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2.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541949

RESUMO

We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient's history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Diagnóstico Diferencial , Discinesias/diagnóstico , Hiperglicemia/diagnóstico , Adesão à Medicação , Idoso , Anticonvulsivantes/uso terapêutico , Gânglios da Base/diagnóstico por imagem , Glicemia/análise , Coma/etiologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Levetiracetam/uso terapêutico , Imagem por Ressonância Magnética , Convulsões/tratamento farmacológico , Convulsões/etiologia , Tomografia Computadorizada por Raios X
3.
J Clin Neurosci ; 85: 78-83, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33581795

RESUMO

Anticoagulation for postoperative venous thromboembolism (VTE) may infer a higher risk of intracranial hemorrhage. We treat patients with VTE using slowly titrating intravenous heparin drip without bolus. When PTT is greater than 60 s, a head CT is obtained to monitor for the development of a intracranial hemorrhage before transition to oral anticoagulation. We evaluated the utility of routine surveillance head CT to monitor for intracranial hemorrhage during anticoagulation. This is a case series of neurosurgical patients in an academic quaternary hospital who developed a VTE after cranial procedures between 2007 and 2017. Over 11,000 patients were screened for the study. Patients' demographics data, surgical indication, PTT at the time of surveillance CT head, surveillance CT head findings, and patient's clinical course were reviewed. A total of 83 patients were included. Three patients (3.6%) developed a new subclinical hemorrhage on CT head imaging while on heparin drip. Interval CT head showed stable hemorrhage in all patients. Heparin drip was stopped in two patients and they both progressed from DVT to pulmonary embolism: one patient died due to cardiac arrest, the other patient was transitioned to oral anticoagulation. In the third patient heparin drip was continued uneventfully and transitioned to oral anticoagulation with no further clinical sequalae. Surveillance CT while on heparin drip for VTE management detected subclinical intracranial hemorrhage in a small subset of patients. Patients whose anticoagulation was stopped had progression of VTE. Undertreatment of VTE in the presence of subclinical hemorrhage may lead to significant morbidity and mortality.


Assuntos
Craniotomia/efeitos adversos , Hemorragias Intracranianas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Heparina/uso terapêutico , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X/métodos , Tromboembolia Venosa/etiologia
4.
Am J Surg ; 221(3): 606-608, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33485622

RESUMO

BACKGROUND: Many institutions obtain a delayed head CT in patients presenting after a ground level fall while on anticoagulation. This study evaluates their risk of delayed ICH. METHODS: Retrospective chart review of 635 patients on anticoagulation who sustained a ground level fall with a negative initial head CT and a GCS above eight. Patients underwent a repeat head CT within 48 h. The ISS was calculated for all patients. RESULTS: Five patients had a delayed ICH. All survived and none required neurosurgical intervention. Patient variables did not have any correlation with development of ICH. Patients with a delayed ICH had a significantly higher ISS. CONCLUSION: Patients on anticoagulation presenting to the hospital after a ground level fall, with a GCS above eight and an initial negative head CT, do not need to undergo repeat imaging. ISS could be used to stratify patients who are at higher risk of delayed ICH.


Assuntos
Acidentes por Quedas , Anticoagulantes/uso terapêutico , Traumatismos Craniocerebrais/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Idoso , Traumatismos Craniocerebrais/complicações , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
5.
Neurology ; 96(9): e1290-e1300, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33431517

RESUMO

OBJECTIVE: To test the hypothesis that bone mineral loss is mechanistically related to cerebral small vessel disease (SVD), we investigated the relationship between bone mineral density and the prevalence and intensity of SVD among patients with stroke. METHODS: We analyzed data of 1,190 consecutive patients with stroke who were >50 years of age and underwent both brain MRI and dual-energy x-ray absorptiometry from the stroke registry of Chung-Ang University Hospital in Seoul, Korea. The patients were categorized into 3 groups according to their bone mineral density (normal, osteopenia, and osteoporosis). White matter hyperintensities, silent lacunes, cerebral microbleeds, and extensive perivascular space were assessed from brain MRI. Multinomial logistic regression model was used to examine the association between osteoporosis and total SVD score. We also recruited 70 patients with stroke to study serum bone turnover markers and microRNAs related to both cerebral atherosclerosis and bone metabolism to understand bone and brain interaction. RESULTS: Osteoporosis was determined among 284 patients (23.9%), and 450 patients (37.8%) had osteopenia. As bone mineral density decreased, total SVD score and the incidence of every SVD phenotype increased except strictly lobar cerebral microbleeds. Multinomial logistic regression analysis showed that osteoporosis was independently associated with severe SVD burden. The levels of microRNA-378f were significantly increased among the patients with osteoporosis and maximal total SVD score and positively correlated with parathyroid hormone and osteocalcin. CONCLUSIONS: These findings suggest a pathophysiologic link between bone mineral loss and hypertensive cerebral arteriolar degeneration, possibly mediated by circulating microRNA.


Assuntos
Densidade Óssea , Doenças de Pequenos Vasos Cerebrais/patologia , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas Metabólicas/complicações , Encéfalo/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Osteocalcina/sangue , Osteoporose/complicações , Hormônio Paratireóideo/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Substância Branca/diagnóstico por imagem
6.
J Stroke Cerebrovasc Dis ; 30(3): 105595, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33450605

RESUMO

BACKGROUND: Endovascular thrombectomy (EVT) is highly effective but may also lead to hemorrhagic transformation (HT) and edema, which may be more pronounced in severe ischemia. We sought to determine whether glibenclamide can attenuate HT and edema in a severe ischemia-reperfusion model that reflects EVT. METHODS: Using a transient middle cerebral artery occlusion (tMCAo) rodent model of stroke, we studied two rat cohorts, one without rt-PA and a second cohort treated with rt-PA. Glibenclamide or vehicle control was administered as an intravenous bolus at reperfusion, followed by continuous subcutaneous administration with an osmotic pump. RESULTS: Compared to vehicle control, glibenclamide improved neurological outcome (median 7, interquartile range [IQR 6-8] vs. control median 6 [IQR 0-6], p = 0.025), reduced stroke volume (323 ± 42 vs. 484 ± 60 mm3, p < 0.01), swelling volume (10 ± 4 vs. 28 ± 7%, p < 0.01) and water content (84 ± 1 vs. 85 ± 1%, p < 0.05). Glibenclamide administration also reduced HT based on ECASS criteria, densitometry (0.94 ± 0.1 vs. 1.15 ± 0.2, p < 0.01), and quantitative hemoglobin concentration (2.7 ± 1.5 vs. 6.2 ± 4.6 uL, p = 0.011). In the second cohort with rt-PA coadministration, concordant effects on HT were observed with glibenclamide. CONCLUSIONS: Taken together, these studies demonstrated that glibenclamide reduced the amount of edema and HT after severe ischemia. This study suggests that co-administration of glibenclamide may be worth further study in severe stroke patients treated with EVT with or without IV rt-PA.


Assuntos
Edema Encefálico/prevenção & controle , Glibureto/administração & dosagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Hemorragias Intracranianas/prevenção & controle , Fármacos Neuroprotetores/administração & dosagem , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/patologia , Modelos Animais de Doenças , Fibrinolíticos/farmacologia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/patologia , Infusões Subcutâneas , Injeções Intravenosas , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/patologia , Masculino , Ratos Wistar , Traumatismo por Reperfusão/diagnóstico por imagem , Traumatismo por Reperfusão/patologia , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/farmacologia
7.
J Stroke Cerebrovasc Dis ; 30(4): 105603, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33484980

RESUMO

OBJECTIVE: To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients. METHODS: Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed. RESULTS: Of 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively. CONCLUSIONS: COVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.


Assuntos
/epidemiologia , Hemorragias Intracranianas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , /terapia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/terapia , Masculino , New York/epidemiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
9.
J Stroke Cerebrovasc Dis ; 30(3): 105538, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341563

RESUMO

OBJECTS: In this study, we investigated the association between plasma total homocysteine(tHcy) levels and the risk of early hemorrhagic transformation(HT) in patients with acute ischemic stroke(AIS). METHODS: Consecutive hospitalized participants who met the inclusion criteria were enrolled and grouped according to plasma tHcy levels. Participants were divided into a low homocysteine level(L-tHcy) group (<12 µmol/L) and a high homocysteine level group(H-tHcy) (≥ 12 µmol/L). Baseline computed tomography (CT) examination was performed. HT was determined via CT or magnetic resonance imaging within 1 to 3 days after admission. RESULTS: A total of 1858 patients were screened and 1378 patients completed the this study(797 patients in the H-tHcy group and 581 patients in the L-tHcy group). HT incidence was 5.2% (30/581,) in the L-tHcy group and 11.2% (90/797) in the H-tHcy group(P<0.05). Binary logistic regression analysis showed that initial NIHSS score, tHcy levels, treatment with recombinant tissue plasminogen activator thrombolysis, systolic blood pressure on admission, glucose level on admission, smoking status and estimated glomerular filtration rate were independent risk factors for HT. Receiver operating characteristic analysis showed that tHcy level was a moderately sensitive and specific index to predict the incidence of HT, and the optimal cutoff was 16.56 µmol/L (sensitivity 63.3%, specificity 41.3%). CONCLUSION: Our study findings reveal that high plasma tHcy level is one independent risk factor associated with increased risk of early HT in patients with AIS.


Assuntos
Homocisteína/sangue , Hemorragias Intracranianas/epidemiologia , /sangue , Idoso , Biomarcadores/sangue , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico por imagem , /epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Regulação para Cima
10.
Acad Radiol ; 28(1): 85-93, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32102747

RESUMO

RATIONALE AND OBJECTIVES: Misdiagnosis of intracranial hemorrhage (ICH) can adversely impact patient outcomes. The increasing workload on the radiologists may increase the chance of error and compromise the quality of care provided by the radiologists. MATERIALS AND METHODS: We used an FDA approved artificial intelligence (AI) solution based on a convolutional neural network to assess the prevalence of ICH in scans, which were reported as negative for ICH. We retrospectively applied the AI solution to all consecutive noncontrast computed tomography (CT) head scans performed at eight imaging sites affiliated to our institution. RESULTS: In the 6565 noncontrast CT head scans, which met the inclusion criteria, 5585 scans were reported to have no ICH ("negative-by-report" cases). We applied AI solution to these "negative-by-report" cases. AI solution suggested there were ICH in 28 of these scans ("negative-by-report" and "positive-by-AI solution"). After consensus review by three neuroradiologists, 16 of these scans were found to have ICH, which was not reported (missed diagnosis by radiologists), with a false-negative rate of radiologists for ICH detection at 1.6%. Most commonly missed ICH was overlying the cerebral convexity and in the parafalcine regions. CONCLUSION: Our study demonstrates that an AI solution can help radiologists to diagnose ICH and thus decrease the error rate. AI solution can serve as a prospective peer review tool for non-contrast head CT scans to identify ICH and thus minimize false negatives.


Assuntos
Inteligência Artificial , Radiologia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Estudos Prospectivos , Estudos Retrospectivos
12.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 24-29, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016673

RESUMO

OBJECTIVE: To identify the likelihood of developing systemic inflammation (SI) as a general pathological process in severe haemorrhagic intracerebral stroke with and without the phenomenon of ineffective cerebral blood flow. MATERIAL AND METHOD: Three groups were examined: 1) 89 blood donors (controls), 2) 15 patients with severe haemorrhagic stroke without the phenomenon of ineffective brain blood flow; 3) 26 patients with severe haemorrhagic stroke with ineffective cerebral blood flow. Ineffective cerebral blood circulation was recorded on the basis of transcranial Doppler ultrasound data; 87% of patients had clinical signs of brain death. All patients in the groups with haemorrhagic stroke had signs of multiple organ dysfunction according to the Sepsis-related Organ Failure scale, all of them received intensive care. An integrated scale based on the determination of plasma concentrations of cytokines (IL-6, IL-8, IL-10, TNF-α), procalcitonin, cortisol, D-dimers, myoglobin, troponin I was used to verify systemic inflammation. RESULTS AND CONCLUSION: Systemic inflammation or borderline state (pre-SI) was identified in all patients of the second group both on 1-3 days from the onset of haemorrhagic stroke, and on 5-8 days. On the contrary, in the third group, there were no signs of SI on 1-3 days. On 5-8 days, signs of SI and pre-SI were recorded only in 18.2% of patients. Apparently, the reason for these differences is the blockade of the passage of tissue decay products and other pro-inflammatory factors into the bloodstream from the damaged brain in the third group.


Assuntos
Circulação Cerebrovascular , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Encéfalo/diagnóstico por imagem , Humanos , Inflamação
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1290-1293, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018224

RESUMO

Intracranial hemorrhage (ICH) is a life-threatening condition, the outcome of which is associated with stroke, trauma, aneurysm, vascular malformations, high blood pressure, illicit drugs and blood clotting disorders. In this study, we presented the feasibility of the automatic identification and classification of ICH using a head CT image based on deep learning technique. The subtypes of ICH for the classification was intraparenchymal, intraventricular, subarachnoid, subdural and epidural. We first performed windowing to provide three different images: brain window, bone window and subdural window, and trained 4,516,842 head CT images using CNN-LSTM model. We used the Xception model for the deep CNN, and 64 nodes and 32 timesteps for LSTM. For the performance evaluation, we tested 727,392 head CT images, and found the resultant weighted multi-label logarithmic loss was 0.07528. We believe that our proposed method enhances the accuracy of ICH identification and classification and can assist radiologists in the interpretation of head CT images, particularly for brain-related quantitative analysis.


Assuntos
Hemorragias Intracranianas , Acidente Vascular Cerebral , Encéfalo , Estudos de Viabilidade , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Cerebrovasc Dis ; 49(5): 540-549, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33080610

RESUMO

INTRODUCTION: Endovascular treatment (EVT) is effective against acute cerebral large vessel occlusion (LVO). However, it has been associated with a high incidence of intracranial hemorrhage (ICH). Because the incidence of ICH and prognostic impact of ICH were not scrutinized in general patients, we investigated the impact of ICH after EVT on functional outcome at 90 days in patients with acute LVO. METHODS: RESCUE-Japan Registry 2 was a multicenter registry that enrolled 2,420 consecutive patients with acute LVO within 24 h of onset. We analyzed 1,281 patients who received EVT and compared the functional outcomes between those with and without ICH (ICH and no-ICH groups, respectively) within 24 h after EVT. We explored the factors associated with ICH and prognostic impact of symptomatic ICH (SICH) among patients with ICH. We estimated the adjusted odds ratios (ORs) for good functional outcome as modified Rankin Scale scores 0-2 and mortality. We also explored the prognostic impact of symptomatic ICH (SICH) among patients with ICH. RESULTS: ICH occurred in 333 patients (26.0%). Several factors such as perioperative edaravone, stent retriever, and baseline glucose were associated with development of ICH within 24 h. A good outcome was observed in 80 (24.0%) and 454 (47.9%) patients in the ICH and no-ICH groups, respectively, and the adjusted OR was 0.3 (95% confidence interval [CI] = 0.2-0.5, p < 0.0001). Incidence of mortality within 90 days was not significantly different between the groups (adjusted OR 1.2; 95% CI: 0.7-1.9, p = 0.5). SICH was observed in 36 (10.8%) of 333 patients with ICH, and the good outcomes were 8.3 and 25.9% in patients with SICH and asymptomatic ICH (AICH), respectively (p = 0.02). Mortality at 90 days was 30.6 and 7.1% in patients with SICH and AICH, respectively (p < 0.0001). CONCLUSIONS: The functional outcomes at 90 days were significantly worse in patients who developed ICH after receiving EVT for acute LVO, but the mortality was generally similar.


Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares/efeitos adversos , Hemorragias Intracranianas/epidemiologia , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
15.
Stroke ; 51(10): 2997-3006, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32951540

RESUMO

BACKGROUND AND PURPOSE: Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management. METHODS: We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020. RESULTS: The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5-3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95% CI, 1.86-9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95% CI, 1.82-3.63]), brainstem location (adjusted odds ratio, 2.93 [95% CI, 1.28-6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95% CI, 1.01-4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77-0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78-0.96]). CONCLUSIONS: Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04076449.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemorragias Intracranianas/etiologia , Adulto , Feminino , Seguimentos , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nomogramas , Recidiva , Medição de Risco , Fatores de Risco , Adulto Jovem
16.
J Stroke Cerebrovasc Dis ; 29(10): 105156, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912510

RESUMO

Mutations in type four collagens, specifically COL4A1 and COL4A2, have been associated with cerebral small vessel disease (SVD), defined as lacunar infarcts, deep intracerebral hemorrhages (ICH), and leukoaraiosis. We present a case of a man with recurrent cerebral infarcts, related to a novel COL4A2 mutation, the p.A1534S variant. Magnetic resonance imaging demonstrated multiple lacunar infarcts, numerous deep and lobar microhemorrhages and advanced leukoaraiosis. Evaluation for COL4A2 mutations should be considered when suspecting a genetic cerebral small vessel disease.


Assuntos
Infarto Cerebral/genética , Colágeno Tipo IV/genética , Hemorragias Intracranianas/genética , Leucoaraiose/genética , Mutação , Infarto Cerebral/diagnóstico por imagem , Análise Mutacional de DNA , Predisposição Genética para Doença , Heterozigoto , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Leucoaraiose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fenótipo , Recidiva , Sequenciamento Completo do Exoma
17.
J Stroke Cerebrovasc Dis ; 29(10): 105122, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912548

RESUMO

BACKGROUND: Endovascular treatment (EVT) is merely recommended as class of recommendation IIb for patients with ASPECTS <6 according to the American Heart Association guideline 2019. In addition, the best determined imaging technique for EVT in patient with ASPECTS<6 remains unknown. The objective of this study was to define the safety and efficacy of EVT for patients with ASPECTS<6 and investigate the superiority between MRI and CT for patient selection. METHODS: A systematic search of PubMed, EMBASE, The Cochrane Library and other additional sources was performed for studies published with no publication period. Our study was conducted corresponding to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMA) guidelines. The analysis was performed using the Comprehensive Meta-Analysis (CMA) 2.0. RESULTS: Five studies reporting data from 844 participants were included in our analysis according to the inclusion criteria. Consequently, EVT was associated with statistically significant higher functional independence compared with MT (OR 5.401, 95% CI 3.227-9.041). Whereas EVT was found to be related to lower mortality compared with MT based on eligible data (OR 0.461, 95% CI 0.329-0.647). No significant difference was identified in sICH between EVT and MT (OR 1.075, 95% CI 0.452-2.558). CONCLUSION: According to the results of our study, we suggested that EVT is a preferred therapy in ACS patients with ASPECTS<6 in consideration of efficacy and safety. Furthermore, MRI did not show superiority over CT as no statistical difference was detected in all subgroups.


Assuntos
Isquemia Encefálica/terapia , Circulação Cerebrovascular , Procedimentos Endovasculares , Hemorragias Intracranianas/terapia , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
18.
J Stroke Cerebrovasc Dis ; 29(9): 105016, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807431

RESUMO

OBJECTIVE: To highlight the increased risk of hemorrhagic stroke secondary to postulated COVID-19 mediated vasculopathy with concomitant ECMO related bleeding complications. BACKGROUND: COVID-19 has shown to be a systemic illness, not localized to the respiratory tract and lung parenchyma. Stroke is a common neurological complication. In particular, critically ill patients on ECMO are likely at higher risk of developing hemorrhagic stroke. CASE PRESENTATION: 38-year-old man presented with fever, cough, and shortness of breath. Due to severe respiratory failure, he required ECMO support. Subsequently, he was found to have left temporal intraparenchymal hemorrhage. Overall, his clinical course improved, and he was discharged with minimal neurological deficits. CONCLUSION: Although intracranial hemorrhage is a known complication of ECMO, patients with COVID-19 infection may be at a higher risk of cerebrovascular complications due to vasculopathy.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea , Hemorragias Intracranianas/etiologia , Pulmão/virologia , Pneumonia Viral/terapia , Acidente Vascular Cerebral/etiologia , Adulto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Interações Hospedeiro-Patógeno , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/virologia , Pulmão/fisiopatologia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/virologia , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 29(9): 105084, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807480

RESUMO

OBJECTIVE: To assess whether smoking increases the risk of bleeding in patients with cerebral arteriovenous malformations (CAVM). MATERIAL AND METHODS: According to our research plan, 385 CAVM patients admitted to Beijing Tiantan Hospital from December 2015 to January 2018 were included in this study, including 210 bleeding patients and 175 non-bleeding patients. We divided patients into three subgroups of current smokers, ex-smokers (those who quit smoking for one year or more) and non-smokers. The relationship between smoking and the risk of CAVM rupture was assessed by univariate and multivariate regression analysis. RESULTS: Multivariate regression analysis showed that there was a statistically significant difference between current smoker and non-smoker (OR = 1.87, p = 0.019). Among the covariates of the multivariate regression analysis, the location, combined with blood flow-related intracranial aneurysms and size were related to the risk of CAVM bleeding. CONCLUSION: Current smoking may increase the risk of CAVM bleeding; however, there was no significant correlation between ex-smoking and CAVM bleeding.


Assuntos
Ex-Fumantes , Malformações Arteriovenosas Intracranianas/epidemiologia , Hemorragias Intracranianas/epidemiologia , não Fumantes , Fumantes , Fumar/efeitos adversos , Adulto , Pequim/epidemiologia , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fumar/epidemiologia , Fatores de Tempo , Adulto Jovem
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