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1.
World Neurosurg ; 133: e121-e128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476469

RESUMO

BACKGROUND: Primary intraventricular hemorrhage (PIVH) is rare, and causes, characteristics, and outcomes remain unknown in children. METHODS: We retrospectively analyzed the clinical characteristics of patients 1 month to 21 years of age who were admitted to the hospital with PIVH over a 7-year period. PIVH was defined as bleeding confined to the ventricular system without parenchymal or subarachnoid hemorrhage involvement. RESULTS: Of 18 included patients, 55.6% were female, and mean age was 13.8 ± 6.0 years. The most common presenting symptoms were headache (77.8%) and vomiting (33.3%). In 15 patients (83.3%), known etiologies were diagnosed, including arteriovenous malformations (66.7%), moyamoya disease (11.1%), and aneurysms (5.6%). Idiopathic PIVH was the diagnosis in 3 patients (16.7%). Surgery was performed in 15 patients (83.3%), and 3 patients (16.7%) received conservative treatment. Four patients (28.6%) had an unfavorable outcome at discharge, and 3 patients (16.7%) had an unfavorable outcome at the 3-month follow-up. Higher Graeb score was associated with an unfavorable outcome in both short-term and long-term follow-up. CONCLUSIONS: Arteriovenous malformations were diagnosed in most pediatric patients with PIVH. Specific surgical treatment of underlying etiologies should be required to increase clinical improvement. Children with a higher Graeb score at admission tended to have poor early and late outcomes.


Assuntos
Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/irrigação sanguínea , Adolescente , Malformações Arteriovenosas/complicações , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Cefaleia/etiologia , Humanos , Lactente , Recém-Nascido , Aneurisma Intracraniano/complicações , Masculino , Doença de Moyamoya/complicações , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia , Adulto Jovem
2.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
3.
Neurology ; 93(9): e879-e888, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31371565

RESUMO

OBJECTIVE: To describe the relationship between intraventricular hemorrhage (IVH) expansion and long-term outcome and to use this relationship to select and validate clinically relevant thresholds of IVH expansion in 2 separate intracerebral hemorrhage (ICH) populations. METHODS: We used fractional polynomial analysis to test linear and nonlinear models of 24-hour IVH volume change and clinical outcome with data from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT)-ICH study. The primary outcome was poor clinical outcome (modified Rankin Scale [mRS] score 4-6) at 90 days. We derived dichotomous thresholds from the selected model and calculated diagnostic accuracy measures. We validated all thresholds in an independent single-center ICH cohort (Massachusetts General Hospital). RESULTS: Of the 256 patients from PREDICT, 127 (49.6%) had an mRS score of 4 to 6. Twenty-four-hour IVH volume change and poor outcome fit a nonlinear relationship, in which minimal increases in IVH were associated with a high probability of an mRS score of 4 to 6. IVH expansion ≥1 mL (n = 53, sensitivity 33%, specificity 92%, adjusted odds ratio [aOR] 2.68, 95% confidence interval [CI] 1.11-6.46) and development of any new IVH (n = 74, sensitivity 43%, specificity 85%, aOR 2.53, 95% CI 1.22-5.26) strongly predicted poor outcome at 90 days. The dichotomous thresholds reproduced well in a validation cohort of 169 patients. CONCLUSION: IVH expansion as small as 1 mL or any new IVH is strongly predictive of poor outcome. These findings may assist clinicians with bedside prognostication and could be incorporated into definitions of hematoma expansion to inform future ICH treatment trials.


Assuntos
Hemorragia Cerebral/diagnóstico , Ventrículos Cerebrais/irrigação sanguínea , /estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Tomografia Computadorizada por Raios X
4.
Rinsho Shinkeigaku ; 59(8): 509-514, 2019 Aug 29.
Artigo em Japonês | MEDLINE | ID: mdl-31341125

RESUMO

This is a case of a 71 years old man. Hemichorea appeared in the left half of his body in the middle of November, 2014. Minute hyperintense areas in the white matter near the posterior horn of the right lateral ventricle and in the right parasagittal frontal cortex was shown in MRI diffusion weighted image. Severe stenosis was seen in the right internal carotid artery, and reduction in cerebral blood flow of the right cerebral hemisphere including the basal ganglia was shown in single photon emission computed tomography (SPECT). After having carotid endarterectomy of the right internal carotid artery in January, 2015, hemichorea disappeared, and the cerebral blood flow of the right cerebral hemisphere improved. It is known that hemichorea is caused by the infarction of the basal ganglia. In recent years, some hemichorea cases are reported around East Asia caused by internal carotid artery stenosis with reduction in cerebral blood flow.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Coreia/etiologia , Endarterectomia das Carótidas , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Circulação Cerebrovascular , Cérebro/irrigação sanguínea , Cérebro/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
5.
Arch Dis Child Fetal Neonatal Ed ; 103(1): F59-F65, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28588126

RESUMO

BACKGROUND AND PURPOSE: The anatomy of the deep venous system plays an important role in the pathogenesis of brain lesions in the preterm brain as shown by different histological studies. The aims of this study were to compare the subependymal vein anatomy of preterm neonates with germinal matrix haemorrhage-intraventricular haemorrhage (GMH-IVH), as evaluated by susceptibility-weighted imaging (SWI) venography, with a group of age-matched controls with normal brain MRI, and to explore the relationship between the anatomical features of subependymal veins and clinical risk factors for GMH-IVH. METHODS: SWI venographies of 48 neonates with GMH-IVH and 130 neonates with normal brain MRI were retrospectively evaluated. Subependymal vein anatomy was classified into six different patterns: type 1 represented the classic pattern and types 2-6 were considered anatomic variants. A quantitative analysis of the venous curvature index was performed. Variables were analysed by using Mann-Whitney U and χ2 tests, and a multiple logistic regression analysis was performed to evaluate the association between anatomical features, clinical factors and GMH-IVH. RESULTS: A significant difference was noticed among the six anatomical patterns according to the presence of GMH-IVH (χ2=14.242, p=0.014). Anatomic variants were observed with higher frequency in neonates with GMH-IVH than in controls (62.2% and 49.6%, respectively). Neonates with GMH-IVH presented a narrower curvature of the terminal portion of subependymal veins (p<0.05). These anatomical features were significantly associated with GMH-IVH (p<0.05). CONCLUSION: Preterm neonates with GMH-IVH show higher variability of subependymal veins anatomy confirming a potential role as predisposing factor for GMH-IVH.


Assuntos
Hemorragia Cerebral Intraventricular , Veias Cerebrais , Ventrículos Cerebrais , Recém-Nascido Prematuro/fisiologia , Análise de Variância , Anatomia Regional/métodos , Causalidade , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/etiologia , Veias Cerebrais/anatomia & histologia , Veias Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Neuroimagem Funcional/métodos , Humanos , Recém-Nascido , Angiografia por Ressonância Magnética/métodos , Masculino , Flebografia/métodos , Medição de Risco
6.
Pediatr Res ; 82(4): 634-641, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28553990

RESUMO

BackgroundPost-hemorrhagic ventricular dilatation (PHVD) is predictive of mortality and morbidity among very-low-birth-weight preterm infants. Impaired cerebral blood flow (CBF) due to elevated intracranial pressure (ICP) is believed to be a contributing factor.MethodsA hyperspectral near-infrared spectroscopy (NIRS) method of measuring CBF and the cerebral metabolic rate of oxygen (CMRO2) was used to investigate perfusion and metabolism changes in patients receiving a ventricular tap (VT) based on clinical management. To improve measurement accuracy, the spectral analysis was modified to account for compression of the cortical mantle caused by PHVD and the possible presence of blood breakdown products.ResultsFrom nine patients (27 VTs), a significant CBF increase was measured (15.6%) following VT (14.6±4.2 to 16.9±6.6 ml/100 g/min), but with no corresponding change in CMRO2 (1.02±0.41 ml O2/100 g/min). Post-VT CBF was in good agreement with a control group of 13 patients with patent ductus arteriosus but no major cerebral pathology (16.5±7.7 ml/100 g/min), whereas tissue oxygen saturation (StO2) was significantly lower (58.9±12.1% vs. 70.5±9.1% for controls).ConclusionCBF was impeded in PHVD infants requiring a clinical intervention, but the effect is not large enough to alter CMRO2.


Assuntos
Hemorragia Cerebral/terapia , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/metabolismo , Circulação Cerebrovascular , Consumo de Oxigênio , Vasodilatação , Peso ao Nascer , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Hemorragia Cerebral/líquido cefalorraquidiano , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatologia , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Masculino , Valor Preditivo dos Testes , Punções , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
7.
J Perinatol ; 37(10): 1070-1077, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28471443

RESUMO

Neurological morbidities such as peri/intraventricular hemorrhage and periventricular leukomalacia largely determine the neurodevelopmental outcome of vulnerable preterm infants and our aim should be to minimize their occurrence or severity. Bed-side neuromonitoring could provide valuable pieces of information about possible hemodynamic disturbances that are significantly associated with neurological morbidities and increased mortality. Near-infrared spectroscopy offers evaluation of regional cerebral oxygenation, which in conjunction with other non-invasive methods may give us a more complete picture about end-organ perfusion. This monitoring tool could help us fully understand the pathophysiology of severe neurological morbidities and guide our management in order to reduce their incidence.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido Prematuro , Leucomalácia Periventricular/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ventrículos Cerebrais/irrigação sanguínea , Circulação Cerebrovascular , Monitorização Hemodinâmica , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Índice de Gravidade de Doença
8.
Int J Stroke ; 12(6): 574-579, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28421877

RESUMO

Posthemorrhagic hydrocephalus is a severe complication following intracranial hemorrhage. Posthemorrhagic hydrocephalus is often associated with high morbidity and mortality and serves as an important clinical predictor of adverse outcomes after intracranial hemorrhage. Currently, no effective medical intervention exists to improve functional outcomes in posthemorrhagic hydrocephalus patients because little is still known about the mechanisms of posthemorrhagic hydrocephalus pathogenesis. Because a better understanding of the posthemorrhagic hydrocephalus pathogenesis would facilitate development of clinical treatments, this is an active research area. The purpose of this review is to describe recent progress in elucidation of molecular mechanisms that cause posthemorrhagic hydrocephalus. What we are certain of is that the entry of blood into the ventricular system and subarachnoid space results in release of lytic blood products which cause a series of physiological and pathological changes in the brain. Blood components that can be linked to pathology would serve as disease biomarkers. From studies of posthemorrhagic hydrocephalus, such biomarkers are known to mutually synergize to initiate and promote posthemorrhagic hydrocephalus progression. These findings suggest that modulation of biomarker expression or function may benefit posthemorrhagic hydrocephalus patients.


Assuntos
Biomarcadores/análise , Hemorragia Cerebral/complicações , Hidrocefalia/diagnóstico , Acidente Vascular Cerebral/complicações , Ventrículos Cerebrais/irrigação sanguínea , Humanos , Hidrocefalia/complicações , Hemorragias Intracranianas/complicações
9.
J Cereb Blood Flow Metab ; 37(4): 1374-1385, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27306753

RESUMO

Recent evidence suggests an extensive exchange of fluid and solutes between the subarachnoid space and the brain interstitium, involving preferential pathways along blood vessels. We studied the anatomical relations between brain vasculature, cerebrospinal fluid compartments, and paravascular spaces in male Wistar rats. A fluorescent tracer was infused into the cisterna magna, without affecting intracranial pressure. Tracer distribution was analyzed using a 3D imaging cryomicrotome, confocal microscopy, and correlative light and electron microscopy. We found a strong 3D colocalization of tracer with major arteries and veins in the subarachnoid space and large cisterns, attributed to relatively large subarachnoid space volumes around the vessels. Confocal imaging confirmed this colocalization and also revealed novel cisternal connections between the subarachnoid space and ventricles. Unlike the vessels in the subarachnoid space, penetrating arteries but not veins were surrounded by tracer. Correlative light and electron microscopy images indicated that this paravascular space was located outside of the endothelial layer in capillaries and just outside of the smooth muscle cells in arteries. In conclusion, the cerebrospinal fluid compartment, consisting of the subarachnoid space, cisterns, ventricles, and para-arteriolar spaces, forms a continuous and extensive network that surrounds and penetrates the rat brain, in which mixing may facilitate exchange between interstitial fluid and cerebrospinal fluid.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Encéfalo , Líquido Cefalorraquidiano/diagnóstico por imagem , Cisterna Magna , Imagem Tridimensional/métodos , Animais , Vasos Sanguíneos/ultraestrutura , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/ultraestrutura , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/ultraestrutura , Cisterna Magna/diagnóstico por imagem , Cisterna Magna/ultraestrutura , Dextranos , Endotélio Vascular/diagnóstico por imagem , Endotélio Vascular/ultraestrutura , Líquido Extracelular/diagnóstico por imagem , Masculino , Microscopia Confocal , Microscopia Eletrônica , Ratos Endogâmicos WKY , Espaço Subaracnóideo
10.
J Neurol Neurosurg Psychiatry ; 88(1): 19-24, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26746184

RESUMO

BACKGROUND AND PURPOSE: Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). METHODS: Pooled analyses of the INTERACT CT substudies-international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP)-randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days. RESULTS: There were 349 (27%) of 1310 patients with baseline IVH, and 107 (11%) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95% CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)). CONCLUSIONS: Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH. TRIAL REGISTRATION NUMBERS: NCT00226096 and NCT00716079.


Assuntos
Hemorragia Cerebral/diagnóstico , Ventrículos Cerebrais/irrigação sanguínea , Hemorragia/diagnóstico , Idoso , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Ventrículos Cerebrais/diagnóstico por imagem , Avaliação da Deficiência , Feminino , Hemorragia/complicações , Hemorragia/diagnóstico por imagem , Hemorragia/mortalidade , Humanos , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
11.
Neonatology ; 111(3): 267-279, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27923236

RESUMO

BACKGROUND: Despite advances in neonatal intensive care, germinal matrix-intraventricular hemorrhage (GMH-IVH) remains a frequent, serious complication of premature birth. Neutral head position and head tilting have been suggested to reduce the risk of GMH-IVH in preterm infants during the first 72 h of life. OBJECTIVE: The aim of this study was to provide a systematic review of the effect of neutral head positioning and head tilting on the incidence of GMH-IVH in very preterm infants (gestational age ≤30 weeks). In addition, we reviewed their effect on cerebral hemodynamics and oxygenation. METHODS: Literature was searched (June 2016) in the following electronic databases: CINAHL, Embase, Medline, SCOPUS, and several trial registers. RESULTS: One underpowered trial studied the effect of head positioning on the incidence of GMH-IVH. This randomized controlled trial enrolled 48 preterm infants and found no effect on the occurrence of GMH-IVH. Three observational studies investigated the effect of head rotation and/or tilting on cerebral oxygenation in 68 preterm infants in total. Their results suggest that cerebral oxygenation is not significantly affected by changes in head positioning. The effect of head positioning and/or tilting on cerebral hemodynamics was described in 2 observational studies of 28 preterm infants and found no significant effect. CONCLUSIONS: There is insufficient evidence regarding the effect of head positioning and tilting on the incidence of GMH-IVH and cerebral hemodynamics and oxygenation in preterm infants. We recommend further research in this field, especially in extremely preterm and clinically unstable infants during the first postnatal days.


Assuntos
Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/irrigação sanguínea , Recém-Nascido Prematuro , Postura/fisiologia , Hemorragia Cerebral/enfermagem , Idade Gestacional , Cabeça , Hemodinâmica , Humanos , Incidência , Recém-Nascido , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Cereb Blood Flow Metab ; 37(7): 2359-2367, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27624844

RESUMO

Intraventricular hemorrhage causes spatial memory loss, but the mechanism remains unknown. Our recent studies demonstrated that traumatic brain injury activates Src family kinases, which cause spatial memory loss. To test whether the spatial memory loss was due to blood in the ventricles, which activated Src family kinases, we infused autologous whole blood or thrombin into the lateral ventricles of adult rats to model non-traumatic intraventricular hemorrhage. Hippocampal neuron loss was examined 1 day to 5 weeks later. Spatial memory function was assessed 29 to 33 days later using the Morris water maze. Five weeks after the ventricular injections of blood or thrombin, there was death of most hippocampal neurons and significant memory deficits compared with sham operated controls. These data show that intraventricular thrombin is sufficient to kill hippocampal neurons and produce spatial memory loss. In addition, systemic administration of the non-specific Src family kinase inhibitor PP2 or intraventricular injection of siRNA-Fyn, a Src family kinase family member, prevented hippocampal neuronal loss and spatial memory deficits following intraventricular hemorrhage. The data support the conclusions that thrombin mediates the hippocampal neuronal cell death and spatial memory deficits produced by intraventricular blood and that these can be blocked by non-specific inhibition of Src family kinases or by inhibiting Fyn.


Assuntos
Ventrículos Cerebrais/irrigação sanguínea , Disfunção Cognitiva/enzimologia , Hemorragias Intracranianas/tratamento farmacológico , Trombina/metabolismo , Quinases da Família src/antagonistas & inibidores , Animais , Ventrículos Cerebrais/enzimologia , Disfunção Cognitiva/patologia , Modelos Animais de Doenças , Inibidores Enzimáticos/farmacologia , Feminino , Hipocampo/enzimologia , Hipocampo/patologia , Injeções Intraventriculares , Hemorragias Intracranianas/enzimologia , Hemorragias Intracranianas/patologia , Hemorragias Intracranianas/psicologia , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Neurônios/enzimologia , Neurônios/patologia , Pirimidinas/farmacologia , RNA Interferente Pequeno/genética , Ratos Sprague-Dawley , Memória Espacial/efeitos dos fármacos , Trombina/administração & dosagem , Quinases da Família src/genética
13.
Clin Imaging ; 40(5): 889-91, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27179960

RESUMO

Intracerebral hemorrhage after spinal surgery is a rare but dreaded complication. The most commonly described form of intracranial hemorrhage after spinal surgery is remote cerebellar hemorrhage (i.e. anatomically distant from the surgical site) (Brockmann MA, Groden C. Remote cerebellar hemorrhage: a review. The Cerebellum 2006;5:64-8); however subdural, subarachnoid, and intraventricular hemorrhage can also occur in combination or isolated (Kaloostian PE, Kim JE, Bydon A, Sciubba DM, Wolinsky JP, Gokaslan ZL, Witham TF. Intracranial hemorrhage after spine surgery. J Neurosurg Spine 2013;19:370-80; Khalatbari MR, Khalatbari J, Moharamzad Y. Intracranial hemorrhage following lumbar spine surgery. Eur Spine J 2012;21:2092-96). Isolated intraventricular hemorrhage after spinal surgery is extremely rare; to our knowledge, there are only two cases reported in the literature (Kaloostian PE, Kim JE, Bydon A, Sciubba DM, Wolinsky JP, Gokaslan ZL, Witham TF. Intracranial hemorrhage after spine surgery. J Neurosurg Spine 2013;19:370-80; Khalatbari MR, Khalatbari J, Moharamzad Y. Intracranial hemorrhage following lumbar spine surgery. Eur Spine J 2012;21:2092-96). Here, we present a 76-year-old female patient who developed isolated intraventricular hemorrhage after spinal surgery.


Assuntos
Angiografia Cerebral/métodos , Hemorragia Cerebral/etiologia , Ventrículos Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Hemorragia Pós-Operatória/etiologia , Fusão Vertebral/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Idoso , Hemorragia Cerebral/diagnóstico , Ventrículos Cerebrais/irrigação sanguínea , Feminino , Humanos , Vértebras Lombares/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Estenose Espinal/cirurgia
14.
Rev. chil. neurocir ; 41(2): 116-119, nov. 2015. ilus
Artigo em Espanhol | LILACS | ID: biblio-869731

RESUMO

La Enfermedad Moyamoya es una arteriopatia oclusiva progresiva de los vasos cerebrales, específicamente de la porción distal de las arterias carótidas internas, por lo general con compromiso bilateral. Esta oclusión trae como consecuencia dilatación de los vasos sanguíneos colaterales con el objetivo de convertirse en vías de circulación colateral, de donde la enfermedad adopta su nombre, debido a la apariencia angiográfica de “nube de humo” de estos pequeños vasos dilatados. Clínicamente se manifiesta como eventos cerebrovasculares isquémicos debido a la oclusión de los vasos mencionados o como eventos hemorrágicos debido a la ruptura de los pequeños vasos sanguíneos dilatados. Presentamos el caso de una paciente femenina de 38 años, que acude al hospital en estado de coma, cuya tomografía computarizada revela hemorragia intraventricular que fue tratada con derivación ventricular externa más activador de plasminógeno tisular. Posterior a su estabilización clínica se realizó angiografía cerebral diagnóstica con hallazgos compatibles con Enfermedad Moyamoya. Se decidió realizar subduro-sinangiosis con el fin de inducir la formación de circulación colateral cerebral. Debido a la baja incidencia de la Enfermedad Moyamoya en Latinoamérica, generalmente no es incluida en el diagnóstico diferencial de los eventos cerebrales vasculares, por lo que recomendamos su sospecha en pacientes jóvenes y sin factores de riesgo que debutan con este tipo de eventos cerebrales.


Moyamoya disease is a progressive occlusive disease of the cerebral vessels, specifically the distal portion of the internal carotid arteries, usually with bilateral involvement. This occlusion results in dilatation of collateral blood vessels in order to form collateral circulation pathways, from which the disease takes its name due to the angiographic appearance of “puff of smoke” of these small dilated vessels. Clinically it manifests as ischemic cerebrovascular events due to occlusion of the vessel mentioned or hemorrhagic events due to rupture of small dilated blood vessels. We report the case of a female patient of 38 years old who was admitted to the hospital in coma state, the CT scan revealed intraventricular hemorrhage that was treated with an external ventricular derivation and tissue plasminogen activator. After clinical stabilization diagnostic cerebral angiography was performed with findings consistent with Moyamoya disease. We decided to perform a subduro-sinangiosis, in order to induce the formation of cerebral collateral circulation. Due to the low incidence of Moyamoya disease in Latin America, generally it is not included in the differential diagnosis of cerebral vascular events, we recommend suspect it in young patients without risk factors who present with this type of brain events.


Assuntos
Humanos , Adulto , Feminino , Isquemia Encefálica , Hemorragia Cerebral , Revascularização Cerebral , Diagnóstico por Imagem , Doença de Moyamoya/cirurgia , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/etiologia , Ventrículos Cerebrais/irrigação sanguínea
15.
Semin Perinatol ; 39(8): 592-603, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26516117

RESUMO

Emerging data suggest intraventricular hemorrhage (IVH) of the preterm neonate is a complex disorder with contributions from both the environment and the genome. Environmental analyses suggest factors mediating both cerebral blood flow and angiogenesis contribute to IVH, while candidate gene studies report variants in angiogenesis, inflammation, and vascular pathways. Gene-by-environment interactions demonstrate the interaction between the environment and the genome, and a non-replicated genome-wide association study suggests that both environmental and genetic factors contribute to the risk for severe IVH in very low-birth weight preterm neonates.


Assuntos
Ventrículos Cerebrais/irrigação sanguínea , Predisposição Genética para Doença/genética , Hemorragias Intracranianas/genética , Índice de Apgar , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença/epidemiologia , Variação Genética , Estudo de Associação Genômica Ampla , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/prevenção & controle , Gravidez , Fatores de Risco , Estados Unidos
18.
Neuroimage ; 118: 13-25, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26070262

RESUMO

Intraventricular hemorrhage (IVH) or bleed within the cerebral ventricles is a common condition among very low birth weight pre-term neonates. The prognosis for these patients is worsened should they develop progressive ventricular dilatation, i.e., post-hemorrhagic ventricle dilatation (PHVD), which occurs in 10-30% of IVH patients. Accurate measurement of ventricular volume would be valuable information and could be used to predict PHVD and determine whether that specific patient with ventricular dilatation requires treatment. While the monitoring of PHVD in infants is typically done by repeated transfontanell 2D ultrasound (US) and not MRI, once the patient's fontanels have closed around 12-18months of life, the follow-up patient scans are done by MRI. Manual segmentation of ventricles from MR images is still seen as a gold standard. However, it is extremely time- and labor-consuming, and it also has observer variability. This paper proposes an accurate multiphase geodesic level-set segmentation algorithm for the extraction of the cerebral ventricle system of pre-term PHVD neonates from 3D T1 weighted MR images. The proposed segmentation algorithm makes use of multi-region segmentation technique associated with spatial priors built from a multi-atlas registration scheme. The leave-one-out cross validation with 19 patients with mild enlargement of ventricles and 7 hydrocephalus patients shows that the proposed method is accurate, suggesting that the proposed approach could be potentially used for volumetric and morphological analysis of the ventricle system of IVH neonatal brains in clinical practice.


Assuntos
Mapeamento Encefálico/métodos , Ventrículos Cerebrais/patologia , Hidrocefalia/patologia , Imagem Tridimensional/métodos , Doenças do Prematuro/patologia , Hemorragias Intracranianas/complicações , Imagem por Ressonância Magnética/métodos , Algoritmos , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Ventrículos Cerebrais/irrigação sanguínea , Dilatação , Humanos , Recém-Nascido , Recém-Nascido Prematuro
19.
J Clin Invest ; 125(3): 1319-28, 2015 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-25689256

RESUMO

Premature birth is a major risk factor for multiple brain pathologies, notably periventricular leukomalacia (PVL), which is distinguished by bilateral necrosis of neural tissue around the ventricles and a sequela of neurological disturbances. The 2 hallmarks of brain pathologies of prematurity are a restricted gestational window of vulnerability and confinement of injury to a specific cerebral region. Here, we examined the proposition that both of these features are determined by the state of blood vessel immaturity. We developed a murine genetic model that allows for inducible and reversible VEGF blockade during brain development. Using this system, we determined that cerebral vessels mature in a centrifugal, wave-like fashion that results in sequential acquisition of a functional blood-brain barrier and exit from a VEGF-dependent phase, with periventricular vessels being the last to mature. This developmental program permitted selective ablation of periventricular vessels via episodic VEGF blockade within a specific, vulnerable gestational window. Enforced collapse of ganglionic eminence vessels and resultant periventricular neural apoptosis resulted in a PVL-like phenotype that recapitulates the primary periventricular lesion, ventricular enlargement, and the secondary cortical deficit in out-migrating GABAergic inhibitory interneurons. These findings provide an animal model that reproduces the temporal and spatial specificities of PVL and indicate that damage to VEGF-dependent, immature periventricular vessels contributes to PVL development.


Assuntos
Leucomalácia Periventricular/fisiopatologia , Neovascularização Fisiológica , Animais , Apoptose , Barreira Hematoencefálica , Hipóxia Celular , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/patologia , Modelos Animais de Doenças , Feminino , Humanos , Interneurônios/fisiologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos ICR , Camundongos Transgênicos , Neurônios/fisiologia , Gravidez , Nascimento Prematuro/fisiopatologia , Transcrição Genética , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/biossíntese , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/genética
20.
J Stroke Cerebrovasc Dis ; 24(3): e75-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25543190

RESUMO

We report a patient who presented with Parkinsonism after external ventricular drainage (EVD) for an intraventricular hemorrhage (IVH). We also demonstrate dopaminergic system dysfunction using (18)F-florinated-N-3-fluoropropyl-2-ß-carboxymethoxy-3-ß-(4-lodophenyl) nortropane ((18)F-FP-CIT) positron emission tomography (PET) scanning. A 50-year-old woman presented with manifestations of Parkinsonism, including severe rigidity and 3-Hz resting tremor, immediately after EVD for IVH. (18)F-FP-CIT PET images at 6 months after onset showed dysfunction of the bilateral caudate nuclei and putamen after EVD that seemed to have induced Parkinsonism, although no lesion was observed in those areas on either conventional computed tomography or magnetic resonance imaging. With a dose of 300/1200 mg/day carbidopa/levodopa, the rigidity of both upper and lower extremities was significantly reduced, and the tremor completely disappeared. The decreased rigidity also improved the activities of daily living performance. In summary, a patient developed Parkinsonism after EVD for IVH, and we demonstrated dopaminergic system dysfunction on (18)F-FP-CIT PET images. Clinicians should pay particular attention to the occurrence of Parkinsonism when performing procedures that can reduce intraventricular pressure.


Assuntos
Ventrículos Cerebrais/irrigação sanguínea , Drenagem/efeitos adversos , Hemorragias Intracranianas/cirurgia , Doença de Parkinson Secundária/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Atividades Cotidianas , Carbidopa/uso terapêutico , Núcleo Caudado/diagnóstico por imagem , Núcleo Caudado/fisiopatologia , Combinação de Medicamentos , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Levodopa/uso terapêutico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Parkinson Secundária/diagnóstico , Doença de Parkinson Secundária/tratamento farmacológico , Doença de Parkinson Secundária/fisiopatologia , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Putamen/diagnóstico por imagem , Putamen/fisiopatologia , Compostos Radiofarmacêuticos , Recuperação de Função Fisiológica , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tropanos
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