Spontaneous intracerebral hemorrhage

We report on 146 patients with spontaneous intracerebral hemorrhage treated in the period between 1984 and 1988. The aim of this retrospective study was to point out factors for operative respectively conservative treatment.Looking for etiology, age, unconsciousness, localization and extension of hematoma as well as bleeding into the ventricles our results showed that patients over 70 years of age and/or in coma III and IV (Brussels Coma Scale) have a bad prognosis as well as patients with intraventricular bleeding. Patients seem to benefit from operation if hematoma is located in the hemisphere or cerebellar and the extension ranges from 3 to 5 cm.     

Modern treatment options for intracerebral hemorrhage

Opinion statement Spontaneous intracerebral hemorrhage (ICH) is a devastating neurological event with a 30-day mortality of approximately 40%. Recent research provides new insights into the pathophysiology of ICH-associated edema, with potential molecular and cellular targets for future therapy. Neuroimaging techniques such as gradient echo MRI are yielding insights into cerebral microbleeds and the microangiopathies associated with hypertension and cerebral amyloid angiopathy. Recent literature provides new medical treatment strategies for fever, acute hypertension, and perihematomal edema, and methods of reducing intracranial pressure. Two randomized controlled trials have provided crucial evidence regarding surgical and medical intervention for acute ICH intervention. Recombinant factor VIIa appears to lessen growth of ICH when administered within 4 hours of ictus. Further study of potential efficacy and safety is underway in an international phase III trial. In addition, the Surgical Trial in Intracerebral Hemorrhage reported results from an international randomized trial of 1033 patients who did not show benefit for surgical evacuation of ICH, compared with medical therapy alone. Less invasive surgical methods for hematoma evacuation, studied previously over the past decade, continue to be investigated.     

Iatrogenic intracerebral hemorrhage.

Intracerebral hemorrhage as a result of a diagnostic or therapeutic procedure is a rare but potentially devastating event. The fear of hemorrhagic complications influences neurosurgical decision making. The incidence of iatrogenic intracerebral hemorrhage and risk factors for this complication are reviewed for neurosurgical procedures as well as for non-neurosurgical procedures with a known risk of intracerebral hemorrhage.     

Aneurysmal intracerebral hemorrhage.

Approximately 20% of all massive nontraumatic intracerebral hemorrhages are caused by ruptured intracranial aneurysms. The possibility for repeated and catastrophic rebleeds, potentially reversible increased intracranial pressure effects, and the need for cerebral vasospasm treatment make the early identification of this cause of hematoma mandatory.     

Estrogen therapy for experimental intracerebral hemorrhage in rats

OBJECT: The aims of this study were to determine the following: whether there are sex differences in intracerebral hemorrhage (ICH) induced brain injury in rats, whether delayed administration of 17beta-estradiol can reduce ICH-induced brain damage, and whether these effects are estrogen receptor (ER)-dependent. METHODS: Male and female Sprague-Dawley rats received an infusion of 100 microl autologous whole blood into the right basal ganglia. Twenty-four hours later the rats were killed. The effects of 17beta-estradiol on ICH-induced brain injury were examined by measuring brain edema and neurological deficits. Both ER-alpha and hemeoxygenase (HO)-1 were investigated through Western blot and immunohistochemical analysis. Brain edema was significantly less severe in female compared with that in male rats. The ER antagonist ICI 182,780 exacerbated ICH-induced brain edema in female but not in male rats, indicating that ER-alpha activation during ICH is protective in female rats. Administration of exogenous 17beta-estradiol in male, but not in female, rats significantly attenuated brain edema, neurological deficits, and ICH-induced changes in HO-1 when given 2 hours after hemorrhage. The effects of exogenous 17beta-estradiol occurred through an ER-independent mechanism. CONCLUSIONS: Results in this study indicate that 17beta-estradiol could be a potential therapeutic agent for ICH.     

Delayed traumatic intracerebral hemorrhage.

Delayed traumatic intracerebral hemorrhage refers to the appearance of hemorrhage (usually within 48 hours of head trauma) in areas of the brain that were normal in appearance or nearly so on the CT scan taken shortly after injury. Neurologic deterioration is common but is not universally the rule. The frequency of delayed traumatic intracerebral hemorrhage is variable but is reported to occur in 1% to 8% of patients with severe head injury. The pathogenesis is multifactorial and may result from one or more of the following: coagulation abnormalities, necrosis of blood vessels in areas of brain injury, dysautoregulation, and release of tamponade effect with evacuation of extra-axial hematomas. Outcome is poor, and most series report a mortality of 50% or higher.     

Management of spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) has the highest mortality of all cerebrovascular events. Thirty-day mortality approaches 50%, and only 20% of survivors achieve meaningful functional recovery at 6 months. Many clinicians believe that effective therapies are lacking; however, this is changing because of new data on the pathophysiology and treatment of ICH, particularly research establishing the role of medical therapies to promote hematoma stabilization. This article provides updates to a recent publication discussing basic principles of ICH management, including initial stabilization, the prevention of hematoma growth, treatment of complications, and identification of the underlying etiology. Minimally invasive surgery (MIS) to reduce clot size is also discussed, with the goal of preserving neurologic function through reduction in parenchymal damage from edema formation.     

Indications for surgical treatment of intracerebral hemorrhage.

The authors report a series of 71 patients with intracerebral hemorrhage: 57 underwent surgery and 14, although suitable candidates for surgery, refused operation. The results are assessed in relation to the site of the hemorrhage, mode of onset, and interval between accident and operation.     

Ultra-early evaluation of intracerebral hemorrhage

The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2 1/2 hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours after onset for seven of the patients and 100 hours after onset for the eighth patient. In four patients, the second CT scan was obtained prospectively. The mean percentage of increase in the volume of hemorrhage between the first and second CT scans was 107% (range 1% to 338%). In each of the six patients with a greater than 40% increase in hemorrhage volume, neurological deterioration occurred soon after the first CT. A systolic blood pressure of 195 mm Hg or greater was recorded during the first 6 hours in five of the same six patients. The data from this study indicate that, in ICH, bleeding may continue after the 1st hour post-hemorrhage, particularly in patients with early clinical deterioration.     

Treatment of acute intracerebral hemorrhage

Opinion statement  Intracerebral hemorrhage (ICH) is a neurologic emergency associated with regular, early, ongoing hemorrhage, progressive clinical deterioration, severe deficits, and high mortality. Hence, it requires prompt recognition, diagnosis, and management. Initial monitoring and management of patients with ICH should occur in an intensive care unit. The overall approach to treatment mandates using therapies to stop or slow the initial bleeding acutely, removing blood from the parenchyma or ventricles (in eligible patients) to prevent secondary brain injury, addressing raised intracranial pressure, and providing good, comprehensive supportive care, including management of airways, oxygenation, blood pressure, circulation, glucose level, fever, and nutrition, as well as deep venous thrombosis prophylaxis.     

Advances in computed tomography-based prognostic methods for intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) has high morbidity and mortality. Computed tomography (CT) plays an important role in the diagnosis, treatment, and research of cerebrovascular diseases. Non-contrast CT is widely used in the clinical diagnosis of ICH because of its high imaging speed and high sensitivity and specificity in the detection of stroke. Many markers-based CT imaging, quantitative parameters, and artificial intelligence (AI) methods based on CT are increasingly used for the prediction of hematoma expansion (HE), prognosis of ICH, and the evaluation of perihematomal edema (PHE). Therefore, we performed a comprehensive review of studies, focusing on current research evidence related to CT use for the prediction of HE and prognostic. This review discusses recent insights into, outlines current limitations, and puts forward suggestions for the challenges and directions of future research. Although at present the prognosis for ICH is not optimistic, the treatment methods remain controversial. However, identifying imaging markers that can evaluate and predict existing possible existing therapeutic targets could help to provide individualized advice for patients and achieve patient risk stratification, which is a key step in improving treatment outcomes.

     

营养制剂在高血压脑出血术后的应用

目的 探讨营养制剂在高血压脑出血术后合理应用的意义和方法 .方法 高血压脑出血24例选择营养支持方案(营养组),与传统治疗的21例(对照组)比较.结果 营养组患者并发症发生率、病死率为28.86%、8.33%,明显低于对照组的66.66%、33.57%,两组比较差异有统计学意义(P＜0.01、P＜0.05).营养组术后的发热时间平均为(14.68±12.49)d,住院平均时间为(35.28±17.15)d,对照组术后发热时间平均为(29.56±17.9)d,住院平均时间为(57.36±25.45)d,两者相比,差异均有统计学意义(P<0.01).结论 脑出血患者术后合理的营养支持疗法,可明显减少手术后的病死率和并发症的发生.     

Experimental animal models of intracerebral hemorrhage

Experimental animal ICH models are able to reproduce the overall important pathophysiologic events documented in human ICH, including edema development, markedly reduced metabolism, and tissue pathologic responses. Thus, ICH models serve as an important tool for new understanding of the mechanisms underlying brain injury after an intracerebral bleed. Currently, ongoing studies in several laboratories using these models investigating secondary inflammatory responses as well as intracellular signaling and molecular events are expected to provide therapeutic targets for treating ICH. Future studies should also be directed at one aspect of ICH modeling that has received little attention--potential differences in the hemostatic systems and physical and biochemical properties of clots in animals that might make their susceptibility to aspiration and/or fibrinolytic drugs and rates of rehemorrhage different than in human beings. Also, future efforts should be directed toward the development of a model that mimics the pathophysiologic processes that lead to spontaneous ICH, progression of hemorrhage, and the recurrence of bleeding in human beings. This model would not only provide better understanding of the dynamic events leading to ICH and tissue injury but should also lead to the development of highly effective pharmacologic and surgical treatments.     

Autonomic dysfunction secondary to intracerebral hemorrhage

IMPLICATIONS: We report a case of autonomic dysfunction secondary to intracranial hemorrhage. The patient had periodical episodes of hypertension, tachycardia, tachypnea, and diaphoresis that responded dramatically to Thorazine, but not to conventional measures.     

Massive intracerebral hemorrhage following carotid endarterectomy

To our knowledge, a particularly lethal complication of carotid endarterectomy, intracerebral hemorrhage, has not been given due consideration in the literature concerning carotid surgery. In the Atlanta area, massive intracranial hemorrhage developed in ten patients following routine carotid endarterectomies performed during a recent ten-year period. All ten of the patients in this series died despite a variety of therapeutic interventions. Risk factors may include the following: extreme arterial stenosis with resultant postoperative hyperperfusion, involvement of multiple extracranial cerebral vessels, postoperative systemic hypertension, and administration of anticoagulant or antiplatelet medications. Unfortunately, identification of the subset of patients potentially at risk for this complication is difficult, and, to date, therapy has been generally ineffective.     

Prognostic data analysis of surgical treatments for intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is a commonly occurring disease in neurosurgery, yet its surgical treatment is controversial. This paper pertains to the study of the effects of different treatment regimens on the outcome of ICH population. Based on a globally shared third-party MIMIC-III database, the researchers firstly described the dissimilarities in survival probability, mortality, and neurological recovery among mainstream treatments for ICH; secondly, patient classification was determined by important clinical features; and outcome variations among treatment groups were compared. The 28-day, 90-day, and in-hospital mortality in the craniotomy group were significantly lower than minimally invasive surgery (MIS) and non-surgical group patients; and, the medium/long-term mortality in MIS group was significantly lower than the non-surgical group. The craniotomy group positively correlated with short-term GCS recovery compared with the MIS group; no difference existed between the non-surgical and MIS groups. The craniotomy group 90-day survival probability and short-term GCS recovery were superior to the other two treatments in the subgroups of first GCS 3–12; this tendency also presented in the MIS group over non-surgical group. For milder patients (first GCS?>?12), the three treatment regimens had a minimal effect on patient survival, but the non-surgical group showed an advantage in short-term GCS recovery. Craniotomy patients have a lower mortality and a better short-term neurological recovery in an ICH population, especially in short-to-medium term mortality and short-term neurological recovery over MIS patients. In addition, surgical treatment is recommendable for patients with a GCS?≤?12.

     

Delayed intracerebral hemorrhage after ventriculoperitoneal shunt

A serious intracerebral hemorrhage occurred as a result of a measurement for grip power performed on the 7th postoperative day of a ventriculoperitoneal shunt. This type of delayed intracerebral hemorrhage after the placement of a ventriculoperitoneal shunt has not been described in the literature. The increased intracranial venous pressure produced by Valsalva's effect induced this complication, which is also considered to be the same mechanism as traumatic delayed intracerebral hemorrhage.