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1.
J Neurointerv Surg ; 11(6): 579-583, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30617144

RESUMO

BACKGROUND: We conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH). METHODS: We evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months. RESULTS: Among 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25-51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm3 (IQR, 25-50) vs 15 cm3 (IQR, 5-20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041). CONCLUSIONS: Minimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/terapia , Gerenciamento Clínico , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroendoscopia/métodos , Adulto , Idoso , Hemorragia dos Gânglios da Base/mortalidade , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Neuroendoscopia/mortalidade , Neuroendoscopia/normas , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
2.
J Neuroradiol ; 45(3): 202-205, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29410371

RESUMO

Treatment of ruptured deep-seated arteriovenous malformations is challenging and associated with elevated risks. This is due to the proximity or involvement of critical brain structures and the specifically fine and delicate angioarchitecture of these lesions, making both endovascular and surgical access technically complicated. We present the advantages of a true combined, open surgical and endovascular transvenous approach in a hybrid operating room. The technique may overcome in part the difficulties and may improve safety and risk related concerns.


Assuntos
Hemorragia dos Gânglios da Base/etiologia , Hemorragia dos Gânglios da Base/terapia , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/complicações , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Angiografia Cerebral , Procedimentos Endovasculares/métodos , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Resultado do Tratamento
4.
J Stroke Cerebrovasc Dis ; 26(7): e138-e139, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28522231

RESUMO

Although multiple cases of cannabis-associated ischemic stroke have been reported, there are only 2 reported cases of hemorrhagic stroke with an associated cerebral vasoconstriction. To our knowledge, we present the first case of basal ganglia hemorrhage after a large-volume oral ingestion of cannabis without other identified risk factors. In our case, cerebral digital subtraction angiography within 24 hours of presentation did not reveal vasoconstriction leading to a possible alternative explanation for hemorrhagic stroke, including cannabis-induced transient arterial hypertension and autoregulation disruption.


Assuntos
Hemorragia dos Gânglios da Base/induzido quimicamente , Abuso de Maconha/complicações , Adulto , Angiografia Digital , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/terapia , Angiografia Cerebral/métodos , Humanos , Masculino
5.
Interv Neuroradiol ; 20(6): 715-21, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25496681

RESUMO

The advent of flow dynamics and the recent availability of perfusion analysis software have provided new diagnostic tools and management possibilities for cerebrovascular patients. To this end, we provide an example of the use of color-coded angiography and its application in a rare case of a patient with a pure middle cerebral artery (MCA) malformation. A 42-year-old male chronic smoker was evaluated in the emergency room due to sudden onset of severe headache, nausea, vomiting and left-sided weakness. Head computed tomography revealed a right basal ganglia hemorrhage. Cerebral digital subtraction angiography (DSA) showed a right middle cerebral artery malformation consisting of convoluted and ectatic collateral vessels supplying the distal middle cerebral artery territory-M1 proximally occluded. An associated medial lenticulostriate artery aneurysm was found. Brain single-photon emission computed tomography with and without acetazolamide failed to show problems in vascular reserve that would indicate the need for flow augmentation. Twelve months after discharge, the patient recovered from the left-sided weakness and did not present any similar events. A follow-up DSA and perfusion study using color-coded perfusion analysis showed perforator aneurysm resolution and adequate, albeit delayed perfusion in the involved vascular territory. We propose a combined congenital and acquired mechanism involving M1 occlusion with secondary dysplastic changes in collateral supply to the distal MCA territory. Angiographic and cerebral perfusion work-up was used to exclude the need for flow augmentation. Nevertheless, the natural course of this lesion remains unclear and long-term follow-up is warranted.


Assuntos
Angiografia Digital/métodos , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Artéria Cerebral Média/anormalidades , Artéria Cerebral Média/diagnóstico por imagem , Adulto , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/terapia , Angiografia Cerebral , Cor , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Fumar/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Conduta Expectante
6.
Acta Neurochir Suppl ; 118: 139-42, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23564120

RESUMO

Twenty patients with traumatic basal ganglia hematoma (TBGH) were studied. Of the 20 patients, 16 were male and 4 were female, with an age range of 4-89 years (mean, 54.4 years). The causes of injury were traffic accidents in 12 patients and falls in 8. The mean admission GCS score was 7.5. Skull fractures were revealed in five patients (25 %). The hematoma was found in the putamen in 15 patients (80 %), the thalamus in 4, and the caudate in 1. The mean hematoma volume was 10.7 mL. The CT findings indicated focal contusions in 9 patients, subdural hematoma in 5, intraventricular hemorrhage in 4, subarachnoid hemorrhage in 10, and diffuse axonal injury in 5. Six patients (30 %) underwent surgery. The final outcomes were poor: 7 patients (35 %) died, 1 was in a vegetative state, 4 experienced severe disabilities, and 8 patients (40 %) made a favorable recovery. The statistical analysis identified the GCS score and midline shift as prognostic factors.Our study revealed interesting characteristics of TBGH, including a high frequency of putaminal involvement, a low frequency of skull fractures, a high frequency of associated intracranial lesions, and a high poor outcome and mortality rate.


Assuntos
Hemorragia dos Gânglios da Base , Gânglios da Base/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/fisiopatologia , Hemorragia dos Gânglios da Base/terapia , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Stroke ; 43(12): 3212-7, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23138444

RESUMO

BACKGROUND AND PURPOSE: The aim of our study was to examine surgical practice in the therapy of spontaneous intracerebral hemorrhage in Germany over a period of 10 years. METHODS: In 1999 and 2009 a questionnaire with 10 different cases of spontaneous intracerebral hemorrhage was sent to all neurosurgical centers in Germany. It included a cranial CT as well as a case description. The question asked if a conservative or surgical procedure was most suitable. When choosing surgery, the participants could decide between large open approach or microsurgery as well as stereotactic aspiration or external ventricular drainage. RESULTS: In 1999, 85 of 121 (70%) and in 2009 111 of 125 (89%) questionnaires could be evaluated. The results of the questionnaires from 1999 and 2009 showed no difference in the decision for or against a surgical procedure, except for a move toward conservative treatment in 1 patient with a massive spontaneous intracerebral hemorrhage. In 2 cases of isolated basal ganglia bleeding, a conservative approach was chosen by approximately 98% of the participants both in 1999 and in 2009. In all other cases of spontaneous intracerebral hemorrhage, in particular when the patient was in poor clinical condition, the decision was very heterogeneous. CONCLUSIONS: Despite new studies, there were no significant differences regarding the decision for or against a surgical procedure in 1999 and 2009. Although clearly unfavorable prognostic factors are known, many patients still undergo a surgical procedure. It appears that at least spontaneous intracerebral hemorrhage in the area of the basal ganglia is a unique domain of conservative treatment.


Assuntos
Hemorragia Cerebral/cirurgia , Hemorragia Cerebral/terapia , Pesquisas sobre Serviços de Saúde , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Neurocirúrgicos/tendências , Adulto , Idoso , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/cirurgia , Hemorragia dos Gânglios da Base/terapia , Hemorragia Cerebral/diagnóstico por imagem , Drenagem , Feminino , Alemanha , Humanos , Masculino , Microcirurgia/estatística & dados numéricos , Microcirurgia/tendências , Pessoa de Meia-Idade , Prognóstico , Técnicas Estereotáxicas/estatística & dados numéricos , Técnicas Estereotáxicas/tendências , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Ulus Travma Acil Cerrahi Derg ; 18(5): 461-2, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23188613

RESUMO

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. Bilateral basal ganglia hemorrhage secondary to blast injury has not described before. We report a case with bilateral basal ganglia hemorrhage secondary to explosion.


Assuntos
Hemorragia dos Gânglios da Base/etiologia , Gânglios da Base/lesões , Traumatismos por Explosões/complicações , Adulto , Doenças dos Gânglios da Base/diagnóstico por imagem , Doenças dos Gânglios da Base/etiologia , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/terapia , Edema/diagnóstico por imagem , Edema/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
9.
Acta Cir Bras ; 27(10): 727-31, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23033135

RESUMO

PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35 ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48 h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgical interventions (p>0.05). However, surgical interventions showed advantages of shorter hospitalization, quick removal of hematoma and obvious reduction of cost. CONCLUSION: The microinvasive craniopuncture technique to drain the hematoma within 6-48 h may be a good way in treating hypertensive hemorrhage of basal ganglia region.


Assuntos
Hemorragia dos Gânglios da Base/terapia , Gânglios da Base/cirurgia , Hemorragia Intracraniana Hipertensiva/terapia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Gânglios da Base/patologia , Hemorragia dos Gânglios da Base/patologia , Distribuição de Qui-Quadrado , Feminino , Hematoma/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Punções/métodos , Fatores de Tempo , Resultado do Tratamento
10.
Acta cir. bras ; 27(10): 727-731, Oct. 2012. tab
Artigo em Inglês | LILACS | ID: lil-650563

RESUMO

PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgical interventions (p>0.05). However, surgical interventions showed advantages of shorter hospitalization, quick removal of hematoma and obvious reduction of cost. CONCLUSION: The microinvasive craniopuncture technique to drain the hematoma within 6-48h may be a good way in treating hypertensive hemorrhage of basal ganglia region.


OBJETIVO: Comparar o efeito curativo de diferentes tratamentos da hemorragia hipertensiva cerebral de 25 a 35ml. MÉTODOS: Foram analisados 595 casos agrupados segundo tratamento conservador e evacuação com técnica de punção transcraniana dentro de 6h ou de 6 às 48h do início do quadro clínico. RESULTADOS: O seguimento após três meses e avaliado pelo Escore de Atividade de Vida Diário, indicou que não houve diferenças significantes entre os tratamentos conservador e cirúrgico (p>0.05) O tratamento cirúrgico mostrou vantagem com hospitalização mais curta e redução de custos. CONCLUSÃO: A técnica de punção transcraniana para drenagem de hematoma dos núcleos da base pode ser uma boa alternativa de tratamento.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia dos Gânglios da Base/terapia , Gânglios da Base/cirurgia , Hemorragia Intracraniana Hipertensiva/terapia , Procedimentos Neurocirúrgicos/métodos , Hemorragia dos Gânglios da Base/patologia , Gânglios da Base/patologia , Distribuição de Qui-Quadrado , Hematoma/cirurgia , Tempo de Internação , Punções/métodos , Fatores de Tempo , Resultado do Tratamento
11.
BMC Neurol ; 12: 34, 2012 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-22676908

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage is a disease with high morbidity, high disability rate, high mortality, and high economic burden. Whether patients can benefit from surgical evacuation of hematomas is still controversial, especially for those with moderate-volume hematomas in the basal ganglia. This study is designed to compare the efficacy of endoscopic surgery and conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage. METHODS: Patients meet the criteria will be randomized into the endoscopic surgery group (endoscopic surgery for hematoma evacuation and the best medical treatment) or the conservative treatment group (the best medical treatment). Patients will be followed up at 1, 3, and 6 months after initial treatment. The primary outcomes include the Extended Glasgow Outcome Scale and the Modified Rankin Scale. The secondary outcomes consist of the National Institutes of Health Stroke Scale and the mortality. The Barthel Index(BI) will also be evaluated. The sample size is 100 patients. DISCUSSION: The ECMOH trial is a randomized controlled trial designed to evaluate if endoscopic surgery is better than conservative treatment for patients with moderate-volume hematomas in the basal ganglia. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-TRC-11001614(http://www.chictr.org/en/proj/show.aspx?proj=1618).


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/terapia , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/terapia , Adolescente , Adulto , Idoso , Hemorragia dos Gânglios da Base/complicações , Endoscopia , Feminino , Hematoma Epidural Craniano/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
J Clin Neurosci ; 19(2): 277-80, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22118795

RESUMO

The risk of basal ganglia hemorrhage (BGH) increases in patients of older age and with hypertension. Current guidelines do not recommend routine vascular imaging. However, a proportion of patients with BGH have underlying vascular abnormalities, and these patients may require a different treatment approach. We aimed to assess the proportion of underlying vascular abnormalities in patients with BGH. In this retrospective study, we included all patients who presented with BGH between January 2007 and December 2009 at a single institution. The following data were collected: patient demographics, vascular risk factors, medications, volume of hematoma, CT scans, CT angiogram, magnetic resonance angiography and digital subtraction angiography. We determined the proportion of underlying vascular abnormalities and correlated these findings with risk factors for BGH. A total of 113 consecutive patients with BGH were identified, and vascular imaging was performed in 61. The median age was 62 years and 48 (78.7%) of these patients were male. Forty-two (68.9%) of 61 patients had hypertension. Positive vascular imaging findings were identified in eight of 61 patients (13.1%): three intracranial aneurysms, three cavernous malformations, one Moyamoya disease and one arteriovenous malformation. There were no significant associations between demographic features, vascular risk factors and the hematoma volume between patients with positive and negative vascular imaging. Specifically, an underlying vascular abnormality was not associated with age (≥ 60 years, 6/36 patients had an underlying vascular abnormality, compared with 2/25 patients< 60 years; p=not significant [n.s.]). There was no relationship with hypertension (5/42 hypertensive patients and 3/19 normotensive patients (n.s.) had an underlying vascular abnormality). We concluded that there is a significant proportion of relevant underlying vascular abnormalities in patients with BGH. This likelihood is not predicted by risk factors such as hypertension and age. These findings indicate the importance of vascular imaging in patients with BGH who are not neurologically devastated.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Malformações Vasculares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Malformações Vasculares/diagnóstico , Malformações Vasculares/terapia , Adulto Jovem
13.
Acta Neurol Belg ; 111(4): 268-75, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22368965

RESUMO

BACKGROUND: Hypertension-associated intracerebral hemorrhage, when compared with cerebral infarction and subarachnoid hemorrhage, is associated with worse clinical outcomes or major disability. Worse clinical outcomes have been observed in the elderly population though age as a factor influencing physicians' final treatment decision is not well determined. MATERIALS AND METHODS: We studied 199 patients diagnosed with intracerebral hemorrhage (ICD code: ICD-9-CM-431) who visited a tertiary medical center from January 2003 to March 2006. Baseline characteristics, major medical histories (including co-morbidities), vital signs, neurological assessment (evaluated by the Glasgow Coma Scale), location of the hemorrhage, and the amount of hemorrhaging were all included as variables. A multivariate logistic regression model was chosen to evaluate the significant independent factors that could influence the physician's choice of treatment approach. RESULTS: There were totally 110 patients meeting the inclusion criteria for enrollment. We observed that worse neurological function on-arrival (chi2 = 8.57, p = .01) and larger amount of bleeding (chi2 = 9.29, p = .01) were more likely to receive surgery. Multivariate logistic regression revealed that age, neurological function on-arrival, and the amount of hemorrhage were significant independent factors influencing the physicians' treatment decision (all p < .05). CONCLUSION: Age, after adjustment for clinical variables representative of clinical severity, was an important factor in the final therapeutic decision. Our data suggest that a comprehensive evaluation of the patients' on-arrival status may be made and that advanced age should not be a determining factor in the choice of final treatment methods.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/terapia , Comportamento de Escolha , Adulto , Fatores Etários , Idoso , Distribuição de Qui-Quadrado , Feminino , Escala de Coma de Glasgow , Humanos , Classificação Internacional de Doenças , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Adulto Jovem
14.
World Neurosurg ; 74(2-3): 286-93, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21492562

RESUMO

BACKGROUND: Brain cortex leptin messenger ribonucleic acid (mRNA) expression and serum leptin level are up-regulated in ischemic mouse brain, as well as in rat brain with traumatic brain injury. Elevated leptin plasma levels predict cerebral hemorrhagic stroke independently of traditional risk factors. The goal of this study was to investigate change in plasma leptin level after intracerebral hemorrhage (ICH) and to evaluate its relation with disease outcome. METHODS: Eighty-six patients admitted within 6 hrs after ICH and 30 healthy controls were included. Plasma samples were obtained on admission and at days 1, 2, 3, 5, and 7 after ICH. Its concentration was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: After ICH, plasma leptin level in patients increased during the 6-hour period immediately, peaked in 24 hours, decreased gradually thereafter, and was substantially higher than that in healthy controls during the 7-day period. Plasma leptin levels were highly associated with initial Glasgow coma scores, ICH volumes, presence of intraventricular hemorrhage, and survival rates (all P < 0.05). A multivariate analysis selected plasma leptin level related to plasma C-reactive protein level (standardized coefficient, 0.293; P = 0.003). A multivariate analysis showed baseline plasma leptin level as a good predictor for 1-week mortality (odds ratio, 1.228; 95% confidence interval, 1.070-1.409; P = 0.003). A receiver operating characteristic curve identified that a baseline plasma leptin level greater than 34.1 ng/mL predicted 1-week mortality of patients with 75.0% sensitivity and 85.2% specificity (P < 0.001). Area under curve of GCS score was statistically significantly larger than that of plasma leptin level (P = 0.035), but ICH volume's area under curve not (P = 0.078). CONCLUSIONS: Increased plasma leptin level is found after ICH and may contribute to inflammatory process of ICH, in association with a poor clinical outcome.


Assuntos
Hemorragia dos Gânglios da Base/sangue , Leptina/sangue , Idoso , Hemorragia dos Gânglios da Base/mortalidade , Hemorragia dos Gânglios da Base/terapia , Biomarcadores , Análise Química do Sangue , Terapia Combinada , Determinação de Ponto Final , Ensaio de Imunoadsorção Enzimática , Feminino , Escala de Coma de Glasgow , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Rofo ; 178(6): 618-26, 2006 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-16703498

RESUMO

PURPOSE: In the nine years since the posterior reversible (leuc) encephalopathy syndrome (PRES) was first described, a number of causes have been under discussion. These not only include arterial hypertension, i. e. hypertensive crises, but also various toxic substances, i. e. immunosuppressive or chemotherapeutic agents, that are responsible for the formation of the symptoms and characteristic MR tomographic brain findings. MATERIALS AND METHODS: Initial and follow-up MRI examinations of 8 patients were analyzed. All patients had acute neurological symptoms (headaches, seizures, visual disorders and vigilance disturbances) together with a detectable hypertensive crisis. RESULTS: MRI disclosed increased signal intensity in subcortical and some cortical lesions in all patient FLAIR sequences. These changes were particularly extensive in the posterior circulation (occipital, cerebellum and brain stem) although they were also detected in brain areas supplied by the carotid artery. However, a cytotoxic genesis of the changes was ruled out in each patient by means of a normal DWI. Furthermore, when the blood pressure was normalized, reversibility of the lesions as proof of the diagnosis was detectable. CONCLUSION: The imaging findings can be typically analyzed as a predominantly posterior distribution of encephalopathic lesions with a high probability of reversibility after lowering blood pressure was patients suffering from a critical increase in blood pressure with corresponding neurological symptoms. The exact pathophysiology remains unclear, but the cause currently most favored is a vasculopathy of the posterior circulation due to diminished adrenergic autoregulation in combination with a dysfunction of the endothelial cells. In conclusion, we suggest designating this subpopulation from the non-uniform pool of patients with posterior (leuc) encephalopathy as "hypertensive encephalopathy". "Hypertensive encephalopathy" has to be distinguished from "toxic encephalopathy", particularly due to different therapeutic and prognostic consequences.


Assuntos
Encéfalo/patologia , Imagem de Difusão por Ressonância Magnética , Hipertensão Maligna/diagnóstico , Encefalopatia Hipertensiva/diagnóstico , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Adulto , Anti-Hipertensivos/uso terapêutico , Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/terapia , Eclampsia/diagnóstico , Eclampsia/terapia , Feminino , Seguimentos , Humanos , Hipertensão Maligna/tratamento farmacológico , Encefalopatia Hipertensiva/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Exame Neurológico/efeitos dos fármacos , Gravidez , Indução de Remissão
16.
Neuroradiology ; 47(2): 105-7, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15714272

RESUMO

Acute or subacute bipallidal lesion, an uncommon radiological feature produced by metabolic disorders or poisoning, has never been attributed to ethylene glycol (EG) intoxication. This 50-year-old Afro-Caribbean alcoholic man had unexplained loss of consciousness. Blood tests showed osmolar gap. Drug screening was positive for EG at 6.06 mmol/l. Brain CT revealed bilateral pallidal haemorrhage. Pallidal haematoma, which could be related to deposition of oxalate crystals issued from EG metabolism, should lead to toxicological screening.


Assuntos
Hemorragia dos Gânglios da Base/induzido quimicamente , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Etilenoglicol/envenenamento , Globo Pálido , Hemorragia dos Gânglios da Base/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
18.
Arq Neuropsiquiatr ; 61(2B): 376-80, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12894270

RESUMO

In the present study, we have evaluated the use of intraventricular pressure catheters in thalamic and ganglionic hemorrhages. Ten patients admitted in our Emergency Department in Glasgow Coma Scale (GCS) equal or below 13 enrolled the study (at least one point should have been lost in the eye opening score to exclude purely aphasic patients that were fully alert). After a complete clinical and neurological evaluation, computed tomography scans were obtained and the volume of the hematomas, as well as presence or absence of hydrocephalus, were considered. Intraventricular pressure catheters connected in parallel to external derivation systems were implanted and patients were thereafter sent to the ICU. Patients that presented mass effect lesions with sustained increased ICP levels or clinical and neurological deterioration were submitted in addition, to the surgical evacuation of the hematomas. Clinical evolution, complications and the rehabilitation of the patients were recorded. Clinical outcome was assessed with the Glasgow Outcome Score. In all but three patients the initial intracranial pressure levels were bellow 20 mmHg (mean for all patients was 14.1 +/- 6.5 mmHg). Notwithstanding, these three patients were extremely difficult to treat. For this group of patients mortality was 100%. Among the patients that presented ICP levels bellow 20 mmHg, 04 developed hydrocephalus and 03 did not display ventricular dilation. As expected, the major benefits concerning the intraventricular pressure catheters connected in parallel with external derivation systems were observed in the group of patients that presented ICP levels bellow 20 mmHg and had hydrocephalus. Mild non-statistically significant correlations for all the three groups were achieved either when the initial GCS and ICP levels (r=-0.28, p=0.43) or when ICP levels and the volumes of the hematomas were compared (r=0.38, p=0.28). In addition, no significant correlations were observed concerning the final outcome of the patients and the variables previously evaluated.


Assuntos
Hemorragia Cerebral/terapia , Pressão Intracraniana , Monitorização Fisiológica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/mortalidade , Hemorragia dos Gânglios da Base/terapia , Cateteres de Demora , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Drenagem/instrumentação , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Tálamo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Stroke ; 32(10): 2237-45, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11588307

RESUMO

BACKGROUND AND PURPOSE: We investigated serial metabolic changes in frontal lobes of patients with deep intracerebral hemorrhage (ICH) to examine the correlation between N-acetylaspartate (NAA) and degree of motor impairment or clinical outcome. METHODS: - Twenty patients with deep ICH were examined with proton magnetic resonance spectroscopy with the application of a multivoxel method (1 voxel=10x10x20 mm; 64 voxels). NAA/creatine ratios in the white matter of the primary motor and premotor areas on both sides were measured sequentially: within 48 hours, at 2 weeks, and 1 month after onset. The National Institutes of Health Stroke Scale and Barthel Index for disability were measured for each patient. RESULTS: - In the primary motor area on the affected side, where the hematoma did not extend, the NAA/creatine ratio decreased sequentially. At 48 hours and 2 weeks after onset, a negative correlation was detected between NAA/creatine and hematoma volume, but there was no correlation 1 month later. At 2 weeks, NAA/creatine correlated negatively with motor impairment (r=-0.750), and there was a significant correlation with clinical outcome as early as 2 weeks after onset (r=0.954). These sequential changes of NAA/creatine varied according to patients' long-term clinical outcome. Patients with poor outcome demonstrated notable reduction of NAA/creatine over the bilateral frontal lobes. CONCLUSIONS: - The delayed gradual reduction of NAA/creatine ratio in the frontal lobes correlates with motor deficit and clinical outcome after deep ICH, suggesting that the neural networks in the frontal lobe could be important for recovery.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico , Hemorragia dos Gânglios da Base/metabolismo , Lobo Frontal/metabolismo , Espectroscopia de Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/metabolismo , Idoso , Idoso de 80 Anos ou mais , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Hemorragia dos Gânglios da Base/complicações , Hemorragia dos Gânglios da Base/terapia , Creatina/metabolismo , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
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