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Objective:To explore the influencing factors of intracranial hemorrhage in elderly patients with acute occlusion of intracranial arteries after treatment and reperfusion.Methods:A retrospective selection was conducted on elderly patients with acute occlusion of the intracranial artery who were treated at the Hebei Petro China Central Hospital from February 2019 to May 2021. Sixty patients who received mechanical thrombectomy treatment were selected as the observation group, and 60 patients who received combined arterial and venous thrombolysis treatment were selected as the control group. The vascular reperfusion rate and incidence of intracranial hemorrhage were observed and compared between the two groups. Meanwhile, multiple logistic regression analysis was used to identify the influencing factors of intracranial hemorrhage.Results:The reperfusion rate of the observation group′s blood vessels was 85.00%(51/60), significantly higher than the control group′s 68.33%(41/60), and the difference was statistically significant (χ 2=4.658, P=0.031). The National Institutes of Health Neurological Deficit Score (NIHSS) of the observation group after treatment was (10.57±2.23), significantly lower than that of the control group (14.73±2.84), and the difference was statistically significant ( P<0.05). The reperfusion rate of blood vessels in patients under 80 years old in the observation group was significantly higher than that in patients ≥80 years old ( P<0.05). The results of univariate analysis showed that there were statistically significant differences in age, NIHSS at admission, Alberta Stroke Program Early CT Score (ASPECTS), and neutrophil absolute value/lymphocyte ratio (NLR) between patients with and without intracranial hemorrhage (all P<0.05); Multivariate logistic regression analysis showed that age ( OR=1.756, 95% CI: 1.184-2.604) and NIHSS at admission ( OR=2.392, 95% CI: 1.401-4.084) were risk factors for postoperative intracranial hemorrhage in elderly patients with acute occlusion of the large intracranial artery, while ASPECTS ( OR=0.364, 95% CI: 0.190-0.697) was a protective factor. Conclusions:Mechanical thrombectomy has good clinical efficacy in the treatment of elderly patients with acute occlusion of intracranial arteries, and is worthy of clinical use; The intracranial hemorrhage after reperfusion is mainly influenced by the patient′s age, NIHSS at admission, and ASPECTS.
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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.
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Introducción. La trombosis venosa cerebral es una causa infrecuente de enfermedad cerebrovascular que viene en aumento a nivel mundial. A pesar de ello, actualmente, en Colombia no se cuenta con estudios suficientes que nos permitan caracterizar epidemiológicamente la enfermedad en nuestra población para identificar los factores de riesgo y las complicaciones más frecuentes en nuestro medio. Objetivo. Describir las características clínicas, demográficas y radiológicas, y los factores de riesgo de una serie de pacientes con trombosis venosa cerebral de dos hospitales de Colombia. Materiales y métodos. Es un estudio descriptivo retrospectivo de pacientes hospitalizados, atendidos en el servicio de neurología de dos hospitales de Bogotá desde diciembre de 2018 hasta diciembre del 2020. Resultados. Se incluyeron 33 pacientes. Las frecuencias más altas correspondieron a mujeres en edad fértil, en puerperio (n=7; 33,3 %) y pacientes con patologías autoinmunes (n=10; 30,3 %). El síntoma inicial más común fue la cefalea (n=31; 93,9 %), seguido de focalización neurológica (n=9; 27,2%) y crisis epiléptica (n=8; 24,2 %). El 51 % (n=17) de los pacientes tuvo un examen físico normal. El infarto venoso cerebral se presentó en el 21,1 % (n=7), la hemorragia subaracnoidea en el 12,1 % (n=4) y el hematoma intraparenquimatoso en el 9 % (n=3) del total de pacientes. El 60,6 % (n=20) quedó con nivel independiente en la escala funcional de Barthel. Ningún paciente falleció. Conclusiones. Se encontraron características sociodemográficas, clínicas y radiológicas similares a lo reportado en la literatura mundial. Con respecto a las diferencias, se encontró en nuestro estudio compromiso de la circulación venosa cerebral profunda en un porcentaje ligeramente mayor a lo descrito, pero sin aumento de complicaciones, ni mortalidad.
Introduction. Cerebral venous thrombosis is an uncommon cause of cerebrovascular disease, which has been increasing worldwide. In Colombia, there are not enough recent studies that allow us to determine epidemiological characteristics of the disease in our population to identify more frequent risk factors and complications according to our living conditions. Objective. To describe clinical, demographic, and radiographic characteristics, and risk factors in a cohort of patients with cerebral venous thrombosis attended at two hospitals in Colombia. Materials and methods. Retrospective descriptive study with patients treated in the hospitalization neurology service of two hospitals in Bogotá, Colombia from December 2018 to December 2020. Results. Thirty-three patients were included. There was a higher incidence of cerebral venous thrombosis in women of childbearing age in the puerperium (n=7; 33.3%) and associated with autoimmune diseases (n=10; 30.3%). The most common initial symptom was headache (n=31; 93.9 %), followed by neurological focal signs (n=9; 27.2%) and seizures (n=8; 24.2%). Fifty-one percent (n=17) of the patients had a normal physical examination. Cerebral venous infarction occurred in 21.1 % (n=7), subarachnoid hemorrhage in 12.1 % (n=4), and intraparenchymal hematoma in 9 % (n=3) of all the patients. Sixty-point six percent (n=20) of the patients had a total independent Barthel functional scale. None of those died. Conclusions. We found similar sociodemographic, clinical, and radiography characteristics to those reported in the world literature. Regarding the differences, deep cerebral venous circulation was higher than that described in previous studies but without complications increase or mortality.
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Trombose Venosa , Trombose dos Seios Intracranianos , Fatores de Risco , Hemorragias Intracranianas , CefaleiaRESUMO
Stroke has become the leading cause of disability and death in China. At present, intravenous thrombolysis is one of the most effective treatment for acute ischemic stroke, but not all patients can benefit from intravenous thrombolysis. In recent years, the exploration of predictive models for the outcomes after intravenous thrombolysis in patients with acute ischemic stroke has attracted increasing attention. This article systematically reviews the scoring models for predicting the functional outcome, death and symptomatic intracranial hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke, with the aim of screening the scoring system suitable for clinical application and providing reference for the clinical diagnosis, evaluation and treatment of acute ischemic stroke.
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Reperfusion therapy, including intravenous thrombolysis and endovascular therapy, is an effective treatment for acute ischemic stroke. As a common complication after reperfusion therapy, hemorrhagic transformation is closely associated with the poor outcomes of patients. Early evaluation of clinical features, imaging and blood biomarkers can predict the risk of hemorrhagic transformation, so as to better guide the reperfusion treatment in patients with acute ischemic stroke.
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Objective:To investigate the predictive value of monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for early neurological deterioration (END) and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received IVT in Hefei Second People's Hospital from May 2020 to January 2022 were retrospectively enrolled. Blood collection was completed and MHR was calculated before intravenous thrombolysis. END was defined as an increase of ≥2 from the baseline in the National Institutes of Health Stroke Scale (NIHSS) score or ≥1 from the baseline in motor function score at any time within 7 d after admission. HT was defined as intracranial hemorrhage newly found by CT/MRI within 24 h after intravenous thrombolysis. Multivariate logistic regression analysis was used to determine the independent predictors of END and HT, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of MHR for END and HT. Results:A total of 186 patients with AIS treated with IVT were included, of which 50 (26.9%) had END and 31 (16.7%) had HT. The median MHR was 0.43. The MHR in the END group was significantly higher than that in the non-END group (0.49 vs. 0.40; P=0.008), and the MHR in the HT group was significantly higher than that in the non-HT group (0.52 vs. 0.40; P=0.013). All patients were divided into 4 groups (MHR1, MHR2, MHR3 and MHR4) according to the MHR quartile from low to high. Multivariate logistic regression analysis showed that after adjusting for confounding factors, taking MHR1 as a reference, MHR3 (odds ratio [ OR] 6.317, 95% confidence interval [ CI] 1.465-27.237; P=0.013) and MHR4 ( OR 8.064, 95% CI 1.910-34.051; P=0.005) were the significant independent predictors of END; Taking MHR1 as a reference, MHR4 ( OR 5.147, 95% CI 1.194-22.182; P=0.028) was the significant independent predictor of HT. The ROC curve analysis showed that the area under the curve of MHR for predicting END was 0.628 (95% CI 0.554-0.698; P=0.008). When the optimal MHR cutoff value was 0.41, its sensitivity and specificity for predicting END was 74.0% and 53.7% respectively. The area under the curve of MHR for predicting HT was 0.642 (95% CI 0.569-0.711; P=0.013). When the best cutoff value was 0.44, the sensitivity and specificity of MHR for predicting HT were 77.4% and 58.1% respectively. Conclusion:Higher MHR is a risk factor for END and HT after intravenous thrombolysis in patients with AIS, but the predictive value of MHR for END and HT is limited.
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Objective:To investigate the predictive value of systemic immune-inflammatory index (SII) for hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the Department of Neurology, Huai’an First People’s Hospital from July 2019 to July 2022 were included retrospectively. The head CT was performed at 24 h after intravenous thrombolysis and determined whether HT existed. sICH was defined as brain parenchymal hematoma, and the National Institutes of Health Stroke Scale (NIHSS) scores increased by ≥4 compared with the baseline, or the patient died within 36 h after onset. Multivariate logistic regression analysis was used to determine the independent correlation between SII and HT and sICH after intravenous thrombolysis. The receiver operating characteristics (ROC) curve was used to evaluate the predictive value of SII for HT and sICH after intravenous thrombolysis. Results:A total of 352 patients with AIS received intravenous thrombolysis were enrolled, including 240 males (68.1%), aged 66.46±12.00 years. The median baseline NIHSS score was 8 (interquartile range, 5-13), and the median SII is 531.91×10 9/L (interquartile range, 351.20-896.91×10 9/L). HT occurred in 62 patients (17.6%) and sICH occurred in 27 patients (7.7%). Univariate analysis showed that the SII of the HT group was significantly higher than that of the non-HT group ( Z=–2.731, P=0.006), and the SII of the sICH group was significantly higher than that of non-sICH group ( Z=–4.125, P<0.01). Multivariate logistic regression analysis showed that the increased SII was the independent risk factor for HT (odds ratio [ OR] 1.001, 95% confidence interval [ CI] 1.000-1.001; P=0.004) and sICH ( OR 1.001, 95% CI 1.001-1.002; P<0.01). ROC curve analysis shows that the area under curve of SII predicting HT was 0.610 (95% CI 0.535-0.686; P=0.006), and the best cutoff value was 488.48×10 9/L. The corresponding sensitivity and specificity were 69% and 47% respectively. The area under the curve of SII predicting sICH was 0.739 (95% CI 0.636-0.842; P<0.01), and the best cutoff value was 846.56×10 9/L, the corresponding sensitivity and specificity were 70% and 77% respectively. Conclusion:The increased SII at admission can predict the risks of HT and sICH in patients with AIS after intravenous thrombolysis.
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Objective:To investigate the effectiveness and safety of endovascular therapy for acute progressive stroke caused by large vessel occlusion (LVO).Methods:Patients with progressive stroke caused by LVO admitted to the Department of Neurology, Yueyang Central Hospital from January 2019 to February 2022 were retrospective included. Patients with an Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS (pc-ASPECTS) ≥6 after progression were selected for endovascular therapy, including mechanical thromboectomy, thrombus aspiration, balloon angioplasty, stenting, or a combination of the above methods. Patients in the time window (anterior circulation within 12 h and posterior circulation within 24 h) and outside the time window (anterior circulation >12 h, posterior circulation >24 h) as well as those in the anterior and posterior circulation were compared.Results:A total of 20 patients with progressive stroke caused by LVO received endovascular treatment were included. There were 17 males and 3 females, aged 59.45±12.06 years. Three patients (15%) developed asymptomatic intracranial hemorrhage, and 12 (60%) had a good outcome 3 months after procedure. There were no statistically significant differences in the rate of successful vascular recanalization, incidence of intracranial hemorrhage, and the rate of poor outcomes between patients within and outside the time window and between the patients with anterior and posterior circulation.Conclusion:Endovascular therapy may be safe and effective for patients with progressive stroke caused by LVO with ASPECTS or pc-ASPECTS scores ≥6.
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Traumatic intracranial hematoma progresses rapidly and may cause quick increase of intracranial pressure and even brain hernia, ultimately leading to coma or death. Therefore, traumatic intracranial hematoma needs prompt treatment, but the prerequisite of treatment is early examination and diagnosis. Due to the limited transportation and other reasons, the existing large-scale detection devices such as CT and MRI cannot be deployed on the rescue site or during patient transportation. Instead, the portable diagnosis devices have the characteristics of miniaturization and high flexibility, which is conducive to promoting early detection, assisting diagnosis and further guiding the formulation of treatment plans. At present, more and more attention has been paid to the portable diagnosis devices in the diagnosis of intracranial hematoma. The authors summarized the conventional diagnosis methods and application of portable diagnosis devices for traumatic intracranial hematoma, aiming to provide a reference for the diagnosis of traumatic intracranial hematoma.
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Objective:To investigate the risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS), and the predictive value of Neutrophil to lymphocyte ratio (NLR).Methods:Consecutive patients with AIS received IVT in Zhengzhou People’s Hospital from January 2021 to December 2022 were retrospectively enrolled. HT was defined as no intracranial hemorrhage was found on the first imaging examination after admission, and new intracranial hemorrhage was found on the imaging examination 24 h after IVT or when symptoms worsened. sHT was defined as HT and the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 compared to admission or required surgical treatment such as intubation and decompressive craniectomy. The baseline clinical and laboratory data of the patients were collected, and NLR, lymphocyte to monocyte ratio (LMR), and platelet to neutrophil ratio (PNR) were calculated. Multivariate logistic regression analysis was used to identify the independent predictors of HT and sHT, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for HT and sHT after IVT. Results:A total of 196 patients were included (age 65.37±13.10 years, 124 males [63.3%]). The median baseline NIHSS score was 4 (interquartile range: 2-10). Twenty patients (10.2%) developed HT, and 12 (6.1%) developed sHT. Univariate analysis showed that there were statistically significant differences in age, baseline NIHSS score, creatinine, NLR, and stroke etiology type between the HT group and the non-HT group (all P<0.05); there were statistically significant differences in age, NLR, PNR, creatinine, baseline NIHSS score, and stroke etiological type between the sHT group and the non-sHT group (all P<0.05). Multivariate logistic regression analysis showed that NLR was an independent predictor of HT (odds ratio [ OR] 1.375, 95% confidence interval [ CI] 1.132-1.670; P=0.001) and sHT ( OR 1.647, 95% CI 1.177-2.304; P=0.004) after IVT. The ROC curve analysis showed that the area under the curve for predicting HT by NLR was 0.683 (95% CI 0.533-0.833; P=0.007), the optimal cutoff value was 5.78, the sensitivity and specificity were 55.0% and 84.1%, respectively. The area under the curve for predicting sHT by NLR was 0.784 (95% CI 0.720-0.839; P=0.001), the optimal cutoff value was 5.94, the sensitivity and specificity were 66.67% and 84.24%, respectively. Conclusions:A higher baseline NLR is associated with an increased risk of HT and sHT after IVT in patients with AIS, and can serve as a biomarker for predicting HT and sHT after IVT.
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Objective:To investigate the feasibility and safety of endovascular mechanical thrombectomy (EMT) combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis (CVST).Methods:The clinical and imaging data of 5 consecutive patients with severe hemorrhagic CVST who received EMT combined with continuous intrasinus urokinase thrombolysis in Beijing Tiantan Hospital from March 2019 to February 2020 were retrospectively analyzed.Results:The average age of 5 patients was 39 years (range, 19-65 years). Two were males and 3 were females. Risk factors associated with CVST were identified in 3 patients. Four had more than two venous sinuses involved, with a total of 10 blood vessels affected by CVST. The affected venous sinus thrombus burden was high, the lesion volume was large, and the clinical manifestations were severe. The average duration of heparin anticoagulation therapy before EMT was 2.3 d (range, 0.5-7 d), and the average duration of intrasinus thrombolysis was 64 h (range, 30-95 h). After treatment, 1 vessel was completely recanalized and 7 vessels were partially recanalized. Four patients who achieved recanalization had good long-term clinical outcomes (modified Rankin Scale score: 0-2 at 3 months, 0-1 at 1 year). One patient failed to achieve recanalization and underwent decompressive craniectomy due to intracranial hypertension, had residual hemiparesis at 1-year follow-up. No procedure-related complications occurred.Conclusion:EMT combined with continuous intrasinus thrombolysis is a potential treatment option for patients with severe hemorrhagic CVST.
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Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.
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Cerebral microbleeds (CMBs) are an imaging biomarker of cerebral small vessel disease (CSVD). Researches have shown that CMBs are a risk factor for hemorrhagic transformation and poor outcomes after reperfusion therapy in patients with acute ischemic stroke. This article reviews the relationship between CMBs and the outcomes of reperfusion therapy in patients with acute ischemic stroke.
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Fundamento: la estratificación del riesgo de rotura de los aneurismas intracraneales es importante para decidir la conducta ante aquellos pacientes con aneurismas que son incidentales o asintomáticos. No existe consenso para determinar la realización de intervención quirúrgica o seguimiento médico de estos pacientes. Objetivo: elaborar un instrumento predictivo de rotura de aneurismas intracraneales incidentales. Métodos: se incluyó una muestra de 152 pacientes con diagnóstico, mediante angiografía por tomografía axial computarizada, de aneurismas intracraneales saculares rotos (n=138) y no rotos(n=22). Se trabajó con 160 imágenes de aneurismas intracraneales. Los 152 pacientes fueron divididos, al azar, en un grupo de desarrollo que corrrespondió a 95 pacientes, 100 imágenes de aneurismas y un grupo de validación que incluyó 57 pacientes con 60 imágenes de aneurismas. Se realizaron mediciones y segmentaciones de los aneurismas; se obtuvieron nueve factores morfológicos. Se realizó una combinación multivariante, mediante regresión logística múltiple, que expresó seis factores demográficos, clínicos y mofológicos predictivos obtenidos de los expedientes clínicos de los pacientes. La selección para inclusión de los factores fue realizada a partir de un consenso de 15 expertos con más de 15 años de experiencia en el tema. Se confeccionó un nomograma representativo del modelo con los predictores significativos. Se evaluó la calibración y la precisión del instrumento predictivo representado por un modelo y su nomograma. Resultados: el instrumento quedó conformado por cinco predictores que resultaron estadísticamente significativos asociados con la rotura en el análisis multivariado: el sexo femenino, la razón de aspecto, el mayor ancho del domo, el volumen, y el índice de no esfericidad. El nomograma mostró una buena calibración y discriminación (grupo de entrenamiento: área bajo la curva = 99 %; grupo de validación área bajo la curva=99 % ). Conclusiones: el instrumento predictivo, validado y representado por el nomograma es un modelo útil para estratificar el riesgo de rotura de aneurismas. Puede emplearse para el seguimiento de aneurismas considerados de menor riesgo.
Background: the stratification of the intracranial aneurysms rupture risk is important to decide the strategy before those patients with aneurysms that are incidental or asymptomatic. There is no consensus to determine the performance of surgical intervention or medical follow-up of these patients. Objective: to develop a predictive instrument for incidental intracranial aneurysm rupture. Methods: a sample of 152 patients diagnosed by computed tomography angiography of ruptured (n=138) and unruptured (n=22) saccular intracranial aneurysms was included. The 160 images of intracranial aneurysms were studied. The 152 patients were randomly divided into a development group consisting of 95 patients, 100 aneurysm images, and a validation group consisting of 57 patients, 60 aneurysm images. Measurements and segmentations of the aneurysms were performed; nine morphological factors were obtained. A multivariate combination was performed, using multiple logistic regression, which expressed six predictive demographic, clinical and morphological factors obtained from the clinical records of the patients. The selection for inclusion of the factors was made from a consensus of 15 experts with more than 15 years of experience in the subject. A representative nomogram of the model with the significant predictors was made. Calibration and accuracy of the predictive instrument represented by a model and its nomogram were evaluated. Results: the instrument was made up of five predictors that were statistically significant associated with breakage in the multivariate analysis: female sex, aspect ratio, the greatest width of the dome, volume, and non-sphericity index. The nomogram showed good calibration and discrimination (training group: area under the curve = 99%; validation group area under the curve = 99% ). Conclusions: the predictive instrument, validated and represented by the nomogram, is a useful model to stratify the risk of aneurysm rupture. It can be used to monitor aneurysms considered to be of lower risk.
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Objective:To investigate the correlation between serum uric acid level and symptomatic intracranial hemorrhage (sICH) and outcomes after endovascular therapy (EVT) in elderly patients with anterior circulation acute ischemic stroke (AIS).Methods:Elderly patients with AIS (aged ≥65 years) received EVT in Beijing Geriatric Hospital and Xuanwu Hospital from December 2017 to December 2020 were retrospectively enrolled. sICH was defined as cerebral parenchymal hemorrhage revealed by CT within 72 h after admission and the Naitonal Institutes of Health Stroke Scale score increased by ≥4 compared with the baseline. At 90 d after onset, the clinical outcome was evaluated by the modified Rankin Scale. 0-2 was a good outcome and 3-6 was a poor outcome. The clinical data of the sICH group and non-sICH group, as well as the good outcome group and poor outcome group were compared. Multivariate logistic regression analysis was used to determine the independent correlation between serum uric acid level and sICH and poor outcomes. Results:A total of 122 patients were enrolled, their age was 73.89±6.24 years, and 73 (59.8%) were male. Fifty-two patients (42.6%) had hemorrhagic transformation, 27 (22.1%) had sICH, and 28 (23.8%) had a good outcome at 90 d after onset. The serum uric acid in the sICH group was significantly lower than that in the non-sICH group ( P=0.002), while the serum uric acid in the good outcome group was similar to that in the poor outcome group ( P=0.510). Multivariate logistic analysis showed that the lower serum uric acid was an independent risk factor for sICH (odds ratio 0.994, 95% confidence interval 0.990-0.998; P=0.011). Conclusion:The lower serum uric acid level was an independent risk factor for sICH after EVT in elderly patients with AIS, but it was not associated with the outcomes.
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Objective:To investigate the predictors of intracranial hemorrhage in patients with cerebral venous sinus thrombosis (CVST).Methods:Patients with CVST treated in Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2008 to March 2021 were retrospectively enrolled. The risk factors, clinical manifestations, imaging examination and 90 d follow-up data were collected. The complicated intracranial hemorrhage group and non-intracranial hemorrhage group were compared. Multivariate logistic regression analysis was used to determine the independent predictors of intracranial hemorrhage in patients with CVST. Results:A total of 104 patients with CVST were enrolled, including 42 males and 62 females. Their age was 35.24 ± 10.92 years old (range 22-68 years). Thirty-eight patients (36.84%) were complicated with intracranial hemorrhage, including 34 hemorrhagic cerebral infarction and 4 complicated subarachnoid hemorrhage. Univariate analysis showed that compared with the non-intracerebral hemorrhage group, the intracranial hemorrhage group was more common in puerperal/pregnant patients (60.52% vs. 48.48%; P=0.012), with more acute onset (57.89% vs. 48.48%; P=0.004), focal neurological signs (47.37% vs. 19.70%; P=0.003) and seizure (39.47% vs. 18.18%; P=0.017), and the site of thrombosis was more common in the superior sagittal sinus (57.89% vs. 36.36%; P=0.033). Multivariate logistic regression analysis showed that puerperium/pregnancy (odds ratio 2.857, 95% confidence interval 1.095-7.453; P=0.031) and superior sagittal sinus thrombosis (odds ratio 2.847, 95% confidence interval 1.110-7.302; P=0.027) were the independent predictors of intracranial hemorrhage in patients with CVST. The analysis at 90 d after onset showed that there was no significant difference in the good outcome rate between the intracranial hemorrhage group and the non-intracranial hemorrhage group (86.84% vs. 89.39%; P=0.695). Conclusions:Puerperium/pregnancy and superior sagittalsinus thrombosis are the independent risk factors for intracranial hemorrhage in patients with CVST. However, complicated with intracranial hemorrhage is not associated with 90-day clinical outcomes.
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Objective:To analyze the risk factors of intracranial hemorrhage after implanting 125-iodine seeds for brain tumors.Methods:A total of 234 patients with intracranial tumors receiving treatment of 125-iodine seeds from March, 2013 to November, 2020 were retrospectively analyzed. Patients were divided into bleeding group and non-bleeding group according to whether postoperative intracranial hemorrhage was reported. Univariate and multivariate analysis was performed by logistic regression to determine the independent risk factors of intracranial hemorrhage.Result:A total of 22 cases (9.4%) reported postoperative intracranial hemorrhage in 234 patients treated with 125-iodine seeds. Univariate analysis showed that the type of tumor and the history of anti-angiogenic drug within one month were possible risk factors ( P<0.1). Multivariate logistic regression analysis showed that anti-angiogenic drug within one month was the independent risk factor for intracranial hemorrhage ( P<0.05). Conclusions:The application of anti-angiogenic drugs within one month is the independent risk factor of intracranial hemorrhage with 125-iodine seeds for the treatment of brain tumors.
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Objective:To investigate the efficacy and safety of using diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch to guide intravenous thrombolysis in patients with ischemic stroke beyond a 4.5-h time window.Methods:Patients with acute ischemic stroke received intravenous thrombolysis with alteplase in the Stroke Center of Hefei Second People's Hospital from July 2019 to June 2021 were retrospectively enrolled. According to the time of onset, they were divided into the time window group and the beyond time window group. The demographic and baseline clinical data of both groups were recorded and compared. The primary outcome measure was the clinical outcome assessed by the modified Rankin Scale (mRS) at 90 d after onset. 0-2 points were defined as good outcome, and >2 were defined as poor outcome. The secondary outcome measure was symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes. Results:A total of 244 patients with acute ischemic stroke were enrollded, including 146 males (58.8%), aged 61.4±8.47 years. The median time from onset to thrombolysis was 142 min, and the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Thirty-six (14.8%) patients exceeded the 4.5 h time window, and 69 (28.3%) patients had poor outcomes. There were no significant differences in the good outcome rate (71.2% vs. 75.0%; χ2=0.224, P=0.636), any intracranial hemorrhage (9.6% vs. 13.9%; χ2=0.233, P=0.629) and the incidence of sICH (5.3% vs. 5.6%; χ2=0.000, P=1.000) between the time window group and the beyond time window group. Univariate analysis showed that the proportion of patients with atrial fibrillation or cardiogenic embolism and the baseline NIHSS score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05), while there was no statistical difference in the proportion of patients receiving intravenous thrombolysis beyond the time window. Multivariate logistic regression analysis showed that only the baseline NIHSS score was an independent risk factor for poor outcomes (odds ratio 1.681, 95% confidence interval 1.457-1.940; P<0.001). Conclusions:Compared with the patients who received intravenous thrombolysis within 4.5 h after onset, intravenous thrombolysis in patients with acute ischemic stroke beyond the 4.5 h time window guided by DWI-FLAIR mismatch results in similar clinical outcomes, and does not increase the incidence of intracranial hemorrhage.
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Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.
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Objective:To investigate the main clinical characteristics, imaging features, diagnosis, and treatment of meningiomas initially manifesting as spontaneous intracranial hemorrhage.Methods:The clinical characteristics, imaging features, treatment, and follow-up data of 19 patients with meningiomas initially manifesting as spontaneous intracranial hemorrhage who received treatment in The First Affiliated Hospital of Shantou University Medical College from January 2011 to December 2020 were retrospectively analyzed.Results:Among the 19 patients, there were 6 males and 13 females, with an average age of (53 ± 14) years. The onset manifestations were sudden and severe headache and vomiting in 6 cases, progressive coma in 4 cases, and hemiplegia in 9 cases. Among the 19 patients, 15 patients showed irregular tumor shape and mixed hyperintense signal in CT, and 4 patients showed a homogeneous hyperintense signal. Eighteen patients showed peritumoral edema. Three patients showed intratumoral calcification. One patient showed an intratumoral fluid level. Fourteen patients showed isointense to hypointense signals on T1WI images and isointense to hyperintense signals on T 2WI images. Five patients showed mixed isointense and hyperintense signals on T 1WI images and mixed hypointense and hyperintense signals on T 2WI images. Heterogeneous enhancement was found in 18 patients, intratumoral cystic necrosis was found in 15 patients, and the meningeal tail sign was found in 16 patients. Preoperative imaging misdiagnosis occurred in 4 patients. Before surgery, all patients underwent surgery to resect the tumor and remove the hematoma. No patients died because of surgery. After surgery, muscle strength was improved compared with that before surgery. The average follow-up time was (46.5 ± 28.4) months. Tumor recurrence occurred in two patients. The Karnofsky Performance Scale score at the last follow-up, at discharge, and before surgery was (73.7 ± 3.4) points, (61.1 ± 5.5) points, and (49.5 ± 5.6) points, respectively ( F = 21.06, P < 0.01). The Karnofsky Performance Scale score at the last follow-up was significantly increased compared with that at discharge and before surgery ( F = 13.13, P < 0.01). Conclusion:Spontaneous hemorrhagic meningioma is rare and has a sudden onset. It is easily misdiagnosed before surgery. Skull CT, skull CT angiography, and enhanced magnetic resonance imaging examination in combination can increase the preoperative diagnosis rate. Early surgical resection of tumors and removal of hematoma can acquire good clinical efficacy.