血浆c-Fn与原发性脑出血早期血肿扩大关系的初步研究

目的探讨原发性脑出血(ICH)患者血浆中细胞纤维连接蛋白(c-Fn)浓度与早期血肿扩大(EHG)的关系。方法入选发病6h内ICH患者59例,健康对照30例。用酶联免疫吸附法(ELISA)测定血浆c-Fn浓度,根据发病后颅脑CT扫描及(24±3)h的第2次CT测定的血肿容量和血肿扩大情况分组。结果 19例患者发生血肿扩大,血肿扩大组血浆c-Fn浓度高于相同血肿容量非血肿扩大组。结论 ICH早期(6h)血肿扩大患者外周血血浆c-Fn浓度高于非血肿扩大患者。     

急性脑出血血肿体积动态变化研究

目的 研究急性脑出血血肿体积动态变化.方法 对30例急性期脑出血患者分别于起病6h以内、1d、3d、7d、14d进行头颅CT扫描,采用体视学法对脑出血血肿及周围低密度水肿灶进行测量,计算二者比值,并根据出血量将患者分为少量及中等量出血组,比较2组血肿、水肿体积及CSS评分. 结果 脑出血急性期血肿体积逐渐缩小,周围低密度水肿灶体积逐渐扩大,7～14d达高峰,差异有统计学意义(P＜0.05),血肿体积与周围低密度水肿灶体积有相关性(|r|=0.75),2组的血肿/水肿比值差异无统计学意义(P＞0.05),2组的CSS评分差异有统计学意义(P＜0.05),但2组的水肿体积与CSS评分无相关性.结论 急性脑出血后起病至3d血肿体积无明显变化,水肿体积小,3～7d后血肿开始逐渐缩小,而水肿明显扩大,14d达高峰.少量及中等量出血血肿及水肿体积变化规律相同,血肿量直接影响CSS评分,而与水肿量无明显相关性.     

Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension

To investigate whether the observed association of leukoaraiosis with intracerebral hemorrhage is direct or mediated by risk factors, we compared 116 patients with intracerebral hemorrhage confirmed by computed tomography and 155 controls without intracerebral hemorrhage, evaluating the prevalence of leukoaraiosis and vascular risk factors. Leukoaraiosis was observed in 21 (18%) of the 116 patients and in 12 (8%) of the 155 controls (p less than 0.01). Only two (6%) of the 31 patients with lobar hemorrhage had leukoaraiosis on computed tomograms, compared with 17 (24%) of the 71 patients with basal ganglionic hemorrhage (p less than 0.05). Leukoaraiosis was significantly correlated with intracerebral hemorrhage after controlling for age and sex by using multiple logistic regression analysis, while the correlation disappeared after controlling for hypertension. Our results indicate that leukoaraiosis is not an independent risk factor for intracerebral hemorrhage.     

Stroke registry in Malm?, Sweden.

BACKGROUND AND PURPOSE: A stroke registry covering the city of Malm?, Sweden (population 232,000) was started in January of 1989 to prospectively follow up stroke incidence, recurrence, and fatality rates. METHODS: Patients with presumed stroke were interviewed within 1 week after admission to the hospital, and their medical records were examined. Continuous validation against hospital diagnosis showed well over 90% of all stroke cases in Malm? to have been included. RESULTS: Incidence rates per 100,000 residents were 300 for all stroke events and 225 for first-ever stroke, lower than those reported from other studies. The distribution of stroke diagnostic categories was 3% subarachnoid hemorrhage, 10% intracerebral hemorrhage, 50% cerebral infarction, and 38% unspecified stroke. The diagnosis was based on computed tomography in 51% of first-ever stroke cases. Median age was 73.1 years for men and 79.7 years for women. Incidence rates for all stroke diagnostic categories except subarachnoid hemorrhage increased with age. Prior stroke, hypertension, smoking, atrial fibrillation, and diabetes mellitus were major risk factors for all stroke events. The presenting symptoms were hemiparesis in 74%, speech disorder in 49%, and clouded consciousness in 19% of the patients. The overall case-fatality rate at 30 days was 15%; the rate for intracerebral hemorrhage was 37% and that for cerebral infarction was 10%. CONCLUSIONS: Our findings confirm the value of a stroke registry for stroke epidemiology purposes and as a tool for specific stroke research.     

Etiology of stroke in patients with Wernicke's aphasia

We reviewed 49 patients with Wernicke's aphasia resulting from a stroke. Their aphasia was classified on the basis of comprehensive neuropsychological testing. Wernicke's aphasia was more common in older patients and in men. Cerebral infarction occurred in 38 patients (78%) and intracerebral hemorrhage in seven (14%); the remaining four patients (8%) developed aphasia after surgery for aneurysmal subarachnoid hemorrhage. Embolic events were the most common etiology of Wernicke's aphasia in the 38 patients with cerebral infarction, with cardiac emboli in 40% and large-vessel atheroemboli from a carotid source in 16%. In patients with Wernicke's aphasia secondary to infarction, an embolic source should be sought. Patients with Wernicke's aphasia should have computed tomography to exclude intracerebral hemorrhage before institution of anticoagulant therapy.     

Incidence of stroke in young adults in Florence, Italy

A population-based study specifically addressing stroke in young adults (aged 15-44 years) was conducted in Florence, Italy, from 1983 to 1985. We identified 47 cases of first stroke by means of a daily check of the medical facilities of the city and nearby towns and a review of death certificates. Patients were assessed by a neurologist shortly after the onset of the stroke, and computed tomography or autopsy was performed in 96%. The average annual incidence rate for all stroke (cases per 100,000 population per year) was 9.0 (95% confidence interval 5.8-13.4) for males and 8.7 (95% confidence interval 5.5-13.0) for females. The average annual incidence rates for the pathologic types of stroke were 3.4 for cerebral infarction, 3.2 for subarachnoid hemorrhage, and 1.9 for intracerebral hemorrhage. The case-fatality ratio was 23.4% at 1 month. Among patients with ischemic strokes, atherosclerosis and cardiac disease accounted for 50% of the cases. Based on angiography or autopsy findings, aneurysm or arteriovenous malformation were demonstrated in 88% of the patients with subarachnoid hemorrhage. In 50% of the patients with intracerebral hemorrhage, no cause of bleeding was detected. Our study may supply information about stroke pathologic types in an unselected series of young adults.     

Prognostic parameters in spontaneous intracerebral hematomas with special reference to anticoagulant treatment

We examined a series of 200 consecutive patients with spontaneous intracerebral hematoma clinically and by computed tomography, excluding patients with trauma, aneurysm, or tumor. Hematoma volume varied from 1 to 230 (average 35) ml, and overall mortality was 30% (60 patients). Of the 200 patients, 14% (28) were receiving anticoagulants; among these 28 patients hematoma volume averaged 72 ml and mortality 57% (16 patients). The 140 survivors were followed for 2-24 months. Our findings indicate that anticoagulation therapy after previous cerebral infarction or embolism of cardiogenic origin did not predispose to intracerebral hemorrhage. Prognosis was poor when the initial level of consciousness was low and the hematoma volume exceeded 50 ml in combination with dilatation of the contralateral ventricle. An intracerebral hematoma of greater than 80 ml volume was always fatal, regardless of therapy. With volumes of 40-80 ml, early surgical evacuation of the lobar hematoma may improve outcome.     

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients**☆

BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were sig     

高血压性脑出血的CT分级与预后

目的 探讨高血压件脑出血的环池、脑干的形态学改变,研究其与预后的关系.方法 回顾性分析165例高血压性脑出血患者的头颅CT资料,以环池、脑于的形态学改变分为4级,记录入院时GCS和发病后6月GOS评分.对数据加以统计分析.结果 对所得的数据进行等级资料的Spearman相关性检验,提示GCS评分与CT分级、CT分级与GOS转归均显著相关(r=0.753,P<0.01;r=0.675,P<0.01).结论 高血压性脑出血的CT分级足早期判断预后的有效指标.     

心厉颤动患者口服抗凝药相关脑出血的研究进展

随着人口老龄化日益严重和口服抗凝剂(OAT)的使用增加,目前OAT相关脑出血的发生率较20世纪90年代相比10年间增加了5倍,其病死率高达67％,自发性脑出血病死率为30％～55％.OAT相关脑出血占脑出血的10％～12％.在世界范围内,OAT相关脑出血的发病率是不应用OAT的7～10倍.文中主要从OAT相关脑出血的流行病学、遗传学、主要危险因素、临床特点、预后、影像学特点及最新的治疗策略等进行文献分析,侧重于传统OAT与新型抗凝剂的对比,并且对抗凝药物相关脑出血尚存在争议的问题进行总结.     

The natural history of lacunar infarction: the Oxfordshire Community Stroke Project

In a consecutive series of 515 first-ever strokes in a community-based study of stroke that combined prompt clinical assessment by a study neurologist with a high rate of confirmed pathologic diagnosis, 108 cases (21%) had a lacunar syndrome. A computed tomography (CT) scan was performed in 104 (96%) of these cases. Only 3 cases had primary intracerebral hemorrhage, and another 3 had "inappropriate" areas of infarcts were seen in 34 of the remaining 98 (35%) CT scans. The crude annual incidence of lacunar infarction was 0.33/1,000. There was no excess risk among men. The case fatality rates were 1% at 1 month and 9.8% at 1 year. The rate of recurrent strokes was 11.8% in the first year. Among patients surviving 1 year, 66% were capable of independent existence.     

Glycosylated Hemoglobin A1c Predicts Intracerebral Hemorrhage with Acute Ischemic Stroke Post-Mechanical Thrombectomy

BackgroundIntracerebral hemorrhage, including symptomatic intracerebral hemorrhage, is a serious post-mechanical thrombectomy complication in patients with acute ischemic stroke. We aimed to determine whether glycosylated hemoglobin A1c parameters could predict intracerebral hemorrhage in this patient population.MethodsWe enrolled patients with acute occlusion of the internal carotid artery or proximal middle cerebral artery and who had undergone mechanical thrombectomy. According to the glycosylated hemoglobin A1c level (%) assessed during the hospital stay, the patients were divided into two groups: > 6.5% and ≤ 6.5%. Intracerebral hemorrhage was evaluated and classified based on cranial computed tomography scans obtained within 24–48 h or when neurological conditions worsened. We assessed the outcome at the end of 90 days using the modified Rankin Scale scores.ResultsAmong 202 patients, 86 (42.6%) suffered intracerebral hemorrhage, while 25 (12.4%) had symptomatic intracerebral hemorrhage; 35.6% of the patients had a favorable outcome (modified Rankin Scale scores 0–2). Multivariable analysis demonstrated an association of glycosylated hemoglobin A1c > 6.5% with intracerebral hemorrhage. Furthermore, glycosylated hemoglobin A1c > 6.5% was independently associated with symptomatic intracerebral hemorrhage (OR, 2.136; 95% CI, 1.279–3.567; P = 0.004). In addition, glycosylated hemoglobin A1c > 6.5% was significantly associated with increased mortality (OR, 1.511; 95% CI, 1.042–2.191; P = 0.029) and negatively associated with favorable outcome (OR, 0.480; 95% CI, 0.296–0.781; P = 0.003) at 90 days.ConclusionsGlycosylated hemoglobin A1c is an independent predictor of intracerebral hemorrhage (specifically, symptomatic intracerebral hemorrhage) in patients with acute ischemic stroke treated with mechanical thrombectomy. Further studies are needed to validate these findings.     

Pediatric moyamoya disease presenting with intracerebral hemorrhage--report of three cases and review of the literature

Intracerebral hemorrhage in patients with moyamoya disease is rare in children. We report three unique cases of pediatric moyamoya disease with hemorrhagic onset. Two 7-year-old girls and a 9-year-old girl were admitted to our hospital because of intracerebral hemorrhage associated with angiographically verified moyamoya disease. Two of them did not demonstrate either an ischemic episode or cerebral infarct on the magnetic resonance images. A decreased regional cerebral blood flow was revealed on single photon emission computed tomography in two patients, who developed cerebral infarction in the acute stage following hemorrhage. They underwent superficial temporal artery-middle cerebral artery anastomoses combined with encephalo-myo-synangiosis, and have not experienced any further ischemic episodes thereafter. Hemodynamic insufficiency associated with moyamoya disease could cause intracerebral hemorrhage even in children. Adequate management in the acute stage of hemorrhage and revascularization surgery are recommended to prevent cerebral infarction, which may easily occur in pediatric patients with moyamoya disease.     

基底节出血30天死亡概率的预测研究

目的：探讨基底节出血30天死亡的危险因素,建立基底节出血30天死亡的概率探测模型。方法：回顾性分析我院近5年来病房收治的290例基底节出血病例,对影响基底节出血死亡的危险因素进行多元Logistic回归分析。结果：290例基底节出血病人,30天病死率为13．4％,单因素X检测表明,意识障碍,脑出血破入脑室,大量出血,伴发糖尿病,缺血性心脏病,消化道出血等6个因素为基底节出血30天死亡的危险因素（＿＜0．05）,多因素Logistic回归分析发现,仅有意识水平＊（OR＝6．949,P＜0．01）和消化道出血（OR＝29．480,P＜0．01）是基底节出血30天死亡的独立预测因子,基底节出血30天死亡的概况预测模型为Logit P=-5.150 2.282X意识＋3．637X消化道出血,该模型对基底节出血30天死亡或生存预测总的正确率为92．8％。结论：意识水平和伴有消化道出血是影响基底节出血30天死亡的最重要危险因素,由此建立的基底节出血30天死亡概率预测模型对临床具有一定的指导意义。     

依达拉奉治疗高血压脑出血继发性脑损伤的疗效分析

目的 评价新型羟白南基消除剂一依达拉奉对高血压脑出血后继发性脑损伤的治疗效果。方法 对60例重症高血压脑出血微创术后患者随机分为治疗组30例和对照组30例,治疗组给予依达托奉注射液30mg2／d,共14d,同时给予抗生素、赖氨酸及对症治疗;对照组除不用依达拉奉外,余同治疗组。采用GOS及日常生活能力量表评分,比较两组的近期（21d）和远期（3个月）疗效。结果 治疗组近期优良率（68．1％）和远期治愈及良好患者比率（76．9％）明显高于对照组（40.3％,45．5％）,差异有显著性（P〈0．05）;治疗组的近期死亡率（6．7％）明显低于对照组（20％）,差异有显著性（P〈0．01）;而治疗组无明显不良反应。结论 依达托奉对高血压脑出血继发性脑损伤的治疗是安全有效的。     

Stroke incidence rates were unchanged, while fatality rates declined, during 1971-1987 in G?teborg, Sweden.

BACKGROUND AND PURPOSE: Stroke risk factors have been shown to change with time in several places; simultaneously, stroke incidence rates have increased in some and decreased in other places. In G?teborg, Sweden, cardiovascular epidemiological research has included stroke registration since 1971. From these data on stroke, incidence and fatality rates from a 17-year period are given. METHODS: During the period 1971-1987 all cases of stroke occurring in people aged 15-65 years in the city of G?teborg were uniformly recorded, with an estimated case detection rate of 90% or more. RESULTS: Age-adjusted incidence rates of first-ever stroke by sex did not change during the period. Age-specific rates and rates for individual types of stroke (subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction-unspecified stroke combined) were also largely unchanged. A slight increase in the incidence rate of intracerebral hemorrhage may be due to better detection after computed tomography came into use in 1976. Stroke fatality rates declined through the whole period in both sexes and all age groups, markedly so for intracerebral hemorrhage and subarachnoid hemorrhage. CONCLUSIONS: This conforms with vital statistics for G?teborg and for Sweden of declining stroke mortality during the period. The decline in stroke fatality rates may be related to decreases in smoking habits and blood pressure together with an increase in the percentage of people on antihypertensive treatment among middle-aged men, and to some extent even middle-aged women, reported from the same population. Why stroke incidence rates did not decline concomitantly is unexplained.     

Clinico-epidemiologic study of stroke in Akita, Japan

An analysis was performed of 2,168 consecutive stroke patients who were examined by computed tomography and entered into a hospital-based stroke registry in Akita Prefecture, Japan. The occurrence of cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage was 30, 55, and 14%, respectively. Age-specific rates of subarachnoid hemorrhage were higher in women than men; other types of stroke showed a preponderance in men. Total strokes increased in the winter; this seasonal difference was confined to cerebral hemorrhage. Putaminal hemorrhages predominated in the younger age groups; thalamic hemorrhage and cerebellar hemorrhage were predominant in the older age groups. The increased accuracy of the diagnosis of stroke subtypes by the use of computed tomography in this study is in contrast to other community-based epidemiologic studies that have relied solely on clinical diagnosis. This increased accuracy is seen to be the reason that new ratios of stroke subtype incidence have been identified.     

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients

BACKGROUND: It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE: To investigate changes in electrocardiogram results in patients with intracerebral hematoma enlargement. DESIGN, TIME AND SETTING: The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS: A total of 225 intracerebral hemorrhage patients (142 males and 83 females) that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confLrrned using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS: According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement (n = 20) and non-hematoma enlargement (n = 205) groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES: The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS: In the hematoma enlargement group, 15 patients (79%) developed electrocardiographic abnormalities. In the non-hematoma enlargement group, 24 patients (43%) presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups (P < 0.01 ). CONCLUSION: Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.     

Intracerebral hematomas during anticoagulant treatment

We retrospectively studied 79 patients from three centers who suffered an intracerebral hemorrhage during treatment with anticoagulants and compared them with 84 patients from one center who suffered a spontaneous intracerebral hemorrhage without anticoagulant treatment. Mortality after 30 days was slightly higher in patients with anticoagulant treatment (67%) than in those without (55%), and the proportion of patients who attained moderate or complete recovery was slightly smaller in the treated group (22% and 36%, respectively); neither difference was statistically significant. Volume of the supratentorial hematoma was measured from computed tomograms in 70% of the patients in both groups and was significantly greater in the 55 patients treated with anticoagulants than in the 59 patients not so treated. Volume was not related to the degree of anticoagulation. Based on the total number of patients treated with anticoagulants in the Heerlen region, we conclude that for patients older than 50 years of age the risk of intracerebral hemorrhage during anticoagulant treatment is increased approximately eightfold but is unrelated to the degree of anticoagulation. Our results suggest that intracerebral hemorrhage is more frequent and more extensive in patients treated with anticoagulants but that once it has occurred in such patients intracerebral hemorrhage is not significantly more serious than in untreated patients.     

Minimal Computed Tomography Attenuation Value Within the Hematoma is Associated with Hematoma Expansion and Poor Outcome in Intracerebral Hemorrhage Patients

Neurocritical Care - Early hematoma expansion in intracerebral hemorrhage (ICH) patients is associated with poor outcome. We aimed to investigate whether the minimal computed tomography (CT)...