Aneurysmal subarachnoid hemorrhage affects 6 to 9 out of every 100,000 people annually, with a mortality rate of 35%. Many people suffer from long-term disabilities, often associated with cognitive impairment. Aneurysmal subarachnoid hemorrhage requires timely stabilization, diagnosis, and treatment. The typical manifestation of severe headaches is common. There are also a wide range of symptoms, including mild pain and coma. We delve into the importance of the field, the significance of ongoing research, and the advancements made in diagnosing and treating this condition, aiming to provide a comprehensive overview.

BackgroundWe aimed to investigate the clinical effectiveness of integrating 3D-printing technology with neuroendoscopy for treating hypertensive intracerebral hemorrhage (HICH). MethodsBetween November 2020 and November 2023, a total of 105 HICH cases were selected and categorized into the conventional surgery group and the neuroendoscopic surgery. General data, Glasgow Coma Scale (GCS), National institutes of health neurological impairment score (NIHSS), preoperative hematoma volume, intracerebral parenchymal and intraventricular hematoma (IVH) clearance rates, Modified Graeb Scale (mGS), postoperative rebleeding rate, intracranial infection, and Modified Rankin Scale (mRS) were collected to assess the therapeutic effectiveness. ResultsThere were no significant statistical differences in gender, age, preoperative GCS scores, NIHSS or hematoma volume between the neuroendoscopic surgery and conventional surgery group. The postoperative results indicated that the clearance rate of intracerebral parenchymal and IVH in neuroendoscopic surgery group was notably higher than the conventional surgery group. The neuroendoscopic surgery group achieved superior outcomes in terms of bone flap area, operation time, extubation time, and average hospital stay compared to the conventional surgery group (P < 0.05). Following a 3-month follow-up, there was no significant difference in the mRS and NIHSS between the two groups. However, when the patients with IVH (mGS≥10) indicated better postoperative outcomes in the neuroendoscopic surgery group (P < 0.05). ConclusionThe integration of neuroendoscopic minimally invasive surgery with 3D-printing technology for treating HICH demonstrated high efficacy for removing intracerebral and IVH. This approach incurred less trauma compared to traditional craniectomy surgery, affording shortened surgical and hospitalization durations. Consequently, it appears to be a highly efficacious method for treating HICH, particularly in cases involving IVH.

ObjectiveThis study retrospectively analyzed the association of blend sign with long-term outcomes in patients who underwent craniotomy following spontaneous supratentorial intracerebral hemorrhage. MethodsA retrospective analysis was conducted on a cohort comprising 259 patients. Initially, patients were stratified into two groups: the blend sign group and the non-blend sign group. Subsequently, the neurological status of these patients was assessed using the NIHSS, GCS, and mRS following craniotomy. Furthermore, at six months post-craniotomy, patients were categorized into either the “good outcome group” or the “poor outcome group”. A multivariate regression analysis was applied to ascertain the independent correlation between the CT blend sign and prognosis. ResultsNo statistically significant disparities were observed in the proportion of patients experiencing favorable outcomes during the follow-up period between the two groups. Nevertheless, it is noteworthy that the incidence of the blend sign was higher among patients in the good outcome group compared to those in the poor outcome group. Multivariate regression analysis disclosed that poor outcomes following craniotomy was not associated with the blend sign. ConclusionsThe presence of the blend sign may not serve as a reliable predictor of functional outcomes in patients undergoing craniotomy for spontaneous supratentorial ICH.

ObjectiveCerebral small vessel disease (CSVD) and its associated stroke are significant contributors to mortality and long-term disability globally. Despite this, there remains a lack of established predictors or preventive strategies for stroke mediated by CSVD, beyond the management of hypertension. In this study, we explored the potential utility of imaging-derived phenotypes (IDPs) of white matter (WM) as risk predictors for CSVD-mediated stroke and clarify the underlying causal relationships. MethodsWe performed a genetic correlation analysis to assess the relationship between WM IDPs and CSVD-mediated stroke, identifying genetically correlated pairs for follow-up Mendelian randomization (MR) studies. Subsequently, we examined the mediating role of WM IDPs in the correlation between blood pressure (BP) traits and CSVD-mediated stroke. ResultsOur findings demonstrate a significant causal relationship between genetic predisposition to increased isotropic or free water volume fraction (ISOVF) in the anterior limb of the left internal capsule (ALLIC) and CSVD-mediated stroke (IVW: odds ratio [OR] = 1.57; 95 % CI: 1.25 to 1.96, p = 8.27 × 10–5). ConclusionsThis study provides evidence for a potential causal link between WM IDPs and CSVD-mediated stroke, which may enhance the predictive capacity for CSVD-mediated stroke.

Patients with malignant tumors face an elevated risk of cerebrovascular complications, such as intratumoral hemorrhage, tumor invasion into arterial and venous sinuses, leptomeningeal infiltration, and tumor embolism. This review examines the significant role and implications of cisplatin and radiation therapy in the development of these cerebrovascular complications, which can occur at various stages: before, during, or long after the completion of cancer treatment. Detailed clinical case studies of CNS involvement during oncological therapy are presented to illustrate these complications. The mechanisms by which cisplatin and radiation therapy contribute to cerebrovascular disorders are multifaceted. Cisplatin, a widely used chemotherapeutic agent, is associated with endothelial damage and thromboembolic events, while radiation therapy can cause vascular injury, leading to long-term changes in cerebral vasculature. These treatments, though effective in managing malignancies, pose significant risks to cerebrovascular health. The review underscores the diverse types and mechanisms of stroke encountered in cancer patients, influenced by tumor stage and pathological characteristics. These include ischemic stroke, hemorrhagic stroke, and transient ischemic attacks, each requiring specific diagnostic and therapeutic strategies. The interaction between cancer pathology and cerebrovascular health necessitates a multidisciplinary approach, integrating oncology, neurology, radiology, and vascular surgery. Such an approach is crucial for effective management and prognosis evaluation in this patient population. Early recognition and intervention are paramount to mitigating risks and improving outcomes. By understanding these complex interactions, healthcare providers can better anticipate and manage cerebrovascular risks in patients undergoing cancer treatment. This comprehensive understanding helps in formulating personalized treatment plans, optimizing both oncological and neurological care, and ultimately enhancing patient quality of life and survival rates.

Intracerebral hemorrhage (ICH) represents a significant health challenge due to its high mortality and severe outcomes. Poly (ADP-ribose) polymerase (PARP) is a chromatin-associated nuclear protease, which would be activated by ROS derived from hematoma metabolites after ICH, and lead to parthanatos, a form of caspase-independent programmed cell necrosis. Recent evidence indicates that PARP activation plays a pivotal role in various human diseases, particularly neurodegenerative disorders, cerebral ischemia–reperfusion injury, and hemorrhagic transformation. However, the link between PARP activation and secondary brain injury (SBI) following ICH remains underexplored. This review delves into the pathological mechanisms of PARP activation in cell injury, with a focus on parthanatos, mitochondrial dysfunction, neuroinflammation, and blood–brain barrier (BBB) disruption after ICH. Understanding these processes may offer new insights into the role of PARP activation in ICH and pave the way for developing more effective therapeutic strategies.

ObjectiveThis study aims to address the difficulties encountered by Traditional Chinese Medicine (TCM) students in learning neuroanatomy during clinical training by utilizing neuroimaging visualization technology. Methods81 students were divided into a control group (40 students) and an observation group (41 students). The control group followed traditional teaching methods as prescribed by the curriculum, while the observation group received additional training with the neuroimaging visualization software DSI Studio. This included whole-brain neural fiber reconstruction and cortical spinal tract evaluation in the context of stroke. Upon completion of the training, both groups were assessed on neuroanatomical theory, case analysis, neurological examination, and clinical skills. The teaching effectiveness was compared based on assessment results and feedback from questionnaires administered to the observation group. ResultsThe observation group significantly outperformed the control group in theoretical knowledge, case analysis, and physical examination (P < 0.05). Over 90 % of students in the observation group reported via questionnaire that the integration of neuroimaging visualization technology significantly enhanced their understanding of neuroanatomy and clinical reasoning skills. ConclusionThe clinical teaching approach augmented with neuroimaging visualization technology significantly improves the standardized training outcomes for TCM neurosurgical residents.

Rebleeding from a ruptured aneurysm is a risk factor for fatal prognosis in subarachnoid hemorrhage (SAH). A novel barbiturate treatment, step-down infusion of barbiturate (sd-B), was previously developed; it showed beneficial effects on patients with severe traumatic brain injuries. The present study established a rebleeding SAH model in rats and evaluated the effect of sd-B. Fifty male Sprague-Dawley rats were divided into sham-operation with distilled water, sham-operation with barbiturate, SAH-rebleeding with distilled water, and SAH-rebleeding with barbiturate groups. For posttreatment with sd-B, thiamylal was intraperitoneally administered at 3 mg/kg/h on days 0–1, 2 mg/kg/h on days 1–2, and 1 mg/kg/h on days 2–3 after SAH using osmotic minipumps. We monitored neurofunction and case fatality as the primary endpoints and evaluated brain injuries, including brain edema and cortical neuronal cell death, as the secondary endpoints. Posttreatment with sd-B improved the modified Garcia test, reduced the brain water content, and inhibited the loss of neuronal cells and microglial expressions in the rat model. Our results revealed that sd-B ameliorated neurofunction and brain injuries on the rebleeding SAH model, suggesting that the novel treatment is a good candidate drug for patients with SAH with rebleeding.

IntroductionSpontaneous (non-traumatic) intracerebral hemorrhage (ICH) is one of the major causes of global death. The purpose of our bioinformatics analysis was to detect viable pathophysiological targets and small-molecule drug candidates and to identify the precise secondary mechanisms of brain injury in ICH. Material and methodsThe GSE24265 dataset, consisting of data from four perihematomal brain tissues and seven contralateral brain tissues, was downloaded from the Gene Expression Omnibus (GEO) database and screened for differentially expressed genes (DEGs) in ICH. Online analysis tool GEO2R and Drug Susceptibility Assessment Module within the ACBI Bioinformation tool was used for data differential expression analysis. TargetScan, miRDB, and RNA22 were used to investigate the miRNAs regulating the DEGs. The functional annotation of DEGs was performed using Gene Ontology (GO) resources, and the cell signaling pathway analysis of DEGs was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG). DAVID is used to perform GO function enrichment analysis and KEGG pathway analysis of candidate target genes. Enrichment analysis was performed for delving the molecular mechanism of DEGs, and protein–protein interaction (PPI) networks and microRNA (miRNA)-messenger RNA (mRNA) networks were used to reveal the hub nodes and the related interaction relationships. Hub genes and miRNA-mRNA interaction of PPI network were identified by STRING version 12.0 online software and Cytoscape. Next, the DEGs were analyzed using the L1000CDS2 database to identify small-molecule compounds with potential therapeutic effects. ResultsA total of 325 upregulated genes and 103 downregulated genes associated with ICH were identified. The biological functions of DEGs associated with ICH are mainly involved in the inflammatory response, chemokine activity, and immune response. The KEGG analysis identified several pathways significantly associated with ICH, including but not limited to cytokine-cytokine receptor interaction and MAPK signaling pathway. A PPI network consisting of 188 nodes and 563 edges was constructed using STRING, and 27 hub genes were identified with Cytoscape software. The miRNA-mRNA network with high connectivity contained key 27 mRNAs (from C-C motif chemokine ligand 5 (CCL5), C-C motif chemokine ligand 8 (CCL8), …., to dishevelled-associated activator of morphogenesis 1 (DAAM1), and FRAT regulator of WNT signaling pathway 1 (FRAT1)) and 135 candidate miRNAs. These genes and miRNAs are closely related to secondary brain injury induced by ICH. In addition, a L1000CDS2 analysis of six small-molecule compounds revealed their therapeutic potential. ConclusionsOur study explores the pathogenesis of brain tissue injury promoted by neuroinflammation in ICH and extends the clinical utility of its key genes. At the same time, we constructed a miRNA-mRNA network which may play crucial roles in the pathogenesis of ICH. In addition, we obtained six small molecule compounds that will have anti-inflammatory effects on ICH, including Geldanamycin, Dasatinib, BMS-345541, Saracatinib, and Afatinib.