Novel Anatomic Classification of Spontaneous Thalamic Hemorrhage Classified by Vascular Territory of Thalamus.

BACKGROUND: Spontaneous thalamic hemorrhage has increased in incidence in recent years. Analysis of the characteristics of thalamic hemorrhage was based on the vascular territories of the thalamus. METHODS: Retrospective analysis included 303 consecutive patients with spontaneous thalamic hemorrhage. Thalamic hemorrhage was classified into 4 types: anterior type (supplied mainly by the tuberothalamic artery), medial (mainly paramedian thalamic-subthalamic artery), lateral (mainly thalamogeniculate artery), and posterior (mainly posterior choroidal artery). The baseline characteristics, complications, and functional outcomes were assessed. RESULTS: The anterior type was found in 10 patients (3.3%), the medial type in 47 (15.5%), the lateral type in 230 (75.9%), and the posterior type in 16 (5.3%). Intracerebral hemorrhage volume was smallest in the anterior type, and significantly smaller than in the medial (P = 0.002) and lateral types (P < 0.001). Intraventricular hemorrhage (IVH) or acute hydrocephalus was significantly associated with the medial type (P < 0.01 or P < 0.01, respectively). Non-IVH or non-acute hydrocephalus was significantly associated with the anterior (P < 0.05 or P < 0.05, respectively) and lateral (P < 0.05 or P < 0.05, respectively) types. Emergency surgery was correlated only with the medial type (P < 0.01). The independent predictors of poor outcome were age (odds ratio [OR], 1.07; P = 0.002), admission National Institutes of Health Stroke Scale score (OR, 1.32; P < 0.001), and type of thalamic hemorrhage (OR, 2.08; P = 0.038). CONCLUSIONS: The present study proposed a novel anatomic classification of thalamic hemorrhage according to the major thalamic vascular territories.

SLAM: Stereotactic Radiosurgery of Large Arteriovenous Malformations: Meta-analysis of Hemorrhage in High-Grade Pollock-Flickinger Arteriovenous Malformations.

BACKGROUND: The prognosis of arteriovenous malformations (AVMs) after treatment has been predicted largely by 2 grading scales: the Spetzler-Martin and Pollock-Flickinger. Although there are studies that examine the rate of hemorrhage with the Spetzler-Martin scale, there have not been studies examining hemorrhage in which the Pollock-Flickinger score was used. The annual hemorrhage rate after radiosurgery of Pollock-Flickinger AVM scores >2 is analyzed. METHODS: Literature search for radiosurgery of large AVMs from January 1, 2000 to June 1, 2014 was conducted. Articles were examined for individual patient data and aggregate patient data that reported hemorrhage rates and mortality. Patients were only included if they had an AVM score ≥2. RESULTS: Annual AVM hemorrhage rate after radiosurgery for all patients (n = 673) was 3.22% (99.3 hemorrhages, 3080.5 follow-up years, 95% confidence interval [95% CI] 2.64%-3.89%). Mortality rate from hemorrhage was 40.08% (95% CI 31.21%-49.90%). A total of 203 patients presented with hemorrhage and 395 did not. In patients with first-time hemorrhage, the annual hemorrhage rate was 3.53% (95% CI 2.66%-4.77%). The annual hemorrhage rate of those with hemorrhagic presentation was 6.10% (95% CI 4.65%-8.07%). The odds ratio comparing re-hemorrhage rate versus first-time hemorrhage is 1.768 (95% CI 1.1571-2.7014, P = 0.0084). Complete obliteration of all AVMs was equal to 33.27% (95% CI, 29.25%-37.54%). CONCLUSIONS: The annual hemorrhage rate in AVMs with scores >2 treated with radiosurgery was comparable with baseline rupture rates reported for untreated AVMs. With further stratification by hemorrhagic versus nonhemorrhagic presentation, the subsequent annual hemorrhage rates are similar to their respective natural histories. Considering the mortality rate from hemorrhage at 40.08% (95% CI, 35.54%-44.62%), the consequences of radiosurgical treatment of large AVMs is significantly worse than the reported 10%-30% fatality rate from hemorrhage of an untreated AVM. Additionally, the overall mortality rate was 6.24% however the percentage of mortalities from hemorrhage was 97.62%.

The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of hematomas.

AIM: The correlation between hematoma volume and outcome in ruptured arteriovenous malformations (AVM) with accompanying posterior fossa hematoma was retrospectively evaluated. MATERIAL AND METHODS: Microsurgery operations were performed on 127 patients with intracranial AVM between January 1998 and January 2009 at our clinic. Fifteen (11.8%) patients were identified as suffering from posterior fossa AVM, and twelve of these patients presented with a cerebellar hematoma. All patients were clinically evaluated according to the following criteria: modified Rankin Scale (mRS) prior to surgery, Spetzler-Martin grade (SMG) of the AVMs, hematoma volume prior to surgery, and mRS following surgery. RESULTS: Postoperative mRS scores were significantly lower than preoperative scores (p=0.0001). Postoperative outcomes were concordant with the SMG of the AVMs (r=0.67, p=0.033), hematoma volume (r=0.537, p=0.072) and preoperative mRS scores (r=0.764, p=0.004). These analyses show that the postoperative mRS score is strongly correlated with a preoperative mRS score, hematoma volume and SMG. CONCLUSION: Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome.

Achados ultra-sonográficos da hemorragia intracraniana em recém-nascidos prematuros / Ultrasonic findings of intracranial hemorrhage in preterm neonates

Intracranial hemorrhage ICH is one of the most common neurological events in pre-term newborn ICH is associated with low birth weight (< 1500 g) and gestational age (GA) at delivery (< 32 weeks). The most common site affected is the germinal matrix. Papile et al. classifies it at four grades. We analyzed, prospectively, 50 newborns (27 boys) with ultrasound diagnostic of ICH; all of them were pre-term (GA < 37 weeks). They were classified according to sex, gestational age, birth weight and degree of ICH. The children were divided into two groups: A--GA < or = 33 weeks and B--34-37 weeks. In group A there were 34 children (25 boys) with mean GA of 31 weeks and birth weights average of 1308 g. In group B there were 16 children (2 boys), mean GA 34 weeks and birth weight average of 1951 g. The grades of ICH were: Group A--I-14, II-14, III-4 and IV-2; Group B--I-12, II-3 and III-1. The complications were more common in group A with 12 than group B with 4 children. The lesions happen in greatest number and most severity in children with low birth weight and younger (low gestational age). Ultrasound has shown to be effective for diagnostic and follow up of those children.

A hemorragia intracraniana (HIC) é a manifestação mais comum no sistema nervoso central de recém-nascidos (RN) prematuros, especialmente os de peso menor que 1500 g, ou com idade gestacional (IG) menor que 32 semanas. O local mais acometido é a matriz germinal e é classificado em graus por Papile et al. Foram analisados prospectivamente 50 RN pré-termo (IG <37 semanas) com diagnóstico de HIC ao exame ultra-sonográfico (US) transfontanelar. Eles foram classificados quanto à idade, sexo, idade gestacional, peso ao nascer, gravidade e evolução ultra-sonográfica da lesão. As crianças foram divididas em dois grupos (A: IG < 33 semanas e B: 34> IG<37 semanas). No grupo A tivemos 34 RN (25 meninos) com IG média de 31 semanas e peso médio de 1308 g. No grupo B tivemos 16 RN (2 meninos) com IG média de 34 semanas e peso médio de 1951 g. A distribuição da HIC nos grupos foi: Grupo A-Grau I- 14, II-14, III-4 e IV-2 e Grupo B-I-12, II- 3, III-1. Não houve diferença estatística do grau da HIC entre meninos e meninas ou entre os grupos de RN. As complicações foram mais comuns no grupo A, com um total de 12, contra 4 no Grupo B. O US se mostrou método eficiente no diagnóstico e acompanhamento dos RN com HIC.