Background: Current American Heart Association guidelines for targeted blood pressure management in spontaneous intracerebral hemorrhage (ICH), published in 2010, suggest a target mean arterial pressure of less than 110 or a blood pressure of less than 160/90 in patients without elevated intracranial pressure. These guidelines acknowledge that these recommendations have been based on incomplete efficacy evidence. A lower level recommendation was given for reducing target blood pressure to a systolic of 140, based on the INTERACT trial published in 2008. The INTERACT2 trial, published in May 2013, has been interpreted to establish the safety of rapid blood pressure lowering to 140 systolic.. Purpose: To determine the current level of adoption by stroke centers of lower targets for blood pressure in patients with spontaneous intracerebral hemorrhage, and whether these targets have changed in 2013.. Methods: We developed a web-based survey that was distributed via email and professional groups to ...
Spontaneous intracerebral haemorrhage: a clinical review.: This article provides a clinical overview of spontaneous intracerebral haemorrhage, focusing on clini
TY - JOUR. T1 - Platelet Count and Function in Spontaneous Intracerebral Hemorrhage. AU - Ziai, Wendy C.. AU - Torbey, Michel T.. AU - Kickler, Thomas S.. AU - Oh, Sangjin. AU - Bhardwaj, Anish. AU - Wityk, Robert J.. PY - 2003/7. Y1 - 2003/7. N2 - Impaired platelet function has been associated with an increased propensity for intracerebral hemorrhage (ICH). The role of platelet count and dysfunction in spontaneous ICH (SICH) is poorly understood. We tested the hypotheses that patients with SICH have subtle platelet dysfunction associated with ICH progression and larger ICH size. In a retrospective case series, we compared platelet counts in patients with SICH with age-matched controls with neuromuscular disorders admitted to a Neurosciences Critical Care Unit (NCCU). In a subset of patients, platelet function was measured within one week of ICH. Computerized tomography (CT) scans were performed within 24 hours of the event and ICH volume determined by the ABC/2 method. Comparison of 43 patients ...
Background and rationale Acute intracerebral haemorrhage (ICH) results from rupture of cerebral vasculature leading to bleeding into the cerebral parenchyma. ICH represents 10-50% of stroke, depending on the population studied, is associated with significant morbidity and mortality, and has limited treatment options. The INTERACT2 trial was designed to assess the role of blood pressure lowering therapy in intracerebral haemorrhage. Guideline therapy (target systolic blood pressure [SBP] ,180 mmHg) was compared against intensive lowering (SBP ,140 mmHg). The outcomes assessed in this trial were death or major disability (according to the modified Rankin scale at 90 days) following ICH. Hyperglycaemia has been widely studied in acute illnesses as myocardial infarction, ischaemic stroke, traumatic brain injury and ICH, and is associated with adverse outcomes. The incidence of hyperglycaemia in the acute phase is due to a combination of factors: diabetic pathophysiology and stress hyperglycaemia. ...
BACKGROUND AND OBJECTIVE: Acute hypertensive response, defined as systolic blood pressure (SBP) 140 mmHg or more within 24 h of onset, is frequently observed in hemorrhagic stroke patients. Although catecholamine surge is pivotal in its pathogenesis, few studies have evaluated the relationship between admission SBP and plasma catecholamine levels.. PATIENTS AND METHODS: A prospective observational study was carried out to investigate potential differences in the acute hypertensive reaction between subarachnoid hemorrhage (SAH) and spontaneous intracerebral hemorrhage (SICH) by analyzing 200 SAH and 200 SICH patients. In each category, patients were quadrichotomized on the basis of their SBPs in emergency department: less than 140 mmHg, 140-184 mmHg, 185-219 mmHg, and 220 mmHg or more. The plasma catecholamine levels were compared among the four groups. Furthermore, multivariate regression analyses were carried out to identify variables correlated with hypertensive emergency (SBP≥185 ...
Twenty-two patients who had evidence of spontaneous intracerebral hemorrhage in brain computerized tomographic(CT) scan specially with small vascular malformations who were angiographically verified and unknown causes, were reviewed. The majority of patients were in first and second decades of life. The duration of symptoms from onset to admission showed relatively short in verified cases and even distributed from 1 day to 1 month in unknown cases. The most common presenting symptoms and signs were headache and papilledema in unknown cases. In brain CT scan, variable findings were seen as hematoma with surrounding eidence of vascular anomaly, hematoma only and blood-fluid level in verified cases, and tumor-like findings in unknown cases. The most common site of hematoma were parietal and occipital lobes in verified cases and were parietal and infratentorial area in unknown cases. The results achieved with excision of these cases were good. These small vascular malformations require special ...
Of the three stroke subtypes, spontaneous intracerebral hemorrhage (ICH) has the highest death rate and the poorest prognosis in survivors. Indeed, half of ICH patients die and only 10-20 % return to...
Introduction Measuring magnetic induction phase shift (MIPS) changes as a function of cerebral hemorrhage volume has the potential for being a simple method for primary and non-contact detection of the occurrence and progress of cerebral hemorrhage. Our previous MIPS study showed that the intracranial pressure (ICP) was used as a contrast index and found the primary correlation between MIPS and ICP. Materials and Methods In this study,we theoretically deduced the approximate relationship between MIPS and ICP and carried out a comparison study between MIPS and ICP on cerebral hemorrhage in rabbits in this study. Acute cerebral hemorrhage was induced by injecting autologous blood (3 to 6mL) into the brain of rabbits in the experimental group (n=7). Results The animal experiment results showed that the MIPS decreased significantly as a function of injection volume in the experimental group and the changes of ICP and MIPS of rabbits from experimental group presented a negative correlation. We also found
Cases reported • Cerebral Hemorrhage; Hemorrhage, Cerebral; Brain Hemorrhage, Cerebral; Cerebral Parenchymal Hemorrhage; Intracerebral Hemorrhage. On-line free medical diagnosis assistant. Ranked list of possible diseases from either several symptoms or a full patient history. A similarity measure between symptoms and diseases is provided.
Computed tomography (CT) is the most common imaging method used to investigate stroke. It demonstrates haemorrhage accurately immediately after the stroke1 but as the haematoma is broken down, the characteristic hyperdensity on CT disappears, becoming indistinguishable from infarction. This has been reported to occur by 14 days for moderately sized lesions,2 and possibly sooner for smaller haemorrhages.3. Primary intracerebral haemorrhage is thought to cause more severe stroke symptoms than an infarct of the same size,4,5 and so primary intracerebral haemorrhage is considered to be a less frequent cause of mild than severe stroke. However, it is possible that this apparently low incidence is an artefact caused by the misclassification of mild stroke resulting from primary intracerebral haemorrhage as ischaemic stroke because of delay in CT scanning in epidemiological studies.6 The actual proportion of primary intracerebral haemorrhages among mild strokes is unknown. Thus there is no information ...
Details of the image Grade IV germinal matrix haemorrahge with intraventricular extension and hydrocephalus Modality: MRI (FLAIR)
Details of the image Grade IV germinal matrix haemorrahge with intraventricular extension and hydrocephalus Modality: MRI (DWI)
Varol and Ozaydin1 raise an important question about the effects of antihypertensive drugs and statins on arterial stiffness. In fact, antihypertensive drugs reduce large arterial stiffness, partly independently of blood pressure reduction, suggesting specific pharmacological effects on arterial remodeling.2 Furthermore, statins and other cholesterol-reducing agents have been shown to have beneficial effects on wave reflection and aortic stiffness reduction in several patient groups.3 In our study,4 25 out of 39 hypertensive patients with deep intracerebral hemorrhage (ICH) and 11 out of 15 hypertensive patients with lobar ICH received antihypertensive drugs, whereas 4 patients with deep ICH and 3 with lobar ICH received statins (Table 1). Fisher test showed no significant differences between the two groups with regard to patients treated with antihypertensive drugs (P=1, not significant) and with statins (P=0.41, not significant), confirming our hypothesis that arterial stiffness may play a key ...
The epinephrine (E) and norepinephrine (NE) urinary excretion before and after a mild "emotional stimulus" (ES) was determined in 22 patients with cerebral infarction and 30 patients with cerebral hemorrhage, as well as in 18 normotensive and 18 hypertensive controls. In patients with cerebral infarction, the majority normotensive, the "emotional stimulus" induced a significant increase in NE excretion, but non-significant alterations in E excretion. Similar changes were noted in normotensive controls. In patients with cerebral hemorrhage, almost all hypertensive, and in hypertensive controls, ES brought about a consistent rise in E excretion without influencing significantly the NE excretion. The presence of a constant increase in E excretion after a mild emotion not only in patients with cerebral hemorrhage but also in subjects with uncomplicated essential hypertension, suggests that the E release found in patients with cerebral hemorrhage is related to the hypertensive state pre-existing the ...
Second time brain hemorrhage - MedHelps Second time brain hemorrhage Center for Information, Symptoms, Resources, Treatments and Tools for Second time brain hemorrhage. Find Second time brain hemorrhage information, treatments for Second time brain hemorrhage and Second time brain hemorrhage symptoms.
Background and purpose The pathogenesis of brain injury after intracerebral hemorrhage is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue. In recent years, there has been a greater research interest into the various inflammatory biomarkers and growth factors that are secreted during intracerebral hemorrhage. The biomarkers investigated in this study are tumor necrosis factor alpha (TNF alpha), C-reactive protein (CRP), homocysteine (Hcy), and vascular endothelial growth factor (VEGF). The aim of this study was to further investigate the effects of these biomarkers in predicting the acute severity outcome of intracerebral hemorrhage (ICH). Methods We conducted a retrospective chart review of patients with spontaneous ICH with TNF alpha, CRP, VEGF, and Hcy levels drawn on admission. Forty-two patients with spontaneous ICH with at least one of the above labs were included in the study. Primary outcomes
Intraparenchymal hemorrhage (IPH) is one form of intracerebral bleeding in which there is bleeding within brain parenchyma. The other form is intraventricular hemorrhage (IVH). Intraparenchymal hemorrhage accounts for approx. 8-13% of all strokes and results from a wide spectrum of disorders. It is more likely to result in death or major disability than ischemic stroke or subarachnoid hemorrhage, and therefore constitutes an immediate medical emergency. Intracerebral hemorrhages and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Substantial displacement of brain parenchyma may cause elevation of intracranial pressure (ICP) and potentially fatal herniation syndromes. Clinical manifestations of intraparenchymal hemorrhage are determined by the size and location of hemorrhage, but may include the following: Hypertension, fever, or cardiac arrhythmias Nuchal rigidity Subhyaloid retinal hemorrhages Altered level of consciousness Anisocoria, ...
TY - JOUR. T1 - Thermo-sensitive assembly of the biomaterial REP reduces hematoma volume following collagenase-induced intracerebral hemorrhage in rats. AU - Park, Joohyun. AU - Kim, Jong Youl. AU - Choi, Seong Kyoon. AU - Kim, Jae Young. AU - Kim, Jae Hwan. AU - Jeon, Won Bae. AU - Lee, Jong Eun. PY - 2017/8. Y1 - 2017/8. N2 - Intracerebral hemorrhage (ICH) frequently results in severe disabilities and high mortality. RGD-containing elastin-like polypeptide (REP), a modified elastin-like polypeptide (ELP), is a thermally responsive biopolymer. REP has high affinity for cells and is known to show non-immunotoxicity, -cytotoxicity, and -inflammatory responses. Here we found that administration of REP in the acute phase of the ICH rat model reduced the hematoma volume, decreased the number of activated microglia, attenuated the expression of von Willebrand Factor (vWF), and prevented the leakage of immunoglobulin G (IgG) into the cerebral parenchyma without any occlusion of intact microvessels. ...
A 4-year-old previously healthy boy presented with a non-traumatic right parietal hemorrhage. A second life-threatening left cerebral hemorrhage occurred three weeks later and was decompressed with a craniotomy. Transthoracic echocardiography revealed a hypermobile elongated tumor of the mitral valve. The cardiac tumor was successfully resected three weeks after the craniotomy. Histological examination of the cardiac tumor revealed a papillary lesion of spindle cells with smooth muscle cell differentiation. In view of the histological findings and the clinical symptoms, a cellular myofibroblastic tumor was considered the most likely diagnosis in our patient. Although a cardiac tumor is a rare cause of a cerebral hemorrhage, a cardiac evaluation is recommended in pediatric patients with a cerebral hemorrhage of unknown etiology ...
Authors: Beslow LA, Abend NS, Gindville MC, Bastian RA, Licht DJ, Smith SE, Hillis AE, Ichord RN, Jordan LC.. IMPORTANCE Seizures are believed to be common presenting symptoms in neonates and children with spontaneous intracerebral hemorrhage (ICH). However, few data are available on the epidemiology of acute symptomatic seizures or the risk for later epilepsy. OBJECTIVE To define the incidence of and explore risk factors for seizures and epilepsy in children with spontaneous ICH. Our a priori hypotheses were that younger age at presentation, cortical involvement of ICH, acute symptomatic seizures after presentation, ICH due to vascular malformation, and elevated intracranial pressure requiring urgent intervention would predict remote symptomatic seizures and epilepsy. DESIGN Prospective cohort study conducted between March 1, 2007, and January 1, 2012. SETTING Three tertiary care pediatric hospitals. PARTICIPANTS Seventy-three pediatric subjects with spontaneous ICH including 20 perinatal ...
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A number of studies have cited immune cell infiltration as a mechanism for secondary injury following intracerebral hemorrhage. However, the role of monocytes remains poorly understood. We hypothesized that monocytes are a beneficial cell type that help remove extravasated blood and other pathogenic substances that enter brain parenchymal tissue during a hemorrhagic stroke. Using macrophage Fas-induced apoptosis (MAFIA) mice, this study documents a time course of monocyte infiltration into brain tissue. We then systemically knocked down monocytes prior to initiating an intracerebral hemorrhage, and studied the motor and cognitive outcomes relative to a vehicle treated group. The genetic alteration present in MAFIA mice causes the co-expression of green fluorescent protein and a suicide protein, exclusively in monocytes and dendritic cells. We established a time course of monocyte infiltration by counting cells expressing green fluorescent protein in brain parenchymal tissue at four time points ...
The use of Minimally Invasive Parafascicular Surgery (MIPS) techniques for removal of traumatic hematoma is encouraging, innovative and promising. Those are the insights from Julian Bailes, MD, Chair of the Joint Section on Neurotrauma and Critical Care for the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), following the evidence highlighted in two abstracts on the subject at the recent AANS Annual Scientific Meeting.. Results from the 10-patient multi-center study, led by Jefferson Chen, MD, PhD, from the University of California Irvine, concluded that techniques using Minimally Invasive Parafascicular Surgery (MIPS) "may be used effectively and safely to remove deep subcortical hemorrhages" and "may improve the patients hospital course and ultimate neurological outcome". Technologies used in the MIPS approach include the NICO BrainPathâ for subcortical access and Myriadâ for hemorrhage evacuation.. "This is the first multi-center experience ...
Background: Antiplatelet treatment remains the first choice for primary and secondary prevention of vascular diseases; even so, expected benefits may be offset by risk of bleeding, particularly cerebral hemorrhage. The aim of this study was to assess the influence of antiplatelet treatment on clinical outcome at hospital discharge. Materials and Methods: Consecutive patients with first-ever stroke due to a primary intraparenchymal hemorrhage were prospectively identified over a 4-year period (2000â€"2003). Data on hemorrhage location, vascular risk factors, and antiplatelet and anticoagulant treatment were collected. At discharge, outcome was measured using the modified Rankin Scale (disabling stroke ≥3). Patients treated with anticoagulant therapy were excluded from the study. Results: Of 457 consecutive patients with cerebral hemorrhage, 94 (20.5%) had been taking antiplatelet agents. The treated patients (mean age for antiplatelet group 78.9 ± 9.0 years) were older than the ...
Background There is much uncertainty about the effects of early lowering of elevated blood pressure (BP) after acute intracerebral haemorrhage (ICH). Our aim was to assess the safety and efficiency of this treatment, as a run-in phase to a larger trial.. Methods Patients who had acute spontaneous ICH diagnosed by CT within 6 h of onset, elevated systolic BP (150-220 mm Hg), and no definite indication or contraindication to treatment were randomly assigned to early intensive lowering of BP (target systolic BP 140 mm Hg; n=203) or standard guideline-based management of BP (target systolic BP 180 mm Hg; n=201). The primary efficacy endpoint was proportional change in haematoma volume at 24 h; secondary efficacy outcomes included other measurements of haematoma volume. Safety and clinical outcomes were assessed for up to 90 days. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00226096.. Findings Baseline characteristics of patients were similar ...
Few animal models of stroke have created haematomas that mimic the processes seen in humans. We developed a new model of intracerebral haemorrhage (ICH) in rats by inducing acute-on-chronic hypertension that more closely mimics the human condition than existing models. We also examined profiles of ICH development in the genetically hypertensive Spontaneously Hypertensive Rat and in normotensive rats made hypertensive by induction of renal disease via renal artery obstruction or kidney resection ...
Intracerebral hemorrhage (ICH) causes 10% to 15% of first-ever strokes, with a 30-day mortality rate of 35% to 52% with only 20% expected to be functionally independent at 6 months. No medical or surgical interventions have been found to alter the natural evolution of this disease. The high risk for mortality and poor outcomes seems to occur despite relatively small hematoma volumes and small amounts of neuronal tissue at risk for injury. The reasons for this observation remain unknown; however perihematomal edema formation and inflammation that follows ICH seems to play an important role.. The Simvastatin for Intracerebral Hemorrhage Study is a prospective double blinded placebo controlled randomized (1:1) clinical trial that compares outcomes in patients receiving generic simvastatin 80 mg for 14 days or until death or discharge with patients in the placebo group.. The hypothesis for our study is that statins ameliorate perihematomal edema evolution thereby reducing mortality and improving ...
TY - JOUR. T1 - The effect of activated factor VII for intracerebral hemorrhage beyond 3 hours versus within 3 hours. AU - Hallevi, Hen. AU - Gonzales, Nicole R.. AU - Barreto, Andrew D.. AU - Martin-Schild, Sheryl. AU - Albright, Karen C.. AU - Noser, Elizabeth A.. AU - Illoh, Kachi. AU - Khaja, Aslam M.. AU - Allison, Teresa. AU - Escobar, Miguel A.. AU - Shaltoni, Hashem. AU - Grotta, James C.. PY - 2008/2/1. Y1 - 2008/2/1. N2 - BACKGROUND AND PURPOSE - Recombinant-activated factor VII (rFVIIa) is an investigational treatment for intracerebral hemorrhage (ICH). We have evaluated the drugs treatment effect based on time to treatment. METHODS - ICH patients treated up to 4 hours from symptom onset were divided based on time to treatment: ≤3 hours (3H) and 3 to 4 hours (4H). Head CT was done at baseline and 24 hours. Outcome measures included: ICH growth at 24 hours, mortality, favorable outcome and discharge disposition. A cohort of nontreated matched ICH patients was used to asses the ...
Looking for hemorrhagic infarct? Find out information about hemorrhagic infarct. Localized death of tissue that is caused by obstructed inflow of arterial blood. Also known as infarction. a focus of organ or tissue necrosis resulting... Explanation of hemorrhagic infarct
Brain Hemorrhage Pipeline Review, H1 2012, provides an overview of the Brain Hemorrhage therapeutic pipeline. This report provides information on the therapeutic development for Brain Hemorrhage, complete with latest updates, and special features on late-stage and discontinued projects. It also reviews key players involved in the therapeutic development for Brain Hemorrhage. Brain Hemorrhage - Pipeline Review, H1 2012 is built using data and information sourced from Global Markets Directs proprietary databases, Company/University websites, SEC filings, investor presentations and featured press releases from company/university sites and industry-specific third party sources, put together by Global Markets Directs team ...
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Grading of intracranial hemorrhage in neonates is based on ultrasound imaging. It has four grades with increasing mortality and decreasing outcome.
METHODS: The study comprised 271 patients admitted to Carlos Haya University Hospital in Malaga with GM hemorrhage. The following data were recorded: gestational age, gender, twin birth, head circumference at birth, weight at birth, and Papile grade. Severe obstetrical (abruption, chorioamnionitis, pregnancy-induced hypertension, tocolytic treatment) and neonatal disorders (respiratory distress syndrome, neonatal infection, coagulation disorder, patent ductus arteriosus, necrotizing enterocolitis) were also recorded. Symptomatic hydrocephalus was diagnosed in the event of a progressive increase in head circumference and ventricular indices requiring shunting ...
The overall objective of this Phase III clinical trial is to obtain information from a population of 500 ICH subjects with intraventricular hemorrhage (IVH), representative of current clinical practice and national demographics of ICH regarding the benefit (or lack thereof) of IVH clot removal on subject function as measured by modified Rankin Scale (mRS). This application requests funding for five years to initiate a Phase III randomized clinical trial (RCT) testing the benefit of clot removal for intraventricular hemorrhage. The investigators propose to compare extraventricular drainage (EVD) use plus recombinant tissue plasminogen activator (rt-PA; Alteplase; Genentech, Inc., San Francisco, CA) with EVD+ placebo in the management and treatment of subjects with small intracerebral hemorrhage (ICH) and large intraventricular hemorrhage (IVH defined as ICH , 30 cc and obstruction of the 3rd or 4th ventricles by intraventricular blood clot ...
The overall objective of this Phase III clinical trial is to obtain information from a population of 500 ICH subjects with intraventricular hemorrhage (IVH), representative of current clinical practice and national demographics of ICH regarding the benefit (or lack thereof) of IVH clot removal on subject function as measured by modified Rankin Scale (mRS). This application requests funding for five years to initiate a Phase III randomized clinical trial (RCT) testing the benefit of clot removal for intraventricular hemorrhage. The investigators propose to compare extraventricular drainage (EVD) use plus recombinant tissue plasminogen activator (rt-PA; Alteplase; Genentech, Inc., San Francisco, CA and Boehringer Ingelheim, Inc., Ingelheim, Germany) with EVD+ placebo in the management and treatment of subjects with small intracerebral hemorrhage (ICH) and large intraventricular hemorrhage (IVH defined as ICH < 30 cc and obstruction of the 3rd or 4th ventricles by intraventricular blood ...
The recently published second Surgical Trial in Intracerebral Haemorrhage (STICH-2) tested whether surgical evacuation of superficial spontaneous intracerebral haemorrhage was effective at reducing death and disability at 6 months after onset. Participants were randomised to a policy of early surgical intervention or initial medical management alone within 48 hours of symptom onset. After enrolling 601 patients across 78 centres in 27 countries, intention to treat analysis showed no difference in outcome. Time to intervention was a median of 26 hours after symptom onset in the surgical arm, and craniotomy accounted for 98% of all surgical procedures. The interpretation of the overall neutral result is confounded by a high proportion of crossovers from the medical management arm of the study, predominantly of more severely affected patients. Further analysis may clarify whether decompressive surgery late after superficial intracerebral haemorrhage has any role in management. ...
This current PhD Thesis in Neuropathology focuses on the development and assessment of in vitro simulation approaches to intracerebral haemorrhage. The PhD Thesis provides a clinical and experimental neuropathological overview of intracerebral haemorrhage as well as an account of the in vitro simulation approaches to the disease, before proceeding to the presentation of the experimental work designed and performed by the author. The development of the herein presented in vitro simulation approaches to intracerebral haemorrhage was based on the use of an immortalized embryonic murine hippocampal cell-line (mHippoE-14) and its response to oligomycin-A and ferrum or haemin under appropriately selected conditions (aiming to simulate the natural history of the disease in a more reliable manner). The PhD Thesis provides a characterization of the mHippoE-14 cell-line (through a real-time cellular response analysis and a cytomorphological characterization), before proceeding to the actual experimental ...
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Author(s): J Puig, G Blasco, M Terceño, P Daunis-i-Estadella, G Schlaug, M Hernandez-Perez, V Cuba, G Carbó, J Serena, M Essig, CR Figley, K Nael, C Leiva-Salinas, S Pedraza, and Y Silva. American Journal of Neuroradiology 40(5): 769-775 External link ...
Results Of 323 patients with ICH, 172 (53%) survived after 1 year, 127 (39%) after 5 years and 57 (18%) after 13 years. Mortality of the 172, 1 year survivors (mean age 67.7 years at ICH) persistently exceeded expected mortality; 13 years post ictus survival was only 34% compared with 61% in the general population. Of 115 deaths among the 172, 1 year survivors, 36% were from cerebrovascular disease and 19% from ischaemic heart disease. Independent risk factors for death among 1 year survivors were age (HR 1.08 per year; 95% CI 1.06 to 1.10; p,0.001), diabetes mellitus at baseline (HR 2.10; 95% CI 1.18 to 3.74; p=0.012) and anticoagulant therapy (HR 1.99; 95% CI 1.12 to 3.53; p=0.018) at ICH onset.. ...
Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage.. Surg Neurol. 2008 May;69(5):441-6. Authors: Miller CM, Vespa P, Saver JL, Kidwell CS, Carmichael ST, Alger J, Frazee J, Starkman S, Liebeskind D, Nenov V, Elashoff R, Martin N. BACKGROUND: Spontaneous ICH is a devastating disease with high morbidity and mortality. Intracerebral hemorrhage lacks an effective medical or surgical treatment despite the acknowledged pathophysiologic benefits of achieved hemostasis and clot removal. Image-guided stereotactic endoscopic hematoma evacuation is a promising minimally invasive approach designed to limit operative injury and maximize hematoma removal. METHODS: A single-center randomized controlled trial was designed to assess the safety and efficacy of stereotactic hematoma evacuation compared to best medical management. Patients were randomized within 24 hours of hemorrhage in a 3:2 fashion to best medical management plus endoscopic hematoma evacuation or best medical management ...
Between July 1994 and June 1995, 23 patients over age 60 years presented to the Massachusetts General Hospital with primary lobar hemorrhage on CT. (This figure excludes patients with known causes of hemorrhage such as trauma, cerebral tumor, coagulopathy, or vascular malformation.) Of the 23 patients, 13 were prospectively evaluated using T2-weighted and gradient-echo MRI. The 10 patients not evaluated by MRI consisted of 5 with terminal clinical state (1 with CAA at postmortem examination), 2 with diagnoses previously established by hematoma resection (both showing CAA in the pathologic tissue), and 3 whose treating physicians chose not to obtain MRI. An additional 2 patients (patients 1 and 10) were evaluated by MRI during this time period for hemorrhages that had occurred 1 to 2 years previously and were added to the series. Mean age of evaluated patients was 75.9 years (range, 65 to 90) and sex distribution was eight men and seven women. MRI evaluation was generally performed within 3 days ...
The mechanism for hemorrhage enlargement in the brain, a key determinant of patient outcome following hemorrhagic stroke, is unknown. We performed computer-based stochastic simulation of one proposed mechanism, in which hemorrhages grow in "domino" fashion via secondary shearing of neighboring vessel segments. Hemorrhages were simulated by creating an initial site of primary bleeding and an associated risk of secondary rupture at adjacent sites that decayed over time. Under particular combinations of parameters for likelihood of secondary rupture and time-dependent decay, a subset of lesions expanded, creating a bimodal distribution of microbleeds and macrobleeds. Systematic variation of the model to simulate anticoagulation yielded increases in both macrobleed occurrence (26.9%, 53.2%, and 70.0% of all hemorrhagic events under conditions simulating no, low-level, and high-level anticoagulation) and final hemorrhage size (median volumes 111, 276, and 412 under the same three conditions), ...
|i|Background:|/i| We recently demonstrated that recombinant activated factor VII (rFVIIa) given to patients presenting within 3 h of acute spontaneous intracerebral hemorrhage (ICH) reduc
Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding within the brain tissue itself - a very life-threatening situation. A stroke occurs when the brain is deprived of oxygen due to an interruption of its blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. Treatment focuses on stopping the bleeding, removing the blood clot (hematoma), and relieving the pressure on the brain.. Intracerebral Hemorrhage (ICH).pdf. ...
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Does intensive blood pressure control improve outcomes and reduce hematoma expansion in acute intracerebral hemorrhage (ICH)? The INTERACT-2 trial previously compared intensive vs. conservative blood pressure control in ICH patients and found no difference in death or disability between the two groups. Enter the ATACH-2 trial, published in the New England Journal of Medicine September 15,…
An intracranial hemorrhage is the accumulation of blood anywhere within the cranial vault. A cerebral hemorrhage is bleeding within the brain tissue. Causes: A cerebral hemorrhage can be due to either A. Intraparenchymal hemorrhage B. Intraventricular hemorrhage(blood in the ventricular system). C. Extradural hemorrhage (An extradural hemorrhage is bleeding between the inside of the skull and the outer covering of the brain) D. Subdural hemorrhage: ( is a type of hematoma, usually associated with traumatic brain injury. Blood gathers between the dura mater, and the brain) E. Sub Arachinoid hemorrhage: (is bleeding into the subarachnoid space-the area between thearachnoid membrane and the pia mater surrounding the brain. This may occur spontaneously, usually from a ruptured cerebral aneurysm, or may result fromhead injury.
BACKGROUND AND PURPOSE: Limited data exist on health-related quality of life (HRQoL) after intracerebral haemorrhage (ICH). We aimed to determine baseline factors associated with HRQoL among participants of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). METHODS: The INTERACT studies were randomised controlled trials of early intensive blood pressure (BP) lowering in patients with ICH (,6 hours) and elevated systolic BP (150-220 mm Hg). HRQoL was determined using the European Quality of Life Scale (EQ-5D) at 90 days, completed by patients or proxy responders. Binary logistic regression analyses were performed to identify factors associated with poor overall HRQoL. RESULTS: 2756 patients were included. Demographic, clinical and radiological factors associated with lower EQ-5D utility score were age, randomisation outside of China, antithrombotic use, high baseline National Institutes of Health Stroke Scale (NIHSS) score, ...