Brain Hemorrhages最新文献

Flow diverter (FD) implantation is increasingly performed for aneurysms that are difficult to treat with conventional endovascular therapy and direct surgery. Now, a new FD stent, the Flow-Redirection Endoluminal Device (FRED), enters into clinical practice and is expected to have higher therapeutic efficacy. To predict whether an aneurysm is completely occluded by FRED, we have developed a novel computational fluid dynamics (CFD) technique using dual-layer porous media modeling that simulates its characteristic stent strut. This technique may be useful to evaluate hemodynamic changes in an aneurysm after FRED implantation using the preoperative patient-specific aneurysm geometry. The authors describe the novel CFD technique with a dual-layer porous media and report the potential usefulness of the technique to predict the aneurysm-occlusion status after FRED implantation preoperatively using an illustrative case of an unruptured internal carotid artery anterior wall aneurysm.

Background

Non-traumatic paediatric haemorrhagic stroke (PHS) is a common cause of death in children. We aimed to delineate the aetiologies of PHS and compare the outcomes of various management approaches to improve the treatment for children with PHS.

Methods

A retrospective analysis of PHS patients from a tertiary neurosurgical centre was conducted. Outcomes were evaluated based on the 30-day complication rate, rebleeding rate and functional outcome using the Modified Rankin Scale.

Results

39 patients were identified. The most common presentation for older children was severe headache, whereas symptoms were non-specific in younger children. Structural vascular lesions are the most common cause of PHS and 46% had arteriovenous malformation. 56% of patients received acute surgical intervention. 47% of patients were treated conservatively in the acute setting requiring interval definitive surgeries. Surgically managed patients experienced a higher 30-day complication rate but lower rebleeding rate. Functional outcome is good for PHS and most patients had full recovery.

Conclusions

Ruptured cerebral arteriovenous malformation was the most common cause of PHS and sudden onset of severe headache was the key presenting symptom. Prompt surgical intervention for PHS reduced the rebleeding rate.

Hemorrhagic stroke (HS) is a disastrous occurrence with high mortality rates, however, there are no established treatments for this pathology. Given recent advances in stem cell therapies, concerted research efforts have elucidated the therapeutic potential of stem cells in treating HS. In 2020, our group reviewed the use of SCs in regulating the neuroinflammatory reactions which occur after HS.¹ This review will build on that work, highlighting more recent advancements in the field of SC treatments for HS. Ultimately, with greater focus in this area of research, innovative SC therapies can be optimized in preclinical studies and soon be transferred to clinical applications for HS therapeutics.

Delayed cerebral ischemia (DCI) and cerebral vasospasm (VS) are rare but serious post-operative complications after surgery for pituitary macroadenomas; the mechanism of which are poorly understood. Pituitary adenylate cyclase-activating polypeptide (PACAP) is a vasoactive neuropeptide expressed in pituitary adenomas and may play a role in DCI/VS. The aim of this case-control study was to investigate the association between tumor expression of PACAP and DCI/VS following pituitary surgery. Tumor tissue from five patients with DCI/VS following pituitary surgery and nine matched controls were evaluated for PACAP expression by immunohistochemistry. Nuclear PACAP expression was significantly elevated in patients with DCI/VS following pituitary surgery compared to controls (0.396 ± 0.0.16 a.u. vs 0.093 ± 0.04 a.u, p < 0.0001). There was a positive linear relationship between nuclear PACAP expression and pre-operative tumor volume (r² = 0.41, p < 0.02) with a significant difference in slopes between the DCI/VS group compared to controls (y = x(5.0 × 10⁻³), r² = 0.76 vs y = x(7.4 × 10⁻⁴), r² = 0.07, p < 0.05). Elevated levels of tumor PACAP expression is associated with DCI/VS following pituitary surgery and may have a role in tumor growth. PACAP signaling may play a role the development of DCI, but further studies are needed.

Pituitary apoplexy (PA) may complicate the course of coronavirus disease 2019 (COVID-19), posing a potential threat to life. Among vaccines designed to prevent COVID-19, there are those adenoviral vector-based, such as Vaxzevria® (formerly COVID-19 Vaccine AstraZeneca). The product insert states that it can cause very rare coagulation disorders, in particular thrombosis with thrombocytopenia syndrome in some cases accompanied by bleeding, cerebrovascular venous or sinus thrombosis, and thrombocytopenia, including immune thrombocytopenia, also associated with bleeding. Here, we report the onset of PA after Vaxzevria® in a 28-year-old healthy Caucasian female, who experienced long-lasting tension-type headache, hyperprolactinemia and menstrual changes, without thrombocytopenia or thrombosis.

Introduction

Chronic subdural hematoma (CSDH) is common in elderly after a mild or trivial head injury. The concern for embolization is the period to wait, as compared to immediate relief of mass effect from surgery. Thus, a combination approach is advocated in our center when in doubt. We here reported our initial experience and observation with respect to time course of resolution.

Method

We retrospectively reviewed all the patients with CSDH undergoing Onyx middle meningeal artery (MMA) embolization with curative intent and excluded patients for palliative treatment in a neurosurgical center in Hong Kong.

Results

Four (50%) CSDH were treated with MMA embolization alone and 4(50%) CSDH were treated with both surgery and MMA embolization. For the 4 patients with MMA embolization alone, one(25%) achieved significant reduction at 6 weeks and 3(75%) achieved resolution at 3 months. For the 4 CSDH with both surgery and MMA embolization, all have resolution at the first follow-up imaging, two(50%) at 6 weeks and 2(50%) at 3 months. There were no procedure related complications, and there were no recurrence nor reoperation in all CSDH.

Conclusion

MMA embolization is safe and feasible within the framework of surgery to cure and prevent recurrence.

Intracranial venous sinus thrombosis (cerebral venous sinus thrombosis, CVST) clinical manifestations and signs are often atypical, and the form of the disease is variable. With the improvement of diagnostic technology and clinical understanding, the detection rate of this disease is on the rise, but the misdiagnosis rate is still at a high level. The goal of our review article is to shed light on CVST to help reduce clinician’s misdiagnosis of the disease.

Methods

A total of 18 misdiagnosed CVST documents were published in Chinese medical journals from 2016 to 2020.

Results

The scope of misdiagnosis involves 22 diseases. The top three misdiagnosed diseases are cerebral hemorrhage, cerebral infarction, and encephalitis. The main reasons for misdiagnosis are the lack of understanding of the disease, the lack of understanding of the imaging manifestations of CVST, the lack of specific symptoms and signs, and the wrong diagnostic thinking methods to meet the diagnosis of common diseases. A total of 51 misdiagnosed cases described the relationship between misdiagnosis and disease outcome, of which 46 cases (90.20%) did not cause adverse consequences due to misdiagnosis.

Conclusion

It is crucial for clinicians to improve their understanding of CVST, and patients that present with headache, increased intracranial pressure, and focal neurological deficits could potentially have CVST and should be promptly sent to get cranial magnetic resonance imaging and magnetic resonance venography or digital subtraction angiography. The differential diagnosis should be checked and strengthened in order to reduce the occurrence of misdiagnosis.

The glymphatic system is a recently identified route for exchanging parenchyma interstitial fluid and cerebrospinal fluid along perivascular space, facilitating brain waste clearance. Glymphatic system dysfunction has been reported in many neurological diseases. Here we discussed the possible role of glymphatic system in posthemorrhagic brain injury, especially posthemorrhagic hydrocephalus.

Neurocysticercosis (NCC) remains the most common helminth infection of the human central nervous system worldwide. Patients with NCC are especially predisposed to cerebrovascular events such as acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage due to an immune-mediated process in which infiltration of inflammatory cells into blood vessel walls leads to endothelial hyperplasia and endarteritis, known as cysticercotic angiitis. Additionally, the oncosphere of the parasite causing NCC produces T. solium enolase, an enzyme which binds and activates human plasminogen receptor proteins to plasmin, leading to a hypercoagulable state. Currently, NCC is not a contraindication to administration of tissue plasminogen activator (tPA) for a suspected AIS. However, to our knowledge, it has not been assessed whether the presence of NCC increases the likelihood of hemorrhagic conversion of an AIS after tPA administration. We present the case of an 83-year-old lady with NCC who developed multifocal right-sided ICH involving the temporal, parietal, and frontal lobes six and a half hours after tPA administration for a suspected AIS. Given this event and the cellular mechanisms provided, we recommend a safety surveillance study to further determine the potential risks of hemorrhagic conversion in this population.

Objective

The aim of study was to establish a quick way to differentiate between hemorrhagic and ischemic stroke by using siriraj stroke score and find its specificity and sensitivity by comparing it with CT scan findings.

Study design

Cross-sectional study.

Place and duration of study

Department of Neurology Pakistan Institute of Medical Sciences Islamabad from Jan 2021 to June 2021.

Methodology

Total 110 patients of acute stroke were included. Any patient of > 20 years old, non-traumatic, focal neurological deficit < 14 days with no obvious reason other than vascular were included. Siriraj stroke score was calculated its findings were compared with a CT scan findings. Data was analyzed by SPSS ver.23.0.

Results

The mean age of patients was 66.10 ± 14.58 years. There were 54 (49.10 %) males and 56 (50.90 %) females. Hypertension was the most common disease found in 79 (71.8 %). The sensitivity, specificity, PPV and NPV of Siriraj stroke score was 83.87 %, 66.6 %, 74.2 % and 71.42 % respectively for hemorrhagic stroke and 93.4 %, 80.95 %, 93.4 % and 37.03 % respectively for non-hemorrhagic stroke.

Conclusion

It is an easy, cost effective and bed side scoring system which can accurately identify the stroke type without any other radiological investigation. It can be employed in areas where CT scan facility is not available and treatment can be started early which will definitely lower mortality and morbidity of stroke patients.