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Hypertensive cerebral hemorrhage

Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Hao Li, Haochen Xu, Hongyan Wen, Tianlong Liu, Yingying Sun, Ning Xiao, Congxia Bai, Jing Ge, Xuliang Wang, Li Song, Yan Song, Yinhui Zhang, Jingzhou Chen
Hypertensive intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with no effective treatment. Lysyl hydroxylase 3 (LH3) is essential for collagen IV intermolecular crosslinking and stabilization. Deficiency in LH3 affects the assembly and secretion of collagen IV and basement membrane (BM) integrity of vessels. Here, we investigated whether LH3 has significant implications for disease progression and therapeutic intervention. Spontaneous hypertensive ICH of mice was induced by angiotensin II and L-NAME treatment...
December 5, 2018: Journal of Cerebral Blood Flow and Metabolism
Chisato Kasuya, Mina Suzuki, Yukako Koda, Hitomi Sato, Katsunori Kashima, Keisuke Honda, Yoshiki Kazama, Katsuhiko Akiyama, Yasuhiro Seki, Yuichiro Yoneoka
A 32-year-old pregnant woman in her 39th week of pregnancy presented at the emergency room complaining of sudden-onset dizziness with gaze disturbance and was admitted to our hospital. Her past medical history included hypertension, diabetes mellitus and infarction in the right medulla oblongata 18 months prior to this event. Magnetic resonance (MR) angiography showed multiple irregular stenosis of the intracranial arterial system. Although MR images revealed no fresh ischemic or hemorrhagic lesions, she was diagnosed with reversible cerebral vasoconstriction syndrome (RVCS) associated with pregnancy...
December 2018: Oxford Medical Case Reports
Whitney M Freeze, Heidi I L Jacobs, Floris H B M Schreuder, Robert J van Oostenbrugge, Walter H Backes, Frans R Verhey, Catharina J M Klijn
Background and Purpose: Hypertensive vasculopathy and cerebral amyloid angiopathy are the two most common forms of cerebral small vessel disease. Both forms are associated with the development of primary intracerebral hemorrhage, but the pathophysiological mechanisms underlying spontaneous vessel rupture remain unknown. This work constitutes a systematic review on blood-brain barrier dysfunction in the etiology of spontaneous intracerebral hemorrhage due to cerebral small vessel disease. Methods: We searched Medline (1946-2018) and Embase (1974-2018) for animal and human studies reporting on blood-brain barrier dysfunction associated with intracerebral hemorrhage or cerebral microbleeds...
2018: Frontiers in Neurology
Erica C Camargo, Steven K Feske, Aneesh B Singhal
Pregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Hemorrhagic stroke is the most common type of obstetric stroke. Hypertensive disorders of pregnancy are important contributors to obstetric stroke and predispose women to premature cardiovascular disease. The rate of stroke associated with hypertensive disorders of pregnancy has increased in the United States...
February 2019: Neurologic Clinics
Oliver Matz, Andre Arndt, Jens Litmathe, Manuel Dafotakis, Frank Block
INTRODUCTION: The aim of this study was to compare possible risk factors for the most common forms of spontaneous intracerebral hemorrhage (ICH), namely hypertensive and cerebral amyloid angiopathy (CAA) associated ICH. METHODS: Retrospectively, different parameters and factors were compared in patients with hypertensive ICH (n = 141) and patients with a CAAassociated ICH (n = 95). These included age, INR value and blood pressure at admission, cardiovascular risk factors as well as pre-medication...
November 12, 2018: Fortschritte der Neurologie-Psychiatrie
Tom J Moullaali, Xia Wang, Renee' H Martin, Virginia B Shipes, Adnan I Qureshi, Craig S Anderson, Yuko Y Palesch
BACKGROUND: There is persistent uncertainty over the benefits of early intensive systolic blood pressure lowering in acute intracerebral hemorrhage. In particular, over the timing, target, and intensity of systolic blood pressure control for optimum balance of potential benefits (i.e. functional recovery) and risks (e.g. cerebral ischemia). AIMS: To determine associations of early systolic blood pressure lowering parameters and outcomes in patients with a hypertensive response in acute intracerebral hemorrhage...
November 12, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Ruchira M Jha, Patrick M Kochanek
PURPOSE OF REVIEW: Standard clinical protocols for treating cerebral edema and intracranial hypertension after severe TBI have remained remarkably similar over decades. Cerebral edema and intracranial hypertension are treated interchangeably when in fact intracranial pressure (ICP) is a proxy for cerebral edema but also other processes such as extent of mass lesions, hydrocephalus, or cerebral blood volume. A complex interplay of multiple molecular mechanisms results in cerebral edema after severe TBI, and these are not measured or targeted by current clinically available tools...
November 7, 2018: Current Neurology and Neuroscience Reports
Yushin Takemoto, Takayuki Kawano, Yuki Ohmori, Takashi Nakagawa, Kazutaka Ohta, Jun-Ichiro Kuroda, Shigetoshi Yano, Akitake Mukasa
Dural arteriovenous fistula (dAVF) associated with an intracranial tumor is a relatively rare condition. Furthermore, to our knowledge, this is the first case report of dAVF associated with intratumor hemorrhage. We experienced this very rare case and report it here, along with a literature review. A 59-year-old woman presented with transient aphasia and dysgraphia. Computed tomography, magnetic resonance imaging, and angiography showed left anterior cranial fossa dAVF and a tumor with an intratumor hemorrhage...
October 31, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Ke Li, Ming Ren, Ran Meng, Yuchuan Ding, Gary B Rajah, Feng Wang, Xunming Ji
BACKGROUND: Venous stenting has been proven to be a safe and effective therapeutic option for patients with idiopathic intracranial hypertension (IIH) and cerebral venous sinus stenosis (CVSS). However, its use in patients with cerebral venous sinus thrombosis-related CVSS has been less reported. PURPOSE: To explore the safety and efficacy of stenting for patients with cerebral venous sinus thrombosis (CVST)-related CVSS. METHODS: The clinical presentation, treatment, and outcome of patients with CVST-related CVSS received venous stenting in the chronic stage after failed medical treatment were retrospectively evaluated...
November 2, 2018: Journal of Neurointerventional Surgery
Pierre Esnault, Johanna Roubin, Mickael Cardinale, Erwan D'Aranda, Ambroise Montcriol, Pierre-Julien Cungi, Philippe Goutorbe, Christophe Joubert, Arnaud Dagain, Eric Meaudre
BACKGROUND: Hypocapnia induces cerebral vasoconstriction leading to a decrease in cerebral blood flow, which might precipitate cerebral ischemia. Hypocapnia can be intentional to treat intracranial hypertension or unintentional due to a spontaneous hyperventilation (SHV). SHV is frequent after subarachnoid hemorrhage. However, it is understudied in patients with severe traumatic brain injury (TBI). The objective of this study was to describe the incidence and consequences on outcome of SHV after severe TBI...
November 1, 2018: Neurocritical Care
Young-Min Lee, Hae-Won Koo, Hyung Koo Kang, Jin Woo Kim, Seong Rok Han, Sang Won Yoon, Chan Young Choi, Moon-Jun Sohn, Chae Heuck Lee
Objective: Cerebral microbleeds (CMBs) are known as the neuroimaging markers of risk in stroke and dementia. Many studies on CMBs in elderly patients with hemorrhagic or ischemic stroke have been reported; however, reports on CMBs in young populations with intracerebral hemorrhage (ICH) are lacking. Materials and Methods: A total of 272 patients aged 18-54 years presented to our hospital with ICH between December 2009 and August 2017. Among these, CMB presence, count, and topography with respect to ICH were evaluated on magnetic resonance imaging (MRI) gradient echo images (GREs)...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
N Marlou Haegens, Celine S Gathier, Janneke Horn, Bert A Coert, Dagmar Verbaan, Walter M van den Bergh
Background and Purpose- Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage. If clinical signs of DCI occur, induced hypertension is a plausible but unproven therapeutic intervention. There is clinical equipoise if the use of hypertension induction is useful or not with the consequence that this strategy is irregularly used. We explored the effect of blood pressure augmentation in preventing cerebral infarction in patients with clinical signs of DCI...
November 2018: Stroke; a Journal of Cerebral Circulation
Yoshihide Inayama, Eiji Kondoh, Yoshitsugu Chigusa, Shingo Io, Takeshi Funaki, Noriomi Matsumura, Susumu Miyamoto, Masaki Mandai
BACKGROUND: Pregnancy is a potential risk factor for stroke in women with Moyamoya disease. However, the rarity of the disease has limited clinical expertise to ensure a healthy pregnancy. The aim of the present study was to explore the possible risk factors for hemorrhagic and ischemic stroke in pregnant women with Moyamoya disease. METHODS: A retrospective review of cases in our hospital during a 20-year period and a review of the reported data were conducted to investigate pregnancy-related cerebrovascular events in women with Moyamoya disease...
October 19, 2018: World Neurosurgery
Eleni Vourla, Andreas Filis, Jan F Cornelius, Richard Bostelmann, Bernd Turowski, Piyush Kalakoti, Christian Rubbert, Marian Preetham Suresh, Angelo Tortora, Hans Jakob Steiger, Athanasios K Petridis
BACKGROUND: De novo aneurysm formation after completely occluded aneurysms via clipping or coiling has not been well studied. Although known to occur several years after initial aneurysm management, the natural history of de novo aneurysms is obscure. We investigated the formation of new aneurysms in patients who had previously undergone treatment of intracranial aneurysms. METHODS: In a retrospective, single-institutional series, eligible patients who had undergone treatment of ruptured cerebral aneurysms from 2000 to 2011 were included...
October 12, 2018: World Neurosurgery
Jianfeng Zheng, Rui Xu, Guojing Liu, Zongduo Guo, Xiaochuan Sun
OBJECTIVE: Hypertension is common in patients with aneurysmal subarachnoid hemorrhage (SAH). However, it is still unclear whether premorbid antihypertensive therapy can help to reduce the risk of severe aneurysmal bleeding. Therefore, this study aims to assess the effect of premorbid hypertension control on outcome of patients with aneurysmal SAH. METHODS: We retrospectively reviewed the clinical data of patients with intracranial aneurysms admitted to our institution from February 2012 to December 2017...
October 12, 2018: Acta Neurochirurgica
Alexandros Sotiradis, Stamatios Petousis, Basky Thilaganathan, Francesc Figueras, Wellington P Martins, Anthony O Odibo, Konstantinos Dinas, Jon Hyett
OBJECTIVE: The rate of maternal and perinatal complications increases after 39 weeks in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the evidence on the effect of elective induction of labor at term on the risk of Cesarean section, and maternal and perinatal outcome. METHODS: We searched PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases from inception to August 2018. We additionally searched the references of retrieved articles...
October 8, 2018: Ultrasound in Obstetrics & Gynecology
Y Liu, D C Han, Y L Hu, L M Chen, J C Li, Y W Su, C X Hu
Objective: To summarize the clinical presentations and imaging features of cerebral venous sinus thrombosis (CVST) in 5 newborns. Methods: The clinical data of 5 newborns with CVST admitted to Department of Neonatology of Maternal and Children Hospital of Hubei Province from February 2017 to April 2018 were analyzed retrospectively. The risk factors, clinical presentations, imaging manifestations and treatment of CVST were investigated. Results: Of the 5 full term neonates, 4 were males and 1 female, with 4 aged less than 7 days and 1 more than 7 days; one with the history of maternal gestational diabetes mellitus, one with maternal gestational hypertension...
October 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Zoltan Ungvari, Andriy Yabluchanskiy, Stefano Tarantini, Peter Toth, Angelia C Kirkpatrick, Anna Csiszar, Calin I Prodan
Multifocal cerebral microhemorrhages (CMHs, also known as "cerebral microbleeds"), which are associated with rupture of small intracerebral vessels, have been recognized as an important cause for cognitive decline in older adults. Although recent studies demonstrate that CMHs are highly prevalent in patients 65 and older, many aspects of the pathogenesis and clinical significance of CMHs remain obscure. In this longitudinal observational study, a case of a 77-year-old man with multifocal CMHs is described, in whom the rupture of intracerebral vessels could be linked to repeatedly performing extended Valsalva maneuvers...
October 4, 2018: GeroScience
Makoto Saito, Hajime Senjo, Minoru Kanaya, Koh Izumiyama, Akio Mori, Masanori Tanaka, Masanobu Morioka, Masahiro Ieko
A 74-years-old male who was a smoker and received treatment for hypertension, dyslipidemia, peripheral arterial disease and idiopathic interstitial pneumonia complained of subcutaneous hemorrhage of the right lower thigh. Marked anemia (hemoglobin 5.5 g/dL) and prolonged activated partial thromboplastin time (≥130 seconds) were noted. The factor VIII activity level was reduced to 1.2%, and the factor VIII inhibitor titer was 285.3 BU/mL, a diagnosis of acquired hemophilia A (AHA) was made. Then, hematomas of 5 intra-muscles were recurred...
September 5, 2018: Hematology Reports
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