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1.
J Stroke Cerebrovasc Dis ; 30(5): 105672, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33730599

RESUMO

OBJECTIVES: The management of patients admitted with intracerebral hemorrhage (ICH) mostly occurs in an ICU. While guidelines recommend initial treatment of these patients in a neurocritical care or stroke unit, there is limited data on which patients would benefit most from transfer to a comprehensive stroke center where on-site neurosurgical coverage is available 24/7. As neurocritical units become more common in primary stroke centers, it is important to determine which patients are most likely to require neurosurgical intervention and transfer to comprehensive stroke centers. MATERIALS AND METHODS: This is a retrospective observational cohort study conducted at an academic comprehensive stroke center in the United States. Four-hundred-fifty-nine consecutive patients transferred or directly admitted to the neurocritical care unit from 2016-2018 with the primary diagnosis of ICH were included. Univariate statistics and multivariate regression were used to identify clinical characteristics associated with neurosurgical intervention, defined as undergoing craniotomy, ventriculostomy, or endovascular embolization of an arteriovenous malformation (AVM). RESULTS: The following variables were associated with neurosurgical intervention in multivariate analysis: age (OR 0.38, 95% CI 0.27-0.55), admission Glasgow Coma Scale (OR 0.29, 95% CI 0.18-0.48), the presence of intraventricular hemorrhage (OR 2.82, CI 1.71-4.65), infratentorial location of ICH (OR 2.28, 95% CI 1.20-4.31), previous antiplatelet use (OR 2.04, 95% CI 1.24-3.34), and an AVM indicated on CT Angiogram (OR 2.59, 95% CI 1.19-5.63) were independently associated with the need for neurosurgical intervention. This was translated into a scoring system to help make quick triage decisions, with high sensitivity (99%, 95% CI 97-99%) and negative predictive value (98%, 95% CI 89-99%). CONCLUSIONS: Using previously well described predictors of severity in ICH patients, we were able to develop a scoring system to predict the need for neurosurgical intervention with high sensitivity and negative predictive value.


Assuntos
Hemorragia Cerebral/cirurgia , Técnicas de Apoio para a Decisão , Prestação Integrada de Cuidados de Saúde , Procedimentos Endovasculares , Procedimentos Neurocirúrgicos , Admissão do Paciente , Transferência de Pacientes , Triagem , Idoso , Hemorragia Cerebral/diagnóstico , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Eur J Endocrinol ; 184(4): 565-574, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33730688

RESUMO

Design: Cushing's disease (CD) is a rare clinical syndrome characterized by chronic exposure to hypercortisolism due to an adrenocorticotropic hormone-secreting pituitary adenoma. The adverse effects of chronic exposure to hypercortisolism on the human brain remain unclear. The purpose of this study was to assess the prevalence of cerebral microbleeds (CMBs) in CD patients and their associations with clinical characteristics. Methods: In this study, 48 active CD patients, 39 remitted CD patients, and 52 healthy control (HC) subjects underwent MRI. CD patients also underwent neuropsychological testing and clinical examinations. The number, locations, and volumes of CMBs were assessed on quantitative susceptibility mapping (QSM) images and with the Microbleed Anatomical Rating Scale. The correlation between CMBs and clinical characteristics was explored. Results: The prevalence of CMBs among active and remitted CD patients was higher than that among HCs (16.3%, 20.5%, and 3.3%, respectively). Moreover, the age of CD patients with CMBs were much younger than HCs with CMBs. Furthermore, the increased number of CMBs in active CD patients was associated with increased cerebrospinal fluid (CSF) volumes in remitted CD patients. Conclusions: Chronic exposure to hypercortisolism may be relevant to CMBs and significantly correlated with altered brain volumes in CD.


Assuntos
Encéfalo/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Imagem por Ressonância Magnética/métodos , Hipersecreção Hipofisária de ACTH/complicações , Adulto , Idoso , Encéfalo/patologia , Mapeamento Encefálico/métodos , Estudos de Casos e Controles , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/patologia , Estudos Transversais , Síndrome de Cushing/complicações , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/patologia , Suscetibilidade a Doenças/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Hipersecreção Hipofisária de ACTH/diagnóstico , Hipersecreção Hipofisária de ACTH/epidemiologia , Hipersecreção Hipofisária de ACTH/patologia , Prevalência
3.
Clin Neurol Neurosurg ; 203: 106594, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33735661

RESUMO

BACKGROUND: Cerebral microbleeds are increasingly reported in critical ill patients with respiratory failure in need of mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO). Typically, these critical illness-associated microbleeds involve the juxtacortical white matter and corpus callosum. Recently, this pattern was reported in patients with respiratory failure, suffering from COVID-19. MATERIALS AND METHODS: In this retrospective single-center study, we listed patients from March 11, 2020 to September 2, 2020, with laboratory-confirmed COVID-19, critical illness and cerebral microbleeds. Literature research was conducted through a methodical search on Pubmed databases on critical illness-associated microbleeds and cerebral microbleeds described in patients with COVID-19. RESULTS AND DISCUSSION: On 279 COVID-19 admissions, two cases of cerebral microbleeds were detected in critical ill patients with respiratory failure due to COVID-19. Based on review of existing literature critical illness-associated microbleeds tend to predominate in subcortical white matter and corpus callosum. Cerebral microbleeds in patients with COVID-19 tend to follow similar patterns as reported in critical illness-associated microbleeds. Hence, one patient with typical critical illness-associated microbleeds and COVID-19 is reported. However, a new pattern of widespread cortico-juxtacortical microbleeds, predominantly in the anterior vascular territory with relative sparing of deep gray matter, corpus callosum and infratentorial structures is documented in a second case. The possible etiologies of these microbleeds include hypoxia, hemorrhagic diathesis, brain endothelial erythrophagocytosis and/or cytokinopathies. An association with COVID-19 remains to be determined. CONCLUSION: Further systematic investigation of microbleed patterns in patients with neurological impairment and COVID-19 is necessary.


Assuntos
/complicações , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Idoso , /terapia , Hemorragia Cerebral/terapia , Estado Terminal , Humanos , Masculino , Pessoa de Meia-Idade
4.
High Blood Press Cardiovasc Prev ; 28(2): 115-128, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33599966

RESUMO

INTRODUCTION: Intracerebral haemorrhage (ICH) is associated with high morbidity and mortality. Blood pressure (BP) control is one of the main management strategies in acute ICH. Limited data currently exist regarding intracranial pressure (ICP) in acute ICH. The relationship between BP lowering and ICP is yet to be fully elucidated. METHODS: We conducted a systematic review to investigate the effects of BP lowering on ICP in acute ICH. The study protocol was registered on PROSPERO (CRD42019134470). RESULTS: Following PRISMA guidelines, MEDLINE, EMBASE and CENTRAL were searched for studies on ICH with BP and ICP or surrogate measures. 1096 articles were identified after duplicates were removed; 18 studies meeting the inclusion criteria. Dihydropyridine calcium channel blockers (CCBs) were the most common agent used to lower BP, but had a varying effect on ICP. Other BP-lowering agents used also had a varying effect on ICP. DISCUSSION AND CONCLUSION: Further work, including large observational or randomized interventional studies, is needed to develop a better understanding of the effect of BP lowering on ICP in acute ICH, which will assist the development of more effective management strategies. TRIAL REGISTRATION: The study protocol was registered on PROSPERO (CRD42019134470) on 29/05/2019.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hemorragia Cerebral/tratamento farmacológico , Pressão Intracraniana/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
5.
BMC Geriatr ; 21(1): 106, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546615

RESUMO

BACKGROUND: Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). METHODS: This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex. RESULTS: 161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127-174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88-6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11-2.35], and cardiovascular disease [OR 1.48 IC95% 1.05-2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89-0.97] and negative predictive value [0.98 (CI95% 0.83-1.12)]. CONCLUSIONS: In the CCP subgroup the incidence density of ICH was 5-60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH. TRIAL REGISTRATION: This study was retrospectively registered in ClinicalTrials.gov ( NCT03247049 ) on August 11/2017.


Assuntos
Hemorragia Cerebral , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
6.
Trials ; 22(1): 93, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33499916

RESUMO

BACKGROUND: All of the existing medication and surgical therapies currently cannot completely inhibit intracerebral hemorrhage (ICH)-mediated brain damage, resulting in disability in different degrees in the involved patients. Normobaric oxygenation (NBO) was reported attenuating ischemic brain injury. Herein, we aimed to explore the safety and efficacy of NBO on rescuing the damaged brain tissues secondary to acute ICH, especially those in the perihematoma area being threatened by ischemia and hypoxia. METHODS: A total of 150 patients confirmed as acute spontaneous ICH by computed tomography (CT) within 6 h after symptoms onset, will enroll in this study after signing the informed consent, and enter into the NBO group or control group randomly according to a random number. In the NBO group, patients will inhale high-flow oxygen (8 L/min, 1 h each time for 6 cycles daily) and intake low-flow oxygen (2 L/min) in intermittent periods by mask for a total of 7 days. While in the control group, patients will breathe in only low-flow oxygen (2 L/min) by mask for 7 consecutive days. Computed tomography and perfusion (CT/CTP) will be used to evaluate cerebral perfusion status and brain edema. CT and CTP maps in the two groups at baseline and day 7 and 14 after NBO or low-flow oxygen control will be compared. The primary endpoint is mRS at both Day14 post-ICH and the end of the 3rd month follow-up. The secondary endpoints include NIHSS and plasma biomarkers at baseline and Day-1, 7, and 14 after treatment, as well as the NIHSS at the end of the 3rd month post-ICH and the incidence of bleeding recurrence and the mortalities within 3 months post-ICH. DISCUSSION: This study will provide preliminary clinical evidence about the safety and efficacy of NBO on correcting acute ICH and explore some mechanisms accordingly, to offer reference for larger clinical trials in the future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04144868 . Retrospectively registered on October 29, 2019.


Assuntos
Edema Encefálico/terapia , Lesões Encefálicas/terapia , Hemorragia Cerebral/terapia , Oxigenoterapia/efeitos adversos , Oxigênio/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/diagnóstico , Edema Encefálico/etiologia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Córtex Cerebral/diagnóstico por imagem , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Máscaras , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Imagem de Perfusão/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
7.
Sud Med Ekspert ; 64(1): 51-56, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33511836

RESUMO

A review of the literature on intracerebral hemorrhages is given. The purpose of the work is to systematize morphological characters that make it possible to differentiate intracranial hemorrhages of various origins. A number of features of hemorrhagic strokes characteristic of cerebrovascular diseases and other nosologies are presented. The analysis found that the differential diagnosis of hemorrhagic strokes in cerebrovascular diseases should be carried out with systemic, oncological, infectious diseases, vasculitis, thrombohemorrhagic syndrome, traumatic brain injury, as well as other diseases and pathological conditions that are complicated by acute disorders of the cerebral circulation of hemorrhages.


Assuntos
Transtornos Cerebrovasculares , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Circulação Cerebrovascular , Transtornos Cerebrovasculares/diagnóstico , Humanos , Hemorragias Intracranianas/diagnóstico
8.
Clin Neurol Neurosurg ; 202: 106503, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33493878

RESUMO

BACKGROUND: hemorrhagic cerebrovascular disease due to vascular malformations represents an emergency for neurosurgery and neuro-interventional departments. During the COVID-19 pandemic, a dramatic reduction in the number of hospitalizations for acute myocardial infarction or stroke and a larger time interval from symptom onset to first medical contact have been reported. This study aims to verify the hypothesis that there would also have been a reduction of admissions for hemorrhagic cerebrovascular disease during the Italian lockdown. MATERIAL AND METHOD: s A multicenter, observational survey was conducted to collect data on hospital admissions for hemorrhagic cerebrovascular disease due to vascular malformations throughout two-months (March 15th to May 15th); the years 2020 (COVID-19 Italian lockdown), 2019 and 2018 were compared. Cases were identified by ICD-9 codes 430, 431, 432.1, 432.9, 747.81 of each hospital database. The statistical significance of the difference between the event rate of one year versus the others was evaluated using Poisson Means test, assuming a constant population. RESULTS: During the 2020 lockdown, the total number of admissions for hemorrhagic cerebrovascular disease was 92 compared with 116 in 2019 and 95 in 2018. This difference was not significant. GCS upon admission was 3-8 in 44 % of cases in 2020 (41 patients), 39.7 % in 2019 (46 patients) and 28 % in 2018 (27 patients). CONCLUSION: Reduction of admissions for hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 lockdown was not confirmed. Nevertheless, some patients reached the emergency rooms only several days after symptoms onset, resulting in a worse clinical condition at admission.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Malformações Vasculares do Sistema Nervoso Central/epidemiologia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Quarentena/tendências , Humanos , Incidência , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/epidemiologia , Itália/epidemiologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/epidemiologia
9.
J Stroke Cerebrovasc Dis ; 30(3): 105565, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33412399

RESUMO

OBJECTIVES: In a previous pilot study, we found an association between high factor XII levels and risk of haemorrhagic stroke suggesting that factor XII is a risk marker for intracerebral haemorrhage (ICH). The aim of this study was to further investigate the association between factor XII and risk of ICH in a larger population. MATERIALS AND METHODS: This study was conducted as a prospective nested case-referent study. All participants underwent a health examination and blood sampling for factor XII analysis at baseline. Cases were defined as participants who were diagnosed with a first-ever ICH between 1985 and 2000. Two referents were matched to each case. RESULTS: We identified 70 individuals with first-ever ICH and 137 matched referents who had undergone a health examination and donated blood samples before the ICH event. The mean age was 54 years, and 33% were women. The median time-to-event was 3.5 years (range 0.04 to 10.2 years). Conditional logistic regression showed no association between factor XII and risk of ICH, (odds ratio 1.06 per SD; [95% confidence interval: 0.57-1.97] in a multivariable model). CONCLUSIONS: A previous finding of an association between high concentration of factor XII and risk of ICH could not be replicated in this larger study.


Assuntos
Hemorragia Cerebral/sangue , Fator XII/análise , Biomarcadores/sangue , Estudos de Casos e Controles , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo
10.
J Stroke Cerebrovasc Dis ; 30(3): 105537, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33338706

RESUMO

BACKGROUND: Intracerebral hemorrhage (ICH) is associated with high mortality, morbidity, and recurrence. Studies have reported the accuracy of several blood biomarkers in predicting clinical outcomes; however, their independent contribution in prediction remains to be established. AIM: To investigate the incremental accuracy in predicting clinical outcomes in patients with ICH in a north Indian population using blood-based biomarkers. METHODS: In this study, a total of 250 ICH cases were recruited within 72 hours of onset. Baseline clinical and CT scan measurement were recorded. Homocysteine (HCY), C-reactive protein (CRP), matrix metalloproteinase-9 (MMP9), E-selectin (SELE), and P-selectin (SELP) levels were measured through ELISA. Telephonic follow-up was done by using mRS scale at three months. RESULTS: The mean age of cohort was 54.9 (SD±12.8) years with 64.8% patients being male. A total of 109 (43.6%) deaths were observed over three months follow-up. Area under the receiver operating characteristics curve-(AUROC) for 90-day mortality were 0.55 (HCY), 0.62 (CRP), 0.57 (MMP9), 0.60 (SELE) and 0.53 (SELP) and for poor outcome at 90-day (mRS: 3-6) were 0.60 (HCY), 0.62 (CRP), 0.54 (MMP9), 0.67 (SELE) and 0.54 (SELP). In multivariable model including age, ICH volume, IVH and GCS at admission, serum SELE (p=0.004) significant for poor outcome with improved AUROC (0.86) and HCY (p=0.04), CRP (p=0.003) & MMP9 (p=0.02) for mortality with least Akaike's Information Criterion-(AIC) (1060.5). CONCLUSIONS: Our findings suggest that the serum SELE is a significant predictor of poor outcome and HCY, CRP & MMP9 for Mortality in patients with ICH in the north Indian population.


Assuntos
Proteína C-Reativa/análise , Hemorragia Cerebral/sangue , Selectina E/sangue , Homocisteína/sangue , Metaloproteinase 9 da Matriz/sangue , Adulto , Idoso , Biomarcadores/sangue , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/cirurgia , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(50): e23557, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327308

RESUMO

Intracerebral hemorrhage (ICH) is the second most common subtype of stroke with higher mortality and morbidity, and it lacks effective prognostic markers. The aim of this research is to construct newly valuable prognostic nomogram incorporating red blood cell distribution width (RDW) for ICH patients.We retrospectively analyzed 953 adult patients with ICH. The impacts of RDW on short-term mortality and functional prognosis were calculated using Akaike information criterion (AIC), Bayesian information criteria (BIC) and the area under the curve (AUC) respectively, which could be used to compare with Glasgow coma scale (GCS) and ICH score. The independent factors of prognosis were identified by univariate and multivariate logistic regression analysis. A nomogram based on RDW for nerve functional prognosis was further constructed and validated. Its clinical value was subsequently explored utilizing decision curve analysis.Cumulative clinical results were retrieved for 235 inpatients from Jan 2012 to June 2017. In 30-day mortality sets, GCS and ICH score had better prognostic performance than RDW (AUC: 0.929 and 0.917 vs 0.764; AIC: 124.101 and 134.188 vs 221.372; BIC: 131.021 and 141.107 vs 228.291). In 30-day functional prognosis sets, the consequences of evaluation systems were inconsistent. GCS was the best parameter for predicting outcome using AIC (262.350 vs 276.392 and 264.756) and BIC (269.269 vs 283.311 and 271.675). However, RDW was higher than GCS and ICH score considering AUC (0.784 vs 0.759 and 0.722). Age, GCS, RDW, platelet distribution width, and surgery were independent prognostic factors by multivariate logistic regression analysis, and those coefficients were used to formulate a nomogram. This nomogram can provide accurate prediction with the concordance index of 0.880 (95% CI, 0.837-0.922) higher than Harrell's concordance index of GCS system 0.759 (95% CI, 0.698-0.819) and RDW 0.784 (95% CI, 0.721-0.847). The calibration plots showed optimal consistency between bootstrap-predicted and the actual observed values of 30-day unfavorable prognosis. Decision curve analysis showed an increased net benefit for utilizing the nomogram.High RDW values are associated with an unfavorable outcome after ICH. The established nomogram incorporating RDW should be considered for a 30-day functional prognosis.


Assuntos
Hemorragia Cerebral/diagnóstico , Índices de Eritrócitos , Eritrócitos/patologia , Nomogramas , Idoso , Biomarcadores/sangue , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/patologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Análise de Sobrevida
12.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370980

RESUMO

We illustrate a case of post-traumatic recurrent transient prosopagnosia in a paediatric patient with a right posterior inferior temporal gyrus haemorrhage seen on imaging and interictal electroencephalogram abnormalities in the right posterior quadrant. Face recognition area mapping with magnetoencephalography (MEG) and functional MRI (fMRI) was performed to clarify the relationship between the lesion and his prosopagnosia, which showed activation of the right fusiform gyrus that colocalised with the lesion. Lesions adjacent to the right fusiform gyrus can result in seizures presenting as transient prosopagnosia. MEG and fMRI can help to attribute this unique semiology to the lesion.


Assuntos
Hemorragia Cerebral/diagnóstico , Procedimentos Neurocirúrgicos , Prosopagnosia/etiologia , Convulsões/diagnóstico , Lobo Temporal/diagnóstico por imagem , Mapeamento Encefálico , Hemorragia Cerebral/complicações , Hemorragia Cerebral/cirurgia , Criança , Eletroencefalografia , Reconhecimento Facial/fisiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Prosopagnosia/diagnóstico , Prosopagnosia/fisiopatologia , Prosopagnosia/cirurgia , Convulsões/etiologia , Convulsões/fisiopatologia , Convulsões/cirurgia , Lobo Temporal/fisiopatologia , Resultado do Tratamento
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1055-1058, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018167

RESUMO

Cerebral Microbleeds (CMBs) are small chronic brain hemorrhages, which have been considered as diagnostic indicators for different cerebrovascular diseases including stroke, dysfunction, dementia, and cognitive impairment. In this paper, we propose a fully automated two-stage integrated deep learning approach for efficient CMBs detection, which combines a regional-based You Only Look Once (YOLO) stage for potential CMBs candidate detection and three-dimensional convolutional neural networks (3D-CNN) stage for false positives reduction. Both stages are conducted using the 3D contextual information of microbleeds from the MR susceptibility-weighted imaging (SWI) and phase images. However, we average the adjacent slices of SWI and complement the phase images independently and utilize them as a two- channel input for the regional-based YOLO method. The results in the first stage show that the proposed regional-based YOLO efficiently detected the CMBs with an overall sensitivity of 93.62% and an average number of false positives per subject (FPavg) of 52.18 throughout the five-folds cross-validation. The 3D-CNN based second stage further improved the detection performance by reducing the FPavg to 1.42. The outcomes of this work might provide useful guidelines towards applying deep learning algorithms for automatic CMBs detection.


Assuntos
Imagem por Ressonância Magnética , Redes Neurais de Computação , Algoritmos , Encéfalo , Hemorragia Cerebral/diagnóstico , Humanos
14.
Cerebrovasc Dis ; 49(5): 495-502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32932248

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is a frequent cerebrovascular disorder and still associated with high mortality and poor clinical outcomes. The purpose of this review was to update a 15-year-old former meta-analysis on randomized clinical trials (RCTs) addressing the question of whether ICH patients treated with dexamethasone have better outcomes than controls. METHODS: The electronic databases PubMed, SCOPUS, and Cochrane as well as web platforms on current clinical trials were searched for the years 1970-2020 without constriction on language. Data were extracted and outcomes were pooled for conventional and cumulative meta-analysis using a commercial software program (www.Meta-Analysis.com). RESULTS: Finally, 7 RCTs were identified and analyzed including 248 participants in the dexamethasone groups and 242 in the control groups. Five studies showed a high risk of bias. The overall relative risk (RR) for death was 1.32 (95% confidence interval [CI] 0.99-1.76; p = 0.06) and did not differ significantly between the 2 groups. After exclusion of studies with high risk of bias, the RR for death was 1.37 (95% CI 0.54-3.42; p = 0.51). The RR for poor outcome did not differ significantly between the 2 groups analyzed for all included studies (RR = 0.69; 95% CI 0.47-1; p = 0.05) and after exclusion of studies with high risk of bias (RR = 0.7; 95% CI 0.45-1.08; p = 0.11). The RR for complications did not differ significantly including all studies (RR = 1.29; 95% CI 0.77-2.17; p = 0.34) and after exclusion of studies with high risk of bias (RR = 1.27; 95% CI 0.18-8.89; p = 0.81). The cumulative statistics delivered no other results; however, it pointed out fewer complications over time in the dexamethasone group. CONCLUSION: Clear evidence of a beneficial or negative effect of dexamethasone is still lacking. Modern RCTs or observational studies with propensity design are necessary to evaluate the efficacy and safety of treatment with dexamethasone in patients with ICH.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Idoso , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Dexametasona/efeitos adversos , Feminino , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Intern Med ; 59(20): 2597-2600, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32893231

RESUMO

The relationship between coronavirus disease 2019 (COVID-19) and intracerebral hemorrhage remains unclear. We herein report a case of severe COVID-19 pneumonia complicated by multiple simultaneous intracerebral hemorrhages (MSICH). The patient died eight days after the episode of MSICH. No apparent coagulopathy was observed; however, extracorporeal membrane oxygenation and anticoagulation might have caused the occurrence of MSICH. Laboratory findings showed hypercoagulability, suggesting that thrombotic etiologies, such as sinus thrombosis or cerebral infarction, might also have caused MSICH. MSICH can occur as a fatal complication of COVID-19, and this should be considered when providing treatment.


Assuntos
Betacoronavirus , Hemorragia Cerebral/virologia , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Betacoronavirus/isolamento & purificação , Hemorragia Cerebral/diagnóstico , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações
16.
J Stroke Cerebrovasc Dis ; 29(9): 105057, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807462

RESUMO

BACKGROUND AND AIMS: In experimental models, enhanced inflammation contributes to secondary brain injury in spontaneous intracerebral hemorrhage (ICH). Several inflammatory markers have investigated in humans with inconclusive results. Here, we report the relationship between Systemic Immune-Inflammation (SII) Index and outcome. METHODS: We reviewed the medical records of 239 supratentorial spontaneous ICH patients. Patients were dichotomized based on modified Rankin Scale (mRS) at discharge in good (mRS 0-3) and poor (mRS 4-6) outcome. Demographic, clinical, laboratory and imaging data at admission were compared for both groups. SII index was calculated as [(Platelet counts x Absolute Neutrophil Counts (ANC)/Absolute Lymphocyte Counts (ALC))/1000]. Logistic regression analyses were performed to determine the association between markers of inflammation (ANC, ALC, Platelets, SII index) and outcome adjusting for baseline differences. RESULTS: Sixty-two percent of patients had poor outcome (median [IQR] age= 60 [52-71] years). Patients with poor outcome had lower Glasgow coma scale, larger hematoma volumes, and higher incidence of diabetes and intraventricular extension (p<0.05 for each variable). In univariate analysis, ANC and SII index were independently associated with poor outcome (p<0.05). In multivariate analysis, only SII index remained significantly associated with poor outcome (OR=1.34, 95% CI=1.04-1.72, p=0.02). ROC analysis showed that adjusted SII index is a good discriminator for poor outcome (AUC=0.89, 95% CI=0.84-0.93; P <0.0001), with the best cut-off value being 0.73 (Sensitivity 95%, Specificity 71%). CONCLUSIONS: In patients with supratentorial spontaneous ICH early SII index is an independent predictor of poor outcome at time of hospital discharge.


Assuntos
Plaquetas , Hemorragia Cerebral/diagnóstico , Inflamação/diagnóstico , Linfócitos , Neutrófilos , Idoso , Hemorragia Cerebral/sangue , Hemorragia Cerebral/imunologia , Hemorragia Cerebral/terapia , Feminino , Nível de Saúde , Humanos , Inflamação/sangue , Inflamação/imunologia , Inflamação/terapia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
PLoS One ; 15(8): e0236196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760077

RESUMO

BACKGROUND: Dynamic CT angiography (dCTA) contrast extravasation, known as the "dynamic spot sign", can predict hematoma expansion (HE) in intracerebral hemorrhage (ICH). Recent reports suggest the phase of spot sign appearance is related to the magnitude of HE. We used dCTA to explore the association between the phase of spot sign appearance and HE, clinical outcome, and contrast extravasation rates. METHODS: We assessed consecutive patients who presented with primary ICH within 4.5 hours from symptom onset who underwent a standardized dCTA protocol and were spot sign positive. The independent variable was the phase of spot sign appearance. The primary outcome was significant HE (either 6 mL or 33% growth). Secondary outcomes included total absolute HE, mortality, and discharge mRS. Mann-Whitney U, Fisher's exact test, and logistic regression were used, as appropriate. RESULTS: Of the 35 patients with spot signs, 27/35 (77%) appeared in the arterial phase and 8/35 (23%) appeared in the venous phase. Thirty patients had follow-up CT scans. Significant HE was seen in 14/23 (60.87%) and 3/7 (42.86%) of arterial and venous cohorts, respectively (p = 0.67). The sensitivity and specificity in predicting significant HE were 82% and 31% for the arterial phase and 18% and 69% for the venous phase, respectively. There was a non-significant trend towards greater total HE, in-hospital mortality, and discharge mRS of 4-6 in the arterial spot sign cohort. Arterial spot signs demonstrated a higher median contrast extravasation rate (0.137 mL/min) compared to venous spot signs (0.109 mL/min). CONCLUSION: Our exploratory analyses suggest that spot sign appearance in the arterial phase may be more likely associated with HE and poorer prognosis in ICH. This may be related to higher extravasation rates of arterial phase spot signs. However, further studies with larger sample sizes are warranted to confirm the findings.


Assuntos
Angiografia Cerebral/métodos , Hemorragia Cerebral/mortalidade , Angiografia por Tomografia Computadorizada/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Hematoma/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Cérebro/irrigação sanguínea , Cérebro/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Seguimentos , Hematoma/etiologia , Mortalidade Hospitalar , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
18.
Stroke ; 51(8): 2282-2286, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32623977

RESUMO

BACKGROUND AND PURPOSE: Evidence regarding sex differences in clinical outcomes and treatment effect following intracerebral hemorrhage is limited. Using the ATACH-2 trial (Antihypertensive Treatment in Intracerebral Hemorrhage-2) data, we explored whether sex disparities exist in outcomes and response to intensive blood pressure (BP)-lowering therapy. METHODS: Eligible intracerebral hemorrhage subjects were randomly assigned to intensive (target systolic BP, 110-139 mm Hg) or standard (140-179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Relative risk of death or disability corresponding to the modified Rankin Scale score of 4 to 6 was calculated, and interaction between sex and treatment was explored. RESULTS: In total, 380 women and 620 men were included. Women were older, more prescribed antihypertensive drugs before onset, and had more lobar intracerebral hemorrhage than men. Hematoma expansion was observed less in women. After multivariable adjustment, the relative risk of death or disability in women was 1.19 (95% CI, 1.02-1.37, P=0.023). The relative risk of death or disability between intensive versus standard BP-lowering therapy was 0.91 (95% CI, 0.74-1.13) in women versus 1.13 (95% CI, 0.92-1.39) in men (P for interaction=0.11), with inconclusive Gail-Simmon test (P=0.16). CONCLUSIONS: Women had a higher risk of death or disability following intracerebral hemorrhage. The benefit of intensive BP-lowering therapy in women is inconclusive, consistent with the overall results of ATACH-2. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01176565.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hemorragia Cerebral/tratamento farmacológico , Hipertensão/tratamento farmacológico , Caracteres Sexuais , Idoso , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/fisiologia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/mortalidade , Internacionalidade , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
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.
J Stroke Cerebrovasc Dis ; 29(8): 104871, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689591

RESUMO

BACKGROUND: Prior studies demonstrated that young adults with stroke present later to medical attention, have lower initial NIHSS, and are frequently misdiagnosed as compared to older adults. We sought to assess potential differences in temporal and clinical characteristics of stroke symptoms between young (age 18-50 years) and older adults (age > 50). METHODS: This retrospective cohort study included patients age ≥ 18 years hospitalized at a comprehensive stroke center with acute ischemic stroke (AIS), transient ischemic attack (TIA), or intracerebral hemorrhage (ICH). Outcomes included progression of neurologic deficits over the first 24 h, fluctuation in neurologic deficits, and characterization of the triage chief complaint as typical or atypical (less specific) for stroke. Univariate analyses for baseline covariates were performed with Chi-square and Mann-Whitney U tests. Associations with the three outcomes were assessed with multivariable logistic regression. RESULTS: 432 adults (73 young adults, 359 older adults) were included in the analysis. Overall, 28% demonstrated progression of neurologic deficits, 14% had fluctuating deficits, and 26% presented with symptoms considered atypical for stroke. After adjustment for demographics, stroke subtype, diabetes, admission blood pressure, and acute revascularization treatments, increased age was inversely associated with progression of deficits (OR 0.97 per year of age, 95% CI 0.95-0.98) and fluctuation in deficits (OR 0.98 per year of age, 95% CI 0.96-0.99). Hemorrhagic stroke subtype was inversely associated with fluctuation in neurologic deficits (OR 0.050, CI 0.0028-0.24). CONCLUSION: Young adults are more likely to have progression or fluctuation of neurologic deficits in acute stroke. Patients with ischemic stroke are more likely to have fluctuation in neurologic deficits.


Assuntos
Hemorragia Cerebral/diagnóstico , Avaliação de Sintomas , Adolescente , Adulto , Fatores Etários , Hemorragia Cerebral/complicações , Hemorragia Cerebral/terapia , Progressão da Doença , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Adulto Jovem
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