Brain Hemorrhages最新文献

{"title":"Recent trends of treatment strategies and outcomes of basal ganglia hemorrhages at a single institution","authors":"","doi":"10.1016/j.hest.2024.03.001","DOIUrl":"10.1016/j.hest.2024.03.001","url":null,"abstract":"<div><h3>Objective</h3><div>The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) Trial was designed to evaluate the minimally invasive <em>trans</em>-sulcal parafascicular surgery (MIPS) approach, a technique advertised for safe access to deep brain structures and ICH removal using the BrainPath® and Myriad® devices (NICO Corporation, Indianapolis, IN). However, basal ganglia hemorrhages (BGHs) were determined to meet the a priori futility rule, resulting in exclusion from further trial enrollment consideration. Since screening for ICH is initiated immediately upon presentation of symptom bearing patients, treatment is curtailed to best preserve remaining neurological function. We sought to determine whether immediate exclusion from consideration of trial enrollment resulted in poorer patient outcomes despite best medical or surgical management.</div></div><div><h3>Methods</h3><div>A retrospective, observational, cohort analysis was performed on data extrapolated from our institution’s intracranial hemorrhage (ICH) screening log. All patients included in this study either (1) were excluded from the ENRICH trial for not meeting trial inclusion criteria or (2) presented on and after February 27<sup>th</sup>, 2019 when BGHs. This inflection point in time was chosen based on the ENRICH trial’s decision to enact an a priori futility rule. Demographical, medical comorbities, presenting features, treatment characteristics, and outcomes were collected by chart review on all patients. These dichotimized groups were compared by univariate and multivariate statistical approaches. The main outcome of interest was functional status at 90 days as measured by the modified Rankin Scale.</div></div><div><h3>Results</h3><div>There were 52 patients with BGHs who presented before the interim exclusion decision, and 67 patients who presented after. The proportion of patients with intraventricular hemorrhage (IVH) occupying > 50 % of either lateral ventricle was higher in the “before” group (40.4 % vs 20.9 %, p = 0.026). There was a significant difference in the evacuation method used, with more patients in the “after” group undergoing craniotomy (10.5 % vs 0 %, p = 0.018). The 90-day mRS scores of 0–2 were significantly lower for patients who presented after the interim exclusion (16.4 % vs 36.5 %, p = 0.019). The 180-day mortality was not significantly different between the two groups (p = 0.56). In multivariate logistical regression, diabetes mellitus, hematoma volume at presentation, and presentation date were significant predictors of a “good” neurological outcome (90-day mRS score of 0–2). A 1 mL increase in hematoma volume at presentation was associated with a 4 % decrease in the likelihood of a good outcome (OR = 0.960, 95 % CI = 0.924–0.997, p = 0.033). Patients who presented after the interim exclusion had a 79.5 % lower likelihood of a “good” neurological outcome compared to those who presented before the interim exclusion (OR = 0.20","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous arterial blood pressure indices and early hematoma expansion in patients with spontaneous intracerebral hemorrhage","authors":"","doi":"10.1016/j.hest.2024.06.001","DOIUrl":"10.1016/j.hest.2024.06.001","url":null,"abstract":"<div><h3>Objective</h3><div>Blood pressure variability (BPV) and its potential association with early hematoma expansion (HE) in intracerebral hemorrhage (ICH) remains to be fully elucidated. Our study explores the potential link between BPV within the first 24 h after admission and HE in ICH.</div></div><div><h3>Methods</h3><div>In a prospective cohort single-center study, we analyzed consecutive patients with spontaneous ICH. Continuous BP data via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) were analyzed over 0–2, 0–8, 0–12, and 0–24 h intervals post-admission. BPV was assessed through successive variability (SV), standard deviation (SD), and coefficient of variation (CV) using all available BP measurements. Early HE was defined as an absolute [≥ 6 ml] or relative [≥ 33 %] increase in ICH volume on 24-hours follow-up brain imaging. Secondary endpoints were the influence of BP on admission and other potential risk factors for HE.</div></div><div><h3>Results</h3><div>Among 305 ICH-patients (mean age ± SD 70.1 ± 14.9 years, 47.9 % female, median NIHSS 6 (3, 13), median ICH score 1 (1, 2)), 41 (13.4 %) experienced HE. HE-patients had higher NIHSS (p = 0.015), ICH-score (p = 0.005), ICH volume (p &lt; 0.001) and higher pre-anticoagulation treatment (p = 0.004) on admission. There was no difference in BPV comparing ICH-patients with HE to those without. However, patients with HE had significantly lower diastolic BP (76.6 ± 14.8 vs. 86.3 ± 19.7 mmHg, p = 0.005) and MAP (103.2 ± 22.4 vs. 112.2 ± 22.6, p = 0.027) on admission. This pattern of lower diastolic BP persisted across the first 24 h. Logistic regression revealed larger ICH volume and pre-existing anticoagulation as significant predictors of HE, with higher initial diastolic BP reducing HE risk. Hemorrhages ≥ 30 cm³ showed significantly lower initial diastolic BP, MAP, and BPV across all time frames compared to ICH &lt; 30 cm³.</div></div><div><h3>Conclusions</h3><div>BPV within the first 24 h was not associated with HE. Lower diastolic BP on admission, anticoagulation use, and larger ICH volume are potential predictors for HE. However, larger hemorrhage size (&gt;30 cm³) experienced lower absolute BP and BPV indices and worse clinical outcomes. These findings suggest a nuanced relationship between BP dynamics and ICH severity, underscoring the need for individualized BP management in acute ICH care. Further research is necessary to explore these relationships and optimize treatment strategies.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141393174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum cholesterol and interleukin-10 are associated with post-intracerebral hemorrhage depression in patients with acute primary supratentorial intracerebral hemorrhage","authors":"","doi":"10.1016/j.hest.2024.05.006","DOIUrl":"10.1016/j.hest.2024.05.006","url":null,"abstract":"<div><h3>Objectives</h3><div>This study explores the correlation between serum cholesterol, interleukin-10 (IL-10), macrophage migration inhibitory factor (MIF), and post-intracerebral hemorrhage (post-ICH) depression in patients with acute ICH.</div></div><div><h3>Methods</h3><div>35 patients with acute primary supratentorial ICH were recruited. Serum cholesterol, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), and low-density lipoprotein cholesterol (LDLC), IL-10, and MIF were measured in the first morning after admission. Additionally, a 24-item Hamilton Depression Scale (HAMD-24) was used to detect depressive symptoms one week after admission. HAMD scores ≥ 8 indicated a diagnosis of post-ICH depression.</div></div><div><h3>Results</h3><div>The levels of TC were significantly lower in ICH patients with depression compared to those without [169.26(139.23–215.67) mg/dL vs. 200.46(182.81–224.74) mg/dL, <em>P</em> = 0.010]. Similarly, levels of LDLC [102.18(78.39–137.28) mg/dL vs. 135.14(120.22–170.63) mg/dL, <em>P</em> = 0.001] and IL-10 [17.56(16.03–22.52) pg/mL vs. 31.17(23.42–37.53) pg/mL, <em>P</em> = 0.001] were also lower in patients with post-ICH depression. Furthermore, the levels of TC (r = -0.433, <em>P</em> = 0.009), TG (r = -0.345, <em>P</em> = 0.043), LDLC (r = -0.549, <em>P</em> = 0.001), and IL-10 levels (r = -0.603, <em>P</em> &lt; 0.001) showed negative correlations with the HAMD scores. Logistic regression analysis indicated that higher IL-10 levels (OR = 0.847, 95 % CI = 0.717–0.999, <em>P</em> = 0.049) were indicative of protection against post-ICH depression in the acute phase.</div></div><div><h3>Conclusion</h3><div>Lower levels of TC, LDLC, and IL-10 were associated with post-ICH depression during the acute phase. Furthermore, decreased levels of IL-10 may serve as a promising predictor for post-ICH depression.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of mesenchymal stem cell-derived exosomes on the inflammatory response after stroke","authors":"","doi":"10.1016/j.hest.2024.04.003","DOIUrl":"10.1016/j.hest.2024.04.003","url":null,"abstract":"<div><div>Stroke, characterized by sudden onset and significant mortality rates, represents a critical challenge in effectively treating neuroinflammation to improve treatment efficacy. In this context, mesenchymal stem cell (MSC)-derived exosomes have attracted significant attention in scientific research due to their diverse cellular origin, tiny size, and huge number of bioactive molecules. Recent studies have shed light on the remarkable potential of MSC-derived exosomes to not only suppress the inflammatory responses of microglia and astrocytes, but also enhance their neuroprotective functions. Moreover, these exosomes have demonstrated a remarkable ability to modulate various immune cells and inflammatory mediators, thereby exerting profound mitigating effects on neuroinflammation. Through a thorough examination of the role and underlying mechanisms of MSC-derived exosomes in mitigating neuroinflammation after stroke, this review aims to provide comprehensive information and recommendations for the development of innovative therapeutic strategies aimed at significantly improving the treatment of stroke.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhage of the hypothalamic cavernous malformation. Clinical case of surgical treatment","authors":"","doi":"10.1016/j.hest.2024.04.005","DOIUrl":"10.1016/j.hest.2024.04.005","url":null,"abstract":"<div><h3>Objective</h3><div>To study the clinical and neurologic symptoms and to determine the indications for surgical treatment of hypothalamic cavernous malformations.</div></div><div><h3>Methods</h3><div>We reviewed scientific literature devoted to hypothalamic cavernomas and compared the clinical symptomatology with our clinical case.</div></div><div><h3>Results</h3><div>The article describes the clinical manifestations of the presented case. A comparative analysis of previously described cases was carried out, and the retionale was presented on the possibility of clinical manifestations depending on the direction of extra-focal hemorrhage. Diagnostic and differential diagnostic aspects of cavernomas of this localization are also described. A case of successful surgical treatment of cavernous malformation of the hypothalamus is presented, and it is also shared with the motives of supporters of conservative treatment by other authors.</div></div><div><h3>Conclusion</h3><div>This case and literature review illustrate the variability of neurological symptoms of hypothalamic cavernous malformation haemorrhage and describe indications for surgical treatment.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain hemorrhages in traumatic brain injury and the excess burden conferred by anticoagulants and antiplatelets","authors":"","doi":"10.1016/j.hest.2024.05.003","DOIUrl":"10.1016/j.hest.2024.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to compare the severity of head injury in patients on an anticoagulant or antiplatelet agent and to look at the burden of these medications in patients 55 + years vs. younger.</div></div><div><h3>Methods</h3><div>This was an observational cohort study of 2256 adult head trauma patients who presented to a Level I Trauma Center and were stratified by anticoagulant/antiplatelet medication use and age. Logistic regression analyses were performed to ascertain whether use of these medications resulted in worse outcomes.</div></div><div><h3>Results</h3><div>Overall, elderly (&gt;55yrs) patients had worse outcomes after TBI. Specifically, they were more likely to have an intracranial hemorrhage, be admitted to the hospital, have an ICU stay, be re-admitted within 30 days, die in the hospital and be dead within 3 months.</div></div><div><h3>Conclusion</h3><div>Geriatric trauma patients along with their preexisting comorbidities are often on anticoagulants that increase their risk for complications, bleeding, mortality in the setting of even minor traumas.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VASP, HCLS1, MSN, and EZR: Key molecular beacons in the pathophysiology of perihematomal edema Post-Intracerebral hemorrhage","authors":"","doi":"10.1016/j.hest.2024.04.002","DOIUrl":"10.1016/j.hest.2024.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>Perihematomal edema (PHE) is one of the significant secondary cerebral damages, with the blood–brain barrier's integrity playing a pivotal role in its progression. Strengthening tight junction (TJ) proteins enhances blood–brain barrier integrity, yet the complex genetics behind brain edema remain not fully understood. Our research endeavors to uncover pivotal genes and their roles in brain edema following cerebral hemorrhage, and to investigate potential treatment strategies.</div></div><div><h3>Methods</h3><div>By analyzing intracerebral hemorrhage (ICH) and control samples using the GSE216607 and GSE206971 datasets, we identified differentially expressed genes. Cross-referencing with the KEGG database, we aligned these genes with those related to tight junctions. Extensive enrichment analysis and protein interactions were performed to examine the expression and clinical significance of the identified genes. Our study employed the C57BL/6J mouse ICH model and qRT-PCR for key gene validation.</div></div><div><h3>Results</h3><div>Notably, VASP, HCLS1, MSN, and EZR, critical for tight junctions, showed increased expression post-ICH, emphasizing their significance in BBB upkeep and PHE progression. Drug validation indicated potential therapeutic effects of Testosterone enanthate, SELENIUM, and LY 294002 on tight junction-related genes.</div></div><div><h3>Conclusion</h3><div>This study sheds light on the potential involvement of these genes in brain edema progression post-ICH, offering promising therapeutic targets. Further research is needed for deeper understanding.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140789592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of different imaging modalities in the detection rate of intracranial aneurysm remnants after microsurgical clipping – A systematic review and meta-analysis","authors":"","doi":"10.1016/j.hest.2024.07.002","DOIUrl":"10.1016/j.hest.2024.07.002","url":null,"abstract":"<div><h3>Objective</h3><div>While the long-term durability of completely clipped intracranial aneurysms (IA) is excellent, IA with remnants poses a significant risk for future re-growth with subsequent need for long-term follow-up or requirement for retreatment. We aim at reviewing the detection rate of IA remnants after clip ligation in the imaging modalities used to date.</div></div><div><h3>Methods</h3><div>A systematic review was performed according to the PRISMA guidelines using the PubMed/Medline database. The search terms included “intracranial aneurysm” AND “remnant” either in combination with “digital subtraction angiography” OR “computed tomography angiography” OR “indocyanine green video angiography”.</div></div><div><h3>Results</h3><div>The overall observed prevalence of IA remnants after clipping was 5.9 %, 10.9 %, 12.5 %, 14.1 % and 28.3 %, using ICG-VA, intraoperative 2D-DSA, CTA, and 3D-DSA, respectively. In studies comparing all imaging modalities altogether, 3D-DSA performed significantly better (p &lt; 0.001) than any other single modality. The diagnostic yield of CTA and DSA gradually improved over time. Irrespective of imaging modality the percentage of IA remnants is higher in ruptured than unruptured IAs.</div></div><div><h3>Conclusion</h3><div>Although the diagnostic yield of CTA and 2D-DSA have substantially improved over recent years 3D-DSA provides the highest overall detection rate of clipped IA remnants. In direct comparison, 3D-DSA performs better than any other imaging modality.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased plasma pigment epithelium-derived factor (PEDF) concentrations as a negative predictor of angiographic vasospasm after aneurysmal subarachnoid hemorrhage","authors":"","doi":"10.1016/j.hest.2024.02.001","DOIUrl":"10.1016/j.hest.2024.02.001","url":null,"abstract":"<div><h3>Objective</h3><p>Cerebral vasospasm remains a major determinant of delayed cerebral ischemia (DCI) and poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). This study was aimed to investigate if a matricellular protein pigment epithelium-derived factor (PEDF) can be a biomarker of angiographic vasospasm (aVSP) after SAH.</p></div><div><h3>Methods</h3><p>In 197 consecutive patients with aneurysmal SAH, plasma PEDF concentrations were serially measured at days 1–12 post-SAH.</p></div><div><h3>Results</h3><p>Plasma PEDF concentrations in SAH patients were elevated compared with patients with unruptured cerebral aneurysms, and especially higher in patients with admission World Federation of Neurological Surgeons (WFNS) grades IV–V. However, higher plasma PEDF concentrations at days 1–3 and 10–12 were associated with no development of aVSP. In an analysis limited to 72 non-sedated patients with preoperative WFNS grades I–III, plasma PEDF concentrations were also significantly higher in patients with neither DCI nor aVSP. Multivariate analysis showed that increased plasma PEDF concentration at days 1–3 was an independent predictor of no development of aVSP.</p></div><div><h3>Conclusion</h3><p>This was the first study to measure plasma PEDF concentrations and to show the relationships with aVSP development in SAH patients. PEDF may act protectively against aVSP, and serve as a negative biomarker and a target for drug discovery for aVSP.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X24000147/pdfft?md5=886bf25ddd8a2763e2546c402cad65f7&pid=1-s2.0-S2589238X24000147-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139892945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum Regarding Previously Published Articles","authors":"","doi":"10.1016/j.hest.2023.11.009","DOIUrl":"10.1016/j.hest.2023.11.009","url":null,"abstract":"","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589238X23000608/pdfft?md5=098869fa876c226ab20f83c422795141&pid=1-s2.0-S2589238X23000608-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138625438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}