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1.
Medicine (Baltimore) ; 100(33): e27022, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414996

RESUMO

RATIONALE: The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment. PATIENT CONCERNS: A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension. DIAGNOSES: An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall. INTERVENTIONS: Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug. OUTCOMES: The patient had no symptoms of neurological damage during 3-month follow-up. LESSONS: Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.


Assuntos
Hematoma/etiologia , Insuficiência Vertebrobasilar/complicações , Idoso , Hemorragia Cerebral/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Hematoma/fisiopatologia , Humanos , Masculino , Insuficiência Vertebrobasilar/fisiopatologia
2.
J Stroke Cerebrovasc Dis ; 30(9): 105992, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34293642

RESUMO

OBJECTIVE: Unruptured intracranial vertebral artery dissection (VAD) generally heals spontaneously. A chronological evaluation of intramural hematoma (IMH) using T1-weighted vessel wall imaging (VWI) may provide a more detailed understanding of the pathophysiology of VAD. We herein investigated the relationship between chronological signal changes in IMH on VWI and the spontaneous healing of VAD. MATERIALS AND METHODS: We retrospectively investigated 26 patients with 27 unruptured VADs who underwent magnetic resonance (MR) imaging more than three times during the follow-up period. Morphological changes were evaluated using MR angiography (MRA). The relative signal intensity (RSI) of IMH against the posterior cervical muscle on T1-weighted VWI was calculated. The ratio of chronological RSI changes was defined as follows: maximum RSI/minimum RSI (RSI max/min). Based on the median value of RSI max/min, 27 VADs were divided into VADs with and without chronological RSI changes. Statistical analyses were performed to compare clinical and radiological findings between the two groups. RESULTS: Spontaneous healing occurred in 17 out of 27 VADs (63%). The median value of RSI max/min was 1.48. The RSI of VADs with chronological RSI changes (RSI max/min ≥ 1.48) increased until three weeks after their onset and decreased over time, while that of VADs without chronological RSI changes (RSI max/min < 1.48) showed no change. The frequency of healing was significantly higher in VADs with than without chronological RSI changes (100% vs 23%, p < 0.0001). CONCLUSIONS: Chronological signal changes in IMH on T1-weighted VWI have potential as a diagnostic imaging marker of the spontaneous healing of VAD.


Assuntos
Angiografia Cerebral , Hematoma/diagnóstico por imagem , Angiografia por Ressonância Magnética , Dissecação da Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Cicatrização , Adulto , Idoso , Feminino , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Artéria Vertebral/fisiopatologia , Dissecação da Artéria Vertebral/fisiopatologia
4.
Stroke ; 52(8): 2629-2636, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34000834

RESUMO

BACKGROUND AND PURPOSE: The computed tomography angiography or contrast-enhanced computed tomography based spot sign has been proposed as a biomarker for identifying on-going hematoma expansion in patients with acute intracerebral hemorrhage. We investigated, if spot-sign positive participants benefit more from tranexamic acid versus placebo as compared to spot-sign negative participants. METHODS: TICH-2 trial (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) was a randomized, placebo-controlled clinical trial recruiting acutely hospitalized participants with intracerebral hemorrhage within 8 hours after symptom onset. Local investigators randomized participants to 2 grams of intravenous tranexamic acid or matching placebo (1:1). All participants underwent computed tomography scan on admission and on day 2 (24±12 hours) after randomization. In this sub group analysis, we included all participants from the main trial population with imaging allowing adjudication of spot sign status. RESULTS: Of the 2325 TICH-2 participants, 254 (10.9%) had imaging allowing for spot-sign adjudication. Of these participants, 64 (25.2%) were spot-sign positive. Median (interquartile range) time from symptom onset to administration of the intervention was 225.0 (169.0 to 310.0) minutes. The adjusted percent difference in absolute day-2 hematoma volume between participants allocated to tranexamic versus placebo was 3.7% (95% CI, -12.8% to 23.4%) for spot-sign positive and 1.7% (95% CI, -8.4% to 12.8%) for spot-sign negative participants (Pheterogenity=0.85). No difference was observed in significant hematoma progression (dichotomous composite outcome) between participants allocated to tranexamic versus placebo among spot-sign positive (odds ratio, 0.85 [95% CI, 0.29 to 2.46]) and negative (odds ratio, 0.77 [95% CI, 0.41 to 1.45]) participants (Pheterogenity=0.88). CONCLUSIONS: Data from the TICH-2 trial do not support that admission spot sign status modifies the treatment effect of tranexamic acid versus placebo in patients with acute intracerebral hemorrhage. The results might have been affected by low statistical power as well as treatment delay. Registration: URL: http://www.controlled-trials.com; Unique identifier: ISRCTN93732214.


Assuntos
Antifibrinolíticos/uso terapêutico , Hemorragia Cerebral/tratamento farmacológico , Hematoma/tratamento farmacológico , Ácido Tranexâmico/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(17): e25698, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907149

RESUMO

RATIONALE: Peripheral nerve injury related to vascular complications associated with extracorporeal membrane oxygenation (ECMO) is perhaps underappreciated. Compared to the well-described central nervous system complications of ECMO, brachial plexopathy and lumbosacral plexopathy have rarely been reported. We report this case to heighten awareness of lumbosacral plexus injury due to pelvic hematoma formation after ECMO. PATIENT CONCERNS: A 53-year-old woman developed a large pelvic hematoma with significant mass effect on intrapelvic structures after receiving lifesaving venoarterial ECMO for cardiogenic shock following a cardiac arrest. During her hospital course, she developed bilateral foot drop that was attributed to critical illness. Her lack of neurological recovery after 6 months prompted referral to neuromuscular medicine for consultation. DIAGNOSIS: The patient was retrospectively diagnosed with bilateral lumbosacral plexopathy due to the large pelvic hematoma. INTERVENTION: Electromyography/nerve conduction study (EMG/NCS) obtained at the time of referral to neuromuscular medicine localized her neurological deficits to the bilateral lumbosacral plexus and demonstrated no volitional motor unit action potentials in her lower leg muscles. OUTCOMES: The patient had minimal recovery of strength at the level of the ankles but was ambulatory with solid ankle-foot orthoses due to spared proximal lower extremity strength. Unfortunately, the absence of any volitionally activated motor unit action potentials in her lower leg muscles on EMG performed 6 months after the initial injury was a poor prognostic indicator for successful reinnervation and future neurological recovery. LESSONS: Neurological deficits occurring during the course of administration of ECMO require accurate localization. Neurology consultation and/or EMG/NCS may be useful if localization is not clear. Lesions localizing to the lumbosacral plexus should prompt radiographic evaluation with computed tomography of the abdomen and pelvis. Hemostasis of a retroperitoneal hematoma may be achieved with embolization. However, if neurological deficits do not improve, surgical consultation for hematoma evacuation may be warranted.


Assuntos
Oxigenação por Membrana Extracorpórea , Parada Cardíaca/cirurgia , Hematoma , Plexo Lombossacral/lesões , Pelve , Traumatismos dos Nervos Periféricos , Neuropatias Fibulares , Estado Terminal/terapia , Eletromiografia/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Parada Cardíaca/etiologia , Hematoma/complicações , Hematoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Condução Nervosa , Pelve/irrigação sanguínea , Pelve/patologia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Choque Cardiogênico/complicações
6.
World Neurosurg ; 147: 23-28, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33316482

RESUMO

BACKGROUND: The island sign of non-contrast computed tomography is a risk factor for hematoma expansion (HE) after spontaneous intracerebral hemorrhage, but has inconsistent conclusions. A meta-analysis was performed to investigate the predictive accuracy of island sign for HE. METHODS: A systematic review of published literature on island sign and hematoma expansion was conducted. The pooled sensitivity, specificity, and summary receiver operating characteristics curve (SROC) were generated. The publication bias was assessed by Deeks' funnel plot asymmetry test. RESULTS: Nine studies with a total of 2939 patients were included in the present study. The pooled sensitivity and specificity of island sign for predicting hematoma expansion was 0.50 and 0.89, respectively. The area under the curve was 0.73 in the SROC curve. There was no significant publication bias. CONCLUSIONS: This meta-analysis suggests that island sign of non-contrast computed tomography has a good predictive accuracy for hematoma enlargement in intracerebral hemorrhage.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , AVC Hemorrágico/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Progressão da Doença , Hematoma/fisiopatologia , AVC Hemorrágico/fisiopatologia , Humanos , Valor Preditivo dos Testes , Prognóstico , Tomografia Computadorizada por Raios X
7.
J Stroke Cerebrovasc Dis ; 29(12): 105340, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33017754

RESUMO

Spontaneous primary intracerebral hemorrhage (ICH) is a stroke subtype associated with the highest mortality rate. High blood pressure (BP) is the most common cause of non-lobar ICH. Recent clinical trials have been inconclusive regarding the efficacy of aggressive BP lowering to improve ICH outcome. The association between high BP and ICH prognosis is rather complex and parameters other than absolute BP levels may be involved. In this regard, there is accruing evidence that BP variability (BPV) plays a major role in ICH outcome. Different BPV indices have been used to predict hematoma growth, neurological deterioration, and functional recovery. This review highlights the available evidence about the relationship between BPV and clinical outcomes among patients. We identified standard deviation (SD), residual SD, coefficient of variation, mean absolute change, average real variability, successive variation, spectral analysis using Fourier analysis, and functional successive variation (FSV) as indices to assess BPV. Most studies have demonstrated the association of BPV with ICH outcome, suggesting a need to monitor and control BP fluctuations in the routine clinical care of ICH patients. When large inter-subject variability exists, FSV is a viable alternative quantification of BPV as its computation is less sensitive to differences in the patient-specific observation schedules for BP than that of traditional indices.


Assuntos
Pressão Sanguínea , Hemorragia Cerebral/etiologia , Hematoma/etiologia , Hipertensão/complicações , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , Avaliação da Deficiência , Hematoma/diagnóstico , Hematoma/fisiopatologia , Hematoma/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
8.
Eur J Vasc Endovasc Surg ; 60(3): 386-393, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32741679

RESUMO

OBJECTIVE: The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA METHODS: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed. RESULTS: The median age at repair was 58.1 years (range 38-86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 ± 3.6 and 45.7 ± 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7-78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage. CONCLUSION: In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Hematoma/cirurgia , Remodelação Vascular , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Stents , Taiwan , Fatores de Tempo , Resultado do Tratamento
9.
Intern Med ; 59(21): 2701-2704, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32641659

RESUMO

A 59-year-old woman presented with pharyngeal discomfort and dysphagia starting the previous day. Esophagogastroduodenoscopy revealed a longitudinal reddish area and hematoma mainly on the left wall of the esophagus. On the previous day, she had felt a piece of meat sticking in her throat while eating; she therefore rapidly gulped down some hot coffee to hasten the passage of the meat. Based on the history, we diagnosed her endoscopic findings as esophageal hematoma and thermal injury associated with hot coffee. We herein describe a case of an acute esophageal hematoma and thermal injury and the clinical course following endoscopy.


Assuntos
Queimaduras/diagnóstico por imagem , Queimaduras/terapia , Café/efeitos adversos , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/terapia , Hematoma/diagnóstico por imagem , Hematoma/terapia , Queimaduras/fisiopatologia , Endoscopia do Sistema Digestório/métodos , Neoplasias Esofágicas/fisiopatologia , Feminino , Hematoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 29(8): 104931, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689636

RESUMO

BACKGROUND: Mesenchymal stem cells (MSCs) are multipotent stromal cells currently being tested as therapy for a variety of diseases. MSC therapy and hematoma evacuation using a minimally invasive approach are being studied separately to improve clinical outcomes after stroke. We report the first case of a patient with intracerebral hemorrhage (ICH) treated with combination MSC therapy and endoscopic hematoma evacuation. CASE REPORT: A 36-year-old woman with a past medical history of essential chronic hypertension and right lung bronchial atresia presented to the emergency department with acute neurologic decline (National Institute of Health Stroke Scale [NIHSS] score, 22). Computed tomography showed a 4.4 × 3.5 × 3.5 cm right basal ganglia hemorrhage with intraventricular extension. An external ventricular drain was placed, and she was enrolled in a Phase I clinical trial investigating intravenous MSC therapy for acute ICH. Continued neurologic deterioration due to increased intracranial pressure led to minimally invasive hematoma evacuation using the Artemis Neuro Evacuation Device (Penumbra, Inc.) on hospital day 4. Follow-up scans showed decreased density and extent of hemorrhage. She was discharged on day 41 with improved neurologic function scores (NIHSS score, 2). At 3-month follow-up, she was walking on her own, but had residual left arm and hand weakness (modified Rankin Score, 2). CONCLUSIONS: This case report suggests that the combination of MSC therapy and minimally invasive hematoma evacuation may be safe and well tolerated. Further larger randomized clinical trials are required to identify whether MSC therapy in combination with minimally invasive hematoma evacuation is safe, tolerable, and potentially improves outcomes than either alone.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Hematoma/cirurgia , Transplante de Células-Tronco Mesenquimais , Procedimentos Neurocirúrgicos , Adulto , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/fisiopatologia , Terapia Combinada , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Pressão Intracraniana , Recuperação de Função Fisiológica , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 29(8): 104869, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32417244

RESUMO

Delayed intraparenchymal hemorrhage (DIPH) is one of the complications of flow diverter (FD) treatment, however, the mechanism is unclear. We present the case of a 54-year-old woman with a partially thrombosed large internal carotid artery aneurysm. She presented intraparenchymal hemorrhage in the right parietal lobe three days after the successful FD treatment. We performed endoscopic hematoma removal, and then her consciousness disturbance was fully recovered. IMP single-photon emission computed tomography showed significant increase of cerebral blood flow in the right hemisphere. We diagnosed DIPH associated with hyperperfusion after FD treatment. It is necessary to consider that DIPH due to hyperperfusion may occur after FD treatment.


Assuntos
Artéria Carótida Interna , Hemorragia Cerebral/diagnóstico por imagem , Circulação Cerebrovascular , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hematoma/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/fisiopatologia , Endoscopia , Feminino , Hematoma/etiologia , Hematoma/fisiopatologia , Hematoma/terapia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
13.
J Stroke Cerebrovasc Dis ; 29(6): 104793, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32224203

RESUMO

OBJECTIVES: Although several studies have shown that interventions to lower blood lipid concentration may reduce the risk of coronary arterial disease and ischemic stroke, the correlation between serum lipid levels and hemorrhagic stroke remains controversial. To clarify any possible association between serum lipid and hematoma expansion, we examined various serum lipid indices in patients with and without early hematoma expansion. METHODS: Data of 572 intracerebral hemorrhage (ICH) patients from the cerebral small vessel disease cohort of Peking Union Medical College Hospital were retrospectively analyzed. Patients who finished the baseline brain computed tomography (CT) examination within 6 h post-ictus and the follow-up CT within 48 h after initial CT were included in the study. Hematoma expansion was delimited as an enlargement of hemorrhage volume over 33% or 12.5 mL between baseline and subsequent CT. Both uni- and multivariate logistic regression analyses were conducted to explore the association between early hematoma growth and various serum lipid indices, including triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, ratios of LDL-C/HDL-C and LDL-C/TC, as well as other demographic and clinical features. RESULTS: Out of 157 patients included in the analysis, hematoma growth occurred in 45 (28.7%). Only higher baseline systolic blood pressure was found to be correlated with an increased risk of hematoma growth based on both univariate (odds ratio [OR] 1.014, 95% confidence interval [CI]: 1.002-1.026, P = .024) and multivariate logistic regression analyses (OR 1.022, 95%CI: 1.008-1.037, P = .003). No associations were detected between the various serum lipid indices examined and other clinical features with a likelihood of early hematoma growth between groups or within various subgroups defined by different characteristics including age, gender, baseline Glasgow Coma Scale score, systolic blood pressure, intraventricular extension, and hematoma location. CONCLUSIONS: No association between various indices of serum lipid and hematoma growth was identified among patients and subgroups with spontaneous ICH in the Chinese population; these findings may help to guide lipid management after ICH. However, further multi-centered, larger scale studies are expected to verify our results.


Assuntos
Hemorragia Cerebral/sangue , Doenças de Pequenos Vasos Cerebrais/sangue , Hematoma/sangue , Lipídeos/sangue , Idoso , Biomarcadores/sangue , Pressão Sanguínea , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , China , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
14.
Cerebrovasc Dis ; 49(2): 177-184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320990

RESUMO

BACKGROUND: Prevention of hematoma enlargement in oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) focuses on blood pressure (BP) reduction and OAC reversal. We investigated whether treatment efficiency and clinical outcomes differ between OAC-ICH patients admitted outside versus during regular working hours. METHODS: Based on pooled data of multicenter cohort studies, we grouped OAC-ICH patients (vitamin K antagonist [VKA], non-vitamin K oral anticoagulant [NOAC]) according to on- vs. off-hour admission. Primary outcome was the functional outcome using the modified Rankin scale (mRS) dichotomized into favorable (mRS 0-3) and unfavorable (mRS 4-6) and mortality at 3 months. Secondary outcome measures included the occurrence of hematoma enlargement, the proportions of patients with systolic BP <140 mm Hg and with anticoagulation treatment achieving international normalized ratio (INR) levels <1.3 at 4 h. Propensity score matching (PSM) was performed to account for imbalances in baseline characteristics. RESULTS: The study population consisted of 76/126 NOAC-ICH patients and 1,005/1,470 VKA patients presenting during off-hours. Functional outcome and mortality rates were not significantly different among PSM patients with VKA-ICH and NOAC-ICH during on- vs. off-hours (mRS 4-6 VKA-ICH: on-hour: 239/357 [66.9%] vs. 253/363 [69.7%] off-hour; p = 0.43; NOAC-ICH: on-hour 26/42 [61.9%] vs. off-hour: 37/57 [64.9%]; p = 0.76; mRS 6 VKA-ICH: on-hour: 127/357 [35.6%] vs. off-hour: 148/363 [40.8%]; p = 0.15; -NOAC-ICH: on-hour 17/42 [40.5%] vs. off-hour: 16/57 [28.1%]; p = 0.20). There were no differences detectable regarding the secondary outcome measures (i.e., hematoma enlargement, the proportion of patients who achieved systolic BP levels <140 mm Hg at 4 h as well as anticoagulation treatment achieving INR levels <1.3 at 4 h) in OAC patients. CONCLUSION: Our study implies that BP reduction and anticoagulation reversal management are well established and associated with similar rates of hematoma enlargement and clinical outcomes in on- vs. off-hour admitted OAC-ICH patients.


Assuntos
Plantão Médico , Anticoagulantes/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Hemorragia Cerebral/tratamento farmacológico , Hematoma/tratamento farmacológico , Hemostáticos/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/fisiopatologia , Avaliação da Deficiência , Progressão da Doença , Feminino , Alemanha , Hematoma/induzido quimicamente , Hematoma/mortalidade , Hematoma/fisiopatologia , Hemostáticos/efeitos adversos , Humanos , Coeficiente Internacional Normatizado , Masculino , Estudos Multicêntricos como Assunto , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
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
16.
Cerebrovasc Dis ; 49(1): 26-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32045911

RESUMO

BACKGROUND: Neurological deterioration (ND) has a major influence on the prognosis of intracerebral hemorrhage (ICH); however, factors associated with ND occurring after 24 h of ICH onset are unknown. METHODS: We performed exploratory analyses of data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial, which compared intensive and standard blood pressure lowering treatment in ICH. NDs were captured on the adverse event case report form. Logistic regression analysis was performed to examine the independent predictors of late ND. RESULTS: Among 1,000 participants with acute ICH, 82 patients (8.2%) developed early ND (≤24 h), and 64 (6.4%) had late ND. Baseline hematoma volume (adjusted OR [aOR] per 1-cm3 increase 1.04, 95% CI 1.02-1.06, p < 0.0001), hematoma volume increase in 24 h (aOR 2.24, 95% CI 1.23-4.07, p = 0.008), and the presence of intraventricular hemorrhage (IVH; aOR 2.38, 95% CI 1.32-4.29, p = 0.004) were independent predictors of late ND (vs. no late ND). Late ND was a significant risk factor for poor 90-day outcome (OR 3.46, 95% CI 1.82-6.56). No statistically significant difference in the incidence of late ND was noted between the 2 treatment groups. CONCLUSIONS: Initial hematoma volume, early hematoma volume expansion, and IVH are independent predictors of late ND after ICH. Intensive reduction in the systolic blood pressure level does not prevent the development of late ND.


Assuntos
Hemorragia Cerebral/complicações , Hemorragia Cerebral Intraventricular/etiologia , Hematoma/etiologia , Idoso , Anti-Hipertensivos/uso terapêutico , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/fisiopatologia , Avaliação da Deficiência , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Clin Neurol Neurosurg ; 191: 105691, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31986364

RESUMO

OBJECTIVES: Current guidelines paid little attention to a unique severe disease about intracranial hematoma owing to aneurysm rupture. We attempted to explore the predictive factors for prognosis in these poor patient population. PATIENTS AND METHODS: One hundred twenty-one aneurysmal subarachnoid hemorrhage combined with intracerebral hematoma patients discharged between 2013 and 2016 were reviewed in this retrospective study. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score of 3, 4, 5, or 6 at 6 months. Multivariable logistic regression was performed to evaluate the association of unfavorable outcome with preoperative and postoperative clinical characteristics. RESULTS: Of 121 patients with intact follow-up data, 34 (28.10 %) had an unfavorable prognosis. The preoperative prognostic model included patients' age, respiratory rate, Hunt-Hess scale, red cell distribution width, and serum sodium at admission. The postoperative prognostic model included patients' age, respiratory rate, red cell distribution width, serum sodium, postoperative delayed cerebral ischemia, and pulmonary infection. Both preoperative and postoperative prognostic models had excellent discrimination with Area Under The Curve (AUC) of 0.864 (P < .001) and 0.898 (P < .001), respectively. CONCLUSION: In clinical practice, we should pay more attention to those old patients with worse admission Hunt-Hess score, presenting deep-slow respiratory and lower serum sodium. Reduction of postoperative delayed cerebral ischemia and pulmonary infection might improve outcomes after aneurysmal SAH with intracerebral hematoma.


Assuntos
Aneurisma Roto/cirurgia , Hemorragia Cerebral/cirurgia , Hematoma/cirurgia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Adulto , Fatores Etários , Idoso , Aneurisma Roto/sangue , Aneurisma Roto/complicações , Aneurisma Roto/fisiopatologia , Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/sangue , Hemorragia Cerebral/complicações , Hemorragia Cerebral/fisiopatologia , Craniectomia Descompressiva , Drenagem , Índices de Eritrócitos , Feminino , Estado Funcional , Hematoma/sangue , Hematoma/complicações , Hematoma/fisiopatologia , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/fisiopatologia , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Taxa Respiratória , Estudos Retrospectivos , Ruptura Espontânea/sangue , Ruptura Espontânea/complicações , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/cirurgia , Sódio/sangue , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia
19.
Catheter Cardiovasc Interv ; 95(1): E30-E36, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31141311

RESUMO

OBJECTIVES: Left atrial dissection (LatD) is a rare and heterogeneous condition affecting many cardiovascular areas. The present article, by the means of personal case report illustration and systemic review of different clinical management, is aimed to give to clinicians further knowledge on this controversial topic. BACKGROUND: LatD is an exceedingly rare but potentially fatal complication of cardiac surgery or catheter-based interventional procedures. Most of the cases are iatrogenic and its incidence is expected to grow due to an increase in the number of percutaneous coronary intervention and structural heart disease procedures. The management of this complication is controversial, and it may depend on related etiologies. METHODS: We have reported our single-case experience and review of the scientific literature, focusing on the decision-making process and the strategical approach by multimodality imaging techniques. RESULTS: Our case of LatD with initial hemodynamic instability was surgically treated. Conservative approach is often employed in literature despite the fact that conservative versus surgical approach is debatable, depending on clinical presentation, hemodynamic stability, multimodal imaging findings, and personal experience of the center. CONCLUSIONS: According to systematic literature review, a watchful-waiting strategy supported by multimodality imaging could be a safe and effective management in stable LatD.


Assuntos
Átrios do Coração/cirurgia , Traumatismos Cardíacos/cirurgia , Hematoma/cirurgia , Doença Iatrogênica , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Função do Átrio Esquerdo , Tomada de Decisão Clínica , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/lesões , Átrios do Coração/fisiopatologia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Seleção de Pacientes , Recuperação de Função Fisiológica , Resultado do Tratamento
20.
Neurocrit Care ; 32(2): 539-549, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31359310

RESUMO

BACKGROUND: Rapid diagnosis and proper management of intracerebral hemorrhage (ICH) play a crucial role in the outcome. Prediction of the outcome with a high degree of accuracy based on admission data including imaging information can potentially influence clinical decision-making practice. METHODS: We conducted a retrospective multicenter study of consecutive ICH patients admitted between 2012-2017. Medical history, admission data, and initial head computed tomography (CT) scan were collected. CT scans were semiautomatically segmented for hematoma volume, hematoma density histograms, and sphericity index (SI). Discharge unfavorable outcomes were defined as death or severe disability (modified Rankin Scores 4-6). We compared (1) hematoma volume alone; (2) multiparameter imaging data including hematoma volume, location, density heterogeneity, SI, and midline shift; and (3) multiparameter imaging data with clinical information available on admission for ICH outcome prediction. Multivariate analysis and predictive modeling were used to determine the significance of hematoma characteristics on the outcome. RESULTS: We included 430 subjects in this analysis. Models using automated hematoma segmentation showed incremental predictive accuracies for in-hospital mortality using hematoma volume only: area under the curve (AUC): 0.85 [0.76-0.93], multiparameter imaging data (hematoma volume, location, CT density, SI, and midline shift): AUC: 0.91 [0.86-0.97], and multiparameter imaging data plus clinical information on admission (Glasgow Coma Scale (GCS) score and age): AUC: 0.94 [0.89-0.99]. Similarly, severe disability predictive accuracy varied from AUC: 0.84 [0.76-0.93] for volume-only model to AUC: 0.88 [0.80-0.95] for imaging data models and AUC: 0.92 [0.86-0.98] for imaging plus clinical predictors. CONCLUSIONS: Multiparameter models combining imaging and admission clinical data show high accuracy for predicting discharge unfavorable outcome after ICH.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Mortalidade Hospitalar , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , Regras de Decisão Clínica , Tomada de Decisão Clínica , Feminino , Estado Funcional , Escala de Coma de Glasgow , Hematoma/fisiopatologia , Hematoma/terapia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
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