Pub Date : 2024-12-01DOI: 10.1016/j.hest.2024.08.003
Ozal Beylerli , Rustam Talybov , Elmar Musaev , Tatyana Trofimova , Huaizhang Shi , Tatiana Ilyasova , Valentin Pavlov
Patients with malignant tumors face an elevated risk of cerebrovascular complications, such as intratumoral hemorrhage, tumor invasion into arterial and venous sinuses, leptomeningeal infiltration, and tumor embolism. This review examines the significant role and implications of cisplatin and radiation therapy in the development of these cerebrovascular complications, which can occur at various stages: before, during, or long after the completion of cancer treatment. Detailed clinical case studies of CNS involvement during oncological therapy are presented to illustrate these complications. The mechanisms by which cisplatin and radiation therapy contribute to cerebrovascular disorders are multifaceted. Cisplatin, a widely used chemotherapeutic agent, is associated with endothelial damage and thromboembolic events, while radiation therapy can cause vascular injury, leading to long-term changes in cerebral vasculature. These treatments, though effective in managing malignancies, pose significant risks to cerebrovascular health. The review underscores the diverse types and mechanisms of stroke encountered in cancer patients, influenced by tumor stage and pathological characteristics. These include ischemic stroke, hemorrhagic stroke, and transient ischemic attacks, each requiring specific diagnostic and therapeutic strategies. The interaction between cancer pathology and cerebrovascular health necessitates a multidisciplinary approach, integrating oncology, neurology, radiology, and vascular surgery. Such an approach is crucial for effective management and prognosis evaluation in this patient population. Early recognition and intervention are paramount to mitigating risks and improving outcomes. By understanding these complex interactions, healthcare providers can better anticipate and manage cerebrovascular risks in patients undergoing cancer treatment. This comprehensive understanding helps in formulating personalized treatment plans, optimizing both oncological and neurological care, and ultimately enhancing patient quality of life and survival rates.
{"title":"Cerebrovascular disorders in patients with malignant tumors","authors":"Ozal Beylerli , Rustam Talybov , Elmar Musaev , Tatyana Trofimova , Huaizhang Shi , Tatiana Ilyasova , Valentin Pavlov","doi":"10.1016/j.hest.2024.08.003","DOIUrl":"10.1016/j.hest.2024.08.003","url":null,"abstract":"<div><div>Patients with malignant tumors face an elevated risk of cerebrovascular complications, such as intratumoral hemorrhage, tumor invasion into arterial and venous sinuses, leptomeningeal infiltration, and tumor embolism. This review examines the significant role and implications of cisplatin and radiation therapy in the development of these cerebrovascular complications, which can occur at various stages: before, during, or long after the completion of cancer treatment. Detailed clinical case studies of CNS involvement during oncological therapy are presented to illustrate these complications. The mechanisms by which cisplatin and radiation therapy contribute to cerebrovascular disorders are multifaceted. Cisplatin, a widely used chemotherapeutic agent, is associated with endothelial damage and thromboembolic events, while radiation therapy can cause vascular injury, leading to long-term changes in cerebral vasculature. These treatments, though effective in managing malignancies, pose significant risks to cerebrovascular health. The review underscores the diverse types and mechanisms of stroke encountered in cancer patients, influenced by tumor stage and pathological characteristics. These include ischemic stroke, hemorrhagic stroke, and transient ischemic attacks, each requiring specific diagnostic and therapeutic strategies. The interaction between cancer pathology and cerebrovascular health necessitates a multidisciplinary approach, integrating oncology, neurology, radiology, and vascular surgery. Such an approach is crucial for effective management and prognosis evaluation in this patient population. Early recognition and intervention are paramount to mitigating risks and improving outcomes. By understanding these complex interactions, healthcare providers can better anticipate and manage cerebrovascular risks in patients undergoing cancer treatment. This comprehensive understanding helps in formulating personalized treatment plans, optimizing both oncological and neurological care, and ultimately enhancing patient quality of life and survival rates.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 284-292"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168792","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}
Pub Date : 2024-12-01DOI: 10.1016/j.hest.2024.08.004
Yan Zhang , Qiuyang Su , Guofeng Wu , Nathanael Matei , Shengling Zeng
Intracerebral hemorrhage (ICH) represents a significant health challenge due to its high mortality and severe outcomes. Poly (ADP-ribose) polymerase (PARP) is a chromatin-associated nuclear protease, which would be activated by ROS derived from hematoma metabolites after ICH, and lead to parthanatos, a form of caspase-independent programmed cell necrosis. Recent evidence indicates that PARP activation plays a pivotal role in various human diseases, particularly neurodegenerative disorders, cerebral ischemia–reperfusion injury, and hemorrhagic transformation. However, the link between PARP activation and secondary brain injury (SBI) following ICH remains underexplored. This review delves into the pathological mechanisms of PARP activation in cell injury, with a focus on parthanatos, mitochondrial dysfunction, neuroinflammation, and blood–brain barrier (BBB) disruption after ICH. Understanding these processes may offer new insights into the role of PARP activation in ICH and pave the way for developing more effective therapeutic strategies.
{"title":"Activation of PARP in secondary brain injury following intracerebral haemorrhage","authors":"Yan Zhang , Qiuyang Su , Guofeng Wu , Nathanael Matei , Shengling Zeng","doi":"10.1016/j.hest.2024.08.004","DOIUrl":"10.1016/j.hest.2024.08.004","url":null,"abstract":"<div><div>Intracerebral hemorrhage (ICH) represents a significant health challenge due to its high mortality and severe outcomes. Poly (ADP-ribose) polymerase (PARP) is a chromatin-associated nuclear protease, which would be activated by ROS derived from hematoma metabolites after ICH, and lead to parthanatos, a form of caspase-independent programmed cell necrosis. Recent evidence indicates that PARP activation plays a pivotal role in various human diseases, particularly neurodegenerative disorders, cerebral ischemia–reperfusion injury, and hemorrhagic transformation. However, the link between PARP activation and secondary brain injury (SBI) following ICH remains underexplored. This review delves into the pathological mechanisms of PARP activation in cell injury, with a focus on parthanatos, mitochondrial dysfunction, neuroinflammation, and blood–brain barrier (BBB) disruption after ICH. Understanding these processes may offer new insights into the role of PARP activation in ICH and pave the way for developing more effective therapeutic strategies.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 293-298"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168793","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}
Anterior cerebral artery (ACA) territory infarctions are relatively rare, accounting for 0.3 % to 4.4 % of stroke cases, with bilateral occurrences being even rarer. These infarctions can lead to quadriplegia/paresis. Bilateral ACA territory infarctions are possibly caused by vasospasm due to subarachnoid haemorrhage (SAH) from ruptured anterior communicating artery (ACoA) aneurysms or thrombosis in the presence of a rudimentary contralateral artery. ACoA aneurysm with quadriparesis is extremely unusual, with this being only the second recorded occurrence and the youngest reported. Overall, understanding the mechanisms and consequences of ACA territory infarctions, especially bilateral occurrences, remains crucial for effective diagnosis and management of such rare but serious neurological events.
Case Presentation
A 35-year-old male, previously healthy, presented with quadriparesis and an ACoA aneurysm. Initially experiencing a headache and brief loss of consciousness, he later developed right foot drop and progressive right-sided weakness, leading to altered consciousness. Subsequent imaging revealed SAH consistent with the aneurysm and also bilateral ACA territory infractions. Upon referral for further management, he presented with intact higher mental functions but motor deficits in the upper and lower limbs. Imaging and assessments confirmed the diagnosis, prompting a decision for craniotomy and clipping. Postoperatively, the patient showed improvement, with enhanced power in both upper limbs at one-month follow-up.
Conclusion
Bilateral ACA territory infarction is unusual, and the symptoms are not yet well understood. ACoA aneurysm with quadriparesis is extremely unusual. Understanding the mechanics and clinical consequences of bilateral ACA territory infarctions is critical for early detection and management.
{"title":"Quadriparesis with bilateral anterior cerebral artery infarction following subarachnoid haemorrhage due to rupture of an anterior communicating artery aneurysm: A case report with literature review","authors":"Zain Saleh, Farhat Abbas, Ahtesham Khizar, Bakht Nawaz","doi":"10.1016/j.hest.2024.04.001","DOIUrl":"10.1016/j.hest.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cerebral artery (ACA) territory infarctions are relatively rare, accounting for 0.3 % to 4.4 % of stroke cases, with bilateral occurrences being even rarer. These infarctions can lead to quadriplegia/paresis. Bilateral ACA territory infarctions are possibly caused by vasospasm due to subarachnoid haemorrhage (SAH) from ruptured anterior communicating artery (ACoA) aneurysms or thrombosis in the presence of a rudimentary contralateral artery. ACoA aneurysm with quadriparesis is extremely unusual, with this being only the second recorded occurrence and the youngest reported. Overall, understanding the mechanisms and consequences of ACA territory infarctions, especially bilateral occurrences, remains crucial for effective diagnosis and management of such rare but serious neurological events.</div></div><div><h3>Case Presentation</h3><div>A 35-year-old male, previously healthy, presented with quadriparesis and an ACoA aneurysm. Initially experiencing a headache and brief loss of consciousness, he later developed right foot drop and progressive right-sided weakness, leading to altered consciousness. Subsequent imaging revealed SAH consistent with the aneurysm and also bilateral ACA territory infractions. Upon referral for further management, he presented with intact higher mental functions but motor deficits in the upper and lower limbs. Imaging and assessments confirmed the diagnosis, prompting a decision for craniotomy and clipping. Postoperatively, the patient showed improvement, with enhanced power in both upper limbs at one-month follow-up.</div></div><div><h3>Conclusion</h3><div>Bilateral ACA territory infarction is unusual, and the symptoms are not yet well understood. ACoA aneurysm with quadriparesis is extremely unusual. Understanding the mechanics and clinical consequences of bilateral ACA territory infarctions is critical for early detection and management.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 299-302"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762048","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}
Pub Date : 2024-12-01DOI: 10.1016/j.hest.2024.07.009
Yingxin Tang
{"title":"Brain Hemorrhages has specially appointed Professor Wang Yongjun from Beijing Tiantan Hospital as Honorary Editor-in-Chief","authors":"Yingxin Tang","doi":"10.1016/j.hest.2024.07.009","DOIUrl":"10.1016/j.hest.2024.07.009","url":null,"abstract":"","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 303-304"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846609","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}
Pub Date : 2024-12-01DOI: 10.1016/j.hest.2024.06.002
Hannaly Cheuk Hang Lui , Yuen Ting Ng , Simon Chun Ho Yu , James Tin Fong Zhuang , George Kwok Chu Wong
Objective
The purposes of this study were to retrospectively review mid-term outcomes of stent-assisted coil embolization for acutely ruptured cerebral aneurysms, and to identify risk factors.
Methods
Between April 2013 and October 2018, thirty-four consecutive patients had stent-assisted coil embolization for treatment of acutely ruptured cerebral aneurysms that were not amendable by simple coiling. Hospital subarachnoid hemorrhage registry and notes on hospital electronic medical systems were retrospectively reviewed. All patients had a dose of intravenous abciximab 10 mg and heparin 2000 units before stenting and started dual antiplatelet therapy after procedure.
Results
Of the thirty-four consecutive patients, twenty-six (76 %) were treated with braided stents and eight (24 %) were treated with laser-cut stents. There was no rebleeding in thirty-two patients who achieved total aneurysmal occlusion or residual neck only. Rebleeding occurred in two patients who only achieved partial embolization, resulting in mortality. There were three (9 %) thromboembolic complications, in which two were ADL-independent upon hospital discharge and the one with WFNS Grade V succumbed. Twenty (59 %) patients achieved clinical favorable outcomes (mRS 0–2) at follow-up (mean+/-SD: 17+/-15 months). The need of EVD insertion was a statistically significant risk factor for procedure-related cerebral infarction, intracerebral hemorrhage and 30-day mortality. The GOS and mRS were closely related to the need of EVD insertion and sidewall location of aneurysm.
Conclusions
The study established the efficacy and safety profile of stent-assisted embolization for treatment acutely ruptured cerebral aneurysms. The embolization goal should be total aneurysmal occlusion or with minimal residual neck to prevent rebleeding and reduce mortality. The use of such technique should be considered when simple coiling or microsurgical clipping is not feasible or suitable. The need of EVD insertion is an independent risk factor for intracerebral hematoma and 30-day mortality. When needed, EVD insertion shall be considered before antiplatelet agents, and require exceptionally meticulous hemostasis intraoperatively.
{"title":"Mid-term outcomes in stent-assisted coil embolization for ruptured cerebral aneurysms in the acute period: A single institution retrospective review","authors":"Hannaly Cheuk Hang Lui , Yuen Ting Ng , Simon Chun Ho Yu , James Tin Fong Zhuang , George Kwok Chu Wong","doi":"10.1016/j.hest.2024.06.002","DOIUrl":"10.1016/j.hest.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>The purposes of this study were to retrospectively review mid-term outcomes of stent-assisted coil embolization for acutely ruptured cerebral aneurysms, and to identify risk factors.</div></div><div><h3>Methods</h3><div>Between April 2013 and October 2018, thirty-four consecutive patients had stent-assisted coil embolization for treatment of acutely ruptured cerebral aneurysms that were not amendable by simple coiling. Hospital subarachnoid hemorrhage registry and notes on hospital electronic medical systems were retrospectively reviewed. All patients had a dose of intravenous abciximab 10 mg and heparin 2000 units before stenting and started dual antiplatelet therapy after procedure.</div></div><div><h3>Results</h3><div>Of the thirty-four consecutive patients, twenty-six (76 %) were treated with braided stents and eight (24 %) were treated with laser-cut stents. There was no rebleeding in thirty-two patients who achieved total aneurysmal occlusion or residual neck only. Rebleeding occurred in two patients who only achieved partial embolization, resulting in mortality. There were three (9 %) thromboembolic complications, in which two were ADL-independent upon hospital discharge and the one with WFNS Grade V succumbed. Twenty (59 %) patients achieved clinical favorable outcomes (mRS 0–2) at follow-up (mean+/-SD: 17+/-15 months). The need of EVD insertion was a statistically significant risk factor for procedure-related cerebral infarction, intracerebral hemorrhage and 30-day mortality. The GOS and mRS were closely related to the need of EVD insertion and sidewall location of aneurysm.</div></div><div><h3>Conclusions</h3><div>The study established the efficacy and safety profile of stent-assisted embolization for treatment acutely ruptured cerebral aneurysms. The embolization goal should be total aneurysmal occlusion or with minimal residual neck to prevent rebleeding and reduce mortality. The use of such technique should be considered when simple coiling or microsurgical clipping is not feasible or suitable. The need of EVD insertion is an independent risk factor for intracerebral hematoma and 30-day mortality. When needed, EVD insertion shall be considered before antiplatelet agents, and require exceptionally meticulous hemostasis intraoperatively.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 267-273"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402885","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}
Pub Date : 2024-12-01DOI: 10.1016/j.hest.2024.07.006
Natasha Cordeiro dos Santos, Nathan Nascimento Loureiro, Larissa Santana Correia, Roque Aras Junior
Introduction
Glibenclamide (GBC), although traditionally used to treat type 2 diabetes mellitus, has demonstrated efficacy in preventing cerebral edema in the setting of stroke, including preserving the integrity of the vascular endothelium, reducing edema and inhibiting brain death. The objective is to investigate the effects of glibenclamide in individuals who have suffered a stroke.
Methods
This is a systematic review. The following databases were used: EMBASE, MEDLINE, Lilacs, Scielo, Cochrane Library and Science Direct. Data collection was carried out from June to November 2023. Studies were included in which the effects of glibenclamide were evaluated in individuals (of both sexes and without age restrictions) diagnosed with stroke. The studies should have been published in the last 10 years; there was no restriction on the language of publication. Review studies and studies that included other pathologies in the same group were excluded.
Results
10 articles were included. The total number of participants was 853 individuals. The results of the studies demonstrated, in general, lower mortality, reduction in midline displacement and cerebral edema in the groups that used glibencamide. There were no hemorrhagic events or hypoglycemia.
Conclusions
The use of glibenclamide had a favorable effect on individuals who had suffered a stroke. However, new studies with a larger sample size and involving other databases are needed so that these results can be generalized and the use of GBC in stroke can be validated.
{"title":"Effects of glibenclamide/glyburide on stroke: Systematic review","authors":"Natasha Cordeiro dos Santos, Nathan Nascimento Loureiro, Larissa Santana Correia, Roque Aras Junior","doi":"10.1016/j.hest.2024.07.006","DOIUrl":"10.1016/j.hest.2024.07.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Glibenclamide (GBC), although traditionally used to treat type 2 diabetes mellitus, has demonstrated efficacy in preventing cerebral edema in the setting of stroke, including preserving the integrity of the vascular endothelium, reducing edema and inhibiting brain death. The objective is to investigate the effects of glibenclamide in individuals who have suffered a stroke.</div></div><div><h3>Methods</h3><div>This is a systematic review. The following databases were used: EMBASE, MEDLINE, Lilacs, Scielo, Cochrane Library and Science Direct. Data collection was carried out from June to November 2023. Studies were included in which the effects of glibenclamide were evaluated in individuals (of both sexes and without age restrictions) diagnosed with stroke. The studies should have been published in the last 10 years; there was no restriction on the language of publication. Review studies and studies that included other pathologies in the same group were excluded.</div></div><div><h3>Results</h3><div>10 articles were included. The total number of participants was 853 individuals. The results of the studies demonstrated, in general, lower mortality, reduction in midline displacement and cerebral edema in the groups that used glibencamide. There were no hemorrhagic events or hypoglycemia.</div></div><div><h3>Conclusions</h3><div>The use of glibenclamide had a favorable effect on individuals who had suffered a stroke. However, new studies with a larger sample size and involving other databases are needed so that these results can be generalized and the use of GBC in stroke can be validated.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 274-283"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845535","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}
Pub Date : 2024-12-01DOI: 10.1016/j.hest.2024.08.005
Haomiao Wang , Shitao Fan , Jinxin Lin , Xuyang Zhang , Tengyuan Zhou , Ran Luo , Chao Zhang , Shuixian Zhang , Qingwu Yang , Rong Hu
Objective
Cerebral small vessel disease (CSVD) and its associated stroke are significant contributors to mortality and long-term disability globally. Despite this, there remains a lack of established predictors or preventive strategies for stroke mediated by CSVD, beyond the management of hypertension. In this study, we explored the potential utility of imaging-derived phenotypes (IDPs) of white matter (WM) as risk predictors for CSVD-mediated stroke and clarify the underlying causal relationships.
Methods
We performed a genetic correlation analysis to assess the relationship between WM IDPs and CSVD-mediated stroke, identifying genetically correlated pairs for follow-up Mendelian randomization (MR) studies. Subsequently, we examined the mediating role of WM IDPs in the correlation between blood pressure (BP) traits and CSVD-mediated stroke.
Results
Our findings demonstrate a significant causal relationship between genetic predisposition to increased isotropic or free water volume fraction (ISOVF) in the anterior limb of the left internal capsule (ALLIC) and CSVD-mediated stroke (IVW: odds ratio [OR] = 1.57; 95 % CI: 1.25 to 1.96, p = 8.27 × 10–5).
Conclusions
This study provides evidence for a potential causal link between WM IDPs and CSVD-mediated stroke, which may enhance the predictive capacity for CSVD-mediated stroke.
{"title":"Assessment of causal relationships between white matter brain imaging-derived phenotypes and CSVD-mediated Stroke: Genetic correlation and Mendelian randomization","authors":"Haomiao Wang , Shitao Fan , Jinxin Lin , Xuyang Zhang , Tengyuan Zhou , Ran Luo , Chao Zhang , Shuixian Zhang , Qingwu Yang , Rong Hu","doi":"10.1016/j.hest.2024.08.005","DOIUrl":"10.1016/j.hest.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>Cerebral small vessel disease (CSVD) and its associated stroke are significant contributors to mortality and long-term disability globally. Despite this, there remains a lack of established predictors or preventive strategies for stroke mediated by CSVD, beyond the management of hypertension. In this study, we explored the potential utility of imaging-derived phenotypes (IDPs) of white matter (WM) as risk predictors for CSVD-mediated stroke and clarify the underlying causal relationships.</div></div><div><h3>Methods</h3><div>We performed a genetic correlation analysis to assess the relationship between WM IDPs and CSVD-mediated stroke, identifying genetically correlated pairs for follow-up Mendelian randomization (MR) studies. Subsequently, we examined the mediating role of WM IDPs in the correlation between blood pressure (BP) traits and CSVD-mediated stroke.</div></div><div><h3>Results</h3><div>Our findings demonstrate a significant causal relationship between genetic predisposition to increased isotropic or free water volume fraction (ISOVF) in the anterior limb of the left internal capsule (ALLIC) and CSVD-mediated stroke (IVW: odds ratio [OR] = 1.57; 95 % CI: 1.25 to 1.96, p = 8.27 × 10<sup>–5</sup>).</div></div><div><h3>Conclusions</h3><div>This study provides evidence for a potential causal link between WM IDPs and CSVD-mediated stroke, which may enhance the predictive capacity for CSVD-mediated stroke.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"5 6","pages":"Pages 261-266"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168791","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}
Pub Date : 2024-10-01DOI: 10.1016/j.hest.2024.03.001
Objective
The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) Trial was designed to evaluate the minimally invasive trans-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.
Methods
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 27th, 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.
Results
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
{"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":"5 5","pages":"Pages 205-212"},"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}
Pub Date : 2024-10-01DOI: 10.1016/j.hest.2024.04.003
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.
{"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":"5 5","pages":"Pages 248-256"},"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}
Pub Date : 2024-10-01DOI: 10.1016/j.hest.2024.06.001
Objective
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.
Methods
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.
Results
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 < 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 < 30 cm3.
Conclusions
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 (>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.
目的血压变异性（BPV）及其与脑内出血（ICH）早期血肿扩大（HE）的潜在联系仍有待全面阐明。我们的研究探讨了入院后 24 小时内的血压变异与 ICH 中血肿扩大之间的潜在联系。方法在一项前瞻性队列单中心研究中，我们分析了连续的自发性 ICH 患者。我们分析了入院后 0-2、0-8、0-12 和 0-24 小时内通过动脉管路提取的连续血压数据。通过所有可用血压测量值的连续变异性 (SV)、标准差 (SD) 和变异系数 (CV) 评估血压变异性。早期 HE 的定义是 24 小时随访脑成像中 ICH 体积绝对值[≥ 6 ml]或相对值[≥ 33 %]增加。次要终点是入院时血压的影响以及 HE 的其他潜在风险因素。结果在 305 名 ICH 患者（平均年龄（± SD）70.1±14.9 岁，47.9% 为女性，中位 NIHSS 6（3，13）分，中位 ICH 评分 1（1，2）分）中，41 人（13.4%）出现 HE。HE 患者入院时的 NIHSS（p = 0.015）、ICH 评分（p = 0.005）、ICH 容量（p < 0.001）和抗凝前治疗（p = 0.004）均较高。有高血压的 ICH 患者与没有高血压的患者相比，BPV 没有差异。但 HE 患者入院时的舒张压（76.6 ± 14.8 vs. 86.3 ± 19.7 mmHg，p = 0.005）和血压（103.2 ± 22.4 vs. 112.2 ± 22.6，p = 0.027）明显较低。逻辑回归显示，较大的 ICH 容量和预先存在的抗凝是 HE 的重要预测因素，而较高的初始舒张压可降低 HE 风险。与 ICH < 30 cm3 相比，出血量≥ 30 cm3 的患者在所有时间段内的初始舒张压、MAP 和 BPV 都明显较低。入院时舒张压较低、使用抗凝药和较大的 ICH 容量是 HE 的潜在预测因素。然而，出血量较大（30 立方厘米）的患者绝对血压和血压变异指数较低，临床预后较差。这些研究结果表明，血压动态变化与 ICH 严重程度之间存在微妙的关系，强调了在急性 ICH 护理中进行个体化血压管理的必要性。有必要开展进一步的研究来探索这些关系并优化治疗策略。
{"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 < 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 cm<sup>3</sup> showed significantly lower initial diastolic BP, MAP, and BPV across all time frames compared to ICH < 30 cm<sup>3</sup>.</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 (>30 cm<sup>3</sup>) 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":"5 5","pages":"Pages 213-222"},"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}
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