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1.
JAMA ; 325(3): 244-253, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33464334

RESUMO

Importance: Whether intravenous thrombolysis is needed in combination with mechanical thrombectomy in patients with acute large vessel occlusion stroke is unclear. Objective: To examine whether mechanical thrombectomy alone is noninferior to combined intravenous thrombolysis plus mechanical thrombectomy for favorable poststroke outcome. Design, Setting, and Participants: Investigator-initiated, multicenter, randomized, open-label, noninferiority clinical trial in 204 patients with acute ischemic stroke due to large vessel occlusion enrolled at 23 hospital networks in Japan from January 1, 2017, to July 31, 2019, with final follow-up on October 31, 2019. Interventions: Patients were randomly assigned to mechanical thrombectomy alone (n = 101) or combined intravenous thrombolysis (alteplase at a 0.6-mg/kg dose) plus mechanical thrombectomy (n = 103). Main Outcomes and Measures: The primary efficacy end point was a favorable outcome defined as a modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]) of 0 to 2 at 90 days, with a noninferiority margin odds ratio of 0.74, assessed using a 1-sided significance threshold of .025 (97.5% CI). There were 7 prespecified secondary efficacy end points, including mortality by day 90. There were 4 prespecified safety end points, including any intracerebral hemorrhage and symptomatic intracerebral hemorrhage within 36 hours. Results: Among 204 patients (median age, 74 years; 62.7% men; median National Institutes of Health Stroke Scale score, 18), all patients completed the trial. Favorable outcome occurred in 60 patients (59.4%) in the mechanical thrombectomy alone group and 59 patients (57.3%) in the combined intravenous thrombolysis plus mechanical thrombectomy group, with no significant between-group difference (difference, 2.1% [1-sided 97.5% CI, -11.4% to ∞]; odds ratio, 1.09 [1-sided 97.5% CI, 0.63 to ∞]; P = .18 for noninferiority). Among the 7 secondary efficacy end points and 4 safety end points, 10 were not significantly different, including mortality at 90 days (8 [7.9%] vs 9 [8.7%]; difference, -0.8% [95% CI, -9.5% to 7.8%]; odds ratio, 0.90 [95% CI, 0.33 to 2.43]; P > .99). Any intracerebral hemorrhage was observed less frequently in the mechanical thrombectomy alone group than in the combined group (34 [33.7%] vs 52 [50.5%]; difference, -16.8% [95% CI, -32.1% to -1.6%]; odds ratio, 0.50 [95% CI, 0.28 to 0.88]; P = .02). Symptomatic intracerebral hemorrhage was not significantly different between groups (6 [5.9%] vs 8 [7.7%]; difference, -1.8% [95% CI, -9.7% to 6.1%]; odds ratio, 0.75 [95% CI, 0.25 to 2.24]; P = .78). Conclusions and Relevance: Among patients with acute large vessel occlusion stroke, mechanical thrombectomy alone, compared with combined intravenous thrombolysis plus mechanical thrombectomy, failed to demonstrate noninferiority regarding favorable functional outcome. However, the wide confidence intervals around the effect estimate also did not allow a conclusion of inferiority. Trial Registration: umin.ac.jp/ctr Identifier: UMIN000021488.


Assuntos
Fibrinolíticos/administração & dosagem , /cirurgia , Trombectomia , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/etiologia , Terapia Combinada , Intervalos de Confiança , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Trombectomia/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
2.
JAMA ; 325(3): 234-243, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33464335

RESUMO

Importance: For patients with large vessel occlusion strokes, it is unknown whether endovascular treatment alone compared with intravenous thrombolysis plus endovascular treatment (standard treatment) can achieve similar functional outcomes. Objective: To investigate whether endovascular thrombectomy alone is noninferior to intravenous alteplase followed by endovascular thrombectomy for achieving functional independence at 90 days among patients with large vessel occlusion stroke. Design, Setting, and Participants: Multicenter, randomized, noninferiority trial conducted at 33 stroke centers in China. Patients (n = 234) were 18 years or older with proximal anterior circulation intracranial occlusion strokes within 4.5 hours from symptoms onset and eligible for intravenous thrombolysis. Enrollment took place from May 20, 2018, to May 2, 2020. Patients were enrolled and followed up for 90 days (final follow-up was July 22, 2020). Interventions: A total of 116 patients were randomized to the endovascular thrombectomy alone group and 118 patients to combined intravenous thrombolysis and endovascular thrombectomy group. Main Outcomes and Measures: The primary end point was the proportion of patients achieving functional independence at 90 days (defined as score 0-2 on the modified Rankin Scale; range, 0 [no symptoms] to 6 [death]). The noninferiority margin was -10%. Safety outcomes included the incidence of symptomatic intracerebral hemorrhage within 48 hours and 90-day mortality. Results: The trial was stopped early because of efficacy when 234 of a planned 970 patients had undergone randomization. All 234 patients who were randomized (mean age, 68 years; 102 women [43.6%]) completed the trial. At the 90-day follow-up, 63 patients (54.3%) in the endovascular thrombectomy alone group vs 55 (46.6%) in the combined treatment group achieved functional independence at the 90-day follow-up (difference, 7.7%, 1-sided 97.5% CI, -5.1% to ∞)P for noninferiority = .003). No significant between-group differences were detected in symptomatic intracerebral hemorrhage (6.1% vs 6.8%; difference, -0.8%; 95% CI, -7.1% to 5.6%) and 90-day mortality (17.2% vs 17.8%; difference, -0.5%; 95% CI, -10.3% to 9.2%). Conclusions and Relevance: Among patients with ischemic stroke due to proximal anterior circulation occlusion within 4.5 hours from onset, endovascular treatment alone, compared with intravenous alteplase plus endovascular treatment, met the prespecified statistical threshold for noninferiority for the outcome of 90-day functional independence. These findings should be interpreted in the context of the clinical acceptability of the selected noninferiority threshold. Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IOR-17013568.


Assuntos
Fibrinolíticos/administração & dosagem , /cirurgia , Trombectomia , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Idoso , Hemorragia Cerebral/etiologia , Terapia Combinada , Procedimentos Endovasculares , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Trombectomia/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos
3.
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
6.
Stroke Vasc Neurol ; 5(4): 388-395, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33376200

RESUMO

Spontaneous intracerebral haemorrhage (ICH) is a devastating type of stroke with high mortality and morbidity and for which no effective treatments are available to date. Much experimental and clinical research have been performed to explore its mechanisms regard the subsequent inflammatory cascade and to seek the potential therapeutic strategies. The aim of this review is to discuss insights from clinical settings that have led to the development of numerous animal models of ICH. Some of the current and future challenges for clinicians to understand ICH are also surveyed.


Assuntos
Hemorragia Cerebral , Animais , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/patologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , Modelos Animais de Doenças , Progressão da Doença , /patologia , /terapia , Humanos , Prognóstico
7.
Yakugaku Zasshi ; 140(11): 1323-1327, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33132267

RESUMO

Intracerebral hemorrhage (ICH) results from blood vessels rupture in the brain, forming a blood clot in the brain parenchyma. Leakage of blood constituents causes detrimental tissue damages, ensuing long-lasting neurological deficits; however, effective therapeutic approaches are not yet developed to date. In this study, leukotriene B4 (LTB4) and its receptor leukotriene B4 receptor 1 (BLT1) are proposed as novel therapeutic targets for ICH therapy. After the onset of ICH, the LTB4 content in the brain transiently elevated. Microglia are considered as the source of LTB4 production. Thrombin, a blood constituent, activated the BV-2 microglia and increased the LTB4 secretion from the BV-2 cells. Microglia-released LTB4 promoted its own microglial activation and neutrophil-like differentiated HL-60 cell migration activity. LTB4 receptors comprised of two types: BLT1 and BLT2, with BLT1 known to be a high-affinity receptor associated with chemotaxis. BLT1 knockout mice showed decreased neutrophil invasion, attenuating sensorimotor dysfunction after ICH. Furthermore, therapeutic administration of ONO-4057, an orally active LTB4 receptor antagonist, attenuated neutrophil invasion, microglial activation, axonal fragmentation, and sensorimotor deficits induced by ICH. These results suggest that LTB4 and its receptor BLT1 can be potential promising therapeutic targets that prevent tissue damages following ICH.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/genética , Descoberta de Drogas , Leucotrieno B4 , Terapia de Alvo Molecular , Fenilpropionatos/administração & dosagem , Fenilpropionatos/farmacologia , Receptores do Leucotrieno B4/antagonistas & inibidores , Administração Oral , Animais , Encéfalo/metabolismo , Movimento Celular , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/patologia , Modelos Animais de Doenças , Células HL-60 , Humanos , Leucotrieno B4/metabolismo , Camundongos , Microglia/metabolismo , Infiltração de Neutrófilos/efeitos dos fármacos , Receptores do Leucotrieno B4/metabolismo , Trombina/fisiologia
8.
J Clin Neurosci ; 79: 275-276, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070912

RESUMO

Since the outbreak with novel corona virus in December 2019, a myriad of different neurological manifestations in patients with COVID-19 infection have been reported. We present a case of non-traumatic intracranial hemorrhage in the olfactory gyrus in a patient who tested positive for SARS-COV-2. The area of hemorrhage is not a common location for spontaneous hemorrhage. Given that loss of smell is considered a relatively common symptom of this pandemic, it is an intriguing association of COVID-19 and olfactory gyrus ICH for neurotropism of SARS-CoV2 for olfactory bulb and glia cells through nasal mucosa. Future studies will need to elucidate the exact mechanism of anosmia from COVID-19 and potential mechanisms leading to ICH.


Assuntos
Betacoronavirus , Hemorragia Cerebral/etiologia , Infecções por Coronavirus/complicações , Lobo Parietal/diagnóstico por imagem , Pneumonia Viral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Pandemias , Olfato
9.
PLoS One ; 15(10): e0239773, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031428

RESUMO

Oral health conditions and cerebral small vessel disease, such as white matter lesions or cerebral microbleeds (CMBs), are associated with the incidence of stroke. The purpose of this study was to examine the associations between oral health conditions (serum IgG titers of periodontal pathogens) with the presence or severity of CMBs in acute stroke patients. From January 2013 to April 2016, acute stroke patients were registered in two hospitals. Serum samples were evaluated for antibody titers against 9 periodontal pathogens using the ELISA method. The cut-off points for reactivity (the positive decision point) to each antigen were defined as more than a mean ELISA unit + 1 standard deviation (after logarithmic transformation) in all subjects. CMBs were evaluated on T2*-weighted MRI. In all, 639 patients were evaluated (ischemic, n = 533 and hemorrhagic, n = 106; 73.1 ± 12.9 years old). Among these patients, 627 were available for CMB evaluation. Among the 9 evaluated periodontal pathogens, only Campylobacter rectus (C. rectus) was associated with the presence of CMBs. the prevalence of positive serum antibody titers against C. rectus was higher among patients with CMBs than among those without CMBs (14.6% vs. 8.7%, P = 0.025). In addition, positive serum antibody titers against C. rectus remained one of the factors associated with the presence of CMBs in multivariate logistic analysis (odds ratio 2.03, 95% confidence interval 1.19-3.47, P = 0.010). A positive serum antibody titer against C. rectus was associated with the presence of CMBs in acute stroke patients.


Assuntos
Infecções por Campylobacter/complicações , Campylobacter rectus/patogenicidade , Hemorragia Cerebral/complicações , Hemorragia Cerebral/etiologia , Doenças Periodontais/etiologia , Doenças Periodontais/microbiologia , Acidente Vascular Cerebral/complicações , Idoso , Isquemia Encefálica/etiologia , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/etiologia , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética/métodos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/microbiologia
10.
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
11.
PLoS One ; 15(9): e0238456, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941455

RESUMO

OBJECTIVE: Cerebral microbleeds (CMBs) are a magnetic resonance imaging (MRI) marker for cerebral small vessel disease. Existing CMBs and those that newly develop are associated with the risks of stroke incidence and recurrence. The purpose of the present study was to investigate the association of oral anticoagulant (OAC) use and the development of new CMBs in cardioembolic stroke patients with atrial fibrillation. SUBJECTS AND METHODS: We prospectively followed cardioembolic stroke patients with atrial fibrillation who had been hospitalized in the stroke center of our hospital, had been prescribed anticoagulants at discharge, and underwent repeated brain MRI with an interval of at least one year from the baseline MRI. Assessing the presence, number and location of CMBs using T2*-weighted gradient-recalled echo MRI, we used logistic regression models to investigate the associations between OAC use and the incidence of new CMBs. We also examined associations of subsequent stroke with OACs and CMBs during the follow-up. RESULTS: A total of 81 patients, consisting of 45 patients receiving direct oral anticoagulants (DOACs) and 36 patients receiving warfarin (WF), were analyzed in the present study. Baseline CMBs were observed in 19/81 patients (23.5%) and new CMBs in 18/81 patients (22.2%) on follow-up MRI (median interval, 34 months). Of the 31 new CMBs, 25 (80.6%) developed in the lobar location and 6 (19.4%) in the deep or infratentorial location. New CMBs occurred in 4 patients (10.0%) taking DOACs alone, in 10 patients (35.7%) taking WF alone, in 3 patients (37.5%) taking WF plus antiplatelet agents and in 1 patient (20.0%) taking DOAC plus antiplatelet agent. Regarding location, the new CMBs were the lobar type in 7 of the 10 patients taking WF alone, as well as in 3 of the 4 patients taking DOACs alone. In multivariate analysis, the presence of CMBs at baseline and WF use (vs. DOAC use) were associated with new CMBs (CMB presence at baseline: OR 4.16, 95% CI 1.19-14.44; WF use: OR 3.38, 95% CI 1.02-11.42). The presence of ≥ 2 CMBs at baseline was related to a higher risk of subsequent stroke (OR 7.25, 95% CI 1.01-52.35, P = 0.048). CONCLUSION: Our findings suggest that DOAC compared with WF use at discharge is associated with a lower incidence of new CMBs in cardioembolic stroke patients with atrial fibrillation. Further prospective studies in the clinical setting are needed to confirm our exploratory data.


Assuntos
Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Hemorragia Cerebral/etiologia , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Varfarina/uso terapêutico
12.
Clin Imaging ; 68: 239-241, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32911311

RESUMO

Neurologic complications of COVID-19 infection have been recently described and include dizziness, headache, loss of taste and smell, stroke, and encephalopathy. Brain MRI in these patients have revealed various findings including ischemia, hemorrhage, inflammation, and demyelination. In this article, we report a case of critical illness-associated cerebral microbleeds identified on MRI in a patient with severe COVID-19 infection and discuss the potential etiologies of these neuroimaging findings.


Assuntos
Infecções por Coronavirus , Estado Terminal , Pandemias , Pneumonia Viral , Acidente Vascular Cerebral , Betacoronavirus , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Humanos , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/epidemiologia
13.
J Stroke Cerebrovasc Dis ; 29(10): 105069, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912497

RESUMO

Hemorrhagic stroke associated with essential thrombocythemia (ET) is very infrequent. Herein, we report a case of a 33-year-old woman with a 2-year history of ET who developed intracerebral and subarachnoid hemorrhage. Angiography demonstrated severe vessel irregularity in the bilateral cerebral arteries. Molecular genetic testing revealed a calreticulin mutation. To our knowledge, hemorrhagic stroke has been reported in only six other patients with ET, and this is the first report of hemorrhagic stroke in an ET patient with a calreticulin mutation. We review the current literature and discuss the possible underlying mechanisms.


Assuntos
Hemorragia Cerebral/etiologia , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/etiologia , Trombocitemia Essencial/complicações , Adulto , Calreticulina/genética , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Craniotomia , Feminino , Predisposição Genética para Doença , Humanos , Mutação , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Trombocitemia Essencial/diagnóstico , Trombocitemia Essencial/genética , Resultado do Tratamento
14.
Neurologia ; 35(9): 621-627, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32912745

RESUMO

INTRODUCTION: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. PATIENTS AND METHODS: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. RESULTS: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P=.002; 95%CI: 4.032-6.022; OR: 3,594). CONCLUSIONS: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Estado Terminal , Doenças Musculares/etiologia , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Doença Aguda , Adulto , Fatores Etários , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Confusão/epidemiologia , Confusão/etiologia , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Musculares/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Neuroimagem , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia
15.
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
16.
Brain Nerve ; 72(8): 907-911, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32741772

RESUMO

Hereditary hemorrhagic telangiectasia (HHT) is characterized by telangiectasias in multiple organs. We experienced an infant with cerebral hemorrhaging and suspected HHT based on his family history of HHT. Computed tomography angiography confirmed a cerebral arteriovenous fistula. The onset of cerebral arteriovenous fistulas associated with HHT is relatively early, and the incidence of bleeding is relatively common. When HHT is suspected based on a family history, early imaging screening is recommended to improve the neurological prognosis, even in asymptomatic cases. (Received April 7, 2020; Accepted May 7, 2020; Published August 1, 2020).


Assuntos
Fístula Arteriovenosa , Hemorragia Cerebral , Telangiectasia Hemorrágica Hereditária , Angiografia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/genética , Humanos , Lactente , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/genética , Tomografia Computadorizada por Raios X
17.
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
18.
Stroke ; 51(9): 2795-2800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772685

RESUMO

BACKGROUND AND PURPOSE: Hemorrhages are a serious complication of brain surgery, and magnesium has shown hemostatic properties in hemorrhagic stroke and non-neurological surgeries. External ventricular drain (EVD) insertion is an advantageous model of emergency neurosurgical hemorrhage risk because it is common, standardized, and the operator is blinded to the outcome during the procedure. We tested the hypothesis that low magnesium is associated with risk of hemorrhagic complications from EVD insertion. METHODS: Patients with spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage were enrolled in a prospective, observational study. Demographic and clinical variables were prospectively recorded, including serum magnesium measurements. Catheter tract hemorrhage (CTH) was measured on postoperative head computed tomography within 48 hours of EVD insertion. RESULTS: We observed 50 CTH among 327 EVD procedures (15.3%) distributed similarly among intracerebral hemorrhage (21/116 [18.1%]) and subarachnoid hemorrhage (29/211 [13.7%]). Magnesium was lower in patients with CTH compared with those without (median 1.8 versus 2.0 mg/dL, P<0.0001). Higher magnesium was associated with lower odds of CTH (odds ratio 0.67 per 0.1 mg/dL magnesium [95% CI, 0.56-0.78], P<0.0001) after adjustment for other risk factors, with similar effect in the intracerebral hemorrhage and subarachnoid hemorrhage subgroups. Preprocedural increase in magnesium (odds ratio 0.68 [0.52-0.85]) and dose of preprocedural magnesium sulfate (odds ratio 0.67 [0.40-0.97]) were associated with reduced CTH risk after adjustment for initial magnesium and other risk factors. CONCLUSIONS: Lower magnesium at the time of EVD insertion was an independent predictor of hemorrhagic complications. Baseline risk was attenuated by preprocedural increases in magnesium, suggesting a therapeutic opportunity.


Assuntos
Hemorragia Cerebral/etiologia , Deficiência de Magnésio/complicações , Sulfato de Magnésio/uso terapêutico , Ventriculostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Deficiência de Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/farmacologia , Complicações Pós-Operatórias , Estudos Prospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Clin Imaging ; 68: 184-187, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32846364

RESUMO

Critical illness-associated cerebral microbleed (CICM) is a relatively rare and newly described condition. It can occur in critically ill ICU patients and can be secondary to many underlying etiologies. CICM is associated with high mortality and permanent neurologic deficits in surviving patients. Distribution of cerebral microhemorrhages in neuroimaging findings is critical for accurate diagnosis of this condition. Here, we present an ICU admitted patient with sickle cell disease crisis and CICM and will discuss their clinically and radiologically distinct phenomenon followed by a review of current literature.


Assuntos
Anemia Falciforme , Estado Terminal , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Humanos , Neuroimagem
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