerebral hemorrhage (ICH. Methods. Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. The influence of comorbidities, baseline characteristics at admission, and in-hospital complications on prolonged LOS was evaluated in a multivariate model. Results. Overall, 13272 patients with ICH were included in the analysis. Surgical therapy of the hematoma was documented in 1405 (10.6% patients. Change points for LOS were 22 days (CI: 8, 22; CL 98% for surgically treated patients and 16 days (CI: 16, 16; CL: 99% for conservatively treated patients. Ventilation therapy was related to prolonged LOS in surgically (OR: 2.2, 95% CI: 1.5–3.1; P<0.001 and conservatively treated patients (OR: 2.5, 95% CI: 2.2–2.9; P<0.001. Two or more in-hospital complications in surgical patients (OR: 2.7, 95% CI: 2.1–3.5 and ≥1 in conservative patients (OR: 3.0, 95% CI: 2.7–3.3 were predictors of prolonged LOS. Conclusion. The definition of prolonged LOS after ICH could be useful for several aspects of quality management and research. Preventing in-hospital complications could decrease the number of patients with prolonged LOS.

  6. Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial.

    Science.gov (United States)

    Mortensen, Jesper; Figlewski, Krystian; Andersen, Henning

    2016-01-01

    To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH). A double-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n = 8) or sham (n = 7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen-Taylor test (JTT). Both groups improved JTT over time (p occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor impairment. It is well tolerated by patients and can easily be applied for home-based training. Larger studies with long-term follow-up are needed to further explore possible effects of tDCS in patients with ICH. Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is well tolerated by patients and can easily be applied for home-based rehabilitation.

  7. Inflammation as Therapeutic Target of Intracerebral Hemorrhage%炎症与脑出血的靶向治疗

    Institute of Scientific and Technical Information of China (English)

    刘晓静; 张拥波; 李继梅

    2013-01-01

      炎症在脑出血后继发性脑损伤过程中起关键作用,涉及胶质细胞、血管内皮细胞以及基质金属蛋白酶(matrix metal oproteinases,MMP)、肿瘤坏死因子(tumor necrosis factor,TNF)-α、白介素(interleukin,IL)及补体等多种炎症细胞及因子。目前对脑出血仍缺乏有效的治疗药物。针对脑出血后炎症反应的治疗方法主要包括环氧化酶(cyclooxygenase,COX)抑制剂、MMP抑制剂、血管紧张素1(angiotensin1,AT1)受体阻滞剂、他汀类药物、干细胞移植等,可能为脑出血的治疗提供新的靶点。%The mechanisms of brain damage induced by cerebral hemorrhage are complicated. Inflammation plays an important role in the secondary process of brain damage. It involves a lot of inflammatory cells and mediators. There are few treatments of cerebral hemorrhage. We conclude the potential drugs which target the inflammatory process during cerebral hemorrhage.

  8. Successful rescuing a pregnant woman with severe hepatitis E infection and postpartum massive hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Zhan-Sheng Jia; Yu-Mei Xie; Guo-Wu Yin; Jun-Rong Di; Wei-Pin Guo; Chang-Xing Huang; Xue-Fang Bai

    2003-01-01

    AIM: To sum up the experience of the successful therapy for the severe hepatitis of pregnant woman with postpartum massive hemorrhage.METHODS: The advanced therapeutic methods including the bilateral uterine artery embolism, hemodialysis and artificial liver support therapy were performed with comprehensive medical treatments and the course of the successful rescuing the patient was analyzed.RESULTS: Through the hospitalization of about two mouths the patient and her neonatus had gotten the best of care in our department and pediatric department separately. Both of them were discharged in good condition.CONCLUSION: The key points for a successful therapy of the pregnant woman with severe hepatitis are termination of the pregnancy and the control of their various complications. It was suggested that the proper combination of these measures of modern therapy would race against time for renewing of hepatic and renal functions.

  9. Massive Retroperitoneal Hemorrhage as an Initial Presentation of a Rare and Aggressive Form of Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Aydah Alawadhi

    2016-01-01

    Full Text Available Multiple myeloma, a plasma cell neoplasm, presents most commonly with anemia, hypercalcemia, renal failure, and bone pain. Only few cases of clinical aggressive presentation associated with bleeding were reported in the medical literature. The reported cases included gastrointestinal bleeding and cardiac tamponade. Spontaneous retroperitoneal haemorrhage as initial presentation has not been so far reported. We hereby report a case of a 64-year-old female who was found to have catastrophic hemorrhage in the retroperitoneal region that extended into intrathecal space causing cord compression. The case posed a significant diagnostic and management dilemma. This case emphasizes the need to think broadly and include multiple myeloma in the diagnosis of unexplained massive retroperitoneal bleeding.

  10. Medical image of the week: abdominal compartment syndrome due to massive upper gastrointestinal hemorrhage

    Directory of Open Access Journals (Sweden)

    Truong VN

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. A 29 year old woman with history of a Whipple procedure for pancreatic cancer and nonalcoholic steatohepatitis cirrhosis presented with a massive upper gastrointestinal bleeding (UGIB likely from esophageal varices and developed hemorrhagic shock. Emergent upper endoscopy could not be performed due to hemodynamic instability. Therefore, a Minnesota Tube was placed emergently for balloon tamponade of the bleeding. A transjugular intrahepatic portosystemic shunt was also placed emergently to decrease bleeding by reducing portal pressure. By this time, the patient had received 4 liters of normal saline, 14 units of packed red blood cells, 6 units of platelets, and 4 units of fresh frozen plasma. The Minnesota tube did control the bleeding somewhat, however, there was continued bloody drainage from the stomach port of the Minnesota tube. The patient’s abdomen became remarkably distended and was dull to percussion throughout. A CT scan of the abdomen and pelvis revealed severe dilatation of ...

  11. Use of Condom Tamponade to Manage Massive Obstetric Hemorrhage at a Tertiary Center in Rajasthan.

    Science.gov (United States)

    Hasabe, Rakesh; Gupta, Kumud; Rathode, Pallavi

    2016-10-01

    Conventionally postpartum hemorrhage (PPH) has been defined as blood loss of more than 500 ml following vaginal delivery and 1000 ml following a cesarean section [Pritchard et al. in Am J Obstet Gynecol 84(10):1271-1282, (1962)]. Another definition labels PPH as any blood loss which causes a 10 % drop in hematocrit [Combs et al. in Obstet Gynecol 77:69-76, (1991)] or which threatens the hemodynamic stability of the patient and necessitates blood transfusion [Prendiville et al. in Cochrane Database Syst Rev 2:CD000007, (2000)]. The purpose of this study was to evaluate the effectiveness of condom tamponade in the management of massive obstetric hemorrhage. To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive PPH. This prospective study was done in the Obstetrics and Gynecology Department of NIMS Medical College and Hospital, Jaipur, between December 2013 and February 2015. With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 ml normal saline according to need. Vaginal bleeding was observed, and further inflation was stopped when bleeding ceased. In all but 2 (94.44 %) the cases, postpartum bleeding was stopped within 10 min of creation of tamponade. On an average, 350 ml of normal saline was required to create adequate tamponade to stop the bleeding. Use of condom tamponade can effectively help in reducing both maternal morbidity and mortality associated with PPH. Our study encourages use of condom tamponade which is efficient, cost-effective, easily available and requires lesser skills as compared to the traditional surgical procedures.

  12. Significance of rehabilitative management during the critical period for motor recovery in intracerebral hemorrhage: a case report.

    Science.gov (United States)

    Kwon, Hyeok Gyu; Jang, Sung Ho

    2012-03-01

    The majority of motor recovery following stroke is known to occur within 3-6 months after onset; this period is therefore regarded as critical for motor recovery in stroke patients. We report here a case of a patient with intracerebral haemorrhage who showed changes in the affected motor function and in the damaged corticospinal tract (CST) at the primary motor cortex (M1) during rehabilitative management. A 51-year-old woman underwent decompressive craniectomy and removal of haematoma due to a rupture of an arteriovenous malformation. Brain magnetic resonance imaging revealed a leukomalactic lesion at the fronto-parietal cortex centred on the precentral knob. Diffusion tensor imaging data were acquired 4 times (5, 8, 11 and 18 weeks after onset) and she started rehabilitation for right hemiplegia at 5 weeks after onset. We found close relationships between changes in the CST branch from M1 on diffusion tensor tractography, the state of motor weakness, and the rehabilitative management: the CST branch from M1 was observed concurrently with motor recovery and the process of rehabilitation. This case report indicates the importance of active and comprehensive rehabilitative management during the critical period for motor recovery in stroke patients.

  13. Anterior placentation as a risk factor for massive hemorrhage during cesarean section in patients with placenta previa.

    Science.gov (United States)

    Baba, Yosuke; Matsubara, Shigeki; Ohkuchi, Akihide; Usui, Rie; Kuwata, Tomoyuki; Suzuki, Hirotada; Takahashi, Hironori; Suzuki, Mitsuaki

    2014-05-01

    In placenta previa (PP), anterior placentation, compared with posterior placentation, is reported to more frequently cause massive hemorrhage during cesarean section (CS). Whether this is due to the high incidence of placenta accreta, previous CS, or a transplacental approach in anterior placenta is unclear. We attempted to clarify this issue. We retrospectively analyzed the relation between the bleeding amount during CS for PP and various factors that may cause massive hemorrhage (>2400 mL) (n = 205) in a tertiary center. If the preoperatively ultrasound-measured distance from the internal cervical ostium to the placental edge was longer in the uterine anterior wall than in the posterior wall, we defined it as anterior previa, and vice versa. Patients with accreta, previous CS, total previa, and anterior placentation bled significantly more than their counterparts. Multivariate logistic regression analysis showed that accreta (odds ratio [OR] 12.6), previous CS (OR 4.7), total previa (OR 4.1), and anterior placentation (OR 3.5) were independent risk factors of massive hemorrhage. Anterior placentation, namely, the placenta with a longer os-placental edge distance in the anterior wall than in the posterior wall, was a risk of massive hemorrhage during CS for PP. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  14. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa

    NARCIS (Netherlands)

    Broekman, Evelien A.; Versteeg, Henneke; Vos, Louwerens D.; Dijksterhuis, Marja G.; Papatsonis, Dimitri N.

    2015-01-01

    Objective To evaluate the effectiveness of temporary balloon occlusion of the internal iliac artery before uterine incision to prevent massive obstetric hemorrhage during cesarean delivery among patients with anterior placenta previa. Methods In a retrospective cohort study conducted at Amphia Hospi

  15. 血友病合并颅内出血的临床治疗探讨%Hemophilia complicated with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    吕乃武; 王红梅; 张轶斌; 刘福庆; 贾锐

    2016-01-01

    Objective To investigate the treatment for hemophilia complicated with intracerebral hemorrhage.Methods 20 patients with hemophilia complicated with intracranial hemorrhage were selected as study objects and were retrospectively analyzed and were followed up.Results 1 patient died at hospital.11 patients can already basicly care themselves.4 patients got hemiplegia.4 patients got secondary intracranial bleeding and ended up mental disorders, among which 1 complicated with hemiplegia.Before and after the diagnosis of hemophilia, there were statistical differences in intracranial bleeding between children ≤1, 3-6, and ≥6 years old (P < 0.05).Conclusion Alternative therapy, such as fresh frozen plasma injection, and antihypertensive drugs, such as mannitol, glucocorticoid, etc.lowering the patient's intracranial pressure, and injecting hemostatic aromatic acid can effectively treat hemophilia complicated with intracranial hemorrhage.Attention should be clinically paid on the patient's mental problems.%目的 探讨血友病合并颅内出血的临床治疗.方法 选取20例血友病患者合并颅内出血患者为研究对象,采用回顾性分析方法,进行随访.结果 1例患者在院内抢救无效死亡,11例患者生活基本自理,4例患者出现偏瘫,4例患者出现二次颅内出血,最终出现精神障碍,其中1例患者合并偏瘫.诊断血友病前后颅内出血情况在≤1岁、3~6岁、≥6岁区间上差异具有统计学意义(P<0.05).结论 采用新鲜冷冻血浆注射等进行替代治疗,并采用一些降压药物如甘露醇、糖皮质激素等药物,降低患者的颅内压水平,并注射止血芳酸,可以有效治疗血友病合并颅内出血疾病,在临床治疗上应该注重患者的精神问题.

  16. Prognostic factors of analysis on patients with nonoperative treatment of intracerebral hemorrhage in basal ganglia%非手术治疗自发性基底节区脑出血预后因素分析

    Institute of Scientific and Technical Information of China (English)

    周焜; 黄冠又; 梁郸; 乔志立; 陈冲; 王恒福; 饶正西; 王诚; 卓志平

    2013-01-01

    Objective To investigate the factors influencing prognosis of nonoperative treatment of intracerebral hemorrhage in basal ganglia. Methods The clinical data and survival status of 109 patients with intracerebral hemorrhage in basal ganglia who were admitted to Neurosurgery of Guiyang Second People' s Hospital during the period from April 2005 to June 2012 were reviewed retrospectively. The survival analysis was analyzed with Kaplan-Meier method. The univariate analysis was used to determine the prognositic factors related with survival rate by Log-rank test. Multivariate factors for the survival rates were analyzed using the Cox proportional hazards regression model. Results Univariate analysis revealed that GOS scale, GCS scale, hypertension, hemorrhage volume, intraventricu-lar hemorrhage, pulmonary infection and glucose were the factors influencing prognostic factors of hypertensive brainstem hemorrhage. Multivariate analysis showed that GCS scale, hemorrhage volume and glucose were independent prognostic factors. Conclusions GCS scale, hemorrhage volume and glucose were important prognostic factors of intracerebral hemorrhage in basal ganglia.%目的 探讨非手术治疗自发性基底节区出血预后相关的因素.方法 回顾性分析贵阳市第二人民医院神经外科2005年4月至2012年6月收治的109例随访资料完整的患者,采用Kaplan-Meier法进行单因素分析.Log-rank法进行生存率显著性检验,Cox比例风险回归模型作多因素分析.结果 单因素分析显示入院时GOS评分、GCS评分、高血压、出血量、出血破入脑室、肺部感染及血糖与预后有关联.多因素分析显示GCS评分、出血量和血糖是自发性基底节区出血预后相关的独立危险因素.结论 发病时GCS评分、出血量和血糖水平是影响患者预后的重要因素.

  17. [Primary gastrointestinal follicular lymphoma of the small intestine with massive hemorrhage: a report of three cases].

    Science.gov (United States)

    Sato, Akiyasu; Tsujimura, Hideki; Sugiyama, Takahiro; Maruyama, Satoshi; Yamada, Shuhei; Ono, Keiko; Wang, Xiaofei; Sugawara, Takeaki; Ise, Mikiko; Itami, Makiko; Kumagai, Kyouya

    2016-03-01

    Primary gastrointestinal follicular lymphoma (FL) has an indolent clinical presentation and many of cases are diagnosed incidentally during routine endoscopic examinations. Herein, we present 3 cases with FL of the small intestine developed massive intestinal hemorrhage that necessitated blood transfusion. In all three patients, upper and lower endoscopic examinations failed to detect the bleeding sites. Eventually, video capsule endoscopies identified ulcerative lesions in the jejunum and biopsies using single- or double-balloon endoscopy confirmed the FL diagnosis in our three cases. The respective clinical stages according to the Lugano system were I, II-1 and II-1. PET-CT did not play a significant role in identifying the gastrointestinal lesions. Two patients received rituximab monotherapy and achieved a complete response. The other remains under observation after termination of antiplatelet drug therapy. Generally, the macroscopic appearance of multiple whitish nodules and the absence of symptoms represent the typical clinical picture of gastrointestinal FL. However, this study demonstrates that patients with ulcerative lesions may be at risk for massive bleeding. Further discussion is required to determine the optimal indications for total endoscopic examination of the small intestine.

  18. 脑出血患者血肿扩大的危险因素分析%Analysis of Risk Factors of Hematoma Enlargement in the Early Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    胡涛; 万国端; 张俊波; 凌三国

    2015-01-01

    目的:探讨影响脑出血早期血肿扩大的危险因素,为临床防治提供依据。方法纳入2011年1月~2014年1月在神经内科住院治疗的158例幕上脑出血患者。结果脑出血患者入院时间在0~3 h复查血肿扩大的检出率高于入院时间在3~6 h的患者,但差异无统计学意义( P>0.05)。结论患者幕上脑出血早期血肿扩大,主要是因为血糖影响,入院时收缩压的影响和患者的长期饮酒史。%Objective To discuss the risk factors for the early hematom a enlargement after intracerebral hemor-rhage, and provide the basis for clinical therapy.Methods Retrospective analysis the identified 158 cases supratentori-al intracerebral hemorrhage patients from January 2011 to January 2014.Results Cerebral hemorrhage patients in the detection of admission time to expand the 0~3 h review hematoma is higher than the rate of hospitalization time in 3~6 h of the patients, but the difference wasn′t statistically significant ( P>0.05).Conclusions Blood glucose, systolic blood pressure, long-term drinking history for supratentorial intracerebral hemorrhage were independent risk factors of early enlargement of hematoma.

  19. Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial.

    Science.gov (United States)

    Mendelow, A David; Gregson, Barbara A; Rowan, Elise N; Francis, Richard; McColl, Elaine; McNamee, Paul; Chambers, Iain R; Unterberg, Andreas; Boyers, Dwayne; Mitchell, Patrick M

    2015-09-01

    Intraparenchymal hemorrhages occur in a proportion of severe traumatic brain injury TBI patients, but the role of surgery in their treatment is unclear. This international multi-center, patient-randomized, parallel-group trial compared early surgery (hematoma evacuation within 12 h of randomization) with initial conservative treatment (subsequent evacuation allowed if deemed necessary). Patients were randomized using an independent randomization service within 48 h of TBI. Patients were eligible if they had no more than two intraparenchymal hemorrhages of 10 mL or more and did not have an extradural or subdural hematoma that required surgery. The primary outcome measure was the traditional dichotomous split of the Glasgow Outcome Scale obtained by postal questionnaires sent directly to patients at 6 months. The trial was halted early by the UK funding agency (NIHR HTA) for failure to recruit sufficient patients from the UK (trial registration: ISRCTN19321911). A total of 170 patients were randomized from 31 of 59 registered centers worldwide. Of 82 patients randomized to early surgery with complete follow-up, 30 (37%) had an unfavorable outcome. Of 85 patients randomized to initial conservative treatment with complete follow-up, 40 (47%) had an unfavorable outcome (odds ratio, 0.65; 95% confidence interval, CI 0.35, 1.21; p=0.17), with an absolute benefit of 10.5% (CI, -4.4-25.3%). There were significantly more deaths in the first 6 months in the initial conservative treatment group (33% vs. 15%; p=0.006). The 10.5% absolute benefit with early surgery was consistent with the initial power calculation. However, with the low sample size resulting from the premature termination, we cannot exclude the possibility that this could be a chance finding. A further trial is required urgently to assess whether this encouraging signal can be confirmed.

  20. Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden: A Meta-analysis.

    Science.gov (United States)

    Tsivgoulis, Georgios; Zand, Ramin; Katsanos, Aristeidis H; Turc, Guillaume; Nolte, Christian H; Jung, Simon; Cordonnier, Charlotte; Fiebach, Jochen B; Scheitz, Jan F; Klinger-Gratz, Pascal P; Oppenheim, Catherine; Goyal, Nitin; Safouris, Apostolos; Mattle, Heinrich P; Alexandrov, Anne W; Schellinger, Peter D; Alexandrov, Andrei V

    2016-06-01

    Cerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding. There are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). To investigate the association of high CMB burden (>10 CMBs on a pre-IVT magnetic image resonance [MRI] scan) with the risk of sICH following IVT for AIS. Eligible studies were identified by searching Medline and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 7, 2015. This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal. Eligible prospective study protocols that reported sICH rates in patients with AIS who underwent MRI for CMB screening prior to IVT. The reported rates of sICH complicating IVT in patients with AIS with pretreatment MRI were extracted independently for groups of patients with 0 CMBs (CMB absence), 1 or more CMBs (CMB presence), 1 to 10 CMBs (low to moderate CMB burden), and more than 10 CMBs (high CMB burden). An individual-patient data meta-analysis was also performed in the included studies that provided complete patient data sets. Symptomatic intracerebral hemorrhage based on the European Cooperative Acute Stroke Study-II definition (any intracranial bleed with ≥4 points worsening on the National Institutes of Health Stroke Scale score). We included 9 studies comprising 2479 patients with AIS. The risk of sICH after IVT was found to be higher in patients with evidence of CMB presence, compared with patients without CMBs (risk ratio [RR], 2.36; 95% CI, 1.21-4.61; P = .01). A higher risk for sICH after IVT was detected in patients with high CMB burden (>10 CMBs) when compared with

  1. 高血压脑出血患者的血压管理%The management of blood pressure in patients with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    孙祥荣

    2015-01-01

    Not only high blood pressure is the main cause of intracerebral hemorrhage(ICH),but also elevated blood pressure is the factor of hematoma enlargement and secondary brain injury after ICH. In recent years antihypertensive therapy studies found that blood pressure reduction in acute ICH could reduce hematoma enlargement, did not reduce blood flow surrounding hematoma to increase ischemic injury, maybe has certain effect in the recovery of neural function. So European Stroke Organisation (ESO) guidelines for the management of spontaneous ICH recuments for intensive lowering of systolic blood pressure to<140mmHg within six-hours of ICH onset.%高血压不仅是脑出血的主要原因,脑出血后血压过高是血肿扩大和继发脑损伤的重要原因。近年来的降压治疗研究发现,超急性期的降压治疗不仅可以降低血肿扩大,并没有造成血肿周围组织的血流量的减少,从而增加缺血性损伤。并且在对神经功能恢复可能有一定的作用。故欧洲卒中组织推荐发病6小时内启动降压治疗,收缩压降至140mmHg是可行的。

  2. Exploring the optimal operation time for patients with hypertensive intracerebral hemorrhage:tracking the expression and progress of cell apoptosis of prehematomal brain tissues

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xin-qing; ZHANG Zhi-min; YIN Xiao-liang; ZHANG Kun; CAI Hui; LING Feng

    2010-01-01

    Background Hypertensive intracerebral hemorrhage (HICH) is a severe disease with high morbidity and mortality.Timely removal of the hematoma through surgical procedures may effectively reduce secondary injuries.However, there has long been a debate over the proper timing of such surgery.In this study, we explored the optimal operation time for HICH patients by observing the pathological changes in perihematomal brain regions during different stages of onset.Methods Twenty-five specimens of brain tissue, obtained from perihematomal region of HICH patients in different phases, were subjected to haematoxylin-eosin (HE) staining, terminal deoxynucleotidyl transferase-mediated deoxyuridine 5-triphosphate nick-end labeling (TUNEL) staining and Caspase-3, matrix metalloproteinases-9 (MMP-9)immunohistochemical staining.The changing roles of necrosis and apoptosis and the expression of MMP-9 and Caspase-3 positive cells were all observed using image analysis.Results The obvious expression of TUNEL positive cells was recognized within 6 hours of ICH onset, reaching its peak between 6 hours and 24 hours in the early phase.Results were highly consistent with Caspase-3 and MMP-9 positive cell counts.Necrosis was found 6 hours after ICH onset and aggravated after 12 hours.Conclusions In the early phase, apoptosis was seen as a major modality of injury in the brain tissue of the perihematomal region and was strongly correlated with the expression of MMP-9 and Caspase-3.The results of the present study suggest that an operation performed as soon as possible after iCH onset may be optimal for preserving the nervous system function.

  3. Increased expression of T cell immunoglobulin and mucin domain 3 aggravates brain inflammation via regulation of the function of microglia/macrophages after intracerebral hemorrhage in mice.

    Science.gov (United States)

    Xu, ChangJun; Wang, Tao; Cheng, Si; Liu, YuGuang

    2013-12-01

    Microglia/macrophages are known to play important roles in initiating brain inflammation after spontaneous intracerebral hemorrhage (ICH). T cell immunoglobulin and mucin domain-3 (Tim-3) have been proven to play a critical part in several inflammatory diseases through regulation of both adaptive and innate immune responses. Tim-3 can be expressed by microglia/macrophages and regulates their function in the innate immune response. However, the effect of Tim-3 on inflammatory responses following ICH is unclear. In this study, we investigated Tim-3 expression, the inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), and brain water content in peri-hematomal brain tissue at 12 hours and at 1, 3, 5, and 7 days post-ICH in wild type (WT) ICH and Tim-3-/- ICH mice. The numbers of Tim-3 positive cells,astrocytes, neutrophils and microglia/macrophages were detected using immunofluorescence staining. Cytokines were measured by ELISA. Double immunofluorescence labeling was performed to identify the cellular source of Tim-3 expression. Mouse neurological deficit scores were assessed through animal behavior. Expression of Tim-3 increased early in mouse peri-hematomal brain tissue after autologous blood injection, peaked at day 1, and was positively correlated with the concentrations of TNF-α, IL-1β, and brain water content. Tim-3 was predominantly expressed in microglia/macrophages. Compared with WT mice, Tim-3-/- mice had reduced ICH-induced brain inflammation with decreased TNF-α and IL-1β, cerebral edema and neurological deficit scores. Moreover, Tim-/- inhibited activation of microglia/macrophages. The number of activated microglia/macrophages in Tim-3-/- ICH mice was much lower than that in WT ICH mice. Our findings demonstrate that Tim-3 plays an important role in brain inflammation after ICH, and may be a potential treatment target.

  4. Dexmedetomidine ameliorates intracerebral hemorrhage-induced memory impairment by inhibiting apoptosis and enhancing brain-derived neurotrophic factor expression in the rat hippocampus.

    Science.gov (United States)

    Hwang, Lakkyong; Choi, In-Young; Kim, Sung-Eun; Ko, Il-Gyu; Shin, Mal-Soon; Kim, Chang-Ju; Kim, Sang-Hoon; Jin, Jun-Jang; Chung, Jun-Young; Yi, Jae-Woo

    2013-05-01

    Intracerebral hemorrhage (ICH) is a severe type of stroke causing neurological dysfunction with a high mortality rate. Dexmedetomidine is an agonist for α2‑adrenoreceptors with sedative, anxiolytic, analgesic and anesthetic effects. In the present study, we investigated the effects of dexmedetomidine on short‑term and spatial learning memory, as well as its effects on apoptosis following the induction of ICH in rats. A rat model of IHC was created by an injection of collagenase into the hippocampus using a stereotaxic instrument. Dexmedetomidine was administered intraperitoneally daily for 14 consecutive days, commencing 1 day after the induction of ICH. The step‑down avoidance test for short‑term memory and the radial 8‑arm maze test for spatial learning memory were conducted. Terminal deoxynucleotidyl transferase‑mediated dUTP nick end-labeling (TUNEL) assay, immunohistochemistry for caspase‑3, and western blot analysis for Bcl‑2, Bax, Bid and caspase-3 expression were performed for the detection of apoptosis in the hippocampus. Western blot analysis for the brain‑derived neurotrophic factor (BDNF) and tyrosine kinase B (TrkB) was also performed for the detection of cell survival in the hippocampus. The induction of ICH deteriorated short‑term and spatial learning memory, increased apoptosis and suppressed BDNF and TrkB expression in the hippocampus. Treatment with dexmedetomidine ameliorated the ICH‑induced impairment of short‑term and spatial learning memory by suppressing apoptosis and enhancing BDNF and TrkB expression. In the normal rats, dexmedetomidine exerted no significant effects on memory function and apoptosis. The present results suggest the possibility that dexmedetomidine may be used as a therapeutic agent for the conservation of memory function in stroke patients.

  5. Autologous Bone Marrow Mononuclear Cells Exert Broad Effects on Short- and Long-Term Biological and Functional Outcomes in Rodents with Intracerebral Hemorrhage

    Science.gov (United States)

    Suda, Satoshi; Schaar, Krystal; Xi, Xiaopei; Pido, Jennifer; Parsha, Kaushik; Aronowski, Jaroslaw; Savitz, Sean I.

    2015-01-01

    Autologous bone marrow-derived mononuclear cells (MNCs) are a potential therapy for ischemic stroke. However, the effect of MNCs in intracerebral hemorrhage (ICH) has not been fully studied. In this study, we investigated the effects of autologous MNCs in experimental ICH. ICH was induced by infusion of autologous blood into the left striatum in young and aged male Long Evans rats. Twenty-four hours after ICH, rats were randomized to receive an intravenous administration of autologous MNCs (1 × 107 cells/kg) or saline. We examined brain water content, various markers related to the integrity of the neurovascular unit and inflammation, neurological deficit, neuroregeneration, and brain atrophy. We found that MNC-treated young rats showed a reduction in the neurotrophil infiltration, the number of inducible nitric oxide synthase-positive cells, and the expression of inflammatory-related signalings such as the high-mobility group protein box-1, S100 calcium binding protein B, matrix metalloproteinase-9, and aquaporin 4. Ultimately, MNCs reduced brain edema in the perihematomal area compared with saline-treated animals at 3 days after ICH. Moreover, MNCs increased vessel density and migration of doublecortin-positive cells, improved motor functional recovery, spatial learning, and memory impairment, and reduced brain atrophy compared with saline-treated animals at 28 days after ICH. We also found that MNCs reduced brain edema and brain atrophy and improved spatial learning and memory in aged rats after ICH. We conclude that autologous MNCs can be safely harvested and intravenously reinfused in rodent ICH and may improve long-term structural and functional recovery after ICH. The results of this study may be applicable when considering future clinical trials testing MNCs for ICH. PMID:26414707

  6. Validation of algorithms to identify stroke risk factors in patients with acute ischemic stroke, transient ischemic attack, or intracerebral hemorrhage in an administrative claims database.

    Science.gov (United States)

    Sung, Sheng-Feng; Hsieh, Cheng-Yang; Lin, Huey-Juan; Chen, Yu-Wei; Yang, Yea-Huei Kao; Li, Chung-Yi

    2016-07-15

    Stroke patients have a high risk for recurrence, which is positively correlated with the number of risk factors. The assessment of risk factors is essential in both stroke outcomes research and the surveillance of stroke burden. However, methods for assessment of risk factors using claims data are not well developed. We enrolled 6469 patients with acute ischemic stroke, transient ischemic attack, or intracerebral hemorrhage from hospital-based stroke registries, which were linked with Taiwan's National Health Insurance (NHI) claims database. We developed algorithms using diagnosis codes and prescription data to identify stroke risk factors including hypertension, diabetes, hyperlipidemia, atrial fibrillation (AF), and coronary artery disease (CAD) in the claims database using registry data as reference standard. We estimated the kappa statistics to quantify the agreement of information on the risk factors between claims and registry data. The prevalence of risk factors in the registries was hypertension 77.0%, diabetes 39.1%, hyperlipidemia 55.6%, AF 10.1%, and CAD 10.9%. The highest kappa statistics were 0.552 (95% confidence interval 0.528-0.577) for hypertension, 0.861 (0.836-0.885) for diabetes, 0.572 (0.549-0.596) for hyperlipidemia, 0.687 (0.663-0.712) for AF, and 0.480 (0.455-0.504) for CAD. Algorithms based on diagnosis codes alone could achieve moderate to high agreement in identifying the selected risk factors, whereas prescription data helped improve identification of hyperlipidemia. We tested various claims-based algorithms to ascertain important risk factors in stroke patients. These validated algorithms are useful for assessing stroke risk factors in future studies using Taiwan's NHI claims data. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. 普通人群脑出血危险因素的汇总分析%Meta-Analysis of Risk Factors for Intracerebral Hemorrhage in General Population

    Institute of Scientific and Technical Information of China (English)

    王红; 李震中; 方保锋; 赵子春; 曹翠芳

    2008-01-01

    To investigate the risk factors for intracerebral hemorrhage in general population.Methods:The related research was searched through English Medical Current Contents (EMCC),China Hospital Knowledge Database (CHKD),MEDLINE,and Chinese Biomedical Literature Database (CBM).The search terms were intracerebral hemorrhage,factor,and case-control study or cohort study.Results:There were 8 literatures with original data were in accordance with the inclusion criteria.All the data could not be combined because there were some differences in counting and metrology in the risk factors included in all the studies.Hypertension,family history of cerebrovascular disease,high salt diet,alcohol consumption,diabetes mellitus,high diastolic pressure,high systolic pressure,smoking,snoring disease,and increased weighted mean difference of body mass index (BMI) (95% confidence interval) were 5.71 (4.00-6.79),3.54 (2.44-5.14),2.58 (1.94-3.43),2.80 (2.29-3.43),2.78 (1.83-4.23,1.90 (1.35-2.70),17.76 (16.60-18.92),30.43 (28.61-32.25),5.42 (5.15-5.70),1.90 (1.34-2.69),6.88 (4.61-10.26,and 5.42 (5.15-5.70),respectively.There were significant differences between the patient groups and control groups among the above indexes (all P<0.000 01).Conclusions:The risk factors for intracerebral hemorrhage include hypertension,family history of cerebrovascular disease,high salt diet,smoking,alcohol consumption,snoring disease,diabetes mellitus,overweight,high diastolic blood pressure,high systolic blood pressure and increased BMI.%目的:探讨普通人群脑出血的危险因素.方法:通过西文生物医学期刊文献数据库(EMCC)、中国医院知识仓库(CHKD)、MEDLINE和中国生物医学文献数据库(CBMdisc)检索相关研究.检索词为脑出血、因素、病例对照研究或队列研究.结果:共有8篇文献符合纳入标准且有原始数据.因各研究包含的危险因素在计数和计量方面存在差异,无法合并所有数据.高血压、脑血管病家族史、高

  8. Nursing Care of Patients with Hypertensive Intracerebral Hemorrhage after Craniotomy Evacuation of Hematoma%高血压脑出血开颅血肿清除患者手术前后的护理

    Institute of Scientific and Technical Information of China (English)

    赵山鹰

    2012-01-01

    目的:探讨高血压脑出血(Hypertensive intracerebral hemorrhage,HICH)开颅血肿清除术后的护理要点.方法:对54例高血压脑出血患者行开颅血肿清除术的术前护理、术后护理及并发症的护理进行总结.结果:54例患者死亡4例,自动出院3例,植物人2例,重度残疾8例,中度残疾34例,好转3例.结论:高血压脑出血开颅血肿清除术的手术期护理尤其重要,术后应控制血压在正常水平,防止再出血和脑缺血,预防感染,加强功能锻炼以促进患者的恢复.%Objective: To investigate the nursing points of patients with hypertensive intracerebral hemorrhage(HICH) undergoing hematoma evacuation.Methods: The preoperative nursing care,postoperative nursing care and complications nursing care of 54 cases of hypertensive intracerebral hemorrhage,who underwent craniotomy evacuation of hematoma,were summarized.Results: In 54 patients,4 patients died,3 cases automatically discharged,3 cases were in vegetative state,8 cases were severe disability,34 cases were moderate disability,3 cases were improved.Conclusion: Operative nursing care is especially important,should pay attention to maintaining the stability of blood pressure to prevent rebleeding and cerebral ischemia,preventing infection,enhancing functional exercise can promote the recovery of patients.

  9. Effects of time periods and astronomical tides on the onset of intracerebral hemorrhage in Rizhao region%时辰和天文潮汐对日照地区脑出血患者发病的影响

    Institute of Scientific and Technical Information of China (English)

    夏永梅; 叶红晖; 李向云; 厉郡华

    2013-01-01

    Objective To investigate the effects of time periods and astronomical tides on the onset of intracerebral hemorrhage in Rizhao region. Methods A total of 509 patients with intracerebral hemorrhage in Rizhao region were collected from January 1, 2006 to December 31, 2010. Using a circular distribution method, the concentration (r) of onset time of patients was calculated first, and then the mean ā an-gle and the dispersion angle (s) were calculated. The time and peak period of the onset of intracerebral hemorrhage were predicted at different time periods and different astronomical tidal periods ( new moon, full moon, first quarter, last quarter and other periods) . Rayleigh test was used for significant difference test. Results ①Among the 509 patients with intracerebral hemorrhage, 340 patients were occurred during the daytime (7:00 to 19 :00) and 169 patients during the night (19 :00 to 7:00) . The former was 2. 01 times than the later. The circular distribution analysis showed (-α) =205° ,Z = 32. 803 (P<0.001). When (-α) was at 11:00 to 13:00, it was the centralized time of the onset;s =94. 87°,(-α) ±s = 109.77° to 299.52°, the peak hours of onset were 5:00 to 19:00. ②117 patients had intracerebral hemorrhage during the new moon and full moon periods, 92 had intracerebral hemorrhage during the first quarter and last quarter periods, and 300 had intracerebral hemorrhage at the other times. The results of the circular distribution analysis showed (-α)= 53 ,27° ,Z =8. 0226 (P<0.001).(-α) in the new moon and full moon periods was the centralized time of the onset of intracerebral hemorrhage, s = 80. 16° ,(-α) ± s = -26. 89° to 133.43°, the peak hours were mainly the new moon, full moon, first quarter, and last quarter periods. Conclusion The distribution of intracerebral hemorrhage onset has circadian cycle rhythms. The onset during the daytime is higher than the night time,and associated with the changes of the astronomical tidal rhythms

  10. Chronic massive fetomaternal hemorrhage in a newborn from immigrants. Clinical and organizational implications.

    Science.gov (United States)

    Ruffini, E; Bianchi, A M; De Petris, L; Fares, M K; Zorzi, G; Carlucci, A

    2012-01-01

    Fetomaternal hemorrhage (FMH) refers to the entry of fetal blood into the maternal bloodstream before or during delivery. FMH of more than 30 mL occurs with the frequency of about 1/300. Fetal outcomes may be compromised by still births, hydrops fetalis, cardiac complications, and increased rates of postpartum infant death. In most cases, the cause is not identified. Clinical manifestations of FMH depend on the volume of blood lost and the rate that it occurred. We report a case of chronic massive FMH in a newborn of an immigrant mother with a favorable outcome. Medical visits and tests during pregnancy, including ultrasound scans, were not performed. The baby was hemodynamically stable after birth, manifesting only pallor. The complete blood count revealed severe hypochromic anemia (hemoglobin 3,8 g/dl, hematocrit 14,4%) and reticulocytosis (reticulocyte 25,2%). There was no ABO blood type incompatibility and the result of direct Coomb's test was negative. The Kleihauer-Betke test revealed 5% of fetal erythrocytes in the maternal bloodstream equivalent to 180 mL. The fact that FMH can occur without prior risk factors, and the diagnosis is often postnatal, underscores the importance of heightened of medical suspicion particularly in infants born to immigrants where there is often the lack of prenatal visits.

  11. Fatal massive hemorrhage caused by nasogastric tube misplacement in a patient with mediastinitis.

    Science.gov (United States)

    Wu, Pei-Yu; Kang, Ting-Jui; Hui, Chung-Kun; Hung, Ming-Hui; Sun, Wei-Zen; Chan, Wei-Hung

    2006-01-01

    Nasogastric tube insertion is a routine procedure in medical care. However, misplacement of the tube can cause a variety of complications, which can be life threatening in some instances. We report a case of fatal hemorrhagic shock immediately after nasogastric tube insertion in a patient undergoing debridement by video-assisted thoracoscopic surgery for mediastinitis. Emergency endoscopy showed that the bleeding came from the nasogastric tube which had perforated the esophagus and possibly tore an intrathoracic large vessel. The nasogastric tube insertion was considered to have directly produced the perforation because no esophageal perforation had been found on preoperative endoscopy. Factors contributing to the risk of esophageal perforation in this case included coexisting mediastinitis, surgical manipulation, endotracheal intubation, inability to cooperate during general anesthesia, and repetitive advancement of the nasogastric tube. Prompt clamping of the nasogastric tube or delayed insertion after failed attempts might have improved the outcome. This report illustrates the complication of massive bleeding that can occur immediately after misplaced insertion of a nasogastric tube. Extraordinary care should be taken to avoid misplacement of the nasogastric tube during insertion.

  12. LDL-C/HDL-C ratio and risk of all-cause mortality in patients with intracerebral hemorrhage.

    Science.gov (United States)

    You, Shoujiang; Zhong, Chongke; Xu, Jiaping; Han, Qiao; Zhang, Xia; Liu, Huihui; Zhang, Yanlin; Shi, Jijun; Huang, Zhichao; Xiao, Guodong; Zhang, Chunyuan; Cao, Yongjun; Liu, Chunfeng

    2016-10-01

    The low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio has been recognized as a strong risk predictor of cardiovascular diseases. However, the association between the LDL-C/HDL-C ratio and the prognosis of acute intracranial hemorrhage (ICH) is unclear. Thus, we prospectively investigated whether a low LDL-C/HDL-C ratio could predict all-cause mortality and whether LDL-C/HDL-C ratio is superior to traditional lipid profiles in predicting mortality among Chinese patients with acute ICH. A prospective cohort study of 356 patients with acute ICH was conducted, and the mean follow-up time point was 80.4 days. Participants were divided into four categories based on LDL-C/HDL-C ratio quartiles. Three-month outcomes were evaluated by in-person or telephone interviews with patients or their family members. The end point was three-month mortality from all causes. Forty-seven deaths from all causes were documented. The multivariate analysis found that LDL-C/HDL-C ratio [hazard ratio (HR) = 0.49, p = 0.008] and LDL-C (HR = 0.27, p = 0.044) were significantly associated with all-cause mortality. The Kaplan-Meier curves show that patients in the lowest quartiles had the highest cumulative incidence rates (log-rank p = 0.027). After adjusting for covariates, a low LDL-C/HDL-C ratio was associated with a 3.55-fold increase in the risk of all-cause mortality (HR, 3.55 [95% confidence interval, 1.04-12.14]; P-trend = 0.011) when the highest and lowest quartiles were compared. The C-statistic of the LDL-C/HDL-C ratio was significantly larger than other traditional lipid profiles (all p HDL-C ratio was independently associated with an increased risk of all-cause mortality at three months in patients with ICH. Moreover, the LDL-C/HDL-C ratio appeared to be a best lipid predictor of all-cause mortality than traditional lipid profiles.

  13. The Challenge of Managing Fusiform Basilar Artery Aneurysms: From Acute Ischemic Stroke to a Massive Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Sofia Bezerra

    2011-02-01

    Full Text Available We present the case of a patient with acute brain stem ischemic stroke who was found to have a fusiform basilar aneurysm with a thrombus within the dilated vessel. Three days after the ischemic stroke, the patient had a massive subarachnoid hemorrhage and died. This case illustrates the difficulties in the acute management of ischemic events in patients with basilar fusiform aneurysms, because the natural history of this disease encompasses both bleeding and thrombosis.

  14. Rapid tumor necrosis and massive hemorrhage induced by bevacizumab and paclitaxel combination therapy in a case of advanced breast cancer

    Directory of Open Access Journals (Sweden)

    Ono M

    2013-10-01

    Full Text Available Mayu Ono, Tokiko Ito, Toshiharu Kanai, Koichi Murayama, Hiroshi Koyama, Kazuma Maeno, Yasuhiro Mochizuki, Asumi Iesato, Toru Hanamura, Toshihiro Okada, Takayuki Watanabe, Ken-ichi ItoDivision of Breast and Endocrine Surgery, Department of Surgery (II, Shinshu University School of Medicine, Matsumoto, JapanAbstract: Bevacizumab when combined with chemotherapy exerts significant activity against many solid tumors through tumor angiogenesis inhibition; however, it can induce severe side effects. We report the rare case of a 27-year-old premenopausal woman with locally advanced breast cancer that was marked by rapid tumor necrosis followed by massive hemorrhage shortly after bevacizumab and paclitaxel administration. On the basis of histopathological examination of a biopsy specimen and computed tomography findings, she was diagnosed with stage IV estrogen and progesterone receptor-negative and human epidermal growth factor receptor type 2-positive breast cancer with multiple organ metastases when she had entered gestational week 24. Cyclophosphamide, Adriamycin®, fluorouracil therapy was initiated, but multiple liver metastases continued to progress. A healthy fetus was delivered by induced delivery and trastuzumab-based treatment was initiated. Although the multiple liver metastases were controlled successfully by trastuzumab combined with paclitaxel, the primary tumor continued to expand even after subsequent administration of three other treatment regimens including anti-human epidermal growth factor receptor type 2 agents and cytotoxic drugs. To inhibit primary tumor growth, a combination therapy with paclitaxel and bevacizumab was subsequently initiated. Following therapy initiation, however, the large tumor occupying the patient's entire left breast became necrotic and ulcerated rapidly. Furthermore, massive hemorrhage from the tumor occurred 5 weeks after bevacizumab-based therapy initiation. Although hemostasis was achieved by manual

  15. 脑出血小骨窗开颅术引流探讨%A Study of the Drainage Way of Small Bone Window Craniotomy in Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    高银河; 张玉定; 程品文

    2016-01-01

    目的:探讨比较小骨窗开颅清除脑内血肿术中常见的两种引流方式对手术效果的影响。方法:选取2012年6月-2015年6月笔者所在科收治的采用小骨窗开颅术治疗的81例脑出血患者,术中随机的采用血肿残腔引流和硬膜下引流两种方式,通过分析术后引流效果及引流后颅内残血量来探讨其优劣。结果:硬膜下引流组52例,引流管堵塞1例,无脑组织损伤患者;残腔引流组29例,引流管堵塞14例。硬膜下引流组平均每天引流血性脑脊液量明显多于残腔引流组;硬膜下引流组术后残腔出血量及硬膜下出血量的分布情况均显著优于残腔引流组,两组比较差异均有统计学意义(P<0.05)。结论:硬膜下引流能够有效的引流术后残余出血,缓解颅内压,降低脑水肿,残腔引流容易堵管,引流效果差,而且是术后再出血的因素之一。%Objective:To explore the effect of two kinds of drainage patterns commonly used in small bone window cleaning on the result of the operation of intracerebral hematoma.Method:From June 2012 to June 2015,81 cases of cerebral hemorrhage patients who were admitted in our department by small bone window craniotomy were selected, ,they were randomly used residual hematoma cavity drainage and subdural drainage,by analysing the postoperative effect of drainage and drainage of intracranial blood residue to discuss their advantages and disadvantages.Result:There were 52 cases in the subdural drainage group, 1 case was drainage tube blockage,there was no cerebral tissue injury,29 cases in residual cavity drainage group and 14 cases were drainage tube blockage.The average daily drainage volume of the subdural drainage group were significantly more than those in the residual cavity drainage group.The subdural drainage group of postoperative residual cavity hemorrhage and subdural hemorrhage distribution were significantly better than those in the

  16. 青年原发性脑出血患者的临床分析%Clinical Analysis of Young Patients with Primary Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    刘倩绫; 罗效萍; 许金明; 钱孟佼

    2014-01-01

    目的:分析青年原发性脑出血(PICH)的危险因素、临床特征、治疗及预后。方法选择我院神经外科2012年1-9月收治的青年 PICH 患者95例,回顾性分析所有患者的临床资料,包括一般资料、PICH 的危险因素、影像学检查结果、治疗及预后。结果95例患者中有饮酒史者59例(62.1%),吸烟史者42例(44.2%),高血压病史者13例(13.7%),否认高血压病史的82例患者中54例(65.9%)发现不同程度的血压升高;颅脑 CT 或 MRI 检查提示基底核区出血53例(55.8%);57例(60.0%)采用开颅手术治疗,38例(40.0%)采用保守治疗;住院期间发生并发症34例(49.5%),死亡10例(10.5%),其余85例出院时哥拉斯哥预后量表(GOS)评分2~5分,平均(3.8±1.3)分。结论高血压、吸烟、饮酒是青年 PICH 的危险因素,出血部位以基底核区为主,主要采用手术治疗且预后较好。%Objective To analyze the risk factors,clinical features,treatment and prognosis of young patients with primary intracerebral hemorrhage(PICH). Methods 95 young PICH patients in Department of Neurosurgery,the First People′s Hospital of Honghe Prefecture,Mengzi County,were chosen from January to September 2012,the clinical data of all patients were retrospectively analyzed,including general information,risk factors for PICH,imaging examination results,treatment and prognosis. Results In the 95 cases,59(62. 1% )had drinking history,42(44. 2% )had smoking history,13(13. 7% ) had hypertension history,54 cases(65. 9% )were found different degrees of elevated blood pressure in the 82 cases who had de-nied hypertension history. by brain CT or MRI examination results,53 cases(55. 8% )had basal ganglia hemorrhage. 57 cases (60. 0% )received surgical treatment,38 cases(40. 0% )received conservative treatment;34 cases(49. 5% )had compli-cations during hospitalization;10 cases died(10. 5% ),and the GOS score of other

  17. Intracerebral haemorrhage.

    Science.gov (United States)

    Qureshi, Adnan I; Mendelow, A David; Hanley, Daniel F

    2009-05-09

    Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival.

  18. Curative effect of transplantation of mesenchymal stem cells transfected with recombinant lentiviral vectors carrying brain-derived neurotrophic factor gene on intracerebral hemorrhage in rats

    Institute of Scientific and Technical Information of China (English)

    任瑞芳

    2013-01-01

    Objective To observe the curative effect of transplantation of mesenchymal stem cells(MSCs) transfected with recombinant lentiviral vectors carrying brain-derived neurotrophic factor(BDNF) gene on intracerebral

  19. A randomized controlled study comparing omeprazole and cimetidine for the prophylaxis of stress-related upper gastrointestinal bleeding in patients with intracerebral hemorrhage.

    Science.gov (United States)

    Liu, Bo-lin; Li, Bing; Zhang, Xiang; Fei, Zhou; Hu, Shi-jie; Lin, Wei; Gao, Da-kuan; Zhang, Li

    2013-01-01

    Patients with intracerebral hemorrhage (ICH) are at high risk for severe stress-related upper gastrointestinal (UGI) bleeding, which is predictive of higher mortality. The aim of this study was to evaluate the effectiveness of omeprazole and cimetidine compared with a placebo in the prevention and management of stress-related UGI bleeding in patients with ICH. In a single-center, randomized, placebo-controlled study, 184 surgically treated patients with CT-proven ICH within 72 hours of ictus and negative results for gastric occult blood testing were included. Of these patients, 165 who were qualified upon further evaluation were randomized into 3 groups: 58 patients received 40 mg intravenous omeprazole every 12 hours, 54 patients received 300 mg intravenous cimetidine every 6 hours, and 53 patients received a placebo. Patients whose gastric occult blood tests were positive at admission (n = 70) and during/after the prophylaxis procedure (n = 48) were treated with high-dose omeprazole at 80 mg bolus plus 8 mg/hr infusion for 3 days, followed by 40 mg intravenous omeprazole every 12 hours for 7 days. Of the 165 assessable patients, stress-related UGI bleeding occurred in 9 (15.5%) in the omeprazole group compared with 15 patients (27.8%) in the cimetidine group and 24 patients (45.3%) in the placebo group (p = 0.003). The occurrence of UGI bleeding was significantly related to death (p = 0.022). Nosocomial pneumonia occurred in 14 patients (24.1%) receiving omeprazole, 12 (22.2%) receiving cimetidine, and 8 (15.1%) receiving placebo (p > 0.05). In patients with UGI bleeding in which high-dose omeprazole was initiated, UGI bleeding arrested within the first 3 days in 103 patients (87.3%). Omeprazole significantly reduced the morbidity of stress-related UGI bleeding in patients with ICH due to its effective prophylactic effect without increasing the risk of nosocomial pneumonia, but it did not reduce the 1-month mortality or ICU stay. Further evaluation of high

  20. Effect of microRNA-129-5p targeting HMGB1-RAGE signaling pathway on revascularization in a collagenase-induced intracerebral hemorrhage rat model.

    Science.gov (United States)

    Ma, Xin-Long; Li, Shu-Ya; Shang, Feng

    2017-09-01

    This study aimed at exploring the effect of microRNA-129-5p (miR-129-5p) targeting high mobility group box-1 (HMGB1)-receptor for advanced glycation end-products (RAGE) signaling pathway on the revascularization in a collagenase-induced intracerebral hemorrhage (ICH) rat model. OX26-pGFAP-IL, an immunoliposome expressing miR-129-5p was constructed. The collagenase-induced ICH rat models were successfully established by 96 Sprague Dawley (SD) rats, which were categorized into the sham group, ICH group, miR-129-5p group, negative control (NC) group, ethyl pyruvate (EP, an inhibitor of HMGB1) group and N-benzyl-4-chloro-N-cyclohe-xylbenzamide (FPS-ZM1, a RAGE receptor antagonist) group. The miR-129-5p expression in the brain tissue homogenate was detected using the quantitative real-time polymerase chain reaction (qRT-PCR) and the protein expressions of HMGB1 and RAGE by Western blotting. Immunohistochemistry (IHC) was used for the detection of the vascular endothelial growth factor (VEGF). Microvessel density (MVD) was also detected. Compared to the sham group, the ICH, NC, EP and FPS-ZM1 groups had a decrease in miR-129-5p expressions, and an increase in the protein expressions of HMGB1, RAGE and VEGF and MVD. In comparison to the ICH, NC, EP and FPS-ZM1 groups the miR-129-5p group had an elevation in the miRNA-129-5p expressions. The miR-129-5p and EP groups had decreased HMGB1 protein expression and the miR-129-5p, EP and FPS-ZM1 groups had a reduced RAGE protein expression as compared to the ICH group. In comparison to the ICH group, the miR-129-5p, EP, FPS-ZM1 groups had a decline in the VEGF protein expression and MVD. Our study proved that up-regulation of miR-129-5p might suppress the HMGB1-RAGE signaling pathway to restrain the revascularization of rats with ICH. Copyright © 2017. Published by Elsevier Masson SAS.

  1. [Massive hemorrhage of upper gastrointestinal tract caused by gastrointestinal stromal tumor of the stomach--case report].

    Science.gov (United States)

    Lalović, Nenad; Dukić Vladicić, Nikolina; Marić, Radmil; Cuk, Mirjana; Simatović, Milan; Jokanović, Dragana

    2012-01-01

    Acute bleeding from the upper gastrointestinal system is a medical emergency which is followed by high mortality rate, ranging from 6 to 15% in spite of modern diagnostic methods and treatment. Bleeding from the upper gastrointestinal system may be caused by gastrointestinal stromal tumors of the stomach, which are mainly characterized by occult bleeding, while profuse bleeding rarely occurs accompanied by hemorrhagic shock. Gastrointestinal stromal tumors of stomach are the most common mesenchimal tumors of the gastrointestinal tract. In our study we showed a 60-year-old female patient with profuse bleeding from the stomach and the clinical picture of severe hemorrhagic shock, caused by gastrointestinal stromal tumor. An ovoid junction, raised towards the lumen, covered with ulcerated mucosa in several places and followed by massive arterial bleeding was found intraoperatively, after the performed gastrotomy. Histopathological examination with immunohistochemical analysis confirmed that this was a gastrointestinal stromal tumor of the stomach. Acute bleeding from the digestive system is a sudden and serious condition of the body. Urgent esophagogastroduodenoscopy is a sensitive and specific diagnostic and therapeutic method of choice. Massive bleeding from the upper gastrointestinal tract is very rarely caused by gastrointestinal stromal tumors, whose clinical picture is very heterogeneous and depends on tumor size and location. Abundant bleeding from the tumor is an indication for urgent surgical intervention. According to the literature massive hemorrhage of the upper digestive system can rarely be caused by gastrointestinal stromal tumor of the stomach. It is shown that abundant hemorrhage of the upper digestive tract can be caused with gastric gastrointestinal stromal tumor. Surgical resection is the main form of treatment of gastrointestinal stromal tumors of the digestive system and bleeding from these tumors caused by failure of endoscopic hemostasis.

  2. Clinical Analysis of Postpartum Hemorrhage Requiring Massive Transfusions at a Tertiary Center

    Science.gov (United States)

    Hu, Jun; Yu, Zhu-Ping; Wang, Peng; Shi, Chun-Yan; Yang, Hui-Xia

    2017-01-01

    Background: The reports on massive transfusions (MTs) in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage (PPH) and the frequency trends over the past 10 years. Methods: We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units (approximately 1000 ml) of red blood cells within 24 h of giving birth were included. The Pearson's Chi-square and Fisher's exact tests were used to compare the frequency distributions among the categorical variables of the clinical features. Results: One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group (2006–2010) and the second 5-year group (2011–2015) (2.5‰ vs. 2.7‰, χ2 = 154.85, P = 0.25). Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities (especially placenta accreta) in the second 5-year group compared with the first 5-year group (34% vs. 23%, χ2 = 188.26, P = 0.03). Twenty-four (23%) women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% (17/24). No maternal death was observed. Conclusions: There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta. PMID:28229990

  3. Anatomic and functional outcome of eyes with massive submacular hemorrhage secondary to retinal macroaneurysm submitted to vitrectomy

    Directory of Open Access Journals (Sweden)

    Leonardo Provetti Cunha

    2015-02-01

    Full Text Available Purpose: To report the anatomic and functional outcome in patients with severe visual loss after acute massive submacular hemorrhage secondary to retinal arterial macroaneurysm submitted to vitrectomy and subretinal recombinant tissue plasminogen activator injection. Methods: Retrospective, observational, case-series of 4 eyes of 4 patients submitted to pars plana posterior vitrectomy (ppV combined with internal limiting membrane (ILM removal and subretinal recombinant tissue plasminogen activator (rtPA-12.5 mg/0.1 ml injection with dilute (20% sulfur hexafluoride (SF6 gas in the vitreous cavity of eyes with recent onset (≤7 days massive macular hemorrhage due to retinal arterial macroaneurysm (RAMA. Optical coherence tomography (OCT was obtained both at presentation and during follow up. Results: Patients ranged in age from 63 to 78 years and all had systemic arterial hypertension. Visual acuity at presentation ranged from hand motions to count fingers at 50 cm. All eyes showed extensive retinal hemorrhage involving more than two-thirds of macular area. The time between the onset of symptoms and the surgery ranged from 3 to 7 days. After a mean postoperative follow-up of 15.5 ± 5.19 months (range, 10-22 months, all eyes showed visual acuity improvement and final visual acuity ranged from 20/30 to 20/80. All had complete displacement of the subretinal hemorrhage from the fovea after the surgery. OCT images showed neurosensory retina thinning and disruption of the reflective line that represents the junction between inner and outer photoreceptors segments (IS/OS line beneath the macular area and absence of the external limiting membrane (ELM. Conclusions: ppV associated with subretinal rtPA injection with intravitreal gas seems to be a safe and effective technique to promote visual improvement in patients with multilevel macular hemorrhage secondary to RAMA. Despite functional improvement, OCT images demonstrate that submacular hemorrhage

  4. Study on prevention of concurrent cerebral infarction after hypertensive intracerebral hemorrhage surgery%高血压脑出血术后并发脑梗死的防治研究

    Institute of Scientific and Technical Information of China (English)

    张晓阳; 刘霄

    2011-01-01

    目的 探讨高血压脑出血术后脑梗死发生的原因及预防和治疗的措施.方法 回顾性分析周口市中心医院收治的90例高血压脑出血术后脑梗死的临床资料.52例术后3d、8例术后6d复查CT见脑梗死征象,其中70例为同侧顶枕叶凸面,14例为同侧额叶,6例为对侧大脑基底节区.并发脑梗死后停用止血药、加强脱水、充分补液、应用血管解痉及改善微循环药物.结果 生存85例,死亡5例.生存者按ADL标准,Ⅰ级+Ⅱ级42例,Ⅲ级+Ⅳ级38例,V级5例.结论 高血压脑出血术后脑梗死是多因素共同作用的结果.术中、术后采取正确的预防和治疗措施,可提高临床疗效.%Objective To explore the causes and prevention of cerebral infarction after hypertensive intracerebral hemorrhage surgery. Methods Retrospectively analyze the data of 90 patients with cerebral infarction after hypertensive intracerebral hemorrhage in our hospital. 52 cases 3 days after surgery and 8 cases 6 days after surgery were reviewed by CT and were found cerebral infarction. 70 of them were hotnolateral parieto - occipital lobe convexity ,14 cases were homolateral frontal lobe,6 cases were contralateral brain basal ganglia. After complication of cerebral infarction stop the hemostatic medicine , strengthen the dehydration, fully rehydration, application of vascular spasmolysis and improving circulation drugs. Results Survival 85 cases,5 cases died. According to the ADL standards,stage Ⅰ and stage Ⅱ 38 cases, stage and stage IV 38 cases, stage V 5 cases. Conclusions Cerebral infarction after hypertensive intracerebral hemorrhage surgery is the consequence of the interaction between multiple factors. Using the correct preventive measures in intraoperation and postoperation can improve the clinical effect.

  5. 青年脑出血的病因及危险因素分析%Analysis of Causes and Risk Factors in Young People with Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    徐辉; 赵薇; 方岩; 王遂山

    2015-01-01

    目的:探讨青年脑出血的危险因素及病因。方法回顾分析商丘市第一人民医院2008年1月-2014年1月间青年脑出血的临床资料。结果青年脑出血779例,占11.52%,男性占64.70%,女性占36.30%;发病年龄(35.45±8.35)岁。病因:高血压病495例(63.53%),血管畸形56例(7.18%),瘤卒中19例(2.44%),血液系统疾病18例(2.31%),妊娠/产褥期27例(3.47%),烟雾病15例(1.92%),不明原因147例(18.87%),系统性红斑狼疮2例(0.26%)。危险因素:高血压541例(69.44%),吸烟141例(18.10%),饮酒213例(27.34%),糖尿病42例(5.39%),心脑血管病家族史186例(23.88%),血脂异常119例(15.28%)。结论近年来青年脑出血发病率逐年增多,男性多见;高血压是主要病因,其次是脑血管畸形,部分患者病因不明;高血压病史、吸烟、饮酒、卒中家族史、血脂异常可能与青年脑出血的发病有关。%Objective To explore the causes and the risk factors of young people with intracerebral hemorrhage (ICH). Methods Collect 779 patients with ICH in department of neurology of the NO 1 hospital of Shangqiu during January 2008 to January 2014. Results Young people with ICH accounted for 11.52% of the total ICH in the same period,which accounted for 64.70% of males and 36.30% for females,the mean age is (35.45 ±8.35)years.The cause of all 779 cases,including hypertension in 495 cases (63.53%),vascular malformations in 56 cases(7.18%),18 cases(2.31%)of the blood system diseases,while 19 cases(2.44%)of tumor apoplexy,27 cases(3.47%)of pregnancy or in the puerperium,15 cases(1.92%)of moyamoya disease,147cases (18.87%) can't find the cause,and 2 cases(0.26%) of SLE.The risk factors:hypertension were 541 cases(69.44%),smoking were 141 cases (18.10%), alcohol consumption were 213 cases (27.34%),family history of cerebrovascular disease were 186 cases (23.88%),lipid disorder were 119 cases (15.28%). Conclusion In the recent six years

  6. Massive post-polypectomy hemorrhage: Successful tulip-bundle technique with endoloop for hemostasis

    Directory of Open Access Journals (Sweden)

    Hsu-Heng Yen

    2016-09-01

    Full Text Available Colonoscopic polypectomy is a common procedure for removing colonic polyps to prevent subsequent development of colon cancer. Hemorrhage is the most common complication following polypectomy, with a reported rate of 0.3% to 6.0%. The risk increases to 12.5% when the size of the polyp stalk exceeds 1 cm. The most commonly used endoscopic preventive techniques, such as injection therapy, prophylactic use of endoclip, or endoloop, were found to decrease the rate of post-polypectomy hemorrhage, and repeated use of these techniques is useful for controlling bleeding. Here, we reported a case of a 65-year-old man with refractory post-polypectomy hemorrhage for a 2-cm adenomatous polyp. Application of an endoloop using the tulip-bundle technique achieved successful hemostasis. To our knowledge, this is the first report of this technique being used to treat refractory acute post-polypectomy hemorrhage.

  7. BDNF对BMSCs向脑出血灶周围组织迁移的保护作用%Protective effect of brain derived neurotrophic factor on mesenchymal stem cells when transplanting to the surrounding issue of intracerebral hemorrhage stove

    Institute of Scientific and Technical Information of China (English)

    任瑞芳; 黄良国; 黄名璐; 蒋国红; 白洁

    2014-01-01

    目的 观察脑源性神经营养因子(BDNE)基因重组慢病毒转染骨髓间质干细胞(BMSCs)后,被移植入大鼠侧脑室内,向对侧脑出血灶周围组织的迁移情况. 方法 将60只脑出血模型大鼠按随机数字表法分为磷酸盐缓冲液(PBS)组、骨髓间质干细胞(BMSCs)组、骨髓间质干细胞-绿色荧光蛋白组(BMSCs-EGFP)、脑源性神经营养因子(BMSCs-EGFP-BDNF)组,每组15只.分别向侧脑室注射PBS,BMSCs,慢病毒(LV)转染的EGFP,LV转染的BDNF-EGFP,在术后7d、14d、21d采用Westen blotting检测各组BDNF在BMSCs中的蛋白表达,免疫荧光检测Brdu标记的BMSCs,EGFP及BDNF. 结果 Western blotting检测BMSCs-EGFP-BDNF组BDNF蛋白表达明显多于BMSCs组及BMSCs-EGFP组(P<0.05);细胞爬片BMSCs-EGFP-BDNF组BDNF荧光表达明显高于BMSCs组及BMSCs-EGFP组;脑组织切片免疫荧光单标显示BMSCs-EGFP-BDNF组迁移至脑出血灶周围组织的BMSCs阳性细胞数明显多于BMSCs组及BMSCs-EGFP组(P<0.05),BMSCs组与BMSCs-EGFP组除7d外,其余比较差异无统计学意义(P>0.05). 结论 基因重组慢病毒修饰的BMSCs中BDNF表达增高,提示BDNF对BMSCs向脑出血灶周围组织迁移具有保护作用.%Objective To observe the migration ofmesenchymal stem cells (MSCs) transfected with recombinant lentiviral vectors carried brain derived neurotrophic factor (BDNF) gene from lateral ventricle to intracerebral hemorrhage stove in rats and to discuss the protective effect of BDNF on MSCs.Methods Intracerebral hemorrhagic models were constructed in 60 SD rats and randomly divided into 4 groups:phosphate buffer solution (PBS) group,BMSCs group,BMSCs-enhanced green fluorescent protein (EGFP) group and BMSCs-EGFP-BDNF group (n=15); PBS,BMSCs,lentiviral vector (LV)carried EGFP and LV carried BDNF-EGFP were,respectively,injected into the lateral cerebral ventricle of each group; 7,14 and 21 d after the injection,BDNF protein expression in the BMSCs of each group was detected by

  8. Hemostatic assessment, treatment strategies, and hematology consultation in massive postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists

    Directory of Open Access Journals (Sweden)

    James AH

    2015-11-01

    Full Text Available Andra H James,1 David L Cooper,2 Michael J Paidas31Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, 2Novo Nordisk Inc., Princeton, NJ, 3Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale Women and Children’s Center for Blood Disorders and Preeclampsia Advancement, Yale University, New Haven, CT, USAObjective: To assess potential diagnostic and practice barriers to successful management of massive postpartum hemorrhage (PPH, emphasizing recognition and management of contributing coagulation disorders.Study design: A quantitative survey was conducted to assess practice patterns of US obstetrician-gynecologists in managing massive PPH, including assessment of coagulation.Results: Nearly all (98% of the 50 obstetrician-gynecologists participating in the survey reported having encountered at least one patient with “massive” PPH in the past 5 years. Approximately half (52% reported having previously discovered an underlying bleeding disorder in a patient with PPH, with disseminated intravascular coagulation (88%, n=23/26 being identified more often than von Willebrand disease (73%, n=19/26. All reported having used methylergonovine and packed red blood cells in managing massive PPH, while 90% reported performing a hysterectomy. A drop in blood pressure and ongoing visible bleeding were the most commonly accepted indications for rechecking a “stat” complete blood count and coagulation studies, respectively, in patients with PPH; however, 4% of respondents reported that they would not routinely order coagulation studies. Forty-two percent reported having never consulted a hematologist for massive PPH.Conclusion: The survey findings highlight potential areas for improved practice in managing massive PPH, including earlier and more consistent assessment, monitoring of coagulation studies, and consultation with a hematologist.Keywords: acquired hemophilia, blood

  9. Nonpneumatic Antishock Garment Combined with Bakri Balloon as a Nonoperative “Uterine Sandwich” for Temporization of Massive Postpartum Hemorrhage from Disseminated Intravascular Coagulation

    Directory of Open Access Journals (Sweden)

    Andrea Jelks

    2015-01-01

    Full Text Available Disseminated intravascular coagulation (DIC is an uncommon but potentially catastrophic complication of postpartum hemorrhage. We describe two cases of massive postpartum hemorrhage complicated by DIC that were successfully temporized with combined use of the Bakri balloon and nonpneumatic antishock garment (NASG during massive transfusion. In the first case, a healthy, term gravida underwent emergent cesarean for fetal bradycardia during labor induction. 10 minutes after completion of surgery, brisk vaginal hemorrhage of nonclotting blood from fulminant DIC resulted in maternal shock. A Bakri balloon and NASG were placed during massive transfusion, resulting in rapid maternal stabilization. In the second case, a healthy, term gravida suffered an amniotic fluid embolism during labor requiring emergent cesarean delivery and complicated by cardiac arrest with successful resuscitation. Postoperative rapid uterine bleeding from DIC was treated with a Bakri balloon and NASG, stabilizing the patient during massive transfusion. Neither patient required further surgical procedures. NASG combined with Bakri balloon may serve as a valuable nonoperative treatment or temporization option in cases of massive postpartum hemorrhage complicated by coagulopathy such as these. Further study of the utility of NASG in high-resource settings is warranted.

  10. Massive fetomaternal hemorrhage caused by an intraplacental choriocarcinoma: a case report

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Maroun, Lisa Leth; Havsteen, Hanne;

    2010-01-01

    of a severely anemic infant. A fetomaternal hemorrhage resulted in a hemoglobin concentration in the infant of only 2,1 g/dL. Neither mother nor child showed signs of metastatic disease. The macroscopic examination showed a hydropic placenta weighing more than 1 kilogram. Microscopy showed an intraplacental...

  11. Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation

    OpenAIRE

    Elsa Oliveira; Margarida Anastácio; Anabela Marques

    2016-01-01

    ABSTRACT Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleed...

  12. Pharmacological mechanisms and clinical application of mannitol in intracerebral hemorrhage%甘露醇治疗脑出血的药理学机制和临床应用

    Institute of Scientific and Technical Information of China (English)

    聂红霞; 杨友松

    2009-01-01

    One of the important therapeutic measures in the acute stage of cerebral hemorrhage is to treat cerebral edema and lower intracranial pressure. Mannitol, an osmotic dehydrant, is most widely used in clinical practice. Its major effects include the reduction of intracranial pressure and cerebral edema and prevention of cerebral herniation. Besides, mannitol scavenges oxygen free radicals and protects brain cells. So it has extremely important significance in reducing the mortality of intracerebral hemorrhage.%脑出血急性期的重要治疗措施之一是积极治疗脑水肿,降低颅内压.甘露醇为临床应用最广泛的渗透性脱水药,主要有降低颅内压、减轻脑水肿、预防脑疝形成的作用.此外,甘露醇能清除氧自由基、保护脑细胞,对于降低脑出血病死率具有极其重要的意义.

  13. Effect observation of piracetam combined mannitol in the treatment of brain edema after intracerebral hemorrhage%吡拉西坦联合甘露醇治疗脑出血后脑水肿的效果观察

    Institute of Scientific and Technical Information of China (English)

    张三军

    2015-01-01

    Objective:To observe the effect of piracetam combined mannitol in the treatment of brain edema after intracerebral hemorrhage.Methods:90 cases of patients with brain edema after cerebral hemorrhage were divided into two groups.The control group were given mannitol treatment.The observation group were given piracetam combined mannitol therapy.The curative effect of the two groups were observed.Results:After treatment,the total effective rate of the observation group 95.56% was significantly higher than that of the control group 51.11%(P<0.05).The brain edema volume of the observation group(7.42±2.15)cm3 was less than that of the control group(15.56 ± 4.28)cm3.The differences were statistically significant(P<0.05).Conclusion:Piracetam combined mannitol in the treatment of brain edema after intracerebral hemorrhage had remarkable effect.%目的:观察脑出血后脑水肿行甘露醇与吡拉西坦联合治疗的效果。方法:收治脑出血后脑水肿患者90例,分为两组。对照组行甘露醇治疗,观察组行甘露醇与吡拉西坦联合治疗,观察两组疗效。结果:治疗后,观察组总有效率95.56%显著高于对照组的51.11%(P<0.05)。观察组脑水肿的体积(7.42±2.15)cm3少于对照组的(15.56±4.28)cm3,差异具有统计学意义(P<0.05)。结论:脑出血后脑水肿行甘露醇与吡拉西坦联合治疗的效果显著。

  14. Aetiology of intracerebral haemorrage

    Directory of Open Access Journals (Sweden)

    Stefano Spolveri

    2011-08-01

    Full Text Available Spontaneous non traumatic intracerebral haemorrhage (ICH is usually caused by many different interacting factors, such as the use of alcohol or fibrinolitic drugs, congenital aneurysm, brain tumors, and blood dyscrasia. Age and hypertension-related small vessel diseases, and cerebral amyloid angiopathy are the most common forms of vascular damage which can lead to ICH. Furthermore, a group of inherited cerebral small vessel diseases linked to ICH have been reported recently and the number of these forms is increasing. The presence of leukoaraiosis, lacunar infarcts and microbleeds has been suggested to indicate a higher risk for cerebral hemorrhage. In recent years, MRI and neuroimaging techniques contributed to the understanding and the diagnosis of this disease.

  15. [Team approaches to critical bleeding (massive bleeding and transfusion) - chairmen's introductory remarks. Questionnaire survey on current status of hospital clinical laboratories evaluating critical hemorrhage].

    Science.gov (United States)

    Kino, Shuichi; Suwabe, Akira

    2014-12-01

    In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).

  16. Arterial hemorrhage from cesarean scar: a rare cause of recurring massive uterine bleeding and successful surgical management.

    Science.gov (United States)

    Wang, Chun-Feng; Hu, Min

    2015-02-01

    Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully used in an attempt to control the bleeding. After she was transferred to our hospital, she had another episode of vaginal bleeding that was successfully managed with oxytocin and hemostatic. Diagnostic hysteroscopy performed under anesthesia revealed an abnormal transected artery in the cesarean section scar with a thrombus visible. In the treatment at the beginning of laparoscopic management, we adopted temporary bilateral uterine artery occlusion with titanium clips to prevent massive hemorrhage. Secondly, with the aid of hysteroscopy, the bleeding site was opened, and then the cesarean scar was wedge resected and stitched interruptedly with 1-0 absorbable sutures. The postoperative recovery was uneventful. It would seem that the worldwide use of cesarean section delivery may contribute to the risk of gynecologic disturbances including some unrecognized and complex conditions as seen in this case.

  17. 小骨窗手术治疗基底节区高血压脑出血40例临床疗效观察%Observation of clinical effects of small bone window surgery on 40 cases with basal ganglia hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    刘鹏鹏; 李军

    2014-01-01

    目的:评价小骨窗开颅微侵袭手术治疗基底节区高血压脑出血的临床疗效。方法:回顾分析采用小骨窗开颅微侵袭手术治疗基底节区高血压脑出血的临床过程。结果:40例采取小骨窗开颅微侵袭手术治疗的基底节区高血压脑患者随访半年,死亡6例,按 ADL 分级法进行测评:I 级7例,II 级13例,III 级9例,IV 级3例,V 级2例。结论:小骨窗开颅微侵袭手术治疗基底节区高血压脑出血是一种较为理想的手术方法。%Objective:To investigate the clinical effect of minimally invasive surgery by small bone window on basal ganglia hy-pertensive intracerebral hemorrhage. Methods:The clinical course of basal ganglia hypertensive intracerebral hemorrhage treated with minimally invasive surgery by small bone window was retrospectively analyzed. Results: In 40 cases of basal ganglia hypertensive in-tracerebral hemorrhage with minimally invasive surgery by small bone window, according to ADL scale, six month-follow up was per-formed: 7 cases got I-class, 13 cases were II-class, 9 cases were III-class, 3 cases were IV-class, and 2 cases were V-class. Con-clusions: Minimally invasive surgery by small bone window is an ideal surgical way for basal ganglia hypertensive intracerebral hemor-rhage.

  18. Clinical observation of edaravone combined with sodium aeseinate in treatment of patients with intracerebral hemorrhage%依达拉奉联合七叶皂苷钠治疗脑出血的临床观察

    Institute of Scientific and Technical Information of China (English)

    高传生; 陈信东; 王萍萍; 祝炳军; 张承平

    2012-01-01

    Objective To investigate the clinical effects of edaravone combined with sodium aeseinate and conservative medical treatment in treating patients with intra-cerebral hemorrhage. Methods Sixty-four cases with intra-cerebral hemorrhage were divided into the trial ( 32 cases ) and control groups ( 32 cases ). The patients in the trial group were treated by edaravone 30 mg intravenous (IV ) drip twice a day combined with sodium aeseinate 20 mg IV drip once a day and conservative medical treatment, while those of the control group were treated by conservative treatment alone. The clinical neurologic function deficit score ( NDS ) were compared before treatment, and the rates of effects and mortality were compared in 14 days and 28 days after treatment between the two groups. Results After treatment, the NDS was significantly improved in the trial group compared with that before the treatment ( 18.91 ±6.85, 11.20±8.46 vs. 25.60 + 6.32, both P< 0.05) , the total effective rate was 75.0% and mortality rate was 12.5%; in the control group, the effective rate was 53.1 % and mortality rate was 21.9 %, there were significant differences compared with two groups (both P<0.01 ). Conclusion Edaravone combined with sodium aeseinate is a safe and effective method in treating patients with intra-cerebral hemorrhage.%目的 探讨依达拉奉联合七叶皂苷钠治疗脑出血的临床疗效.方法 64例脑出血患者随机分为两组.观察组(32例)采用依达拉奉30 mg静脉滴注,每日2次;七叶皂苷钠20 mg静脉滴注,每日1次;以及常规内科保守治疗;对照组(32例)采用常规内科保守治疗.于治疗前及治疗后14 d、28 d进行疗效评定.结果 观察组治疗后14 d、28 d神经功能缺损程度评分(NDS,分)较治疗前明显改善(18.91±6.85、11.20±8.46比25.60±6.32,均P<0.01),总有效率较对照组明显提高(75.0%比53.1%,P<0.01),病死率较对照组明显降低(12.5%比21.9%,P<0.01).结论 依达拉奉联合七

  19. Effect of breviscapine on neuroplasticity in intracerebral hemorrhage in rats%灯盏花素对脑出血大鼠神经可塑性的影响

    Institute of Scientific and Technical Information of China (English)

    胡仲红; 李晓琳; 王登科; 朱继红

    2014-01-01

    Objective To investigate the effect of breviscapine on neuroplasticity in intracerebral hemorrhage in rats.Methods A total of 108 Sprague-Dawley rats were randomly divided into a sham operation,a model and a breviscapine group.Intracerebral hemorrhage was induced by collagenase injections.Neurological scores were performed for each group.Immunohistochemical staining was used to detect the expression levels of nestin and Shankl in the perihematomal tissue.A transmission electron microscope was used to observe the synaptic ultrastructural changes.Results The synaptic ultrastructures were basically normal in the sham operation group.The synapses and organelles were dissolved and destroyed in the model group.The synapse ultrastructures tended to be normal in the breviscapine group.Compared with the model group,the number of synapses,interfacial curvature,and postsynaptic dense zone were increased significantly (allP <0.01),the synapse gaps were narrowed significantly (P <0.01),and the expression levels of Shankl and nestin increased significantly (P < 0.01).The neurological function was normal in the sham operation group.After modeling,the neurological scores increased in the model and breviscapine groups,and the neurological function was improved rapidly in the breviscapine group.There were significant differences in the neurological scores at day 3,7,and 14 in the breviscapine group compared with the model group (all P <0.01).Conclusions Breviscapine may promote the neural repair and the neurological function recovery in intracerebral hemorrhage in rats.Enhancing the plasticity of brain tissue may be one of the possible mechanisms.%目的 探讨灯盏花素对大鼠脑出血后神经可塑性的影响.方法 108只Sprague-Dawley大鼠随机分为假手术组、模型组和灯盏花素组.采用胶原酶注射法建立脑出血模型.对各组大鼠进行神经功能评分,应用免疫组化染色检测血肿周围脑组织巢蛋白和Shank1

  20. The Effect of Musical - Electroacupuncture on SOD and MDA in Brain Tissue and Serum of Rats with Intracerebral Hemorrhage%音乐电针对脑出血大鼠脑组织及血清SOD和MDA的影响

    Institute of Scientific and Technical Information of China (English)

    张淑丽; 严晓燕; 王素兰; 王晓敏; 刘利

    2011-01-01

    目的:通过观察脑出血模型大鼠血肿周围脑组织和血清中SOD、MDA含量变化,探讨音乐电针治疗脑出血的相关机理.方法:胶原酶加肝素注入脑尾状核诱导脑出血模型,SD成年大鼠30只随机分为正常组、模型组、治疗组.治疗组针刺曲池、合谷、髀关、足三里,接音乐电针仪,每次30 min,每日1次.14 d后处死行脑组织及血清SOD、MDA测定.结果:脑组织及血清SOD、MDA治疗组较模型对照组有显著性差异(P<0.05).结论:音乐电针能促进脑出血模型大鼠的神经功能缺损恢复,提高SOD活力,增强其抗自由基损伤的能力.%Objective: To study the effects and the possible mechanisms of Musical electroaoupuncture therapy by observing change of SOD and MDA in Intracerebral Hemorrhage rats. Methods: Thirty SD rats were divided into three groups at random;normal group,model group and treatment group. Collagenase and heparin were injected into caudate nucleus to establish Intracerebral Hemorrhage rats. The points such as "quchi" ,"hegu" , "zusanli" ,"biguan"were electroacupunctured for 30 mins. To observe and evaluate the nerve missing sign and the deference of SOD and MDA between groups after 14 days. Results: Treatment group had clearly improved neurologic impairment compared with model group (P<0. 05). The SOD and MDA had an obvious difference with model group (P <0.05). Conclusion: Musical - electroacupuncture therapy can promote neuological function of the IGH rats,and enhance its ability against free radical damage.

  1. Double Balloon Cervical Ripening Catheter for Control of Massive Hemorrhage in a Cervical Ectopic Pregnancy

    Science.gov (United States)

    Zambrano, Nabila; Reilly, James; Moretti, Michael

    2017-01-01

    Cervical pregnancy can be complicated by perfuse vaginal bleeding. Mechanical compression directed at tamponing the cervical vessels can control hemostasis. There are several types of balloon catheters that have been described for cervical compression. However use of a double balloon catheter is a novel approach for cervical tamponade, as one balloon is positioned below the external cervical os and the second balloon is situated above in the internal cervical os. This compresses the cervix from internal os to external os between the two balloons, forming a “cervical sandwich.” We describe this method of cervical tamponade using a silicone double balloon cervical ripening catheter that rapidly controlled hemorrhage in a patient that failed conservative management with methotrexate. PMID:28261511

  2. Massive fetomaternal hemorrhage caused by an intraplacental choriocarcinoma: a case report

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Maroun, Lisa Leth; Havsteen, Hanne

    2010-01-01

    Background. Intraplacental choriocarcinoma is a rare but highly malignant trophoblastic neoplasm. When found near term the risk of maternal metastasis is high because of the late diagnosis. Case. We describe a case of an intraplacental choriocarcinoma diagnosed postpartum after a near-term delive...... choriocarcinoma 3 cm in diameter. The tumor had infiltrated the maternal basal plate. Conclusion. Fetomaternal bleeding is a rare form of presentation of choriocarcinoma but its presence should always warrant detailed examination of placenta, mother, and infant....... of a severely anemic infant. A fetomaternal hemorrhage resulted in a hemoglobin concentration in the infant of only 2,1 g/dL. Neither mother nor child showed signs of metastatic disease. The macroscopic examination showed a hydropic placenta weighing more than 1 kilogram. Microscopy showed an intraplacental...

  3. [MASSIVE HEMORRHAGE FROM THE FISTULA FORMATION BETWEEN CUTANEOUS URETEROSTOMY AND INFERIOR EPIGASTRIC ARTERY: A CASE REPORT].

    Science.gov (United States)

    Fujinami, Hiroyuki; Shibuya, Tadamasa; Mori, Kenichi; Shin, Toshitaka; Sumino, Yasuhiro; Sato, Fuminori; Mimata, Hiromitsu; Sato, Yoshiyasu; Matsubara, Takanori; Sakamoto, Sadaaki; Kamei, Noritaka; Hongo, Tetsuo

    2015-04-01

    A 87-year-old man received radical nephroureterectomy for right renal pelvic cancer in 2009 and left cutaneous ureterostomy after radical cystectomy for bladder cancer in 2013. He visited the hospital for exchanging a 7 or 8 Fr single-J catheter every 2 to 4 weeks. Eleven months after the 2nd operation, massive bleeding from the stoma occurred when ureteral catheter was exchanged. Contrast-enhanced computed tomography showed that left inferior epigastric artery was located close to left ureter. Angiography of the left inferior epigastric artery didn't show an obvious fistula, but revealed the stoma was surrounded by ramified new blood vessels from left inferior epigastric artery. We suspected a rupture of the vessels and performed embolization for the branch of inferior epigastric artery to left ureter. This embolization made it possible for the bleeding to be controlled. Massive bleeding from the branch of inferior epigastric artery is very rare, and we report the case and review the literature.

  4. Massive upper gastrointestinal hemorrhage due to invasive hepatocellular carcinoma and hepato-gastric fistula.

    Science.gov (United States)

    Sayana, Hari; Yousef, Osama; Clarkston, Wendell K

    2013-11-14

    A 36-year-old male Asian immigrant with a history of hepatitis B and hepatitis C related unresectable hepatocellular carcinoma in the left lobe of the liver presented with hematemesis and severe anemia. He was diagnosed with a liver mass that was resected 8 years ago described as a benign tumor in his home country. He had received trans-arterial chemoembolization (TACE) four months ago after subsequent diagnosis of unresectable hepatoma, and currently was receiving chemotherapy with Sorafenib. After resuscitation, a contrast enhanced computerized tomography was performed which showed fistulization of hepatocellular carcinoma into adjacent stomach. This finding was confirmed during endoscopy with direct visualization of the fistulous opening. Hepatocellular carcinoma (HCC) invading the gastrointestinal (GI) tract is rare. We present a case and literature review of HCC with local invasion of the stomach causing massive upper GI bleeding after receiving TACE.

  5. Serum cortisol changes in spontaneous intracerebral hemorrhage patients%自发性脑出血患者血清皮质醇含量变化的相关性研究

    Institute of Scientific and Technical Information of China (English)

    杨彬; 于思淼; 王亮; 刘晓智; 赵玉军; 刘振林

    2014-01-01

    目的 研究自发性脑出血后患者血清总皮质醇、皮质醇结合蛋白、游离皮质醇及游离皮质醇指数的变化,探讨其与患者病情轻重程度以及预后的关系.方法 筛选92例自发性脑出血患者,采用免疫分析法于患者发病后1、3、7、10和14 d晨6:00连续测定血清总皮质醇、皮质醇结合蛋白、游离皮质醇,并计算出游离皮质醇指数,采用SPSS 16.0统计学软件对实验结果数据进行分析研究,以P <0.05为差异有统计学意义.结果 发病第1天观察组较对照组血清总皮质醇、游离皮质醇和游离皮质醇指数均升高(P <0.001),之后逐渐下降.而皮质醇结合蛋白与对照组差异无统计学意义(P>0.05),之后逐渐升高.血清皮质醇水平低下的自发性脑出血患者与血清皮质醇水平正常的患者比较预后不良(P<0.05).结论 自发性脑出血可引起HPA轴的迅速激活,故发病后机体内的应激激素水平是升高的.当病情危重时,机体应激反应过于强烈,导致HPA轴衰竭,出现皮质醇不足,最终影响患者预后.%Objective To study the changes of total cortisol、cortisol binding globulin、free cortisol and free cortisol index in spontaneous cerebral hemorrhage patients,and to discuss the relationship between the changes and disease severity and the prognosis.Methods 92 patients with spontaneous intracerebral hemorrhage were enrolled in this study.The serum were collected at 6 am at the 1st day、3rd day、7th day、10th day and 14th day.The total cortisol、cortisol binding globulin and free cortisol were analyzed using of immunity method.The free cortisol index was calculated by Coolens equation.The data were analyzed with SPSS 16.0.Results The levels of total cortisol、free cortisol and free cortisol index showed significantly increased and got peak at the 1st day (P < 0.001),and then gradually declined.The cortisol binding protein at the onset had no obvious difference (P > 0.05),and

  6. Time-Dependent FTIR Spectral Changes in Rats of Massive Hemorrhage Death during the Later Postmortem Period

    Institute of Scientific and Technical Information of China (English)

    LI Shi-ying; SHAO Yu; LI Zheng-dong; LI Li; CHEN Yuan-yuan; CHEN Yi-jiu; HUANG Ping

    2012-01-01

    The aim of the current study was to investigate the spectra in the different organs of the rats which died of massive hemorrhage; to explore their spectral changes 15 days postmortem and the best mathematical model with different band absorption ratio changes to postmortem interval(PMD; and to compare the spectral changes of different temperature.Thirty male Sprague-Dawley rats were sacrificed by cutting abdominal aorta,and the cadavers were divided equally and kept at 4 ℃,20℃ and 30℃ in the control chamber.From the same rat,seven different organs were sampled at intervals of 1-15 days postmortem,and then measured by Fourier transfom infrared (FTIR) spectrometer.Six mathematical model functions were explored.The absorbance of bands and band absorbance ratios of absorption peak in each organ showed a time-dependent increase or decrease,most band absorbance ratios remaining stable for 7-15 days postmortem.Cubic model functions of the various bands absorbance ratios against PMI showed a stronger related coefficient.The absorbance bands with obvious changes at 20 ℃ showed stabilized tendencies at 4 ℃ and significant changes at 30 ℃ within 15 days postmortem.In addition,FTIR spectroscopy revealed a time-dependent metabolic process,with potential of being used to estimate PMI during 7 days postmortem,which merits further investigation.

  7. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa.

    Science.gov (United States)

    Broekman, Evelien A; Versteeg, Henneke; Vos, Louwerens D; Dijksterhuis, Marja G; Papatsonis, Dimitri N

    2015-02-01

    To evaluate the effectiveness of temporary balloon occlusion of the internal iliac artery before uterine incision to prevent massive obstetric hemorrhage during cesarean delivery among patients with anterior placenta previa. In a retrospective cohort study conducted at Amphia Hospital Breda (Breda, Netherlands), data were analyzed from women with anterior placenta previa who delivered by cesarean between January 1, 2001, and September 30, 2012. Cases with and without balloon occlusion of the internal iliac artery were included. The primary outcomes were the amount of blood loss during cesarean delivery, drop of hemoglobin level, and blood loss of more than 1000 mL. Of 68 eligible women, 42 (62%) had temporary balloon occlusion and 26 (38%) had no balloon occlusion. Median blood loss was 800 mL (interquartile range [IQR] 488-1113) in the balloon group and 1000 mL (IQR 694-1307) in the no balloon group (P=0.06). Blood loss of 1000 mL or more was recorded in 16 (38%) women in the balloon group and 18 (69%) in the no balloon group (P=0.01). Temporary balloon occlusion of the internal iliac artery before uterine incision during cesarean delivery could potentially reduce blood loss among patients with anterior placenta previa. Large, randomized controlled trials are needed to confirm the results. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Massive choroidal hemorrhage after intravitreal administration of bevacizumab (Avastin® for AMD followed by controlateral sympathetic ophthalmia

    Directory of Open Access Journals (Sweden)

    Dimitrios Brouzas

    2009-08-01

    Full Text Available Dimitrios Brouzas, Chryssanthi Koutsandrea, Marilita Moschos, Spiros Papadimitriou, Ioannis Ladas, Michael Apostolopoulos1st Eye Department , University of Athens, Athens, GreecePurpose: To report a severe ocular complication initiated ten days after intravitreal administration of bevacizumab (Avastin®, in a patient with exudative age-related macular degeneration (AMD.Patients and method: Case report.Results: Ten days after intravitreal injection of 1.25 mg Avastin®, the patient manifested acute loss of vision with excruciating pain. An extensive choroidal detachment was evident in close contact with the lens, which necessitated an emergency sclerotomy with reconstruction of the anterior chamber. Four months later, the eye proceeded to phthisis bulbi. Five months after the injection, the patient complained of mild pain, photophobia, and visual acuity deterioration from the fellow eye. The diagnosis of sympathetic ophthalmia was suggested and treated with intravitreal injections of triamcinolone acetonide every three months with good response, complicated by elevation of intraocular pressure which we managed with Ahmet valve implantation.Conclusion: Serious ocular complications after intravitreal of Avastin® can not be excluded, including massive choroidal hemorrhage and sympathetic ophthalmia of the fellow eye.Keywords: Avastin® complication, intravitreal injection, choroidal detachment, Phthisis bulbi, sympathetic ophthalmia

  9. 动物实验性脑出血后血肿内红细胞管涌现象研究%RBC "piping phenomenon" in hematoma due to experimental intracerebral hemorrhage in rats

    Institute of Scientific and Technical Information of China (English)

    何国林; 陈湛愔; 梁余航; 吕田明; 陆兵勋; 陈逢俭; 林海峰

    2013-01-01

    Objective To study the RBC "piping phenomenon" in hematoma due to intracerebral hemorrhage in rats .Methods Sixty SD male rats were randomly divided into experimental group (n=30) and control group(n=30) .Each group was further divided into 1 h group ,6 h group ,24 h group ,3 d group ,7 d group(5 ineach group).A rat model of autologous cerebral artery hemorrhage was established with FITC probe-labeled RBC .Brain and neck deep lymph node tissues were cut into sections which were stained with HE and observed under fluorescence microscope . The distribution features of RBC were analyzed .Results The FITC-RBC and free-FITC were distributed in experimental group ,bilateral cerebral hemisphere ,brain stem Virchow-Robin spaces , and bilateral neck deep lymph nodes 1 h after hematoma formation .Yellow or yellow-green flores-cent granular phagocytes were observed ,the FITC-RBC were gradually disappeared and the number of free-FITC began to decrease 6 h after hematoma formation . The number of yellow or yellow-green florescent granular phagocytes began to increase and yellow florescent granules could be found in lymph node germinal center . No such phenomina were observed in control group .Conclusion The spread of RBC "piping phenomenon" is limited while the free-RBC "piping phenomenon" is extensive in hematoma due to intracerebral hemorrhage .The RBC "piping phenomenon" is one of the absorption ways of RBC in hematoma .%目的 探索脑出血后血肿内红细胞通过"管涌现象"的分布特征.方法 SD雄性大鼠60只,随机分为实验组30只和对照组30只,每组分为5个不同观察时间点:1 h、6 h、24 h、3 d、7 d,每个时间点5只.采用异硫氰酸荧光素(FITC)标记血液中红细胞,建立大鼠自体动脉血脑出血模型,分别于不同时间点进行大鼠脑组织、颈深淋巴结组织病理切片,荧光显微镜下观察以及HE染色后显微镜下观察,对比分析红细胞的分布特征.结果 实验组血肿形成1 h后,病灶以

  10. The Experimental Influences of Baihui - Qubin Acupuncture on Interleukin -6Expression of Rats With Intracerebral Hemorrhage%“百会透曲鬓”针刺法对脑出血模型大鼠脑组织IL-6蛋白表达影响的实验研究

    Institute of Scientific and Technical Information of China (English)

    孔莹; 赵佳辉; 邹伟; 乔胜楠; 王珑; 迟庆斌; 刘鹏; 黄亮; 郭新年; 滕伟

    2012-01-01

    目的:通过观察“百会透曲鬓”针刺法对脑出血急性期大鼠模型脑组织中白介素-6(IL -6)蛋白表达的影响,研究本针刺法对脑出血后继发性脑损伤的神经保护机制,从而指导临床实践.方法:选用60只雄性Wistar大鼠,随机分为空白组、模型组、针刺组、西药组(脑复康).分别于脑出血急性期大鼠模型造模成功后6h,2天,7天三个时间点并完成相应治疗,治疗后进行神经功能学评分,然后处死大鼠,取大鼠脑组织,用免疫组化分析法( IHC)检测脑组织中IL -6蛋白表达的平均灰度值,在光镜下观察脑组织形态学变化.结果:针刺治疗能减少神经功能缺损评分,造模后2天及7天后,针刺组与模型组比较有显著性差异(P<0.01);针刺治疗能降低IL -6阳性细胞平均灰度值,造模后2天及7天后,针刺组与模型组比较有显著性差异(P<0.01);光镜下脑组织病理改变结果显示,针刺组与模型组有差异.结论:“百会透曲鬓”针刺法可明显改善大鼠的神经功能学评分,有利于脑出血后肢体运动功能的恢复.在脑出血急性期,针刺“百会透曲鬓”穴可以通过下调IL -6的蛋白表达,减轻脑出血后炎性反应导致的继发性脑损伤程度,从而改善脑组织缺血缺氧状态及保护受损伤的神经元细胞.%Objective; By observing the BaiHui - QuBin scalp -acupuncture on acute cerebral hemorrhage in the rat model of brain tissue IL - 6 protein expression, to study the acupuncture on the cerebral hemorrhage secondary brain injury after the neuro protective mechanisms in order to guide clinical practice. Method; 1. Totally 60 male wistar rats were randomly allocated into four group:blank group(n =6),intracerebral hemorrhage control group ( n = 18 ) , acupuncture group ( n = 18 ) , and western medicine ( pisacetam) group ( n = 18 ). 2. The rat models of acute intracerebral hemorrhage were made. 3. The acupuncture point; BaiHui point to Qu

  11. Distribution of pathogens causing postoperative infections in acute intracerebral hemorrhage patients undergoing general anesthesia%急性脑出血全麻患者术后感染病原菌分析

    Institute of Scientific and Technical Information of China (English)

    陈洁; 王光磊; 王云; 张智卿; 白延仓

    2016-01-01

    OBJECTIVE To analyze the pathogen distribution and its effect on recognition function in acute intrace‐rebral hemorrhage patients with general anesthesia ,so as to provide reference for clinical treatment .METHODS A total of 170 cases of patients got infections after general anesthesia operation for the acute intracerebral hemorrhage in our hospital from Sep .2012 to Sep .2014 were enrolled as infected group .Another 170 cases of healthy subjects at the same period in our hospital were taken as control group .And another 170 cases of uninfected patients after general anesthesia operation for acute intracerebral hemorrhage were taken as uninfected group .The changes of recognition function , serum fibroblast growth factor and inflammatory factors were compared in these three groups .RESULTS A total of 170 strains of pathogens were isolated from the 170 cases of patients ,including 77 (45 .3% ) strains of gram‐positive bacteria ,mainly Staphylococcus aureus 18 (10 .6% ) strains , Staphylococcus saprophyticus 12(7 .1% ) strains ,and Enterococcus f aecalis 11(6 .5% ) strains .There were 93 (54 .7% ) strains of gram‐negative bacteria ,including Pseudomonas aeruginosa 18 (10 .6% ) strains , Enterobacter aerogenes 17 (10 .0% ) strains ,and Neisseria meningitides 16(9 .4% ) strains .The MMSE scores of infected patients were de‐creased obviously ,and catalase and superoxide dismutase in serum were lower than control group and uninfected group obviously ,but MDA ,IL2 ,IL10 and TNF‐α were increased significantly compared with control and unin‐fected groups (P<0 .05) .CONCLUSION There is big chance for acute intracerebral hemorrhage patients got infec‐ted ,and which could influence the cognition function of patients .%目的:研究急性脑出血全麻患者术后感染病原菌分布及对患者认知功能的影响,为临床治疗提供参考。方法选取医院2012年9月-2014年9月诊治的170例急性脑出血全麻术后感

  12. 显微手术治疗幕上高血压性脑出血的体会%Experience of Microsurgical Operation in the Treatment of Supratentorial Hypertensive Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    孙郑春; 曹新亮; 马旭东

    2014-01-01

    Objective To explore the curative effects of microsurgical clearance for supratentorial hypertensive intracerebral hemorrhage. Methods A retrospective analysis of clinical data of 30 cases of supratentorial hypertensive intracerebral hemorrhage in our hospital from January 2010 to January 2013 was carried out. According to the head CT images, the position of incision was determined. Under orotracheal intubation general anesthesia, a bone flap craniotomy was performed. A cortex fistula 2-3 cm in length was made. Then by using an automatic retraction device, the hematoma was revealed from the shallower to the deeper, and microscopic clearance of hematoma was completed. Results All the 30 cases of operation were successful. Re-examination of head CT scans on the first postoperative day showed hematoma was completely removed in 14 cases, was 90%cleared in 11 cases, and 80%in 5 cases. Four patients died within 4 weeks after operation (13.3%):2 patients died of cerebral hernia caused by brainstem function failure, 1 patient died of lung infection, and 1 patient died of multiple organ failure. The postoperative survival rate was 86.7%.The ADL grade assessment 3 months after operation showed gradeⅠin 7 cases, grade Ⅱin 9 cases, grade Ⅲin 6 cases, grade Ⅳ in 3 cases, and grade Ⅴin 1 case. Conclusion Microscopic hematoma clearance and open haemostatic intervention has advantages of little brain tissue damage, good haemostatic results, and satisfactory efficacy.%目的:探讨显微镜下清除幕上高血压性脑出血的疗效。方法我院2010年1月~2013年1月显微手术治疗30例幕上高血压性脑出血,根据头颅CT影像定位确定手术切口,游离骨瓣开颅,做一长2~3 cm皮层瘘口,用自动牵开器由浅入深显露血肿,显微镜下清除血肿。结果30例手术均获得成功。术后次日复查头颅CT,14例血肿完全清除,11例血肿清除率达到90%,5例清除率达到80%。术后死亡4例(13.3

  13. Research Progress in Association of Matrix Metalloproteinases with Cerebral Edema after Hypertensive Intracerebral Hemorrhage%基质金属蛋白酶与高血压脑出血后脑水肿相关性的研究进展

    Institute of Scientific and Technical Information of China (English)

    周德生; 李煦昀; 王仙伟

    2012-01-01

    Hypertensive intracerebral hemorrhage is one of the critical diseases in neurological system. In addition to the mass effect of hematoma,the blood brain barrier damage and cerebral edema caused by hema-toma components and the secondary nerve damage caused by cerebral edema are the main causes of deterioration and death the cerebral hemorrhage patients. Recent studies suggested that matrix metalloproteinases increased expression after hypertensive intracerebral hemorrhage, which participated in and mediated cerebral edema, and the expression and adjustment of which has become the new target for the treatment of cerebral e-dema.%高血压脑出血是神经系统的危重病之一.除了血肿本身的占位效应外,血肿成分引发的血脑屏障的破坏和脑水肿反应,以及脑水肿导致的继发性神经损害,是脑出血患者病情恶化和引起死亡的主要原因.基质金属蛋白酶在高血压脑出血后表达增高,参与和介导了脑水肿的发生、发展,其表达和调控成为研究脑水肿的治疗靶点.

  14. Clinical characteristics of hospital-acquired pneumonia in patients with spontaneous intracerebral hemorrhage%自发性脑出血患者医院获得性肺炎的临床特点

    Institute of Scientific and Technical Information of China (English)

    徐祥英; 付怀栋

    2014-01-01

    Objective To investigate the clinical characteristics and the risk factors of hospital-acquired pneumonia(HAP) in the patients with intracerebral hemorrhage(ICH) .Methods The clinical data of 1 184 cases of ICH complicating HAP from Sep .2009 to Sep .2012 were analyzed retrospectively and statistically .Results The incidence rate of HAP was 13 .0% in these ICH patients , the detected pathogens were in turn Gram-negative bacilli(63 .4% ) ,Gram-positive cocci(26 .7% ) and fungi(9 .9% );the risk factors of HAP in ICH patients were related with the age of patients ,underlying disease ,length of hospital stay ,conscious state ,tracheoto-my ,amount of cerebral hemorrhage ,bulbar palsy and nutritional status .Conclusion The patients with ICH are easy to develop HAP .Aiming at the above risk factors ,the comprehensive measures should be adopted to reduce the incidence rate of HAP in ICH patients .%目的:探讨脑出血患者医院获得性肺炎的临床特点及危险因素。方法2009年9月至2012年9月共收治1184例自发性脑出血(IC H )患者,对其发生医院获得性肺炎的相关资料进行回顾性统计分析。结果 IC H患者医院获得性肺炎的发生率为13.0%,检出的病原菌依次为革兰阴性杆菌(63.4%)、革兰阳性球菌(26.7%)、真菌(9.9%);其危险因素与患者年龄、基础疾病、住院时间、意识状态、气管插管或切开、出血量、球麻痹、营养状况等有关。结论 IC H患者易发生医院获得性肺炎,应针对上述危险因素,采取综合措施,降低发生率。

  15. 高血压脑出血无创颅内压及脑灌注压监测临床研究%Monitoring noninvasive intracranial pressure and cerebral perfusion pressure in treatment of patients with hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    张文德; 张湘; 邹志浩; 吴勤奋; 殷捷; 王建江; 郑玺; 莫拉丁

    2012-01-01

    Objective To evaluate clinical significance of monitoring noninvasive intracranial pressure (NICP) and cerebral perfusion pressure (CPP) in treatment of patients with hypertensive intracerebral hemorrhage. Methods This clinical randomized controlled trial enrolled 120 patients with hypertensive intracerebral hemorrhage who had sought medical treatment in our department from June 2008 through May 2010. They were randomized equally into a monitoring group where NICP and CPP were continuously monitored before and after operation and a non-monitoring group where no monitoring of NICP and CPP was performed. Results In the monitoring group,increased NICP and decreased CPP were shown in 50 patients and only 10 patients were shown with normal NICP (<26.6mmHg) and CPP (> 124.3 mm Hg). The abnormal NICP and CPP continuously monitored were treated with specific interventions like further operation or medication. In the non-monitoring group,patients received only conventional treatments.According to the Glasgow Outcome Scale (GOS), 31 patients (51.7%) had good recovery,20 (33.3%) were moderately disabled,5 (8.3%) severely disabled and 4 (6.7%) dead in the monitoring group while 23 (38.3%) patients had good recovery,18 (30.0%)were moderately disabled,10 (16.7%) severely disabled and 9 (15.0%) dead in the non-monitoring group.The outcomes of the monitoring group were significantly better than those of the non-monitoring group (P<0.05). Conclusion Continuous monitoring of NICP and CPP before and after operation should be performed in the treatment of patients with hypertensive intracerebral hemorrhage because it is helpful for clinical medication and reducing complications and mortality as well.%目的 探讨高血压脑出血手术前后监测无创颅内压(NICP)、脑灌注压(CPP)变化的临床意义. 方法 收集解放军第474医院神经外科自2008年6月至2010年5月收治的120例高血压脑出血手术患者,按照随机数字表法分为

  16. “REBOA” – Is it Really Safe? A Case with Massive Intracranial Hemorrhage Possibly due to Endovascular Balloon Occlusion of the Aorta (REBOA)

    Science.gov (United States)

    Uchino, Hayaki; Tamura, Nobuichiro; Echigoya, Ryosuke; Ikegami, Tetsunori; Fukuoka, Toshio

    2016-01-01

    Patient: Female, 86 Final Diagnosis: Polytrauma Symptoms: Shock Medication: — Clinical Procedure: Resuscitative endovascular balloon occlusion of the aorta Specialty: Orthopedics and Traumatology Objective: Unusual or unexpected effect of treatment Background: Non-compressible torso hemorrhage continues to be the leading cause of preventable death in trauma patients. Recent case series report that resuscitative endovascular balloon occlusion of the aorta (REBOA) in the trauma population is a technically feasible method to manage the patients with exsanguinating hemorrhage. On the other hand, it seems that REBOA is being widely promoted prematurely. Complications due to REBOA haven’t been reported much in the literature, and they could have been underestimated. Case Report: An 86-year-old female presented to our emergency department following a pedestrian-vehicle accident. On admission, she was hemodynamically unstable with systolic blood pressure (SBP) of 78 mm Hg. She responded to fluid administration, and computed tomography (CT) scan showed cerebral contusion, subarachnoid hemorrhage, pelvic fracture with contrast extravasation, and thoracic spine fracture. Her condition deteriorated after the CT scan, and she became hemodynamically unstable. REBOA was inserted and inflated. Her blood pressure recovered and even became as high as SBP of 180 mm Hg. Transarterial embolization for pelvic fracture was successfully performed. A subsequent head CT scan showed massive intracranial hemorrhage with penetration to the ventricle, which was fatal. She died on the same day due to cerebral herniation. Conclusions: REBOA is now considered as an alternative to resuscitative thoracotomy or even widely indicated to control hemorrhage. We should be more cautious about using REBOA for polytrauma patients since it could make hemorrhage worse. Further research, assessing its potential complications and safety, will be required to elucidate clear indications for REBOA in trauma

  17. The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Shuang; Lv, Yan; Zheng, Xin; Qiu, Jing; Chen, Hui-Sheng

    2017-07-01

    It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis. Two retrospective and nine prospective studies met inclusion criteria (total 2702 patients). The overall prevalence of CMBs on pre-IVT MRI scans was 24.0%. Pre-existing CMBs on MRI scans were not significantly associated with a higher risk of early sICH (OR 1.74; 95% CI 0.91-3.33; I (2) = 44.5%). Subgroup analyses did not substantially influence these associations. The presence of CMBs was associated with the increased risk of 3-month PFO (OR 1.58; 95% CI 1.08-2.31; I (2) = 54.2%), PH (OR 2.14; 95% CI 1.34-3.42; I (2) = 11.0%) and any ICH (OR 1.42; 95% CI 1.04-1.95; I (2) = 0.0%), respectively. This meta-analysis showed that CMBs presence was not significantly associated with the increased risk of early sICH after IVT. However, the results also demonstrated that CMBs presence increased the risks of 3-month PFO, PH and any ICH after IVT. Due to a small number of included studies and methodological limitations, the results of this meta-analysis should be interpreted cautiously. CMBs presence should not be a contraindication to IVT for AIS patients based on the existing evidence.

  18. CT灌注成像在急性自发性高血压性脑出血中的应用%Application of CT perfusion imaging in acute spontaneous hypertension intracerebral hemorrhage patients

    Institute of Scientific and Technical Information of China (English)

    许化致; 曹国全; 王美豪; 朱姬莹; 谢福荣

    2012-01-01

    Objective To quantify hemodynamic changes in patients with acute spontaneous hypertensive intracerebral hemorrhage (shICH) using computed tomography perfusion (CTP) imaging. Methods 26 patients (22 men and 4 women, age range 33~74, mean age 55. 08 years) who suffered from a supratentorial shICH, were at admission and received CTP scanning within 8~19 h (mean 14. 88 h) after symptom onset. At the maximum levels of the hematoma, cerebral blood flow (CBF) , cerebral blood volume (CBV) and mean transit time (MTT) were measured in three different regions of interest (ROI)manually outlined on CT scan: ① hemorrhagic core( hyperdense on unenhanced CT image); ② perihematomal area (isodense within 1 cm rim of perilesion area); ③ normal area far from ipsilateral hemorrhage, and ④ a mirrored area(CBVn, CBFn, MTTn) , including the clot and the perihematomal region located in the contralateral hemisphere. rCBF, rCBV, rMTT were calculated (rCBV=CBV/CBVn, rCBF=CBF/CBFn, rMTT= MTT/MTTn). Results The CBF, CBV, and MTT color maps showed a centrifugal distribution with a gradual improvement from the core of hematoma to the periphery. The CBV, CBF, and MTT value of perihematoma area were (16. 48 ± 17. 38) ml ·100g-1 · min-1), (1.61±1. 53) ml· 100g-1), (9.12 ± 2.57) s, respectively. There was significantly decreased CBF, CBV and prolonged MTT in perihematomal group against contralateral mirrored area (ZCBV=-2. 603, ZCBF=-4. 178, tMTT = 4. 747, P0. 05). Mean CBF value of perihematomal group was lower than that of remote area ( Z =-2. 288, P 0. 05). Conclusion Multi parametric CTP imaging can indicate low perfusion states around hematoma in acute shICH patients, but there is no evidence of ischemic penumbra.%目的 应用CT灌注成像(CT perfusion,CTP)对急性自发性高血压出血性脑卒中(acute spontaneously hypertensive intracerebral hemorrhage,shICH)血肿周围脑血液动力学变化进行定量研究,验证血肿周围是否存在缺血半暗带.方法 对26

  19. Massive fetomaternal hemorrhage

    DEFF Research Database (Denmark)

    Larsen, Rune; Berkowicz, Adela; Lousen, Thea

    2008-01-01

    to the standard dose of intramuscular (IM) anti-D (300 microg) given immediately after delivery, 2700 microg of anti-D was administered intravenously (IV). The clearance of D+ fetal cells from the maternal circulation was monitored by flow cytometry in samples obtained on a daily basis using anti-D. The mother......BACKGROUND: The clearance of D+ red blood cells (RBCs) from the circulation in D- individuals mediated by passively administered anti-D occurs by opsonization with the antibody and subsequent removal in the spleen. Few data exist on the kinetics of clearance of large volumes of D+ RBCs from...... had no detectable anti-D 6 months after delivery. RESULTS: No clearance of fetal cells was apparent after the insufficient dose of IM anti-D. The IV administration of anti-D caused accelerated clearance of D+ fetal RBCs with a t1/2 of 24.5 hours. D+ reticulocytes comprised 4.2 percent of all D+ cells...

  20. An analysis on the prognosis in 225 patients with spontaneous intracerebral hemorrhage and inspection of the forecast model%自发性脑出血225例预后分析及其预测模型

    Institute of Scientific and Technical Information of China (English)

    甄志刚; 张秋莲; 张生; 高志红; 彭延波; 王晋朝

    2014-01-01

    Objective It is tO investigate the risk factOrs related tO prOgnOsis On 3 mOnth in patients with spOntaneOus in-tracerebral hemOrrhage(ICH)and tO evaluate the fOrecast mOdel. Methods TwO hundred and twenty-five patients with ICH were cOllected and their data was retrOspectively analyzed. The prOgnOsis On 3 mOnth was evaluated by the mOdified Rankin Scale(mRS)scOre. Univariate analysis was perfOrmed tO find risk factOrs related tO favOrable prOgnOsis(mRS≤2)and unfa-vOrable prOgnOsis(mRS>2). At last,multivariate LOgistic analysis was perfOrmed tO find independent risk factOrs assOciated tO unfavOrable prOgnOsis. AccOrding tO the independent risk factOrs,the fOrecast mOdel was established and its reliability was evaluated. Results Multivariate LOgistic regressiOn analysis indicated that age,NIHSS scOre On admissiOn,early enlargement Of hematOma Or nOt and with histOry Of intracerebral hemOrrhage Or nOt were independent influencing factOrs fOr prOgnOsis in 3 mOnth. AccOrdingly,a fOrecast mOdel was established and the mOdel's sensitivity,specificity and tOtal accuracy was 66. 7%, 82. 7% and 76. 1%. Conclusion In ICH patients,advanced age,higher NIHSS scOre On admissiOn,early enlargement Of he-matOma and histOry Of intracerebral hemOrrhage are earlier predictOrs fOr unfavOurable OutcOme.%目的:探讨自发性脑出血( ICH)3个月预后相关危险因素,并对预测模型进行考察分析。方法回顾性分析225例 ICH 患者资料,采用 mRS 评分对患者3个月时预后情况进行评价。首先进行单因素分析,筛选与预后良好( mRS≤2分)或预后不良( mRS≥3分)相关的因素;其次以3个月预后良好与否进行多因素 LOgistic回归分析,探讨与预后相关的独立危险因素。最后,根据相关独立危险因素,建立预测模型并进行可靠性考察。结果年龄、入院时 NIHSS评分、有无 ICH后早期血肿扩大及既往有无脑出血史为3个月预后的独

  1. 鼻咽癌放疗后大出血43例%Clinical analysis of 43 cases nasopharyngeal massive hemorrhage with nasopharyngeal carcinoma after radiotherapy

    Institute of Scientific and Technical Information of China (English)

    蒋军; 张宁

    2010-01-01

    目的 探讨鼻咽癌放疗后大出血的相关因素及预防措施.方法 回顾性分析43例鼻咽癌放疗后大出血的临床资料.结果 43例中,肿瘤广泛侵及颅底39例(90.7%),继往曾接受高剂量放疗36例(83.7%),接受后程大分割放疗10例(23.3%),伴有糖尿病者13例(30.2%).结论 肿瘤发生部位是鼻咽癌大出血最主要的因素;放疗剂量、分割方式、糖尿病则是次要的相关因素.对于伴有上述高危因素的患者,应尽量采用超分割,控制总剂量、血糖等.积极地预防比抢救更重要.%Objective To investigate the related factors and preventive measures of nasopharyngeal massive hemorrhage in patients with nasopharyngeal carcinoma after radiotherapy. Methods Clinical data of 43 nasopharyngeal massive hemorrhage patients with nasopharyngeal carcinoma after radiotherapy were analyzed retrospectively. Results Thirty-nine cases(90.7 %) had abroad skull base invasion due to tumor, 36 cases (83.7%) received high dose of radiation, and 13 cases (30.2 %) were accompanied by diabetes. Conclusion Tumor location is the major factor for nasopharyngeal massive hemorrhage, while radiation dosage, fractionation patterns and diabetes are the secondary factors. The measures in cluding hyperfractionation, overall dose control and blood sugar regulation should be taken for the high risk patients. Prevention is more important than salvage.

  2. 出血性脑卒中术后患者近期预后及其死亡风险方程%Early prognosis of patients with intracerebral hemorrhage after surgical treatment and establishing an equation of death risk

    Institute of Scientific and Technical Information of China (English)

    柴宗举; 孙红卫; 亓自强; 贾涛杰; 闫晓民

    2012-01-01

    目的:了解出血性脑卒中(ICH)患者术后的近期预后,构建死亡风险方程,为救护措施的制定和预后评估提供指导.方法:纳入手术治疗的242例首发ICH患者,追踪术后30 d生存情况.结果:(1)本组ICH 患者30 d生存率为78.0%.(2)死亡组与生存组在年龄、收缩压、血K+、NIHSS评分、GCS评分、出血部位、脑中线结构移位和发病到手术时间的暴露水平不同(P < 0.05).其中年龄(RR = 1.949)、出血部位(RR = 2.256)、NIHSS评分(RR = 1.075)和发病到手术时间(RR = 2.336,RR = 2.895)是影响预后的独立因素.(3)死亡风险方程:h(t,X)/h0(t)=Exp[0.668年龄+0.841出血部位+0.072 NIHSS评分+0.849(发病到手术时间6 ~ 12 h)+1.063(发病到手术时间≥ 12 h)].方程、NIHSS评分、发病到手术时间、出血部位、年龄预测死亡的ROC曲线下面积分别是0.835、0.692、0.662、0.642和0.614.结论:ICH术后具有高病死率,NIHSS评分、发病到手术时间、出血部位和年龄均可用于预后的评估,以多个指标综合评估预后的可靠性更佳.%Objectives To understand the early prognosis of patients with intracerebral hemorrhage (ICH) after surgical treatment, and to establish an equation of death risk which guide treatment and prognostic assessment. Methods We analyzed 242 patients with first-episode ICH after surgical treatment. All patients were followed up for 30 days. Results (1) The 30-day survival rate was 78.0%. (2) The death group and the survival group had significant differences in their age , systolic pressure , serum postassium level, NIHSS score, GCS score, hemorrhagic sites,brain midline structure dislocation,ICH onset and surgery delay time (P< 0.05). Among them, the age(RR = 1.949), hemorrhagic sites(RR = 2.256), NIHSS score(RR = 1.075)and ICH onset and surgery delay time(RR = 2.336, RR = 2.895) were independent prognostic factors for ICH patients. (3) The equation of death risk: h(t, X)/ hO(t) = Exp[0.668 age

  3. Diagnosis of chronic myeloid leukemia from acute intracerebral hemorrhage:a case report

    Institute of Scientific and Technical Information of China (English)

    Chakroun-Walha Olfa; Rejeb Imen; Kammoun Leila; Ksibi Hichem; Ayadi Adnane; Chaari Mourad; Chaari Adel; Kallel Choumous; Rekik Noureddine

    2015-01-01

    Intracerebral hemorrhage (ICH) is frequent pathology in emergency departments. Coagulopathies leading to ICH are rare. We describe here the case of diagnosis of a chronic myeloid leukemia from ICH in emergencies.

  4. Drought, epidemic disease, and the fall of classic period cultures in Mesoamerica (AD 750-950). Hemorrhagic fevers as a cause of massive population loss.

    Science.gov (United States)

    Acuna-Soto, Rodolfo; Stahle, David W; Therrell, Matthew D; Gomez Chavez, Sergio; Cleaveland, Malcolm K

    2005-01-01

    The classical period in Mexico (AD 250-750) was an era of splendor. The city of Teotihuacan was one of the largest and most sophisticated human conglomerates of the pre-industrial world. The Mayan civilization in southeastern Mexico and the Yucatan peninsula reached an impressive degree of development at the same time. This time of prosperity came to an end during the Terminal Classic Period (AD 750-950) a time of massive population loss throughout Mesoamerica. A second episode of massive depopulation in the same area was experienced during the sixteenth century when, in less than one century, between 80% and 90% of the entire indigenous population was lost. The 16th century depopulation of Mexico constitutes one of the worst demographic catastrophes in human history. Although newly imported European and African diseases caused high mortality among the native population, the major 16th century population losses were caused by a series of epidemics of a hemorrhagic fever called Cocoliztli, a highly lethal disease unknown to both Aztec and European physicians during the colonial era. The cocoliztli epidemics occurred during the 16th century megadrought, when severe drought extended at times from central Mexico to the boreal forest of Canada, and from the Pacific to the Atlantic coast. The collapse of the cultures of the Classic Period seems also to have occurred during a time of severe drought. Tree ring and lake sediment records indicate that some of the most severe and prolonged droughts to impact North America-Mesoamerica in the past 1000-4000 years occurred between AD 650 and 1000, particularly during the 8th and 9th centuries, a period of time that coincides with the Terminal Classic Period. Based on the similarities of the climatic (severe drought) and demographic (massive population loss) events in Mesoamerica during the sixteenth century, we propose that drought-associated epidemics of hemorrhagic fever may have contributed to the massive population loss

  5. Analysis on relationship between Tau protein and outcome of acute intracerebral hemorrhage%血清 Tau 蛋白水平与脑出血患者早期预后的相关性分析

    Institute of Scientific and Technical Information of China (English)

    郝璞珩; 李娜; 金林; 张冬子; 贾卓鹏; 陈斌; 行治国

    2014-01-01

    Objective To explore the relationship between Tau protein and outcome of acute intracerebral hemorrhage(ICH).Methods The clinical data of 274 patients with acute ICH were analyzed retrospectively.The general informations of patients on admission, medical history, clinical data and imaging features were collected.The patients were divided into good outcome group ( GOS 4-5) and poor outcome group ( GOS 1-3 ) using the Glasgow Outcome Rating Scale ( GOS ) of discharged patients.Results Of 274 patients, 145 had a good outcome, accounting for 52.9% of the total number and 129 poor outcome, accounting for 47.1%.In poor outcome group (394.7 ± 29.6 pg/ml) initial Serum Tau protein level was significantly higher than that in the good outcome group (201.2 ±18.5pg/ml).High Tau protein level was associated with poor outcome.Conclusion In patients with acute ICH, admission high Tau protein is strong predictor of a poor prognosis.%目的:探讨血清Tau蛋白水平与脑出血( ICH)患者早期预后的关系。方法回顾性分析274例自发的脑出血患者的病历资料,收集患者入院时的一般资料、病史、临床资料以及影像学特点等指标,采用GOS评分对患者出院时情况进行评分,分为预后良好组( GOS 4~5分)和预后不良组( GOS 1~3分)。结果274例患者中145例患者预后良好,占总人数的52.9%,129例预后不良,占47.1%。预后不良组入院时血清Tau蛋白(394.7±29.6 pg/ml)明显高于预后良好组(201.2±18.5 pg/ml)。血清高Tau蛋白水平与不良预后相关。结论在ICH患者中,入院时血清高Tau蛋白水平是预后不良的强预测因素。

  6. 上消化道大量出血的临床治疗%Clinical Treatment of Upper Gastrointestinal Massive Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    徐凌涛

    2015-01-01

    Objective To explore the effective treatment for upper gastrointestinal massive hemorrhage. Methods Tract massive hemorrhage in 42 patients from 2011 October to 2013 October in our hospital emergency department were on digestion,from the admission day were given comprehensive treatment measures, and to observe the therapeutic effect of.Results In 42 patients,hemorrhage was stopped in 32 cases,were discharged or transferred to digestion Department of internal medicine treatment;blood volume was reduced in 2 cases,to be signs stable after into the Department of general surgery treatment,the effective rate is 81.0%;8 cases died,the fatality rate was 19.0%.Conclusion Tract massive hemorrhage onset quickly using Department of internal medicine comprehensive treatment in treatment of upper digestive,can reduce the mortality of patients, when necessary,surgical treatment.%目的:探讨上消化道大量出血的有效治疗方式。方法选取2011年10月至2013年10月我院急诊科收治的上消化道大量出血患者42例,从入院起均给予综合治疗措施,并观察治疗效果。结果42例患者中,出血基本停止32例,均康复出院或转入消化内科治疗;血量明显减少2例,待体征平稳后转入普外科治疗,治疗有效率为81.0%;抢救无效死亡8例,病死率为19.0%。结论运用内科综合方式治疗上消化道大量出血起效快,能降低患者病死率,必要时可进行外科手术治疗。

  7. 尼莫地平联合依达拉奉治疗高血压脑出血的Meta分析%Efficacy of nimodipine combined with edaravone in treatment of hypertensive intracerebral hemorrhage: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    陈谦学; 丁大成; 秦军

    2014-01-01

    Objective To systematically evaluate the clinical efficacy and safety of nimodipine combined with edaravone in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods The databases of PubMed,Cochrane Database of System Reviews,EMbase,CNKI,VIP,Wanfang Data,and CBM were searched for randomized controlled trials (RCTs) on the efficacy of nimodipine combined with edaravone in the treatment of HICH,which strictly met the inclusion and exclusion criteria.And a meta-analysis was performed using software RevMan (version 5.1).Results A total of 8 RCTs involving 610 patients with HICH were evaluated.The meta-analysis showed that the overall response rate of the combination therapy group was significantly higher than that of the control group (OR =3.15,95% CI:2.06-4.83).After treatment,both groups showed significantly reduced neurologic impairment score and volumes of cephalophyma and brain edema (P < 0.05),but the neurologic impairment score and volumes of cephalophyma and brain edema in the therapy group were significantly lower than those in the control group (P < 0.05),and the volume of cephalophyma in the therapy group was significantly reduced compared with that in the control group (SMD =-5.14,95% CI:-5.83-(-4.45)).Conclusions For patients with HICH,nimodipine combined with edaravone has significant clinical efficacy in the treatment of hypertensive cerebral hemorrhage,and can improve the functional rehabilitation of the nerves and effectively reduce the volumes of intracranial hematoma and peripheral edema.%目的 系统评价尼莫地平联合依达拉奉治疗高血压脑出血的临床疗效和安全性.方法 严格按照纳入、排除标准,检索PubMed、Cochrane Database of Systematic Reviews、EMbase、CNKI、VIP、Wanfang Data及CBM中关于尼莫地平联合依达拉奉治疗高血压脑出血的随机对照试验(RCT),采用RevMan 5.1软件进行Meta分析.结果 共纳入8篇文献,包括610例患者.Meta分析结果显示:尼莫地

  8. Instant effect of acupuncture to acute intracerebral hemorrhage rabbits studied by PWI and MRS%急性脑出血家兔针刺即刻效应的PWI和MRS研究

    Institute of Scientific and Technical Information of China (English)

    王凡; 鲍春龄; 焦志华; 东贵荣; 雷慧姝; 詹松华; 李欢欢; 赵喜

    2012-01-01

    Objective: To observe the regularity for immediate change of hemodynamics and neural material metabolism on brain tissues of intracerebral hemorrhage rabbit after acupuncture treatment, exploring the mechanism of the instant effects of acupuncture. Methods: A total of 20 New Zealand rabbits were randomly divided into model group and acupuncture group, with 10 cases in each group. Self-arterial injection method had been used to copy the ICH rabbit model. After the ICH rabbit model was successfully established, the acupuncture group was treated on scalp acupoint of hemorrhage side, equivalent to Baihui (GV20) through Taiyang (EX-HN5) in human body. Quantitative analysis of 1H-MRS (Magnetic Resonance Spectroscopy) and PWI (Perfusion Weigted Imaging) were used to observe the MTT, rCBV, rCBF and content of NAA and Cr in perihematoma tissues before, instantly and 1 hour after ICH model was successfully established. Results: After the ICH model was established, NAA/Cr level decreased markedly, MTT extended, and rCBV and rCBF reduced significantly (P<0.05) in both groups, and there was no difference between them. After acupuncture therapy, MTT shortened, and rCBV and rCBF increased (P<0.05), with no significant change in NAA/Cr. No obvious change in all those indexes for model group, whose MTT, rCBV and rCBF had statistically significant difference compared with acupuncture group (P<0.05). Conclusion: Point-through-point scalp acupunture method has instant effect on ICH by improving hemodynamic changes of the brain, and it probably could be one important mechanism of acupuncture's instant effect on ICH.%目的:探讨针刺对脑出血家兔脑组织血流动力学和神经物质代谢的即刻效应.方法:20只新西兰兔随机分为模型组和针刺组,每组10例.自体血二次注血法复制急性脑出血模型.针刺组造模成功后进行头针治疗(位置相当于人体“百会”透“太阳”穴).两组分别在造模前、造模后即刻和针刺后即

  9. Clinical Analysis of 45 Cases of Ancylostomatic Upper Digestic Tract Massive Hemorrhage%钩(虫虫虫)性上消化道大出血45例临床分析

    Institute of Scientific and Technical Information of China (English)

    沈维柏; 朱余良; 廖金辉

    2002-01-01

    Objective To study clinical characteristic diagnosis and treatment for ancylostomatic upper digestic tracthemorrhage. Methods Analysing prospectively 45 cases of clinical characteristic and treatment. Results Oversevere anemiaaccount for 11.1% severe anemia 55.6%. Moderate anemia 33.3% among all cases except 13 cases of misdiagnosis, 40patients from countryside with 100% cure rate. Conclusion Major cases are chronic hemorrhage and some severe infectioncan result in massive hemorrhage and be liable to misdiagnosis.

  10. The enlarged burr-hole craniotomy for treatment of hypertensive intracerebral hemorrhage in geriatric patients%小骨窗开颅手术治疗老年性高血压脑出血51例临床分析

    Institute of Scientific and Technical Information of China (English)

    徐已奕; 钟春龙; 郑彦; 张明坤; 崔振文; 吴增宝; 王勇; 江基尧; 罗其中

    2011-01-01

    目的 研究老年性高血压脑出血的微创治疗策略.方法 回顾性分析51例应用小骨窗开颅技术治疗的老年(>65岁)高血压脑出血患者.均在直视下清除血肿,术后血肿残余大于15 ml者辅助尿激酶稀释液灌注引流.结果 血肿近全清除36例,大部清除14例,再出血后二次手术清除1例.由于老年病人存在脑萎缩,血肿清除后减压均较充分.随访6个月至2年,GOS优28例,中残15例.重残7例,死亡1例.恢复良好率达84.3%.结论 小骨窗开颅手术治疗高血压脑出血,具有微创、可视、省时、病人恢复快等优点.%Objective To investigate the strategy of minimally invasive treatment for hypertensive intracerebral hemorrhage in geriatric patients. Methods Review the clinical date of fifty- one aged patients(>65years old) who were treated with the enlarged burr-hole craniotomy because of hypertensive intracerebral hemorrhage. All hematomas were evacuated under direct visualization. If the volume of residual hematoma on follow-up CT was more than 15ml, a drainage procedure would be performed after the perfusion of the urokinase. Results Nearly total e-vacuation of hematoma was achieved in 36 cases , subtotal evacuation in 14 cases, but in 1 case rebleeding occurred and reoperation was done. The decompression was sufficient because of the shrinkage of brain tissues in aged patients. Followed up for 6 months to 2 years, good recovery was found in 28 cases, moderate disability in 15 cases, severe disability in 7 cases and death in 1 case according to the glasgow outcome scale ( GOS) . The rate of favorable outcomes was 84. 3%. Conclusion The advantages of enlarged burr-hole craniotomy in the treatment of hypertensive intracerebral hemorrhage are minimally invasive, visible, less time consuming and quick recovery of patients.

  11. Efficacy of Piracetam Injection Combined With Mannitol in the Treatment of Cerebral Edema After Intracerebral Hemorrhage%吡拉西坦注射液联合甘露醇治疗脑出血后脑水肿的疗效观察

    Institute of Scientific and Technical Information of China (English)

    师卫中

    2015-01-01

    目的:探讨吡拉西坦注射液联合甘露醇治疗脑出血后脑水肿的疗效。方法选自本院2013年7月~2014年7月收治64例脑出血后脑水肿患者,采用随机抽样法分为两组,予对照组32例甘露醇治疗,予观察组32例吡拉西坦注射液联合甘露醇治疗,比较两组疗效。结果两组治疗8d、20d后脑水肿体积均缩小,但观察组脑水肿体积在8d、20 d时均小于对照组,比较差异具有统计学意义(P<0.05);且两组均未发生严重不良反应(P>0.05)。结论吡拉西坦注射联合甘露醇能够有效治疗脑出血后脑水肿。%Objective To discuss the effect of piracetam injection combined with mannitol in the treatment of cerebral edema after intracerebral hemorrhage. Methods 64 cases of cerebral edema after intracerebral hemorrhage patients in July 2013~2014 July in our hospital were divided into two groups by random sampling, 32 cases in the control group were treated with mannitol, 32 cases in observation group were treated with piracetam injection combined with mannitol therapy, compared the effect between two groups. Results After treatment for 8 d, 20 d, cerebral edema volume were reduced, but the cerebral edema volume in 8 d and 20 d in observation group were less than the control group, the difference had statistically signiifcant (P0.05) . Conclusion Piracetam injection combined with mannitol are effective treatment for cerebral edema after intracerebral hemorrhage.

  12. 脑出血患者细胞因子IL-6、TNF-α含量与病情严重度及预后的关系%RELATIONSHIP BETWEEN CYTOKINE IL-6,TNF-A AND SEVERITY AND PROGNOSIS IN ACUTE INTRACEREBRAL HEMORRHAGE

    Institute of Scientific and Technical Information of China (English)

    黄樱; 刘铮; 钟善全

    2011-01-01

    [Objective] To explore the Relationship between cytokine IL-6 、TNF-α and severity and prognosis in acute intracerebral hemorrhage. [Methods] Two hundred and twenty-six patients with acute intracerebral hemorrhage were collected. Patients were divided into two groups according to survival (n = 165) or death (n = 61). The contents of cytokine IL-6 and TNF-α were measured at the admission day. The severity of illness was determined by APACHE H score. The differences of cytokine IL-6 and TNF-α between the two groups were analyzed, and the relationship between the cytokine IL-6, TNF-α and APACHE U score were studied. [Results] The contents of cytokine IL-6 was increased (P<0.01) and TNF-α elevated obviously in the death group (P< 0.05). The APACHE II score of the death group was much higher than that of the survival group (P < 0.05). [Conclusion] The cytokine IL-6 and TNF-α is associated with the prognosis and severity of acute intracerebral hemorrhage.%[目的]探讨脑出血患者细胞因子IL-6、TNF-α含量与病情严重度及预后的关系.[方法]将2006年10月1日~2007年12月31日起病24 h内收住某院确诊为脑出血患者226例分为死亡组(165例)和生存组(61例),分析比较两组患者细胞因子IL-6、TNF-α的差异及细胞因子异常与病情严重度(APACHEⅡ评分)的关系.[结果](1)死亡组患者细胞因子IL-6含量明显高干存活组(P<0.01),TNF-α含量也明显高于生存组(P<0.05).(2)IL-6、TNF-α含量升高患者的APACHEⅡ评分也明显增高(P<0.05).[结论]细胞因子IL-6、TNF-α含量的检测对判断脑出血患者的预后及评估病情严重度有一定指导意义.

  13. Antineutrophil cytoplasmic antibody–negative pauci-immune glomerulonephritis with massive intestinal bleeding

    Directory of Open Access Journals (Sweden)

    Miyeon Kim

    2015-09-01

    Full Text Available A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45th hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody–negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

  14. Risk factors for intracerebral hemorrhage and coronary heart diseases over a 3-year period in patients admitted to some hospitals of Tongliao city of Nei Monggol Autonomous Region Retrospective analysis on case data

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Intracerebral hemorrhage(ICH) and coronary heart disease (CHD) have the same pathological base, atherosclerosis, and the similar risk factors, such as smoking ,drinking, hypertension,hyperlipemia, diabetes mellitus, etc; but the distributions of two diseases are very different in the populations.This may be related to the exposure of risk factors and different effects of risk factors on two diseases.OBJECTIVE: To analyze the distribution difference of risk factors for ICH and CHD in the populations of Tongliao city of Nei Monggol Autonomous Region.DESIGN: Retrospective analysis.SETTING: School of Radiation Medicine and Public Health, Soochow University; Tongliao Hospital, Nei Monggol Autonomous Region.PARTICIPANTS: Random sampling was used toselect 6 hospitals from 10 hospitals affiliated to Tongliao City ofNei Monggot Autonomous Region. Totally 1 672 medical records of patients with ICH and 2 195 medical records of patients with CHD admitted to Department of Neurology and Department of Cardiovascular Internal Medicine of above-mentioned 6 hospitals between January 2003 and December 2005 were collected according to the investigation need.METHODS: The subjects, whose medical records were involved, were performed retrospective analysis with pre-prepared questionnaire "Stroke and Coronary Heart Disease Epidemiologic Questionnaire". The main contents included: ①Social demography condition: The distributions of gender, age, nationality, etc. ②Previous history of disease: hypertension, diabetes mellitus, etc. ③Related risk factors: systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol,low-density lipoprotein cholesterol, smoking, drinking and glucose (GLU). The database of Epidata was transformed to SPSS database. Single-and multiple-factor non-conditional Logistic regression analysis were performed on the data, and OR value and 95% CI were calculated. The distribution differences of

  15. CLINICAL ECONOMIC ANALYSES OF XINGNAOJING INJECTION IN THE TREATMENT OF SPONTANEOUS INTRACEREBRAL HEMORRHAGE%醒脑静注射液治疗脑出血的经济性评价

    Institute of Scientific and Technical Information of China (English)

    罗骞; 涂星; 熊芬; 唐洪梅

    2015-01-01

    Objective To establish a clinical decision model and make a cost -effectiveness analyses of Xingnaojing injection in the treatment of spontaneous intracerebral hemorrhage ( SIH) compared with Citicoline , and provide a reference for the rational and safe use of drugs for SIH .Methods Total effective rate was regarded as ef-fectiveness index , which were gained by analyzing the literatures reported the treatment of SIH using Citicoline or Xingnaojing injection .Expected total cost was regarded as cost index , which were gained by analyzing the cost data of a certain grade-three general hospital in Guangzhou .A sensitivity analysis was made , with prices of drug falling by 15%and fees of nursing rising by 10%.Results Total effective rate of the treatment of SIH using Xingnaojing in-jection and Citicoline were 93.8%, 84.55%.Therefore, the ratio of cost and effect (C/E) were 130.83 and 144. 92 respectively .Sensitivity analysis showed that C/E of the treatment of SIH using Xingnaojing injection and Citico-line were 131.52 and 144.4 when the prices of drug falling by 15%.C/E were 132.4 and 145.12 when the fees of nursing rising by 10%.Conclusion From the clinical economics evaluation and social benefits , therapeutic sched-ule of Xingnaojing injection was advised to use in treating SIH .%目的:评价醒脑静和胞二磷胆碱治疗脑出血的成本-效果,构建临床决策模型,为其临床安全合理用药提供参考。方法效果指标采用文献分析法计算总有效率,通过对已有研究的间接分析获得;成本指标包括直接医疗成本和非直接医疗成本,通过广州某三甲医院治疗和收费标准统计获得。并以药价下调15%和护理费用上调10%进行敏感性分析。结果醒脑静和胞二磷胆碱治疗脑出血的总有效率分别为93.8%,84.55%;成本效果比分别为130.83和144.92,敏感性分析结果显示,当取消15%的药品加成后,成本效果比131.52和144.4

  16. Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature.

    Science.gov (United States)

    Mousa, Albeir Y; Abu-Halimah, Shadi; Alhalbouni, Saadi; Hass, Stephen M; Yang, Calvin; Gill, Gurpreet; AbuRahma, Ali F; Bates, Mark

    2014-10-01

    Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Dynamic Expression of HIF -1α and COX -2 in Perihematoma after Intracerebral Hemorrhage in Rats%大鼠脑出血灶周HIF-1α和COX-2的动态变化

    Institute of Scientific and Technical Information of China (English)

    李婷婷; 牛小媛

    2012-01-01

    目的 观察大鼠脑出血后血肿灶周脑组织中HIF -1α、COX -2蛋白的动态表达,探讨二者与脑水肿的关系,以及HIF -1α和COX -2蛋白的表达在血肿灶周脑组织损伤中的作用机制.方法 SD大鼠35只,随机分为假手术组、脑出血6h、1、3、7、14、21天组,每组5只.采用自体血体内注射法建立脑出血动物模型,用免疫组化法检测脑出血后血肿灶周脑组织中HIF -1α和COX -2蛋白的动态表达,并用干/湿比重法测定脑含水量.结果 脑出血后6h HIF - 1α、COX -2蛋白的表达和脑水含量明显升高,3~7天达到高峰,第14天明显降低,COX -2及脑水含量在21天基本降至正常.HIF - 1α在21天仍有较高水平的表达.造模后6h,脑出血组与假手术组相比,HIF -1 α及COX -2蛋白的表达和脑水含量明显增高,其差异有统计学意义(P<0.05).脑出血组的各时间点间比较,其差异均有统计学意义(P<0.05).HIF - 1α蛋白的表达与脑水含量呈正相关(r =0.636,P<0.01);COX -2蛋白的表达与脑水含量呈正相关(r=0.927,P<0.01).结论 大鼠脑出血后血肿灶周HIF -1α、COX -2蛋白的表达呈一定的变化规律.随着脑出血时间的延长HIF -1α蛋白、COX -2蛋白的表达程度和脑组织水肿程度呈正相关.%Objective To investigate the dynamic changes of HIF-lot and COX-2 protein in perihematoma after Intracerebral hemorrhage in rats, to analysis their correlation with the time of ICH and brain edema, and try to explore the mechanism of action of the expression HIF-lα and COX-2 protein on the brain tissue injury. Methods Thirty-five healthy SD rats were randomly divided into sham operation group (n=5) and ICH model groups (n =30). Rats were sacrificed at 6h,1days,3days,7days, 14days and 21 days after operation, respectively. The expressions of HIF-1α and COX-2 were investigated using immunohistochemistry, Brain water content was measured by the wet/dry specific gravity method. Results HIF-1

  18. Effect of An Nao Wan on the Expression of OX42,BDNF and SYN in Rats after Intracerebral Hemorrhage%安脑丸对急性脑出血大鼠OX42、脑源性神经营养因子及突触素表达的影响

    Institute of Scientific and Technical Information of China (English)

    梁慧; 梅元武

    2012-01-01

    Objective: To study the effects of An Nao Wan (ANW) on the expression of OX42,BDNF and SYN in rats after intracerebral hemorrhage. Methods: One hundred and ninety SD rats were randomly divided into normal control group (n=10), sham operated group, model group and ANW treatment group (n = 60 respectively). Experimental intracerebral haematoma was made by injecting Ⅶ type collagenase into the right globus pallidus of rats in the model group and the ANW treatment group. The rats in the ANW treatment group were treated by ANW. Immunohistochemical staining and western blot analysis were employed to detect the expression of OX-42, BDNF and SYN at l2 h,ld,2d,4d,7d or 10 d after the operation. Results: The numbers of OX42 and BDNF positive cells and the expression of BDNF and SYN protein in the model group and the ANW treatment group were increased significantly when compared with those in the normal control group and the sham operated group (P<0. 01). Compared with those in the model group, the number of OX42 positive cells was decreased significantly while the number of BDNF positive cells and the expression of BDNF and SYN protein were increased significantly in the ANW treatment group (P<0. 01). Conclusion: The activation of microglia and the expression of BDNF and SYN were involved in the pathological process of intracerebral hemorrhage. ANW treatment could inhibit the activation of microglia and increase the expression of BDNF and SYN protein after intracerebral hemorrhage.%目的:观察安脑丸对大鼠脑出血后OX42、脑源性神经营养因子(BDNF)及突触素(SYN)表达的影响.方法:SD大鼠190只随机分为正常组10只,假手术组、模型组、安脑丸组各60只;后3组又随机分为造模后12h、1d、2d、4d、7d、10 d共6个时间点,各10只.模型组制作脑出血模型,安脑丸组加用安脑丸灌胃.于各时间点采用免疫组化法及western blot法检测OX42、BDNF及SYN表达情况.结果:模型组及安脑丸组OX42及BDNF

  19. The mechanism of action of dopamine promoting rehabilitation to the rat of intracerebral hemorrhage%Dopamin 促进出血性卒中大鼠恢复的作用机制研究

    Institute of Scientific and Technical Information of China (English)

    袁宇; 郭毅; 李春晖; 史彦芳; 胡福广

    2014-01-01

    目的:应用多巴胺( dopamine )对实验性脑出血大鼠进行腹腔注射,研究dopamine对出血性卒中的神经保护作用机制。方法 SD雄性大鼠60只,体质量300±20g,造脑出血模成功后随机分为dopamine治疗组、生理盐水(NS)对照组( n=30),同一条件下饲养。每天进行神经功能评分,不同亚组按相应时间点取材。分别测定出血周围脑组织胶质纤维酸性蛋白( GFAP )和脑源性神经营养因子( BDNF )的免疫组化评分。取脾组织制作匀浆,反转录聚合酶链式反应( RT-PCR),测定转录调节家族中叉头翼状双螺旋家族的一个独特的成员Foxp3与β-actin的相对密度值,表示CD4+、CD25+、T细胞的活性。结果 dopamine组大鼠与NS组在对应时间点进行神经功能评分,显示前者高于后者差异有统计学意义( P<0.05)。 GFAP和BDNF在实验大鼠脑组织中的表达,dopamine组均高于相应对照组差异有统计学意义( P<00.1)。 Foxp3mRNA 在dopamine组的大鼠脾脏中的表达与相应的对照组比较,差异有统计学意义( P<0.01)。结论 dopamine 能上调实验性脑出血大鼠脑内GFAP和BDNF蛋白表达水平,促进神经症状的好转。 CD4+、CD 25+、调节性T细胞对中枢神经系统损伤的恢复有抑制作用;dopamine可下调CD4+、CD25+、调节性T细胞对D4+Th1细胞的抑制作用,促进出血性卒中大鼠脑损伤的恢复。%Ob jective To explore the neuroprotective mechanism of dopamine on intracerebral hemorrhage (ICH).Methods The male adult Sprague-Dawley rats ( experimental ICH rats ).Weighing 300 ±20g, were randomly divided into dopamin group ( 30 rats ) and normal sodium ( NS ) group ( 30 rats ) .Each group had five subgroups, including 1d(one day after ICH, 6 rats), 3d(three days after ICH,6 rats) 7d(7 days after ICH,6 cats), 14d(14 days after ICH, 6 cats), 21d (21 days afer ICH, 6 cats

  20. Expression of Rho Kinase Ⅱ in Rat Model of Intracerebral Hemorrhage and Its Relationship with Thrombin%脑出血模型大鼠Rho激酶Ⅱ的表达及其与凝血酶的关系

    Institute of Scientific and Technical Information of China (English)

    文洪波; 崔桂云; 高修明; 王晓龙; 陆军; 沈霞

    2013-01-01

    Objective:To investigate the expression of Rho kinase Ⅱ (ROCK Ⅱ) around hematoma in rats after intracerebral hemorrhage (ICH) at different time points and its relationship with thrombin.Methods:A total of 180 healthy male SD rats were randomly divided into sham group(S group),ICH group and argatroban group(ICH + A group).ICH model was established by injecting autologous blood.Argatroban was injected in situ at a dose of 0.5 mg/L.The expression of ROCK Ⅱ around hematoma at different time points and its effect on thrombin were detected by immunohistochemical method.The expression of ROCK Ⅱ protein around hematoma was detected by Western blotting.Nerve functions of rats were assessed at 48 h by Longa score and forelimb use asymmetry test.Results:Expression of ROCK Ⅱ around hematoma was found at 0.5 h and reached to a maximal value at 24 h in ICH group and ICH + A group.Subsequently it decreased gradually.However,at the corresponding time points after 12 h,the expression levels of ROCKⅡ in ICH + A group were obviously lower than those in ICH group(P<0.01).The expression levels of ROCK Ⅱ in S group were obviously lower than those in ICH group and ICH + A group,and the trend has not changed.The results of ICH group by Western blotting method and immunohistochemical method were consistent.Neurological deficit scores in ICH group and ICH + A group at 48 h increased significantly than those in S group(P< 0.01),while neurological deficit scores in ICH + A group were significantly lower than those in ICH group(P<0.01).Conclusions:ROCK Ⅱ play a role in brain injury after ICH.Thrombin may have a role in brain injury after ICH through promoting the expression of ROCK Ⅱ.%目的:观察大鼠脑出血(ICH)后不同时间点血肿周围组织Rho激酶Ⅱ(ROCKⅡ)表达及其与凝血酶的关系.方法:180只健康雄性SD大鼠随机分为假手术组(S组)、ICH组和阿加曲班组(ICH+A组).ICH组和ICH+A组采用自体血注入法建立大鼠ICH模

  1. Analysis of relevant factors to the outcomes of spontaneous intracerebral hemorrhage in young adults%青年自发性脑出血预后的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    陈兰兰; 万琪; 陈蓓蕾; 张娴娴; 叶青; 张扬威; 李晓波

    2013-01-01

    目的 探索青年自发性脑出血预后的相关因素及其预测价值.方法 回顾性收集2008年至2011年所有入住苏北人民医院的首次急性自发性脑出血青年患者.使用逐步logistic回归法分析30 d的死亡及预后良好(mRS评分为0~2)的因素,使用受试者工作特征曲线分析各因素的预测价值.结果 青年自发性脑出血30 d死亡的危险因素有:合并高血压病(P =0.023)或糖尿病(P =0.007)、幕下血肿(P =0.000)、血肿体积大(P =0.008)、GCS评分低(P =0.000)、外周血白细胞高(P=0.000)、血糖高(P =0.039)、凝血酶原时间长(P=0.001).预后良好的独立因素有:年纪轻(P=0.001)、无高血压病(P =0.010)或糖尿病(P =0.028)、血肿体积小(P =0.000)、NIHSS评分低(P=0.000)、外周血白细胞低(P=0.000)、血糖低(P=0.012)、收缩压水平低(P =0.000).其中NIHSS评分及GCS评分对预后判断具有很高的价值,收缩压、外周血白细胞及血肿体积对预后也有较好的预测作用.结论 青年自发性脑出血短期预后判断时应综合考虑各因素及其预测价值.%Objective To study factors used to predict 30-day mortality and favorable outcomes to intracerebral hemorrhage (ICH) in young adult subjects and to estimate the reliability of these predictors.Methods Data of 175 acute ICH patients selected from 201 patients admitted to our hospital from 2008 to 2011 were reviewed retrospectively.Patients were assessed with Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) and routine laboratory examinations after admission.Independent predictors of 30-day mortality or good outcome (modified Rankin score,0-2) were identified by stepwise logistic regression.Results There were 90 male and 85 female,and 142 survivals and 33 deaths.The modified Rankin score (mRS) of survival group was <6 and mRS =6 in death group,and mRS <3 in good outcome group and mRS > or =3 in poor outcome group.Independent factors for 30-day

  2. Effect of Huangzhu Qingnao Granule on The Brain Tissue Apoptosis in Acute Intracerebral Hemorrhage (Tanre Fushi syndrome)Rats%黄竹清脑颗粒对脑出血急性期(痰热腑实证)大鼠脑组织细胞凋亡影响的实验研究

    Institute of Scientific and Technical Information of China (English)

    刘淑霞; 徐雪; 高军宁; 李晓斌; 任惠峰

    2011-01-01

    Objective:To study the Huangzhu Qingnao granule on acute intracerebral hemorrhage (Tanre Fushi syndrome)in rat brain tissue surrounding hematoma apoptosis.Methods: Collagenase Ⅶ - heparin mixture of stereotactic injection and with the SD rats were fed with autologous method of production of faeces rats(60) with acute intracerebral hemorrhage( Tanre Fushi syndrome)rat model,rats were randomly divided into blank control group, Tanre Fushi syndrome model group, Huangzhu Qingnao granules large, medium,low -dose group and Qingkailing oral group, using TUNEL method (terminal deoxynucleotidyl transferase -mediated dUTP nick end labeling)in the brain cell apoptosis detection.Results: (1)Tanre Fushi syndrome model group compared with the blank control group, the former in rat brain tissue surrounding hematoma positive rate of apoptosis, which was significantly higher than normal brain tissue in rats(P<0.01 ), prompted modeling success;(2)Huangzhu Qingnao granule of large, medium -dose group were superior efficacy of oral liquid group and Qingkai ling Huangzhu Qingnao granule is small -dose group( P <0.05).Conclusion: Huangzhu Qingnao granule particles could significantly reduce the cerebral hemorrhage period ( Tanre Fushi syndrome) Rat droppings dry, irritability easy to move, dry mouth, polydipsia, throat Phlegm - ming, greasy yellow tongue and other symptoms and improve the nervous system in rats after intracerebral hemorrhage in pathological signs, and has significantly reduced apoptosis in rat brain cells,play a role in protecting brain cells.%目的:研究黄竹清脑颗粒对脑出血急性期(痰热腑实证)大鼠血肿周围脑组织细胞凋亡的影响.方法:采用胶原酶Ⅶ-肝素混合液立体定位注射及配合SD大鼠自体粪便灌胃的方法制作60只脑出血急性期(痰热腑实证)大鼠模型,将大鼠随机分为空白对照组、疾热腑实证模型组、黄竹清脑颖粒大、中、小量组及清开灵口服液组,采用TUNEL法(

  3. Distribution of pathogens causing nosocomial infections in patients with spontaneous intracerebral hemorrhage and analysis of risk factors%自发性脑出血患者医院感染病原菌分布与危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈江利; 邵高峰; 陈飞; 杨刚; 袁东海; 刘建芳

    2015-01-01

    OBJECTIVE To explore the distribution of pathogens causing nosocomial infections in patients with spontaneous intracerebral hemorrhage and analyze the risk factors so as to provide guidance fore the clinical diag‐nosis and treatment .METHODS The clinical data of 817 patients with spontaneous intracerebral hemorrhage who were treated from May 2012 to Feb 2014 were retrospectively analyzed ,the incidence of nosocomial infections and the distribution of infection sites were statistically analyzed ,and the relationship between the gender ,age ,stroke scale (NIHSS) score ,Glasgow coma scale (GCS) score ,smoking history ,history of diabetic mellitus and the inci‐dence of nosocomial infections was observed .RESULTS The nosocomial infections occurred in 127 of 817 patients with spontaneous intracerebral hemorrhage ,the incidence of nosocomial infections was 15 .54% .Among the pa‐tients with nosocomial infections ,the patients with respiratory tract infections accounted for 58 .27% ,the patients with gastrointestinal tract infections 16 .54% ,the patients with urinary tract infections 13 .38% .A total of 127 strains of pathogens have been isolated , including 89 (70 .08% ) strains of gram‐negative bacteria and 38 (29 .92% ) strains of gram‐positive bacteria ;the K lebsiella pneumoniae , Pseudomonas aeruginosa , Escherichia coli , Enterobacter cloacae ,and Enterobacter aerogenes were dominant among the gram‐negative bacteria ;the Staphylococcus aureus ,Enterococcus faecalis ,coagulase‐negative Staphylococcus ,and Enterococcus feces were the predominant species of gram‐positive bacteria .The incidence of nosocomial infections in the patients with spon‐taneous intracerebral hemorrhage was associated with the no less than 65 years of age ,NIHSS score no less than 10 points , GCS score less than 8 points , history of diabetic mellitus , and smoking history ( P < 0 .05 ) . CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing

  4. Pulmonary hypoplasia on preterm infant associated with diffuse chorioamniotic hemosiderosis caused by intrauterine hemorrhage due to massive subchorial hematoma: report of a neonatal autopsy case.

    Science.gov (United States)

    Yamada, Sohsuke; Marutani, Takamitsu; Hisaoka, Masanori; Tasaki, Takashi; Nabeshima, Atsunori; Shiraishi, Mika; Sasaguri, Yasuyuki

    2012-08-01

    A male infant born prematurely at 31 weeks of gestation weighed 789 g and had mildly brown-colored oral/tracheal aspirates at delivery. The amniotic fluid was also discolored, and its index was below 5. The patient died of hypoxemic respiratory and cardiac failure 2 hours after birth. The maternal profiles showed placenta previa and intrauterine growth restriction (IUGR) at 22 weeks of gestation, and revealed recurrent episodes of antenatal and substantial vaginal bleeding and oligohydramnios, indicating chronic abruption-oligohydramnios sequence. The thickened placenta, weighing 275 g, grossly displayed unevenness and diffuse opacity with green to brown discoloration in the chorioamniotic surface, and revealed chronic massive subchorial hematomas (Breus' mole) with old peripheral blood clot, circumvallation, and infarction. Microscopically, diffuse Berlin-blue staining-positive hemosiderin deposits were readily encountered in the chorioamniotic layers of the chorionic plate, consistent with diffuse chorioamniotic hemosiderosis (DCH) due to Breus' mole, accompanied by diffuse amniotic necrosis. At autopsy, an external examination showed several surface anomalies and marked pulmonary hypoplasia, 0.006 (less 0.012) of lung:body weight ratio. Since Breus' mole has a close relationship with intrauterine hemorrhage, resulting in DCH, IUGR, and/or pulmonary hypoplasia of the newborn, the present features might be typical.

  5. 经额上沟入路神经内镜手术治疗高血压脑出血疗效分析%Curative effect analysis of neuroendoscopic surgery via superior frontal sulcus in the treatment of ;hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    陶亮; 陈治标; 张华平

    2016-01-01

    Objective To investigate the surgical technique and the curative effects of neuroendoscopic surgery via superior frontal sulcus in the treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 63 patients with hypertensive intracerebral hemorrhage were analyzed retrospectively. Thirty-one of them were treated by neuroendoscopic surgery via superior frontal sulcus(neuroendoscopic surgery group), and 32 of them were treated by mini- invasive drainage (conventional therapy group). All of them were followed up for 6 months, and were assessed by the activity of daily living (ADL) scale. Results After treatment, all patients reviewed CT. The clear rate of hematoma in neuroendoscopic surgery group was 86.0%, in conventional therapy group was 23.3%, and there was significant difference (P<0.05). There were one death case in neuroendoscopic surgery group and 2 death cases in conventional therapy group. The survival patients were followed up for 6 months .The rate of better prognosis in neuroendoscopic surgery group was 83.3%(25/30), in conventional therapy group was 53.3%(16/30), and there was significant difference (P<0.05). Conclusions The surgical technique of neuroendoscopic surgery via superior frontal sulcus in the treatment of hypertensive intracerebral hemorrhage is safe and effective.%目的:探讨经额上沟入路神经内镜辅助脑内血肿清除术治疗高血压脑出血的手术策略及治疗效果。方法63例高血压脑出血患者,31例行经额上沟入路神经内镜辅助脑内血肿清除术(内镜辅助组),32例行常规微创穿刺引流术(常规治疗组)。术后随访6个月,应用日常生活量表(ADL)进行评定并比较。结果术后复查头颅CT,内镜辅助组血肿清除率为86.0%。常规治疗组血肿清除率为23.3%,两组血肿清除率比较差异有统计学意义(P<0.05)。内镜辅助组死亡1例,常规治疗组死亡2例。存活患者术后随访6个月,内镜

  6. Clinical experience of Piracetam and Mannitol in the treatment of encephaledema after intracerebral hemorrhage%吡拉西坦注射液联合甘露醇治疗脑出血后脑水肿的临床体会

    Institute of Scientific and Technical Information of China (English)

    舒茂红; 孟祥成

    2015-01-01

    Objective: To study the Clinical experience of Piracetam and Mannitol in the treatment of encephaledema after intracerebral hemorrhage.Methods: 110 patients who were diagnosed with encephaledema after intracerebral hemorrhage from January 2011to October 2014 were the study object of this paper. They were divided into two groups according to the order of their treatment. Patients with the odd number were divided in the observation group and treated with Piracetam and Mannitol, while patients with the even number were arranged in the control group and treated only with Piracetam. Then the clinical effects of the two groups were compared and analyzed.Results: Compared with the 80% efifciency rate of the control group, the efifciency rate of the observation group is 94.55%, much higher than the control group. Their difference is statistically signiifcant. The improvement of the observation group is much better than the control group in the aspect of neurology (NIHSS) and viability. Their difference is remarkable, with statistical signiifcance (P < 0.05).Conclusion: The combination of Piracetam and Mannitol in the treatment of encephaledema after intracerebral hemorrhage can improve not only the clinical effect but also the NIHSS and viability. Thus this method should be recommended in the clinical application.%目的 研究吡拉西坦注射液联合甘露醇治疗脑出血后脑水肿的临床体会.方法 将2011年01月—2014年10月间我院接诊的110例脑出血后脑水肿患者按照接诊顺序的单双号均分为两组,对单号组患者进行吡拉西坦注射液联合甘露醇治疗(观察组),对双号组患者单纯使用甘露醇治疗(对照组),对比观察二者的临床治疗效果.结果 在总有效率方面,观察组的94.55%远远高于对照组的80.00%,二者差异显著,具有统计学意义(P<0.05);在神经功能缺损(NIHSS)评分和生活能力评分方面,观察组患者的改善情况明显优于对照组患者的改善情况,

  7. Clinic application of serum low-density lipoprotein cholesterol level in predicting expansion hematoma in elderly male patients with acute hypertensive intracerebral hemorrhage%血清LDL-C水平对老年男性高血压性脑出血血肿扩大的预测作用

    Institute of Scientific and Technical Information of China (English)

    周红霞; 刘首峰; 李玉旺; 王欣; 徐小林

    2015-01-01

    Objective To investigate whether serum level of low-density lipoprotein cholesterol can predict the expan⁃sion of hemorrhage growth in elderly male patients with acute hypertensive intracerebral hemorrhage. Methods Patients (n=108) who visited our hospital with from June 2012 until May 2014 spontaneous hypertensive intracerebral hemorrhage with⁃in 6 hours of onset which is confirmed by initial computed tomography (CT) were sent to repeated CT within 24 hours of on⁃set. All selected patients were divided into the LDL-C≥2.49 mmol/L group and LDL-C<2.49 mmol/L group. Clinical data of these 2 groups were compared and the relationships of hematoma growth and its risk factors were analyzed. Results Baseline blood pressure, the level of blood glucose, PT, APTT, FIB, PLT and hemorrhage volume did not differ significantly between the LDL-C≥2.49 mmol/L group and LDL-C<2.49 mmol/L group. The ratio of hemorrhage growth in LDL-C<2.49 mmol/L group was significantly higher than that in LDL-C≥2.49 mmol/L group (34.21%vs 11.43%). Multiple logistic regres⁃sion analysis showed that LDL-C<2.49 mmol/L was the only risk factor contribute to hemorrhage growth. Conclusion Pa⁃tients with LDL-C<2.49 mmol/L in acute intracerebral hemorrhage are of high risk of hemorrhage growth so early attention and appropriate procedure are needed to prevent or slow its growth.%目的:探讨血清低密度脂蛋白胆固醇(LDL-C)水平对老年男性高血压性脑出血急性期血肿扩大有无预测作用。方法收集我院2012年6月—2014年5月发病6 h以内的老年男性高血压性脑出血患者108例,按发病时LDL-C水平分为LDL-C<2.49 mmol/L组和LDL-C≥2.49 mmol/L组,对2组患者入院时的收缩压(SBP)、舒张压(DBP)、血糖水平、凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、纤维蛋白原(FIB)、血小板计数、血肿体积进行对比分析,并于发病24 h复查头CT了解2组血肿扩大情况并进

  8. 妊娠合并脑出血的临床特征和影响预后的相关因素分析%Clinical characteristics and influencing factors on prognosis of pregnancy complicated with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    梁竹巍; 蔺莉; 冯力民; 高婉丽

    2016-01-01

    Objective To analyze the clinical features and factors affecting prognosis for intracerebral hemorrhage (ICH) during pregnancy and postpartum.Methods A study of ICH was performed on 61 women in Beijing Tiantan Hospital,Capital Medical University between January 1997 and December 2014,and all cases were diagnosed with cerebral hemorrhage or subarachnoid hemorrhage during pregnancy or six weeks after delivery with CT or MRI after exclusion of ICH due to craniocerebral trauma.The subjects were divided into surgery (n=26) and conservative treatment (n=35) groups according to different ways of treatment;pregnancy associated problems (n=11) and cerebrovascular diseases groups according to the aetiology of ICH;low (n=13) and high score group (n=48) according their Glasgow score at the first visit;and short clinical onset to diagnosis time (O-D time) group (≤ 24 h,n=33) and long O-D time (>24 h) group (n=28).We compared the maternal clinical features and prognosis between different groups with t,Mann-Whitney U or Chi-square tests.A stratified logistic regression was used to assess the effect of factors affecting the prognosis.Results The average gestational age at the onset of ICH of the 61 cases was (28.8±8.3) weeks (6-40 weeks),the Glasgow score was (11.3±4.8),the median O-D time was 24.0 h,the modified Rankin scale (mRS) was 2.7,and 14 maternal deaths were reported (23.0%).Among the 61 women,three were terminated in early trimester,12 terminated in second trimester,and the rest 46 delivered in late term among which two fetal deaths,44 live births,and four neonatal deaths.Thus the perinatal infant death rate was 13.0% (6/46).The difference of maternal clinical features and prognosis between the surgery and conservative treatment group was not significant (all P>0.05).However,comparison between the cerebrovascular disease and pregnancy associated diseases group showed the latter had a lower Glasgow score and Apgar score [12.2(3.0) vs 7.5(12.0),(8.9±1.9) vs (7

  9. GDNF基因修饰的BMSCs在脑出血大鼠脑内存活与分化的实验研究%An experimental research on the survival and differentiation of GDNF gene-modified BMSCs in a rat model of intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    周玲; 邓莉; 涂江义; 高小青; 杨朝鲜

    2012-01-01

    目的:探讨胶质细胞源性神经营养因子(GDNF)基因修饰的骨髓间充质干细胞(BMSCs)在脑出血大鼠脑内的存活与分化.方法:分别将BMSCs/GDNF、BMSCs和生理盐水移植入脑出血大鼠脑内建立不同的实验组,采用Western blot检测各组大鼠GDNF蛋白的表达,DAPI 和免疫荧光组织化学染色观察移植细胞在脑内的存活和分化情况.结果:与生理盐水组和BMSCs组相比,BMSCs/GDNF组的GDNF蛋白表达显著上调;与BMSCs组相比,BMSCs/GDNF组的BMSCs存活率增高,神经微丝阳性细胞率上升,但胶质纤维酸性蛋白阳性细胞率无明显变化.结论:GDNF基因修饰有助于BMSCs在脑出血大鼠脑内的存活和向神经元样细胞方向分化.%Objetive To explore the survival and differentiation of GDNF gene-modified BMSCs in a rat model of intracerebral hemorrhage (ICH). Methods Different groups were established by transplanting with BMSCs/GDNF, BMSCs and saline into the brains of ICH rats , respectively. The expression of GDNF protein was tested by western blot analysis. DAPI and immunohistochemistry staining were used to observe the survival and differentiation of transplanted cells in rat brains. Results The expression of GDNF protein was significantly increased in BMSCs/GDNF group when compared with saline group and BMSCs group. The survival rate of BMSCs increased in BMSCs/GDNF group when compared with BMSCs group. The percentage of NF-200 positive cells in BMSCs/GDNF group was more than that in BMSCs group. Conclusion GDNF gene modification of BMSCs may contribute to the survival and neuron-like differentiation of the transplanted BMSCs in a rat model of intracerebral hemorrhage.

  10. Application and comparison of two kinds of nutritional evaluation methods in nutritional screening in elderly patients with spontaneous intracerebral hemorrhage%两种营养评价方法在老年脑出血患者营养筛查中的应用

    Institute of Scientific and Technical Information of China (English)

    陈伟; 王朝琴; 黄宗谭; 郭大芬; 雷丹; 姚声涛

    2016-01-01

    目的 探讨营养风险筛查2002 (NRS 2002)和微型营养评定法简版(MNA-SF)在老年自发性脑出血患者中的应用效果,并评价2种工具的适用性.方法 采用NRS2002、MNA-SF对60例老年自发性脑出血患者进行营养不良风险筛查,根据评分结果判断患者有无潜在的营养风险,比较2种营养评价工具应用效果.结果 采用NRS2002评分≥3分者59例(98.3%),<3分者仅1例(1.7%).采用MNA-SF评分12~14分3例,占5.0%;8~11分7例,占11.7%;0~7分50例,占83.3%.2种营养评价方法筛查的营养不良风险发生率差异无统计学意义(x2=1.034,P=0.619).结论 老年自发性脑出血患者住院期间营养不良的风险高,NRS 2002和MNA-SF 2种方法对于老年自发性脑出血患者均适用,MNA-SF更方便、快捷、全面.%Objective To investigate the application effect of two methods,the nutritional risk screening 2002 (NRS 2002) and the mini nutritional assessment short-form (MNA-SF),on nutritional screening in elderly patients with spontaneous intracerebral hemorrhage,and to evaluate the applicability of two kinds of methods.Methods Using NRS 2002 and MNA-SF,the malnutrition risk screening was performed in 60 cases of elderly patients with cerebral hemorrhage.Based on malnutrition risk score results,the potential nutritional risks were judged,and the application effectiveness was compared between two nutritional evaluation tools.Results Among 60 cases,there were 59 (98.3%) cases with NRS-2002 score≥3,and 1 (1.7%) case with NRS-2002 score < 3.By contrast,using the MNA-SF analysis,among 60 cases there were 3 (5.0%) cases with score of 12-14,7 (11.7%) cases with score of 8-11,and 50 (83.3%) cases with score of 0-7.No statistically significant difference was found between these two methods for analyzing the malnutrition risk incidence (x2 =1.034,P =0.619).Conclusion The risk grade of malnutrition is very high in elderly patients with spontaneous intracerebral

  11. Fatal hemorrhage in irradiated esophageal cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Nemoto, Kenji; Takai, Yoshihiro; Ogawa, Yoshihiro; Kakuto, Yoshihisa; Ariga, Hisanori; Matsushita, Haruo; Wada, Hitoshi; Yamada, Shogo [Tohoku Univ., Sendai (Japan). Dept. of Radiology

    1998-09-01

    Between 1980 and 1994, 423 patients with esophageal cancer were given curative radiation therapy. Of these patients, 31 died of massive hemorrhage and were used as the subjects of analysis in this study. The incidence of massive hemorrhage in all patients was 7% (31/423). In the 31 patients who died of massive hemorrhage, 27 had local tumors and two had no tumors at hemorrhage (two unknown cases). The mean time interval from the start of radiation to hemorrhage was 9.2 months. In 9 autopsy cases the origin of hemorrhage was a tear of the aorta in 5 cases, necrotic local tumor in 3 cases and esophageal ulcer in 1 case. The positive risk factors for this complication seemed to be excess total dose, infection, metallic stent, and tracheoesophageal fistula. Chest pain or sentinel hemorrhage proceeding to massive hemorrhage was observed in about half of the patients. (orig.)

  12. Efficacy of Stereotactic Catheter Indwelt Hematoma Aspiration in Patients with Hypertensive Intracerebral Hemorrhage:Meta-analysis%立体定向软通道颅内血肿清除术与内科保守治疗高血压性脑出血疗效的Meta分析

    Institute of Scientific and Technical Information of China (English)

    孟曙庆; 张洪; 黎黎

    2014-01-01

    Objective To evaluate stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage. Methods Cochrane database of systematic review (CENTRAL), MEDLINE, Excerpta Medica Database (EMbase), Physiotherapy Evidence Database, Open System for Information on Grey Literature in Europe (OpenSIGLE), National Technical Information Service (NTIS), China National Knowledge Infrastructure (CNKI), VIP, Wanfang data, and China Biology Medicine disc (CBMdisc) were searched for the randomized controlled trials (RCTs) of stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage from the data of establishment of the databases to December 2012. The bibliographies of included studies were searched, too. Two researchers evaluated the included studies using grading of recommendations assessment, development and evaluation (GRADE). The extract data were analyzed by RevMan 5.2 and GRADE proifler 4.0.3. Results A total of 11 trials were discovered. Meta-analysis showed that there were significant differences in clinical beneift, fatality rate, infection, and rebleeding in stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage compared with initial conservative treatment (odds ratio [OR] 3.34, 95%conifdence interval [CI] 2.13 to 5.22;OR 0.42, 95%CI 0.29 to 0.60;OR 0.42, 95%CI 0.27 to 0.64;and OR 0.47, 95%CI 0.28 to 0.77). The four outcomes were all of low quality in the GRADE system. Conclusion The current evidence shows stereotactic catheter indwelt hematoma aspiration in patients with hypertensive intracerebral hemorrhage was effective whereas reduction in the numbers of fatality rate, infection and rebleeding and increase at clinical benefit at the end of 3 months, compared with initial conservative treatment. The clinician should recommend it for its simplicity, low input costs, low operating costs and fewer side effects. Due to the limitations of the

  13. Boon's disease : Hemorrhagic cystitis in conjunction with massive exfoliation of degenerated urothelial cells (apoptosis?) during intercontinental flights in an otherwise healthy person

    NARCIS (Netherlands)

    Kok, LP

    2001-01-01

    Hemorrhagic cystitis is a well-defined clinical emergency, usually occurring in the course of treatment with toxic agents such as cyclophosphamide. We present a case of hemorrhagic cystitis in an otherwise completely healthy female. The three documented attacks it-ere severe and started during inter

  14. 早期肠内营养干预对预防高血压脑出血患者应激性溃疡的作用%The kole effect of early enteral nutritionon preventing of patients with hypertensive intracerebral hemorrhage to stress ulcer

    Institute of Scientific and Technical Information of China (English)

    范玉梅; 吴修凤

    2014-01-01

    Objective To analyze the effect of early enteral nutrition intervention on preventing patients with hypertensive intracerebral hemorrhage from stress ulcer.Methods One hundred and fifty- patients with hypertensive cerebral hemorrhage admitted to our hospital from July 2012 to July 2013 were selected as research subjects ,conventional therapy or enteral nutrition intervention was taken respectively ,the stress ulcer symptoms such as the amount of bleeding ,total hospitalization time , poor prognosis ,of the two groups were compared.Results In the observation group ,the incidence of stress ulcer (11.54% ) , bleeding (43.42 ± 11.65) mL , bleeding time (3.35 ± 1.04 ) d , total hospitalization time (8.42 ± 2.04 ) d , poor prognosis (1.28% ) were significantly lower than those of the control group (P< 0.05).Conclusion Early enteral nutrition interventions may be effective in preventing patients with hypertensive cerebral hemorrhage from stress ulcer ,promoting the rehabilitation of patients and improving their prognosis.%目的:分析早期肠内营养干预对预防高血压脑出血患者应激性溃疡的效果。方法选择本院于2012-07-2013-07收治的156例高血压脑出血患者为研究对象,分别采取常规治疗措施及早期肠内营养干预,比较2组患者应激性溃疡各项症状出现情况、出血量及总住院时间、不良预后发生情况等差异。结果观察组应激性溃疡发生率11.54%,出血量(43.42±11.65)m L ,出血停止时间(3.35±1.04)d ,住院时间(8.42±2.04)d ,不良预后(1.28%),明显低于对照组( P<0.05)。结论早期肠内营养干预可有效预防高血压脑出血患者出现应激性溃疡,促进患者康复,改善其预后。

  15. Analysis of Bleeding Position and Prognosis of Intracerebral Hemorrhage Complicated with Hyponatremia%脑出血后并发低钠血症与出血部位及预后分析

    Institute of Scientific and Technical Information of China (English)

    刘玉芝

    2011-01-01

    [目的]探讨脑出血患者出血部位与低钠血症的关系,并发低钠血症后患者的预后情况.[方法]对256例脑出血患者的出血部位,血清钠降低情况及头部CT等临床资料进行分析.[结果]全组患者死亡54例(21.1%);低钠血症患者31例,死亡19例(61.3%)(χ2 =25.357,P<0.01),低钠血症的程度与病死率呈负相关(r=-0.73,P<0.01).[结论]脑出血患者的预后与低钠血症的发生有关,其低钠血症的程度越严重,病死率越高.%[Objective]To explore the relationship between bleeding position in patients with cerebral hemorrhage and the occurrence of hyponatremia and the prognosis of the patients accompanied by hyponatremia.[Methods] The clinical data such as bleeding position, the decreasing level of serum sodium and head CT of 256 patients with cerebral hemorrhage were analyzed. [Results]Among all patients, 54 patients(21. 1%) died.Of31 patients with hyponatremia, 19 patients(61. 3%) died(x2=25. 357, P <0. 0l). The degree of hyponatremia was negatively correlated with the mortality(r=- 0. 973, P <0. 0l). [Conclusion] The prognosis of the patients with cerebral hemorrhage is closely related to the occurrence and degree of hyponatremia. The lower the serum sodium, the higher the mortality.

  16. 血压调控对高血压脑出血患者早期病情的影响%The Effect of Blood Pressure Control for Hypertensive Intracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    刘关振; 许春梅; 李文杰

    2011-01-01

    Objective To investigate the relationship between blood pressure control and the progression of hypertensive cerebral hemorrhage. Methods According to the situation of cerebral hemorrhage,the 60 patients were divided to two group: the minor and the medium group. At the early stage of pathogenesis, patients accepted the therapy for controlling the hypertension, and then observe the progression of disease. Results 3 days after cerebral hemorrhage, CT examination were conducted for review, suggesting that there was no significant increase of intracranial hematoma in 57 patients, their condition had improved; the rest 3 patients'hematoma expanded contrasting to the situation when admitted to the hospital,disturbance of consciousness also became more severe. Conclusion Hypertensive cerebral hemorrhage may be accompanied hypertensive encephalopathy or hypertensive crisis, and the hypertension may also induce continued bleeding or hematoma expansion, therefore, reducing high blood pressure timely plays a role in the controlling of the disease progression, and improving the patients'early prognosis.%目的 探讨调控血压与控制高血压脑出血病情进展的关系.方法 分析60例高血压脑出血,出血量小到中等,早期行调控血压治疗,观察其病情变化.结果 60例高血压脑出血患者3 d后复查头颅CT,57例颅内血肿无明显扩大,病情好转,只有3例血肿较入院时扩大,意识障碍较入院时加重.结论 高血压脑出血患者,可能同时伴有高血压脑病或高血压危象,也可因过高的血压导致继续出血、血肿扩大,因此,及时地降低过高的血压可控制病情进展,改善患者早期预后.

  17. Intracranial hemorrhage in late hemorrhagic disease of the newborn.

    Science.gov (United States)

    Pooni, Puneet A; Singh, Daljit; Singh, Harmesh; Jain, B K

    2003-03-01

    This study was conducted to evaluate the clinical profile and outcome in late hemorrhagic disease of the newborn (HDN) with particular reference to intracranial hemorrhage. Infants (n = 42) presenting with late HDN from January 1998 to December 2001 were studied. Majority (76%) were in the age group of 1-3 months. All were term babies on exclusive breast-feeding and none received vitamin K at birth. 71% patients presented with intracranial hemorrhage, commonest site being intracerebral and multiple ICH. Visible external bleeding was noted in 1/3rd of patients only. Three patients expired. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Isolated intracranial hemorrhage is a common mode of presentation.

  18. Prevention of intracerebral haemorrhage.

    Science.gov (United States)

    Mitchell, Patrick; Mitra, Dipayan; Gregson, Barbara A; Mendelow, A David

    2007-07-01

    Nontraumatic intracerebral haemorrhages arise from a wide range of causes falling into two broad groups: discreet vascular "ictohaemorrhagic" lesions such as aneurysms, arteriovenous malformations, cavernomas, tumours, and dural fistulae; and more generalised amyloid or hypertension related conditions. It is now possible using family history, associated risk factors and gradient echo MRI to predict cases at high risk of hypertensive or amyloid related haemorrhage. There is considerable potential for prevention of hypertensive haemorrhages by treatment of high risk cases with antihypertensive medication. As yet no effective preventative treatment for amyloid angiopathy related ICH has emerged although a variety of drugs are under investigation. Prevention of haemorrhage from ictohaemorrhagic lesions revolves around removal or obliteration of the lesion. Although there is a wide range of such lesions available treatments come down to three modalities. These are surgical excision, stereotactic radiosurgery and endovascular embolisation.

  19. Intracerebral haemorrhage after carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Boesen, J

    1987-01-01

    Among 662 consecutive carotid endarterectomies eight cases of postoperative ipsilateral intracerebral haemorrhage were identified, occurring into brain areas which, preoperatively were without infarction. As blood pressures across the stenosis were routinely measured during surgery, the internal...

  20. Analysis of Different Surgical Treatment of Hypertensive Intracerebral Hemorrhage after Cerebral Edema%不同术式治疗高血压脑出血对术后脑水肿的影响分析

    Institute of Scientific and Technical Information of China (English)

    朱冠军

    2015-01-01

    ObjectiveTo investigate the effect on braln edema of different surgical methods for the treatment of hypertensive cerebral hemorrhage.Method For the patients with in our hospital from December 2011 to December 2013 were selected for hypertensive cerebral hemorrhage, 67 patients were randomly divided into two groups were observed and compared, including the control group using the traditional craniotomy operation, experimental group received minimally invasive evacuation of intracranial hematoma for treatment.Results After operation, the volume of edema, cerebral edema duration and idiotic left blood volume, the experimental group was statistically signiifcant difference compared with the control group(P<0.05).Conclusion In the treatment of hypertensive cerebral hemorrhage, intracranial hematoma can signiifcantly shorten the duration of postoperative braln edema, reduce the volume of edema, is worth the clinical promotion.%目的:了解不同术式治疗高血压脑出血对术后脑水肿的影响。方法对我院2011年12月至2013年12月收治的高血压脑出血患者进行抽样,选取67例患者随机分成两组进行对比观察,其中对照组采用传统开颅手术,实验组予以微创颅内血肿清除术进行治疗。结果术后在水肿体积、脑水肿持续时间以及脑残留血液量上,实验组较对照组差异具有显著统计学意义(P<0.05)。结论针对高血压脑出血治疗,微创颅内血肿清除术能显著缩短水肿持续时间,降低术后脑水肿体积,值得临床推广。

  1. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09-3.24, p year (ICH: HR 2.02, 95% CI 1.75-2.32, p ... and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year. RESULTS: Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20-49 years...

  2. Risk Factors Related to Outcome of Patients with Severe Massive Hemorrhage in Intensive Care Unit%重症医学科严重大出血患者预后危险因素

    Institute of Scientific and Technical Information of China (English)

    周翔; 刘大为; 隆云; 姚波; 苏龙翔

    2016-01-01

    目的:探讨影响重症医学科病房( Intensive Care Unit,ICU)严重大出血患者预后的危险因素。方法回顾性分析北京协和医院2013年1月至2015年12月全部收住ICU 24 h内输注红细胞( red blood cell,RBC)超过20 U的大出血患者的临床资料,比较生存组与死亡组的差异,并采用Logistic回归分析影响这些患者预后的危险因素。结果研究共纳入严重大出血患者141例,生存组和死亡组患者分别为78例和63例,住院死亡率44.7%。其中非手术相关大出血78例,手术相关大出血63例。全部严重大出血患者死亡组ICU输RBC量( P=0.002)、非手术相关大出血患者的比例( P=0.002)以及来自急诊的大出血患者的比例(P=0.010)均显著高于生存组,而来自手术科室患者的比例低于生存组(P=0.001),输RBC前凝血功能,肝、肾功能明显较生存组差(P均﹤0.05)。在非手术相关大出血患者中,死亡组感染造成大出血患者的比例显著高于生存组(P=0.009),而应激性溃疡导致大出血患者的比例(P=0.048)、输RBC前血小板水平(P=0.003)和采用手术止血措施的患者比例(P=0.039)均显著低于生存组。在手术相关大出血患者中,死亡组ICU输RBC量显著多于生存组( P=0.019),输RBC前基线肝、肾功能受损的比例显著高于生存组( P均﹤0.05)。Logistic回归分析显示患者凝血功能紊乱(P=0.014,OR=3.594)及入ICU后仍存在活动性大出血(P=0.025,OR=2.680)为全部严重大出血患者死亡危险因素。结论患者凝血功能紊乱及入ICU后仍存在活动性大出血是严重大出血患者的死亡危险因素。%Objective To investigate the risk factors related to outcome of patients with severe massive hemorrhage in Intensive Care Unit( ICU ). Methods Clinical data of all patients receiving transfusion of red blood cell( RBC)of ﹥20 U for

  3. Effect of early enteral nutrition on immune function and prognostic indicators of the patients with severe intracerebral hemorrhage%早期肠内营养支持治疗对重症脑出血患者免疫功能和预后指标的影响

    Institute of Scientific and Technical Information of China (English)

    邱斌; 邢小珍; 肖展翅; 王洲羿

    2015-01-01

    Objective: To investigate the effects of early enteral nutrition (EEN) on immune function and prognostic indicators of the patients with severe intracerebral hemorrhage.Methods:A total of 173 patients of severe intracerebral hemorrhage accompanied with dysphagia were randomly divided into control group (n=77) and EEN group (n=96). At 12~48 h atfer admission,the patients in EEN group were given nasogastric enteral nutrition support with enteral nutritional emulsion (TPF) while the patients in control group were treated with general nasal feeding diet. Neurological scores of patients were tested by National Institutes of Health Stroke Scale (NIH Stroke Scale, NIHSS) at 2 and 14 d atfer admission respectively, and the changes of nutritional indicators and the complications were observed simultaneously. Furthermore, immunoglobulin and T lymphocyte subsets in blood samples from two group patients were detected.Results: At the 14th day, the NIHSS in treatment group were signiifcantly lower than that of the control group (P0.05).Conclusion:hTe treatment of EEN can improve the neurological and immune functions of patient as well as the nutritional status of body.%目的:探讨早期肠内营养(early enteral nutrition,EEN)治疗对重症脑出血患者免疫功能和预后指标的影响.方法:随机将173例重症脑出血伴吞咽障碍患者分为对照组(n=77)和EEN组(n=96),入院后12~48 h分别给普通鼻饲饮食和予肠内营养(EN).两组患者于入院第2和第14天后采用美国国立卫生院神经功能缺损量表(National Institutes of Health Stroke Scale,NIHSS)进行功能评分,并观察两组患者营养指标及免疫球蛋白(IgA、IgG、IgM),淋巴细胞计数(LYM)和细胞因子CD4+、CD8+、CD4+/CD8+值,并且比较两组患者预后并发症的发生情况.结果:入院14 d后,EEN组患者NIHSS评分显著低于对照组(P0.05).结论:早期肠内营养支持治疗可以改善重症脑出血患者的神经功能、免疫功能、身体营养状态.

  4. Rescue and nursing of vaginal acute massive hemorrhage of uterine cervix cancer patients%宫颈癌阴道急性大出血患者的抢救及护理

    Institute of Scientific and Technical Information of China (English)

    陈伟月; 梁平; 余勇妙; 梁志群

    2009-01-01

    Objective To explore the rescue and nursing of vaginal acute massive hemorrhage of uterine cervix cancer patients. Methods The clinical data of 12 uterine cervix cancer patients with vaginal acute massive hemorrhage were analyzed retrospectively. The measures were included: ①Rescne shock: establishing two intravenoun pathways quickly, checking blood type, crees matching and rapid expanding the blood volume; ②Hemostasia as possible: rapid hemostasia by vagina packing with sterile or iodoform gauze, reducing the psychentonia of patients and receiving antibiotic treatment; ③Oxygen inhalation; ④Cloee observation: observing the change of vaginal hemorrhage and vital signs closely; ⑤ Strengthening the basic nursing and preventing the complication. Results All patients were cured in time. After anti - inflammation, hemostasia, operation and radiotherapy, all patients were discharged from hospital or received radiotherapy in ontology department. Conclusions The right nursing measures and hemostasia as possible are the key to rescuer the uterine cervix cancer patients with vaginal acute massive hemorrhage.%目的 探讨宫颈癌阴道急性大出血患者的抢救及护理有关问题.方法 回顾分析12例宫颈癌阴道急性大出血患者的临床资料、抢救及护理过程,措施包括:①抢救休克:快速建立两条静脉通道、查血型及交叉配血,快速扩充血容量;②迅速止血:迅速阴道内填塞无菌纱布或碘仿纱条压迫止血,减少精神紧张等因素,给予抗生素;③氧气吸入;④密切观察:密切观察阴道流血及生命体征变化,对症施护;⑤加强基础护理、预防并发症.结果患者得到及时的救治,经抗炎、止血、手术、放射治疗,全部患者康复出院或转肿瘤科继续放疗.结论 宫颈癌引起阴道急性大流血,争取时机尽快止血、护理措施正确及时是抢救成功的关键.

  5. Diagnosis and Treatment Analysis of Massive Gastrointestinal Hemorrhage from Pseudoaneurysm Caused by Pancreatitis%胰腺炎并假性动脉瘤继发消化道大出血诊治剖析

    Institute of Scientific and Technical Information of China (English)

    蒋海涛; 陈银; 周本刚; 王红

    2016-01-01

    Objective To investigate the key points of diagnosis and treatment of pancreatic pseudoneurysm compli-cated with massive gastrointestinal hemorrhage. Methods Clinical data of a pancreatitis patient complicated with pseudoan-eurgs clinically manifested by massive hemorrhage was retrospectively analyzed, and the relevant literatures were reviewed. Results The patient was admitted for abdominal pain, hematemesis and tarry stool for a week, and had a history of pancreati-tis for 5 years. The patient with the major clinical symptom of massive gastrointestinal hemorrhage was diagnosed by abdominal enhanced CT, and then checked by digital subtraction angiography ( DSA) . The patient was treated by transcatheter arterial embolism ( TAE ) . After remobilization, clinical symptom was significantly alleviated, and discharged from hospital. CT showed no bleeding foci after 11 months of follow up after discharge, no gastrointestinal hemorrhage recurred. Conclusion Pancreatic pseudoneurysm is one of the rare complications of chronic pancreatitis. CT, DSA are the main diagnosis methods, and TAE is a safe and effective method for treatment of pancreatitis with pseudoaneurysm.%目的:探讨胰腺炎并假性动脉瘤继发消化道大出血的诊治要点。方法回顾性分析以消化道大出血为主要临床表现的胰腺炎并假性动脉瘤1例的临床资料并复习相关文献。结果本例因腹痛伴呕血、排柏油便1周入院。有胰腺炎病史5年。行腹部增强CT示疑似胃十二指肠假性动脉瘤破裂,行数字减影血管造影( DSA)确诊后行经导管动脉栓塞( TAE)治疗,栓塞后未再出血,痊愈出院。随访11个月,无再发出血。结论胰腺炎并假性动脉瘤形成是胰腺炎较少见的并发症之一,诊断主要依据CT、DSA等影像学检查,TAE是治疗胰源性假性动脉瘤最安全、有效的方法。

  6. 脑溢安对出血性中风大鼠脑内磷酸化蛋白激酶表达的影响%Effect of Nao Yi An on the Expression of P-C-Jun in the Brain of Experimental Intracerebral Hemorrhagic Rat

    Institute of Scientific and Technical Information of China (English)

    聂亚雄; 黎杏群; 袁梦石; 张花先; 张化彪; 唐涛

    2001-01-01

    To investigate the effect of traditional Chinese medicine Nao Yi An (NYA) on the expression of P-C-Jun in the brain of experimental intracerebral hemorrhagic rat.The rats were randomly divided into the normal control group,the model control group and NYA treatment group.By injecting collagenase type Ⅶ stereotaxically into the right globas pallidus,rat models with haemorrhagic stroke were made.We investigated the changes of the expression of P-CJun in the piriform cortex of the rats.Results:The expression of P-C-Jun in NYA group was weaker than that in the model control group(P<0.05).Conclusion:NYA interferes in the expression of P-C-Jun in the brain of rat models with haemorrhagic stroke,and affects the MAPK signal transduction.%探讨脑溢安对出血性中风大鼠脑内磷酸化蛋白激酶(P-C-Jun)表达的影响和治疗机理。根据Roserberg法复制大鼠脑出血模型,采用免疫组织化学方法观察脑出血后梨状皮质内P-C-Jun的表达变化,并用组织病理学方法分析脑皮质内神经元的损伤状况。结果:脑溢安治疗组较模型组脑内P-C-Jun蛋白表达弱,神经元受损状况轻。结论:脑溢安下调脑内P-C-Jun蛋白表达,从而干预了丝裂原活化的蛋白激酶(MAPK)信号转导通路。

  7. 大鼠脑出血后细胞凋亡与Caspase-3、Ref-1表达的相关性%Correlation between expression of Caspase-3、 Ref-1 and apoptosis after intracerebral hemorrhage in rats

    Institute of Scientific and Technical Information of China (English)

    洪丽蓉; 沈国理; 喻森明; 胡晓华

    2007-01-01

    [目的]研究脑出血(intracerebral hemorrhage,ICH)血肿周围缺血半暗带区中半胱氨酸蛋白酶(Caspase-3)与氧化还原因子-1(redox factor-1,Ref-1)的表达与细胞凋亡的关系.[方法]采取立体定向技术,将SD大鼠自体不凝血50 μl注入大脑尾状核区制备脑出血模型,将大鼠随机分为正常组和出血组,分别在不同时间点断头取脑,连续切片作TUNEL、Ref-1和Caspase-3免疫组化染色.[结果]脑出血后血肿周围缺血半暗带区中细胞凋亡与Caspase-3表达呈正相关(r=0.466,P<0.01),与Ref-1表达呈负相关(r=-0.195,P<0.05);且Caspase-3表达在开始及高峰时间上先于细胞凋亡的发生,Ref-1表达明显下降和下降谷底时间均早于细胞凋亡出现的时间.[结论]缺血半暗带区脑组织中细胞凋亡与Ref-1及Caspase-3表达相关,且caspase-3表达的高峰、Ref-1表达的下降均先于细胞凋亡的发生.

  8. Multiple intracranial hemorrhages in a normotensive demented patient: A probable cerebral amyloid angiopathy.

    Science.gov (United States)

    Chitsaz, Ahmad; Norouzi, Rasul; Marashi, Seyed Mohammad Javad; Salimianfard, Marzieh; Fard, Salman Abbasi

    2012-01-01

    Cerebral amyloid angiopathy (CAA) is the most common cause of lobar intracerebral hemorrhage. Repeated bleeding may be presented with vascular dementia. We have reported a 68-year-old normotensive demented patient with probable CAA presented with hemiparesia, headache and vomiting. According to the experience of this case, it is recommended to consider CAA for normotensive elderly patients presented with multiple and superficial intracerebral hemorrhage.

  9. 脑动静脉畸形破裂出血并脑疝的急诊手术治疗%Emergent Surgical Treatment of Acute Hemorrhagic Intracranial Arteriovenous Malformation with Intracerebral Herniation

    Institute of Scientific and Technical Information of China (English)

    魏健; 刘维生; 王永和; 曹培成; 卜振富

    2013-01-01

      目的探讨脑动静脉畸形(AVMs)破裂出血并脑疝的急诊手术问题。方法回顾性分析我院17例AVMs急性破裂出血合并脑疝并行急诊手术治疗的病例资料。结果患者术后半年GOS评定疗效,良好4例,中残6例,重残2例,植物生存2例,死亡3例。术后并发肺部感染4例,皮瓣下积液2例,颅内感染并脑积水1例,迟发血肿1例。结论急诊手术治疗是AVMs破裂出血并脑疝首选治疗方法,能够提高病人生存率,降低致残率。%Objective To study the emergent operative treatment of acute hemorrhagic cerebral arteriove-nous malformations(AVMs) with cerebral herniation.Methods A retrospective analysis of 17 patients with acute hemor-rhagic cerebral AVMs with cerebral herniation was carried out ,who were treated with emergent operative treatment .Re-sults According to GOS scale six month after operation ,4 patients recovered well,moderately disabled in 6 cases,se-verely disabled in 2 cases,vegetably survived in 2 cases,3 patients died after operation,4 cases with pneumonia after op-eration,2 cases with subdural hydroma ,1 case with intracranial infection and hydrocephalus ,1 case with recurrent hema-toma.Conclusion The emergent hematoma debridement and AVMs excision by microneurosurgery is the optimal effec-tive method to treat AVMs with cerebral herniation because it can heighten survival rate and decrease disability rate .

  10. 脑出血患者血清NSE、GFAP、BDNF水平变化与认知障碍相关性研究%Correlation of serum levels of NSE, GFAP, BDNF and cognitive impairment in patients with intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    刘宇明; 邓燕华; 许治强; 梁燕玲; 胡佳佳; 林永强

    2016-01-01

    Objective To investigate the serum neuron specific enolase(NSE)and glial fibrillary acidic protein(GFAP), brain derived neural nutrition factor(BDNF)level changes in cerebral hemorrhage patients and the correlation with cognitive impairment. Method 100 cases of acute spontaneous cerebral hemorrhage were selected, and the corresponding treatments were given in the hospital, the seru NSE, GFAP and BDNF were detected. 100 patients were divided into cognitive impairment group(57cases)and non cognitive impairment group(43cases) according to whether there were cognitive impairment. Those three indicators were compared between different levels of cognitive injury(MMSE score)group, and the correlation between the three indicators and MMSE. Results The serum GFAP and NSE were significantly higher in the patients with cognitive impairment than those without cognitive impairment, and BDNF was significantly lower(t=7.039,t=2.247,t=4.847,P<0.01). The serum levels of NSE, GFAP and BDNF were significantly different in the mild injury group, moderate injury group and severe injury group (F=22.752, F=31.506, F=38.294, P<0.01). The levels of serum NSE and GFAP were positively correlated with MMSE scores(r=0.641, r=0.604, P<0.05), and BDNF was negatively correlated with MMSE scores(r=0.582, P<0.05). Conclusion The levels of serum NSE, GFAP and BDNF in patients with cerebral hemorrhage are closely related to cognitive dysfunction after stroke, which can be used to determine the severity of cognitive impairment in patients with cerebral hemorrhage.%目的:探讨脑出血患者血清神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)水平变化与认知障碍相关性。方法选择急性自发性脑出血患者100例,入院时均给予相应治疗,并进行 NSE、GFAP、BDNF 检测。将100例患者依据是否发生认知障碍分为认知障碍组(57例)和无认知障碍组(43例)。并

  11. 纱布填塞术治疗骨盆骨折大出血%Gauze packing for massive hemorrhage in pelvic fracture

    Institute of Scientific and Technical Information of China (English)

    杨永良; 周东生; 王鲁博; 王伯珉; 李连欣; 王永会; 董金磊

    2015-01-01

    following pelvic fracture.Results Systolic pressure was (95.2 ± 4.6) mmHg and mean heart rate was declined to (85.4 ± 13.2)beats/min after pelvis volume control and gauze packing,with significant differences compared to these preoperatively (P < 0.05).Red blood cell transfusion before internal or external fixation and gauze packing was (15.0 ± 2.4) units versus (8.3 ± 1.5) units within the first postoperative 24 hours (P < 0.05).Twenty-four out of the 42 patients underwent temporary abdominal aorta occlusion.Six patients died postoperatively with the death rate of 14%.Mean time of removing the packing gauze was (51.4 ± 10.3) hours (range,24-168 hours).Conclusion Anti-shock treatment with concurrent gauze packing and pelvis volume control is effective to arrest the massive hemorrhage in hemodynamically unstable pelvic fracture.

  12. 胰十二指肠切除术后迟发性出血诊疗分析%Delayed massive hemorrhage after pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    孟翔飞; 王敬; 王志军; 黄晓强; 夏红天; 董家鸿

    2012-01-01

    Objective To summarize our clinical experiences of delayed massive hemorrhagc (DMH),a rare but fatal complication,after pancreaticoduodenectomy (PD).Methods The clinical data of 14 DMH patients at our medical center were collected and analyzed to evaluate the risk factors and to compare the efficacies of different therapies.Results A total of 1008 PD patients were treated since April 1993.Fourteen DMHs occurred post-operatively (1.4%).In these cases,10/14 (71.4%) were complicated with pancreatic fistula. Sentinel bleeding was observed in 10 (71.4%) cases.The clinical manifestations of DMH included simple abdominal hemorrhage (n =6,42.9% ), alimentary tract hemorrhage (n =6,42.9% ) and both (n =3,21.4% ).Shock (n =2,14.3% ) might also be the initial symptom.Thirteen cases achieved post-therapeutic hemostasis while 1 patient died before re-admission.The therapeutic modalities included interventional therapy ( n =8 ) and surgery ( n =5 ).According to the therapeutic modalities,the re-bleeding rate,morbidity and final mortality of two groups were 50.0% vs 40.0% ( P =0.83 ),75.0% vs 60.0% ( P =0.96 ) and 50.0% vs 80.0% ( P =0.62) respectively.Five patients survived at the end of treatment.The mortality rate was 71.4%.Conclusion As a rare but fatal complication after PD,DMH is difficult to diagnose and treat.Postoperative pancreatic fistula remains a possible but undetermined risk factor. Sentinel bleeding is of great predicative value for DMH. Regular interventional arteriography is an effective method of improving diagnosis and treatment.Both interventional therapy and surgery may be used to treat DMH.%目的 总结胰十二指肠切除术(PD)后迟发性出血(DMH)的诊疗经验和文献观点,提高对该并发症的诊治水平.方法 对解放军总医院14例DMH患者的临床数据进行回顾性分析,初步分析其危险因素,并对不同治疗方式的效果进行比较.结果 1993年3月-2011年4月共有1008例患者于解放

  13. [Intracranial hemorrhage during hemorrhagic disease of the newborn infant at term].

    Science.gov (United States)

    Moyoukolo, J; Retbi, J M; Allemon, M C; Semaan, N; J'Mii, B

    1990-01-01

    The authors report a case of intra-cerebral hematoma in a patient with hemorrhagic disease of the newborn. This hematoma had to be taped, and after that, an hydrocephalus shunted. The state of deficiency of vitamin K in the newborn should be treated systematically. The oral route is as good as the intra-muscular route for the baby.

  14. Effect of RhoA/Rho associated coiled coil forming protein kinase signal pathway on blood brain barrier at early stage of cerebral hemorrhage after intracerebral hemoglobin injection%RhoA/Rho激酶信号通路在脑出血后血红蛋白影响血脑屏障通透性中的作用

    Institute of Scientific and Technical Information of China (English)

    付正浩; 陈祎招; 杨硕; 邓心情; 张润; 丁锐; 冯亮; 张世忠; 柯以铨

    2013-01-01

    ,n=10).Rat models of cerebral hemorrhage in the Hb group were induced by intracerebral hemoglobin injection; BBB permeability was measured by Evans blue dye; dry-wet method was used to measure the brain tissue water content for all groups; the distributions of RhoA and ROCK2 were detected by immunohistochemistry (DAB stainning); the mRNA expressions of RhoA and ROCK2 were evaluated by real time fluorescent quantitative PCR.Results As compared with those in the sham-operated group and normal control group,Evans blue permeation and water content of perihematoma significantly increased in the Hb group at all time points (P<0.05).Immunohistochemistry indicated no obvious expressions of RhoA and ROCK2 in the normal control group,while RhoA and ROCK2 showed claybank in the brain tissue of Hb group,which mainly expressed in the cytoplasm.As compared with those in the normal control group and sham-operated group,the mRNA level of RhoA significantly elevated in the Hb group at all time points (P<0.05) and that of ROCK2 significantly elevated in the Hb group at 6 and 12 h time points (P<0.05).Conclusion Hemoglobin induces RhoA/ROCK signal pathway activation after intracerebral hemorrhage,which may attribute to BBB permeability increase and subsequent cerebral edema formation.

  15. Effect of Operation Time on the Curative Efficacy in Hypertensive Intracerebral Hemorrhage in Basal Ganglia Treating With Small Window Craniotomy Microsurgical Operation%小骨窗显微手术时机对基底节区高血压性脑出血疗效的影响

    Institute of Scientific and Technical Information of China (English)

    李建; 高觉民

    2014-01-01

    Objective To investigate the effect of operation time on the curative efficacy in hypertensive intracerebral hemorrhage (HICH) in basal ganglia treating with small window craniotomy microsurgical operation. Methods 80 cases of HICH in basal ganglia treating with small window craniotomy microsurgical operation meeting the inclusion criteria were randomly divided into ultra-early group (within 6 h) and early group (6~24 h) equally. Then the curative efficacy and life quality scores were observed and compared. Results The rate of recurrent hemorrhage in the ultra-early group was 10.0%, which was statistically same with that of 15.0% in the early group (P>0.05). Meanwhile, the ultra-early group had a mortality rate of 5.0%, which was statistically lower than that of 20.0% in the early group (P0.05). Three months after, life quality scores in the ultra-early group was significantly statistically higher than that in the early group (P<0.05). Conclusion The ultra-early small window craniotomy microsurgical operation can significant reduce mortality rate of patients with HICH in basal ganglia, improve life quality and prognosis, without increasing the rate of recurrent hemorrhage. And the ultra-early operation time is ideal for patients with optimum conditions.%目的:探讨小骨窗显微手术时机对基底节区高血压性脑出血(HICH)疗效的影响。方法80例符合纳入标准的行小骨窗显微手术的基底节区 HICH 患者随机分为超早期组(发病6 h 内手术)和早期组(发病6~24 h 内手术),每组各40例,观察治疗疗效及患者生活质量评分变化情况。结果超早期组和早期组的再出血率分别为10.0%和15.0%,两组比较无统计学差异(P >0.05)。超早期组的手术死亡率为5.0%,明显低于早期20.0%的死亡率,比较有统计学差异(P <0.05)。术前,两组患者生活质量评分比较无统计学差异(P >0.05)。术后3个月,超早期组的生活质量

  16. 高血压脑出血手术后合并糖尿病非酮症高渗性昏迷的临床抢救措施%After Operation of Hypertensive Intracerebral Hemorrhage Combined With Clinical Measures to Rescue the Diabetic non Ketotic Hyperosmolar Coma

    Institute of Scientific and Technical Information of China (English)

    田振宇

    2015-01-01

    Objective To study the analysis of operation treatment of hypertensive cerebral hemorrhage, diabetic non ketotic hyperosmolar coma first-aid measures.Method select 2014.01—2015.01 during operation in our hospital to accept the treatment of patients with hypertensive cerebral hemorrhage in 25 cases, postoperative were complicated with diabetes in non with hyperosmolar coma, timely according to the rescue and treatment of.Results after the rescue after the treatment, all the patients blood glucose, serum sodium, serum potassium and plasma osmotic pressure of water on average significantly decrease, the difference has statistical significanceP<0.05. This group of 25 patients, 13 cases of self-care, 5 cases of partial self-care, 5 cases of vegetative state, 2 cases of death.Conclusion the effect of operation treatment and prognosis after intracerebral hemorrhage complicated with diabetic nonketotic hyperosmolar coma is very poor, clinical must be early diagnosis, timely correct dehydration, rehydration, maintain water electrolyte balance, rational application of insulin, most likely to improve the success rate of rescue.%目的:研究分析高血压脑出血手术治疗后,并发糖尿病非酮症高渗性昏迷的急救措施。方法选择2014年1月—2015年1月期间在该院接受手术治疗的25例高血压脑出血患者,术后均并发糖尿病非同症高渗性昏迷,及时给予针对性的抢救治疗。结果经抢救治疗后,全部患者的血糖、血钠、血钾以及血浆渗透压水平均显著降低,差异有统计学意义P<0.05。本组25例患者中,生活自理者13例,部分生活自理者5例,植物生存者5例,死亡者2例。结论手术治疗高血压脑出血后合并糖尿病非酮症高渗性昏迷的预后效果很差,临床必须及早确诊,及时纠正脱水、补液、维持水电解质平衡,合理应用胰岛素,最可能提高抢救的成功率。

  17. A complicated case of antepartum eclamptic fit with HELLP syndrome, acute renal failure and multiple intracranial hemorrhages: A mortality report

    Directory of Open Access Journals (Sweden)

    Ahmed Samy El-agwany

    2016-04-01

    Full Text Available HELLP is an acronym for hemolysis, elevated liver enzymes and low platelets count, affecting 0.2–12% of all pregnancies or 4–12% of those with preeclampsia. The maternal mortality reported from the literature is up 4% due to disseminated intravascular coagulation, placental abruption, acute renal failure, eclampsia, and cerebral hemorrhage. A 20 year old, G2P1, at 36 weeks of gestation, was referred to our hospital because of postictal coma state with bilateral mydriasis and epistaxis due to repeated antepartum eclamptic fits. Elevated blood pressure level 170/110 mmHg was accompanied with massive proteinuria. Cesarean section was performed and female newborn were delivered. Laboratory findings were characteristic of preeclampsia, HELLP syndrome and renal failure. The patient developed an intraventricular hematoma and an intracerebral hemorrhage with subarachnoid one, which were not suitable to neurosurgical treatment. The patient died from refractory hemolytic anemia, spontaneous bleeding of multiple organs, renal failure and intracranial hemorrhage. Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure appropriate management and treatment success.

  18. Expression of Autophagy Related Proteins Regulated by Nuclear Factor-κB after Intracerebral Hemorrhage in Mice%小鼠脑出血后自噬相关蛋白表达及NF-κB信号通路对其调节作用的研究

    Institute of Scientific and Technical Information of China (English)

    孙玉霞; 秦正红; 朱广友; 陶陆阳; 包海军; 刘伟丽; 王涛; 戴定坤; 王龙; 张璐; 王尧琪; 黄娅

    2011-01-01

    Objective To investigate whether autophagy was activated and the effects of SN50, an inhibitor of NF-κB, on expression of autophagy-related proteins after intracerebral hemorrhage (ICH) in mice. Methods Intracerebral hemorrhage was produced by injection of collagenase Ⅳ into striatum in adult Kun'ming mice, and mice were randomly divided into the SN50 pretreatment group, the saline vehicle group, the ICH group, and the control group. The SN50 and saline groups were produced by intracerebroventricular (i. c. v. ) administration of SN50 (0.1 μg/μl,1 μl) or saline (1 μl) 5 min before ICH.Animals were sacrificed 1 h, 6 h, 24 h, 48 h and 7 d after ICH in each group, and brains were harvested. Region of hemorrhage and perilesional were dissected for Western blot analysis of Beclin-1, Bcl-2 and LC3. Results Beclin-1 was significantly up-regulated and Bcl-2 significantly down-regulated from 6 to 48 h post ICH in mice ( P < 0. 05 ). The ratio of Beclin-1/Bcl-2 was increased from 6 to 48 h post ICH ( P < 0. 05 ). LC3 was significantly activated from 1 to 7 d after ICH in mice ( P < 0.05 ). Up-regulation of LC3 activation was enhances in SN50-pretreated groups compared with that in saline vehicle groups.Conclusion Autophagy is activated and ratio of Beclin-1/Bcl-2 is one of the regulation mechanisms in ICH mice. Inhibition of NF-κB signal pathway by SN50 enhances the up-regulation of autophagy-related protein induced by ICH in mice.%目的 研究小鼠脑出血(ICH)后自噬是否被激活及NF-κB信号通路对ICH诱发的自噬相关蛋白表达的影响.方法 正常昆明小鼠纹状体注射胶原酶Ⅳ建立脑出血模型,或于脑出血模型建立前5 min,侧脑室给药SN50(0.1μg/μl)或生理盐水1 μl,随机分为脑出血组、SN50处理组和生理盐水处理组,同时设立空白对照组.每组分别于脑出血1 h,6 h,24 h,48 h,7 d后(5只/时间点)断头取脑,脑出血各组取出血区及周边脑组织进

  19. Migraine and risk of hemorrhagic stroke

    DEFF Research Database (Denmark)

    Gaist, David; González-Pérez, Antonio; Ashina, Messoud

    2014-01-01

    BACKGROUND: We investigated the association between hemorrhagic stroke and migraine using data from The Health Improvement Network database. FINDINGS: We ascertained 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH). Density-based sampling was used...... to select 10,000 controls free from hemorrhagic stroke. Using unconditional logistic regression models, we calculated the risk of hemorrhagic stroke associated with migraine, adjusting for age, sex, calendar year, alcohol, body mass index, hypertension, previous cerebrovascular disease, oral contraceptive...... use, and health services utilization.The risk (odds ratio [OR]) of ICH among migraineurs was 1.2 (95% confidence interval [CI] 0.9-1.5), and of SAH was (1.2, 95% CI 0.9-1.5). The association with ICH was stronger for migraine diagnosed ≥20 years prior to ICH (OR 1.6, 95% CI 1.0-2.4), but not with SAH...

  20. The experiment of exogenous BDNF combined with bone mesenchymal stem cells after intracerebral hemorrhage on adult rats%骨髓间质干细胞联合脑源性神经营养因子用于大鼠脑出血的实验研究

    Institute of Scientific and Technical Information of China (English)

    施迎兵; 黄良国; 蒋国红

    2011-01-01

    Objective To observe the treatment effect of bone marrow mesenchymal stem cells ( MSCs) combined brain-derived neurotrophic factor (BDNF) on the adult rats with intracerebral hemorrhage (ICH). Methods We built rat ICH models, cultured and mark the purified MSCs in vitro, and implanted them into the brain through the left ventricle while using BDNF locally. Then we record the recovery of rats neurological function of control group, BDNF group, MSCs group and MSCs + BDNF group after 7d,14d,21d. Immunohistochemistry methods was used to detect MSCs migration and differentiation in the brain. The level of neuronal apoptosis was observed with electron microscopy. Results Motor function of MSCs group improved significantly,ICH injury of MSCs + BDNF group got most obvious repairment. BDNF + MSCs group had a higher level of MSCs,NEUN,GFAP and CNP immunoreactive cells than MSCs group(P <0.01) at each time point. MSCs + BDNF group had the least number of inhibited apoptosis among all groups. Conclusion MSCs transplantation in rat brain improves repairing of the structure and the function of damaged parts due to ICH,and BDNF has a synergistic effect in this repairing process.%目的 观察骨髓间质干细胞(MSCs)联合脑源性神经营养因子(BDNF)治疗大鼠脑出血(ICH)的疗效.方法建立大鼠ICH模型,体外培养标记纯化的MSCs,经侧脑室植入脑部,同时局部注入BDNF.记录对照组、BDNF组、MSCs组和MSCs+ BDNF组7d、14d、21d大鼠神经功能改善程度;免疫组化法检测MSCs脑内迁移及分化;电子显微镜观察神经凋亡细胞.结果MSCs组大鼠运动功能有明显改善,MSCs+ BDNF组对ICH损伤的修复作用最明显.MSCs+BDNF组各时间点MSCs阳性细胞数及NEUN、GFAP、CNP免疫阳性细胞数均高于MSCs组(P<0.01),且MSCs+BDNF组神经细胞凋亡程度最轻.结论MSCs脑部移植可促进大鼠ICH损伤部位结构和功能修复,BDNF对其修复具有协同作用.

  1. Effects of atorvastatin on apoptosis and cytochrome c expression in perihematoma tissue after intracerebral hemorrhage in rats%阿托伐他汀对大鼠脑出血后血肿周围组织细胞凋亡和细胞色素c表达的影响

    Institute of Scientific and Technical Information of China (English)

    王跃华; 林贵军; 饶芝国

    2013-01-01

    .80)个对(13.67±2.94)个;P=0.349].结论 阿托伐他汀可抑制脑出血后血肿周围神经细胞CytC释放,从而抑制CytC介导的细胞凋亡,减轻脑出血后脑神经功能缺损.%Objective To investigate the effect of atorvastatin on cytochrome c (CytC) expression and neuronal apoptosis after intracerebral hemorrhage in rots.Methods A total of 108 male Sprague-Dawley rats were randomly allocated into 3 groups:sham operation group,saline control group,and atorvastatin group (n =36 each group).All the groups were redivided into 6 h,12 h,day 1,3,5 and 7 time points (n =6 at each time point).An intracerebral hemorrhage model was induced by using a modified two-step injection method.After modeling,atorvastatin was used for gavages (20 rng/kg,once a day) in the atorvastatin group.The saline control group was given the same volume of saline.Behavior evaluation was used for neurological score.TUNEL staining was used to detect apoptosis in perihematoma tissue.Immunohistochemical method was used to detect the CytC expression in perihematoma tissue.Results Behavior evaluation showed that the neurological scores decreased gradually with the passage of time in the atorvastatin group and the saline control group.There were no significant differences at 6 h,12 h,day 1 and day 3,but the neurological scores in the atorvastatin group were significantly lower than those in thc saline control group at day 5 (0.50 ± 0.55 vs.1.50 ± 0.55; t =3.162,P =0.010) and day 7 (1.00 ±0.63; t =2.712,P =0.022).TUNEL staining showed that the numbers of apoptotic cells increased first and then decreased in the saline control group and the atorvastatin group.They reached the peak at 1 hour after modeling.There were significant differences in the number of apoptotic cells in each group in perihematoma tissue at the same time point (all P =0.000),and the significance in the saline control group was more than that in the sham operation group and the atorvastatin group (all P <0.05),but at

  2. 吡格列酮对大鼠脑出血后脑组织细胞凋亡及自由基水平的影响%Effects of Pioglitazone on Cell Apoptosis and Free Radical Levels in Brain Tissue of Rats withIntracerebral Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    韩宁; 吴丹红; 黄菲菲; 孙姬

    2012-01-01

    Aim: To investigate the protective effect of pioglitazone on intracerebral hemorrhage in rats and its possible mechanism. Methods: A total of 72 male SD rats were divided randomly into six groups. Intervention group 1 (n=12): Pioglitazone peroxisome proliferator-activated receptor gamma(PPAR7 activator) were gastrically administrated 6 h before modeling, and the original dosages were maintained after modeling. Intervention group 2 (n=12): Pioglitazone were gastrically administrated 6 h before modeling, and were withdrawn after modeling. Intervention group 3 (n=12): The drugs were not given before modeling, and were gastrically administrated after modeling. Model group 4 (n=12): The drags were not given before and after modeling. Sham operation group (n=12): The rats were performed with needling insertion without injection. Normal group (n=12) was set up. The dose of gastrically administrated pioglitazone was 15 mg·kg-1d-1. Rats in each group were sacrificed at 72 h after operation. Biochemical detection of the superoxide dismutase (SOD) and malondialdehyde (MDA) concentration of brain tissue were performed. The Western blot was used to determine the PPARy and caspase-3 protein expression in brain tissue. HE and TUNEL staining were used to observe the brain edema and apoptosis respectively. Results: PPARy activator pioglitazone could significantly reduce the extent of brain edema and inflammatory cell infiltration of the brain tissue in rats at 72 h after cerebral hemorrhage, as well as reduce the number of apoptotic cells in brain tissue, and enhance the SOD activity and increase the expression of PPARy, and caspase-3 protein in brain tissue, and inhibit the MDA levels. The effect of prophylactic administration of piogiitazone before cerebral hemorrhage was better than that of the treatment after hemorrhage. Conclusion: PPARy activator pioglitazone can relieve the hemorrhagic brain injury in the rat brain, and protect the brain, possibly by increasing the PPARy

  3. Neural stem cell activation and proliferation in situ after intracerebral hemorrhage:an experimental study in adult rats%大鼠脑出血后内源性神经干细胞激活和增殖的实验研究

    Institute of Scientific and Technical Information of China (English)

    刘安民; 蔡望青; 麦荣康; 李方成; 邓跃飞; 胡震; 李军亮; 潘伟生

    2008-01-01

    目的 观察大鼠脑出血模型内源性神经干细胞(NSCs)的激活、增殖情况及其对神经行为学表现的影响.方法 将72只SD大鼠按单双号分为脑出血组和假手术组.每组36只.脑出血组利用立体定向技术,将一定量的Ⅳ型胶原酶用微量进样器分别精确注入大鼠内囊诱导脑出血模型.假手术组注射等量体积的PBS.分别于术后1、7、14、21、28和35 d观察大鼠的神经功能表现.所有大鼠处死前1 d腹腔内注射5.溴脱氧尿嘧啶(BrdU),免疫组织化学方法动态检测大鼠脑内巢蛋白(nestin)和BrdU的表达.结果 假手术组大鼠脑内未见nestin和BrdU的表达.脑出血组血肿周围基底节和脑室下区可见nestin和BrdU的表达.脑出血后7 d后开始明显增加.14 d达高峰,21 d开始下降.28d恢复正常.脑出血后l~35d大鼠神经功能无明显恢复,与内源性NSCs的增殖程度无明显相关.结论 脑出血可导致内源性NSCs的激活和诱导其增殖:然而这种状态下NSCs的增殖能力和内源性NSCs对脑出血后神经功能缺损的修复均有限.%Objective To observe neural stem cell activation and proliferation in situ afterintracerebal hemorrhage (ICH) and its effect on the neurological function of the injured adult rats.Methods Seventy-two adult rats were randomized into ICH and sham operation groups (n=36). In theICH group, type Ⅳ collagenase was injected into the internal capsule through a microinfusion pump toinduce intracerebral hemorrhage, and the rats in the sham operation group received only phosphate buffersolution injection. The neurological functions of the rats were observed by rotarod motor test on days 1, 7,14, 21, 28, and 35 after the injection. One day before sacrifice, the rots were subjected to intraperitonealBrdU injection to label the regenerated cells, and immunohistochemistry was used to detect theexpressions of nestin and BrdU in the brain tissue. Results No nestin- or BrdU-positive cells werefound

  4. Acute cerebral paragonimiasis presenting as hemorrhagic stroke in a child.

    Science.gov (United States)

    Chen, Zhi; Zhu, Gang; Lin, Jiangkai; Wu, Nan; Feng, Hua

    2008-08-01

    A hemorrhagic stroke in children is rarely secondary to cerebral paragonimiasis. We describe a 9-year-old boy in whom an intracerebral hemorrhage was the leading clinical indication of acute cerebral paragonimiasis. He was hospitalized because of a sudden onset of headache, right hemiparesis, and dysarthria. A computed tomography scan revea