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1.
World Neurosurg ; 128: e895-e904, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082547

RESUMO

BACKGROUND: Brainstem hemorrhage (BSH) is the most dangerous and devastating subtype of intracerebral hemorrhage and is associated with high morbidity and mortality. However, to date, no effective prevention methods or specific therapies have been available to improve its clinical outcomes. We preliminarily explored the efficacy of deferoxamine (DFO), a clinical chelator known for its iron-scavenging activities, in a rat model of BSH induced with collagenase infusion. METHODS: DFO or saline was administrated 6 hours after BSH induction and then every 12 hours for ≤7 days. The survival curve of the rats was created, and the neurological scores were examined on days 1, 3, and 7 after BSH. The rats were sacrificed after 1, 3, and 7 days of DFO treatment for histological examination and immunohistochemistry. RESULTS: The results showed that administration of DFO delayed erythrocytes lysis, reduced iron deposition, reduced reactive oxygen species generation, reduced heme oxygenase-1 expression, and alleviated brain injury such as neuron degeneration and myelin sheath injury. However, DFO did not improve the survival rate and neurobehavioral outcomes in this model. CONCLUSIONS: Administration of DFO had limited therapeutic effects on collagenase-induced brainstem hemorrhage in rats. Some potential explanations were proposed, and more preclinical work is required to clarify the controversial curative effect of DFO in ICH.


Assuntos
Hemorragia do Tronco Encefálico Traumática/complicações , Quelantes/uso terapêutico , Desferroxamina/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/etiologia , Animais , Hemorragia do Tronco Encefálico Traumática/induzido quimicamente , Colagenases , Heme Oxigenase-1/metabolismo , Imuno-Histoquímica , Masculino , Bainha de Mielina/patologia , Degeneração Neural/prevenção & controle , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Ratos , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio/metabolismo , Análise de Sobrevida
4.
Br J Neurosurg ; 33(4): 442-443, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28885045

RESUMO

Duret hemorrhage has always been reported during an episode of increased intracranial pressure with transtentorial herniation. We reported a Duret hemorrhage occurring during an episode of intracranial hypotension resulted in sinking skin flap syndrome which was responsible for acute paradoxal descending transtentorial herniation and Duret hemorrhage, 10 days after large hemicraniectomy which could indicate early cranioplasty.


Assuntos
Hemorragia do Tronco Encefálico Traumática/etiologia , Retalhos Cirúrgicos/efeitos adversos , Craniectomia Descompressiva/métodos , Encefalocele/complicações , Hematoma Subdural/etiologia , Humanos , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Crânio/cirurgia , Síndrome
6.
J Forensic Leg Med ; 55: 74-75, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29471250

RESUMO

Hanging is one of the most lethal methods of suicide, where survival is an obvious rarity. Those who survive the initial act of hanging mostly suffer from hypoxic ischemic encephalopathy, and show some form of neurological damage. Intracranial haemorrhages are rarely associated with hanging. We report the first case of Duret haemorrhages in a 58 years old victim who survived for 8 days after the attempted hanging. Duret haemorrhage is mostly associated with fatal outcome. It is thus implied that cerebral edema should be brought under control at the earliest to prevent transtentorial herniation and subsequent Duret haemorrhages.


Assuntos
Hemorragia do Tronco Encefálico Traumática/patologia , Edema Encefálico/patologia , Hemorragia do Tronco Encefálico Traumática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Lesões do Pescoço/patologia , Suicídio
8.
Neurocrit Care ; 27(2): 199-207, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28477152

RESUMO

BACKGROUND: Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as "grade 3 diffuse axonal injury," but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome. METHODS: Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) magnetic resonance imaging (MRI). TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the disability rating scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients. RESULTS: Mean ± SD number of TMBs was: dorsal brainstem = 0.7 ± 1.4, ventral brainstem = 0.2 ± 0.6, corpus callosum = 1.8 ± 2.8, and global = 14.4 ± 12.5. The mean ± SD TMB volume within AAN nuclei was 6.1 ± 18.7 mm3. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R = 0.37, p = 0.02, and R = 0.36, p = 0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes. CONCLUSIONS: These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Hemorragia do Tronco Encefálico Traumática/diagnóstico , Tronco Encefálico/lesões , Lesão Axonal Difusa/diagnóstico , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Tronco Encefálico/diagnóstico por imagem , Hemorragia do Tronco Encefálico Traumática/diagnóstico por imagem , Hemorragia do Tronco Encefálico Traumática/etiologia , Lesão Axonal Difusa/diagnóstico por imagem , Lesão Axonal Difusa/etiologia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Prognóstico , Estudos Retrospectivos , Adulto Jovem
11.
J Clin Neurosci ; 22(7): 1133-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25982189

RESUMO

Our aim was to evaluate the mortality rate of primary pontine hemorrhage (PPH) and to determine the factors related to the prognosis. Limited data exist on the long-term prognosis and determinants of death in patients with PPH in China. Our study analyzed consecutive cases of first-ever PPH from April 2007 to March 2011 in a hospital-based stroke registry. Mortality rates during 30 day and 3 year follow-ups were analyzed. We used the Kaplan-Meier method to estimate the event rates and binary logistic regression analysis, and Cox proportional hazard regression analysis to identify predictors of short-term and long-term prognosis, respectively. A total of 76 patients were identified, 44 (57.89%) were men. Both 30 day and 3 year overall mortalities in men were higher than women but this different was not statistically significant. Coma on admission, hematoma ⩾ 4 mL and a massive hemorrhage were significantly related to 30 day mortality of PPH. Multivariate Cox proportional hazard regression revealed that coma on admission (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.16-4.13; p = 0.02) and hematoma ⩾ 4 mL (HR 2.23; 95% CI 1.25-3.96; p = 0.01) were independent predictors of 3 year mortality. In conclusion, the short-term mortality rate and factors related to the prognosis of Chinese patients with PPH are similar to those reported for other populations. A low Glasgow coma scale score on admission and a large hematoma volume may be related to poor 3 year prognosis after PPH.


Assuntos
Hemorragia do Tronco Encefálico Traumática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Hemorragia do Tronco Encefálico Traumática/epidemiologia , Hemorragia do Tronco Encefálico Traumática/mortalidade , Causas de Morte , China/epidemiologia , Coma/etiologia , Feminino , Escala de Coma de Glasgow , Hematoma/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Análise de Sobrevida , Tomografia Computadorizada por Raios X
12.
J Clin Neurosci ; 22(7): 1213-4, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25863998

RESUMO

We report a 58-year-old man who developed hyptertrophic olivary degeneration (HOD) after haemorrhage of a cavernous malformation in the pons. Lesions of the triangle of Guillain and Mollaret (the dentatorubro-olivary pathway) may lead to HOD, a secondary transsynaptic degeneration of the inferior olivary nucleus. HOD is considered unique because the degenerating olive initially becomes hypertrophic rather than atrophic. The primary lesion causing pathway interruption is often haemorrhage, either due to hypertension, trauma, surgery or, as in our patient, a vascular malformation such as a cavernoma. Ischaemia and demyelination can also occasionally be the inciting events. The classic clinical presentation of HOD is palatal myoclonus, although not all patients with HOD develop this symptom. The imaging features of HOD evolve through characteristic phases. The clue to the diagnosis of HOD is recognition of the distinct imaging stages and identification of a remote primary lesion in the triangle of Guillain and Mollaret. Familiarity with the classic imaging findings of this rare phenomenon is necessary in order to avoid misdiagnosis and prevent unnecessary intervention.


Assuntos
Hemorragia do Tronco Encefálico Traumática/complicações , Hemorragia do Tronco Encefálico Traumática/patologia , Degeneração Neural/etiologia , Degeneração Neural/patologia , Núcleo Olivar/patologia , Erros de Diagnóstico , Progressão da Doença , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Mioclonia/diagnóstico , Mioclonia/etiologia , Ponte/patologia
13.
Intern Med ; 54(4): 427-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25748961

RESUMO

A 48-year-old man experienced lateral medullary infarction resulting from spontaneous vertebral artery (VA) dissection. Minimal fusiform dilatation was noted on basi-parallel anatomic scanning-magnetic resonance imaging; therefore, the patient was treated conservatively. Eight months later, he experienced deterioration of dysphagia and the onset of gait ataxia. Repeated imaging studies showed enlargement of the VA aneurysm with bulbar compression. Parent artery occlusion on the proximal side of the VA affected by the dissection relieved the patient's symptoms. Although the majority of dissected lesions stabilize within a few months, studies with longer observation periods and more frequent neuroimaging examinations are required.


Assuntos
Hemorragia do Tronco Encefálico Traumática/patologia , Infarto/diagnóstico , Aneurisma Intracraniano/diagnóstico por imagem , Bulbo/irrigação sanguínea , Trombose/diagnóstico , Dissecação da Artéria Vertebral/diagnóstico , Artéria Vertebral/patologia , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/terapia , Hemorragia do Tronco Encefálico Traumática/terapia , Diagnóstico Diferencial , Humanos , Infarto/complicações , Aneurisma Intracraniano/terapia , Imagem por Ressonância Magnética , Masculino , Bulbo/patologia , Pessoa de Meia-Idade , Radiografia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Trombose/complicações , Trombose/terapia , Resultado do Tratamento , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/terapia
16.
Rev. chil. neurocir ; 40(1): 37-41, jul. 2014. ilus
Artigo em Inglês | LILACS | ID: biblio-831381

RESUMO

La lesión de los nervios craneales es un acompañamiento común de un trauma en la cabeza. Lesiones de los nervios craneales asociados con la lesión cerrada de la cabeza ha sido encontrado para ser asociado con una mayor gravedad de la lesión. Los objetivos de este estudio son documentar la incidencia de lesiones de los nervios craneales en lesiones en la cabeza, que se correlaciona con la incidencia de los hallazgos radiológicos, para evaluar el tiempo de recuperación con respecto a los signos y síntomas en la presentación inicial. Se presenta un caso de un varón de 51 años de edad, con lesiones nerviosas del segundo, sexto, séptimo, octavo, noveno y décimo después de una lesión grave en la cabeza. Lo admitieron a la víctima con un historial de conducir una motocicleta utilizando un casco y con una caída a alta velocidad. Su Resonancia Magnética (RM) presenta contusión en el tronco cerebral y su tomografía computarizada (TC) simple mostró pequeña hemorragia a la derecha del tronco cerebral y el paciente fue tratado de forma conservadora. Por otra parte, si se detectan múltiples lesiones de los nervios craneales hay una necesidad de evaluar más a fondo la lesión del tronco cerebral por RM con el fin de evaluar mejor el tronco cerebral. La mayoría de las lesiones de los nervios craneales pueden recibir tratamento conservador, aunque algunos autores indican intervención quirúrgica temprana para el tratamiento de la parálisis facial con fractura a través del canal facial.


Injury to the cranial nerves is a common accompaniment of head trauma. Cranial nerve injuries associated with closed head trauma has been found to be associated with injuries of a higher severity. The incidence of cranial nerve injury in head trauma varies in the literature, ranging from 5 to 23 percent. The objectives of this study are: to document the incidence of cranial nerve injuries in head trauma; to correlate the incidence with radiological findings and to assess recovery time according with signs and symptoms at initial presentation. We report a case of a 51-year-old male having second, sixth, seventh, eighth, ninth and tenth nerve injuries after severe head trauma. He was admitted after an accident with a history of riding a motorcycle wearing a helmet and falling at high speed. Study by Magnetic Resonance Imaging (MRI) of this case presented stem contusion and a plain Computerized Tomography (CT) showed small hemorrhage on the right of the brain stem. The patient was managed conservatively. Multiple cranial nerve palsies after head injury may not carry a bad prognosis as previously thought, and may be reversible. Moreover, if multiple cranial nerve injuries are detected, a better evaluation of the stem brain is needed by MRI in order to evaluate possible lesions in this site. The majority of the cranial nerve injuries are treated conservatively, although some authors indicate early surgical intervention to treat facial palsy with fracture through the facial canal.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Acidentes por Quedas , Acidentes de Trânsito , Hemorragia do Tronco Encefálico Traumática , Traumatismos Cranianos Fechados/complicações , Traumatismos dos Nervos Cranianos/cirurgia , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X
17.
Br J Oral Maxillofac Surg ; 52(5): 467-9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24685474

RESUMO

LeFort I osteotomy is a standard technique for the surgical correction of dentofacial deformities. Despite its low morbidity, it can lead to various complications at the base of the skull. We report the case of a fractured clivus as an unusual complication.


Assuntos
Fossa Craniana Posterior/lesões , Osteotomia de Le Fort/efeitos adversos , Fraturas Cranianas/etiologia , Adulto , Hemorragia do Tronco Encefálico Traumática/etiologia , Infartos do Tronco Encefálico/etiologia , Assimetria Facial/cirurgia , Mentoplastia/métodos , Humanos , Masculino , Osteotomia Sagital do Ramo Mandibular/métodos , Paresia/etiologia , Fossa Pterigopalatina/cirurgia , Tomografia Computadorizada por Raios X/métodos
18.
Brain Inj ; 28(3): 374-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24354466

RESUMO

BACKGROUND: Although Duret haemorrhage of the brainstem caused by descending transtentorial herniation is considered fatal, a few cases have been reported to have good outcome. Moreover, most patients with Duret haemorrhage have severe primary brain injury and the potential outcome of those with mild primary brain injury remains unknown. CASE REPORT: This study reports the case of a patient presenting with Duret haemorrhage caused by an idiopathic subdural haematoma who demonstrated dramatic recovery. The patient presented with a low Glasgow Coma Scale score and bilateral oculomotor palsy on admission. Pre-operative CT revealed a large subdural haematoma and Duret haemorrhage of the mid-brain. The subdural haematoma was immediately evacuated under local anaesthesia and the patient demonstrated dramatic post-operative recovery, with no residual quadriparesis and minimal cognitive dysfunction. Interestingly, only bilateral oculomotor palsy persisted. This indicates that Duret haemorrhage restricted to the central portion of the mid-brain without severe primary brain injury has good prognosis. CONCLUSION: Therefore, patients with Duret haemorrhage of the mid-brain caused by simple subdural haematoma presenting with bilateral oculomotor palsy, including bilateral pupillary dilation, may not always have a poor prognosis.


Assuntos
Hemorragia do Tronco Encefálico Traumática/patologia , Hematoma Subdural/patologia , Recuperação de Função Fisiológica , Hemorragia do Tronco Encefálico Traumática/cirurgia , Escala de Coma de Glasgow , Hematoma Subdural/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Neurocrit Care ; 21(2): 192-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23839705

RESUMO

BACKGROUND AND PURPOSE: Despite extensive studies of supratentorial intracerebral hemorrhage (ICH), limited data are available on determinants of hematoma volume in infratentorial ICH. We therefore aimed to identify predictors of infratentorial ICH volume and to evaluate whether location specificity exists when comparing cerebellar to brainstem ICH. METHODS: We undertook a retrospective analysis of 139 consecutive infratentorial ICH cases (95 cerebellar and 44 brainstem ICH) prospectively enrolled in a single-center study of ICH. ICH volume was measured on the CT scan obtained upon presentation to the Emergency Department using an established computer-assisted method. We used linear regression to identify determinants of log-transformed ICH volume and logistic regression to evaluate their role in surgical evacuation. RESULTS: Median ICH volumes for all infratentorial, cerebellar, and brainstem ICH were nine [interquartile range (IQR), 3-23], ten (IQR, 3-25), and eight (IQR, 3-19) milliliters, respectively. Thirty-six patients were on warfarin treatment, 31 underwent surgical evacuation, and 65 died within 90 days. Warfarin was associated with an increase in ICH volume of 86 % [ß = 0.86, standard error (SE) = 0.29, p = 0.003] and statin treatment with a decrease of 69 % (ß = -69, SE = 0.26, p = 0.008). Among cerebellar ICH subjects, those on warfarin were five times more likely to undergo surgical evacuation (OR = 4.80, 95 % confidence interval 1.63-14.16, p = 0.005). CONCLUSIONS: Warfarin exposure increases ICH volume in infratentorial ICH. Further studies will be necessary to confirm the inverse relation observed between statins and ICH volume.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia do Tronco Encefálico Traumática/tratamento farmacológico , Doenças Cerebelares/tratamento farmacológico , Hemorragia Cerebral/tratamento farmacológico , Hematoma/induzido quimicamente , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Varfarina/efeitos adversos , Idoso , Hemorragia do Tronco Encefálico Traumática/diagnóstico por imagem , Hemorragia do Tronco Encefálico Traumática/cirurgia , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/cirurgia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
20.
Int J Stroke ; 9(2): 183-7, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23521841

RESUMO

BACKGROUND: The cause of perimesencephalic hemorrhage is unknown, but a venous source is suggested. If perimesencephalic hemorrhage is of venous origin, less elevation of the intracranial pressure and less perfusion deficits are expected than after aneurysmal subarachnoid hemorrhage. AIMS: We compared perfusion in the acute stage after perimesencephalic hemorrhage and aneurysmal subarachnoid hemorrhage. METHODS: We included 45 perimesencephalic hemorrhage patients and 45 aneurysmal subarachnoid hemorrhage patients, who were matched on clinical condition at admission and underwent computerized tomographic scanning <72 h after subarachnoid hemorrhage. Cerebral blood flow was assessed in 12 predefined regions of interest. Differences in cerebral blood flow values with corresponding 95% confidence intervals were calculated. Sub-group analyses were performed stratified on comparable amounts of blood and location of blood (posterior circulation aneurysms and additionally in infratentorial and supratentorial aneurysms). RESULTS: Cerebral blood flow was higher in perimesencephalic hemorrhage patients (mean: 63·8) than in aneurysmal sub-arachnoid hemorrhage patients (mean: 55·9; difference of means: -7·9 [95% confidence interval: -10·7 to -5·2]) and also in the sub-group with comparable amounts of blood (mean cerebral blood flow: 56·4; difference of means: -7·4 [95% confidence interval: -10·4 to -4·3]). Cerebral blood flow was comparable with perimesencephalic hemorrhage patients for the sub-group with posterior circulation aneurysms (difference of means: -0·7 [95% confidence interval: -5·2 to 3·8]); however, differences diverged after stratifying posterior circulation aneurysms into supratentorial (difference of means -3·9 [95% confidence interval: -9·3 to 1·4]) and infratentorial aneurysms (difference of means 3·0 [95% confidence interval: -2·8 to 8·8]). CONCLUSIONS: Perimesencephalic hemorrhage patients have a higher cerebral blood flow than aneurysmal subarachnoid hemorrhage patients. The findings of this study further support a venous origin of bleeding in perimesencephalic hemorrhage patients. Future studies should further elaborate on cerebral blood flow in posterior circulation aneurysms.


Assuntos
Hemorragia do Tronco Encefálico Traumática/diagnóstico por imagem , Circulação Cerebrovascular , Mesencéfalo/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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