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1.
Zhongguo Zhong Yao Za Zhi ; 45(15): 3511-3517, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32893538

RESUMO

To explore the population characteristics and clinical application characteristics of patients with cerebral hemorrhage treated with Xingnaojing Injection in real world. The model was established by Apriori algorithm, and the general information and medication information of 8 369 patients with cerebral hemorrhage treated with Xingnaojing Injection were analyzed by using Clementine 12.0 in the databases of information systems of 33 class Ⅲ grade A hospitals in China. The results showed that among the 8 369 patients with cerebral hemorrhage treated with Xingnaojing Injection, the median age was 59 years old. And the male to female ratio was about 1.74∶1. Most of them did manual labor(31.26%), and were hospitalized in winter(27.46%), especially during the Cold Dew(5.1%). The majority of the patients were in a stable condition(50.94%), and preferred neurosurgery department(48.82%). 29.03% of patients were hospitalized for 15-28 days, and 42.47% of patients spent 10 000-50 000 Yuan of hospitalization expenses. The single dose of Xingnaojing Injection was 10-20 mL at most(46.03%). And the course of medication was mostly 3 days or less(68.60%). Lidocain was the most frequently used Western medicine in drug combination(5.05%), and Huayu Tongmai Ji was the most frequently used traditional Chinese medicine in drug combination(10.73%). The most frequently used one type of traditional Chinese medicine combined with one type of Western medicine was Huayu Tongmai Ji + Dexamethasone(8.08%). The most frequently used two Western medicines in drug combination were Omeprazole + Dexamethasone(5.07%). Prilosec + Dexamethasone + Lidocaine(3.35%) were three Western drugs with the most frequent combination. When the dosage was 10-20 mL and the number of days of treatment was > 15 days, the largest number of the patients was cured and improved(44.78%, 45.85%). The results showed that cerebral hemorrhage patients treated with Xingnaojing Injection were mostly middle-aged and elderly people, with more males than females. Brain hemorrhage often occurred in winter and spring. Xingnaojing Injectiont was often combined with glucocorticoids, proton pump inhibitors and cardiovascular drugs to prevent cerebral hemorrhage complications. The clinical medication met the guidelines for the treatment of cerebral hemorrhage. Some patients had over-treatment use, which can provide a reference for clinicians in treating cerebral hemorrhage.


Assuntos
Medicamentos de Ervas Chinesas , Idoso , Hemorragia Cerebral , China , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 99(33): e21822, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872083

RESUMO

Amantadine is currently recommended for use in patients of posttraumatic brain injury with unconsciousness. However, the application of amantadine in consciousness disturbance after cerebral hemorrhage has only been rarely reported. This allows for a further exploration of the role of amantadine in the treatment of PVS resulting from severe cerebral hemorrhage.Retrospective cohort study from 1/2015 to 7/2019 in Beijing Chaoyang hospital. We included adult patients treated with amantadine after severe cerebral hemorrhage in PVS. Primary outcome was time of consciousness recovery and Glasgow Out Scale scores after 5 months from onset. We compared characteristics and outcomes to a control cohort. matched on age, Coma Recovery Scale-Revised score, volume and location of hemorrhage.Among the 12 patients who received amantadine treatment, 6 patients regained consciousness (50%) after 5 months of disease onset, but were still severely disabled. Besides, the time for regaining consciousness was within 3 months of disease onset. The remaining 6 patients were still in a PVS. Compared with the amantadine group, the consciousness recovery rate (50% vs 33.3%, P = .68) after 5 months in the nested control group was not significantly different. The awakening time for patients in the amantadine group was earlier than the control group (100% vs 25%, P = .03).In this study, amantadine can accelerate the recovery of consciousness in patients following severe cerebral hemorrhage. We recommend further randomized controlled studies to determine the efficacy of amantadine.


Assuntos
Amantadina/uso terapêutico , Hemorragia Cerebral/complicações , Dopaminérgicos/uso terapêutico , Estado Vegetativo Persistente/tratamento farmacológico , Adulto , Idoso , Hemorragia Cerebral/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/etiologia , Estudos Retrospectivos
3.
J Stroke Cerebrovasc Dis ; 29(10): 105111, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912557

RESUMO

INTRODUCTION: Since the emergence of Coronavirus Disease 19 (COVID-19) pandemic, multiple neurologic complications in infected patients have been reported. Despite these reports, the mechanism of COVID-19 nervous system injury is not well understood. We report the case of a COVID-19 patient with diffuse microhemorrhages on brain MRI, positive anticardiolipin antibodies, and purpuric rash with biopsy showing a thrombotic vasculopathy, all features suggestive of secondary microangiopathy. CASE REPORT: A 69-year-old male with history of hypertension, chronic kidney disease, and hypothyroidism presented with one week of dyspnea, cough, diarrhea, and fevers. Chest x-ray demonstrated bibasilar consolidations and nasopharyngeal reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. He had subsequent respiratory decline requiring intubation the day after admission. He developed a truncal morbilliform rash and diffuse purpura, a biopsy of which showed small dermal blood vessels with intraluminal microthrombi consistent with thrombotic vasculopathy. He was found to have elevated aCL IgM and IgG and equivocal lupus anticoagulant study. Brain MRI obtained for persistent encephalopathy showed innumerable areas of susceptibility weighted imaging changes throughout the bilateral juxtacortical white matter, corpus callosum, basal ganglia, and brainstem, as well as multiple small areas of FLAIR hyperintensities, consistent with microhemorrhage DISCUSSION: While there have been several reported cases of neurologic manifestations of COVID-19, the pathophysiology may not be related to neurotropism of the virus itself. The new development of antiphospholipid antibodies and thrombotic vasculopathy in dermal blood vessels in this patient suggest a secondary microangiopathy potentially related to a virally-induced inflammatory state.


Assuntos
Betacoronavirus/patogenicidade , Hemorragia Cerebral/virologia , Doenças de Pequenos Vasos Cerebrais/virologia , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Púrpura/virologia , Idoso , Betacoronavirus/isolamento & purificação , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Progressão da Doença , Evolução Fatal , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Púrpura/diagnóstico , Púrpura/terapia
4.
No Shinkei Geka ; 48(9): 827-833, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32938811

RESUMO

We encountered a case of cerebral amyloid angiopathy(CAA)-related cerebral hemorrhage that recurred 20 times within 9 months. The patient was a 68-year-old woman with a history of hypertension, and whose blood pressure was controlled with antihypertensive medicine. She was hospitalized due to cerebral hemorrhage of the right temporal lobe and underwent conservative treatment;however, cerebral hemorrhage of the right frontal lobe recurred on day 60, and 18 cerebral hemorrhages occurred in the following 7 months. Most of the bleeding occurred in the cerebral subcortex, and CAA-related inflammation(CAA-I)had appeared to have developed since subacute progressive cerebral white matter lesions and meningeal contrasting findings were found with MRI. Although cerebral hemorrhage recurrence was not observed for 1 month after steroid pulse therapy, cerebral hemorrhage was subsequently repeated. Thus, in rare cases, CAA-I results in the recurrence of cerebral hemorrhage within a short period of time, and steroids may be effective for preventing this recurrence.


Assuntos
Angiopatia Amiloide Cerebral , Idoso , Hemorragia Cerebral , Feminino , Humanos , Inflamação , Imagem por Ressonância Magnética , Recidiva
5.
Orv Hetil ; 161(37): 1574-1578, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894737

RESUMO

Intracranial surgical interventions and spontaneous intracerebral hemorrhages challange neuroanesthesia and neurocritical care. First, the brain is the most sensitive organ to tissue hypoxia in the case of severe intraoperative bleedings and, second, a growing hemorrhage within the closed intracranial space may result in a ciritcal elevation of intracranial pressure resulting in an imminent life danger. The authors summerize the potential treatment strategies during neuroanesthesia and neurocritical care. Perioperative organ-specific optimalization of hemoglobin concentration, thrombocyte count and fibrinogen concentrations are key elements in elective neurosurgical interventions. Prior antithrombotic and anticoagulant treatment may indicate targeted pharmacological optimalization and treatment that should be based on laboratory diagnosis. In intracerebral hemorrhages, treatment strategy should be based on the etiology and laboratory diagnostics and targeted pharmacological treatment is preferable. Orv Hetil. 2020; 161(37): 1574-1578.


Assuntos
Anticoagulantes , Hemorragia Cerebral , Hemostáticos , Procedimentos Neurocirúrgicos , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/terapia , Humanos , Hemorragias Intracranianas , Procedimentos Neurocirúrgicos/efeitos adversos
6.
Neuroradiol J ; 33(5): 374-376, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32757827

RESUMO

We are reporting the imaging findings of the rare entity of critical illness-associated cerebral microbleeds in a COVID-19-positive 66-year-old woman with hypoxic respiratory failure, who was eventually intubated and ventilated. Multiple scattered cerebral microhaemorrhages diffusely distributed in the juxtacortical white matter and internal capsule region, sparing the deep and periventricular white matter, basal ganglia, thalami and cortex were seen, which is a unique imaging finding in critically ill patients with respiratory failure and hypoxemia requiring mechanical ventilation. The mechanism underlying these microhaemorrhages relates to the endpoint of critical illness, rather than a specific underlying disease.


Assuntos
Edema Encefálico/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Idoso , Betacoronavirus , Edema Encefálico/complicações , Hemorragia Cerebral/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Estado Terminal , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X
7.
Am J Case Rep ; 21: e925641, 2020 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-32799213

RESUMO

BACKGROUND Acute hemorrhagic necrotizing encephalitis (AHNE) is a rare manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. AHNE usually involves the subcortical white matter but not the cortical grey matter. This study describes the disruptive effects of AHNE associated with SARS-CoV-2 on cognitive function in a previously healthy and sound middle-aged woman resulting from alterations in cortical areas involved in the cognitive network. CASE REPORT A 44-year-old previously healthy woman with a history of inter-state travel developed a flu-like illness, followed by acute, steadily progressive cognitive impairment. She was admitted in a comatose state after a first tonic-clonic seizure. Blood tests were non-informative. Cerebral magnetic resonance imaging (MRI) was indicative of AHNE. Cerebrospinal fluid analysis showed mild lymphocytosis with normal protein and normal glucose but an elevated IgG index. After testing positive for SARS-CoV-2, she was administered steroids. Treatment was ineffective, and the patient died. CONCLUSIONS SARS-CoV-2 is a potential central nervous system (CNS) pathogen, which may manifest as AHNE. These patients may present with generalized tonic-clonic seizures and frontal dysexecutive syndrome, with cognitive impairment being the presenting feature of neuro-coronavirus disease-2019 (COVID-19). The patient described in this report is unique for acute-onset and isolated cognitive impairments due to SARS-CoV-2 infection in the absence of clinical or radiological respiratory manifestations. These findings may help in the early detection and diagnosis of neuro-COVID-19, especially among clinicians and neurologists working in areas of endemic SARS-CoV-2 infection.


Assuntos
Betacoronavirus , Hemorragia Cerebral/virologia , Disfunção Cognitiva/virologia , Infecções por Coronavirus/diagnóstico , Encefalite/virologia , Pneumonia Viral/diagnóstico , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Imagem por Ressonância Magnética , Pandemias , Convulsões/virologia
8.
No Shinkei Geka ; 48(8): 725-731, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32830138

RESUMO

Spontaneous retroclival subdural hematoma is rare among adults. To the best of our knowledge, only six cases have been reported. A 73-year-old man presented with sudden severe headache, diplopia, and dysarthria, with no history of trauma. Head CT revealed a retrociliary hematoma. No obvious causes of bleeding, such as cerebral aneurysms or malformations, were detected. Conservative treatment was provided to the patient. MRI showed an intraventricular hemorrhage and a space between the basilar artery and hematoma three days after onset. The hematoma almost disappeared on day 7. MRI, particularly T2-weighted sagittal MRI, is effective in localizing hematomas and confirming intraventricular hemorrhages.


Assuntos
Hematoma Subdural , Imagem por Ressonância Magnética , Adulto , Idoso , Hemorragia Cerebral , Hematoma , Humanos , Masculino , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 99(32): e21594, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769914

RESUMO

BACKGROUND: To evaluate the effect of dl-3-N-butylphthalide (NBP) on new cerebral microbleeds (CMBs) in patients with acute ischemic stroke (AIS). METHODS: We will prospectively enroll patients with AIS admitted to the stroke center of Jingjiang People's Hospital. Qualified participants will be randomly assigned to either the NBP group (NBP injection) or the control group (NBP injection placebo) in a ratio of 1:1. Patients will complete the brain magnetic resonance imaging within 48 hours and 14 days after stroke onset to observe the CMBs through susceptibility weighted imaging, and evaluate whether the use of NBP will affect the new CMBs in AIS patients. SPSS 20.0 will be used for statistical analyses. RESULT: We will provide practical and targeted results assessing the safety of NBP for AIS patients, to provide reference for clinical use of NBP. CONCLUSION: The stronger evidence about the effect of NBP on new CMBs in AIS patients will be provided for clinicians.


Assuntos
Benzofuranos/uso terapêutico , Hemorragia Cerebral/tratamento farmacológico , Protocolos Clínicos , Acidente Vascular Cerebral/tratamento farmacológico , Benzofuranos/normas , Hemorragia Cerebral/complicações , Humanos , Isquemia/complicações , Isquemia/tratamento farmacológico , Imagem por Ressonância Magnética/métodos , Inibidores da Agregação de Plaquetas/normas , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos
10.
Yonsei Med J ; 61(8): 736-738, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734739

RESUMO

Remote intracerebral hemorrhage (ICH) is defined as an ICH that occurs at a distant site from the treated lesion and is a considerable post-neurointerventional complication. Because such a life-threatening complication should not be neglected, we report our experience with delayed remote ICH in a patient with symptomatic intracranial atherosclerotic stenosis (ICAS) treated by Wingspan stenting following on-label usage guidelines. A middle-aged person suffered a lobar-type subcortical hemorrhage on the left temporal lobe 22 days after Wingspan stenting in the left internal carotid artery. The present case seemed to correspond with a previous report in which remote ICH tended to occur as an ipsilateral lobar-type hemorrhage in patients with unruptured intracranial aneurysm on the internal carotid artery undergoing treatment with stents or flow diverters. Delayed remote ICH should be considered as a potential risk of using a Wingspan stent covering the carotid siphon for ICAS.


Assuntos
Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Hemorragia Cerebral/etiologia , Stents/efeitos adversos , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(34): e21846, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846833

RESUMO

INTRODUCTION: Stroke often causes residual hemiparesis, and upper extremity motor impairment is usually more disabling than lower extremity in those who are suffering from post-stroke hemiparesis. Cell therapy is one of the promising therapies to reduce post-stroke disability. PATIENT CONCERNS: Three male participants were included in the study to investigate the feasibility and tolerability of autologous adipose tissue derived stromal vascular fraction. DIAGNOSIS: All participants had hemiparesis after 1st-ever stroke longer than 6 months previously. INTERVENTIONS: Under general anesthesia, liposuction of abdominal subcutaneous fat was performed. Stromal vascular fraction freshly isolated from the adipose tissue extract was injected into the muscles of paretic upper extremity. All participants received inpatient stroke rehabilitation consisted of physical and occupational therapy more than 3 hours a day for 2 months or more. OUTCOMES: The whole procedure did not produce any significant adverse event in all participants. Adipose tissue extracts yielded sufficient stromal cells. One participant showed clinically important change in upper extremity Fugl-Meyer assessment after the injection and it lasted up to 6 months. Functional magnetic resonance imaging showed concomitant increase in ipsilesional cortical activity. The other 2 participants did not show remarkable changes. LESSONS: Intramuscular injection of autologous adipose tissue derived stromal vascular fraction seems to be a safe and tolerable procedure in subjects with chronic stroke, and its utility in rehabilitation needs further investigation.


Assuntos
Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/transplante , Transplante de Células-Tronco Mesenquimais/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Células Estromais/transplante , Tecido Adiposo/citologia , Adulto , Hemorragia Cerebral/complicações , Humanos , Injeções Intramusculares , Lipectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Células-Tronco Mesenquimais , Terapia Ocupacional/métodos , Paresia/fisiopatologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Células Estromais/citologia , Extremidade Superior/fisiopatologia
13.
J Med Life ; 13(2): 125-131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742502

RESUMO

Intracerebral hemorrhage is a significant public health problem, as it is a disease associated with overwhelming mortality and disability. We performed a retrospective feasibility study of patients admitted with acute intracerebral hemorrhage in our department for four months. Our aims were to identify peculiarities of the risk factors, demographic and clinical characteristics of intracerebral hemorrhage patients from our population, to estimate a feasible recruitment rate for a larger prospective study of patients with intracerebral hemorrhage and to analyze and correct potential drawbacks in the methodology of a more extensive prospective study of patients with intracerebral hemorrhage hospitalized in our department. During the study period, we admitted 53 patients with intracerebral hemorrhage in our department. The mean age of the patients was 69.1 years, and 53% were men. Arterial hypertension was the most common etiologic factor leading to intracerebral hemorrhage. 50.01% of patients died during hospitalization, 31.19% were discharged with significant disability, and 18.8% had a favorable short-term outcome. Higher hematoma volumes, male sex, deep location of the hemorrhage, and age between 51 and 60 years were factors associated with an unfavorable short-term outcome.


Assuntos
Hemorragia Cerebral/terapia , Distribuição por Idade , Idoso , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/mortalidade , Estudos de Viabilidade , Feminino , Hematoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Romênia , Resultado do Tratamento
14.
Stroke ; 51(9): 2649-2655, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755456

RESUMO

BACKGROUND AND PURPOSE: We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes. METHODS: We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings. RESULTS: Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days; P<0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus 14; P<0.001), and had higher peak D-dimer levels (8018±6677 versus 3183±3482; P<0.001), lower nadir platelet count (116.9±62.2 versus 158.3±76.2; P=0.03), higher peak international normalized ratio (2.2 versus 1.57; P<0.001) values when compared with patients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus 9.1 days; P<0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus 23.8%, P<0.001). These patients had longer hospitalizations (42.1 versus 20.9 days; P<0.001), overall worse functional status on discharge (mRS 5 versus 4; P=0.001), and higher mortality (20% versus 9%; P=0.144). CONCLUSIONS: The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.


Assuntos
Hemorragia Cerebral/complicações , Infecções por Coronavirus/complicações , Leucoencefalopatias/complicações , Pneumonia Viral/complicações , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Estado Terminal , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Coeficiente Internacional Normatizado , Tempo de Internação , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Contagem de Plaquetas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(28): e20951, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664097

RESUMO

Perihematomal edema (PHE) surrounding intracerebral hemorrhage (ICH) may contribute to disease-associated morbidity. Before quantifying PHE's effects on morbidity, a fast, accurate, and reproducible method for measuring PHE volume is needed. The aim of this study is to demonstrate the use of a semiautomated dual clustering segmentation algorithm to generate PHE volumetrics on noncontrast computed tomography (CT) of the head and compare this technique to physicians' manual calculations.This is a single-center, retrospective imaging study that included head CTs performed from January 2008 to December 2014 on 154 patients with ICH. Subjects ≥ 18 years old who were admitted to the hospital with spontaneous ICH were included. Included subjects had head CTs performed upon admission and within 6 to 24 hours. Two neurologists, 2 neuroradiologists, and a computer program all calculated hemorrhage and PHE volumes. Inter-rater correlation was evaluated using 2 statistical methods: intraclass correlations (ICCs) and limits of agreement (LOA). Additionally, correlation between volumes was separately evaluated using Pearson correlation coefficient.There was an excellent correlation between measurements performed by neurologists and neuroradiologists using ABC/2 for ICH (0.93) and PHE (0.78). There was a good correlation between measurements performed by neurologists using ABC/2 and the volume measurements generated by the algorithm for ICH (0.69) and PHE (0.70). There was a fair correlation between measurements performed by neuroradiologists using ABC/2 and volume measurements generated by the algorithm for ICH (0.47) and good correlation for PHE (0.73).Although the ABC/2 method for measuring PHE is quick and practical, algorithms that do not assume ellipsoidal shape may be more accurate.


Assuntos
Algoritmos , Edema Encefálico/complicações , Edema Encefálico/diagnóstico por imagem , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hematoma/complicações , Hematoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Humanos , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 99(29): e21124, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702864

RESUMO

INTRODUCTION: Sensory ataxia is a dysfunction of dynamic balance due to impairment of sensory input into the control of movement. The sequelae of stroke, such as hemiplegia, somatosensory impairment, and impaired balance may cause significant disability and may affect patients' quality of life. In addition to rehabilitation programs, acupuncture therapy has been applied to stroke patients and is recommended as a complementary therapy in stroke rehabilitation. PATIENT CONCERNS: A 70-year-old male had a sudden onset of conscious loss. The brain computed tomography showed intracerebral hemorrhage with subdural hemorrhage and subarachnoid hemorrhage. DIAGNOSIS: Intracerebral hemorrhagic stroke was diagnosed. INTERVENTIONS: He received craniotomy with hematoma evacuation immediately and waked up 3 weeks with bilateral hemiparesis (right side weaker than left), impaired position sensation and tactile perception in the right lower limb. He then began to receive rehabilitation therapy and had significant improvement in muscle strength and static balance, but no improvement in tactile perception of position sense in the right lower limbs and reached plateau. Then he received acupuncture therapies to Yongquan (KI1), Tongtien (BL7) and Houxi (SI3). OUTCOMES: The patient's walking ability recovered after receiving rehabilitation programs for 3 years, but the impairment in proprioception and dynamic balance persisted. The perception and dynamic balance had significantly improved after patient received acupuncture therapy, especially the acupuncture point of Yongquan (KI1). CONCLUSION: The clinical effect of acupuncture in combination with conventional rehabilitation therapy for neurological impairment recovery, improving activity of daily living performance and improving post-stroke imbalance was explored. We hope that this report can facilitate further well controlled quantitative objective studies on a big size of samples.


Assuntos
Terapia por Acupuntura/normas , Ataxia/etiologia , Ataxia/terapia , Hemorragia Cerebral/complicações , Terapia por Acupuntura/métodos , Idoso , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos
17.
Medicine (Baltimore) ; 99(29): e21382, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702937

RESUMO

RATIONALE: Computed tomography plays a key role in the initial evaluation of suspected acute stroke by ruling out the possibility of hemorrhage before thrombolysis. Recently, many reports have described cases of symptomatic microbleeds, and there may also have been a case of computed tomography- negative intracerebral hemorrhage. PATIENT CONCERNS: A 70-year-old female patient who had a history of lacunar infarction and severe small vessel disease developed dysarthria. On brain non-contrast computed tomography there was no evidence of intracerebral hemorrhage. However, brain magnetic resonance imaging performed at 3 hours after the initial computed tomography showed cerebral hemorrhage. DIAGNOSES: The diagnosis was computed tomography-negative intracerebral hemorrhage. INTERVENTIONS: The patient was treated with cilostazole 100 mg twice a day with blood pressure management. OUTCOMES: The dysarthria was fully recovered within 5 days and the patient did not suffer recurrent stroke symptoms over the following 2 years. LESSONS: In patients with underlying severe small vessel disease and microbleeds, there could be computed tomography-negative hemorrhage and susceptibility weighted magnetic resonance image could be needed. More attention is required before applying thrombolysis therapy because there is a possibility of cerebral hemorrhage in those patients.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Idoso , Encéfalo/diagnóstico por imagem , Reações Falso-Negativas , Feminino , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Tomografia Computadorizada por Raios X
18.
Lancet ; 396(10244): 129-142, 2020 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-32653056

RESUMO

Stroke is a major cause of death and disability globally. Diagnosis depends on clinical features and brain imaging to differentiate between ischaemic stroke and intracerebral haemorrhage. Non-contrast CT can exclude haemorrhage, but the addition of CT perfusion imaging and angiography allows a positive diagnosis of ischaemic stroke versus mimics and can identify a large vessel occlusion target for endovascular thrombectomy. Management of ischaemic stroke has greatly advanced, with rapid reperfusion by use of intravenous thrombolysis and endovascular thrombectomy shown to reduce disability. These therapies can now be applied in selected patients who present late to medical care if there is imaging evidence of salvageable brain tissue. Both haemostatic agents and surgical interventions are investigational for intracerebral haemorrhage. Prevention of recurrent stroke requires an understanding of the mechanism of stroke to target interventions, such as carotid endarterectomy, anticoagulation for atrial fibrillation, and patent foramen ovale closure. However, interventions such as lowering blood pressure, smoking cessation, and lifestyle optimisation are common to all stroke subtypes.


Assuntos
Encéfalo/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Amilose/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Intervenção Médica Precoce/métodos , Endarterectomia das Carótidas/métodos , Procedimentos Endovasculares/métodos , Forame Oval Patente/cirurgia , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Imagem de Perfusão/métodos , Polímeros/uso terapêutico , Recidiva , Acidente Vascular Cerebral/epidemiologia , Succinatos/uso terapêutico , Trombectomia/métodos , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X/métodos
19.
PLoS One ; 15(7): e0235561, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634141

RESUMO

BACKGROUND: The active extravasation of contrast on CT angiography (CTA) in primary intracerebral hemorrhages (ICH) is recognized as a predictive factor for ICH expansion, unfavorable outcomes and mortality. However, few studies have been conducted on the setting of traumatic brain injury (TBI). PURPOSE: To perform a literature systematic review and meta-analysis of the association of contrast extravasation on cerebral hemorrhagic contusion expansion, neurological outcomes and mortality. DATA SOURCES: The PubMed, Cochrane Library, Medline, Scielo, VHL and IBECS databases up to September 21, 2019, were searched for eligible studies. STUDY SELECTION: A total of 505 individual titles and abstracts were identified and screened. A total of 36 were selected for full text analysis, out of which 4 fulfilled all inclusion and exclusion criteria. DATA ANALYSIS: All 4 studies yielded point estimates suggestive of higher risk for hematoma expansion with contrast extravasation and the summary RR was 5.75 (95%CI 2.74-10.47, p<0.001). Contrast extravasation was also associated with worse neurological outcomes (RR 3.25, 95%CI 2.24-4.73, p<0.001) and higher mortality (RR 2.77, 95%CI 1.03-7.47, p = 0.04). DATA SYNTHESIS: This study is a Systematic Review and Meta-Analysis revealed the extravasation of contrast is a useful imaging sign to predict hematoma expansion, worse neurological outcomes and higher mortality. LIMITATIONS: Only four articles were selected. CONCLUSIONS: The extravasation of contrast in the setting of TBI is a useful imaging sign to predict hematoma expansion, worse neurological outcomes and higher mortality.


Assuntos
Lesões Encefálicas Traumáticas/patologia , Hemorragia Cerebral/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/mortalidade , Lesões Encefálicas Traumáticas/complicações , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/mortalidade , Angiografia por Tomografia Computadorizada , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Mortalidade Hospitalar , Humanos , Risco , Sensibilidade e Especificidade
20.
Zhongguo Zhong Yao Za Zhi ; 45(14): 3316-3323, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32726045

RESUMO

In this study, Tabu search algorithm was used to analyze the effect of Xingnaojing Injection in the treatment of cerebral hemorrhage in the real world. Through the analysis of the results, the therapies based on the pathogeny of cerebral hemorrhage were screened out: Xingnaojing Injection+hemostatic drugs for promoting blood circulation and removing stasis. Cerebral hemorrhage complicated with brain edema: combined with mannitol or mannitol+aescin. The patients with relevant complications in the acute stage of cerebral hemorrhage could select according to the indications: ①Aminocycline+Oxiracetam+Piperacillin Sodium Sulbactam Sodium+Sodium Lactate Ringer; ②Aminocycline+Oxiracetam+Nifedipine+Captopril+Metoclopramide+Cimetidine; ③Insulin+Pantoprazole+So-dium Nitroprusside. The combined therapies for patients of the stable stage with complicating diseases could select according to the indications: ① Monosialotetrahexosyl Ganglioside Sodium+Deproteinized Calf Blood Serum+Nitroglycerin+Compound Potassium Dihydrogn Phosphate; ② Edaravone+Gangliosides+Captopril+Levofloxacin+Tanreqing Injection+Aminophylline. The analysis of subgroup module of drugs for promoting blood circulation and removing blood stasis suggested that the safety of traditional Chinese medicine should be paid attention to in the treatment of cerebral hemorrhage. This study was based on the data of the real world, but with some problems, such as lack of data and confounding factors. The summarized medication plan is only for the reference of clinicians. The clinical application shall be based on the specific situation of patients and the clinical benefits and risks, and pay attention to the incompatibility.


Assuntos
Edema Encefálico , Medicamentos de Ervas Chinesas , Algoritmos , Hemorragia Cerebral , Humanos , Medicina Tradicional Chinesa
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