Brain Hemorrhages最新文献

Objective

This study aimed to assess the changes in patient demographics, aneurysm characteristics, and treatment modalities for subarachnoid hemorrhage (SAH) over the past two decades.

Methods

We analyzed SAH 6,446 patients between 2002 and 2022, which was divided into three periods: 2002–2011 (FP), 2012–2021 (SP), and post-clazosentan 2022 (PC). The final cohort included 2878, 2016, and 152 patients in FP, SP, and PC groups, respectively. We examined patient demographics, surgical procedures, spasm prevention therapy, and delayed ischemic neurological deficits (DIND).

Results

The mean age of the patients increased over the study period (64, 66, and 68 years in FP, SP, and PC groups, respectively). Clipping was the predominant method during FP (79 %); however, coiling surpassed clipping in 2022 (coiling vs. clipping, 47 % vs. 46.3 %). Before clazosentan introduction, fasudil was the primary spasm prevention treatment (>80 %); however, its use decreased (63.9 %) after clazosentan introduction. DIND varied across FP, SP, and PC groups (37.4 %, 24.2 %, and 16.7 % respectively). Age and generation were significantly associated with DIND and irreversibility.

Conclusion

Regarding the management of patients with SAH, shift from clipping to coiling, and the introduction of new spasm prevention treatments such as clazosentan were observed, led to a decrease in DIND.

Objective

Cerebral vasospasm is an unelucidated complication of subarachnoid hemorrhage. Various treatments exist against cerebral vasospasms however, consensus on the optimal treatment is lacking. We use clazosentan, which is used to prevent cerebral vasospasm, with multidrug combinations. In this study, we aimed to clarify the initial results of using clazosentan in multidrug combinations in the real world.

Methods

We retrospectively investigated 54 patients who were treated for subarachnoid hemorrhage and received clazosentan. We compared the results of these patients on the basis of two groups: those with good outcomes (modified Rankin scale score: 0–3) and poor outcomes (4–6) at discharge.

Results

Among the patients, poor outcome was observed in 19 patients (35.2 %). Angiographic vasospasms occurred in 10 patients (good outcome [n = 6] vs. poor outcome [n = 4]; p = 0.73), and symptomatic vasospasms occurred in 4 patients (n = 2 vs. n = 2, p = 0.61). The incidence of pleural effusion (28.6 % vs. 73.7 %, p < 0.01) and the mean daily fluid balance (303.5 mL/day vs. 785.4 mL/day, p < 0.01) were higher in the poor outcome group.

Conclusion

Pleural effusion and high positive balance may be associated with poor outcome. However, the number of cases examined was small; therefore, further large-scale studies with a bigger sample size are needed.

COVID-19, or coronavirus infection, is an acute respiratory illness caused by the corona virus that can develop into a life-threatening form of ARDS. Extracorporeal membrane oxygenation (ECMO) is a highly effective treatment for life-threatening instances. One of the many complications associated with ECMO was bleeding. COVID patients are at risk for intracerebral bleeding due to several factors, including the drug's action on ACE2 receptors, leading to hypertension, as well as hypercoagulability, dysregulated immune response, DIC, and the use of anticoagulants.

Falx interhemispheric subdural hematoma (FISH) is a rare subtype of subdural hematoma that occurs between the cerebral hemispheres along with falx cerebri. It represents less than 0.5% of all subdural hematomas and is frequently misdiagnosed due to its rarity and nonspecific clinical presentation. We present a case of 59-year-old female with a history of urticaria and hypertension who developed FISH following minor head trauma. The patient experienced presyncope, nausea, dizziness, and headache. A non-contrast computed tomography (CT) scan of the head revealed FISH, and the patient was managed conservatively without surgical intervention. This case report highlights the importance of considering FISH in the differential diagnosis of patients presenting with headache, dizziness, and presyncope, particularly in the setting of minor head trauma. We discuss the potential relationship between FISH, urticaria, and hypertension, as well as the possible causes of presyncope in this case, including orthostatic hypotension probably due to vagal nerve stimulation. Indeed, further studies are needed to explore these associations and to better understand the underlying mechanisms.

Objective

To appraise the overall outcomes of microsurgical resection of low-grade arteriovenous malformations (AVMs) in a low-middle-income country.

Methods

Data was collected prospectively from three different neurosurgical centres in Pakistan for this study and it lasted for two years. According to the Spetzler-Martin (S-M) grading system, patients diagnosed with cerebral AVMs were divided into three classes A, B, and C. AVMs of grade 1 and 2 were included in Class A. Class B contained grade 3 AVMs, while Class C contained grade 4 and 5 AVMs. All male and female patients in Class A were eligible for this study. Patients were evaluated postoperatively for seizures, haemorrhage, focal neurological deficits, and AVM cure rates. Morbidity, mortality, and functional recovery were used to evaluate the outcome. Functional recovery and cure rate were observed after 6 months of follow-up.

Results

There were a total of 22 patients. Mean age was 36.41 ± 14.32 SD years. There were 12 (54.5 %) male patients and 10 (45.5 %) female patients. 13 patients (59.1 %) presented with spontaneous intracerebral haemorrhage, while 9 patients (40.9 %) presented with seizures. 14 patients (63.6 %) had S-M grade 1 and 8 patients (36.4 %) had S-M grade 2. All patients underwent microsurgical resection. We discovered 4.5 % morbidity in our study. There was no postoperative mortality. At 6 months, an excellent functional outcome of 95.5 % (according to the Glasgow outcome scale) and 100 % cure rate was observed.

Conclusion

Microsurgery is a safe and effective treatment for low-grade AVMs in terms of morbidity, mortality, functional outcome and cure rates in our country.

Objective

This study aims to investigate the impact of the infection with the novel coronavirus Omicron variant on the outcomes of patients with severe spontaneous intracerebral hemorrhage.

Methods

We conducted a multicenter prospective non-randomized cohort study during the peak of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) Omicron strain epidemic. Clinical data were collected from nine centers in China between December 1, 2022, and February 28, 2023. Patients were categorized into good and poor outcomes groups based on modified Rankin Scale scores at discharge. Clinical characteristics were compared, and univariate and multivariate logistic regression analyses were performed. Additionally, coagulation function was compared between SARS-CoV-2 Omicron positive and negative patients.

Results

Among 86 included patients, 30 (35 %) had a favorable outcome, while 56 (65 %) had an unfavorable outcome. Of these, 32 (37 %) tested positive for SARS-CoV-2 Omicron, while 54 (63 %) tested negative. Multivariate analysis identified Glasgow Coma Scale score and hypertension as independent risk factors affecting outcomes (P < 0.05). Surprisingly, SARS-CoV-2 Omicron infection emerged as a protective factor for patient outcomes (P < 0.05). Additionally, SARS-CoV-2 Omicron-positive patients exhibited significantly elevated fibrinogen levels upon admission (P < 0.05).

Conclusion

In comparison to patients without SARS-CoV-2 Omicron infection, patients with severe spontaneous intracerebral hemorrhage who were co-infected with SARS-CoV-2 Omicron exhibited a more favorable short-term outcome.

Intracranial Hemorrhage (ICH) can lead to various clinical manifestations and complications. These include mental disorders that range from impaired cognitive function to disturbances in the sensorium, perception, thought content, and emotions. One of the most common outcomes of ICH is mood disturbances and cognitive dysfunction. Therefore, this study presents the case of a 50-year-old patient who came to the emergency room with a stroke and was diagnosed with ICH and a mental organic disorder after radiographic and laboratory examinations. The management of mental disorders must be given special attention in the care of ICH patients. This is because complications of Neurobehavioral after ICH are often recognized too late and lead to poor long-term patient outcomes. An increase in patient mortality can also occur, with decreased outcomes and quality of life, leading to sequelae.

Objective

Neurological adverse reactions to SARS-CoV-2 vaccines include a wide variety of central nervous system (CNS) disorders; however, the cause-and-effect relationship is unclear. Herein, we present a fatal case of extensive basal ganglia bleeding after mRNA-based SARS-CoV-2 vaccination and discuss the pathophysiological mechanisms of brain hemorrhage.

Case presentation

A 66-year-old woman with cerebral palsy and a history of neonatal asphyxia suddenly presented with hypothermia and consciousness disturbance one day after the sixth dose of an mRNA-based SARS-CoV-2 vaccine (Moderna). Clinical investigations revealed a normal thrombocyte count, but stage 1 hypertension and mild prolongation of the prothrombin time and activated partial thromboplastin time. Urgent brain computed tomography (CT) revealed extensive left basal ganglia hemorrhage with global brain edema and downward herniation of the brainstem. The region of the large hematoma corresponded to the basal ganglia lesion which had been produced by neonatal asphyxia at birth. Because the neurosurgeons evaluated her state as inoperable, conservative therapy was continued, but the patient died on day 5 after the event.

Conclusion

We hypothesized that two pathophysiological mechanisms were responsible for the brain hemorrhage in this case: disruption of focal cerebrovascular autoregulation in preexisting neonatal asphyxiated lesions and disturbance of coagulation pathways after mRNA-based SARS-CoV-2 vaccination.

Objective：The triglyceride-glucose (TyG) index is an indicator for insulin resistance (IR). Several studies have validated the impact of the TyG index on cerebrovascular disease. However, the value of the TyG index in patients with subarachnoid hemorrhage (SAH), requiring admission to the intensive care unit (ICU), remains unclear. In this study, we aimed to investigate the relationship between the TyG index and clinical outcomes in SAH patients.

Methods：

In this study, we identified patients with severe SAH requiring ICU admission from the Medical Information Marketplace for Intensive Care (MIMIC-IV) database. These patients were then categorized into tertiles based on their TyG index levels. After adjusting for confounders, multivariate Cox proportional hazards analysis and restricted cubic spline analysis were performed to assess the relationship between the TyG index and clinical outcomes in critically ill SAH patients.

Results：

The study outcomes included in-hospital mortality and ICU mortality. The rate of in-hospital mortality and ICU mortality were 16.8 % and 13.1 %, respectively. After adjusting for confounders, multivariate Cox proportional hazards analysis showed that an elevated TyG index was significantly associated with all-cause mortality. Specifically, patients with a high TyG index had a significantly higher risk of in-hospital mortality (adjusted hazard ratio: 1.72; 95 % confidence interval: 0.81–3.66; P = 0.16) and ICU mortality (adjusted hazard ratio: 2.60; 95 % confidence interval: 1.04–6.43; P = 0.039). The TyG index was most strongly associated with ICU mortality. Moreover, restricted cubic spline curves demonstrated a progressive increase in the risk of all-cause mortality with an increase in the TyG index.

Conclusion：

Overall, our findings suggest that the TyG index may be a useful tool in identifying SAH patients at a higher risk of all-cause mortality in both, the hospital and the ICU setting.

It is unknown whether plasma concentrations of a matricellular protein periostin change in association with the development of angiographic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In 113 patients with aneurysmal SAH of World Federation of Neurological Surgeons grades 1–3 at admission, plasma periostin concentrations were serially measured at days 1–3, 4–6, 7–9 and 10–12 after SAH onset. Measured periostin levels and clinical variables were compared between patients with and without angiographic vasospasm. Periostin concentrations were significantly higher in patients with angiographic vasospasm at days 4–6 and 7–9. Receiver operating characteristic curve analyses indicated that cutoff plasma periostin values of 54.3 ng/ml at days 4–6 and 58.1 ng/ml at days 7–9 predicted or diagnosed angiographic vasospasm development with a specificity of 66.0 % and a sensitivity of 72.7 %, and a specificity of 75.0 % and a sensitivity of 55.0 %, respectively. Multivariate analyses also revealed that increased plasma periostin concentrations at days 7–9 was independently associated with angiographic vasospasm development. This study showed for the first time that plasma periostin levels were increased in patients with angiographic vasospasm. These findings suggest that plasma periostin can serve as a biomarker and may be a new therapeutic target for angiographic vasospasm after SAH.