Prognosis for patients treated conservatively for spontaneous intracerebral hematomas

The long-term clinical and CT-outcome of 53 conservatively treated patients with spontaneous intracerebral hematomas (ICH) was studied in relation to the acute findings. The acute mortality of ICH was 27%. Determinant for the immediate prognosis was the level of consciousness and the volume of the hematoma. The crucial size was 50 ml with a mortality of 90% for hematomas larger and 10% for hematomas smaller than that. Intraventricular hemorrhage was a bad prognostic sign only in the ganglionic-thalamic hematomas. At follow-up at a median of 4 1/2 years after ICH, 30% of the total series had a completely normal neurological examination and 28% had resumed work. Thirteen per cent had minor neurological deficits and 17% had debilitating sequelae. During the follow-up period 7 patients had died, which indicates an excess mortality for ICH survivors. The CT findings at follow-up consisted of low density areas smaller than the original hematomas, focal atrophy, calcifications and porencephalic cysts. In 10% the CT scan revealed no trace of the previous hematoma.     

Use of somatosensory evoked potentials for prognostic evaluation of patients with intracerebral hematoma

Evoked somatosensory potential (SEP) was studied in 15 patients with intracerebral haematomas comparing the obtained results with those in healthy subjects. In all studied patients the diagnosis was based on clinical picture and on computerized tomography. In 6 patients normal symmetrical records of SEP or records with slight differences of latency, amplitude or symmetry of various components between the ipsilateral and contralateral side in relation to the pathological focus were obtained. The postoperative course in this group was good. In 9 patients SEP on the ipsilateral or contralateral side (in relation to the pathological focus) was absent or deformed. The postoperative course in this group was unfavourable, and all patients died despite intensive treatment.     

The value of CT head scan in elderly psychiatric patients

The authors present the results of routine CT head scans done on 80 consecutively admitted elderly psychiatric patients. Many patients had abnormal scans but in few cases were the results of major clinical importance. Patients in whom the clinical history suggests a recent change in behaviour or personality, or whose findings on physical examination have recently altered, represent a select group for whom CT scans should be considered.     

Alb及NLR对创伤性脑出血患者的近期预后价值

目的探讨血清白蛋白(Alb)及中性粒细胞/淋巴细胞比值(NLR)对创伤性脑出血(TICH)患者的近期预后价值。方法选取海南省第三人民医院收治的TICH患者286例,根据28d预后情况分成存活组(n=229)和死亡组(n=57)。采用美国国立卫生研究院卒中量表(NIHSS)对患者神经功能缺损分为轻度组(n=94,4分)、中度组(n=120,4~15分)、重度组(n=72, 15分)。比较各组入院第1、3、7天Alb及NLR水平变化。应用受试者工作特征(ROC)曲线分析各时间点血清Alb及NLR水平预测TICH患者死亡的价值。结果死亡组第1、3、7天血清Alb水平均明显低于存活组(33. 80±5. 74 vs 38. 26±6. 13; 28. 24±4. 62 vs 42. 35±7. 40; 21. 73±4. 15 vs 46. 28±7. 85,均P 0. 05),而死亡组第1、3、7天NLR均明显高于存活组(5. 94±2. 26 vs 4. 38±1. 36; 7. 15±2. 40 vs 3. 34±1. 27; 8. 62±3. 24 vs 2. 13±0. 91,均P 0. 05)。重度组第1、3、7天血清Alb水平均明显低于轻度组和中度组(均P 0. 05),而重度组第1、3、7天NLR均明显高于轻度组和中度组(均P 0. 05)。ROC曲线显示,第3天血清Alb及NLR水平预测TICH患者死亡的最佳截值分别为31. 52 g/L和5. 27,两项联合预测TICH患者死亡的AUC(95%CI)为0. 925(0. 861~0. 975)明显高于单项Alb[0. 836(0. 780~0. 893)]及NLR[0. 851(0. 782~0. 903)],其敏感度和特异度为93. 0%和87. 5%。相关分析显示,死亡组血清Alb水平与NLR、NIHSS评分呈负相关(r=-0. 827、r=-0. 724,P 0. 01),NLR与NIHSS评分呈正相关(r=0. 775,P 0. 01)。结论 Alb及NLR水平与TICH患者的病情严重程度相关,第3天两项联合预测TICH患者预后的价值较高。     

Two cases of giant intracerebral aneurysm simulating neoplasm on CT scan; one with coexistent chronic subdural hematoma

Summary Two cases of giant intracerebral aneurysm are presented. Both exhibit increased absorption values in a circumferential configuration peripherally after the administration of contrast material. In addition, one case demonstrates a coexistent contralateral chronic subdural hematoma. No previous example of intracranial aneurysm exhibiting this configuration on computed tomography has been described in the literature. The operative, computed tomographic, radionuclide and angiographic findings are described and the differential diagnosis discussed.

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Zusammenfassung Es werden zwei Fälle von intrazerebralem Riesenaneurysma geschildert. Beide zeigten eine ringförmige dichte Zunahme in der Peripherie nach Gabe von Kontrastmittel. Außerdem zeigte ein Fall ein begleitendes chronisches Subduralhämatom auf der Gegenseite. Kein Fall von intrakraniellem Aneurysma mit diesen Charakteristika in der computerisierten axialen Schädeltomographie ist bisher in der Literatur beschrieben worden. Es werden der operative Befund und das Ergebnis des CAT, der Hirnszintigraphie und der Angiographie geschildert und die Differentialdiagnose diskutiert.

     

头颅平扫CT“岛征”对HICH患者早期血肿扩大的预测价值研究

目的分析头颅平扫CT岛征对高血压脑出血(HICH)患者早期血肿扩大(HE)的预测价值。方法收集2015年12月至2017年12月就诊于佳木斯大学附属第一医院的发病6h内行第1次头颅平扫CT检查,并在发病72h内复查头颅CT或病情有变化时复查头颅CT的非手术HICH患者的病例资料180例。计算前后血肿体积,以血肿体积扩大> 33%或血肿体积绝对增加> 12.5ml为标准。将所有患者分为血肿扩大组与血肿未扩大组,再将两组分别分为岛征阳性组与岛征阴性组,有意义的岛征定义为:①血肿周围存在于血肿不接壤的小血肿≥3个;②血肿周围存在与血肿不接壤或接壤但突出存在的小血肿≥4个。进行单因素和多因素Logistic回归分析以评估头颅平扫CT岛征对HICH患者早期血肿扩大的关系。结果共180例患者被纳入研究,在基线CT扫描中,有岛征者27例(15%),在62例血肿扩大的患者中,有岛征者21例(33.9%)。两名阅片者之间鉴定岛征的一致性符合要求(k=0.926,P> 0.05)。结论 岛征在头颅平扫CT上很容易识别,并且对预测HICH患者早期血肿扩大具有高度特异性。     

Incidence of surgery in conservatively treated patients with scoliosis

The effectiveness of bracing and the effectiveness of conservative treatment of scoliosis as a whole is widely denied and rejected. We therefore carried out the present study in order to establish whether the work involved in the conservative treatment of scoliosis is reasonable and worthwhile, including as it does the education of patients, techniques of brace moulding, time-consuming follow-ups and the strain put on patients by the treatment itself. Study design : A retrospective analysis of the incidence of surgery in patients with scoliosis presenting every kind of aetiology. To improve comparison with data already published by other centres, this group of patients was matched with the study design of the control group. Materials and methods: Since 1992, in addition to the intensive inpatient rehabilitation programme developed at our centre, we have also been practising moulding techniques according to Chêneau in order to construct scoliosis orthoses of high correction. For the purposes of this study we chose a number of scoliosis patients from our data bank who had had conservative treatment at our centre between 1993 and 1996. All the patients, like those of the untreated control group, were at least 15 years of age at the time they were last investigated or questioned. The incidence of surgery in our group was compared statistically with data published by other centres. Results: Three hundred and forty-three patients (females only) with a curvature of 33.4° (SD = 18.9) were included in our study and could be followed up under the described pre-conditions. Forty-one patients (11.95%) had had surgery. In patients with adolescent idiopathic scoliosis, we found an incidence of surgery of only 7.3% compared with 28% in the control group with the same diagnosis. Statistically, therefore, the incidence of surgery in our group was highly significantly lower than the incidence of surgery in the control group from Ireland and other centres described in literature. Conclusions: The conservative treatment of scoliosis (which includes outpatient physiotherapy, inpatient intensive scoliosis rehabilitation (SIR) and high-correction-effect bracing based on plastercasting) shows an obvious reduction in the rate of surgery in patients with idiopathic scoliosis compared with untreated scoliosis patients. Thus it can be seen that the conservative treatment of scoliosis may reduce the incidence of surgery, which not only causes considerable medical expenses but also carries with it the risk of repeated operations and further complications. In our study, we also found highly significant differences by comparison with the work of a bracing centre in the USA. Therefore, the quality of the bracing itself and the effects of primary correction must receive greater consideration in future scientific studies on the subject of 'conservative' treatment of scoliosis.     

颅内血肿微创清除术对高血压性脑出血患者血肿周围水肿的影响

高血压性脑出血血肿的机械性压迫和血肿周围水肿,缺血、出血后凝血酶和血红蛋白的毒性作用,是导致神经功能缺失的主要原因,如何减少这些损害越来越引起人们的关注.2002年1月～2004年12月,我们对43例高血压性脑出血患者进行颅内血肿微创清除治疗,以观察其对血肿周围水肿及神经功能的影响,报告如下.     

高血压脑出血应激性高血糖患者miR-223 HMGB1水平对预后的判断价值

目的研究高血压脑出血(HIH)应激性高血糖患者miR-223、血清高迁移率族蛋白B1(HMGB1)水平对预后的判断价值。方法选取郑州大学附属郑州中心医院2017-03—2019-03收治的125例HIH患者,根据血糖水平分为正常血糖组和高血糖组,收集患者一般资料,比较空腹血脂、血糖水平、神经功能(NIHSS)评分;实时荧光定量PCR(qRT-PCR)法测定血清miR-223水平;酶联免疫吸附法(ELISA)测定血清HMGB1水平;受试者工作特征曲线(ROC)评估miR-223、HMGB1水平对患者预后的判断价值;Logistic回归分析影响预后的因素。结果与HIH正常血糖组相比,HIH高血糖组血糖水平、LDL-C水平、NIHSS评分、miR-223水平、HMGB1水平显著升高(P<0.05);与预后良好组相比,预后不良组患者血清miR-223、HMGB1水平显著升高(P<0.05);根据ROC曲线图可得知,miR-223、HMGB1判断HIH应激性高血糖患者不良预后曲线下面积分别为0.84(95%CI0.721~0.921)、0.81(95%CI0.687~0.899),截断值分别为1.67、4.77 ng/mL;Logistic回归分析表明LDL-C水平、NIHSS评分、miR-223水平、HMGB1水平是影响HIH应激性高血糖患者不良预后的独立危险因素。结论miR-223、HMGB1在HIH应激性高血糖患者血清中水平升高,具有一定的预后判断价值,是影响此类患者不良预后的独立危险因素。     

The 90-day prognostic value of copeptin in acute intracerebral hemorrhage

The aim of the study was to assess the 90-day prognostic value of copeptin in a group of Chinese patients with acute intracerebral hemorrhage (ICH). In this study, all consecutive patients with first-ever ICH from 2010 to 2012 were recruited to participate in the study. On admission, plasma copeptin levels were measured by enzyme-linked immunosorbent assay. The Glasgow Coma Scale (GCS) and Hemphill ICH scores were assessed on admission blinded to plasma copeptin levels. For the assessment of functional outcome at 90 days, Modified Rankin Scale was used. During the study period, 271 patients were diagnosed as ICH and were included in the analysis. The median GCS score on admission was 11 points. Patients with an unfavorable outcomes and non-survivors had significantly increased plasma copeptin levels on admission (P < 0.001 for both). Copeptin was an independent prognostic marker of functional outcome and death [odds ratio 3.45 (95 % confidence intervals: 1.85–6.99) and 3.66 (2.42–8.28), respectively, P < 0.001 for both, adjusted for age, the hematoma volume and other predictors] in patients with ICH. In receiver operating characteristic curve analysis, copeptin could improve the Hemphill score in predicting 90-day functional outcome [area under the curve (AUC) of the combined model, 0.83; 95 % CI 0.74–0.90; P < 0.001] and mortality (AUC of the combined model, 0.88; 95 % CI 0.82–0.93; P < 0.001). In conclusion, our study suggests that copeptin levels are a useful tool to predict unfavorable functional outcome and mortality 90 days after ICH and have a potential to assist clinicians.     

功能磁共振对高血压脑出血患者血肿周边"半暗带"的研究

目的 研究高血压脑出血患者血肿周边是否存在"半暗带"区;以及"半暗带"出现的时间和空间规律.方法 根据"半暗带"区的灌注标准和代谢标准,对符合人选标准的高血压脑出血患者,于发病后1、3、5、25d采用动态核磁共振(MRI)评定,获取所需的弥散、灌注和波谱等观察数据.结果 高血压脑出血患者发病后1、3、5、25d,用灌注标准或代谢标准评定都存在有"半暗带";"半暗带"呈斑片状分布在血肿周围;"半暗带"可位于血肿周边上、下、前、后、内、外侧等方向,其中位于血肿内侧多见.1例患者血肿周边"半暗带"演变为脑梗死灶.结论 高血压脑出血患者血肿周围存在斑片状"半暗带";"半暗带"存在于研究的各时间点,以血肿内侧多见.     

神经内镜技术在高龄自发性脑出血的应用

目的 探讨神经内窥镜在治疗高龄自发性脑出血的作用.方法 回顾性分析神经内镜及同期常规开颅手术治疗高龄自发性脑出血共61例,内镜组28例,开颅组33例.结果 各组年龄、术前GCS评分、出血部位及出血量,并发症发生率,无统计学差异,随访3个月GOS评分差异有统计学意义.结论 神经内镜治疗高龄自发性脑出血省时,微创,止血彻底,病人恢复较快,可以获得较为满意的疗效.     

前循环动脉瘤破裂伴颅内血肿和脑疝患者的CT特点和直接手术疗效

目的 探讨前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现和直接手术疗效. 方法 回顾性分析四川省人民医院神经外科自2007年12月至2010年12月收治的11例前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现及治疗,分析前循环动脉瘤破裂形成血肿与动脉瘤位置关系及手术处理要点. 结果 本组患者颅内出血原因术中均证实为动脉瘤破裂出血,其中前交通动脉瘤2例,后交通动脉瘤3例,大脑中动脉瘤6例;多发动脉瘤2例,1例为大脑中动脉瘤(责任动脉瘤)合并同侧后交通动脉瘤,1例为后交通动脉瘤(责任动脉瘤)合并对侧大脑中动脉瘤:术后GOS分级显示V级6例,Ⅳ级2例,Ⅲ级1例,Ⅱ级0例,Ⅰ级2例. 结论 依据前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现,早期手术治疗效果满意.     

自发性脑出血早期血肿扩大首诊CT分析

探讨首诊头部CT影像对自发性脑出血早期血肿扩大的预测价值。300例发病后6h内入院的自发性脑出血患者,经CT检查显示其中61例(20.33%)发生早期血肿扩大,经单因素和多因素Logistic回归分析显示,早期血肿扩大与首诊CT距发病时间短、血肿密度不均匀、中至重度脑萎缩及血     

Assessment of acute spontaneous intracerebral hematoma by CT perfusion imaging

A single-section deconvolution-derived computerized tomographic perfusion imaging was performed in 45 patients (22 male and 23 female; mean age=69.89+/-10.07 years) with acute supratentorial spontaneous intracerebral hemorrhage. Mean rCBF and rCBV were lower in the hemorrhagic core than in the perihematomal low density area (p<0.001), and in the perihematomal low density area than in normal appearing brain parenchyma (p<0.001). Mean rMTT values were higher in perihematomal low density area than in normal appearing area (p<0.01) and in both hemorrhagic and perihematomal area than in controlateral ROI (p<0.001). There were no differences in rMTT mean values between hemorrhagic core and perihematomal area, as well as between normal appearing and controlateral areas. We found a concentric distribution of all CT perfusion parameters characterized by an improvement from the core to the periphery, with low perihematomal rCBF and rCBV values suggesting edema formation.     

脑出血继续出血患者血液纤溶活性的研究

目的探讨脑出血（ICH）继续出血与血液纤溶活性的关系。方法将107例ICH患者根据病情分为继续出血组（21例）和非继续出血组（86例）,利用发色底物法及酶联免疫吸附试验双抗体夹心法分别测定两组患者在发病后0-3d、4-9d、14-21d时血浆中组织型纤溶酶原激活物活性（tPAA）、纤溶酶原抑制物活性（PAIA）、纤溶酶原抑制物-1（PAI-1）及D-二聚体（D-D）的水平,并与同期健康体检者进行比较。结果ICH患者发病后0-3d及4-9d血中tPAA显著低于正常对照组（P〈0.05-0.01）,至14-21d与正常对照组差异无统计学意义;ICH后0-3d及4-9d血中PAIA及D-D显著高于正常对照组（P〈0.05-0.01）,至14-21d与正常对照组差异无统计学意义;ICH各期血中PAI-1水平与正常对照组差异无统计学意义;未继续出血组与继续出血组各期各纤溶指标间差异无统计学意义。结论ICH后血中不存在原发性纤溶活性亢进,ICH继续出血与血液纤溶活性无关。