Brain Hemorrhages最新文献

Objective

The aim of this study is to compare the clinical outcomes, safety, and workflow of patients who underwent endovascular treatment (EVT) alone or in combination with intravenous thrombolysis (IVT), against a control group who only received EVT.

Methods

A retrospective analysis from May 2018 to September 2021 was conducted on 50 patients exhibiting acute ischemic stroke symptoms. 35 patients received EVT alone, while 15 received EVT and IVT. The data collected included demographic information, comorbid diseases, symptom onset time, duration from admission to puncture, and clinical outcomes via the National Institutes of Health Stroke Scale score and modified Rankin scale score at admission and 90 days post-procedure.

Results

No significant differences were observed in the 90-day modified Rankin scale scores between the EVT + IVT and EVT alone groups (p > 0.05). NIHSS scores were also similar between the groups (p > 0.05). The EVT + IVT group demonstrated higher intracranial hemorrhage and symptomatic intracranial hemorrhage rates than the EVT alone group, but the difference became insignificant after adjusting for age and sex (p < 0.01). Mortality outcomes showed no significant difference (p > 0.05).

Conclusion

The combined EVT and IVT treatment's safety outcomes are not inferior, aligning with existing literature.

Objective

To evaluate the feasibility of free-hand bedside catheterization using axial computed tomography (CT) in patients with brain hemorrhage after ischemic revascularization.

Methods

Patients who received revascularization therapy and underwent bedside catheterization were consecutively screened from December 2020 to July 2022. Revascularization included intravenous thrombolysis with or without mechanical thrombectomy, balloon angioplasty, and stenting. The catheter trajectory was designed according to the axial CT along the long axis of the hematoma body and projected onto the scalp at the calculated distance and angle. Urokinase was used locally to drain the hematoma.

Results

In 12 patients (mean age 66 ± 8 years), an 86% reduction in hematoma volume was found after catheter drainage, from 48.6 ± 20.4 ml to 6.7 ± 5.7 ml (P＜0.001). In accordance with the reduction of the hematoma volume, the Glasgow Coma Scale improved from 7 (6.5–8) to 10 (7–10.5) (P = 0.031). Four patients (33.3%) achieved good outcomes (modified Rankin Scale 0–3) at the 180-day follow-up. All-cause mortality was 25%. One patient experienced active hemorrhage. No bacterial brain infections were observed.

Conclusions

Free-hand bedside catheterization according to axial CT localization is feasible for treating extensive revascularization-related hematoma after ischemic stroke.

Malaria is one of the most common and lethal endemic disease in tropical countries. Severe malaria can be manifested as impaired consciousness, respiratory distress, convulsions, jaundice, pulmonary oedema and even death. Involvement of CNS and spontaneous abnormal bleeding from body organs is common; however spontaneous bleeding in brain is extremely rare. We report a rare case of spontaneous acute subdural hematoma (SDH) in P. falcifarum malaria. A systematic review of cases reported in literature is done with its Neurosurgical implications.

The CSA Cerebral Hemorrhage Minimal Invasive Treatment Society was successfully established in Wuhan, Hubei, China. During the inauguration, the first committee of the CSA Cerebral Hemorrhage Minimal Invasive Treatment Society was established.

Chronic cerebral artery occlusion is an important cause of ischemic stroke, resulting in up to 45% of all ischemic strokes. Therefore, treatment of chronic cerebral artery occlusion is critical to improve outcomes in effected patients. In the past, treatment of chronic cerebral artery occlusion focused on drugs and surgical bypass, but effectiveness and potential benefits are not well-supported. In recent years, endovascular recanalization therapy has become more prominent as a treatment for chronic cerebral artery occlusion, due to advances in endovascular procedures, experience and equipment, as well as more advanced imaging methods. Small clinical studies have shown that interventional therapy for chronic cerebral artery occlusions may be safe and effective, yet, there is still a lack of uniform guidelines. This review discusses the current support for recanalization of chronic intracranial large vessel occlusion.

Subdural effusions (SE) have already been associated with several viruses, but there are few associations with Covid-19 reported to date, and all of them had one thing in common: the presence of superimposed bacterial rhinosinusitis. Here we describe the case of a 76-year-old male patient that was transferred to our center due to severe SARS-CoV-2 infection and developed a SE during hospital stay. He presented sensory level impairment during hospitalization, but an initial Head CT scan showed no alterations. A new CT scan performed six days later evidentiated a bilateral SE. The patient had a cardiorespiratory arrest during the night of the same day, resulting in death. Covid-19 as a direct cause of subdural effusion (positive Covid-19 PCR in subdural fluid) has never before been reported in the literature, and, unfortunately, it was not possible to rule out or confirm this phenomenon in our case due to the rapid evolution of the clinical picture. However, our case clearly differs from the literature as the patient did not show any signs of sinus disease or intracranial hypotension, and the possible causes of the effusion boil down to spontaneity and the direct action of Covid-19 in the CNS and subdural space.

Inauguration & 1st Annual Conference of CSA Cerebral Hemorrhage Minimal Invasive Treatment Society was successfully held at China Optics Valley Convention & Exhibition Center in Wuhan, Hubei, Chian. During the conference, many well-known neurology experts in China conducted in-depth discussions on the research progress of minimal invasive treatment of cerebral hemorrhage, which benefited the participants a lot.