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Hypertensive cerebral hemorrhage

Wei Wang, Caihou Lin, Jingfang Hong, Shousen Wang, Jianjun Gu
OBJECTIVE: Cerebral venous infarction (CVI) is a rare vascular disease, most commonly caused by cerebral venous thrombosis, which leads to brain tissue ischemia and anoxia, followed by necrosis, hemorrhage, and infarct formation. CVI has diverse clinical manifestations; thus, diagnosis is very difficult, and the prognosis is poor. The goal of this study is to provide a theoretical basis for treating patients suffering from CVI combined with high intracranial pressure. To this end, a rabbit model of CVI was established by placing a recoverable epidural sacculus...
August 7, 2018: World Neurosurgery
Andrea Wagner, Karl-Michael Schebesch, Florian Zeman, Stefan Isenmann, Andreas Steinbrecher, Thomas Kapapa, Dobri Baldaranov, Roland Backhaus, Felix Schlachetzki
Background and Purpose: Intracerebral hemorrhage (ICH) requires rapid decision making to decrease morbidity and mortality although time frame and optimal therapy are still ill defined. Ideally, specialized neurologists, neurosurgeons, and (neuro-) radiologists who know the patient's clinical status and their cerebral computed tomography imaging (cCT) make a joint decision on the clinical management. However, in telestroke networks, a shift toward cCT imaging criteria used for decision making can be observed for practical reasons...
2018: Frontiers in Neurology
Ayako Kurihara, Tomonori Okamura, Daisuke Sugiyama, Aya Higashiyama, Makoto Watanabe, Nagako Okuda, Aya Kadota, Naoko Miyagawa, Akira Fujiyoshi, Katsushi Yoshita, Takayoshi Ohkubo, Akira Okayama, Katsuyuki Miura, Hirotsugu Ueshima
AIM: To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population. METHODS: A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a three-day semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox's proportional hazards model after adjusting for confounding factors...
August 9, 2018: Journal of Atherosclerosis and Thrombosis
Hiroshi Izuma, Fumiaki Oka, Hideyuki Ishihara, Takao Inoue, Eiichi Suehiro, Sadahiro Nomura, Michiyasu Suzuki
BACKGROUND: The aim of this study was to assess the risk and the threshold of hemorrhagic transformation (HT) after treatment with recombinant tissue plasminogen activator (rtPA) under the novel oral anticoagulant, rivaroxaban. METHODS: Fifty-three spontaneous hypertensive rats were used in this study. We performed transient middle cerebral artery occlusion for 270 minutes. Placebo, 10 mg/kg or 20 mg/kg rivaroxaban were administered via a stomach tube 180 minutes after induction of ischemia, and rtPA (10 mg/kg) was administered just before reperfusion...
July 25, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
C Michael Dunham, Rema J Malik, Gregory S Huang, Chander M Kohli, Brian P Brocker, Kene T Ugokwe
Although hypertonic saline (HTS) decreases intracranial pressure (ICP) with traumatic brain injury (TBI), its effects on survival and post-discharge neurologic function are less certain. We assessed the impact of HTS administration on TBI outcomes and hypothesized that favorable outcomes would be associated with larger amounts of 3% saline. This is a retrospective study of consecutive-patients with the following criteria: blunt trauma, age 18-70 years, intracranial hemorrhage, Glasgow Coma Scale score (GCS) 3-12, and mechanical ventilation ≥ 5 days...
2018: International Journal of Burns and Trauma
Jack Garland, Kilak Kesha, Dianne Vertes, Lucy Modahl, David Milne, Thomas Ruder, Simon Stables, Rexson Tse
Cerebral venous thrombosis is a rare condition which constitutes 0.5% to 2% of all types of stroke and carries a mortality of up to 20% to 50%. It leads to cerebral edema, infarction, hemorrhage and venous hypertension. Clinically the diagnosis is confirmed using enhanced computed tomography (CT) angiography which demonstrates an empty delta sign in cerebral veins, particularly in the superior sagittal sinus. However, postmortem CT (PMCT) findings on cerebral venous thrombosis have not been documented in the literature...
July 17, 2018: American Journal of Forensic Medicine and Pathology
Shahed Toossi, Asma M Moheet
Non-traumatic intracranial hemorrhage includes subarachnoid hemorrhage, subdural hemorrhage, and intracerebral hemorrhage (ICH), which can be classified as primary or secondary. Primary ICH is due to arterial hypertension or cerebral amyloid angiopathy, and secondary ICH is due to cerebral vascular malformations, coagulopathies, infectious complications, brain tumors, and illicit stimulant drug use. This review explores the epidemiology and management of non-traumatic ICH in women, with a focus on pregnancy and the post-partum period, defined as 6 weeks post-delivery...
July 11, 2018: Neurocritical Care
Daniel Agustin Godoy, Jose Orquera, Alejandro A Rabinstein
Paroxysmal sympathetic hyperactivity represents an uncommon and potentially life-threatening complication of severe brain injuries, which are most commonly traumatic. This syndrome is a clinical diagnosis based on the recurrent occurrence of tachycardia, hypertension, diaphoresis, tachypnea, and occasionally high fever and dystonic postures. The episodes may be induced by stimulation or may occur spontaneously. Underdiagnosis is common, and delayed recognition may increase morbidity and long-term disability...
April 2018: Revista Brasileira de Terapia Intensiva
Siu-Lung Chan, Nicole Bishop, Zhaojin Li, Marilyn J Cipolla
BACKGROUND AND PURPOSE: Aging and hypertension, comorbidities prevalent in the stroke population, are associated with poor collateral status and worsened stroke outcome. However, underlying mechanisms by which these conditions affect stroke outcome are not clear. We studied the role of PAI (plasminogen activator inhibitor)-1 that is increased in aging and hypertension on brain and vascular expression of inflammatory factors and perfusion that may contribute to worse stroke outcomes. METHODS: Aged (≈50 weeks) and young (≈18 weeks) spontaneously hypertensive rats (SHR) were subjected to ischemia by middle cerebral artery occlusion (2 hours) and reperfusion (2 hours) with or without treatment with the PAI-1 inhibitor TM5441...
July 10, 2018: Stroke; a Journal of Cerebral Circulation
Khalil M Yousef, Elizabeth Crago, Yuefang Chang, Theodore F Lagattuta, Khadejah Mahmoud, Lori Shutter, Jeffrey R Balzer, Michael R Pinsky, Robert M Friedlander, Marilyn Hravnak
INTRODUCTION: Vasopressors are commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to sustain cerebral pressure gradients. Yet, the relationship between vasopressors and the degree of cerebral microcirculatory support achieved remains unclear. This study aimed to explore the changes in cerebral and peripheral regional tissue oxygen saturation (rSO2) as well as blood pressure (BP) before and after vasopressor infusion in patients with aSAH. METHODS: Continuous noninvasive cerebral and peripheral rSO2 was obtained using near-infrared spectroscopy for up to 14 days after aSAH...
August 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Eliza C Miller, Kathryn M Sundheim, Joshua Z Willey, Amelia K Boehme, Dritan Agalliu, Randolph S Marshall
BACKGROUND: Pregnancy is a sex-specific risk factor for causing hemorrhagic stroke (HS) in young adults. Unique physiological characteristics during pregnancy may alter the relative risk for HS in pregnant/postpartum (PP) women compared to HS in other young women. We compared patient characteristics and HS subtypes between young non-pregnant and PP women. METHODS: We reviewed the medical records of all women 18-45 years old admitted to our center with HS from October 15, 2008 through March 31, 2015, and compared patient characteristics and stroke mechanisms using logistic regression...
July 6, 2018: Cerebrovascular Diseases
Salim Harris, Mohammad Kurniawan, Al Rasyid, Taufik Mesiano, Rakhmad Hidayat
Background and Purpose: Stroke is the number one cause of morbidity and mortality in Indonesia. Lacunar infarction is one of cerebral small vessel disease spectrum. This study aimed to present stroke epidemiology in Indonesia and risk factors associated with cerebral small vessel disease. Methods: A multicenter prospective cross-sectional study of 18 hospitals in Indonesia was conducted using Stroke Case Report Form from 2012 to 2014. Stroke was diagnosed based on clinical findings confirmed with non-contrast computed tomography of the brain...
2018: SAGE Open Medicine
Guojing Liu, Zongduo Guo, Xiaochuan Sun, WeiNa Chai, Lingjun Qi, Hui Li, Jianfeng Zheng, Tengyun Guo, Zhaohui He, Xiaodong Zhang, Ji Zhu, Yetao Luo
OBJECTIVE: To detect cerebral autoregulation (CA) in patients with aneurysmal subarachnoid hemorrhage (aSAH) by near-infrared spectroscopy and to assess its association with delayed cerebral ischemia (DCI). METHODS: From January to August 2017, 81 patients (average age 53.25 ± 10.27 years) were studied. Near-infrared spectroscopy was used to monitor CA, and associated factors were evaluated. Monitoring of CA was carried out at 5 time points (preoperative day 1 and postoperative days 1, 2, 3, and 7)...
June 30, 2018: World Neurosurgery
Belal Neyazi, I Erol Sandalcioglu, Homajoun Maslehaty
The PHASES score was developed to determine the risk of rupture of un-ruptured intracranial aneurysms (UIAs). The purposes of the current study were to apply this score on patients with actually ruptured intracranial aneurysms and to analyze the hypothetically prediction of the risk in this particularly patient group. We extracted the data of 100 recently treated patients (23 male, 77 female, mean age 56.4 years, range 17-93 years) with ruptured saccular intracranial aneurysms from our prospectively maintained neurovascular database according to the parameters used in the PHASES score (population, hypertension, age, earlier SAH, size and site of the aneurysm)...
June 11, 2018: Neurosurgical Review
Elena I Fomchenko, Emily J Gilmore, Charles C Matouk, Jason L Gerrard, Kevin N Sheth
PURPOSE OF REVIEW: Subdural hematomas (SDH) represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. SDH incidence increases with age; numbers of patients affected by SDH continue to rise with our aging population and increasing number of people taking antiplatelet agents or anticoagulation. Medical and surgical SDH management remains a subject of investigation. RECENT FINDINGS: Initial management of patients with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining ICP < 22 mmHg, CPP > 60 mmHg, MAP 80-110 mmHg, and PaO2 > 60 mmHg, followed by rapid sequence intubation if necessary, and expedited acquisition of imaging to identify a space-occupying lesion...
June 23, 2018: Current Treatment Options in Neurology
Naoki Kato, Toshinori Hasegawa, Hiroshi Iizuka, Takenori Kato, Takashi Yamamoto, Jun Torii
BACKGROUND: To date, there have been many publications concerning relationship of meteorological condition and stroke onset. However, little is known about detailed meteorological factors that affect stroke onset. With hospital characteristics that most inpatients at our institution lived around Komaki, we examined the relationship between stroke onset and meteorological factors based on detailed meteorological data of Komaki. MATERIALS AND METHODS: Between April 1, 2012 and March 31, 2015, 1351 stroke patients admitted to Komaki City Hospital were enrolled in this study...
June 2018: No Shinkei Geka. Neurological Surgery
A A Sychev, Yu V Pilipenko, T M Birg, I A Savin, T F Tabasaranskiy, E Yu Sokolova, N V Kurdyumova, Ya V Savchenko, A I Baranich, An N Konovalov
Treatment of children in the acute stage of hemorrhage from cerebral aneurysms is based on clinical cases reported in the literature and descriptions of small series of observations. There are no studies that enable the development of evidence-based approaches to intensive care in treatment of children with aSAH. We present a clinical case with a favorable outcome of complex treatment in a child admitted to the Burdenko Neurosurgical Institute at an extremely severe condition. The efficacy of treatment was based on a timely urgent neurosurgical intervention and adequate intensive therapy in the form of extended neuromonitoring with continuous measurement of intracranial pressure, which enabled using the whole complex of measures for timely management of intracranial hypertension...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Koin Lon Shum, Yuyang Tan
Pneumocephalus, the presence of air within the cranium, commonly suggests a breach in the meningeal layer or an intracranial infection by a gas-producing organism. Trauma is the most common cause of pneumocephalus, followed by cranial surgery. Other causes include infection and intracranial neoplasm. An 87-year-old man was conveyed to the emergency department after being found to be drowsy by his helper. He was noted to have a new onset right-sided hemiparesis. Past medical history was significant for hypertension, stage 5 chronic kidney disease, cerebrovascular accident, pacemaker insertion for sick sinus syndrome, transurethral resection of the prostate for benign prostatic hyperplasia, and pulmonary tuberculosis...
April 14, 2018: Curēus
Michelle L Allen, Tobias Kulik, Salah G Keyrouz, Rajat Dhar
BACKGROUND: Induced hypertension (IH) remains the mainstay of medical management for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). However, raising blood pressure above normal levels may be associated with systemic and neurological complications, of which posterior reversible encephalopathy syndrome (PRES) has been increasingly recognized. OBJECTIVE: To ascertain the frequency and predisposing factors for PRES during IH therapy. METHODS: We identified 68 patients treated with IH from 345 SAH patients over a 3-yr period...
June 8, 2018: Neurosurgery
Hsin-Hsi Tsai, Jong S Kim, Eric Jouvent, M Edip Gurol
Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences...
May 2018: Journal of Stroke
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