scholarly journals Pediatric angiocentric glioma with acute intracerebral hemorrhage: A case report with 36 months follow-up

2021 ◽  
Vol 12 ◽  
pp. 499
Author(s):  
Rui Zhang ◽  
Xin Xu ◽  
Huakang Zhou ◽  
Dongying Yao ◽  
Ru Wei ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Parietal Lobe ◽  
Intracranial Tumor ◽  
Admission Diagnosis ◽  
Histopathological Diagnosis ◽  
Limb Weakness ◽  
Fluid Attenuated Inversion Recovery ◽  
Angiocentric Glioma ◽  
Acute Intracerebral Hemorrhage

Background: Angiocentric glioma (AG) is an extremely rare intracranial tumor that was first described in 2005 and identified as a special type of intracranial tumor in 2007 by the WHO, which mainly affects children and young adolescents. Epilepsy is the main presentation; therefore, it was recognized as a seizure-related tumor in the past. Here, we report a case of AG with acute intracerebral hemorrhage (ICH) as the first symptom who never had a seizure onset. Case Description: A 3-year-old girl with the right limb weakness was admitted to our hospital 4 h after onset in 2018. Computed tomography showed a hematoma of about 20 ml accompanied by a hyper/iso-dense spheroid lesion located in the sub-cortex of the left parietal lobe. Magnetic resonance image (MRI) showed signs of hypointense signal in T1, T2, and fluid-attenuated inversion recovery sequence, distinct enhancement of this tumefactive lesion in the contrast-enhanced sequence. Thus, the admission diagnosis was neoplasm with acute ICH. A gross total resection of the tumor was achieved by parietal craniotomy. The histopathological diagnosis was AG. No signs showed tumor recurrence after 36 months of follow-up. Conclusion: This is the sole case of AGs with acute intracranial hemorrhage as the first symptom without any kind of epilepsy by far. This case had unique MRI signs that were different from the previous description. This case enriches the clinical and radiological manifestations of AG and reveals that further investigations are needed to further understand AG.

Abstract 2276: Microhemorrhage Burden Increases the Risk of Hematoma Growth in Patients with Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Joan Martí-Fàbregas ◽  
Estrella Morenas ◽  
Raquel Delgado-Mederos ◽  
Lavinia Dinia ◽  
Esther Granell ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Statistical Analysis ◽  
Intracerebral Hemorrhage ◽  
Multicentre Study ◽  
Symptom Onset ◽  
Variable Time ◽  
Hematoma Growth ◽  
Acute Intracerebral Hemorrhage ◽  
Radiological Studies

Introduction Microhemorrhages (MH) are lesions detected on radiological studies resulting from an underlying small-vessel angiopathy. We assesed the hypothesis that the presence of MH increases the risk of hematoma growth (HG) in patients with acute Intracerebral Hemorrhage (ICH). Methods We evaluated a series of patients in a prospective and multicentre study. We included patients with a spontaneous supratentorial ICH within the first 6 hours after symptom onset, that also had a follow-up CT 24-72 hours later and a MRI performed after a variable time after ICH. HG was defined as an increase >33% in the volume of hematoma on the follow-up CT, in comparison with the admission CT. The volume was calculated using the formula AxBxC/2. On MR scans we assessed the presence, number and distribution of MH. After differential diagnosis with other radiological lesions, MH were evaluated on echo-gradient sequences and defined as hypointense rounded lesions with a diameter <10mm. Statistical analysis: Bivariate tests with the whole sample and with the subgroup of patients with less than 3 hours from symptom onset. Results We studied 46 patients, whose mean age was 68.8±11.2 y and 68% were men. Mean baseline volume was 19.1±27.3 cc. We detected MH in 7/15 patients with HG and in 18/31 patients without HG (46.7% vs 58.1%, p=0.53). In the subgroup of patients with 10 MH, the risk of HG was higher than in patients with 0-10 MH (75% vs 28.6%, p=0.067), and this difference was significant when considering only patients with a <3 hours evolution (100% vs 31%, p=0.044). We did not observe any association between risk of HG and distribution of MH. Age and time to CT were equivalent in the two groups (with and without HG), either in the <6 or <3 hours subgroups. Conclusions In conclusion, in patients with hyperacute ICH, the presence of more than 10 MH increases the risk of HG. This is probably an indirect marker of a more severe underlying angiopathy.

Abstract TP336: Characteristics and Outcome of Patients With Acute Intracerebral Hemorrhage Who Overuse Alcohol

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Carla Avellaneda-Gómez ◽  
Maria Serra Martínez ◽  
Alejandra Gómez González ◽  
Ana Rodríguez-Campello ◽  
Angel Ois ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Alcohol Intake ◽  
Short Term ◽  
Acute Intracerebral Hemorrhage ◽  
Stroke Center ◽  
Ich Score ◽  
Heavy Alcohol Intake ◽  
Long Term Mortality

Background: Alcohol overuse (AO) is considered a cause of spontaneous intracerebral hemorrhage (ICH), but the clinical and outcome characteristics of these patients (AO+ICH) are not well known. Methods: All patients with ICH admitted from January 2005 to June 2015 to a single university tertiary stroke center were prospectively studied and followed up during 5 years. Demographic features, radiological characteristics, and clinical outcome of patients with acute ICH and previous heavy alcohol intake (>40 gr/day or >300 gr/week) were analyzed. Results: During the study period, 609 patients with ICH were admitted. Nineteen patients were excluded because data on alcohol intake was not available. At admission, 83 patients (13.6%) were identified with AO (22.7% of men vs 2.9% of women; p< 0.0001) and was more frequent in younger patients (mean age, 63.11 years, compared to 72.7 years overall; p< 0.0001). Smoking was associated with AO (63,9% vs 13,8% non-AO; p< 0.0001) but not significant differences were found according with cardiovascular risk factors (dyslipidemia, diabetes and hypertension). ICH score was lower in the AO group (1.3 vs 1.8, p= 0.009) and deep ICH were more frequent (p= 0.036), compared to non-AO. Adjusted by sex, age, and high blood pressure, a trend in favor of increased deep ICH in AO patients remained (HR: 1.68 [95% CI: 0.92-3.05], p= 0.086). Adjusted mortality at 3-month, 12-month, and 5-year follow-up was similar in both groups. Conclusions: AO was present in 13.6% of ICH patients. These patients were an average of 11.5 years younger, predominantly men, and smokers, compared to the non-AO group. Adjusted short-term and long-term mortality was similar in AO and non-AO groups.

scholarly journals Early Cognitive Impairment after Intracerebral Hemorrhage in the INTERACT1 Study

2017 ◽  
Vol 44 (5-6) ◽  
pp. 320-324 ◽  
Author(s):  
Shoujiang You ◽  
Xia Wang ◽  
Richard I. Lindley ◽  
Thompson Robinson ◽  
Craig S. Anderson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Intracerebral Hemorrhage ◽  
Mini Mental State Examination ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Background Data ◽  
Acute Intracerebral Hemorrhage ◽  
State Examination ◽  
Intensive Blood Pressure

Background: Data on cognitive impairment after acute intracerebral hemorrhage (ICH) are limited. This study is aimed at determining the frequency and predictors of cognitive impairment among participants of the pilot phase, Intensive Blood Pressure (BP) Reduction in Acute Cerebral Hemorrhage Trial (INTERACT1). Methods: INTERACT1 was an open randomized trial of early intensive (target systolic BP <140 mm Hg) compared with contemporaneous guideline-recommended BP lowering in 404 patients with elevated systolic BP (150–220 mm Hg) within 6 h of ICH onset. Cognitive impairment was defined by scores ≤24 on the Mini-Mental State Examination (MMSE) assessed by interview on follow-up at 90 days. Results: A total of 231 (64.5%) of 358 90-day survivors had MMSE scores for analyses, and 75 (32.5%) had cognitive impairment. In multivariable analysis, older age (OR 2.48, 95% CI 1.73–3.56 per 10-year increase; p < 0.001), female sex (OR 2.06, 95% CI 1.00–4.23; p = 0.049), prior ICH (OR 2.87, 95% CI 1.08–7.65; p = 0.035), high baseline National Institute of Health Stroke Scale score (OR 1.06, 95% CI 1.00–1.13; p = 0.044), and high mean systolic BP over the first 24 h post-randomization (OR 1.34, 95% CI 1.07–1.68/10 mm Hg increase; p = 0.011) were independently associated with cognitive impairment. Conclusions: One third of patients have significant cognitive impairment early after ICH, which is more frequent in the elderly, females, those with prior ICH, and more severe initial neurological deficit and with persistently high early systolic BP.

scholarly journals Spotlight on Consent:  Lessons from the SPOTLIGHT Trial for Acute Intracerebral Hemorrhage

2020 ◽  
Author(s):  
Tess Fitzpatrick ◽  
Michel Shamy ◽  
Brian Dewar ◽  
Julie Spence ◽  
Andrew M. Demchuk ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Emergency Treatment ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Treatment Options ◽  
Item Questionnaire ◽  
Acute Intracerebral Hemorrhage ◽  
Initial Survey ◽  
Trial Participants

Abstract Background SPOTLIGHT was a Canadian multicentre, placebo-controlled, randomized trial of emergency treatment with recombinant Factor VIIa for patients with acute intracerebral hemorrhage that enrolled a subset of eligible patients via deferral of consent. We investigated attitudes towards deferral of consent among participants and their legally-authorized representatives (LARs). Methods All participants or LARs approached for enrolment in SPOTLIGHT were invited to complete an 11-item questionnaire within the first 4 days of enrolment, and again at 90 days. Results Eight out of 50 participants in SPOTLIGHT (16%) were enrolled via deferral of consent. Ten LARs for participants (20%) completed the initial survey and 6 completed the 90 day follow-up survey. Ninety percent of respondents agreed with the process of deferral of consent both in principle and specifically for the SPOTLIGHT trial. Participants were more likely to support deferral of consent for low-risk or time-sensitive interventions, or in situations with no alternative treatment options. Conclusions The majority of respondents were supportive of using deferral of consent to enrol participants into SPOTLIGHT and acute stroke trials.

Initial Single-Center Technical Experience With the BrainPath System for Acute Intracerebral Hemorrhage Evacuation

2016 ◽  
Vol 13 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Andrew M. Bauer ◽  
Peter A. Rasmussen ◽  
Mark D. Bain
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Glasgow Coma Score ◽  
Cleveland Clinic ◽  
Interquartile Range ◽  
High Morbidity ◽  
Single Center ◽  
Acute Intracerebral Hemorrhage

Abstract BACKGROUND: Surgical intervention has been proposed as a means of reducing the high morbidity and mortality associated with acute intracerebral hemorrhage (ICH), but many previously reported studies have failed to show a clinically significant benefit. Newer, minimally invasive approaches have shown some promise. OBJECTIVE: We report our early single-center technical experience with minimally invasive clot evacuation using the BrainPath system. METHODS: Prospective data were collected on patients who underwent ICH evacuation with BrainPath at the Cleveland Clinic from August 2013 to May 2015. RESULTS: Eighteen patients underwent BrainPath evacuation of ICH at our center. Mean ICH volume was 52.7 mL ± 22.9 mL, which decreased to 2.2 mL ± 3.6 mL postevacuation, resulting in a mean volume reduction of 95.7% ± 5.8% (range 0-14 mL, P &lt; .001). In 65% of patients, a bleeding source was identified and treated. There were no hemorrhagic recurrences during the hospital stay. In this cohort, only 1 patient (5.6%) died in the first 30 days of follow-up. Median Glasgow Coma Score improved from 10 (interquartile range 5.75-12) preoperation to 14 (interquartile range 9-14.25) postoperation. Clinical follow-up in this cohort is ongoing. CONCLUSION: Evacuation of ICH using the BrainPath system is safe and technically effective. The volume of clot removed compares favorably with other published studies. Early improved clinical outcomes are suggested by improvement in Glasgow Coma Score and reduced 30-day mortality. Ongoing analysis is necessary to elucidate long-term clinical outcomes and the subsets of patients who are most likely to benefit from surgery.

scholarly journals Idarucizumab as Antidote to Intracerebral Hemorrhage under Treatment with Dabigatran

2016 ◽  
Vol 8 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Valentin Held ◽  
Philipp Eisele ◽  
Christoph C. Eschenfelder ◽  
Kristina Szabo
Keyword(s):  
Intracerebral Hemorrhage ◽  
Vitamin K ◽  
Real World ◽  
Antibody Fragment ◽  
Hematoma Expansion ◽  
Preclinical Studies ◽  
Safety And Efficacy ◽  
Emergency Situations ◽  
Acute Intracerebral Hemorrhage

Background and Purpose: Non-vitamin K anticoagulants (NOAC) such as dabigatran have become important therapeutic options for the prevention of stroke. Until recently, there were only nonspecific agents to reverse their anticoagulant effects in a case of emergency. Idarucizumab, an antibody fragment targeting dabigatran, is the first specific antidote for a NOAC to be approved, but real-world experience is limited. Methods: We report two cases of patients on dabigatran with acute intracerebral hemorrhage who received idarucizumab. Results: In both cases, idarucizumab promptly reversed the anticoagulant effect of dabigatran and there was no hematoma expansion in follow-up imaging. Conclusions: In addition to clinical and preclinical studies, our cases add to the experience regarding the safety and efficacy of idarucizumab. They show that idarucizumab may be an important safety option for patients on dabigatran in emergency situations.

scholarly journals Comparison of MRI and CT for Detection of Acute Cerebral Haemorrahge

2021 ◽  
Vol 15 (6) ◽  
pp. 1892-1894
Author(s):  
Memona Nazir ◽  
Tahir Baig ◽  
Atif Hussain ◽  
Muhammad Tahir ◽  
Haider Ali ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Interrater Reliability ◽  
P Value ◽  
Time Duration ◽  
Acute Intracerebral Hemorrhage ◽  
The Mean ◽  
Stroke Center

Objective: To compare the diagnostic accuracy of MRI and CT for detection of acute cerebral haemorrahge. Study Design: Comparative Study Place and Duration: Mohiuddin Islamic Teaching Hospital Mirpur AJK for period of six months from 1st August, 2020 to 31stJanuary, 2021. Methodology: A total of 20 patients of both genders with age of 25 years and onward with intracerebral hemorrhage who underwent MRI following CT in the first 6 hours of onset and last known well time and admission in stroke center were included in the study. The follow up time duration for both the scans was 24 hours to 48hours. The Mc-Nemar test was used to determine the comparison between MRI and CT on contingency table. Results: The mean age of the participants was 53.26±2.45. The frequency of the male participants was 13(65%) and that of female was 7(35%). All cases were of acute ICH 20(100%). The number of positive cases on MRI and CT scan was 17, while the frequency of positive cases on MRI and negative on CT scan was 3 with the p- value of less than 0.001 and a confidence interval of 95%. (See table 1 for details). The interrater reliability for acute ICH on MRI is from 0.72 to 0.80 on k statistics. The interrater reliability for acute ICH on CT is from 0.83 to 0.92. Conclusion: It is concluded that the findings of MRI scan were more accurate than CT in the detection of acute intracerebral hemorrhage. Keywords: Acute Cerebral Hemorrhage, MRI, CT, Diagnostic Accuracy

Quantitative assessment of local perfusion change in acute intracerebral hemorrhage areas with and without “dynamic spot sign” using CT perfusion imaging

2018 ◽  
Vol 60 (3) ◽  
pp. 367-373
Author(s):  
Fan Fu ◽  
Binbin Sui ◽  
Liping Liu ◽  
Yaping Su ◽  
Shengjun Sun ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Control Group ◽  
Regional Cerebral Blood ◽  
Spot Sign ◽  
Positive Group ◽  
Regional Cerebral Blood Volume ◽  
Acute Intracerebral Hemorrhage

Background Positive “dynamic spot sign” has been proven to be a potential risk factor for acute intracerebral hemorrhage (ICH) expansion, but local perfusion change has not been quantitatively investigated. Purpose To quantitatively evaluate perfusion changes at the ICH area using computed tomography perfusion (CTP) imaging. Material and Methods Fifty-three patients with spontaneous ICH were recruited. Unenhanced computed tomography (NCCT), CTP within 6 h, and follow-up NCCT were performed for 21 patients in the “spot sign”-positive group and 32 patients in the control group. Cerebral perfusion change was quantitatively measured on regional cerebral blood flow/regional cerebral blood volume (rCBF/rCBV) maps. Regions of interest (ROIs) were set at the “spot-sign” region and the whole hematoma area for “spot-sign”-positive cases, and at one of the highest values of three interested areas and the whole hematoma area for the control group. Hematoma expansion was determined by follow-up NCCT. Results For the “spot-sign”-positive group, the average rCBF (rCBV) values at the “spot-sign” region and the whole hematoma area were 21.34 ± 15.24 mL/min/100 g (21.64 ± 21.48 mL/100g) and 5.78 ± 6.32 mL/min/100 g (6.07 ± 5.45 mL/100g); for the control group, the average rCBF (rCBV) values at the interested area and whole hematoma area were 2.50 ± 1.83 mL/min/100 g (3.13 ± 1.96 mL/100g) and 3.02 ± 1.80 mL/min/100 g (3.40 ± 1.44 mL/100g), respectively. Average rCBF and rCBV values of the “spot-sign” region were significantly different from other regions ( P < 0.001; P = 0.004). The average volumes of hematoma expansion in the “spot-sign”-positive and control groups were 25.24 ± 19.38 mL and −0.41 ± 1.34 mL, respectively. Conclusion The higher perfusion change at ICH on CTP images may reflect the contrast extravasation and be associated with the hematoma expansion.

Intracerebral Hematoma, Perihemorrhagic Edema and Urinary Excreted Cysteinyl Leukotrienes Correlation Study

2014 ◽  
Vol 68 (2) ◽  
pp. 85-88
Author(s):  
Natalija Dolnenec-Baneva ◽  
Dijana Nikodijevic ◽  
Gordana Kiteva-Trenchevska ◽  
Igor Petrov ◽  
Dragana Petrovska-Cvetkovska ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Correlation Study ◽  
Intracerebral Hematoma ◽  
Moderate Correlation ◽  
Hematoma Volume ◽  
Cysteinyl Leukotrienes ◽  
Edema Volume ◽  
Perihemorrhagic Edema

AbstractIntroduction.Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage.Methods.An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2).Results.CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rdday (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5thday (R=0.3).Conclusion.In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rdday, a moderate correlation on admission and on the 5thday, which means that high cysLT and hematoma values were associated with high/moderate edema values.

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