RESUMO
BACKGROUND: In December 2019, coronavirus disease 2019 spread worldwide, causing acute respiratory distress syndrome. Coronavirus disease 2019 presents from an asymptomatic infection to severe disease causing multiorgan failure. Neurological manifestations were observed in some patients, including intracerebral hemorrhage. Bilateral basal ganglia hemorrhage is rare due to trauma. CASE PRESENTATION: Our patient was a 14-year-old Iranian boy with multiple trauma and loss of consciousness who tested positive for coronavirus disease 2019. The brain computed tomography scan reported bilateral basal ganglia hemorrhage. Bilateral ground glass opacity was reported through a chest computed tomography scan. DISCUSSION AND CONCLUSIONS: In this study, we reported a 14-year-old boy referred to the emergency room due to multiple trauma. Through the medical interventions, bilateral basal ganglia hemorrhage was discovered incidentally. Coronavirus disease 2019 was detected in this patient on the basis of findings in chest computed tomography scan and positive real reverse transcription polymerase chain reaction test. Several clinical reports and series exploring the relationship between coronavirus disease 2019 and ischemic strokes have been published. Coronavirus disease 2019, like other acute respiratory syndromes, can invade the central nervous system through hematogenous and neuronal dissemination or it can be an immune response to the cytokine storm. In conclusion, it is vital to know the pathophysiology of the neurological manifestations of coronavirus disease 2019 and prevent the mild neurological manifestations leading to severe conditions.
Assuntos
Hemorragia dos Gânglios da Base , COVID-19 , Traumatismo Múltiplo , Masculino , Humanos , Adolescente , COVID-19/complicações , Irã (Geográfico) , Hemorragia dos Gânglios da Base/etiologia , Tomografia Computadorizada por Raios X/métodos , Traumatismo Múltiplo/complicaçõesAssuntos
Neoplasias do Córtex Suprarrenal/diagnóstico , Adenoma Adrenocortical/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Hiperaldosteronismo/diagnóstico , Hipertensão/tratamento farmacológico , Neoplasias do Córtex Suprarrenal/sangue , Neoplasias do Córtex Suprarrenal/complicações , Neoplasias do Córtex Suprarrenal/cirurgia , Adrenalectomia , Adenoma Adrenocortical/sangue , Adenoma Adrenocortical/complicações , Adenoma Adrenocortical/cirurgia , Anti-Hipertensivos/uso terapêutico , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/etiologia , Hemorragia Cerebral/etiologia , Humanos , Hiperaldosteronismo/sangue , Hipertensão/etiologia , Hipopotassemia/diagnóstico , Hipopotassemia/tratamento farmacológico , Hipopotassemia/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
Bilateral basal ganglia hemorrhage is exceedingly rare. To our knowledge, our patient is the first reported case of a confirmed coronavirus disease 2019 (COVID-19) patient who had bilateral basal ganglia hemorrhage. In the absence of other risk factors for bilateral deep cerebral involvement, we suspect that COVID-19 may be contributing to these rare pathologies. Most published data represent a correlation between COVID-19 and neurologic complications, and more research is still needed to prove causation.
Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , COVID-19 , Feminino , Humanos , Imageamento por Ressonância Magnética , Imagem Multimodal , Pandemias , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Secondary intracerebral hemorrhage (SICH) score is used to predict risk of intracranial hemorrhage (ICH) associated vascular lesions. However, it has low clinical utility in identifying patients without need for neurovascular imaging. This study aims to develop a modified scoring system to capture patients with low risk of underlying vascular pathology, thereby decreasing need for vascular imaging and its associated morbidity. METHODS: A retrospective analysis of 994 patients with atraumatic ICH over 8 years was conducted, excluding known underlying pathology, subarachnoid hemorrhage, or lack of vascular imaging. Using a multivariate logistic regression model, independent predictors of vascular pathology were identified and utilized toward developing a modified Secondary Intracerebral Hemorrhage (mSICH) score. RESULTS: Of 575 patients identified, 60 (10.4%) had underlying vascular etiology. Statistically significant predictors of vascular pathology included age; female sex; admission systolic blood pressure <160 mm Hg; locations other than basal ganglia, thalamus, pons, or midbrain; presence of high-risk imaging features; and proximity to large vessel-containing cisterns. The mSICH score correlated with an increasing incidence of vascular pathology [0-1 (0%), 9 (4.3%), 12 (9.7%), 21 (40.4%), 6 (33.3%), 8 (88.9%), and 4 (100%)] and had a significantly higher number of patients receiving scores with 0% incidence of vascular lesions compared with the SICH score [159 (27.6%) versus 12 (2.1%); P < 0.001)]. CONCLUSIONS: The mSICH score can more accurately predict risk of underlying vascular pathology of ICH and identify patients with lowest risk of vascular pathology. This may minimize the cost and associated risks of invasive cerebrovascular imaging.
Assuntos
Hemorragia Cerebral/etiologia , Transtornos Cerebrovasculares/epidemiologia , Acidente Vascular Cerebral Hemorrágico/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/epidemiologia , Angiografia Digital , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/etiologia , Pressão Sanguínea , Tronco Encefálico , Hemorragia Cerebral/diagnóstico por imagem , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Acidente Vascular Cerebral Hemorrágico/diagnóstico por imagem , Humanos , Hipertensão/epidemiologia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: In patients with normal pressure hydrocephalus (NPH), lumbar puncture (LP) is an effective method for assessing both the diagnosis as well as the possible efficacy of ventriculoperitoneal shunting based on symptom improvement. However, it should be considered that there exists a low risk of complications and that these risks may result in morbidity and mortality. We present a patient who developed hematoma in the basal ganglia following LP. CASE DESCRIPTION: A 56-year-old man presented with progressive dementia, ataxia, and urinary incontinence for 8 months. The patient received LP. He had no history of coagulopathy and had NPH findings on cranial magnetic resonance imaging. On the second day after LP, he complained of headache and had left hemiparesis, and intracerebral hematoma was observed at the basal ganglia, posterior to the lentiform nucleus. CONCLUSIONS: Although intracerebral hematoma after LP is one of the rare complications to be more cautious about, particularly in patients with a history of chronic disease or chronic changes in imaging, a history of previous cerebrovascular events and recurrent LPs with probably less cerebrospinal fluid drainage should be planned. Moreover, it should be considered that intracerebral hematoma may develop in patients with clinical deterioration, and good clinical follow-up is required.
Assuntos
Hemorragia dos Gânglios da Base/etiologia , Gânglios da Base , Hematoma/etiologia , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/terapia , Punção Espinal/efeitos adversos , Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Hidrocefalia de Pressão Normal/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
To evaluate potential bleeding sources and predictive variables for basal ganglia hemorrhage. Fifty-seven patients with basal ganglia hemorrhage admitted to our neurosurgical ICU between 2005 and 2016 were retrospectively reviewed. Univariate and multivariate logistic analyses were used to assess predictive variables for identifying the bleeding source and outcome. ROC curves were plotted for a cutoff value for age and hematoma volume in patients with a vascular pathology and patients without a vascular pathology. In 19 patients, a vascular pathology was found as a bleeding source for basal ganglia hemorrhage (33.3%; 95% CI 0.33 [0.21; 0.47]). Most of the arteriovenous malformations (AVMs) were small sized (61.1%) with deep venous drainage (94.4%). A single vein was found in 17 (77.8%) AVMs. Patients younger than 50 years were more likely to have a vascular pathology (AUC of 0.85 [95% CI 0.73; 0.98]; p = 0.001; cutoff value 46.5 years). Four (21.1%) patients older than 50 years suffered an AVM hemorrhage; 75% of them were located ventricular or thalamic. Hematoma volume in patients with AVM hemorrhage was predominantly less than 30 cm3 (AUC of 0.86 [95% CI 0.76; 0.96]; p = 0.001; cutoff value 12.6 cm3). Outcome in patients with a vascular pathology was more often favorable as in patients with a spontaneous hemorrhage (92.9% vs. 7.1%; p = 0.001). Young age and hematoma volume are significant predictors for presence of a bleeding source and outcome in basal ganglia hemorrhage. These criteria must be taken into account in the emergency diagnostics and therapy in order to achieve a rapid and sufficient result. Outcome in patients with AVM hemorrhage in basal ganglia is more often favorable.
Assuntos
Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/etiologia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Hematoma/complicações , Hematoma/patologia , Hematoma/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Estudos Retrospectivos , Adulto JovemRESUMO
Post-traumatic striatocapsular infarction is extremely rare and has been described only within the vascular territory of the perforating arteries originating from the middle cerebral artery (MCA). We recently encountered a patient presenting with unilateral multifocal striatocapsular hemorrhagic infarctions following mild head injury. This 25-year-old female was admitted to our trauma center after a motorcycle accident. Initial brain computed tomography and magnetic resonance (MR) imaging showed multifocal acute hemorrhagic infarctions with a clustering in the right caudate head, anterior limb of internal capsule, and globus pallidus. MR angiography and digital subtraction angiography showed suspicious luminal irregularities of the lenticulostriate arteries of the right MCA. Vessel wall MR images (VWI) did neither indicate intramural hematoma nor wall enhancement in the right MCA, suggesting dissection. However, VWI showed the passages of each lenticulostriate artery supplying each infarction site. Therefore, based on both conventional images and VWI, we postulate that this patient's post-traumatic multifocal striatocapsular hemorrhagic infarctions were caused by damage to multiple lenticulostriate arteries.
Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Gânglios da Base/irrigação sanguínea , Gânglios da Base/diagnóstico por imagem , Hemorragia Cerebral Traumática/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Adulto , Hemorragia dos Gânglios da Base/etiologia , Hemorragia Cerebral Traumática/complicações , Infarto Cerebral/etiologia , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Intracranial hemorrhage is a rare but potentially severe complication of spinal surgery. Most reported post-operative ICH cases consist of cerebellar hemorrhage. There are fewer reported cases of supratentorial ICH following spinal surgery. CASE PRESENTATION: A 56-year-old woman underwent spinal surgery complicated by bilateral supratentorial intraparenchymal basal ganglia hemorrhage with both intraventricular extension and subarachnoid hemorrhage in both cerebral hemispheres. CONCLUSION: The occurrence of neurological deterioration post-operatively following spinal surgery should alert physicians to the possibility of intracranial hemorrhage in order to facilitate rapid and optimal management. To our knowledge, this is the first case reporting basal ganglia hemorrhage following spinal surgery. Moreover, consideration should be given to the possibility of this complication prior to recommendation of elective spinal surgery.
Assuntos
Hemorragia dos Gânglios da Base/etiologia , Discotomia/efeitos adversos , Estenose Espinal/cirurgia , Vértebras Cervicais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Treatment of ruptured deep-seated arteriovenous malformations is challenging and associated with elevated risks. This is due to the proximity or involvement of critical brain structures and the specifically fine and delicate angioarchitecture of these lesions, making both endovascular and surgical access technically complicated. We present the advantages of a true combined, open surgical and endovascular transvenous approach in a hybrid operating room. The technique may overcome in part the difficulties and may improve safety and risk related concerns.
Assuntos
Hemorragia dos Gânglios da Base/etiologia , Hemorragia dos Gânglios da Base/terapia , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/complicações , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Angiografia Cerebral , Procedimentos Endovasculares/métodos , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Resultado do TratamentoRESUMO
Fahr's disease is a rare idiopathic nosological entity, characterized by calcification of the basal ganglia and dentate nuclei of the cerebellum. Sometimes it may be associated to other diseases like cerebrovascular disorders. However, this link remains unclear and it needs to be further validated. We report two cases of patients with cerebrovascular disorders and Fahr's disease. In the first case, a 69-years-old woman with right internal capsule-basal ganglia haemorrhage. In the second case, a 72-years-old woman with ischemic stroke and pericallosal artery aneurysm. The physiopathology is discussed and concerning literature is reviewed.
Assuntos
Doenças dos Gânglios da Base/complicações , Hemorragia dos Gânglios da Base/etiologia , Calcinose/complicações , Aneurisma Intracraniano/etiologia , Doenças Neurodegenerativas/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Transtornos Cerebrovasculares/etiologia , Feminino , HumanosRESUMO
Toluene is an aromatic hydrocarbon that is often used as a solvent in paints, paint thinners, glues, disinfectants and as an industrial solvent for the manufacturing of pharmaceuticals, paints and chemicals. Metabolic acidosis is a recognized complication of toluene poisoning. However, we here report an unusual case of toluene poisoning presenting with bilateral intracerebral haemorrhage.
Assuntos
Hemorragia dos Gânglios da Base/diagnóstico , Tolueno/intoxicação , Hemorragia dos Gânglios da Base/etiologia , Humanos , Pintura , SolventesRESUMO
BACKGROUND: The aim of this article is to summarize the clinical experience stemming from the administration of different surgical therapies in hypertensive basal ganglia hemorrhage (HBGH) patients. METHODS: A series of 87 patients with HBGH who had received surgical therapy individually were enrolled in this study. The surgical therapies were stereotactic aspiration (SA), stereotactic aspiration plus fibrinolytic therapy (SA+F) and microsurgery with small bone window (MS), respectively. The outcomes of the patients were evaluated by evolution of hematoma evacuation, activities of daily living (ADL) scale, mortality and complications. RESULTS: We found that there was no significant difference in the 24-hour evacuation rate, mortality and complication rate among treated groups (P>0.05). Though patients in level III and level IV of ADL scores were significantly different among the three groups, the overall ADL scale result demonstrated a similar ADL result. CONCLUSIONS: HBGH patients should be treated with an individualized surgical approach based on their condition and on the CT morphology of the hematoma.
Assuntos
Atividades Cotidianas , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/cirurgia , Hipertensão/complicações , Procedimentos Neurocirúrgicos/métodos , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia dos Gânglios da Base/etiologia , Terapia Combinada , Feminino , Fibrinolíticos/uso terapêutico , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Técnicas EstereotáxicasRESUMO
BACKGROUND: Intracerebral hemorrhage can be classified as either primary or secondary to various conditions such as vascular anomalies or stroke. We present a case of real-time incident detected on digital subtraction angiography (DSA) during thrombectomy in a patient with acute variable M1 occlusion. MATERIALS AND METHODS: A comprehensive literature search of the PubMed and Scopus databases was conducted: this is the first real-time visualization using DSA of a basal ganglia hematoma formation secondary to distal multifocal bleeding points just before a thrombectomy in a patient with acute variable M1 occlusion. CONCLUSION: We suggest that the positions of the clot before and during the procedure be compared always.
Assuntos
Doença Cerebrovascular dos Gânglios da Base/etiologia , Hemorragia dos Gânglios da Base/etiologia , Infarto da Artéria Cerebral Média/terapia , Trombectomia/efeitos adversos , Doença Aguda , Angiografia Digital , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Hemorrhage of the basal ganglia is common in hypertensive patients, and most of the cases are spon- taneous unilateral hemorrhage. Traumatic basal ganglia hemorrhage is uncommon, while bilateral hemorrhage of the basal ganglia after trauma is an extremely rare entity. This report described a rare case of bilateral hemorrhage of the basal ganglia after head trauma. We also analyzed the mechanisms and reviewed relative literatures.
Assuntos
Hemorragia dos Gânglios da Base/etiologia , Traumatismos Craniocerebrais/complicações , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
CONTEXT: Hypertension is the single most important risk factor for intracerebral hemorrhage (ICH) and often leads to solitary hematoma. Multiple spontaneous simultaneous ICH is not common, and bilateral hemorrhages occurred in symmetrical basal ganglia is extremely rare. Most reported cases accepted conservative treatment and suffered extremely poor outcome. CASE REPORT: A 57-year-old male became unconscious when having supper and was transported to our emergency room immediately. Non-contract CT brain scanning showed simultaneous bilateral hypertensive basal ganglia hemorrhage; he was treated by stereotactic aspiration and thrombolysis for both sides, with subsequent thrombolysis and clot aspiration through hematoma-indwelling catheter. The hematomas were almost totally cleared within a week. His condition improved gradually. Nearly 10 months after onset, he could chow and swallow food, controlling bowels and bladder all by himself, but need some help when feeding and using toilet. CONCLUSION: Simultaneous bilateral hypertensive basal ganglia hemorrhage is a devastating cerebrovascular disease with significant high morbidity and mortality. Stereotactic aspiration and thrombolysis is a safe and effective way to clear hematomas within short time, thus reducing the neurological impairment from hematoma mass effect and secondary brain injury, improving prognosis.
Assuntos
Hemorragia dos Gânglios da Base/etiologia , Encéfalo/diagnóstico por imagem , Hipertensão/complicações , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas Estereotáxicas , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: High-velocity trauma with acceleration/deceleration forces turns into shear stress over lenticulostriate or anterior choroidal arteries that lead to basal ganglia hemorrhage. Traumatic basal ganglia hematoma has rarely been described in pediatric population. The aim of this study was to present our clinical series of pediatric patients with traumatic basal ganglia hematoma and to analyze the prognostic indicators of traumatic basal ganglia hematoma. METHODS: In this retrospective case series, emergency admissions of pediatric patients with traumatic basal ganglia hematoma due to closed head injury were analyzed. Demographic, clinical, and radiographical data of the patients were retrieved from patients' charts and picture archiving and communication system. RESULTS: There were four children with traumatic basal ganglia hematoma (TBGH). All patients were male. Median age was 8 years (range = 7-16 years). Road accident (three) and fall (one) were the causes of the traumas. Basal ganglia hematoma was present on the right side in one patient and on the left side in three patients. Hematoma volumes ranged from 0.9 to 8.94 ml. All patients were treated conservatively. One patient recovered fully; two patients were moderately disabled at their last clinical follow-ups. The last patient with diffuse subarachnoidal hemorrhage and edema died despite all interventions. CONCLUSIONS: Traumatic basal ganglia hematomas are unique and different from other kind of intracerebral hematomas. The eloquent nature of basal ganglia makes it more vulnerable to head trauma. Mechanism of injury, energy and velocity of injury are the most important prognostic criteria. Post-traumatic phase of injury should be carefully observed in patients with TBGH, especially when mechanism and velocity of injury are severe and high.
Assuntos
Hemorragia dos Gânglios da Base/etiologia , Traumatismos Cranianos Fechados/complicações , Adolescente , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Criança , Feminino , Traumatismos Cranianos Fechados/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Tomógrafos ComputadorizadosAssuntos
Diabetes Mellitus Tipo 2/complicações , Gastroparesia/complicações , Gastropatias/etiologia , Ar , Hemorragia dos Gânglios da Base/etiologia , Descompressão Cirúrgica , Diagnóstico Diferencial , Humanos , Íleus/etiologia , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Gastropatias/diagnóstico por imagem , Gastropatias/cirurgiaRESUMO
OBJECTIVE: To observe the effect of Xingnaojing Injection combined with minimally invasive percutaneous drainage on brain edema and content of serum aquaporin-4 (AQP4) in patients with moderate hypertensive basal ganglia hemorrhage, and discuss the treatment mechanism of Xingnaojing injection combined with minimally invasive percutaneous drainage for cerebral hemorrhage. METHOD: Forty-two patients with moderate (25-50 mL) hypertensive basal ganglia hemorrhage (< 24 h) were selected and randomly divided into two groups: the observation group (n = 22) and the control group (n = 20). The neurological severity score were evaluated by the NIHSS (national institutes of health stroke scale), the volume of brain edemas were measured by head CT, the serum levels of AQP4 were determined by ELISA method on admission and 1 and 2 weeks after treatment. RESULT: On admission, there was no significant difference in the scores of NIHSS, the volume of brain edemas and the level of serum AQP4 between the observation group and the control group. At the end of the first week after the treatment, the score of NIHSS of the observation group were lower than that of the control group, with significant different (P < 0.05); the observation group showed reduced volume of brain edemas than that on admission (P < 0.05), whereas the control group the control group showed increased volume of brain edemas than that on admission; the control group displayed increased level of serum AQP4 than that on admission, but without significant difference; the observation group displayed decreased level of serum AQP4 than that on admission (P < 0.05). At the end of the second week after the treatment, the control group showed decreased score of NIHSS than that on admission and at the end of the first week after treatment (P < 0.05). Compared with the control group, the observation group showed a much lower score of NIHSS (P < 0.01), the control group displayed reduced volume of brain edemas than that on admission and at the end of the first week after treatment, but the observation group was even lower than the control group. Both of observation and control groups displayed significantly reduced level of AQP4 (P < 0.05), but the observation group showed a lower AQP4 level than that of the control group (P < 0.05). CONCLUSION: The therapy of Xingnaojing injection combined with minimally invasive percutaneous drainage could remarkably reduce brain edema, and promote neural functional recovery, thus could be selected as a therapeutic regimen for patients with moderate hypertensive basal ganglia hemorrhage.
Assuntos
Aquaporina 4/sangue , Hemorragia dos Gânglios da Base/tratamento farmacológico , Hemorragia dos Gânglios da Base/cirurgia , Edema Encefálico/tratamento farmacológico , Edema Encefálico/cirurgia , Drenagem , Medicamentos de Ervas Chinesas/administração & dosagem , Hipertensão/complicações , Idoso , Aquaporina 4/genética , Hemorragia dos Gânglios da Base/sangue , Hemorragia dos Gânglios da Base/etiologia , Edema Encefálico/sangue , Edema Encefálico/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Bilateral traumatic basal ganglia haematoma is an extremely rare event in traumatic brain injuries, with only five reported cases. The presumed mechanism is due to shearing forces leading to haemorrhage from the lenticulostriate or anterior choroidal artery. The prognosis appears to be dependent on the extent and severity of underlying brain injury. CASE STUDY: A case of a 38 year old fully conscious male, who presented with bilateral basal ganglia haematoma and extradural haematoma, is presented and the relevant literature is briefly reviewed.
Assuntos
Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/etiologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/etiologia , Acidentes por Quedas , Adulto , Hemorragia dos Gânglios da Base/reabilitação , Lesões Encefálicas/reabilitação , Estado de Consciência , Hematoma Epidural Craniano/reabilitação , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: Early hematoma expansion is a known cause of morbidity and mortality in patients with intracerebral hemorrhage (ICH). The goal of this study was to identify clinical predictors of ICH growth in the acute stage. MATERIALS AND METHODS: We studied 201 patients with acute (<6 h) deep ganglionic ICH. Patients underwent CT scan at baseline and hematoma expansion (>33% or >12.5 ml increase) was determined on the second scan performed within 24 h. Fourteen clinical and neuroimaging variables (age, gender, GCS at admission, hypertension, diabetes mellitus, kidney disease, stroke, hemorrhagic, antiplatelet use, anticoagulant use, hematoma density heterogeneity, hematoma shape irregularity, hematoma volume and presence of IVH) were registered. Additionally, blood pressure was registered at initial systolic BP (i-SBP) and systolic BP 1.5 h after admission (1.5 h-SBP). The discriminant value of the hematoma volume and 1.5 h-SBP for hematoma expansion were determined by the receiver operating characteristic (ROC) curves. Factors associated with hematoma expansion were analyzed with multiple logistic regression. RESULTS: Early hematoma expansion occurred in 15 patients (7.0%). The cut-off value of hematoma volume and 1.5 h-SBP were determined to be 16 ml and 160 mmHg, respectively. Hematoma volume above 16 ml (HV>16) ([OR]=5.05, 95% CI 1.32-21.36, p=0.018), hematoma heterogeneity (HH) ([OR]=7.81, 95% CI 1.91-40.23, p=0.004) and 1.5 h-SBP above 160 mmHg (1.5 h-SBP>160) ([OR]=8.77, 95% CI 2.33-44.56, p=0.001) independently predicted ICH expansion. If those three factors were present, the probability was estimated to be 59%. CONCLUSIONS: The presented model (HV>16, HH, 1.5 h-SBP>160) can be a practical tool for prediction of ICH growth in the acute stage. Further prospective studies are warranted to validate the ability of this model to predict clinical outcome.