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intra cerebral hemorrhage

Vinayak Narayan, Hima Pendharkar, Bhagavatula Indira Devi, Dhananjaya I Bhat, Dhaval P Shukla
Background: The conventional medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is associated with uncertainty of outcome and complications. Aims and Objectives: To examine the effect of direct intra-arterial nimodipine therapy on outcome in patients with delayed cerebral ischemia (DCI). Settings and Design: The retrospective observational study was conducted at a single neurosurgical unit and interventional neuroradiolgy suite of a center managing SAH...
March 2018: Neurology India
V Bhatia, V Gupta, D Khurana, R R Sharma, N Khandelwal
BACKGROUND AND PURPOSE: Stroke is a debilitating illness for which treatment window is limited. Most patients present to the healthcare facility beyond that window. Autologous stem cells have shown some promise for this group of patients. This study was performed to evaluate the safety and the efficacy of intra-arterial infusion of bone marrow-derived mononuclear cells in patients with middle cerebral artery ischemic stroke. MATERIALS AND METHODS: A prospective, randomized, open-label, blinded-end point study was performed from July 2015 to June 2016...
March 15, 2018: AJNR. American Journal of Neuroradiology
Kenichi Sato, Hidenori Endo, Miki Fujimura, Toshiki Endo, Yasushi Matsumoto, Hiroaki Shimizu, Teiji Tominaga
OBJECTIVE: Although most intracranial aneurysms can be treated with microsurgery or endovascular procedure alone, a subset of aneurysms may require a combined approach. The purpose of this study was to assess the efficacy of endovascular interventions combined with bypass surgery for the treatment of complex intracranial aneurysms. METHODS: We retrospectively reviewed medical records from a prospectively maintained patient database to identify patients who underwent endovascular treatment of an intracranial aneurysm at our institutes from 2007 to 2017...
March 3, 2018: World Neurosurgery
Shanshan Wang, Brian P Head
Cardiovascular disease and associated cerebral stroke are a global epidemic attributed to genetic and epigenetic factors, such as diet, life style and an increasingly sedentary existence due to technological advances in both the developing and developed world. There are approximately 5.9 million stroke-related deaths worldwide annually. Current epidemiological data indicate that nearly 16.9 million people worldwide suffer a new or recurrent stroke yearly. In 2014 alone, 2.4% of adults in the United States (U...
February 5, 2018: Current Vascular Pharmacology
Ting-Yu Yi, Wen-Huo Chen, Yan-Min Wu, Mei-Fang Zhang, Ding-Lai Lin, Xiao-Hui Lin
BACKGROUND: Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the complex technique) in acute ischemic stroke. MATERIAL AND METHODS: A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center...
March 15, 2018: Journal of the Neurological Sciences
Alexander D Horsch, Edwin Bennink, Tom van Seeters, L Jaap Kappelle, Yolanda van der Graaf, Willem P T M Mali, Hugo W A M de Jong, Birgitta K Velthuis, Jan Willem Dankbaar
INTRODUCTION: Hemorrhagic transformation (HT) in acute ischemic stroke can occur as a result of reperfusion treatment. While withholding treatment may be warranted in patients with increased risk of HT, prediction of HT remains difficult. Nonlinear regression analysis can be used to estimate blood-brain barrier permeability (BBBP). The aim of this study was to identify a combination of clinical and imaging variables, including BBBP estimations, that can predict HT. MATERIALS AND METHODS: From the Dutch acute stroke study, 545 patients treated with intravenous recombinant tissue plasminogen activator and/or intra-arterial treatment were selected, with available admission extended computed tomography (CT) perfusion and follow-up imaging...
January 8, 2018: Cerebrovascular Diseases
Jennifer L Carpenter, Yangyang R Yu, Darrell L Cass, Oluyinka O Olutoye, James A Thomas, Cole Burgman, Caraciolo J Fernandes, Timothy C Lee
BACKGROUND: Advances in extracorporeal membrane oxygenation (ECMO) have led to increased use of venovenous (VV) ECMO in the pediatric population. We present the evolution and experience of pediatric VV ECMO at a tertiary care institution. METHODS: A retrospective cohort study from 01/2005 to 07/2016 was performed, comparing by cannulation mode. Survival to discharge, complications, and decannulation analyses were performed. RESULTS: In total, 160 patients (105 NICU, 55 PICU) required 13 ± 11 days of ECMO...
January 18, 2018: Pediatric Surgery International
Sang-Bae Ko, Byung-Woo Yoon
Hypertension is the most common modifiable risk factor for stroke (both ischemic and hemorrhagic types). In the hyperacute phase, a majority of patients shows an elevated blood pressure (BP) at the time of presentation because of sympathetic hyperactivity or a physiological response to tissue ischemia. Therefore, BP may decrease spontaneously in a few hours and may drop further when complete recanalization is achieved. In stroke guidelines, an elevated BP is usually left untreated up to a systolic BP (SBP) of 220 mm Hg and a diastolic BP of 120 mm Hg...
December 2017: Seminars in Respiratory and Critical Care Medicine
S Taghipour Zahir, M Mortaz, M Baghi Yazdi, N Sefidrokh Sharahjin, M Shabani
Glioblastoma multiforme (GBM) is a high grade glial tumor, primarily located in cerebral hemispheres. The most common clinical presentations are slowly progressive neurological deficit such as motor weakness, seizure, and headaches that last less than three months. Calvarium and extra-axial invasion are very rare and generally occur after a brain biopsy or surgery, or secondary to radiotherapy of primary intra-axial glial tumors. We report a case of GBM with calvarium involvement in a 60-year-old man who presented with a frontal bump and left-sided clumsiness...
December 13, 2017: Neuro-Chirurgie
Xianwei Yang, Yiwen Qiu, Bin Huang, Wentao Wang, Shu Shen, Xi Feng, Yonggang Wei, Jianyong Lei, Jichun Zhao, Bo Li, Tianfu Wen, Lunan Yan
Ex vivo liver resection combined with autotransplantation is a recently introduced approach to cure end-stage hepatic alveolar echinococcosis (HAE), which is considered unresectable by conventional radical resection due to echinococcal dissemination into the crucial intrahepatic conduits and adjacent structures. This article aims discuss the manipulation details and propose reasonable indications for this promising technique. All patients successfully underwent liver autotransplantation with no intraoperative mortality...
December 12, 2017: American Journal of Transplantation
Faisal Khosa, Rachel E Clough, Xiaoen Wang, Ananth J Madhuranthakam, Robert L Greenman
Hemorrhage and lipid deposits contribute to instability in atherosclerotic plaques. Unstable carotid artery plaques can lead to cerebral ischemic events. While MRI studies have shown the ability to identify plaque components, the identification of hemorrhage and lipids has proven to be problematic. The purpose of this study was to quantitatively evaluate the potential of the MRI fat/water separation method known as iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) to complement and improve existing methods for the identification of hemorrhage and lipids in carotid artery plaques...
December 5, 2017: Magnetic Resonance Imaging
Ilya L Gubskiy, Daria D Namestnikova, Elvira A Cherkashova, Vladimir P Chekhonin, Vladimir P Baklaushev, Leonid V Gubsky, Konstantin N Yarygin
The middle cerebral artery occlusion (MCAO) model in rats closely imitates ischemic stroke and is widely used. Existing instrumental methods provide a certain level of MCAO guidance, but monitoring of the MCA-occluding intraluminal filament position and possible complications can be improved. The goal of this study was to develop a MRI-based method of simultaneous control of the filament position, blood flow in the intracranial vessels, and hemorrhagic complications. Rats were subjected to either MRI-guided MCAO (group 1, n = 51) or MCAO without MRI control (group 2, n = 38)...
November 25, 2017: Translational Stroke Research
Joyce S Balami, Philip M White, Peter J McMeekin, Gary A Ford, Alastair M Buchan
Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
Eun-Sung Park, Dae-Won Kim, Sung-Don Kang
Objective: The cause of severe clinical vasospasm after aneurysmal subarachnoid hemorrhage remains unknown, despite extensive research over the past 30 years. However, the intra-arterial administration of vasodilating agents and balloon angioplasty have been successfully used in severe refractory cerebral vasospasm. Materials and Methods: We retrospectively analyzed the data of 233 patients admitted to our institute with aneurysmal subarachnoid hemorrhage (SAH) over the past 3 years...
September 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
Motohiro Nomura, Kentaro Mori, Akira Tamase, Tomoya Kamide, Syunsuke Seki, Yu Iida, Kazutaka Shirokane, Eiichi Baba, Atsushi Tsuchiya, Hiroshi Shima
Background In cases of subarachnoid hemorrhage due to aneurysm rupture, the administration of an anticoagulant or antiplatelet agent involves the risk of rebleeding from the aneurysm. There is a possibility of inducing thromboembolic events during the endovascular embolization of ruptured cerebral aneurysms. Patients and methods From April 2006 to March 2017, we treated a total of 70 patients with ruptured cerebral aneurysms with an endovascular technique. Among them, five patients (7.1%) showed intra-arterial thrombus formation...
January 1, 2017: Interventional Neuroradiology
Christopher Donaldson, Anthea H O'Neill, Lee-Anne Slater, Winston Chong, Leon T Lai, Ronil V Chandra
Background: Objective assessment and quantification of the severity of cerebral vasospasm following aneurysmal subarachnoid hemorrhage is not routinely utilized. We investigated the feasibility of angiographic perfusion imaging derived from digital subtraction angiography (DSA) following endovascular vasospasm treatment procedures. Methodology: Real-time blood flow analysis was performed using parametric color coding on pre- and postintervention DSA. Semiquantitative parenchymal perfusion parameters (arrival time [AT] of contrast, time to peak [TTP] opacification, and mean transit time [MTT] of contrast) were calculated across 3 vascular territories (anterior cerebral artery [ACA], middle cerebral artery [MCA], and lenticulostriate arteries) using standard 2-D angiographic perfusion software...
October 2017: Interventional Neurology
Mehdi Farhoudi, Kaveh Mehrvar, Homayoun Sadeghi-Bazargani, Mazyar Hashemilar, Manouchehr Seyedi-Vafaee, Elyar Sadeghi-Hokmabad, Reza Rikhtegar, Babak Saber-Maroof, Mohammad Abutalebi, Mahsa Rezaei, Sahar Vaferi, Alireza Aghili, Omid Ebrahimi
Background: Stroke is the second most common cause of death and first cause of disability in adults in the world. About 80% of all stroke deaths occur in developing countries. So far, the data on stroke epidemiology have been limited in Iran. Therefore, this study was focused on stroke demographic data, risk factors, types and mortality. Methods: A retrospective study was done in two university tertiary referral hospitals in Tabriz, northwest of Iran, from March 2008 to April 2013. Patients diagnosed with stroke were enrolled in the study...
July 6, 2017: Iranian Journal of Neurology
Jennifer D Sokolowski, Ching-Jen Chen, Dale Ding, Thomas J Buell, Daniel M Raper, Natasha Ironside, Davis G Taylor, Robert M Starke, Kenneth Liu
OBJECTIVE: Although endovascular therapy has been widely adopted for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH), its effect on clinical outcomes remains incompletely understood. The aims of this retrospective cohort study are to evaluate the outcomes of endovascular intervention for post-aSAH vasospasm and identify predictors of functional independence at discharge and repeat endovascular vasospasm treatment. METHODS: We assessed the baseline and outcomes data for patients with aSAH who underwent endovascular vasospasm treatment at our institution, including intra-arterial (IA) vasodilator infusion and angioplasty...
October 27, 2017: Journal of Neurointerventional Surgery
Waqar Aziz Rehman, Muhammad Sohaib Anwar
OBJECTIVE: To assess the risks and benefits of surgical treatment (Open Craniotomy) of Intra-cerebral hematoma (ICH). METHODS: Twenty seven patients of ICH who underwent surgical treatment at Neurosurgical department of Sheikh Zayed Hospital, Rahim Yar Khan, from 1(st) January 2015 to 31(st) December 2015 were included in this study. The primary outcome measured was death and improvement in GCS Status among survivor's at three months. RESULTS: Mean age of the patients was 58...
July 2017: Pakistan Journal of Medical Sciences Quarterly
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