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Intracerebral hemorrhage randomized

Airton Leonardo de Oliveira Manoel, R Loch Macdonald
Aneurysmal subarachnoid hemorrhage (SAH) is a sub-type of hemorrhagic stroke associated with the highest rates of mortality and long-term neurological disabilities. Despite the improvement in the management of SAH patients and the reduction in case fatality in the last decades, disability and mortality remain high in this population. Brain injury can occur immediately and in the first days after SAH. This early brain injury can be due to physical effects on the brain such as increased intracranial pressure, herniations, intracerebral, intraventricular hemorrhage, and hydrocephalus...
2018: Frontiers in Neurology
Zhiwei Xia, Xinlong Wu, Jing Li, Zhixiong Liu, Fenghua Chen, Longbo Zhang, Hongfu Zhang, Xin Wan, Quan Cheng
BACKGROUND: Outcomes of minimally invasive surgery (MIS) versus conventional craniotomy (CC) for patients with spontaneous supratentorial intracerebral hemorrhage(SICH) have not been previously compared. We reviewed the current evidence regarding the safety and efficacy of MIS as compared with conventional craniotomy, in patients with SICH. METHODS: We conducted a meta-analysis of studies that comparing MIS and CC in patients with computed tomography confirmed SICH, published from January 2000 to April 2018 in Medline, Embase, and Cochrane Controlled Trials Register (CCTR) based on PRISMA inclusion and exclusion criteria...
May 3, 2018: World Neurosurgery
Jia-Chen Cai, Wei Liu, Fei Lu, Wen-Bing Kong, Xin-Xuan Zhou, Peng Miao, Cheng-Xiang Lei, Yan Wang
Resveratrol (RESV) improves histopathological and behavioral outcomes in diseases of the central nervous system. However, to the best of our knowledge, there have been no studies investigating its neuroprotective effects on secondary brain injury following intracerebral hemorrhage (ICH). The aim of the present study was to evaluate the neuroprotective function of resveratrol following ICH. Male Sprague-Dawley rats were randomly divided into 3 groups: Sham, ICH and ICH+RESV groups. Rats underwent ICH and received an intraperitoneal injection of RESV daily...
May 2018: Experimental and Therapeutic Medicine
Else Charlotte Sandset, Nerses Sanossian, Lisa J Woodhouse, Craig Anderson, Eivind Berge, Kennedy R Lees, John F Potter, Thompson G Robinson, Nikola Sprigg, Joanna M Wardlaw, Philip M Bath
Rationale Despite several large clinical trials assessing blood pressure lowering in acute stroke, equipoise remains particularly for ischemic stroke. The "Blood pressure in Acute Stroke Collaboration" commenced in the mid-1990s focussing on systematic reviews and meta-analysis of blood pressure lowering in acute stroke. From the start, Blood pressure in Acute Stroke Collaboration planned to assess safety and efficacy of blood pressure lowering in acute stroke using individual patient data. Aims To determine the optimal management of blood pressure in patients with acute stroke, including both intracerebral hemorrhage and ischemic stroke...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Ashkan Shoamanesh, Andrea Morotti, Javier M Romero, Jamary Oliveira-Filho, Frieder Schlunk, Michael J Jessel, Alison M Ayres, Anastasia Vashkevich, Kristin Schwab, Mohammad R Afzal, Christy Cassarly, Renee H Martin, Adnan I Qureshi, Steven M Greenberg, Jonathan Rosand, Joshua N Goldstein
Importance: Response to intensive blood pressure (BP) lowering in acute intracerebral hemorrhage (ICH) might vary with the degree of underlying cerebral small vessel disease. Objectives: To characterize cerebral microbleeds (CMBs) in acute ICH and to assess the potential for interaction between underlying small vessel disease (as indicated by CMB number and location) and assignment to acute intensive BP targeting for functional outcomes and hematoma expansion. Design, Setting, and Participants: Preplanned subgroup analyses in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial were performed...
April 16, 2018: JAMA Neurology
Johannes Kaesmacher, Pasquale Mordasini, Marcel Arnold, Elena López-Cancio, Neus Cerdá, Tobias Boeckh-Behrens, Justus F Kleine, Mayank Goyal, Michael D Hill, Vitor Mendes Pereira, Jeffrey L Saver, Jan Gralla, Urs Fischer
BACKGROUND: Whether pretreatment with intravenous thrombolysis prior to mechanical thrombectomy (IVT+MTE) adds additional benefit over direct mechanical thrombectomy (dMTE) in patients with large vessel occlusions (LVO) is a matter of debate. METHODS: This study-level meta-analysis was presented in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effect sizes were calculated using the inverse variance heterogeneity model and displayed as summary Odds Ratio (sOR) and corresponding 95% confidence interval (95% CI)...
April 28, 2018: Journal of Neurointerventional Surgery
Alexander E Merkler, Gino Gialdini, Michael P Lerario, Neal S Parikh, Nicholas A Morris, Benjamin Kummer, Lauren Dunn, Michael E Reznik, Santosh B Murthy, Babak B Navi, Zachary M Grinspan, Costantino Iadecola, Hooman Kamel
BACKGROUND AND PURPOSE: We sought to determine the long-term risk of seizures after stroke according to age, sex, race, and stroke subtype. METHODS: We performed a retrospective cohort study using administrative claims from 2 complementary patient data sets. First, we analyzed data from all emergency department visits and hospitalizations in California, Florida, and New York from 2005 to 2013. Second, we evaluated inpatient and outpatient claims from a nationally representative 5% random sample of Medicare beneficiaries...
April 25, 2018: Stroke; a Journal of Cerebral Circulation
Bruce C V Campbell, Peter J Mitchell, Leonid Churilov, Nawaf Yassi, Timothy J Kleinig, Richard J Dowling, Bernard Yan, Steven J Bush, Helen M Dewey, Vincent Thijs, Rebecca Scroop, Marion Simpson, Mark Brooks, Hamed Asadi, Teddy Y Wu, Darshan G Shah, Tissa Wijeratne, Timothy Ang, Ferdinand Miteff, Christopher R Levi, Edrich Rodrigues, Henry Zhao, Patrick Salvaris, Carlos Garcia-Esperon, Peter Bailey, Henry Rice, Laetitia de Villiers, Helen Brown, Kendal Redmond, David Leggett, John N Fink, Wayne Collecutt, Andrew A Wong, Claire Muller, Alan Coulthard, Ken Mitchell, John Clouston, Kate Mahady, Deborah Field, Henry Ma, Thanh G Phan, Winston Chong, Ronil V Chandra, Lee-Anne Slater, Martin Krause, Timothy J Harrington, Kenneth C Faulder, Brendan S Steinfort, Christopher F Bladin, Gagan Sharma, Patricia M Desmond, Mark W Parsons, Geoffrey A Donnan, Stephen M Davis
BACKGROUND: Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy for ischemic stroke. Tenecteplase, which is more fibrin-specific and has longer activity than alteplase, is given as a bolus and may increase the incidence of vascular reperfusion. METHODS: We randomly assigned patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery and who were eligible to undergo thrombectomy to receive tenecteplase (at a dose of 0...
April 26, 2018: New England Journal of Medicine
Junfeng Liu, Loes Rutten-Jacobs, Ming Liu, Hugh S Markus, Matthew Traylor
BACKGROUND AND PURPOSE: The relationship between type 2 diabetes mellitus (T2D) and cerebral small vessel disease (CSVD) is unclear. We aimed to examine the causal effect of T2D, fasting glucose levels, and higher insulin resistance on CSVD using Mendelian randomization. METHODS: Five CSVD phenotypes were studied; 2 were clinical outcomes associated with CSVD (lacunar stroke: n=2191/27 297 and intracerebral hemorrhage [ICH]: n=2254/8195 [deep and lobar ICH]), whereas 3 were radiological markers of CSVD (white matter hyperintensities: n=8429; fractional anisotropy [FA]: n=8357; and mean diffusivity: n=8357)...
April 23, 2018: Stroke; a Journal of Cerebral Circulation
Hung-Yu Cheng, Li-Chuan Huang, Hsiao-Fen Peng, Jon-Son Kuo, Hock-Kean Liew, Cheng-Yoong Pang
Objective: Spontaneous intracerebral hemorrhage (ICH) accounts for 10%-15% of all strokes and causes high mortality and morbidity. In the previous study, we demonstrated that ethanol could aggravate the severity of brain injury after ICH by increasing neuroinflammation and oxidative stress. In this study, we further investigate the acute effects of ethanol on brain injury within 24 h after ICH. Materials and Methods: Totally, 66 male Sprague-Dawley rats were assigned randomly into two groups: saline pretreatment before ICH (saline + ICH), and ethanol pretreatment before ICH (ethanol + ICH)...
January 2018: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Kok Wai Giang, Zacharias Mandalenakis, Mikael Dellborg, Georgios Lappas, Peter Eriksson, Per-Olof Hansson, Annika Rosengren
BACKGROUND AND PURPOSE: The risk of ischemic stroke is increased in patients with congenital heart disease (CHD); however, data on the risk of hemorrhagic stroke, including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), are lacking. METHODS: The Swedish Patient Register was used to identify all patients who were born with a diagnosis of CHD between 1970 and 1993. Each patient was compared with 10 randomly selected controls from the general population, matched for age, sex, and county...
April 6, 2018: Stroke; a Journal of Cerebral Circulation
Jens Sundbøll
The connection between the heart and mind has been studied since Sir William Harvey observed more than 350 years ago that negative emotions adversely affect the heart. Today, we know that diseases of the mind can affect the heart and, conversely, that heart diseases can cause both physical and mental diseases of the brain. To explore this relation further, we examined how previous depression affects survival in patients with myocardial infarction (MI) (study II), and how the occurrence of MI affects the risk of ischemic and hemorrhagic stroke (study III) and dementia (study IV)...
April 2018: Danish Medical Journal
Lucia Rivera-Lara, Santosh B Murthy, Saman Nekoovaght-Tak, Hasan Ali, Nichol McBee, Rachel Dlugash, Malathi Ram, Richard Thompson, Issam A Awad, Daniel F Hanley, Wendy C Ziai
BACKGROUND: Concomitant acute ischemic lesions are detected in up to a quarter of patients with spontaneous intracerebral hemorrhage (ICH). Influence of bleeding pattern and intraventricular hemorrhage (IVH) on risk of ischemic lesions has not been investigated. METHODS: Retrospective study of all 500 patients enrolled in the CLEAR III randomized controlled trial of thrombolytic removal of obstructive IVH using external ventricular drainage. The primary outcome measure was radiologically confirmed ischemic lesions, as reported by the Safety Event Committee and confirmed by two neurologists...
March 27, 2018: Neurocritical Care
Feng Li, Jing Yang, Xiaoyan Guo, Xiaomei Zheng, Zhiyu Lv, Chang Qing Shi, Xiaogang Li
OBJECTIVE: To investigate the changes of Apo-J and Omi/HtrA2 protein expression in rats with intracerebral hemorrage. METHODS: 150 SD adult rats were randomly divided into 3 groups: (1) Normal Control (NC) group, (2) Sham group, (3) Intracerebral Hemorrage (ICH) group. The data were collected at 6h, 12h, 1d, 2d, 3d, 5d and 7d. Apoptosis was measured by Tunel staining. The distributions of the Apo-J and Omi/HtrA2 proteins were determined by immunohistochemical staining...
March 23, 2018: World Neurosurgery
Mona N Bahouth, Melinda C Power, Elizabeth K Zink, Kate Kozeniewski, Sowmya Kumble, Sandra Deluzio, Victor C Urrutia, Robert D Stevens
OBJECTIVE: To measure the impact of a progressive mobility program on patients admitted to a neuroscience critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early mobilization of critically ill patients with spontaneous ICH is a challenge due to the potential for neurologic deterioration and hemodynamic lability in the acute phase of injury. Patients admitted to the ICU have been excluded from randomized trials of early mobilization after stroke. DESIGN: An interdisciplinary working group developed a formalized NCCU Mobility Algorithm which allocates patients to incremental passive or active mobilization pathways on the basis of level of consciousness and motor function...
March 23, 2018: Archives of Physical Medicine and Rehabilitation
Guofang Chen, Xia Wang, Thompson G Robinson, Miriam Pikkemaat, Richard I Lindley, Shengkui Zhou, Lei Ping, Weiwei Liu, Leijing Liu, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: History of prior stroke (PS) and diabetes mellitus (DM) are considered relative contraindications to the use of intravenous alteplase in patients with acute ischemic stroke (AIS). We aimed to assess whether a history of PS and DM modified the comparative effects of low- versus standard-dose alteplase in patients who participated in the alteplase-dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). METHODS: Data from an international, multi-center, prospective, randomized, open-label, blinded-endpoint trial were used to assess the benefits and risks of low (0...
April 15, 2018: Journal of the Neurological Sciences
Liling Zeng, Li Tan, Haijun Li, Qixin Zhang, Yongxian Li, Jianwen Guo
Intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. Several recent controlled trials have reported that deferoxamine (DFX) therapy appears to be effective for ICH. The aim of this study was to perform a systematic review of DFX therapy for ICH patients and evaluate the efficacy and safety of DFX therapy for ICH patients. We searched Medline, Embase, the Cochrane Database of Systematic Reviews,, all Chinese databases and the reference lists of all included studies and review articles...
2018: PloS One
Alexandros Rentzos, Jan-Erik Karlsson, Christer Lundqvist, Lars Rosengren, Mikael Hellström, Gunnar Wikholm
Background and purpose Recent randomized clinical trials have proved the efficacy of endovascular treatment of acute ischemic stroke in the anterior circulation. However, the benefit of endovascular treatment of ischemic stroke in the posterior circulation remains to be proven since it was excluded from these trials. We evaluate the benefit of endovascular treatment in posterior circulation strokes. Methods A total of 110 consecutive patients with posterior circulation stroke who underwent endovascular treatment in our institute in the period 1991-2015 were included...
January 1, 2018: Interventional Neuroradiology
Kathryn F Kirchoff-Torres, Ekaterina Bakradze
PURPOSE OF REVIEW: Cerebral hyperperfusion syndrome (CHS) is a rare but significant complication after carotid revascularization and is increasingly recognized after acute stroke treatments. In this review, we discuss the epidemiology and pathophysiology of CHS, clinical presentation including ipsilateral headache, seizures, and focal neurological deficits, and radiographic presentation. We propose preventive therapies with emphasis on acute stroke post-thrombectomy hyperperfusion. RECENT FINDINGS: CHS was first described after carotid revascularization but is now also reported in patients with acute ischemic stroke...
March 19, 2018: Current Pain and Headache Reports
Danfeng Zhang, Jigang Chen, Jiaming Guo, Ying Jiang, Yan Dong, Benjamin Ping-Chi Chen, Junyu Wang, Lijun Hou
BACKGROUND: and Purpose Hematoma expansion (HE) is independently associated with clinical outcome after intracerebral hemorrhage (ICH). Hematoma heterogeneity on noncontrast computed tomography (NCCT) is reported to be predictive of HE, but conclusions are inconsistent. We seek to clarify the relationship between hematoma heterogeneity and HE by pooling the pertinent publications. METHODS: Cochrane library, PubMed and Embase were searched for related studies examining the correlation of HE with hematoma heterogeneity, and secondary endpoint was defined as poor outcome...
March 13, 2018: World Neurosurgery
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