Brain Hemorrhages最新文献

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.

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.

Traumatic intracranial pseudoaneurysm (TIP) after head trauma is rare, but it frequently ruptures in early phase. Although early detection and prompt treatment is important, the details are still unknown. Here, we report a case who was diagnosed with TIP in early phase after trauma and underwent endovascular treatment with parent artery occlusion (PAO), resulted in a good outcome.

A 17-year-old boy hospitalized for severe head trauma. Computed tomography (CT) revealed an acute epidural hematoma (AEDH) in the right middle fossa along with the fracture from the right lateral optic canal to the right superior orbital fissure, and CT angiography showed no obvious aneurysm at that time. CT angiography on 5 days showed an irregular shaped aneurysm at a C2-C3 posterior wall in the right internal carotid artery (ICA). As balloon occlusion test revealed complete ischemic tolerance, endovascular PAO was performed without any bypass. Postoperative imaging showed no hypoperfusion area.

Prompt diagnosis for TIP is important and the patients with skull fracture around ICA area are considered to provide cerebral angiography in early phase. In addition, TIP in early phase has a risk of rupture, suitable treatment strategy using BOT is important for the favorable outcome in those patients.

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.

Objective

To establish a new animal model of lobar cerebral microbleeds (CMBs), we examined whether intranasal administration of collagenase induced CMBs in young mice which did not have hypertensive pathologic features.

Methods

We used thirty-two male CD1 mice (8–10 weeks old), which were received either phosphate-buffered saline (PBS) or collagenase by intranasal administration twice a day for 5 days. A dose response study was conducted, and motor function and number of CMBs was evaluated at one day after completing the intranasal administration. Temporal profile of cognitive impairment and number of CMBs through 7 days was evaluated after completing intranasal administration of 3.6U collagenase.

Results

The number of CMBs showed an increasing trend in a dose-dependent manner and higher number of CMBs were observed with 3.6U collagenase. Cognitive impairment and CMBs was observed in 3.6U collagenase groups up to 7 days after administration. In addition, successful brain delivery via intranasal route was comfirmed by administering fluorescein isothiocyanate-labeled bovine serum albumin.

Conclusions

Intranasal collagenase administration is a feasible and minimally invasive method to produce CMBs and cognitive impairment in mice. This model has potential for producing CMBs in animals with cerebral amyloid angiopathy such as transgenic mice models of Alzheimer’s disease.

Objective

To investigate the efficacy and safety of MMA embolization in patients with CSDH who failed atorvastatin treatment.

Methods

Seventeen CSDH patients who failed atorvastatin treatment from Jan 1, 2021 to Dec 31, 2021 were included in the study. All patients were treated with MMA embolization using polyvinyl alcohol (PVA) particles.

Results

Twenty-six MMAs (unilateral embolization in 8 patients and bilateral embolization in 9 patients) were successfully embolized in all patients. Hematoma re-accumulated in only one patient (5.9%) after MMA embolization and was surgically evacuated. Procedural adverse events, mortality, or complications were not observed. At the last follow-up of an average of 51.5 days post MMA embolization, maximum hematoma thickness improved in 95.2% of CSDHs with a mean reduction of 52.1%, while mRS score improved in 94.1% of patients. In addition, 5 (29.4%) patients with unilateral hematoma underwent bilateral MMA embolization and hematoma absorbed completely in all 5 cases.

Conclusions

MMA embolization may be a minimally invasive alternative to surgical evacuation for CSDH patients resistant to atorvastatin. In unilateral CSDH, bilateral superselective angiography and bilateral MMA embolization could be a useful and effective treatment strategy.

Sixty-three patients admitted to 5 hospitals in 2014–2020 for the treatment of severe hypertensive brainstem hemorrhage by CT-guided and bone marker-oriented transcerebellar aspiration were enrolled in this study. The puncture accuracy, duration of hematoma removal, tracheal decannulation, postoperative complications, postoperative consciousness recovery time, Glasgow Outcome Scale (GOS) score, and prognosis outcome at follow-up were retrospectively analyzed. Additionally, the relationship between admission Glasgow Coma Scale (GCS) score and GOS score, and between hematoma volume and prognosis of patients was analyzed at follow-up. Results showed that CT localization–based and bone marker oriented transcerebellar hematoma aspiration in the treatment of severe hypertensive brainstem hemorrhage ensures high puncture accuracy, relatively low surgery risk, and good prognosis. The prognosis relates to the state of consciousness and hematoma volume.