Brain Hemorrhages最新文献

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.

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.