Intracranial hemorrhages in patients with COVID-19: a systematic review of the literature, regarding six cases in an Amazonian population / Hemorragias intracranianas em pacientes com COVID-19: uma revisão sistemática da literatura, a propósito de seis casos na população amazônica

Abstract Background Coronavirus disease 2019 (COVID-19) has emerged as a public health emergency worldwide, predominantly affecting the respiratory tract. However, evidence supports the involvement of extrapulmonary sites, including reports of intracranial hemorrhages. Objective To describe six original cases and review the literature on intracranial hemorrhages in patients diagnosed with COVID-19 by molecular methods. Methods A systematic literature review was performed on MEDLINE, PubMed, and NCBI electronic databases to identify eligible studies. Of the total 1,624 articles retrieved, only 53 articles met the inclusion criteria. Results The overall incidence of intracranial hemorrhage in patients hospitalized for COVID-19 was 0.26%. In this patient group, the mean age was 60 years, and the majority were male (68%) with initial respiratory symptoms (73%) and some comorbidity. Before the diagnosis of hemorrhage, 43% of patients were using anticoagulants, 47.3% at therapeutic doses. The intraparenchymal (50%) was the most affected compartment, followed by the subarachnoid (34%), intraventricular (11%), and subdural (7%). There was a predominance of lobar over non-lobar topographies. Multifocal or multicompartmental hemorrhages were described in 25% of cases. Overall mortality in the cohort studies was 44%, while around 55% of patients were discharged from hospital. Conclusion Despite the unusual association, the combination of these two diseases is associated with high rates of mortality and morbidity, as well as more severe clinicoradiological presentations. Further studies are needed to provide robust evidence on the exact pathophysiology behind the occurrence of intracranial hemorrhages after COVID-19 infection.

Resumo Antecedentes A COVID-19 emergiu como uma emergência de saúde pública em todo o mundo, proporcionando lesão principalmente do trato respiratório. No entanto, várias evidências apontam para acometimento de sítios extrapulmonares, incluindo relatos de hemorragias intracranianas. Objetivo Descrever seis casos originais e revisar a literatura sobre hemorragias intracranianas em pacientes com diagnostico de COVID-19 por métodos moleculares. Métodos A revisão sistemática da literatura foi feita nas bases de dados eletrônicas da MEDLINE, PubMed e NCBI para identificar os estudos elegíveis. Do total de 1.624 artigos recuperados, apenas 53 artigos preencheram os critérios de inclusão. Resultados A incidência geral de hemorragia intracraniana nos pacientes internados por COVID-19 foi de 0,26%. A média de idade foi de 60 anos, e a maioria dos pacientes era do sexo masculino (68%) com sintomas respiratórios iniciais (73%) e alguma comorbidade. Antes do diagnóstico de hemorragia, 43% estavam em uso de anticoagulantes, 47,3% destes em doses terapêuticas. O compartimento mais acometido foi o intraparenquimatoso (50%), seguido do subaracnoideo (34%), intraventricular (11%) e subdural (7%). Houve predomínio de topografias lobares sobre as não-lobares. Hemorragias multifocais ou multicompartimentais foram descritas em 25% dos casos. A mortalidade geral nos estudos de coorte foi de 44%, enquanto houve alta hospitalar em cerca de 55% dos pacientes. Conclusão Apesar da associação incomum, a combinação dessas doenças está relacionada com altas taxas de mortalidade e morbidade, bem como apresentações clínico-radiológicas mais graves. Mais estudos são necessários para oferecer evidências robustas sobre a fisiopatologia exata por trás da ocorrência de hemorragias intracranianas após infecção por COVID-19.

Hemorrhagic Cerebrovascular Disease: An Unusual Presentation of Hyperhomocysteinemia / Accidente cerebrovascular hemorrágico: una inusual presentación de hiperhomocisteinemia / Acidente vascular cerebral hemorrágico: uma apresentação incomum da hiper-homocisteinemia

Introduction: Stroke is a major cause of morbidity and mortality worldwide, with hemorrhagic stroke being the deadliest form of acute stroke. Therefore, the cause of the event should be determined to direct the associated therapy and take preventive measures. Hyperhomocysteinemia has been described as a rare etiology of stroke. Although hyperhomocysteinemia has been associated with venous thrombotic events, altered endothelial function, and procoagulant states, its clinical role in stroke remains controversial. Case description: We present a case of a 60-year-old male patient with primary autoimmune hypothyroidism who presented with dysarthria, facial paresis, and left upper-limb monoparesis after sexual intercourse. A simple skull computed tomography scan showed hyperintensity in the right basal ganglion, indicating an acute hemorrhagic event. Etiological studies were performed, including ambulatory blood pressure monitoring, cerebral angiography, and transthoracic echocardiogram, which ruled out underlying vascular pathology. During follow-up, vitamin B12 deficiency and hyperhomocysteinemia were detected, without other blood biochemical profile alterations. Supplementation was initiated, and homocysteine levels gradually decreased, without new neurological deficits observed during follow-up. Conclusion: Quantification of homocysteine should be considered in patients with a cerebrovascular disease without apparent cause, as documenting hyperhomocysteinemia and correcting its underlying etiology are essential not only for providing appropriate management but also for preventing future events.

Introducción: el accidente cerebrovascular es una causa importante de morbilidad y mortalidad en todo el mundo, y el accidente cerebrovascular hemorrágico es la forma más mortífera de accidente cerebro- vascular agudo. La determinación de la causa del evento es esencial para dirigir la terapia asociada y poder tomar medidas preventivas. La hiperhomocisteinemia se ha descrito como una etiología poco frecuente de accidente cerebrovascular. Aunque esta se ha asociado con eventos trombóticos venosos, disfunción endotelial alterada y estados procoagulantes, sigue siendo controvertido su papel clínico en el accidente cerebrovascular. Descripción del caso: se presenta el caso de un hombre de 60 años con hipotiroidismo autoinmune primario que presentó disartria, paresia facial y monoparesia del miembro superior izquierdo después de un encuentro sexual. Una simple tomografía computarizada de cráneo mostró hipointensidad en la región del ganglio basal derecho, que indicaba un evento hemorrágico agudo. Se realizaron estudios etiológicos, incluyendo monitorización ambulatoria de la presión arterial, angiografía cerebral y ecocardiograma transtorácico, que descartaron patología vascular subyacente. Durante el seguimiento, se detectó deficiencia de vitamina B12 e hiperhomocisteinemia, sin otras alteraciones en el perfil bioquímico sanguíneo. Se inició la suplementación y los niveles de homocisteína disminuyeron gradualmente, sin observar nuevos déficits neurológicos durante el seguimiento. Conclusión: la cuantificación de homocisteína debe ser considerada en casos de enfermedad cerebrovascular sin causa aparente, dado que documentar la hiperhomocisteinemia y corregir su etiología subyacente es esencial no solo para proporcionar un manejo adecuado, sino también para prevenir eventos futuros.

Introdução: o acidente vascular cerebral (AVC) é uma das principais causas de morbidade e mortalidade em todo o mundo, sendo o AVC hemorrágico a forma mais letal de AVC agudo. A determinação da causa do evento é essencial para direcionar a terapia associada e poder tomar medidas preventivas. A hiperhomocisteinemia tem sido descrita como uma etiologia rara de acidente vascular cerebral. Embora a hiper-homocisteinemia tenha sido associada a eventos trombóticos venosos, disfunção endotelial alterada e estados pró-coagulantes, seu papel clínico no AVC permanece controverso. Descrição do caso: apresentamos o caso de um homem de 60 anos com hipotireoidismo autoimune primário que apresentou disartria, paresia facial e monoparesia do membro superior esquerdo após relação sexual. A tomografia computadorizada de crânio mostrou hipointensidade na região do gânglio da base direito, indicando evento hemorrágico agudo. Foram realizados estudos etiológicos, incluindo monitorização ambulatorial da pressão arterial, angiografia cerebral e ecocardiograma transtorácico, que descartaram patologia vascular subjacente. Durante o acompanhamento, foram detectados deficiência de vitamina B12 e hiper-homocistei- nemia, sem outras alterações no perfil bioquímico sanguíneo. A suplementação foi iniciada e os níveis de homocisteína diminuíram gradualmente, sem novos déficits neurológicos observados durante o acompanhamento. Conclusão: a quantificação da homocisteína deve ser considerada em casos de doença vascular cerebral sem causa aparente, pois documentar a hiper-homocisteinemia e corrigir sua etiologia subjacente é essencial não apenas para fornecer manejo adequado, mas também para prevenir eventos futuros.

Hipernatremia en pacientes con estado crítico por afecciones neurológicas

Fundamento: los trastornos del sodio son los más comunes y menos entendidos en pacientes con lesión cerebral aguda debido al papel principal que desempeña el sistema nervioso central en la regulación de la homeostasis del sodio y agua lo que puede llevar a complicaciones graves y resultados adversos, incluyendo la muerte. Objetivo: determinar la contribución a la mortalidad de la hipernatremia en pacientes con estado crítico por afecciones neurológicas. Métodos: estudio observacional analítico sobre 55 pacientes que ingresaron en las unidades de atención al grave del Hospital Universitario Arnaldo Milián Castro, entre octubre del 2020 y mayo del 2022, con independencia del valor del sodio plasmático a su admisión en el servicio, así como durante su estadía en las unidades de atención al grave. Se emplearon métodos estadísticos univariados y bivariados en el análisis de los datos. Resultados: el promedio de edad fue de 60±16 años. Los diagnósticos más relevantes fueron la hemorragia intraparenquimatosa (56,37 %), el trauma craneoencefálico y el accidente cerebrovascular isquémico (ambos 30 %). Las concentraciones plasmáticas de sodio mostraron diferencias significativas (pX2= 0,000), siendo la media mayor a las 24 horas de ingreso (174,2±133,6) y la menor al 5to día (102,9±72,9). Existió correlación significativa entre las concentraciones plasmáticas de sodio al ingreso ( 24 h y 72 h) y el estado al egreso. En el análisis bivariado individual por período, solo a las 24 horas hubo relación significativa, en este periodo la hipernatremia contribuyó a la mortalidad en 1,78 veces más que en aquellos que no tenían el sodio elevado (OR=1,78 con IC: 1,39-3,4). Conclusiones: la hipernatremia en el paciente con estado crítico por afecciones neurológicas se asocia con incremento de la mortalidad.

Background: sodium disorders are the most common and least understood in patients with acute brain injury due to the major role played by the central nervous system in regulating sodium and water homeostasis, which can lead to serious complications and adverse outcomes, including death. Objective: to determine the hypernatremia contribution to mortality in patients with neurological conditions in critical state. Methods: longitudinal analytical observational study on 55 patients who were admitted to the acute care units at the Arnaldo Milián Castro University Hospital, between October 2020 and May 2022, regardless of the plasma sodium value upon admission to the service, as well as during their stay in the critical care units. Univariate and bivariate statistical methods were used in data analysis. Results: the average age was 60 ± 16 years. The most relevant diagnoses were intraparenchymal hemorrhage (56.37%), head trauma, and ischemic stroke (both 30%). Plasma sodium concentrations showed significant differences (pX2= 0.000), with the highest average at 24 hours of admission (174.2 ± 133.6) and the lowest at the 5th day (102.9 ± 72.9). There was a significant correlation between plasma sodium concentrations at admission, 24h and 72h with the state at discharge. In the individual bivariate analysis by period, there was only a significant relationship after 24 hours. In this period, hypernatremia contributed 1.78 times more to mortality than in those who did not have elevated sodium (OR=1.78 with CI: 1,39-3,4). Conclusions: hypernatremia in critically ill patients with neurological conditions is associated with increased mortality.

Correlation study between early neurological deterioration and cerebral microbleeds in patients with acute small artery occlusion / 中国医师进修杂志

Objective:To investigate the relationship between the degree and location of cerebral microbleeds (CMBs) and the early neurological deterioration (END) within 72 h after admissionin in patients with acute small artery occlusive stroke (SAO).Methods:Patients with first-onset SAO hospitalized in Changzhou Second People′s Hospital from July 2020 to January 2021 were retrospectively enrolled. All patients completed the head magnetic resonance imaging including susceptibility weighted imaging. Collected baseline data, and evaluated the National Institutes of Health Stroke Scale (NHISS) scores before admission and within 72 h after onset. Patients were divided into END group and no END group according to whether NIHSS scores increased by ≥3 within 72 h after admission. The baseline characteristics were compared between these two groups. Moreover, the correlation between the degree and location of CMBs and END were analyzed by multivariate Logistic regression.Results:A total of 163 first-episode SAO patients were enrolled. There were 47 patients (28.83%) with END. In END group, there were 35 patients (74.47%) with CMBs which was higher than those in non-END group [42 patients (36.21%)]. In END group, there were 21 patients (44.68%) with severe CMBs, 11 patients (23.41%) with basal ganglia CMBs, 16 patients (34.04%) with mixed CMBs, which were all higher than those in non-END group [5 patients (4.31%) with severe CMBs, 9 patients (7.76%) with basal ganglia CMBs, and 13 patients (11.21%) with mixed CMBs]. The difference was statistically significant ( P<0.05). After adjusting for triglyceride, location of infarcated lesions, and the degree of WMHs, further Logistic regression analysis revealed that severe CMBs ( OR = 6.139, 95% CI 1.377 - 27.375, P = 0.017), basal ganglia CMBs ( OR = 5.253, 95% CI 1.105 - 24.975, P = 0.037) and mixed CMBS ( OR = 5.098, 95% CI 1.197 - 21.704, P = 0.028) were independent risk factors of END in SAO patients. Conclusions:The location and degree of CMBs are closely related to the occurrence of END in patients with SAO. Severe CMBs, basal ganglia CMBs and mixed CMBs may be the effective predictors of END in patients with SAO.

Chronic kidney disease and cerebral microbleeds / 国际脑血管病杂志

Because the brain and kidneys share a common basis for small vessel lesions, the related research on cerebral microbleeds (CMBs) in patients with chronic kidney disease (CKD) is gradually increasing. The development of neuroimaging technology has significantly increased the detection rate of CMBs, but there is still controversy over whether CKD will increase the incidence of CMBs. This article reviews the relationship between CKD and CMBs, pathogenesis, biomarkers, and treatment.

Cerebral small vessel disease and spontaneous cerebral hemorrhage / 国际脑血管病杂志

Spontaneous intracerebral hemorrhage (ICH) is the second common subtype of stroke, characterized by high morbidity, mortality, and disability. Cerebral small vessel disease (CSVD) refers to a series of clinic, imaging, and pathological syndromes caused by various causes that affect small arteries, arterioles, capillaries, and small venules in the brain. In recent years, there has been increasing research on the correlation between CSVD and ICH recurrence and outcomes. This article mainly reviews the relationship between CSVD imaging markers and ICH, in order to have a deeper understanding of ICH.

Gut microbiota and cerebral vessel diseases / 国际脑血管病杂志

Gut microbiota is involved in maintaining intestinal homeostasis. The bidirectional communication between intestinal flora and brain can also be conducted through the neuro-immune-endocrine network, namely, the "microbiota-gut-brain axis". A number of studies have shown that the "microbiota-gut-brain axis" disorder plays an important role in the occurrence, development and prognosis of some cerebrovascular diseases, such as cerebral small vessel disease and stroke. This article introduces the latest research progress of the relationship between gut microbiota and cerebrovascular diseases, so as to provide more ideas and options for the treatment of cerebrovascular diseases.

Ventricular hemorrhage secondary to spontaneous intracerebral hemorrhage: pathophysiological, imaging evaluation and treatment / 国际脑血管病杂志

Intraventricular hemorrhage (IVH) accounts for about 3%-5% of all intracerebral hemorrhage, which can be divided into primary and secondary IVH. Primary IVH is mostly caused by choroid plexus vascular or subependymal artery rupture, and secondary IVH refers to spontaneous intracerebral hemorrhage that breaks into the ventricle and the prognosis was poor. This article reviews the pathophysiological mechanism, severity assessment, and treatment progress of secondary IVH.

Effect of acupressure combined with repetitive transcranial magnetic stimulation on the motor function recovery after stroke: a prospective randomized controlled study / 国际脑血管病杂志

Objective:To investigate the effect of acupressure combined with repetitive transcranial magnetic stimulation (rTMS) on the motor function recovery after stroke.Methods:Patients with post-stroke hemiplegia treated with rehabilitation in Beijing Tongzhou District Integrated Traditional Chinese and Western Medicine Hospital from February 2020 to May 2022 were enrolled prospectively. They were randomly divided into acupressure + rTMS group and rTMS group according to the random number table method. All patients were given routine rehabilitation training and drug intervention after admission. The rTMS group was treated with high-frequency rTMS on the dorsolateral prefrontal cortex of the affected sides, and the acupressure + rTMS group conducted acupressure on the basis of the rTMS group. The treatment time was 6 weeks for both groups. Before and after treatment, Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test Scale (WMFT) were used to evaluate motor function.Results:A total of 112 patients were enrolled in the study, including 56 patients in the acupressure + rTMS group and 56 patients in the rTMS group. The BBS score, FMA score and WMFT score in both groups after treatment were significantly improved than those before treatment ( P<0.001), but the BBS score, FMA score and WMFT score in the acupressure + rTMS group after treatment were significantly higher than those in the rTMS group ( P<0.001). Conclusion:The application of acupressure combined with rTMS can promote the recovery of motor function after stroke, and the treatment effect is significant.

Combined HAT score and neutrophil to lymphocyte ratio predict symptomatic intracranial hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the value of hemorrhage after thrombolytic (HAT) score and neutrophil to lymphocyte ratio (NLR) in combination predicting symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Consective patients with AIS received intravenous thrombolysis with ateplase in Tianjin TEDA Hospital from January 2016 to December 2021 were retrospectively enrolled. sICH was defined as cerebral CT showing hemorrhage at any part of the brain after intravenous thrombolysis, and the National Institutes of Health Stroke Scale (NIHSS) score was increased by≥4 compared with the baseline, or there was a manifestation indicating clinical aggravation. Univariate analysis was used to compare the baseline data of sICH group and non-sICH group. A binary multivariate logistic regression model was used to determine the independent influencing factors of sICH. The receiver operating characteristic (ROC) curve was used to evaluate the value of HAT score and NLR in combination predicting sICH. Results:A total of 429 patients with AIS were enrolled. Univariate analysis showed that there were significant differences in atrial fibrillation, systolic blood pressure, NLR, HAT score and NIHSS score between the sICH group and the non-sICH group (all P<0.05). Multivariate analysis showed that NLR (odds ratio [ OR] 1.405, 95% confidence interval [ CI] 1.193-2.958), HAT score ( OR 1.512, 95% CI 1.207-3.169) and NIHSS score ( OR 1.221, 95% CI 1.082-2.634) had significant independent correlation with sICH after adjusting for atrial fibrillation and systolic blood pressure. The ROC curve showed that the areas under the curve of HAT score, NLR and their combination predicting sICH were 0.719 (95% CI 0.609-0.832), 0.723 (95% CI 0.618-0.835) and 0.854 (95% CI 0.765-0.931), respectively. The areas under the curve of the two methods in combination were significantly larger than those of the single method ( P=0.029 and 0.032, respectively), and their sensitivity and specificity were 74.1% and 83.5% respectively. Conclusion:Combined HAT score and NLR is of high value in predicting sICH after intravenous thrombolysis in patients with AIS, and has clinical application potential.

Research progress of fibroblast growth factor in nervous system diseases / 浙江大学学报·医学版

Fibroblast growth factors (FGF) are a group of structurally related polypeptides which constitute an elaborate signaling system with their receptors. Evidence accumulated in the years suggests that the FGF family plays a key role in the repair of central nervous system injury. The main protective mechanisms include activating the expression of PI3K-Akt, peroxisome proliferator-activated receptor (PPARγ) and other signals; inhibiting NF-κB-mediated inflammatory response, oxidative stress and apoptosis; regulating neuronal differentiation and neuronal excitability as well as participating in protection of neurovascular units and nerve function repair. This paper comprehensively summarizes the latest research progress in FGF signaling related to diseases of the central nervous system such as cerebral infarction, cerebral hemorrhage, traumatic brain injury, Alzheimer's disease, Parkinson's disease, epilepsy and depression, aiming to provide scientific basis and reference for the development of innovative FGF drugs for the prevention and treatment of neurological diseases.

Cerebrovascular mortality: trend and seasonality in Brazilian capitals, 2000-2019 / Mortalidade cerebrovascular: tendência e sazonalidade nas capitais brasileiras, 2000-2019

ABSTRACT OBJECTIVE To evaluate the trend and seasonality of cerebrovascular mortality rates in the adult population of Brazilian capitals from 2000 to 2019. METHODS This is an ecological and descriptive study of a time series of mortality due to cerebrovascular causes in adults (≥ 18 years) living in Brazilian capitals from 2000 to 2019, based on the Brazilian Mortality Information System. Descriptive statistical techniques were applied in the exploratory analysis of data and in the summary of specific, standardized rates and ratios by sociodemographic characteristics. The jointpoint regression model was used to estimate the trend of cerebrovascular mortality rates by gender, age groups, and geographic regions. The seasonal variability of rates by geographic regions was estimated using the generalized additive model by smoothing cubic splines. RESULTS People aged over 60 years comprised 77% of all cerebrovascular deaths. Women (52%), white individuals (47%), single people (59%), and those with low schooling (57%, elementary school) predominated in our sample. Recife (20/1,000 inhab.) and Vitória (16/1,000 inhab.) showed the highest crude mortality rates. Recife (49/10,000 inhab.) and Palmas (47/10,000 inhab.) prevailed after we applied standardized rates. Cerebrovascular mortality rates in Brazil show a favorable declining trend for adults of all genders. Seasonality influenced rate increase from July to August in almost all region capitals, except in the North, which rose in March, April, and May. CONCLUSIONS Deaths due to cerebrovascular causes prevailed in older single adults with low schooling. The trend showed a tendency to decline and winter, the greatest risk. Regional differences can support decision-makers in implementing public policies to reduce cerebrovascular mortality.

RESUMO OBJETIVO Avaliar a tendência e a sazonalidade das taxas de mortalidade cerebrovascular na população adulta das capitais brasileiras de 2000 a 2019. MÉTODOS Estudo ecológico e descritivo de séries temporais de mortalidade por causas cerebrovasculares em adultos (≥ 18 anos) residentes nas capitais do Brasil no período 2000-2019, obtidas do Sistema de Informações sobre Mortalidade. Técnicas de estatística descritiva foram aplicadas na análise exploratória dos dados e no resumo de taxas específicas, padronizadas e razões por características sociodemográficas. A regressão de pontos de junção (jointpoint regression model) estimou a tendência das taxas de mortalidade cerebrovascular por sexo, grupos etários e regiões geográficas. A variabilidade sazonal por regiões geográficas das taxas foi estimada utilizando o modelo aditivo generalizado por meio de splines de suavização cúbica. RESULTADOS As pessoas maiores de 60 anos representaram 77% dos óbitos cerebrovasculares. Predominaram o sexo feminino (52%), a raça branca (47%), os solteiros (59%) e a baixa escolaridade (57%, ensino fundamental). As capitais Recife (20/1.000 hab.) e Vitória (16/1.000 hab.) apresentaram as maiores taxas brutas de mortalidade. Aplicando as taxas padronizadas Recife (49/10.000 hab.) e Palmas (47/10.000 hab.) prevaleceram. As taxas de mortalidade cerebrovascular no Brasil apresentam uma tendência favorável ao declínio em ambos os sexos e em adultos. A sazonalidade mostrou influenciar na elevação das taxas entre os meses de julho a agosto em quase todas as capitais das regiões, exceto na Norte, que se elevaram nos meses de março, abril e maio. CONCLUSÕES Os óbitos por causa cerebrovascular prevaleceram em pessoas idosas, solteiras e com baixa escolaridade. A tendência foi favorável ao declínio, sendo o inverno o período de maior risco. As diferenças regionais permitem subsidiar os tomadores de decisões em relação à implementação de políticas públicas para reduzir a mortalidade cerebrovascular.

Hematoma cerebral intraparenquimatoso e intraventricular por cocaína: reporte de un caso

Introducción: La cocaína es una de las sustancias psicoactivas más consumidas mundialmente. Es altamente adictiva y puede producir cuadros graves por su consumo, esporádico o habitual o, por su abstinencia, a nivel sistémico y neurológico. La exposición aguda a esta sustancia desencadena manifestaciones psiquiátricas inmediatas, como cambios en el afecto o conducta: sensación de irritabilidad, hiperactividad, ansiedad, desasosiego, euforia o psicosis. Esta sintomatología contrasta con inducción en ciertos casos de depresión, aislamiento o tristeza con la cronificación en su consumo. Además de los diversos efectos sensoperceptuales descritos, la sustancia puede generar daños neurológicos y/o cardiovasculares graves, como trastornos del ritmo cardíaco, arritmias malignas, emergencias hipertensivas, síndromes coronarios y enfermedades cerebrovasculares. Métodos: Presentamos el caso de un paciente quien ingresó al Hospital Universitario del Valle, en la ciudad de Santiago de Cali, departamento del Valle del Cauca, en Colombia, por un cuadro neurológico que permitía sospechar origen central. Este paciente no tenía factores de riesgo cardiovasculares, pero sí antecedentes de síndrome de Guillain Barré y de consumo de cocaína desde su adolescencia. Resultados: Al mencionado paciente se le realizaron múltiples estudios, destacándose los imagenológicos (tomografía, resonancia y angiorresonancia magnética de cerebro) y la estrategia invasiva de angiografía cerebral, en la cual logró documentarse que las manifestaciones neurológicas del paciente obedecían a una enfermedad cerebrovascular hemorrágica severa secundaria al consumo de cocaína. Conclusiones: Siempre indagar en pacientes con sangrados intraparenquimatosos el consumo de psicoactivos, en especial la cocaína, por su efecto lesivo sobre la vasculatura cerebral.

Introduction: Cocaine is one of the most widely consumed psychoactive substances worldwide. It is highly addictive and can produce serious systemic and neurological symptoms due to sporadic or habitual use or withdrawal. Acute exposure to this substance triggers immediate psychiatric manifestations such as changes in affect or behavior: feelings of irritability, hyperactivity, anxiety, restlessness, euphoria or psychosis; this symptomatology contrasts with induction in certain cases of depression, isolation or sadness with the chronification of its consumption. In addition to the various sensory-perceptual effects described, the substance can cause serious neurological and/or cardiovascular damage, such as heart rhythm disorders, malignant arrhythmias, hypertensive emergencies, coronary syndromes and cerebrovascular diseases. Methods: We present the case of a patient who was admitted to the Hospital Universitario del Valle, in the city of Santiago de Cali, department of Valle del Cauca, in Colombia, for a neurological condition that suggested a central origin. This patient had no cardiovascular risk factors, but had a history of Guillain Barré syndrome and cocaine use since adolescence. Results: The aforementioned patient underwent multiple studies, highlighting the imaging studies (CT, MRI and MRA of the brain) and the invasive strategy of cerebral angiography, in which it was possible to document that the patient's neurological manifestations were due to severe hemorrhagic cerebrovascular disease secondary to cocaine consumption. Conclusions: Always inquire in patients with intraparenchymal bleeds the consumption of psychoactives, especially cocaine, for its injurious effects on the cerebral vasculature.

Progress of Rhei Radix et Rhizoma and Its Combination in Treatment of Cerebral Hemorrhage： A Review / 中国实验方剂学杂志

Cerebral hemorrhage accounts for about 10%-15% of all strokes， and its pathogenesis is complex. Currently， the main clinical treatment is mainly medical symptomatic treatment， including the use of antihypertensive drugs， hypoglycemic drugs， and hemostatic drugs， and surgical treatment is required in some cases， but there is still a lack of effective treatment. In recent years， traditional Chinese medicine and proprietary Chinese medicine have been widely accepted for their stable efficacy， high safety， and low cost. Rhei Radix et Rhizoma is one of the most commonly used herbal medicines for the treatment of cerebral hemorrhage. This paper summarizes the relevant literature on the treatment of cerebral hemorrhage with Rhei Radix et Rhizoma and finds that its active ingredients are mainly anthraquinones， such as emodin， Rhei Radix et Rhizoma acid， and Rhei Radix et Rhizoma phenol. The herbal formulas are Da Chengqitang， Shengdi Dahuangtang， Liangxue Tongyufang， and Naoxueshu oral liquid. The effects involve protecting the blood-brain barrier， promoting hematoma absorption， reducing inflammation levels， decreasing lactic acid accumulation at the bleeding site， and increasing the expression of brain-derived neurotrophic factors. The pathways involved include aquaporin 4 （AQP4）， phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， extracellular signal-regulated kinase 1/2 （ERK1/2）， Toll-like receptor 4 （TLR4）， nuclear transcription factor-κB （NF-κB）， nuclear factor E2-related factor 2 （Nrf2）， and Wnt3a/β-linked protein pathway. This paper summarizes the progress of clinical studies and animal experiments on the treatment of cerebral hemorrhage with active ingredients of Rhei Radix et Rhizoma and herbal compounds containing Rhei Radix et Rhizoma， so as to provide a reference for the treatment protocol of cerebral hemorrhage.

Advances in molecular imaging of cerebral amyloid angiopathy / 中华神经科杂志

Cerebral amyloid angiopathy (CAA) is a common age-related small vessel disease characterized by amyloid-β (Aβ) deposition in the wall of small arterioles and capillaries of the leptomeninges and cerebral cortex. Several molecular imaging technologies such as amyloid-β positron-emission tomography (PET) and 18F-fluorodeoxyglucose-PET have been successfully applied in the patients with CAA. Amyloid-PET may indicate the distribution and burden of Aβ deposition by the tracer′s specific binding to the pathological markers, providing qualitative and quantitative information for the diagnosis of CAA. However, amyloid-β PET is inadequate to differentiate CAA from other Aβ-related diseases like Alzheimer′s disease. Other novel techniques of molecular imaging including tau-PET, single photon emission computed tomography and other highly selective PET radioligands have been investigated widely at present. This article mainly reviewed the advances in molecular imaging of CAA.

The change trend analysis of incidence of intracerebral hemorrhage in Tengzhou City,Shandong Province from 2013 to 2021 / 中华神经科杂志

Objective:To analyze the changing trend of intracerebral hemorrhage (ICH) incidence among residents with different characteristics during 9 years of comprehensive hypertension prevention and control (hypertension prevention and control) in Tengzhou from 2013 to 2021.Methods:From January 1, 2013 to December 31, 2021, the new ICH cases collected by the Center for Disease Control and Prevention in Tengzhou City were analyzed to calculate the incidence of ICH, and the trend of its distribution was analyzed among residents with different ages, sexes, and between urban and rural areas. The registered population information came from Tengzhou Public Security Bureau. Age and sex standardized incidence was calculated based on the 7th National Population Census in 2020. The Cochran-Armitage test was used to analyze the time and age trends of the incidence.Results:The overall ICH crude and standardized incidence in Tengzhou City decreased from 97.30/100 000 to 52.13/100 000 ( Z=-9.93, P<0.001) and 119.30/100 000 to 50.69/100 000 ( Z=-15.40, P<0.001) from 2013 to 2021, and both elevated to form a single peak in 2020, with 22.58% ( χ 2=24.02, P<0.001) and 18.09% ( χ 2=17.08, P<0.001) higher than in 2019, respectively. The trends in male and female incidence over the same period were similar to the overall trends, and the incidence was higher in males than in females in all years. The incidence of ICH increased with age in all years. The difference of increase in male incidence rate in 2020 was statistically significant in three age groups ≥45 years compared with 2019 (36.29%, 23.57% and 16.18%, respectively, χ 2=6.73, 4.65, 4.00, P<0.001). The incidence of ICH decreased by 70.07% and 36.23% ( Z=18.44, 5.22, P<0.001) in urban and rural areas respectively from 2013 to 2021, whereas increased by 34.15% ( χ 2=10.88, P<0.01) and 22.08% ( χ 2=18.63, P<0.001) in 2020 compared with 2019 separately. Conclusions:The incidence of ICH in Tengzhou from 2013 to 2021 showed a significant downward trend, with the decrease in the incidence of ICH in women exceeding that in men. The decrease in the incidence of ICH in urban areas exceeded that in rural areas, and male morbidity seemingly had a younger trend.

Research progress of microglia regulating phagocytosis of apoptotic neurons after intracerebral hemorrhage / 中华神经科杂志

Intracerebral hemorrhage is the bleeding caused by spontaneous non-traumatic rupture of blood vessels in brain parenchyma. It has high disability rate and mortality. A series of injuries after intracerebral hemorrhage will lead to neuronal apoptosis. If apoptotic neurons are not cleared in time, intracellular toxic substances will be released, thereby further aggravating the inflammatory reaction. Therefore, the timely clearance of apoptotic cells is of great significance to the brain homeostasis after intracerebral hemorrhage. At the same time, a large number of phagocytic "eat me" signal phosphatidylserine (PS) will appear on the surface of apoptotic neurons. Microglia, as resident macrophages in the brain, have a variety of PS receptors on their surface, which promote the phagocytosis of apoptotic neurons by microglia and reduce the occurrence of local inflammatory responses.

Bilateral hypertensive intracerebral hemorrhage in basal ganglia: a case report / 中华神经科杂志

Hypertensive intracerebral hemorrhage (ICH) is mostly single in basal ganglia, thalamus and pons. Simultaneous hemorrhage in other brain regions is relatively rare, accounting for only 5.6% of all hemorrhagic strokes, while bilateral symmetrical hemorrhage is extremely rare. A case of bilateral basal ganglia symmetrical hemorrhage is reported for clinical reference.

Pay attention to subsequent arterial ischemic events after intracerebral hemorrhage / 中华神经科杂志

Survivors of intracerebral hemorrhage (ICH) have significantly higher risks of both arterial ischemic events and recurrent ICH after the first event. This uncertainty leaves clinicians with dilemmas about the therapy strategies for the secondary prevention of major vascular events after ICH. Clinicians mainly focus on the prevention of hemorrhage recurrence but overlook the increased risk of ischemic disease after ICH in routine clinical practice. Secondary stroke prevention measures after ICH including antithrombotic and statin treatments remain challenging due to the lack of dedicated studies with strong evidence. Decision-making on stroke prevention requires algorithmic approaches based on the hemorrhagic and ischemic risk stratification. This article systematically reviews the current evidence for the prevention and management of subsequent arterial ischemic events after ICH, aiming to promote further attention and research to address the current controversies and knowledge gap on this topic.

Value of unenhanced CT-based 5-point predictive score combined with blood glucose detection for predicting short-term prognosis in patients with spontaneous intracerebral hemorrhage / 中国基层医药

Objective:To investigate the value of a 5-point predictive score based on unenhanced CT combined with blood glucose detection for predicting short-term prognosis in patients with spontaneous cerebral hemorrhage.Methods:A total of 102 patients with spontaneous intracerebral hemorrhage who received treatment in Zhejiang Provincial People's Hospital from March 2020 to March 2022 were included in this study and analyzed retrospectively. Blood glucose level was measured and BAT score was used to evaluate hematoma enlargement. After 30 days, Glasgow Outcome Scale was used to evaluate the prognosis of patients. The relationships between blood glucose and BAT score, and between blood glucose and BAT score and prognosis were analyzed. The value of blood glucose and BAT score for predicting short-term prognosis was analyzed.Results:The Glasgow Outcome Scale results showed that among the 102 patients, 24 patients (23.53%) had poor prognosis. The BAT score and blood glucose level in patients with poor prognosis were (3.13 ± 0.68) points and (11.58 ± 2.30) mmol/L, respectively, which were significantly higher than (2.40 ± 0.59) points and (8.88 ± 1.71) mmol/L in patients with good prognosis ( t = 5.10, 5.30, both P < 0.05). Pearson correlation analysis showed that in patients with spontaneous intracerebral hemorrhage, blood glucose level was positively correlated with BAT score ( r = 0.43, P < 0.05). Spearman correlation analysis showed that in patients with spontaneous intracerebral hemorrhage, blood glucose level and BAT level were positively correlated with prognosis ( r = 0.42, 0.47, both P < 0.05). The receiver operating characteristic curve showed that the area under the curve plotted for BAT score combined with blood glucose level for predicting short-term prognosis was 0.874, which was significantly greater than the area under the curve plotted for BAT score alone for predicting short-term prognosis ( Z = 2.54, P < 0.05). Conclusion:A large proportion of patients with spontaneous intracerebral hemorrhage have a poor prognosis. The patients with a poor prognosis have higher blood glucose levels and BAT scores than those with good prognosis. Blood glucose and BAT score have a high value for predicting the prognosis of patients with spontaneous intracerebral hemorrhage.