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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(4): 513-520, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895104

RESUMO

Objective To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH). Methods The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated.Results Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all P<0.001).In the ultra-early stage after surgery,HCR was significantly higher in the KAES group(P<0.001),whereas in the early and sub-early stage,HCR showed no significant differences(all P>0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all P>0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(P=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all P>0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(P=0.413).Conclusions Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.


Assuntos
Hemorragia Intracraniana Hipertensiva , Gânglios da Base , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase
2.
Artigo em Russo | MEDLINE | ID: mdl-32412195

RESUMO

Introduction: Currently, minimally invasive methods of surgical treatment of hypertensive intracerebral hematomas (ICHs) are actively used. However, anesthetic management of these surgeries are unclear. Moreover, advisability of locoregional anesthesia (LRA) for endoscopic aspiration of hypertensive ICHs has not been studied. Objective: To analyze application of regional anesthesia in minimally invasive surgery of hypertensive intracerebral hematomas. Material and methods: Patients were divided into 2 groups. Group 1 included 45 patients who underwent surgery under total intravenous anesthesia with mechanical ventilation (TIVA + mechanical ventilation), group 2 (n=43) - surgery under LRA. The incidence of pneumonia and postoperative outcomes in accordance with the GOS grading system were analyzed depending on the method of anesthesia. Results: Pneumonia was 3 times more common in the first group (33%) that required prolonged ventilation and tracheostomy. Thus, there were 9 tracheostomies (20%) in the first group. In the second group, one patient required mechanical ventilation on the second postoperative day due to severe chronic obstructive pulmonary disease followed by deterioration of respiratory failure. Tracheostomy was also performed in this case. According to analysis of GOS outcomes, the LRA group was characterized by 4 times lower mortality and 1.5 times greater number of patients with good recovery and moderate disabilities compared with the first group. Conclusions: LRA is a feasible and effective method for the anesthetic management of minimally invasive surgery in patients with hypertensive ICHs. This approach ensures decrease of mortality rate, increase of good neurological outcomes and reduce pulmonary infectious complications.


Assuntos
Hemangioma , Hemorragia Intracraniana Hipertensiva , Endoscopia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento
4.
Ann Palliat Med ; 9(2): 339-345, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233639

RESUMO

BACKGROUND: To evaluate and analyze the therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage. METHODS: Sixty patients with hypertensive cerebral hemorrhage admitted to our hospital from September 2014 to September 2019 were selected for study and randomly divided into study group (n=30) and routine group (n=30) according to admission number. Two groups of patients were given basic treatment after admission, while routine group patients were given small bone window hematoma removal, study group patients were given stereotactic soft channel puncture and drainage, and the clinical effects of the two groups were analyzed. RESULTS: The total effective rate of the study group was 96.67%, which was significantly higher than that of the routine group (80.00%), and the difference was statistically significant (P<0.05). The level of independent living in the study group was significantly higher than that in the conventional group, and the level of neurological deficit was lower than that in the conventional group, with statistically significant difference (P<0.05). Before treatment, there was no significant difference in the hematoma volume between the two groups (P>0.05). after treatment for 1, 2 and 4 weeks, the hematoma volume of the two groups decreased, and the hematoma volume of the study group was significantly less than that of the conventional group, with significant difference (P<0.05). There was no difference in CD3+ positive cell rate and CD8+ positive cell rate between the two groups before treatment (P>0.05). After treatment, the CD8+ positive cell rate in the study group was lower than that in the conventional group, and the CD3+ positive cell rate was higher than that in the conventional group, with statistically significant difference (P<0.05). The incidence of postoperative complications such as pulmonary infection, urinary tract infection, liver and kidney dysfunction in the study group was lower than that in the conventional group, and the difference was statistically significant (P<0.05). CONCLUSIONS: Stereotactic soft-channel puncture and drainage has the advantages of less trauma, less bleeding, fewer complications and rapid postoperative recovery. It can be used for the treatment of hypertensive cerebral hemorrhage, promote the recovery of neurological function of patients, improve independent living standard and effectively improve prognosis.


Assuntos
Hemorragia Intracraniana Hipertensiva/cirurgia , Paracentese/métodos , Técnicas Estereotáxicas , Adulto , Encéfalo/cirurgia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Resultado do Tratamento
5.
J Stroke Cerebrovasc Dis ; 29(5): 104719, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32122779

RESUMO

OBJECTIVE: To evaluate the etiology and discharge outcome of nontraumatic intracerebral hemorrhage (ICH) in young adults admitted to a comprehensive stroke center. METHODS: A retrospective chart review was performed on patients with a discharge diagnosis of nontraumatic ICH admitted from 7/1/2011 to 6/30/2016. Data was collected on demographics, clinical history, ICH score, hemorrhage location, do-not-resuscitate (DNR) orders, likely etiology, and discharge disposition. Categorical data was reported as percentage. Chi-squared test was performed to evaluate association of location of ICH, etiology of ICH, and ICH score with the discharge outcome. RESULTS: Sixty-three patients met the study criteria, with mean age 35.4 ± 6.4 years including 26 (41%) women and 40 (64%) whites. Headache (65%) and change in mental status (48%) were the most common presenting symptoms. Hemorrhage was most commonly seen in the deep structures in 29 (46%) patients followed by lobar ICH in 14 (22%) patients. The most common etiology of ICH was hypertension in 23 (37%) patients, followed by vascular abnormalities in 18 (29%) patients. Forty-two (67%) had good outcome defined as discharge to home (n = 25) or acute inpatient rehabilitation (n = 17). Twenty-one (33%) patients had bad outcome with discharge to skilled nursing facility (n = 6), hospice (n = 1) or died in the hospital (n = 14). Hospital DNR orders were noted in 11 (18%) patients. Higher ICH score (P < .0001) and use of DNR orders (P < .0001) were associated with bad outcome. All 11 patients with DNR orders died in the hospital. Location or etiology of hemorrhage were not associated with discharge outcome. CONCLUSIONS: Hypertension, a modifiable risk factor, is a major cause of nontraumatic ICH in young adults. Aggressive management of hypertension is essential to halt the recent increased trends of ICH due to hypertension. Early DNR orders may need to be cautiously used in the hospital.


Assuntos
Hipertensão/complicações , Hemorragia Intracraniana Hipertensiva/etiologia , Hemorragia Intracraniana Hipertensiva/terapia , Adolescente , Adulto , Fatores Etários , Pressão Sanguínea , Feminino , Hospitais para Doentes Terminais , Mortalidade Hospitalar , Hospitais de Reabilitação , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/terapia , Hemorragia Intracraniana Hipertensiva/diagnóstico , Hemorragia Intracraniana Hipertensiva/mortalidade , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Ordens quanto à Conduta (Ética Médica) , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Instituições de Cuidados Especializados de Enfermagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
World Neurosurg ; 134: e8-e11, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31421295

RESUMO

BACKGROUND: Hypothyroidism is widely thought to cause vascular endothelial disorders and atherosclerosis. The purpose of this study was to explore whether patients with hypertension and hypothyroidism may have a higher incidence of hypertensive intracerebral hemorrhage. METHODS: Cases of hypertensive intracerebral hemorrhage collected from the neurology department and neurosurgery department of our hospital from January 1, 2018, to December 31, 2018, were retrospectively collected. A case-control study was conducted on an equal number of patients with hypertension without hypertensive intracerebral hemorrhage randomly selected through age matching in the same period. The history of hypothyroidism and other common risk factors at admission was recorded. RESULTS: A total of 231 patients with hypertensive intracerebral hemorrhage were included and 231 patients with hypertension were selected for control subjects according to the age matching and random screening principles. Hypothyroidism was present in 54 patients (23.4%) and 33 matched controls (14.3%). Multivariate logistic regression analysis showed that hypothyroidism was an independent risk factor for hypertensive intracerebral hemorrhage (odds ratio, 2.29; 95% confidence interval, 1.38-3.79; P = 0.001). CONCLUSIONS: Hypothyroidism may be independently associated with hypertensive intracerebral hemorrhage. In view of the known pathophysiologic relationship between hypothyroidism and vascular endothelial dysfunction and atherosclerosis, further research and exploration are necessary.


Assuntos
Hipertensão/epidemiologia , Hipotireoidismo/complicações , Hemorragia Intracraniana Hipertensiva/complicações , Hemorragia Intracraniana Hipertensiva/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Hemorragia Cerebral/complicações , Hemorragia Cerebral/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/complicações , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
8.
World Neurosurg ; 134: 477-488, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669683

RESUMO

BACKGROUND: No consensus has been achieved on the superiority between neuroendoscopy (NE) and craniotomy (CT) for the treatment of supratentorial hypertensive intracerebral hemorrhage (HICH). The purpose of this study is to analyze the efficacy and safety of NE versus CT for supratentorial HICH. METHODS: A systematic search of English databases (PubMed, Embase, the Cochrane Library, and Web of Science) was performed to identify related studies reported from September 1994 to June 2019. The Newcastle-Ottawa Scale and the Cochrane Reviewer's Handbook 5.0.0 were separately used to evaluate the quality of the included observational studies and randomized controlled trials. RevMan 5.3 software was adopted to conduct the meta-analysis. The outcome measures included the primary and secondary outcomes. Subgroup analysis was performed to explore the impact of year of publication, initial Glasgow Coma Scale (GCS) score, age, time to surgery, hematoma volume, and surgical methods on the outcome measures. RESULTS: Fifteen studies (3 randomized controlled trials and 12 observational studies), comprising 1859 patients with supratentorial HICH, were included in this meta-analysis. The pooled results showed that NE could increase the good functional outcome (GFO) (P < 0.0003) and hematoma evacuation rate (P = 0.0007) and reduce the mortality (P < 0.00001), blood loss (P = 0.004), operation time (P < 0.00001), hospital stays (P = 0.006), and intensive care unit stays (P < 0.0001) compared with CT. In addition, NE could also have a positive effect on preventing postoperative infection (P < 0.00001) and total complications (P < 0.00001). However, in postoperative rebleeding incidence (P = 0.12), no obvious difference was found between the 2 groups. Publication bias was low regarding GFO, mortality, and hematoma evacuation rate. Subgroup analysis suggested that year of publication, initial GCS score, age, hematoma volume, and surgical methods did not affect the hematoma evacuation rate significantly. The difference in mortality was not statistically significant in the subgroup of hematoma volume <50 mL (P = 0.44) and initial GCS score >8 (P = 0.09). In addition, the data suggested that time to surgery and surgical methods might be the important factors affecting GFO and mortality. CONCLUSIONS: NE might be a safer and more effective surgical method than CT in the treatment of patients with supratentorial HICH. However, because of the existence of some limitations, the safety and validity of NE were weakened. More high-quality trials should be included to verify our conclusion.


Assuntos
Craniotomia/métodos , Hemorragia Intracraniana Hipertensiva/cirurgia , Neuroendoscopia/métodos , Humanos
9.
Medicine (Baltimore) ; 98(51): e18430, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861010

RESUMO

RATIONALE: The improvement of microneurosurgery and neuroimaging, as well as neuronavigation and neurophysiological monitoring, enables neurosurgeons to safely and accurately resect lesions on the brainstem. PATIENT CONCERNS: A 54-year-old man, with 2-year history of hypertension, presented with sudden loss of consciousness for 1.5 hours. DIAGNOSES: Spontaneous brainstem hemorrhage. INTERVENTIONS: We performed posterior fossa decompression together with hematoma evacuation in the super early stage for the patient. OUTCOMES: The patient regained normal spontaneous breathing function after surgery. And he needed help for daily activities with hemiplegia of right limb at three-month follow-up. LESSONS: The hematoma evacuation together with posterior fossa decompression in the super early stage maybe a good treatment for patients in a deep coma with a large hematoma at the dorsal side.


Assuntos
Tronco Encefálico/cirurgia , Hemorragia Intracraniana Hipertensiva/cirurgia , Tronco Encefálico/diagnóstico por imagem , Humanos , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 472-478, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484608

RESUMO

To explore the correlation between hematoma expansion within 24 hours of hypertensive intracerebral hemorrhage and signs on nonenhanced computed tomography(NECT). Methods The clinical data and CT images of 185 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed.The differences in CT parameters were compared between the expansion group and the unexpanded group.Binary logistic regression analysis was performed on the indicators with statistical significance between the two groups to identify the potential correlation between CT parameters and hematoma expansion.The roles of blend sign,lobulation sign,and black hole sign in predicting early hematoma expansion were assessed. Results The CT quantitative data including initial volume,maximum diameter,minimum diameter,maximum CT value,mean CT value,difference between maximum diameter and minimum diameter showed no significant difference between these two group(all P>0.05).CT qualitative data including blend sign,lobulation sign,and black hole sign were significantly different(P<0.05)but the differences became not significant after the hematoma broke into the ventricles.Binary logistic regression analysis showed that blend sign,lobulation sign,and black hole sign were independent risk factors for early hematoma expansion,with sensitivity,specificity,positive predictive value,and negative predictive value of the combined signs and the early hematoma expansion calculated by the four-fold table method being 78.4%,59.0%,42.1%,and 87.8%,respectively,and the Youden index was 0.374.Its Youden index was closer to 1 than the blend sign,the black hole sign,and the lobulation sign. Conclusion The blend sign,lobulation sign,and black hole sign in NECT can be used to predict hematoma expansion within 24 hours after hypertensive cerebral hemorrhage.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Stroke ; 50(8): 2016-2022, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31272326

RESUMO

Background and Purpose- It is unknown whether blood pressure (BP) reduction influences secondary brain injury in spontaneous intracerebral hemorrhage (ICH). We tested the hypothesis that intensive BP reduction is associated with decreased perihematomal edema expansion rate (PHER) in deep ICH. Methods- We performed an exploratory analysis of the ATACH-2 randomized trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2). Patients with deep, supratentorial ICH were included. PHER was calculated as the difference in perihematomal edema volume between baseline and 24-hour computed tomography scans divided by hours between scans. We used regression analyses to determine whether intensive BP reduction was associated with PHER and if PHER was associated with poor outcome (3-month modified Rankin Scale score 4-6). We then used interaction analyses to test whether specific deep location (basal ganglia versus thalamus) modified these associations. Results- Among 1000 patients enrolled in ATACH-2, 870 (87%) had supratentorial, deep ICH. Of these, 780 (90%) had neuroimaging data (336 thalamic and 444 basal ganglia hemorrhages). Baseline characteristics of the treatment groups remained balanced (P>0.2). Intensive BP reduction was associated with a decrease in PHER in univariable (ß= -0.15; 95% CI, -0.26 to -0.05; P=0.007) and multivariable (ß=-0.12; 95% CI, -0.21 to -0.02; P=0.03) analyses. PHER was not independently associated with outcome in all deep ICH (odds ratio, 1.14; 95% CI, 0.93-1.41; P=0.20), but this association was modified by the specific deep location involved (multivariable interaction P=0.02); in adjusted analyses, PHER was associated with poor outcome in basal ganglia (odds ratio, 1.42; 1.05-1.97; P=0.03) but not thalamic (odds ratio, 1.02; 95% CI, 0.74-1.40; P=0.89) ICH. Conclusions- Intensive BP reduction was associated with decreased 24-hour PHER in deep ICH. PHER was not independently associated with outcome in all deep ICH but was associated with poor outcome in basal ganglia ICH. PHER may be a clinically relevant end point for clinical trials in basal ganglia ICH.


Assuntos
Anti-Hipertensivos/uso terapêutico , Edema Encefálico/patologia , Hemorragia Intracraniana Hipertensiva/tratamento farmacológico , Hemorragia Intracraniana Hipertensiva/patologia , Nicardipino/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
12.
Int J Med Robot ; 15(5): e2024, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267676

RESUMO

OBJECTIVE: To verify the minimally invasive surgical approach and therapeutic effects of using the medical neurosurgery robot Remebot to treat hypertensive intracerebral hemorrhage (HICH). METHODS: Clinical data for 17 HICH patients were analyzed retrospectively. Hematoma evacuation and tube drainage using Remebot frameless stereotaxic techniques were performed for all patients, and urokinase was injected into the hematomas after the operations. RESULTS: Robot-assisted stereotactic techniques can accurately guide hematoma punctures, and no deaths occurred among these patients. The average positioning error was 1.28 ± 0.49 mm. The average drainage duration was 3.4 days. The 3-month postoperative follow-up revealed improved neurological functions and quality of life for all patients. CONCLUSIONS: The medical neurosurgery robot Remebot is minimally invasive, has high positional accuracy, and facilitates surgical planning according to the shape of the hematoma. Therefore, robot-assisted surgery using Remebot represents a safe and effective treatment method for hematoma evacuation and tube drainage in HICH patients.


Assuntos
Hemorragia Intracraniana Hipertensiva/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Técnicas Estereotáxicas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Tomografia Computadorizada por Raios X
13.
Crit Care Med ; 47(8): 1125-1134, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31162192

RESUMO

OBJECTIVES: Elevated intracranial pressure and inadequate cerebral perfusion pressure may contribute to poor outcomes in hypertensive intraventricular hemorrhage. We characterized the occurrence of elevated intracranial pressure and low cerebral perfusion pressure in obstructive intraventricular hemorrhage requiring extraventricular drainage. DESIGN: Prospective observational cohort. SETTING: ICUs of 73 academic hospitals. PATIENTS: Four hundred ninety-nine patients enrolled in the CLEAR III trial, a multicenter, randomized study to determine if extraventricular drainage plus intraventricular alteplase improved outcome versus extraventricular drainage plus saline. INTERVENTIONS: Intracranial pressure and cerebral perfusion pressure were recorded every 4 hours, analyzed over a range of thresholds, as single readings or spans (≥ 2) of readings after adjustment for intracerebral hemorrhage severity. Impact on 30- and 180-days modified Rankin Scale scores was assessed, and receiver operating curves were analyzed to identify optimal thresholds. MEASUREMENTS AND MAIN RESULTS: Of 21,954 intracranial pressure readings, median interquartile range 12 mm Hg (8-16), 9.7% were greater than 20 mm Hg and 1.8% were greater than 30 mm Hg. Proportion of intracranial pressure readings from greater than 18 to greater than 30 mm Hg and combined intracranial pressure greater than 20 plus cerebral perfusion pressure less than 70 mm Hg were associated with day-30 mortality and partially mitigated by intraventricular alteplase. Proportion of cerebral perfusion pressure readings from less than 65 to less than 90 mm Hg and intracranial pressure greater than 20 mm Hg in spans were associated with both 30-day mortality and 180-day mortality. Proportion of cerebral perfusion pressure readings from less than 65 to less than 90 mm Hg and combined intracranial pressure greater than 20 plus cerebral perfusion pressure less than 60 mm Hg were associated with poor day-30 modified Rankin Scale, whereas cerebral perfusion pressure less than 65 and less than 75 mm Hg were associated with poor day-180 modified Rankin Scale. CONCLUSIONS: Elevated intracranial pressure and inadequate cerebral perfusion pressure are not infrequent during extraventricular drainage for severe intraventricular hemorrhage, and level and duration predict higher short-term mortality and long-term mortality. Burden of low cerebral perfusion pressure was also associated with poor short- and long-term outcomes and may be more significant than intracranial pressure. Adverse consequences of intracranial pressure-time burden and cerebral perfusion pressure-time burden should be tested prospectively as potential thresholds for therapeutic intervention.


Assuntos
Drenagem/métodos , Fibrinolíticos/uso terapêutico , Hemorragia Intracraniana Hipertensiva/terapia , Hipertensão Intracraniana/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Feminino , Humanos , Hemorragia Intracraniana Hipertensiva/complicações , Hemorragia Intracraniana Hipertensiva/fisiopatologia , Hipertensão Intracraniana/complicações , Pressão Intracraniana , Masculino , Monitorização Fisiológica , Estudos Prospectivos , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(19): e15503, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083190

RESUMO

BACKGROUND: We aimed to study the feasibility of body surface projection in neuroendoscopic treatment of intracranial hemorrhage (ICH), and to evaluate the prognosis of muscle strength using diffusion tensor imaging (DTI) technique. METHODS: We utilized 3D-SLICER software and adopted hematoma body surface projection orientation to eliminate ICH by using neuroendoscope for 69 cases of spontaneous intracerebral hemorrhage. The standard of correct location was determined by the direct view of hematoma at the first operation. Evacuation rate by comparing computed tomography (CT) before and after the surgery and Glasgow coma scale (GCS) was computed. DTI was used for pyramidal tract imaging 3 weeks after the operation, while the prognosis of muscle strength was assessed after 6 months. The control group included 69 patients with basal ganglia hemorrhage who received conservative treatment during the same period. RESULTS: The hematoma evacuation rate was 90.75% in average. The average GCS score rose by 4 points one week after the surgery. The shape of pyramidal tract affected the prognosis of body muscle strength, and the simple disruption type was the worst. There was no difference in mortality between the surgery group (10.1%) and the conservative group (4.3%). The muscle strength improvement value and modulate RANK score (MRS) in the surgery group were better than the control group. CONCLUSION: It is convenient and feasible to use the surface projection to determine the target of operation, and the clearance rate of hematoma is high. Pyramidal tract imaging can predict the prognosis of muscle strength.


Assuntos
Hemorragia Intracraniana Hipertensiva/cirurgia , Neuroendoscopia/métodos , Adulto , Idoso , Imagem de Tensor de Difusão , Estudos de Viabilidade , Feminino , Humanos , Imageamento Tridimensional , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Força Muscular , Tomografia Computadorizada por Raios X
15.
Stroke ; 50(6): 1409-1414, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136288

RESUMO

Background and Purpose- We investigated factors associated with early and delayed neurological deterioration (END and DND, respectively) after acute spontaneous intracerebral hemorrhage in the main INTERACT (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial)-2. Methods- INTERACT-2 was a randomized trial of early intensive versus guideline-recommended blood pressure lowering in hypertensive intracerebral hemorrhage (<6 hours from symptom onset) patients. END and DND were defined as a ≥4-point increase on the National Institutes of Health Stroke Scale or ≥2-point decrease on Glasgow Coma Scale, in periods baseline to 24 hours and 24 hours to 7 days, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and 90-day outcomes (death and dependency on the modified Rankin Scale). Results- Of 2598 participants, 450 (17.3%) had either END or DND. Non-China recruitment, higher systolic blood pressure, larger baseline hematoma volume, left hemisphere hematoma location, intraventricular hemorrhage, subarachnoid extension, heterogeneous hematoma density, and cerebral white matter lesions, were predictors of END (all P≤0.045). Higher systolic blood pressure, lower diastolic blood pressure, higher glucose, larger baseline hematoma volume, intraventricular hemorrhage, lobar location, brain atrophy, and heterogeneous hematoma density were predictors of DND (all P≤0.042). END and DND were both related to death, and death or major disability (modified Rankin Scale scores of 3-6), in adjusted analyses ( P<0.001). Conclusions- Common variables, most directly related to the intracerebral hemorrhage morphology and underlying cerebral features, determine END and DND and their influence on poor outcomes of death and major disability. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT00716079.


Assuntos
Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Hematoma , Hemorragia Intracraniana Hipertensiva , Idoso , Feminino , Hematoma/complicações , Hematoma/tratamento farmacológico , Hematoma/mortalidade , Hematoma/fisiopatologia , Humanos , Hemorragia Intracraniana Hipertensiva/complicações , Hemorragia Intracraniana Hipertensiva/tratamento farmacológico , Hemorragia Intracraniana Hipertensiva/mortalidade , Hemorragia Intracraniana Hipertensiva/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/tratamento farmacológico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/mortalidade , Doenças do Sistema Nervoso/fisiopatologia
16.
World Neurosurg ; 127: e835-e842, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954736

RESUMO

OBJECTIVE: Hypertensive cerebral hemorrhage leads to greater mortality and worse functional outcomes at high altitudes. Experimental studies have suggested that hemoglobin can lead to increased perihemorrhagic edema after intracerebral hemorrhage. METHODS: Patients were divided into a high-hemoglobin (H-H) group (>180 g/L) and a low-hemoglobin (L-H) group (≤180 g/L). The distance from the cortex to the midline was used to indicate the degree of edema. At 1, 7, 14, and 21 days, the patients' status was scored using the Glasgow coma scale, and survival was plotted using Kaplan-Meier survival curves. Pearson correlation analysis showed that the difference between the postoperative and preoperative Glasgow coma scale score correlated with the hemoglobin concentration. The Glasgow outcome scale was used to assess neurological recovery after 6 months. RESULTS: On days 7, 14, and 21, the edema of the H-H group was significantly greater than that of the L-H group (P < 0.01 and P < 0.001, respectively). The edema of the H-H group peaked at 14 and 21 days, but that of the L-H group peaked at 7 days. The hemoglobin concentration and postoperative neurological recovery had a linear relationship in the H-H group. The L-H group had greater survival compared with the H-H group (P < 0.05). The L-H group had higher Glasgow outcome scale scores compared with the H-H group (P < 0.05). CONCLUSION: The hemoglobin concentration affects the mortality and morbidity from hypertensive cerebral hemorrhage in high-altitude regions, and a linear relationship exists between hemoglobin concentration and neurological recovery in the H-H group.


Assuntos
Altitude , Hemorragia dos Gânglios da Base/sangue , Hemoglobinas/biossíntese , Hipertensão/etiologia , Hemorragia Intracraniana Hipertensiva/sangue , Idoso , Hemorragia dos Gânglios da Base/cirurgia , Hemorragia Cerebral/cirurgia , Humanos , Hemorragia Intracraniana Hipertensiva/cirurgia , Masculino , Pessoa de Meia-Idade
17.
World Neurosurg ; 126: e1330-e1336, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898753

RESUMO

OBJECTIVE: Recent advances in endoscopic surgery have led to more patients being able to undergo endoscopic removal of hypertensive intracerebral hemorrhage (HICH). However, because of the minimal invasiveness, endoscopic HICH removal through a narrow surgical window can result in a low removal rate. The goal of the present study was to investigate the factors that affect the removal rate of HICH evacuation. METHODS: The data from 28 patients with supratentorial HICH who had undergone endoscopic hematoma evacuation were retrospectively analyzed. The inclusion criteria were spontaneous supratentorial HICH with a hematoma volume >30 mL, admission to the hospital within 24 hours of ictus, and a Glasgow coma scale score of ≥4. RESULTS: Of the 28 patients, 9 were women and 19 were men, ranging in age from 41 to 86 years (mean, 60.7 ± 12.7). The hematoma location was the basal ganglia in 25 patients and subcortical in 3 patients. The mean preoperative hematoma volume was 62.4 ± 22.5 mL. The hematoma removal rate was <60% for 11 patients (poor evacuation group) and ≥60% for in 17 patients (good evacuation group). Comparing the 2 groups, chronic renal failure treated with hemodialysis (P = 0.0072, χ2 test), liver cirrhosis (P = 0.023, χ2 test), and surgeon experience with ≥10 cases of endoscopic HICH removal (P = 0.016, χ2 test) were significant factors related to the HICH removal rate. CONCLUSION: To achieve a good removal rate, surgeons should have experience performing the endoscopic procedure. Also, patients with end-stage chronic renal failure or liver cirrhosis should be excluded.


Assuntos
Hematoma/cirurgia , Hemorragia Intracraniana Hipertensiva/cirurgia , Neuroendoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Feminino , Hematoma/etiologia , Humanos , Hemorragia Intracraniana Hipertensiva/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sucção/métodos , Resultado do Tratamento
18.
Cardiovasc Pathol ; 40: 55-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30870795

RESUMO

Joseph Stalin was one of the most important world leaders during the first half of the 20th century. He died suddenly in early March 1953 after a short illness, which was described in a series of medical bulletins in the Soviet newspaper Pravda. Based on both the clinical history and autopsy findings, it was concluded that Stalin had died of a massive hemorrhagic stroke involving his left cerebral hemisphere. However, almost 50 years later, a counter-narrative developed suggesting a more nefarious explanation for his sudden death, namely, that a "poison," warfarin, a potent anticoagulant, had been administered surreptitiously by one or more of his close associates during the early morning hours prior to the onset of his stroke. In the present report, we will examine this counter-narrative and suggest that his death was not due to the administration of warfarin but rather to a hypertension-related cerebrovascular accident resulting in a massive hemorrhagic stroke involving his left cerebral hemisphere. The counter-narrative was based on the misunderstanding of certain specific autopsy findings, namely, the presence of focal myocardial and petechial hemorrhages in the gastric and intestinal mucosa, which could be attributed to the extracranial pathophysiologic changes that can occur as a consequence of a stroke rather than the highly speculative counter-narrative that Stalin was "poisoned" by the administration of warfarin.


Assuntos
Morte Súbita , Hipertensão/história , Hemorragia Intracraniana Hipertensiva/história , Acidente Vascular Cerebral/história , Autopsia , Causas de Morte , Morte Súbita/etiologia , Pessoas Famosas , História do Século XX , Humanos , Hipertensão/complicações , Hipertensão/patologia , Hipertensão/terapia , Hemorragia Intracraniana Hipertensiva/etiologia , Hemorragia Intracraniana Hipertensiva/patologia , Hemorragia Intracraniana Hipertensiva/terapia , Federação Russa , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/terapia
19.
World Neurosurg ; 127: e162-e171, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30876994

RESUMO

OBJECTIVE: To develop and validate a risk-scoring model for predicting recurrent hypertensive cerebral hemorrhage (RHCH) occurring within 1 year after initial hypertensive cerebral hemorrhage and to facilitate preemptive clinical intervention for the prevention of secondary hemorrhage. METHODS: Patient gender, age, blood pressure, Glasgow Coma Scale (GCS) score, location of cerebral hemorrhage, surgery, past medical history, blood biochemical parameters, and Glasgow Outcome Scale score were analyzed using logistic regression analysis to determine independent predictors of RHCH. A risk-scoring model was constructed by assigning coefficients to each predictor and validating it in another independent cohort. The accuracy of the model was then assessed by the area under the receiver operating characteristic curve (AUC), and the calibration ability of the model was assessed by the Hosmer-Lemeshow test. RESULTS: Of 520 patients in the derivation cohort, 38 developed RHCH within 1 year after discharge. Independent risk factors of RHCH were age >60 years; stage 3 hypertension at admission; GCS score 9-12 (admission); GCS score 3-8 (discharge); history of cerebral ischemic stroke, smoking, alcoholism; and plasma homocysteine (Hcy) level ≥10 µmol/L. The recurrence rates for the low-risk (0-13 points), intermediate-risk (14-26 points), and high-risk (27-39 points) groups were 1.73%, 6.11%, and 57.14%, respectively (P < 0.001). The corresponding rates in the validation cohort, of whom 10/107 (9.35%) developed RHCH, were 3.45%, 7.14%, and 71.43%, respectively (P < 0.001). The risk-scoring model showed good discrimination in both the derivation and validation cohorts, with an AUC of 0.802 versus 0.863. The model also showed good calibration ability (the Hosmer-Lemeshow P values of the two cohorts were 0.532 vs. 0.724). CONCLUSIONS: This model will help identify high-risk groups for RHCH in order to facilitate and improve preemptive clinical intervention.


Assuntos
Hemorragia Intracraniana Hipertensiva/epidemiologia , Modelos Cardiovasculares , Medição de Risco/métodos , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Área Sob a Curva , Glicemia/análise , Dano Encefálico Crônico/etiologia , Estudos de Coortes , Comorbidade , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Transtornos Hemorrágicos/epidemiologia , Humanos , Hiper-Homocisteinemia/epidemiologia , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/complicações , Lipídeos/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Curva ROC , Recidiva , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Tomografia Computadorizada por Raios X
20.
World Neurosurg ; 126: e888-e894, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30872203

RESUMO

OBJECTIVE: Efficacy of minimally invasive craniopuncture with the YL-1 puncture needle (hard-channel) and soft drainage tube (soft-channel) in treating hypertensive intracerebral hemorrhage (HICH). MATERIALS AND METHODS: A total of 150 patients with HICH were randomly assigned into 3 groups: conservative group (n = 50), hard-channel group (n = 50), and soft-channel group (n = 50). Computed tomography, National Institutes of Health Stroke Scale (NIHSS) and the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA) in serum and in drainage fluid were examined on days 2, 4, and 6 after operation. RESULTS: Compared with the conservative group, the serum levels of IL-6, TNF-α, and MDA were decreased and SOD was increased (P < 0.05); volumes of hematoma and perihematomal edema as well as NIHSS were reduced (P < 0.05) in minimally invasive groups on days 7, 14, and 28 after operation. Compared with the hard-channel group, the serum levels of IL-6, TNF-α, MDA, and SOD showed the same trend as above in the soft-channel group. In the soft-channel group, MDA was reduced and SOD was increased in brain drainage fluid on days 2, 4, and 6 (P < 0.05); volumes of hematoma and perihematomal edema on days 14 and 28 were found to be reduced compared with the hard-channel group (P < 0.05). There was no significant difference of volumes of hematoma and perihematomal edema on day 7 between minimally invasive groups. NIHSS of the soft-channel group appeared to be significantly reduced on days 7, 14, and 28 after operation (P < 0.05). CONCLUSIONS: Soft-channel minimally invasive craniopuncture is an ideal technique for treating HICH, with advantages of alleviating cerebral edema, reducing oxidative stress, and inhibiting inflammatory response.


Assuntos
Encéfalo/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paracentese/métodos , Feminino , Humanos , Interleucina-6/sangue , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Superóxido Dismutase/sangue , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
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