scholarly journals Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage

2013 ◽  
Vol 34 (5) ◽  
pp. E5 ◽  
Author(s):  
Satoru Takeuchi ◽  
Kojiro Wada ◽  
Kimihiro Nagatani ◽  
Naoki Otani ◽  
Kentaro Mori
Keyword(s):  
Intracranial Pressure ◽  
Intracerebral Hemorrhage ◽  
Mortality Rates ◽  
Present Knowledge ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Safety And Efficacy ◽  
Decompressive Hemicraniectomy ◽  
Optimum Management ◽  
Large Hematoma

Intracerebral hemorrhage (ICH) is devastating, with high mortality rates, but its optimum management has not been fully established. Decompressive hemicraniectomy is a surgical procedure used to relieve the malignant elevation of intracranial pressure. The application of decompressive hemicraniectomy in patients with hemispheric ICH has been much less common, although several studies have shown the usefulness of this procedure for large hemispheric ICH. In this review, the present knowledge of the safety and efficacy of this procedure are evaluated. The authors conclude that decompressive hemicraniectomy with hematoma evacuation for large ICH might be a safe and effective procedure in patients with severely disturbed consciousness and large hematoma volume.

scholarly journals Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage

2021 ◽  
Vol 12 (1) ◽  
pp. 58-66
Author(s):  
Doan Nguyen ◽  
Vi Tran ◽  
Alireza Shirazian ◽  
Cruz Velasco-Gonzalez ◽  
Ifeanyi Iwuchukwu
Keyword(s):  
Intracerebral Hemorrhage ◽  
Negative Correlation ◽  
Mononuclear Cells ◽  
Inflammatory Cells ◽  
Favorable Outcome ◽  
Hospital Length Of Stay ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Peripheral Blood Mononuclear ◽  
Anti Inflammatory

Abstract Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.

scholarly journals 17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (7) ◽  
pp. 1618-1625 ◽  
Author(s):  
Sandro Marini ◽  
William J. Devan ◽  
Farid Radmanesh ◽  
Laura Miyares ◽  
Timothy Poterba ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume

scholarly journals HEMATOMA VOLUME AND OTHER PROGNOSTIC FACTORS WITH MORTALITY IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE

2015 ◽  
Vol 3 (Suppl 1) ◽  
pp. A981
Author(s):  
HB Rotzel ◽  
A Serrano Lázaro ◽  
D Aguillón Prada ◽  
A Mesejo Arizmendi ◽  
C Sanchís Piqueras ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume

N-Terminal Pro-Brain Natriuretic Peptide Concentrations After Hypertensive Intracerebral Hemorrhage: Relationship With Hematoma Size, Hyponatremia, and Intracranial Pressure

2017 ◽  
Vol 33 (12) ◽  
pp. 663-670 ◽  
Author(s):  
Fei Li ◽  
Qian-Xue Chen ◽  
Shou-Gui Xiang ◽  
Shi-Zhun Yuan ◽  
Xi-Zhen Xu
Keyword(s):  
Intracranial Pressure ◽  
Intracerebral Hemorrhage ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Linear Regression Analysis ◽  
Peak Level ◽  
Hematoma Volume ◽  
The Mean ◽  
Hypertensive Intracerebral Hemorrhage ◽  
Mean Concentration

Introduction: The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP). Methods: This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient. Results: The peak-to-mean concentration of NT-proBNP was 666.8 ± 355.1 pg/mL observed on day 4. The NT-proBNP levels in patients with hematoma volume >30 mL were significantly higher than those in patients with hematoma volume <30 mL ( P < .05). In patients with severe HICH, the mean concentration of NT-proBNP was statistically higher than that in patients with mild–moderate HICH ( P < .05), and the mean level of NT-proBNP in hyponatremia group was significantly higher than that in normonatremic group ( P < .05). In addition, the linear regression analysis indicated that serum NT-proBNP concentrations were positively correlated with ICP ( r = .703, P < .05) but negatively with blood sodium levels only in patients with severe HICH ( r = −.704, P < .05). The serum NT-proBNP levels on day 4 after admission were positively correlated with hematoma size ( r = .702, P < .05). Conclusion: The NT-proBNP concentrations were elevated progressively and markedly at least in the first 4 days after HICH and reached a peak level on the fourth day. The NT-proBNP levels on day 4 were positively correlated with hematoma size. There was a notable positive correlation between plasma NT-proBNP levels and ICP in patients with severe HICH. Furthermore, only in patients with severe HICH, the plasma NT-proBNP levels presented a significant correlation with hyponatremia, which did not occur in patients with mild–moderate HICH.

Impact of ischemic heart disease and atrial fibrillation on survival after spontaneous intracerebral hemorrhage

2008 ◽  
Vol 108 (6) ◽  
pp. 1172-1177 ◽  
Author(s):  
Sami Tetri ◽  
Liisa Mäntymäki ◽  
Seppo Juvela ◽  
Pertti Saloheimo ◽  
Juhani Pyhtinen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Ischemic Heart Disease ◽  
Mortality Rates ◽  
Ischemic Heart ◽  
University Hospital ◽  
Spontaneous Intracerebral Hemorrhage

Object The well-known predictors for increased early deaths after spontaneous intracerebral hemorrhage (ICH) include the clinical and radiological severity of bleeding as well as being on a warfarin regimen at the onset of stroke. Ischemic heart disease and atrial fibrillation may also increase early deaths. In the present study the authors aimed to elucidate the role of the last 2 factors. Methods The authors assessed the 3-month mortality rate in patients with spontaneous ICH (453 individuals) who were admitted to the stroke unit of Oulu University Hospital within a period of 11 years (1993–2004). Results The 3-month mortality rate for the 453 patients was 28%. The corresponding mortality rates were 42% for the patients who had ischemic heart disease and 61% for those with atrial fibrillation on admission. The following independent predictors of death emerged after adjustment for sex and the use of warfarin or aspirin at the onset of ICH: 1) ischemic heart disease (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12–2.48, p < 0.02); 2) atrial fibrillation on admission (HR 1.79, 95% CI 1.12–2.86, p < 0.02); 3) the Glasgow Coma Scale score on admission (HR 0.82 per unit, 95% CI 0.79–0.87, p < 0.01); 4) size of hematoma (HR 1.11 per 10 ml, 95% CI 1.07–1.16, p < 0.01); 5) intraventricular hemorrhage (HR 2.62, 95% CI 1.71–4.02, p < 0.01); 6) age (HR 1.04 per year, 95% CI 1.02–1.06, p < 0.01); and 7) infratentorial location of the hematoma (HR 1.93, 95% CI 1.26–2.97, p < 0.01). Conclusions Both ischemic heart disease and atrial fibrillation independently and significantly impaired the 3-month survival of patients with ICH.

Abstract WP455: Intracranial Pressure Monitoring in Patients With Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Ching-Jen Chen ◽  
Dale Ding ◽  
Natasha Ironside ◽  
Thomas J Buell ◽  
Andrew M Southerland ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracerebral Hemorrhage ◽  
Intracranial Pressure Monitoring ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Pressure Monitoring

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

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