Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 189
Filtrar
1.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 34(5): 221-227, sept. oct. 2023.
Artigo em Inglês | IBECS | ID: ibc-224903

RESUMO

Objective Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage. Methods We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores≥3 and related factors. Results Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores≥3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores≥3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores≥3 than group B (p=0.00). Conclusion In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage (AU)


Objetivo Aunque el putamen es la zona más común de la hemorragia intracerebral espontánea, los informes previos sobre los efectos de la cirugía son limitados. En ocasiones se observa un mal pronóstico en los pacientes en los que no hay daño en la cápsula interna, pero sí en la región de la arteria insular larga (AIL). El propósito de este estudio fue confirmar la relación entre el daño de la AIL y el pronóstico de los pacientes tras la cirugía de la hemorragia putaminal. Métodos Se recogieron retrospectivamente los datos de 287 casos quirúrgicos que se presentaron con hemorragia putaminal entre enero de 2004 y marzo de 2022. Entre ellos, elegimos a los pacientes sin daño inicial en la extremidad posterior de la cápsula interna, y dividimos a estos pacientes en 2 grupos, los que no tenían (grupo A) y los que tenían (grupo B) daño final en la región AIL. Se compararon las tasas de positividad de las puntuaciones finales de la prueba muscular manual (TMM)≥3 y los factores relacionados. Resultados Sesenta y tres de los 287 pacientes fueron incluidos en este estudio. De ellos, 11 casos del grupo A tuvieron puntuaciones de MMT≥3 positivas (68,8%) y 9 casos (19,1%) del grupo B tuvieron puntuaciones de MMT≥3, 7 días después de la cirugía. Así pues, el grupo A tuvo una tasa significativamente mayor de puntuaciones MMT≥3 que el grupo B (p=0,00). Conclusión En los pacientes sin daño inicial en la cápsula interna, la lesión del AIL podría ser un signo clave para predecir el pronóstico funcional de la hemorragia putaminal (AU)


Assuntos
Humanos , Artérias Cerebrais , Hemorragia Putaminal/cirurgia , Hemorragia Cerebral , Estudos Retrospectivos , Prognóstico
2.
Medicine (Baltimore) ; 102(30): e34195, 2023 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-37505172

RESUMO

RATIONALE: Corticospinal tract (CST) and corticoreticular pathway (CRP) injury patterns (i.e., the continuity of the nerve fibers) are associated with gait disturbance in post-stroke patients. In this case series study, we examined the case of 3 patients with different CST and CRP injury patterns and analyzed the characteristics of gait disturbance in each patient. PATIENT CONCERNS: Patient 1 (P1) was a 73-year-old woman who presented with paralysis of the right upper and lower extremities due to a left lacunar infarction. Patient 2 (P2) was a 41-year-old man who presented with paralysis of the right upper and lower extremities due to a left putamen hemorrhage. Patient 3 (P3) was a 57-year-old man who presented with paralysis of the left upper and lower extremities due to a right putamen hemorrhage. DIAGNOSIS: In P1, the CRP in the affected hemisphere was intact, but the CST was discontinuous. In P2, the CST in the affected hemisphere was intact, but the CRP was discontinuous. P3 was discontinuous in both CST and CRP in the affected hemisphere. OUTCOMES: Over time, all 3 patients improved to the level of gait independence, but they exhibited different gait patterns. Among them, P3 showed a markedly abnormal gait pattern that included spatiotemporal gait asymmetry, lateral shift of the trunk, and hip hiking. LESSONS: This case series study demonstrated that even if both the CST and CRP were injured, gait recovered to some extent (i.e., independent level-ground gait), but the abnormal gait pattern might remain remarkable.


Assuntos
Hemorragia Putaminal , Acidente Vascular Cerebral , Masculino , Feminino , Humanos , Idoso , Adulto , Pessoa de Meia-Idade , Tratos Piramidais , Acidente Vascular Cerebral/complicações , Marcha , Paralisia
3.
Neurocirugia (Astur : Engl Ed) ; 34(5): 221-227, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36775739

RESUMO

OBJECTIVE: Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage. METHODS: We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores≥3 and related factors. RESULTS: Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores≥3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores≥3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores≥3 than group B (p=0.00). CONCLUSION: In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage.


Assuntos
Hemorragia Putaminal , Humanos , Hemorragia Putaminal/complicações , Hemorragia Putaminal/diagnóstico por imagem , Estudos Retrospectivos , Putamen/diagnóstico por imagem , Putamen/irrigação sanguínea , Prognóstico , Artérias
4.
Acta Med Okayama ; 76(3): 329-332, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35790364

RESUMO

Putaminal hemorrhage is a common type of spontaneous cerebral hemorrhage. However, to our knowledge, there have been no reports of sequential cerebral hemorrhage and infarction in the same perforating arterial territory. Herein, we present the first reported case of the sequential development of putaminal hemorrhage and corona radiata infarction in the same lenticulostriate arterial (LSA) territory. Early intensive blood pressure lowering treatment may have aggravated ischemic damage. If a patient presents with motor weakness that cannot be explained by putaminal hemorrhage, the sequential development of corona radiata infarction in the same LSA territory should be ruled out.


Assuntos
Hemorragia Putaminal , Hemorragia Cerebral , Humanos , Infarto , Hemorragia Putaminal/complicações
5.
Acta Neurochir (Wien) ; 164(8): 2229-2233, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34997353

RESUMO

Absolute pitch (AP) recognizes and labels the pitch chroma of a given tone without external reference. Its neural mechanism remains unclear. We report a 68-year-old AP musician who developed a left putaminal hemorrhage edematous lesion under the posterior insular cortex. Diffusion tensor tractography with the region of interest, including Heschl's gyrus, was performed. In the left hemisphere, the middle longitudinal fasciculus was absent, especially at the parietal lobe. Her AP ability was lost. As the hematoma was absorbed and the left MdLF was observed on the tractography, her AP ability recovered. Our case suggested that the left middle longitudinal fasciculus, a part of the ventral auditory pathway, plays a role in AP.


Assuntos
Córtex Auditivo , Música , Hemorragia Putaminal , Idoso , Imagem de Tensor de Difusão , Feminino , Humanos , Imageamento por Ressonância Magnética , Hemorragia Putaminal/diagnóstico por imagem
6.
J Integr Neurosci ; 20(3): 677-685, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34645101

RESUMO

Relationships among language ability, arcuate fasciculus and lesion volume were investigated by use of diffusion tensor tractography in patients with putaminal hemorrhage. Thirty-three right-handed patients within six weeks of hemorrhage onset were recruited. Correlation of the aphasia quotient with subset (fluency, comprehension, repetition, naming) scores, diffusion tensor tractography parameters and lesion volume of patients, aphasia quotient (r = 0.446) with subset (naming: r = 0.489) score had moderate positive correlations with fractional anisotropy of the left arcuate fasciculus. The aphasia quotient subset (repetition) score had a strong positive correlation with fractional anisotropy of the left arcuate fasciculus (r = 0.520), whereas, aphasia quotient subset (fluency and comprehension) scores had no significant correlations with fractional anisotropy of the left arcuate fasciculus after Benjamini-Hochberg correction. Aphasia quotient (r = 0.668) with subset (fluency: r = 0.736, comprehension: r = 0.739, repetition: r = 0.649, naming: r = 0.766) scores had strong positive correlations with the tract volume of the left arcuate fasciculus and strong negative correlations with lesion volume (r = -0.521, fluency: r = -0.520, comprehension: r = -0.513, repetition: r = -0.518, naming: r = -0.562). Fractional anisotropy of the left arcuate fasciculus had a moderate negative correlation with lesion volume (r = -0.462), whereas the tract volume of the left arcuate fasciculus had a strong negative correlation with lesion volume (r = -0.700). According to the result of mediation analysis, tract volume of the left arcuate fasciculus fully mediated the effect of lesion volume on the aphasia quotient. Regarding the receiver operating characteristic curve, the lesion volume cut-off value was 29.17 cm3 and the area under the curve (0.74), sensitivity (0.77) and specificity (0.80) were higher than those of fractional anisotropy, tract volume and aphasia quotient cut-off values. It was found that level of language disability was related to lesion volume as well as to injury severity of arcuate fasciculus in the dominant hemisphere of patients with putaminal hemorrhage. In particular, the tract volume of the arcuate fasciculus in the dominant hemisphere fully mediated the effect of lesion volume on language ability. Additionally, a lesion volume of approximately 30 cm3 was helpful in discriminating arcuate fasciculus discontinuation in the dominant hemisphere.


Assuntos
Imagem de Tensor de Difusão , Transtornos da Linguagem/fisiopatologia , Hemorragia Putaminal/patologia , Hemorragia Putaminal/fisiopatologia , Substância Branca/patologia , Adulto , Idoso , Feminino , Humanos , Transtornos da Linguagem/etiologia , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/patologia , Hemorragia Putaminal/complicações , Hemorragia Putaminal/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
8.
Clin Neurol Neurosurg ; 202: 106521, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33571783

RESUMO

Absolute pitch (AP) is known as the ability to recognize and label the pitch chroma of a given tone without external reference. The neural mechanism and its asymmetry of AP musicians remain unclear. We herein report a 41-year-old AP musician who developed a right putaminal hemorrhage. On a postoperative day 5, a fluid-attenuated inversion recovery image revealed the rest of the hematoma and edematous lesion at the right white matter between the Heschl's gyrus and other cortices. Diffusion tensor tractography with the region of interest at the Heschl's gyrus was performed. In the left hemisphere, the anterior part of the arcuate fiber and middle longitudinal fasciculus were observed. However, these connections were absent in the right hemisphere, but her AP ability was maintained. Our case suggested that the fibers from the right Heschl's gyrus to the right frontal lobe via the right ventral stream is not associated with AP.


Assuntos
Córtex Auditivo/diagnóstico por imagem , Lobo Frontal/diagnóstico por imagem , Música , Percepção da Altura Sonora/fisiologia , Hemorragia Putaminal/cirurgia , Adulto , Córtex Auditivo/fisiologia , Vias Auditivas/diagnóstico por imagem , Vias Auditivas/fisiologia , Imagem de Tensor de Difusão , Feminino , Lobo Frontal/fisiologia , Humanos , Imageamento por Ressonância Magnética , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/fisiopatologia , Hemorragia Putaminal/reabilitação
9.
Acta Otolaryngol ; 141(4): 374-380, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33573440

RESUMO

BACKGROUND: In central auditory disorders caused by damage of the cerebral hemispheres, there are cortical deafness and auditory agnosia. Although clinical cases of cortical deafness have been reported, little is known about the hearing problems and localized lesions associated with cortical deafness. AIMS/OBJECTIVES: The aims of our research are to elucidate lesion sites associated with cortical deafness and to clarify why patients with cerebral lesions are not aware of any sound at all. MATERIALS AND METHODS: Three patients diagnosed as having total loss of hearing participated in this study. We conducted pure-tone audiometry, speech audiometry, distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), and brain magnetic resonance imaging (MRI) to diagnose cortical deafness with aphasia tests of these patients. RESULTS: Our studies showed that waves VI and VII as well as waves I to V have normal peak latencies in ABRs in all three patients. In brain MRI, we found complete damage of proximal parts of bilateral auditory radiations in the three patients. CONCLUSIONS: We propose 'subcortical deafness' as a subtype of auditory agnosia.


Assuntos
Agnosia/etiologia , Potenciais Evocados Auditivos do Tronco Encefálico , Perda Auditiva Central/etiologia , Acidente Vascular Cerebral Hemorrágico/complicações , Adulto , Idoso , Agnosia/fisiopatologia , Audiometria de Tons Puros , Percepção Auditiva , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Perda Auditiva Central/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Hemorragia Putaminal/complicações , Hemorragia Subaracnóidea/complicações
10.
Medicine (Baltimore) ; 100(3): e24302, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546056

RESUMO

RATIONALE: Cortical deafness is a rare auditory dysfunction caused by damage to brain auditory networks. The aim was to report alterations of functional connectivity in intrinsic auditory, motor, and sensory networks in a cortical deafness patient. PATIENT CONCERNS: A 41-year-old woman suffered a right putaminal hemorrhage. Eight years earlier, she had suffered a left putaminal hemorrhage and had minimal sequelae. She had quadriparesis, imbalance, hypoesthesia, and complete hearing loss. DIAGNOSES: She was diagnosed with cortical deafness. After 6 months, resting-state functional magnetic resonance imaging (rs-fMRI) and diffuse tensor imaging (DTI) were performed. DTI revealed that the acoustic radiation was disrupted while the corticospinal tract and somatosensory track were intact using deterministic tracking methods. Furthermore, the patient showed decreased functional connectivity between auditory and sensorimotor networks. INTERVENTIONS: The patient underwent in-patient stroke rehabilitation therapy for 2 months. OUTCOMES: Gait function and ability for activities of daily living were improved. However, complete hearing impairment persisted in 6 months after bilateral putaminal hemorrhagic stroke. LESSONS: Our case report seems to suggest that functional alterations of spontaneous neuronal activity in auditory and sensorimotor networks are related to motor and sensory impairments in a patient with cortical deafness.


Assuntos
Córtex Auditivo/anormalidades , Perda Auditiva Central/etiologia , Rede Nervosa/anormalidades , Córtex Sensório-Motor/anormalidades , Adulto , Córtex Auditivo/fisiopatologia , Feminino , Perda Auditiva Central/fisiopatologia , Acidente Vascular Cerebral Hemorrágico/complicações , Acidente Vascular Cerebral Hemorrágico/fisiopatologia , Humanos , Testes de Estado Mental e Demência , Rede Nervosa/fisiopatologia , Hemorragia Putaminal/complicações , Hemorragia Putaminal/fisiopatologia , Córtex Sensório-Motor/fisiopatologia
12.
Eur J Phys Rehabil Med ; 57(3): 321-326, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31976635

RESUMO

BACKGROUND: In stroke rehabilitation, the most important concern of the patients and their families is whether the patients can walk independently and whether they need braces after discharge. AIM: This study aims to investigate the relationship between several types of putaminal hemorrhage and walking independence and orthotic therapy in patients with hemiplegia. DESIGN: Observational study. SETTING: Inpatients rehabilitation department, Fujita Health University Nanakuri Memorial Hospital, Japan. POPULATION: Total 264 patients with putaminal hemorrhage admitted to our hospital. METHODS: Neurological and cognitive functions were examined as per the stroke scale of the National Institutes of Health and the Mini-mental state examination, respectively. The hematomas were classified into five types, and the volume was measured using computed tomography (CT). Walking ability was evaluated by Functional Ambulation Category (FAC), and walking independence was defined as FAC ≥4. The relationship between the types of hematomas and walking independence and orthotic therapy in patients with hemiplegia with putaminal hemorrhage was also analyzed. RESULTS: We observed differences within the hematoma types in volume, neurological symptoms, and cognitive function but not in age, sex, and lesion side aspects of these patients - 143 of whom could walk independently (FAC≥4) and 121 non-independently. Walking independently and the need for orthosis were closely related to the type of hematoma. CONCLUSIONS: CT imaging at stroke onset can provide useful information when examining walking independence and indicate necessity for an orthosis at the time of discharge to the rehabilitation ward. CLINICAL REHABILITATION IMPACT: This study might help to better understand the role of neuroimaging in stroke rehabilitation.


Assuntos
Hemiplegia/diagnóstico por imagem , Hemiplegia/reabilitação , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Caminhada/fisiologia , Atividades Cotidianas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Tomografia Computadorizada por Raios X
14.
No Shinkei Geka ; 48(10): 921-926, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071228

RESUMO

We report a case of glioblastoma due to putaminal hemorrhage. Notably, the glioblastoma was located at some distance from the hematoma. A 42-year-old right-handed man presented with a sudden-onset headache, motor aphasia, and right hemiplegia. CT showed left putaminal hemorrhage and a mass lesion with a slightly high density in the midbrain away from the hematoma. Conservative treatment was initiated for the patient. Initially, we suspected a benign tumor-like cavernous malformation based on the CT findings. However, MRI showed ring enhancement of the mass lesion on contrast-enhanced MRI and hyperintensity on arterial spin labeling(ASL). A part of the wall of the putaminal hemorrhage also exhibited hyperintensity on ASL. Since we suspected a malignant brainstem tumor and a secondary intracerebral hemorrhage caused by this tumor, we performed a stereotactic brain biopsy. Histological examination revealed that the tumor was a wild-type IDH-1 glioblastoma. In the acute phase, the intracerebral hemorrhage presented as a hyperintensity on T1-weighted imaging. Therefore, it was difficult to distinguish hemorrhagic glioblastoma from an intracerebral hemorrhage. Even if an intracerebral hemorrhage is observed at common sites, it is important to consider the possibility of a malignant brain tumor and complete a prompt examination. In addition, ASL imaging may be useful in detecting hemorrhagic malignant brain tumors.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Hemorragia Putaminal , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/complicações , Glioblastoma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Hemorragia Putaminal/complicações , Hemorragia Putaminal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
J Stroke Cerebrovasc Dis ; 29(9): 105063, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807468

RESUMO

BACKGROUND AND OBJECTIVE: After cerebral hemorrhage, cognitive functions and activities of daily living (ADL) are affected by various factors, including hematoma volume and patient age. In the present study, we investigated the effect of age and hematoma volume on cognitive functions and on ADL. METHODS: The sample comprised 274 patients (183 men and 91 women; mean age 58.2 ± 12.5 years) with putaminal hemorrhage who were hospitalized in a convalescent rehabilitation ward. Hematoma volume was estimated from computed tomography imaging at stroke onset. Cognitive functions were evaluated using Raven's Colored Progressive Matrices test (RCPM) and the Mini-Mental State Examination (MMSE) at hospital admission, while ADL score was assessed at discharge using the Functional Independence Measure motor subscale (FIM-M). In the present study, we classified the patients into six groups according to whether they were non-elderly or elderly (cutoff age, 60 years) and whether their hematoma was small, medium, or large (cutoff volumes, 20 and 40 mL, respectively). Subsequently, the scores on the RCPM, MMSE, and FIM-M were compared among the groups. RESULTS: In both age groups, patients with a larger hematoma volume had lower RCPM and MMSE scores. Patients <60 years old exhibited different trends in their RCPM and MMSE scores, such that the RCPM score showed a step-wise decrease according to hematoma volume, while a difference in the MMSE score was only observed at the 20 mL boundary. Most of the younger patients (<60 years of age) attained high FIM-M scores at discharge, as long as their hematoma volume was either medium or small (<40 mL). This age group had higher RCPM scores on admission, which may have contributed to their higher FIM-M scores on discharge. CONCLUSIONS: In the present study, we demonstrated that advancing age increases the effect of hematoma volume on RCPM and MMSE scores and identified differences in the effects observed on these two scores. Thus, it may be important to use the RCPM alongside the MMSE for patient assessment.


Assuntos
Atividades Cotidianas , Transtornos Cognitivos/etiologia , Cognição , Envelhecimento Cognitivo , Hemorragia/diagnóstico por imagem , Hemorragia Putaminal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Feminino , Hemorragia/complicações , Hemorragia/fisiopatologia , Hemorragia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Prognóstico , Hemorragia Putaminal/complicações , Hemorragia Putaminal/fisiopatologia , Hemorragia Putaminal/psicologia , Fatores de Risco
16.
Artigo em Inglês | MEDLINE | ID: mdl-32457227

RESUMO

OBJECTIVE: To describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement. METHODS: Evaluation of cause, clinical symptoms, and treatment response. RESULTS: A 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission. CONCLUSIONS: COVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.


Assuntos
Anemia Aplástica/complicações , Infecções por Coronavirus/complicações , Leucoencefalite Hemorrágica Aguda/etiologia , Pneumonia Viral/complicações , Tonsila do Cerebelo/diagnóstico por imagem , Anemia Aplástica/terapia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Edema Encefálico/fisiopatologia , Edema Encefálico/terapia , Tronco Encefálico/diagnóstico por imagem , COVID-19 , Infecções por Coronavirus/terapia , Dexametasona/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Evolução Fatal , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Leucoencefalite Hemorrágica Aguda/diagnóstico por imagem , Leucoencefalite Hemorrágica Aguda/fisiopatologia , Leucoencefalite Hemorrágica Aguda/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Transfusão de Plaquetas , Pneumonia Viral/terapia , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/etiologia , Hemorragia Putaminal/fisiopatologia , Respiração Artificial , Convulsões/etiologia , Núcleos Talâmicos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
J Stroke Cerebrovasc Dis ; 29(6): 104812, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32303401

RESUMO

PURPOSE: Computed tomography (CT) is used for initial assessment of patients with suspected stroke. Motor outcome prediction using the initial CT image is important for clinical rehabilitation. However, there is inconsistency in the results reported by the few publications on hematoma volume and motor outcomes in patients with putaminal hemorrhage. To clarify the direction of hematoma and relationship between the hematoma volume and motor outcomes in patients with putaminal hemorrhage using an initial CT image, we evaluated the volume of direction of hematoma in 170 patients in the subacute phase after putaminal hemorrhage using CT at stroke onset. METHODS: The patients were divided into 5 groups according to the direction of the hematoma. For each group, Spearman's correlation coefficients were calculated to investigate the relationship between hematoma volume and motor outcomes. Motor outcomes were assessed using the motor items of Stroke Impairment Assessment Set, which are impairment indexes for the distal and proximal functions of the upper and lower extremities after stroke. RESULTS: Hematoma volume was significantly correlated with all the motor items in the group whose hematoma extended to the posterior limb of the internal capsule alone (Bonferroni corrected P <.05). On the other hand, significant correlations between hematoma volume and motor outcomes could not be found in almost all the other groups. CONCLUSIONS: Motor outcome after putaminal hemorrhage can be predicted by evaluating the progression of hematoma to the corticospinal tract and its volume using CT images at stroke onset.


Assuntos
Hematoma/diagnóstico por imagem , Atividade Motora , Hemorragia Putaminal/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Avaliação da Deficiência , Feminino , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Hemorragia Putaminal/fisiopatologia , Tratos Piramidais/fisiopatologia
18.
Neurocrit Care ; 32(2): 392-399, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31845172

RESUMO

BACKGROUND: Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC. METHODS: This retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes. RESULTS: The study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months' follow-up (p = 0.709). There was no difference in the mortality rate between the two groups (p = 0.538). The rate of complications was lower in group A than that in group B (p = 0.024). Smaller preoperative midline shift (p = 0.008) and absent intraventricular extension (p = 0.044) have contributed significantly to better outcomes. CONCLUSION: Endoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.


Assuntos
Craniectomia Descompressiva/métodos , Hematoma/cirurgia , Neuroendoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Hemorragia Putaminal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/epidemiologia , Infarto Cerebral/epidemiologia , Feminino , Escala de Coma de Glasgow , Hematoma/diagnóstico por imagem , Humanos , Hidrocefalia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade , Análise Multivariada , Hemorragia Putaminal/diagnóstico por imagem , Resultado do Tratamento
19.
Clin Neurol Neurosurg ; 188: 105617, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775069

RESUMO

OBJECTIVE: This study was performed to explore the efficacy and safety of different surgical interventions in patients with spontaneous supratentorial intracranial hemorrhage (SSICH) and determine which intervention is most suitable for such patients. PATIENTS AND METHODS: We searched the PubMed, Medline, OVID, Embase, and Cochrane Library databases. The quality of the included studies was assessed. Statistical analyses were performed using the software Stata 13.0 and RevMan 5.3. RESULTS: Endoscopic surgery (ES), minimally invasive surgery combined with urokinase (MIS + UK), minimally invasive surgery combined with recombinant tissue plasminogen activator (MIS + rt-PA), and craniotomy were associated with higher survival rates and a lower risk of intracranial rebleeding than standard medical care (SMC) in patients with SSICH, especially in younger patients with few comorbidities. The order from highest to lowest survival rate was ES, MIS + UK, MIS + rt-PA, craniotomy, and SMC. The order from lowest to highest intracranial rebleeding risk was ES, MIS + UK, craniotomy, MIS + rt-PA, and SMC. Additionally, compared with SMC, all four surgical interventions (ES, MIS + rt-PA, MIS + UK, and craniotomy) improved the prognosis and reduced the proportion of patients with serious disability. The order from most to least favorable prognosis was MIS + rt-PA, ES, MIS + UK, craniotomy, and SMC. The order from highest to lowest proportion of patients with serious disability was ES, MIS + rt-PA, MIS + UK, craniotomy, and SMC. CONCLUSIONS: This study revealed that the efficacy and safety of different surgical interventions (ES, MIS + UK, MIS + rt-PA, craniotomy) were superior to those of SMC in the patients with SSICH, especially in younger patients with few comorbidities. Among them, ES was the most reasonable and effective intervention. ES was found not only to improve the survival rate and prognosis but also to have the lowest risk of intracranial rebleeding and the lowest proportion of patients with serious disability.


Assuntos
Craniotomia/métodos , Acidente Vascular Cerebral Hemorrágico/cirurgia , Hemorragias Intracranianas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Hemorragia dos Gânglios da Base/cirurgia , Terapia Combinada , Drenagem/métodos , Fibrinolíticos/uso terapêutico , Humanos , Metanálise em Rede , Hemorragia Putaminal/cirurgia , Recidiva , Taxa de Sobrevida , Doenças Talâmicas/cirurgia , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...