Brain Hemorrhages最新文献

Introduction

Rapid diagnosis is crucial for stroke patients since it is an emergency that may result in morbidity and mortality. The gold standard, which is a CT scan of the brain is not always feasible, hence, Siriraj and Bahrudin Score, as well as Gajah Mada Algorithm are likely to be alternatives.

Objectives

This study aims to determine the specificity and sensitivity of the Siriraj and Bahrudin Score as well as Gajah Mada Algorithm.

Method

A cross-sectional study was undertaken at five network hospitals of the Medical Faculty University in Muhammadiyah Malang. It involves a sample of 304 medical records used to determine the sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve with output area under the curve (AUC).

Result

The result showed that the sensitivity and specificity of Bahrudin and Siriraj Acore, as well as Gajah Mada Algorithm for determining infarct stroke was 91.3% vs 89.7% vs 61.2% and 67.7% vs 69.4% vs 77.4%, respectively. For determining hemorrhagic stroke the values were 67.7% vs 69.4% vs 77.4% and 91.3% vs 89.7% vs 61.2%, respectively. Furthermore, the area under the curve of Bahrudin and Siriraj Scores was better than Gajah Mada Algorithm.

Conclusion

In conclusion, Bahrudin and Siriraj Scores have good accuracy, sensitivity, and specificity in diagnosing stroke than Gajah Mada Algorithm.

The peripheral immune system response to Intracerebral Hemorrhage (ICH) may differ with ICH in different brain locations. Thus, we investigated peripheral blood mRNA expression of Deep ICH, Lobar ICH, and vascular risk factor-matched control subjects (n = 59). Deep ICH subjects usually had hypertension. Some Lobar ICH subjects had cerebral amyloid angiopathy (CAA). Genes and gene networks in Deep ICH and Lobar ICH were compared to controls. We found 774 differentially expressed genes (DEGs) and 2 co-expressed gene modules associated with Deep ICH, and 441 DEGs and 5 modules associated with Lobar ICH. Pathway enrichment showed some common immune/inflammatory responses between locations including Autophagy, T Cell Receptor, Inflammasome, and Neuroinflammation Signaling. Th2, Interferon, GP6, and BEX2 Signaling were unique to Deep ICH. Necroptosis Signaling, Protein Ubiquitination, Amyloid Processing, and various RNA Processing terms were unique to Lobar ICH. Finding amyloid processing pathways in blood of Lobar ICH patients suggests peripheral immune cells may participate in processes leading to perivascular/vascular amyloid in CAA vessels and/or are involved in its removal. This study identifies distinct peripheral blood transcriptome architectures in Deep and Lobar ICH, emphasizes the need for considering location in ICH studies/clinical trials, and presents potential location-specific treatment targets.

Objective

The aim of the current study is to evaluate if ET_B inhibition following ICH can mitigate the deleterious impact of ET-1, e.g., BBB disruption, and improve neurological function.

Methods

A total of 90 male rabbits (2.8–3.4 kg) were randomly assigned to the following groups (n = 10 per group): normal control (NC), pseudo-control (PC), drug control using normal saline (DC), model control (MC + ICH), minimally invasive surgery (MIS + ICH), minimally invasive surgery + ET-1 receptor agonist (MIS + IRL1620 + ICH), IRL1620 + ICH, ET-1 receptor antagonist (BQ788 + ICH), and IS + BQ788 + ICH. ICH was induced in all groups except for NC, DC and PC groups.

In MIS, MIS + BQ788, and MIS + IRL1620 groups, at the 6-hour mark following ICH, MIS was used to evacuate the hematoma followed by immediate drug (BQ788 or IRL1620 or saline) injection into the ear vein. On day 3, all rabbits were evaluated by purdy score and then sacrificed. The perihematomal brain tissue was removed to determine the expression of ET-1 and MMP-9 by immunohistochemical procedures. MDA expression was evaluated by ELISA, and BBB permeability was evaluated using Evens Blue (EB) methods. Brain water was determined using a dry-wet weighing method.

Results

The purdy score, ET-1, MDA, MMP-9, BWC, and BBB permeability were decreased in groups treated with BQ788 and increased in groups treated with IRL1620. The combination of MIS + BQ788 markedly decreased these deleterious outcomes (purdy score, ET-1, MDA, MMP-9, BWC, and BBB permeability) compared to the MIS group.

Conclusions

Using a non-selective antagonist of ET_B, deleterious outcomes associated with increased levels of ET-1 following ICH were ameliorated.

Cerebral amyloid angiopathy (CAA) is a cerebrovascular disease with vascular amyloid-β deposits and is commonly observed among the elderly. Often associated with Alzheimer’s disease, CAA is among the leading causes of intracerebral hemorrhage (ICH) and age-related cognitive decline. Several research studies have tried to understand the mechanisms underlying CAA, but further use of in vivo models is needed to fully understand its pathophysiology. In this review, we provide information gathered from key findings dealing with the mechanisms of beta deposition in cerebral arteries, the diagnosis of different CAA types, and advances in treatment for CAA. Since CAA is a risk factor for ICH, we also review previously used in vivo and in vitro models of CAA and their features with respect to CAA-related ICH. Currently available transgenic mouse models of CAA show a limited occurrence of hemorrhage at variable locations, which often do not produce any obvious neurological deficits. Thus, the development of novel models to more closely mimic the clinical condition of CAA-related ICH is warranted.

Purpose

A prospective, observational study was done at the country leading tertiary care hospital to evaluate etiologies, clinical features, diagnosis, and prognosis of cerebral venous sinus thrombosis (CVST) in the Pakistani population.

Methods

34 patients with clinical and MRI features suggestive of CVST were evaluated. Modified Rankin Score (mRS) was assessed of all patients at presentation.

Results

The mean age of presentation was 30.69 years with female predominance (n = 28). Headache was most common presenting symptoms (97%, n = 33) followed by seizure (59%, n = 20), hemiparesis (56%; n = 19), altered sensorium (47%; n = 16), vomiting (21%; n-7) and cranial nerve involvement (18%; n = 6). 72% of patients (n = 23) had thrombosis of superior sagittal sinus, 53% of patients (n = 17) had thrombosis of the transverse sinus, 25% patients (n = 8) of patients had sigmoid sinus thrombosis, 16 % patients (n = 8) had straight sinus thrombosis. The most common cause for provoked CVST was found to be pregnancy/puerperium in 53% (n = 18 patients), followed by previous CVST/DVT in 12% (n = 4), and then OCP and parainfectious causes which were 3% (n = 1) for each and elevated factor VIII and protein deficiency were found in 7 patients. MRS between 3 and 5 was assessed in most patients on presentation (n = 23).

Conclusion

CVST is an under-recognized cause of stroke in the young population, especially in the puerperium period. Clinical presentation is highly variable, and correction with magnetic resonance imaging with venography is the current diagnostic modality of choice. Aggressive management with anticoagulants is safe with excellent clinical outcomes.

Delayed cerebral ischemia (DCI) is a life-threatening complication of aneurysmal subarachnoid hemorrhage (aSAH). The vasoactive P450 eicosanoids 20-hydroxyeicosatretraenoate (20-HETE) and 14,15-epoxyeicosatrenoate (14,15-EET) are associated with the development of DCI and may play opposing roles in DCI risk. We hypothesized that the ratio of these opposing eicosanoids in cerebrospinal fluid (CSF) is associated with hemorrhage severity and the risk of developing DCI after aSAH. In a preclinical model, rats received intracisternal blood injections to approximate aSAH. Hemorrhage severity, cerebral blood flow (CBF), cortical spreading depolarizations were recorded, and CSF eicosanoid levels were quantified using mass spectrometry. In a parallel clinical study, CSF samples were collected and analyzed prospectively from subjects with aSAH and outcomes were tracked. Preclinically, rats with greater hemorrhage severity had impaired CBF and lower median 14,15-EET/20-HETE ratios compared to those with lesser or no hemorrhage. In aSAH patients, the CSF 14,15-EET/20-HETE ratio was negatively correlated with hemorrhage grade on imaging. Patients who developed DCI had lower median 14,15-EET/20-HETE ratios compared to those without DCI. The CSF 14,15-EET/20-HETE ratio correlates with hemorrhage severity and may reflect a mechanistic underpinning of microvascular dysfunction that contributes to DCI. These results suggest that vasoactive eicosanoids may be a therapeutic target in aSAH.

Parkinson's disease (PD) presents clinical heterogeneity in late-stage patients who show a varied responsivity to subthalamic nucleus deep brain stimulation (STN-DBS) on motor symptoms. To explore the heterogeneity of STN-DBS effect on motor symptoms in late-stage PD patients and to categorize the patients, basic characteristics, preoperative motor symptoms, and motor symptoms one month and one year after the operation of 28 late-stage PD patients were collected and analyzed with agglomerative hierarchical clustering. Preoperative motor complications, non-motor symptoms, and late-stage related manifestations were also collected and compared among the clusters. The analysis revealed three patient clusters with different motor features: 1) high response; 2) low response, and 3) moderate response with fast progression. Clinical characteristics showed significant differences in disease duration, postoperative UPDRS-III, decrease in UPDRS-III, and index of progression. Patterns of the six major motor symptoms can clearly differentiate the three clusters. Preoperative dyskinesia, memory decline, and visual hallucination were also found to differ in the three clusters. The current study identified three clusters of late-stage PD patients showing distinct responses to STN-DBS on motor symptoms. These clustering patterns may relate with diverse dopaminergic/non-dopaminergic impairments and hopefully help to categorize late-stage PD patients and to select adequate STN-DBS candidates.