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2.
World Neurosurg ; 133: e281-e287, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518739

RESUMO

BACKGROUND: The spot sign (SS) in spontaneous intracerebral hemorrhage has been reported to be a predictive factor of poor outcome; however, how SS is related with the clinical outcome remains unclear. We aimed to investigate how etiology associated with SS affects the clinical outcome of endoscopic surgery. METHODS: We retrospectively analyzed data from 104 patients (43 women and 61 men, mean age: 64.2 ± 11.0 years) who underwent endoscopic surgery for supratentorial intracerebral hemorrhage. The outcome variables analyzed were in-hospital mortality and modified Rankin scale score at 90 days from onset. RESULTS: The prevalence of intraventricular hemorrhage and the mean initial modified Graeb score were greater in SS-positive than in SS-negative patients (100% vs. 47.7%, P < 0.001, and 14.4 ± 5.4 vs. 10.6 ± 6.0, P = 0.03, respectively). Postoperative rebleeding occurred more frequently in SS-positive than -negative patients (25.0% vs. 6.8%, P = 0.045). The in-hospital mortality rate was 7.7% and was not significantly different between the groups (18.8% vs. 5.7%, P = 0.09). There was a significant unfavorable shift in modified Rankin scale scores at 90 days among SS-positive patients compared with SS-negative patients in an analysis with ordinal logistic regression (adjusted common odds ratio, 4.38; 95% confidence interval 0.06-0.79, P = 0.02). CONCLUSIONS: Intraventricular hemorrhage and postoperative rebleeding were considered to be associated with the poor outcome in patients with SS. The SS on computed tomography angiography may be valuable in predicting rebleeding and clinical outcome after surgery.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Hematoma/diagnóstico por imagem , Neuroendoscopia , Idoso , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/cirurgia , Comorbidade , Feminino , Hematoma/complicações , Hematoma/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
3.
J Surg Res ; 245: 99-106, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415935

RESUMO

BACKGROUND: Brainstem hemorrhage is an acute and severe neurosurgical disease. Cerebral hemorrhage is surgically treated via hematoma puncture drainage because of its minimally invasive nature. However, the placement of puncture must be extremely accurate due to the special anatomical location of the brainstem and its physiological functions. The present study aimed to evaluate whether the application of a three-dimensional (3D)-printed navigation mold achieved good outcomes in the surgical treatment of brainstem hemorrhage. MATERIAL AND METHODS: The present study included seven patients (three men and four women aged 40-56 y) who underwent 3D print-assisted hematoma puncture drainage between June 2016 and March 2018 at Binzhou Medical University Hospital. The amount of brainstem hemorrhage was 15-47 mL. We analyzed the basic surgical conditions, deviation distance, and postoperative clinical improvement. RESULTS: In all cases, the operation was completed successfully; no patient died or contracted an infection intraoperatively. The end of the puncture tube was located in the hematoma cavity in all cases. The deviation distance ranged from 2.5 to 7.2, and this distance gradually reduced with improvements in the technique. The hematoma drainage achieved satisfactory postoperative outcomes, with improvements in symptoms such as respiratory failure and hyperthermia. CONCLUSIONS: Use of a 3D-printed navigation mold for puncture drainage of brainstem hemorrhage realized the purpose of individualized and precision medicine, which is important in maintaining the vital signs of patients with severe brainstem hemorrhage.


Assuntos
Hemorragia Cerebral/cirurgia , Drenagem/instrumentação , Hematoma/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Punções/instrumentação , Adulto , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Drenagem/métodos , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(43): e17660, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651891

RESUMO

RATIONALE: The term crossed aphasia in dextrals (CAD) describes aphasia following a right hemisphere lesion in right-handed subjects. The diagnostic criteria for CAD, defined on the basis of clinical cases observed over the years, are aphasia; lesion in right hemisphere; strong preference for right hand use without familial history of left handedness; structural integrity of left hemisphere; and absence of brain damage in childhood. The studies of CAD have mainly been focused on the neurobiological mechanisms underlying the functional neurocognitive lateralization and organization of the brain, such as a dissociation between language and handedness, language and praxis, or other cognitive functions.Patient concerns: We described a case of a patient affected by an aphasic syndrome following cerebral hemorrhage located in right hemisphere. DIAGNOSIS: Considering the correlation between clinical data and instrumental investigations such as magnetic resonance imaging, we diagnose the patient with non-fluent aphasia. Specifically, the patient came to our attention showing a trans-cortical mixed aphasia that, later, developed in a trans-cortical motor aphasia. Contrary to most cases of CAD, our patient does not show apraxia and visuo-spatial neglect. Interventions language and visual attention when latter functions are related to right hemisphere. INTERVENTIONS: The rehabilitation program consisted in exercises stimulating verbal fluency, comprehension, reading, and writing. OUTCOMES: After 5 months of rehabilitation patient showed significant improvement in comprehension and absence of echolalia. LESSONS: At present there is no agreement about pathogenesis of CAD and neural mechanism is still unclear. Considering the clinical symptomatology, we can argue that we observed a non-fluent aphasia. However, a more large sample should be studied to asses the role of brain circuits.


Assuntos
Afasia/etiologia , Afasia/reabilitação , Hemorragia Cerebral/complicações , Adulto , Afasia/fisiopatologia , Lateralidade Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/fisiopatologia
6.
Medicine (Baltimore) ; 98(42): e17626, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626144

RESUMO

To establish a nomogram model to predict early cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.A retrospective cohort study was held between January 2016 and October 2018. One hundred twenty seven out of 170 consecutive patients with supratentorial spontaneous intracranial hematoma were enrolled in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good discrimination ability on both development and validation dataset with AUC 0.911 and 0.919. Most patients would benefit from the model according to the decision curve analysis.A nomogram, constructed based on bleeding volume, GCS, and IVH can provide a feasible tool to evaluate cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.


Assuntos
Hemorragia Cerebral/complicações , Cognição/fisiologia , Disfunção Cognitiva/diagnóstico , Hematoma/complicações , Nomogramas , Adulto , Hemorragia Cerebral/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Seguimentos , Hematoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
No Shinkei Geka ; 47(9): 961-968, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31564657

RESUMO

Chronic encapsulated intracerebral hematoma(CEIH)with arteriovenous malformation(AVM)is rare. We report a case of CEIH shrinking after feeder embolization for AVM. A 60-year-old man experiencing headaches for 2 weeks was admitted to our hospital due to intracerebral hematoma detected by MRI. The hematoma was shown as a low-density mass lesion on CT scans. Angiography and enhanced MRI showed an AVM in the right temporal lobe associated with the CEIH. Mild disturbance of consciousness and headaches gradually worsened, as the CEIH grew. Before AVM resection, feeder embolization was performed. On the day after the embolization, symptoms improved and the CEIH shrunk in size. A week following the embolization, the AVM including the partial hematoma capsule was resected without neurological deficit. Previous literature showed similarities between CEIH and chronic subdural hematoma(CSDH)in clinical features and pathological findings of the capsule. This case indicated that feeder embolization might be a treatment option for CEIH with AVM, such as embolization of middle meningeal artery for intractable CSDH.


Assuntos
Hemorragia Cerebral , Embolização Terapêutica , Hematoma , Malformações Arteriovenosas Intracranianas , Hemorragia Cerebral/complicações , Hemorragia Cerebral/terapia , Hematoma/complicações , Hematoma/terapia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
8.
Neurology ; 93(16): e1498-e1506, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31519778

RESUMO

INTRODUCTION: To determine the influence of white matter hyperintensity (WMH) burden on functional outcome, rate of symptomatic intracerebral hemorrhage (sICH), and procedural success in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) with current stentriever/aspiration devices. METHODS: Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. WMH volumes were obtained by semiautomated planimetric segmentation and tested in association with the rate of favorable outcome (90-day functional independence), substantial recanalization after MT, and sICH. RESULTS: A total of 496 participants were included between 2015 and 2018 (50% female, mean age 68.1 ± 15.0 years). Overall, 434 (88%) patients presented with detectable WMH (mean ± SD 4.93 ± 7.7). Patients demonstrated increasingly worse outcomes with increasing WMH volumes (odds ratio [aOR]1.05 per 1-cm3 increase for unfavorable outcome, 95% confidence interval [CI] 1.01-1.06, p = 0.014). Fifty-seven percent of patients in the first quartile of WMH volume vs 28% in the fourth quartile demonstrated favorable outcome (p < 0.001). WMH severity was not associated with sICH rate (aOR 0.99, 95% CI 0.93-1.04, p = 0.66), nor did it influence recanalization success (aOR 0.99, 95% CI 0.96-1.02, p = 0.84). CONCLUSION: Our study provides evidence that in patients with AIS due to LVO and high burden of WMH as assessed by pretreatment MRI, the safety and efficacy profiles of MT are similar to those in patients with lower WMH burden and confirms that they are at higher risk of unfavorable outcome. Because more than a quarter of patients in the highest WMH quartile experienced favorable 3 months outcome, WMH burden may not be a good argument to deny MT. CLINICALTRIALSGOV IDENTIFIER: NCT01062698.


Assuntos
Isquemia Encefálica/cirurgia , Leucoaraiose/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/complicações , Hemorragia Cerebral/cirurgia , Feminino , Humanos , Leucoaraiose/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Trombectomia/efeitos adversos , Trombectomia/métodos , Resultado do Tratamento , Substância Branca/cirurgia
9.
Cancer Radiother ; 23(6-7): 708-715, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31477442

RESUMO

Stereotactic radiation therapy of brain metastases is a treatment recognized as effective, well tolerated, applicable for therapeutic indications codified and validated by national and international guidelines. However, the effectiveness of this irradiation, the evolution of patient care and the technical improvements enabling its implementation make it possible to consider it in more complex situations: proximity of brain metastases to organs at risk; large, cystic, haemorrhagic or multiple brain metastases, combination with targeted therapies and immunotherapy, stereotactic radiotherapy in patients with a pacemaker. This article aims to put forward the arguments available to date in the literature and those resulting from clinical practice to provide decision support for the radiation oncologists.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Órgãos em Risco , Radiocirurgia/métodos , Neoplasias Encefálicas/patologia , Tronco Encefálico , Hemorragia Cerebral/complicações , Terapia Combinada/métodos , Contraindicações de Procedimentos , Humanos , Imunoterapia , Imagem por Ressonância Magnética/efeitos adversos , Terapia de Alvo Molecular , Nervo Óptico , Marca-Passo Artificial , Carga Tumoral
10.
No Shinkei Geka ; 47(8): 883-892, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31477632

RESUMO

We report a case of cerebral amyloid angiopathy(CAA)-related subarachnoid hemorrhage(SAH)with Parkinson's disease dementia(PDD), along with a literature review. CASE: A 67-year-old woman with a history of Parkinson's disease was diagnosed with SAH(World Federation of Neurosurgical Societies grade I). The plain head CT performed on admission, revealed an atypical hematoma distribution. Blood sampling, MRI and cerebral angiography revealed no vascular abnormalities, meningitis, encephalitis, or primary angiitis of the central nervous system. MRI performed on the third day after admission confirmed the presence of bilateral cortical or subcortical hemorrhage in the parietal lobe, with amyloid-related imaging abnormalities. A preliminary diagnosis of CAA was made, based on the Boston criteria. She was also diagnosed with PDD, based on the cognitive decline during hospitalization. CONCLUSION: Stroke related with CAA, as seen in SAH, may contribute to cognitive decline and the progression of lesions in PDD.


Assuntos
Angiopatia Amiloide Cerebral , Demência , Doença de Parkinson , Hemorragia Subaracnóidea , Idoso , Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/diagnóstico , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Demência/complicações , Demência/diagnóstico , Feminino , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico
11.
World Neurosurg ; 132: 103-105, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493595

RESUMO

BACKGROUND: We present a case of a concurrent rupture of a middle cerebral artery (MCA) aneurysm and thrombosis of the associated vessel. CASE DESCRIPTION: A male patient presented with acute onset of hemiparesis and nuchal pain. A computed tomography scan revealed a right sided frontotemporal intracerebral hemorrhage and a basal subarachnoid hemorrhage. Owing to obliteration of the M1 segment of the MCA, no aneurysm was visible on digital subtraction angiography. Because of otherwise typical imaging for a subarachnoid hemorrhage, surgical exploration of the MCA was performed. During surgery, a thrombosed MCA bifurcation aneurysm was identified, clipped, and subsequently, endovascular (partly) recanalization of the MCA was performed. CONCLUSIONS: In extremely rare cases of aneurysm rupture and subsequent thrombosis of the associated vessel, a 2-stage approach seems to be feasible. In the present case, initial surgical securing of the aneurysm followed by endovascular recanalization of the occluded vessel provided good results.


Assuntos
Aneurisma Roto/cirurgia , Hemorragia Cerebral/cirurgia , Procedimentos Endovasculares/métodos , Infarto da Artéria Cerebral Média/terapia , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Aneurisma Roto/complicações , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/etiologia , Aneurisma Intracraniano/complicações , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
Neurology ; 93(15): e1463-e1473, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31492719

RESUMO

OBJECTIVES: To explore the relationship between insufficient ipsilateral cerebral venous drainage and the development of perihematomal edema (PHE) and functional outcome in patients with acute intracerebral hemorrhage (ICH). METHODS: We retrospectively reviewed our prospectively collected database for patients with acute spontaneous supratentorial ICH and analyzed patients who underwent baseline CT perfusion (CTP) within 6 hours of onset and noncontrast CT at 24 hours. Absence of filling of 1 or more of the ipsilateral superficial middle cerebral vein, vein of Trolard, vein of Labbé, basal vein of Rosenthal, and internal cerebral vein, evaluated on venous maps generated from baseline CTP, was identified as absent ipsilateral venous filling (AIVF). Relative PHE (rPHE) was calculated as the ratio of PHE volume to hematoma volume on follow-up CT. RESULTS: A total of 138 patients were included. Median absolute PHE volume on follow-up CT was 3.5 (1.0-9.3) mL and rPHE was 24.3% (9.0%-49.4%). One absent ipsilateral vein was observed in 38 (27.5%) patients, and 2 absent veins were observed in 5 (3.6%) patients. Multivariate analysis showed that AIVF was independently associated with large rPHE at 24 hours (odds ratio [OR] 4.032, 95% confidence interval [CI] 1.739-9.347, p < 0.001). Large PHE volume was independently associated with poor outcome (OR 1.109, 95% CI 1.009-1.218, p = 0.031). CONCLUSION: AIVF was observed in about one-third of patients with acute ICH, which might be attributed to hypoperfusion after ICH and was strongly related to the development of PHE. Identification of cerebral venous filling status might be a promising imaging marker for PHE and a potential therapeutic target in ICH.


Assuntos
Edema Encefálico/complicações , Hemorragia Cerebral/complicações , Veias Cerebrais/fisiopatologia , Hematoma/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/fisiopatologia , Hemorragia Cerebral/fisiopatologia , Drenagem/métodos , Edema/complicações , Edema/fisiopatologia , Feminino , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada
13.
Neurol Res ; 41(11): 980-990, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31378168

RESUMO

Background. As the survival of preterm infants has increased significantly, germinal matrix hemorrhage (GMH) has become an important public health issue. Nevertheless, treatment strategies for the direct neuronal injury are still scarce. The present study aims to analyze the neuroprotective properties of cannabidiol in germinal matrix hemorrhage. Methods. 112 Wistar rat pups (P7) were submitted to an experimental collagenase induced model of GMH. Inflammatory response and neuronal death were analyzed both at the perilesional area as at the distant ipsilateral CA1 hippocampal area. Immunohistochemistry for GFAP and caspase 3 was used. The ipsilateral free water content was assessed for stimation of cerebral edema, and neurodevelopment and neurofunctional tests were conducted. Results. Reduction of reactive astrocytosis was observed both in the perilesional area 24 hours and 14 days after the hemorrhage lesion (p < 0.001) and in the Stratum oriens of the ipsilateral hippocampal CA1 14 days after the hemorrhage lesion (p < 0.05) in the treated groups. Similarly, there was a reduction in the number of Caspase 3-positive astrocytes in the perilesional area in the treated groups 24 hours after the hemorrhage lesion (p < 0.001). Finally, we found a significant increase in the weight of the rats treated with cannabidiol. Conclusion. The treatment of GMH with cannabidiol significantly reduced the number of apoptotic cells and reactive astrocytes in the perilesional area and the ipsilateral hippocampus. In addition, this response was sustained 14 days after the hemorrhage. These results corroborate our hypothesis that cannabidiol is a potential neuroprotective agent in the treatment of germinal matrix hemorrhage.


Assuntos
Apoptose/efeitos dos fármacos , Canabidiol/farmacologia , Hemorragia Cerebral/tratamento farmacológico , Hemorragias Intracranianas/tratamento farmacológico , Animais , Animais Recém-Nascidos , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Edema Encefálico/complicações , Edema Encefálico/patologia , Canabidiol/administração & dosagem , Hemorragia Cerebral/complicações , Hemorragia Cerebral/patologia , Modelos Animais de Doenças , Hemorragias Intracranianas/complicações , Masculino , Fármacos Neuroprotetores/farmacologia , Ratos Wistar
14.
Medicine (Baltimore) ; 98(34): e16902, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441869

RESUMO

RATIONALE: Nontraumatic pontine hemorrhage represents approximately 10% of all cases of nontraumatic intracranial hemorrhage. The predominant cause and symptom of pontine hemorrhage are hypertension and disturbance of consciousness, respectively. PATIENT CONCERNS: A 64-year-old man was transported to hospital by ambulance for sudden articulation disorder and right leg paralysis. He was neurologically alert with mild dysarthria, right leg paralysis, and increased deep tendon reflex in all limbs. DIAGNOSIS: Plain head computed tomography showed an approximately 1.5 mL hemorrhage in the dorsomedial pons. INTERVENTION: He was admitted to the Stroke Care Unit and received antihypertensive therapy. OUTCOMES: Around the time of admission, bilateral hearing loss suddenly developed with poorly defined wave V shown bilaterally on auditory brainstem response testing. As the hematoma subsequently resolved, the bilateral hearing loss recovered sufficiently to enable everyday conversation. LESSONS: We report herein a rare case of acute onset bilateral hearing loss caused by nontraumatic pontine hemorrhage. Pontine hemorrhage is often associated with disturbance of consciousness; however, care is required as latent communication disorder due to impaired hearing is possible regardless of the state of consciousness.


Assuntos
Hemorragia Cerebral/complicações , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva Bilateral/etiologia , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Ponte/diagnóstico por imagem
15.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 193-197, jul.-ago. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183586

RESUMO

A subependymoma is a benign primary brain tumor classified as a World Health Organization grade I tumor; it is asymptomatic in most cases. We present the case of a 66-year-old Japanese man with a complaint of recurrent vomiting that led to the discovery of a large mass with hemorrhage, peritumoral edema, and a midline shift in the posterior horn of the right lateral ventricle. The patient was pathologically diagnosed with subependymoma after undergoing total tumor resection; a year after the surgery, he was free from tumor recurrence. Although symptomatic subependymomas are rare, they tend to show hemorrhage with peritumoral edema on neuroradiological tests and tend to be confused with high-grade brain tumors. In the present case, we highlight the importance of the appropriate diagnosis for subependymomas showing neuroradiological features that mimic high-grade gliomas. This diagnosis will help in providing suitable treatment for subependymomas


Un subependimoma es un tumor cerebral primario benigno, clasificado por la Organización Mundial de la Salud como un tumor grado I. En la mayoría de los casos es asintomático. Presentamos el caso de un varón japonés de 66 años de edad que reportaba vómitos recurrentes, los que lo llevaron al descubrimiento de una gran masa con hemorragia, edema peritumoral y una desviación de la línea media del cuerno posterior del ventrículo lateral derecho. Se le realizó un diagnóstico patológico de subependimoma luego de que se le sometiera a una resección total del tumor. Un año después de la cirugía no presentaba recurrencia del tumor. Aunque los subependimomas sintomáticos son raros, en las pruebas neurorradiológicas tienden a presentar hemorragia con edema peritumoral y se tiende a confundirlos con tumores cerebrales de alto grado. En el presente caso, destacamos la importancia de un diagnóstico adecuado de los subependimomas que presentan características neurorradiológicas que imitan a gliomas de alto grado. Este diagnóstico ayudará a brindar el tratamiento adecuado para dichos subependimomas


Assuntos
Humanos , Masculino , Idoso , Glioma Subependimal/diagnóstico por imagem , Glioma Subependimal/radioterapia , Hemorragia Cerebral/complicações , Neoplasias Encefálicas/cirurgia , Neurocirurgia , Glioma Subependimal/patologia , Edema Encefálico/complicações , Edema Encefálico/diagnóstico por imagem , Imuno-Histoquímica , Diagnóstico Diferencial , Ventrículos Cerebrais/cirurgia
16.
J Craniofac Surg ; 30(5): e397-e400, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299790

RESUMO

The fourth ventricle outlet obstruction (FVOO) is a rare but well-established cause of obstructive tetra-ventricular hydrocephalus, characterizing with dilatation or large cerebrospinal fluid collection of the foramina of Magendie and Luschka. In children, it is usually the consequence of posterior cerebral fossa malformations; while in adult, the occlusion is rather acquired than congenital, mostly linked to an inflammatory process, intraventricular hemorrhage, head trauma, brain tumors or Arnold-Chiari malformation. However, idiopathic FVOO is extremely rare, and only 6 such cases have been reported in the English literature. Hereby, we described an extraordinarily rare case of idiopathic FVOO in a 15-year-old patient successfully treated with direct microsurgical excision of the obstruction membrane. Furthermore, the clinical characteristics and treatment for this rare disease were investigated and reviewed.


Assuntos
Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Adolescente , Malformação de Arnold-Chiari/complicações , Neoplasias Encefálicas/patologia , Hemorragia Cerebral/complicações , Traumatismos Craniocerebrais/complicações , Humanos , Doenças Raras/patologia
17.
Geriatr Gerontol Int ; 19(8): 815-822, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31267646

RESUMO

AIM: We investigated the long-term risk of dementia for up to 10 years in patients with stroke and broadened the correlates. METHODS: We carried out a case-control study using the Taiwan National Health Insurance Research database in 2000 with a sampled population of 1 million. The study cohort comprised 8236 patients with stroke and no dementia history. We carried out a 1:1 case-control matched analysis on estimated propensity scores. Cox proportional hazards regressions were carried out to estimate the risk of dementia during the 5- and 10-year follow-up periods. The risk factors were also investigated. RESULTS: The stroke cohort was significantly at more risk of dementia during the 5- and 10-year follow-up periods, with adjusted hazard ratios 1.87 and 1.53, respectively. The patients with ischemic stroke, transient ischemic attack and intracerebral hemorrhage had a significantly higher risk of dementia after 5 and 10 years, with adjusted hazard ratios of 1.81 and 1.49, 1.92 and 1.61, and 2.14 and 1.61, respectively. The significant risk factors of dementia were age ≥60 years, resident in southern and eastern regions, having low insurance range, and antiplatelet use. CONCLUSIONS: Stroke and the subtypes, including ischemic stroke, transient ischemic attack and intracerebral hemorrhage, increase the long-term risk of dementia. The incidence of post-stroke dementia increases yearly, but the relative risk decreases gradually. Older adults, residents in southern and eastern regions, having low insurance range and antiplatelet use were prominent risk factors of post-stroke dementia in Taiwan. Careful management of stroke and risk factors of post-stroke dementia with long-term follow up of cognition should be reinforced. Geriatr Gerontol Int 2019; 19: 815-822.


Assuntos
Isquemia Encefálica , Hemorragia Cerebral , Demência , Ataque Isquêmico Transitório , Efeitos Adversos de Longa Duração , Acidente Vascular Cerebral , Fatores Etários , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , Hemorragia Cerebral/complicações , Hemorragia Cerebral/epidemiologia , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Feminino , Humanos , Incidência , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/epidemiologia , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/epidemiologia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Taiwan/epidemiologia
19.
Yonsei Med J ; 60(8): 774-781, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347333

RESUMO

PURPOSE: Cerebral small vessel disease (SVD) is known to be associated with ischemic stroke, intracerebral hemorrhage (ICH), and cognitive impairment. In this retrospective observational study, we explored SVD markers on MRI relevant to spontaneous ICH. MATERIALS AND METHODS: The ICH group consisted of 150 consecutive patients with a first primary parenchymal ICH, and the control group consisted of 271 age- and sex-matched individuals who underwent brain MRI in a health care center. We compared cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular space (EPVS), and lacunae in the ICH and control groups. RESULTS: A total of 1278 CMB lesions were identified in 121 of the 150 patients in the ICH group (80.6%), while 77 CMB lesions were found in 32 of the 271 individuals in the control group (11.8%). WMH and EPVS were more severe and lacunae were more frequent in the ICH patients than in the control group. When receiver operating characteristic (ROC) curves were plotted, number of CMBs most significantly predicted ICH. All imaging markers were significantly associated with ICH in every age group. The location of CMBs coincided with the location of ICH, and ICH volume correlated with CMB count. CONCLUSION: All MRI markers for SVD were worse in ICH patients than in healthy controls, and these markers were prominent even in young ICH patients. Lacunae, WMH, EPVS, and CMB should be considered as factors related with spontaneous ICH.


Assuntos
Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Curva ROC , Estudos Retrospectivos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
20.
Neurology ; 93(7): e695-e707, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31337715

RESUMO

OBJECTIVE: To determine whether patients with TIA or ischemic stroke with coexisting cardiovascular disease (i.e., history of coronary or peripheral artery disease) are still at high risk of recurrent ischemic events despite current secondary prevention guidelines. METHODS: In a population-based study in Oxfordshire, UK (Oxford Vascular Study), we studied consecutive patients with TIA or ischemic stroke for 2002-2014. Patients were treated according to current secondary prevention guidelines and we determined risks of coronary events, recurrent ischemic stroke, and major bleeding stratified by the presence of coexisting cardiovascular disease. RESULTS: Among 2,555 patients (9,148 patient-years of follow-up), those (n = 640; 25.0%) with coexisting cardiovascular disease (449 coronary only; 103 peripheral only; 88 both) were at higher 10-year risk of coronary events than those without (22.8%, 95% confidence interval 17.4-27.9; vs 7.1%, 5.3-8.8; p < 0.001; age- and sex-adjusted hazard ratio [HR] 3.07, 2.24-4.21) and of recurrent ischemic stroke (31.5%, 25.1-37.4; vs 23.4%, 20.5-26.2; p = 0.0049; age- and sex-adjusted HR 1.23, 0.99-1.53), despite similar rates of use of antithrombotic and lipid-lowering medication. However, in patients with noncardioembolic TIA/stroke, risk of extracranial bleeds was also higher in those with coexisting cardiovascular disease, particularly in patients aged <75 years (8.1%, 2.8-13.0; vs 3.4%, 1.6-5.3; p = 0.0050; age- and sex-adjusted HR 2.71, 1.16-6.30), although risk of intracerebral hemorrhage was not increased (age- and sex-adjusted HR 0.36, 0.04-2.99). CONCLUSIONS: As in older studies, patients with TIA/stroke with coexisting cardiovascular disease remain at high risk of recurrent ischemic events despite current management. More intensive lipid-lowering might therefore be justified, but benefit from increased antithrombotic treatment might be offset by the higher risk of extracranial bleeding.


Assuntos
Hemorragia Cerebral/complicações , Ataque Isquêmico Transitório/complicações , Acidente Vascular Cerebral/complicações , Tempo , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/patologia , Feminino , Humanos , Ataque Isquêmico Transitório/patologia , Masculino , Pessoa de Meia-Idade , Risco , Fatores de Risco , Prevenção Secundária , Acidente Vascular Cerebral/patologia
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