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1.
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
2.
J Stroke Cerebrovasc Dis ; 30(4): 105616, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33476961

RESUMO

OBJECTIVES: Intracerebral hemorrhage comprises a large proportion of inter-hospital transfers to comprehensive stroke centers from centers without comprehensive stroke center resources despite lack of mortality benefit and low comprehensive stroke center resource utilization. The subset of patients who derive the most benefit from inter-hospital transfers is unclear. Here, we create a triage model to identify patients who can safely avoid transfer to a comprehensive stroke center. MATERIALS AND METHODS: A retrospective cohort of spontaneous intracerebral hemorrhage patients transferred to our comprehensive stroke center from surrounding centers was used. Patients with early discharge from the Neuroscience Intensive Care Unit without use of comprehensive stroke center resources were identified as low risk, non-utilizers. Variables associated with this designation were used to develop and validate a triage model. RESULTS: The development and replication cohorts comprised 358 and 99 patients respectively, of whom 78 (22%) and 26 (26%) were low risk, non-utilizers. Initial Glasgow Coma Scale and baseline hemorrhage volume were associated with low risk, non-utilizers in multivariate analysis. Initial Glasgow Coma Scale >13, intracerebral hemorrhage volume <15ml, absence of intraventricular hemorrhage, and supratentorial location had an area under curve, specificity, and sensitivity of 0.72, 91.4%, 52.6%, respectively, for identifying low risk, non-utilizers, and 0.75, 84.9%, 65.4%, respectively, in the replication cohort. CONCLUSIONS: Spontaneous intracerebral hemorrhage patients with Glasgow Coma Scale >13, intracerebral hemorrhage volume <15 ml, absence of intraventricular hemorrhage, and supratentorial location might safely avoid inter-hospital transfer to a comprehensive stroke center. Validation in a prospective, multicenter cohort is warranted.


Assuntos
Hemorragia Cerebral/terapia , Técnicas de Apoio para a Decisão , Transferência de Pacientes , Triagem , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Tomada de Decisão Clínica , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X
3.
J Stroke Cerebrovasc Dis ; 30(3): 105584, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33412398

RESUMO

OBJECTIVE: To investigate the radiographic features, temporal evolution, and outcome of patients who develop non-traumatic intracerebral hemorrhage (ICH) while hospitalized for other causes. METHODS: We retrospectively reviewed consecutive Emergency Department ICH (ED-ICH) and in-hospital ICH (IH-ICH) over an 8-year period. Variables including demographics, medical history, lab values, lead time to diagnosis, defined as time from last known well to first CT scan, and clinical characteristics, follow-up CT scan, as well as the frequency of withdrawal of life support were compared in the two groups. Mortality in correlation with ICH score was assessed. RESULTS: Sixty-One IH-ICH and 216 ED-ICH patients were compared. History of cardiac disease, cancer, coagulopathy and higher SOFA score at time of diagnosis were significantly higher in the IH-ICH group (all P< 0.01). Time from symptom onset to diagnosis was shorter in the IH-ICH group (median 95 versus 117 minutes, P=0.011). Thirty six percent of IH-ICH fell into a worse ICH category when recalculated 6 hours from initial scan time, compared to only 10% of the ED-ICH. ICH score was well calibrated in ED-ICH when assessed both at diagnosis and 6 hours later, but underestimated actual mortality in the IH-ICH, particularly at ICH scores 0 to 3. End of life measures were pursued in 69% of IH-ICH group compared to 19% in the ED-ICH group. CONCLUSIONS: IH-ICH, is associated with higher overall mortality rates and often times heralds withdrawal of life sustaining therapies in patients. In addition, IH-ICH in comparison to ED-ICH, significantly changes in severity metrics within the first 6 hours. ICH score is not accurate and not calibrated to reflect reasonable stratification of mortality in IH-ICH. Prospective validation and investigation of variables accounting for higher IH-ICH mortality are needed.


Assuntos
Hemorragia Cerebral , Serviço Hospitalar de Emergência , Hospitalização , Adulto , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados , Cuidados para Prolongar a Vida , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Suspensão de Tratamento
4.
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
5.
Cerebrovasc Dis ; 49(5): 556-562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33011723

RESUMO

INTRODUCTION: Intracerebral hemorrhage (ICH) is the most fatal type of stroke worldwide. Herein, we aim to develop a predictive model based on computed tomography (CT) markers in an ICH cohort and validate it in another cohort. METHODS: This retrospective observational cohort study was conducted in 3 medical centers in China. The values of CT markers, including hypodensities, hematoma density, blend sign, black hole sign, island sign, midline shift, baseline hematoma volume, and satellite sign, in predicting poor outcome were analyzed by logistic regression analysis. A nomogram was developed based on the results of multivariate logistic regression analysis in development cohort. Area under curve (AUC) and calibration plot were used to assess the accuracy of nomogram in this development cohort and validate in another cohort. RESULTS: A total of 1,498 patients were included in this study. Multivariate logistic regression analysis indicated that hypodensities, black hole sign, island sign, midline shift, and baseline hematoma volume were independently associated with poor outcome in development cohort. The AUC was 0.75 (95% confidence interval [CI]: 0.73-0.76) in the internal validation with development cohort and 0.74 (95% CI: 0.72-0.75) in the external validation with validation cohort. The calibration plot in development and validation cohort indicated that the nomogram was well calibrated. CONCLUSIONS: CT markers of hypodensities, black hole sign, and island sign might predict poor outcome of ICH patients within 90 days.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Nomogramas , Tomografia Computadorizada por Raios X , Idoso , Hemorragia Cerebral/terapia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
Medicine (Baltimore) ; 99(44): e22989, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126374

RESUMO

BACKGROUND: Cerebral hemorrhage (CH) is a very common cerebrovascular disorder in clinical practice. More and more studies reported that proper nursing care could promote the rate of treatment, and improve the prognosis after treatment. Clinical nursing pathway (CNP) refers to original nursing mode with good quality, outstanding efficiency, and low treatment spending. Few articles have reported the effect of CNP in patients with acute CH. The program is in urgent need of convinced evidence to prove the reliability. Thus, we perform this randomized controlled trial protocol and hypothesize that CNP is associated with improved outcomes and nursing satisfaction, reduced adverse reactions in patients with acute CH. METHOD: It is a single-center randomized controlled study to be conducted from October 2020 to October 2021. It was admitted via the Ethics Committee of the West China Hospital of Sichuan University (0038842/121). Eighty patients meet diagnostic standards for CH are included. The study group receives the clinical nursing path model. In the control group, patients receive the routine care before and after taking to the hospital. The main outcome contains the Barthel index score, the patient's degree of satisfaction about care, the length of hospital stay, and the risk of complications such as infection, bedsores and gastrointestinal function between the 2 groups. Six months after admission, the functional independence measure and Fugl Meyer score are recorded. All data are analyzed by the IBM SPSS Statistics, version 20 (IBM Corp., Armonk, NY edition). RESULTS: Table 1 shows the clinical outcomes between groups. CONCLUSION: CNP may improve the clinical outcomes for patients with acute CH and have a significant value in actual applications. TRIAL REGISTRATION NUMBER: researchregistry6061.


Assuntos
Hemorragia Cerebral/enfermagem , Procedimentos Clínicos , Satisfação do Paciente , Melhoria de Qualidade , Hemorragia Cerebral/psicologia , Hemorragia Cerebral/terapia , China , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(9): 1359-1364, 2020 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-32990235

RESUMO

OBJECTIVE: To explore the effect of mild hypothermia on inflammatory response and angiogenesis in brain tissues of rats with intracerebral hemorrhage (ICH) and its possible mechanism for improving behavioral deficits of the rats After ICH. METHODS: A total of 120 healthy male SD rats were randomly divided into sham operation group, ICH group and mild hypothermia group. Rat models of ICH were established in the latter two groups by stereotactic injection of autogenous blood in the brain, and the rats in the sham operation group received injection of normal saline in the same manner. At 15 min after modeling, the rats in hypothermia group were subjected to mild hypothermia (30-32 ℃) for 8 h followed by rewarming (37-38 ℃); the body temperature was maintained at 37-38 ℃ in the other two groups. At 2, 4, 7, 14 and 21 days after the treatment, Longa scoring, balance beam scoring and Berderson scoring were used to evaluate the behavioral deficits of the rats. Immunohistochemical staining was used to detect the protein expressions of tumor necrosis factor-α (TNF-α) and nuclear factor-κB (NF-κB) in the brain tissue of the rats, and the mRNA expressions of α subunit of hypoxia-inducible factor 1 (HIF1-α) and vascular endothelial growth factor (VEGF) were detected using RT- PCR. RESULTS: At 2, 4, 7, 14 and 21 days after the treatment, the behavioral scores of the rats were significantly higher in ICH group and mild induced hypothermia group than in the sham operation group (P < 0.05 or 0.01). The protein expressions of TNF-α and NF-κB and mRNA expressions of HIF1-α and VEGF were significantly higher in ICH group and mild hypothermia group than in the sham operation group (P < 0.01). The behavioral scores were significantly lower in mild hypothermia group than in ICH group (P < 0.05), and the protein expressions of TNF-α and NF-κB were lower and the mRNA expressions of HIF1- α and VEGF were higher in mild hypothermia group than in ICH group (P < 0.05 or 0.01). CONCLUSIONS: Mild hypothermia can improve behavioral deficits in rats with ICH possibly by antagonizing brain inflammation and promoting angiogenesis.


Assuntos
Hipotermia , Animais , Encéfalo , Hemorragia Cerebral/terapia , Masculino , Ratos , Ratos Sprague-Dawley , Fator A de Crescimento do Endotélio Vascular/genética
8.
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
9.
J Stroke Cerebrovasc Dis ; 29(10): 105111, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912557

RESUMO

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


Assuntos
Betacoronavirus/patogenicidade , Hemorragia Cerebral/virologia , Doenças de Pequenos Vasos Cerebrais/virologia , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Púrpura/virologia , Idoso , Betacoronavirus/isolamento & purificação , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Progressão da Doença , Evolução Fatal , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Púrpura/diagnóstico , Púrpura/terapia
10.
J Stroke Cerebrovasc Dis ; 29(9): 105026, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807441

RESUMO

BACKGROUND: Identification and modification of risk factors are essential for preventing intracerebral hemorrhage (ICH). Prior hospital admissions provide opportunities to intervene. We reported hospital admissions prior to primary ICH and investigated factors associated with survival. METHODS: Cohort design using patient-level data from the Australian Stroke Clinical Registry (2009-2013) linked with hospital administrative datasets from four states (VIC, NSW, WA, QLD). Prior hospital admission is divided into within 90 days and more than 90 days prior to the index ICH event. The International Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification codes were used to define principal diagnoses of previous admissions/presentations and comorbidities. Factors associated with survival after ICH were investigated using Cox proportional hazards regression. RESULTS: Among 15,482 admissions for stroke, 2,098 (14%) had an ICH (median age 76 years, 52% male), 1,732 patients (83%) had a prior hospital admission, including 440 patients (21%) within 90 days of their index ICH admission. Patients with prior admission were older, had more comorbidities, and greater hospital frailty risk score than those without prior admission. Diseases of the circulatory system (14%) were the most common principal diagnoses for hospital admissions prior to ICH. Of the comorbidities associated with survival, neoplasms conferred the greatest hazard of death at 180 days after ICH (adjusted hazard ratio 1.42, 95% confidence interval 1.15 - 1.76, p = 0.001). CONCLUSION: Hospital presentations in the 90 days prior to ICH are common. Future research should be focussed on identifying opportunities for preventing ICH.


Assuntos
Hemorragia Cerebral/epidemiologia , Readmissão do Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Comorbidade , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo
11.
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
13.
J Med Life ; 13(2): 125-131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742502

RESUMO

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


Assuntos
Hemorragia Cerebral/terapia , Distribuição por Idade , Idoso , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/mortalidade , Estudos de Viabilidade , Feminino , Hematoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Romênia , Resultado do Tratamento
14.
Cerebrovasc Dis ; 49(4): 375-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829328

RESUMO

INTRODUCTION: Intracerebral hemorrhage (ICH) comprises 15-20% of all strokes with debilitating consequences. Data regarding characteristics and outcomes of primary ICH in the young are lacking, given its rarity, making comparisons between younger and older cohorts difficult to perform. Nationally representative administrative databases enable analysis of such rare events. OBJECTIVE: To determine the baseline characteristics, all-cause readmission rates, and reasons for primary ICH in younger and older adults using a nationally representative database. METHODS: A retrospective cohort analysis was performed using the Nationwide Readmissions Database 2013. Validated ICD-9-CM codes identified index ICH admissions, comorbidities, demographics, behavioral risk factors, procedures, and Elixhauser and Charlson Comorbidity indices. We compared "younger" (age ≤ 45 years) and "older" (age > 45) index ICH admissions by weighted 30-day all-cause readmission rates, primary diagnosis code for 30-day readmissions, most common comorbidities during the index hospitalization, and Kaplan-Meier cumulative risk of readmission up to 1 year. RESULTS: Older admissions had higher comorbidity scores and mortality, but both groups had similar total comorbidities. Younger admissions exhibited longer length of stay with more procedures performed. Vascular anomalies (aneurysm 7.2 vs. 4.6% and arteriovenous malformation 5.9 vs. 0.8%) and behavioral risk factors (smoking 26.5 vs. 23.0%, alcohol abuse 6.7 vs. 4.6%, and substance use 13.5 vs. 2.9%) were more prevalent in younger admissions, while older patients had more cardiovascular comorbidities. All-cause 30-day readmission rates (13.1 vs. 13.0%) and 1-year cumulative risk of readmission (log-rank p value 0.7209) were similar. Readmissions in the younger cohort were primarily for neurological conditions, and those in the older cohort were for systemic conditions. CONCLUSIONS: Adults <45 years with ICH had similar total comorbidities as older adults but more procedures, longer hospital stay, and more behavioral risk factors. Readmission rates were similar though reasons differed; younger patients were more for neurological reasons than for other systemic causes.


Assuntos
Hemorragia Cerebral/terapia , Admissão do Paciente , Readmissão do Paciente , Acidente Vascular Cerebral/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Zhongguo Zhen Jiu ; 40(7): 757-63, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32648401

RESUMO

OBJECTIVE: To observe the effect of acupuncture at "Baihui" (GV 20) through "Qubin" (GB 7) on NLRP3 inflammatory corpuscle in rats with intracerebral hemorrhage (ICH), and to explore the action mechanism of acupuncture on promoting the recovery of neural function in rats with ICH. METHODS: Forty SPF six-week-old male SD rats were randomly divided into a sham operation group, a model group, a non-acupoint group and an acupuncture group, 10 rats in each group. The rats in the model group, non-acupoint group and acupuncture group were intervened with autologous blood injection to prepare ICH model, while the rats in the sham operation group were only intervened with operation but not injection with autologous blood. About 3 hours after the establishment of the model, the rats in the acupuncture group were intervened with acupuncture at "Baihui" (GV 20) through "Qubin" (GB 7), once every 12 hours, for 7 days; the rats in the non-acupoint group were intervened with acupuncture at the non-acupoint [parallel to the "Baihui" (GV 20), 1 cm next to the midline] on the affected side, and other treatment was the same as the acupuncture group. At the end of the intervention, the composite nerve function score of each group was evaluated; the histomorphology of the hemorrhage penumbra was observed by HE staining; the expression of NLRP3 inflammatory corpuscle in the brain was detected by immunohistochemistry; the relative protein expression levels of NLRP3, interleukin-1ß (IL-1ß) and interleukin-18 (IL-18) in brain were detected by the method of Western blot. RESULTS: Seven days into intervention, compared with the sham operation group, each item score and total score of composite nerve function in the model group were significantly reduced (P<0.01, P<0.05). There was edema and karyopyknosis in brain neuron as well as necrocytosis and inflammatory cell infiltration in the model group. Compared with the model group and the non-acupoint group, the total score of composite nerve function and the scores of symmetrical movement of limbs (LS) and proprioception of tentacles (VP) in the acupuncture group were increased (P<0.01, P<0.05), and the cell necrosis and inflammatory cell infiltration were relieved. Compared with the sham operation group, NLRP3 inflammatory corpuscle expression and the relative protein expression levels of NLRP3, IL-1ß and IL-18 in brain tissue in the model group were increased (P<0.01); compared with the model group and the non-acupoint group, NLRP3 inflammatory corpuscle expression and the relative protein expression levels of NLRP3, IL-1ß and IL-18 in brain tissue in the acupuncture group were reduced (P<0.01). CONCLUSION: Acupuncture at "Baihui" (GV 20) through "Qubin" (GB 7) could downregulate the expression of NLRP3, IL-1ß and IL-18 in the brain tissue of ICH rats, inhibit the inflammatory response, and promote the recovery of neural function.


Assuntos
Terapia por Acupuntura , Hemorragia Cerebral/terapia , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Pontos de Acupuntura , Animais , Encéfalo , Hemorragia Cerebral/metabolismo , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley
16.
Medicine (Baltimore) ; 99(29): e21124, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702864

RESUMO

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


Assuntos
Terapia por Acupuntura/normas , Ataxia/etiologia , Ataxia/terapia , Hemorragia Cerebral/complicações , Terapia por Acupuntura/métodos , Idoso , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos
17.
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
18.
J Stroke Cerebrovasc Dis ; 29(8): 104802, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689604

RESUMO

BACKGROUND AND PURPOSE: The influence of chronic kidney disease (CKD) on functional outcome in intracerebral hemorrhage (ICH) is scarcely investigated and reported findings are conflicting mostly because of nonaccounting for imbalances. Aim of the present study was to determine the impact of CKD on functional long-term outcome in ICH-patients. METHODS: In this observational cohort study of spontaneous ICH-patients admitted to our Department of Neurology between 2006 and 2015 we investigated retrospectively as primary outcome the dichotomized functional status (modified-Rankin-Scale = 0-3-versus-4-6) at 12 months according to renal function (CKD versus non-CKD), including categorial estimates of the glomerular filtration rate subanalyses. Confounding was addressed by propensity-score(ps)-matching and adjusted multivariable regression analyses. RESULTS: We identified 1076 eligible ICH-patients, of which 131 (12.2%) suffered from CKD on hospital admission. Confounders associated with CKD consisted of hypertension (P = .023), Diabetes mellitus (P = .001), prior ischemic stroke and/or transitory ischemic attack (TIA) (P = .021), congestive heart failure (P < .01), impaired liver function (P < .01), antiplatelet therapy (P = .01), poorer premorbid functional status (P < .01), and deep ICH-location (P = .006). After balancing for confounding, patients with CKD showed a significantly decreased rate of favorable functional outcome at 12 months (CKD:29 of 111(26.1%)-versus-non-CKD:78 of 206 (37.9%); P = .035). Subanalyses showed that stages of CKD were evenly associated with mortality at 12 months (GFR category G3a, OR:2.811; CI (1.130-6.994); P = .026; GFR category G3b, OR:1.874; CI (.694-5.058); P = .215; GFR category G4, OR:10.316; CI (1.976-53.856); P = .006; GFR category G5, OR:8.989; CI (1.900-42.518); P = .006). CONCLUSIONS: As compared to ICH-patients without CKD, those with CKD show increased rates of mortality and worse functional outcomes even after statistical correction for imbalanced baseline characteritsics. This finding is presumably linked to comorbidity and warrants further investigation in prospective studies.


Assuntos
Hemorragia Cerebral/fisiopatologia , Taxa de Filtração Glomerular , Rim/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Avaliação da Deficiência , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
J Stroke Cerebrovasc Dis ; 29(8): 104958, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689605

RESUMO

BACKGROUND AND OBJECTIVE: Patients with intracerebral hemorrhage are susceptible to venous thromboembolism, but the relationship between venous thromboembolism and outcome is largely unknown. We aim to investigate the association of in-hospital venous thromboembolism with functional outcome in patients with intracerebral hemorrhage. METHODS: From September 2014 through August 2016, we conducted a hospital-based, prospective study by consecutively recruiting eligible patients with first-ever acute spontaneous intracerebral hemorrhage. In-hospital venous thromboembolism was defined as observation of pulmonary embolism or deep vein thrombosis during initial hospitalization. The primary end point was death or disability (modified Rankin Scale 3 to 6) at discharge, 3-month and 1-year follow-up. Logistic analysis was conducted to evaluate the association of venous thromboembolism and poor functional outcome. RESULTS: Among 637 participants included in the analysis, the prevalence of venous thromboembolism was 22.6%. After adjusting for confounding factors, venous thromboembolism was independently associated with death or disability at discharge (odds ratio 2.09, 95% confidence interval 1.12-3.85), 3-month follow-up (2.00 [1.12-3.54]) and 1-year follow-up (2.00 [1.14-3.49]). Venous thromboembolism was also an independent indicator of disability (modified Rankin Scale 3-5) among ICH survivors, with odds ratios ranging from 1.93 to 2.08 (all P<0.05). The relationship was stronger in patients with hematoma volume <10 ml (3.24 [1.11-9.46]) and ≥30 ml (2.57 [1.03-6.44]) (P for interaction=0.002) at 1-year follow-up. The results were confirmed by sensitivity analysis. CONCLUSION: In-hospital venous thromboembolism was independently associated with poor outcome at discharge, 3-month and 1-year in patients with intracerebral hemorrhage.


Assuntos
Hemorragia Cerebral/epidemiologia , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Idoso , Pequim/epidemiologia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Avaliação da Deficiência , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/terapia , Trombose Venosa/diagnóstico , Trombose Venosa/mortalidade , Trombose Venosa/terapia
20.
J Stroke Cerebrovasc Dis ; 29(8): 104867, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689632

RESUMO

OBJECTIVE: To establish a model for predicting the outcome according to the clinical and computed tomography(CT) image data of patients with intracerebral hemorrhage(ICH). METHODS: The clinical and CT image data of the patients with ICH in Qinghai Provincial People's Hospital and Xuzhou Central Hospital were collected. The risk factors related to the poor outcome of the patients were determined by univariate and multivariate logistic regression analysis. To determine the effect of factors related to poor outcome, the nomogram model was made by software of R 3.5.2 and the support vector machine operation was completed by software of SPSS Modelor. RESULTS: A total of 8265 patients were collected and 1186 patients met the criteria of the study. Age, hospitalization days, blend sign, intraventricular extension, subarachnoid hemorrhage, midline shift, diabetes and baseline hematoma volume were independent predictors of poor outcome. Among these factors, baseline hematoma volume๥20ml (odds ratio:13.706, 95% confidence interval:9.070-20.709, p < 0.001) was the most significant factor for poor outcome, followed by the volume among 10ml-20ml (odds ratio:11.834, 95% confidence interval:7.909-17.707, p < 0.001). It was concluded that the highest percentage of weight in outcome was baseline hematoma volume (25.0%), followed by intraventricular hemorrhage (23.0%). CONCLUSION: This predictive model might accurately predict the outcome of patients with ICH. It might have a wide range of application prospects in clinical.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Nomogramas , Máquina de Vetores de Suporte , Tomografia Computadorizada por Raios X , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
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