Basal Ganglia Hemorrhage Research Articles

Evaluation of Volumetric Change of Intracerebral Hemorrhage in Patients Treated with Thrombolysis for Intraventricular Hemorrhage

BackgroundIntraventricular hemorrhage (IVH) is often caused by irruption of intracerebral hemorrhage (ICH) of basal ganglia or thalamus into the ventricular system. Instillation of recombinant tissue plasminogen activator (rtPA) via an external ventricular drainage (EVD) has been shown to effectively decrease IVH volumes while the impact of rtPA instillation on ICH volumes remains unclear. In this series, we analyzed volumetric changes of ICH in patients with and without intrathecal lysis therapy.MethodsBetween 01/2013 and 01/2019, 36 patients with IVH caused by hemorrhage of basal ganglia, thalamus or brain stem were treated with rtPA via an EVD (Group A). Initial volumes were determined in the first available computed tomography (CT) scan, final volumes in the last CT scan before discharge. During the same period, 41 patients with ICH without relevant IVH were treated without intrathecal lysis therapy at our neurocritical care unit (Group B). Serial CT scans were evaluated separately for changes in ICH volumes for both cohorts using OsiriX DICOM viewer. The Wilcoxon signed-rank test was performed for statistical analysis in not normally distributed variables.ResultsMedian initial volume of ICH for treatment Group A was 6.5 ml and was reduced to 5.0 ml after first instillation of rtPA (p < 0.01). Twenty-six patients received a second treatment with rtPA (ICH volume reduction 4.5 to 3.3 ml, p < 0.01) and of this cohort further 16 patients underwent a third treatment (ICH volume reduction 3.0 ml to 1.5 ml, p < 0.01). Comparison of first and last CT scan in Group A confirmed an overall median percentage reduction of 91.7% (n = 36, p < 0.01) of ICH volumes and hematoma resolution in Group A was significantly more effective compared to non-rtPA group, Group B (percentage reduction = 68%) independent of initial hematoma volume in the regression analysis (p = 0.07, mean 11.1, 95%CI 7.7–14.5). There were no adverse events in Group A related to rtPA instillation.ConclusionIntrathecal lysis therapy leads to a significant reduction in the intraparenchymal hematoma volume with faster clot resolution compared to the spontaneous hematoma resorption. Furthermore, intrathecal rtPA application had no adverse effect on ICH volume.

Retrospective analysis of surgical management for spontaneous basal ganglia haemorrhage and outcome: A tertiary institute experience

Background: Spontaneous intracranial haemorrhage (ICH) is the most severe type of stroke with high mortality rates. This entity accounts for 17 to 33% of all strokes and is associated with a higher mortality rate. Approximately, 35–50% of patients with ICH die within the 30 days after event. Long-term survivors are often remaining with permanent deficits, with up to 75% suffering permanent disability and only 12% to 39% of the survivors have favourable outcomes. Several studies aiming to explore the efficacy of surgery for patients with ICH have been carried out. However, the results were inconclusive. To provide evidence for clinical practice, here we present a retrospective study to explore the effect of surgery for patients with spontaneous basal ganglia haemorrhage. Methods: The present study was conducted in the Neurosurgery Department of a tertiary care hospital in the Northern part of India from January 2018 to March 2020. Sixty-one patients aged between 20-70 years of basal ganglia haemorrhage who presented within 24 hours of ictus and operated were included in this study. Results: A total of 61 patients underwent surgical intervention consisting of 49 (80%) males and 12 (20%) females. Their age varied from 27 to 70 with mean age ± SD 51.93 ± 13.19 years. Thirty-six patients were ≥ 50 years of age, out of which 72% patients had unfavourable outcomes (GOS 1-3) and 28% had favourable outcome (GOS 4-5). There were 31 patients with GCS 5-8. Most patients (81%) had GOS 1-3(at the time of discharge). Out of 25 patients with GCS 9-12; 64% had GOS 4-5. The patients with volume of haematoma 40-60 ml, 82% patients had GOS 4-5. The patients with midline shift &gt; 5 mm; 78% patients had GOS 1-3. Patients with midline shift &lt; 5 mm; 82% had GOS 4-5 (P=0.005). The mean hospital stays of unfavourable outcomes group was 28.71 ± 10.25 days and of favourable outcomes group was 22.07 ± 6.32 days (0.000). Conclusions: Early surgery (within 6 hours) along with multi-modality medical management has definite positive role in the outcome of patients with spontaneous basal ganglionic haemorrhage. Patients ≥ 50 years, signs of brain herniation, volume of haematoma ≥ 60ml, hydrocephalic dilatation due the intraventricular haemorrhage, midline shift &gt; 5 mm, and GCS ≤ 8 at presentation had poor prognosis.

Clinical characteristics of cerebral hemorrhage with bilateral sudden deafness as the first symptom.

To summarize and analyze the clinical data of 12 Chinese patients of cerebral hemorrhage with bilateral sudden deafness as the first symptom and to explore the relationship between cerebral hemorrhage and bilateral sudden deafness. Retrospective analysis of clinical data of patients, including age, clinical manifestations, location of cerebral hemorrhage, hearing loss, and recovery. The average age of onset in 12 patients was 53.92years, 9 had a history of hypertension, 7 had a history of stroke, and 6 had typical stroke symptoms. There were 7 cases of basal ganglia hemorrhage; 2 cases of cerebellum hemorrhage; and 1 case of pontine hemorrhage, temporal lobe hemorrhage, and thalamus infarction. The auditory brainstem evoked potential test results of 3 patients were normal, and 5 of 6 patients who completed pure tone audiometry had hearing impairment. Five out of 9 patients had basically or completely recovered hearing. The results showed that patients were mostly middle-aged and elderly with no typical stroke symptoms, and a history of stroke and hypertension increased the risk of hearing loss. The cause of hearing loss in patients with cerebral hemorrhage may be related to the damage of the hearing conduction pathway or (and) the lack of blood supply to the central auditory nervous system. Detecting hearing impairment in time and actively intervening can help most patients to improve their hearing significantly. The degree of hearing damage and recovery is related to the bleeding site, the amount of bleeding, and the timely treatment.

Analysis of the Effect of Neuroendoscopic Hematoma Evacuation Through Keyhole Approach in the Treatment of Cerebral Hemorrhage in Basal Ganglia of Moderate Hypertension

Analysis of the Effect of Neuroendoscopic Hematoma Evacuation Through Keyhole Approach in the Treatment of Cerebral Hemorrhage in Basal Ganglia of Moderate Hypertension

Prediction of Motor Recovery in Patients with Basal Ganglia Hemorrhage Using Diffusion Tensor Imaging.

Predicting prognosis in patients with basal ganglia hemorrhage is difficult. This study aimed to investigate the usefulness of diffusion tensor imaging in predicting motor outcome after basal ganglia hemorrhage. A total of 12 patients with putaminal hemorrhage were included in the study (aged 50 ± 12 years), 8 patients were male (aged 46 ± 11 years) and 4 were female (aged 59 ± 9 years). We performed diffusion tensor imaging and measured clinical outcome at baseline (pre) and 3 weeks (post1), 3 months (post2), and 6 months (post3) after the initial treatment. In the affected side of the brain, the mean fractional anisotropy (FA) value on pons was significantly higher in the good outcome group than that in the poor outcome group at pre (p = 0.004) and post3 (p = 0.025). Pearson correlation analysis showed that mean FA value at pre significantly correlated with the sum of the Brunnstrom motor recovery stage scores at post3 (R = 0.8, p = 0.002). Change in the FA ratio on diffusion tractography can predict motor recovery after hemorrhagic stroke.

3D-printed model-guided endoscopic evacuation for basal ganglia hemorrhage

The purpose of this study was to investigate the effectiveness and practicality of 3D-printed model-guided endoscopic surgery for the treatment of basal ganglia hemorrhage. The authors retrospectively analyzed the data of all patients who underwent endoscopic evacuation of basal ganglia hemorrhage in the Department of Neurosurgery at Dalang Hospital and Shipai Hospital between December 2017 and February 2019. Twelve patients, in whom the 3D-printed model guidance was used for endoscopic evacuation, were included in this investigation. Using 3D reconstructed technology, we designed the appropriate surgical approach. Then, an individualized facial model with the guide orifice was printed by a 3D printer. Further, the 3D-printed model was employed to guide the insertion of the endoscope sheath. As a result, the average evacuation rate was 97.2% (range 90.1–100.0%). The GCS and mRS score were improved in each patient from admission to discharge examination. All patients had a good prognosis based on their functional independence measure (FIM) scores at the 6-month follow-up. The 3D-printed model-guided endoscopic evacuation was effective and safe for basal ganglia hemorrhage. This technique deserves further investigation to determine its role in intracerebral hemorrhage management.

Imaging diagnosis of acute necrotizing encephalopathy of childhood

Objective To analyze the imaging features of acute necrotizing encephalopathy of childhood (ANEC), and try to investigate its potential clinical value. Methods The clinical and imaging findings of 22 children from Wuhan Children′s Hospital diagnosed with ANEC were retrospective analyzed, from January 2013 to October 2018. All children were presented with hyperpyrexia and rapidly developed into rapid neurological deterioration after prodromic infection. In the initial imaging examination, all patients underwent head MRI, and 6 cases underwent additional head CT. During MRI follow-up, 4 cases were lost, 6 cases were followed up only once ( 14 days).The presence of hemorrhage and encephalomalacia in thalamus, brainstem, white matter and basal ganglia was carefully investigated throughout the follow-up. Results For the imaging manifestations of ANEC, bilateral thalamus were involved in all children. Other symmetrical lesions included white matter (14 cases), basal ganglia (15 cases), brainstem (16 cases), cerebellum (9 cases), corpus callosum (2 cases) and hippocampus (1 case). There were 3 children with asymmetric lesions, which were found in white matter (2 cases) and cerebellum (1 case).In the acute phase, the most typical head MRI showed tricolor pattern(high signal intensity in the center with surrounding low-signal, and hyperintense signals in the periphery of thalamus) or bicolor pattern(low signal in the central thalamus with surrounding hyperintense signals) of the thalamus on the apparent diffusion coefficient (ADC) imaging. Hemorrhage and encephalomalacia on MRI may suggest poor clinical outcome. Conclusions ANEC is a rapid progressive encephalopathy with typical imaging features. Hemorrhage and encephalomalacia on MRI may be associated with poor prognosis. Key words: Brain diseases; Child; Magnetic resonance imaging; Thalamus

Clinical effect of directional soft-channel puncture and suction drainage in the treatment of spontaneous cerebral hemorrhage in basal ganglia and its influence on neurological function

Objective To investigate the clinical effect of directional soft-channel puncture and suction drainage in the treatment of spontaneous cerebral hemorrhage in basal ganglia and its influence on neurological function. Methods From January 2017 to December 2018, 61 patients with spontaneous cerebral hemorrhage in basal ganglia were selected in the First People's Hospital of Jiande.According to the random table method, they were divided into control group (30 cases) and observation group (31 cases). The control group was treated conservatively, while the observation group was treated with directional soft-channel puncture and suction drainage combined with conventional therapy.The therapeutic effects, NIHSS score, ADL score, brain edema volume change and complications were compared before treatment, 1 week after treatment and 2 weeks after treatment. Results The total effective rate of the observation group (96.77%) was higher than that of the control group (76.67%) (χ2=3.989, P<0.05). The NIHSS score of the observation group was (16.54±2.19)points at one week after treatment and (9.12±1.24)points at two weeks after treatment, which were lower than those of the control group [(19.98±1.65)points and (13.25±2, 37)points] (t=6.911, 8.568, all P<0.05). The ADL score of the observation group was (43.42±5.67)points at one week after treatment and (63.98±3.46)points at two weeks after treatment, which were higher than those of the control group [(37.89±2.86)points and (52.37±4.10)points] (t=4.785, 11.967, all P<0.05). The volume of brain edema of the observation group was (12.08±2.14)mL at 1 week after treatment and (4.37±0.89)mL at 2 weeks after treatment, which were lower than those of the control group [(16.89±3.20)mL and (9.74±1.07)mL] (t=6.922, 21.339, all P<0.05). The incidence of complications in the observation group (6.45%) was lower than that in the control group (30.00%) (χ2=5.720, P<0.05). Conclusion Directional soft-channel puncture and suction drainage is effective in the treatment of spontaneous cerebral hemorrhage in basal ganglia, which can reduce the degree of neurological deficit and with fewer complications, and it is worthy of clinical study. Key words: Cerebral hemorrhage; Paracentesis; Neurological deficit; Activity of daily living; Brain edema volume; Complications

Application value of sufentanil combined with propofol anesthesia in basal ganglia intracerebral hemorrhage

Objective To investigate the clinical value of sufentanil combined with propofol anesthesia in cerebral hemorrhage in basal ganglia. Methods From November 2015 to June 2018, 100 patients with cerebral hemorrhage in the basal ganglia of the People's Hospital of Shanxi Province were enrolled and randomly divided into two groups according to the digital table, with 50 cases in each group.The control group received fentanyl+ propofol, and the study group received sufentanil + propofol.At T0 (before induction of anesthesia), T1 (after anesthesia induction), T2 (after tracheal intubation), T3 (surgery), the hemodynamic parameters[mean arterial pressure (MAP), heart rate (HR)] level, postoperative recovery time (recovery of spontaneous breathing, recovery time and extubation time), preoperative and postoperative 6 h serum angiotensin Ⅱ (Ang Ⅱ), renin activity (PRA), neuron specific enolase (NSE) ), glial fibrillary acidic protein (GFAP) levels, the incidence of adverse reactions of the two groups were counted. Results (1)Hemodynamics: MAP and HR levels in the two groups were higher in T1, T2 and T3 than those in T0(all P<0.05), and HR and MAP in the study group were lower than those in the control group (all P<0.05). (2)Postoperative recovery: the time of extubation, recovery time and spontaneous breathing time of the study group were (12.42±3.27)min, (9.10±1.95)min, (7.32±2.23)min, respectively, which were shorter than those of the control group[(15.30±3.35)min, (12.67±2.18)min, (8.96±2.48)min] (t=4.350, 8.631, 3.477, all P<0.05). (3)Serum Ang Ⅱ and PRA: the serum Ang Ⅱ and PRA levels in the two groups at 6 h after surgery were higher than those before surgery(all P<0.05), and Ang Ⅱ, PRA levels of the study group were lower than those of the control group (t=4.350, 8.631, 3.477, all P<0.05). (4) Serum NSE and GFAP: the serum NSE and GFAP levels in the two groups at 6 h after surgery were higher than those before surgery(all P<0.05), and NSE, GFAP levels of the study group were lower than those of the control group (all P<0.05). (5) Adverse reactions: the incidence of adverse reactions in the study group [12.0%(6/50)] was lower than that in the control group [28.0%(14/50)] (χ2=4.000, P<0.05). Conclusion Sufentanil combined with propofol anesthesia in patients with cerebral hemorrhage in the basal ganglia can promote hemodynamic fluctuations, inhibit the increase of Ang Ⅱ and PRA, NSE and GFAP, and has less adverse reactions and high security. Key words: Cerebral hemorrhage; Anesthesia; Blood pressure; Heart rate; Hemodynamics; Sufentanil; Propofol

Abstract WP59: Cerebral Blood Flow Increase After Endovascular Thrombectomy on Perfusion Weighted Image is Associated With Hemorrhagic Transformation

Introduction: The role of increased CBF after endovascular thrombectomy in post-ischemic hyperperfusion has not been studied in detail. We aimed to investigate the timing of CBF increases on PWI after thrombectomy in association with hemorrhagic transformation. Methods: We analyzed prospectively collected data in consecutive patients treated with endovascular thrombectomy. Inclusion criteria were: (1) patients with ICA or M1 occlusion, and (2) PWI and GRE obtained within 12 hours and 12-48 hours after thrombectomy. We compared each rCBF with early hemorrhage (within 12 hours after thrombectomy), late hemorrhage (12-48 hour) and non-hemorrhage in basal ganglia (BG) and MCA cortical or subcortical (CS) region. In each PWI dataset, ROIs were placed in two slice levels of the BG and three slice levels of the CS region. Results: Fifty-three patients met inclusion criteria. Early BG hemorrhages were noted in 13 patients, with 4 late BG hemorrhage, 8 early CS hemorrhage and 3 late CS hemorrhage. There were no significant differences on rCBF in PWI within 12 hours after thrombectomy between early hemorrhage, late hemorrhage and non-hemorrhage groups. In contrast, rCBF on 12-48 hours PWI in the BG region was significantly higher in the early BG hemorrhage than non-BG hemorrhage (lower BG slice 1.36 vs 1.01, p&lt;0.001, upper BG slice 1.33 vs 0.96, p&lt;0.001) and rCBF in CS region were significantly higher in early CS hemorrhage than non-CS hemorrhage (lower CS slice 1.55 vs 0.98, p=0.001, middle CS slice 1.31 vs 0.92, p=0.018). There were no significant differences in rCBF on 12-48 hours PWI between the late hemorrhage and non-hemorrhage group. Conclusions: Most intracerebral hemorrhages after thrombectomy were seen within 12 hours after intervention. A rCBF increase in hemorrhage cases was not seen on PWI within 12 hours after thrombectomy. rCBF increases on PWI 12-48 hours after thrombectomy, however, was associated with post-thrombectomy hemorrhage within 12 hours.

Surgical Techniques and Prevention of Complications in the Treatment of Basal Ganglia Hemorrhage Through the Distal Transsylvian Approach.

Basal ganglia hemorrhage can damage the internal capsule and lead to high rates of disability and mortality. The distal transsylvian approach is a validated approach in the treatment of basal ganglia hemorrhage. However, this approach is difficult and prone to complications. The present study was performed to investigate the surgical techniques and prevention of complications of basal ganglia hemorrhage through the distal transsylvian approach. From January 2015 to January 2018, the authors treated 40 cases of basal ganglia hemorrhage using the distal transsylvian approach. The surgical video recordings and the patients' clinical data were retrospectively analyzed. The authors discussed the surgical techniques and prevention of complications through the distal transsylvian approach. Thirty-eight cases of basal ganglia hemorrhage were successfully treated through the distal transsylvian approach. The other 2 cases were converted to the transcortical transtemporal approach. In the early cases, complications occurred in 3 stages: sylvian fissure dissection, insula lobectomy, and hematoma removal. In the subsequent cases, the authors implemented appropriate surgical techniques to prevent complications. Basal ganglia hemorrhage can be treated through the distal transsylvian approach, but not in all patients. The distal transsylvian approach is highly technical and more problematic than the transcortical transtemporal approach. Mastering certain operative skills can reduce the surgical complications.

Clinical efficacy of minipterional craniotomy with rostral transsylvian-transinsular approach for hypertensive basal ganglion hemorrhage

Background: Clinical applications of transsylvian-transinsular (TS-TI) approaches to hypertensive basal ganglia hemorrhages (HBGHs) have an enormous difference in functional independence rate. The aim of this study is to investigate the clinical efficacy of minipterional craniotomy with rostral TS-TI approach to HBGH and compare functional independence rate with distal TS-TI variant. Methods: From April 2017 to April 2019, eleven patients with symptomatic HBGH accepting minipterional craniotomies with rostral TS-TI approaches were analyzed retrospectively. Results: The mean volume of preoperative hematoma was 57.08 ml with a 99.20% evacuation rate. Postoperative images revealed no rebleeding or newly developed hypodense lesion. Nine out of eleven patients got clear consciousness with functional independence at 3 months postoperatively. Conclusions: In comparison with distal TS-TI approach, minipterional craniotomy with rostral TS-TI approach to HBGH provides satisfactory outcome with higher functional independence rate.

Clinical efficacy of minipterional craniotomy with rostral transsylvian-transinsular approach for hypertensive basal ganglion hemorrhage

Background: Clinical applications of transsylvian-transinsular (TS-TI) approaches to hypertensive basal ganglia hemorrhages (HBGHs) have an enormous difference in functional independence rate. The aim of this study is to investigate the clinical efficacy of minipterional craniotomy with rostral TS-TI approach to HBGH and compare functional independence rate with distal TS-TI variant. Methods: From April 2017 to April 2019, eleven patients with symptomatic HBGH accepting minipterional craniotomies with rostral TS-TI approaches were analyzed retrospectively. Results: The mean volume of preoperative hematoma was 57.08 ml with a 99.20% evacuation rate. Postoperative images revealed no rebleeding or newly developed hypodense lesion. Nine out of eleven patients got clear consciousness with functional independence at 3 months postoperatively. Conclusions: In comparison with distal TS-TI approach, minipterional craniotomy with rostral TS-TI approach to HBGH provides satisfactory outcome with higher functional independence rate.

A Delayed Modified ICH Score Outperforms Baseline Scoring in Acute Intracerebral Hemorrhage.

The Modified Intracerebral Hemorrhage (MICH) score is a simple tool created to provide prognostication in basal ganglia hemorrhages. Current prognostic scores, including the MICH, are based on the assessment of baseline patient characteristics, failing to account for significant developments, such as intraventricular extension and clinical deterioration, which may occur over the first 72 hours. We propose to validate the MICH in all hemorrhage locations and hypothesize that its calculation at 72 hours will outperform its baseline counterpart with respect to predicting mortality and functional outcome. We performed a retrospective analysis of collated data from the Virtual International Stroke Trials Archive database. Primary outcome was 90-day mortality. Secondary outcome was poor outcome (modified Rankin Scale 4-6) at 90 days. Receiver operating characteristic curves were generated looking at the predictive ability of the MICH score for mortality and poor outcome, at baseline and at 72 hours. Competing curves were assessed with nonparametric methods. A total of 226 patients were included, with a 90-day mortality of 22.5%. The MICH scores calculated at 72 hours were more predictive of mortality than at baseline (area under the curve [AUC]: 0.89 [95% confidence interval [CI]: 0.83-0.94] vs 0.78 [95% CI: 0.70-0.85]), P < .01. The MICH scores at 72 hours similarly better predicted functional outcome (AUC: 0.78 [95% CI: 0.72-0.84] vs AUC: 0.72 [95% CI: 0.66-0.78]), P = .047. The MICH score has positive prognostic value for mortality and poor functional outcome in all hemorrhage locations. Delaying its calculation resulted in higher predictive values for both and suggests that delaying discussions around withdrawal of care may result in more accurate prognostication in acute intracerebral hemorrhage.

Stereotactic Operation Integrating With Thrombolysis in Basal Ganglion Hemorrhage Evacuation II

Stereotactic Operation Integrating With Thrombolysis in Basal Ganglion Hemorrhage Evacuation II

Computerized Tomography Radiomics Features Analysis for Evaluation of Perihematomal Edema in Basal Ganglia Hemorrhage.

To evaluate the edema area around basal ganglia hemorrhage by the application of computerized tomography (CT)-based radiomics as a prognostic factor and improve the diagnosis efficacy, a total of 120 patients with basal ganglia hemorrhage were analyzed retrospectively. The texture analysis software Mazda 3.3 was used to preprocess the CT images and manually sketch the region of interest to extract the texture features. The extracted texture features were selected by Fisher coefficient, POE+ACC and mutual information. The texture discriminant analysis uses the B11 module in the Mazda 3.3 software. The data were randomly divided into a training dataset (67%) and test dataset (33%). To further study the texture features, the training dataset can be divided into groups according to the median of GCS score, NIHSS score, and maximum diameter of hematoma. Random forest model, support vector machine model, and neural network model were built. AUC of the receiver operating characteristics curve was used to assess the performance of models with test dataset. Among all texture post-processing methods, the lowest error rate was 2.22% for the POE+ACC/nonlinear discriminant. For the maximum diameter of hematoma, GCS score, and NIHSS score group, the lowest error rate were 26.66%, 23.33%, and 30.00%, respectively. The values of AUCs were 0.87, 0.81, and 0.76, for random forest model, support vector machine model, and neural network model in the test dataset, respectively. Radiomic method with proper model may have a potential role in predicting the edema area around basal ganglia hemorrhage. It can be used as a secondary group in the diagnosis of edema area around basal ganglia hemorrhage.

Central fever in patients with spontaneous intracerebral hemorrhage at a tertiary hospital in Baguio city: Prevalence and outcomes

Central fever was considered a poor prognostic factor in patients with intracerebral hemorrhage and is associated with increased mortality rates and poor outcomes. To determine the effect of fever on the neurologic outcomes of patients with intracerebral hemorrhage. This is an observational cross-sectional study using probability sampling. A sample size of 323 yielded a 95% CI with a 5% margin of error. Data were analyzed using descriptive statistics. The relationship between the location and volume of the hemorrhage with the outcome of patients who developed central fever was determined using ANOVA. P-value was set at ≤0.01. Twenty eight percent had infectious fever while the remaining 72% had a central cause. 99 patients had severe strokes involving the basal ganglia (39%) followed by the thalamus (23%). Using ANOVA, a statistically significant relationship existed between hemorrhage involving the pons (p value = 0.001) and basal ganglia (p value = 0.001). The relationship between poor neurologic outcome with that of a ≥30cc hemorrhage (p value = 0.000) or a bleed of <30 cc (p value = 0.000) were both statistically significant. There is also a significant relationship between poor outcomes among those with central fever with (p value = 0.000) or without (p value = 0.000) intraventricular involvement. Central fever negatively impacts outcome in pontine and basal ganglia hemorrhages within the 24, 48 and 72 hours upon admission. Central fever also leads to poor neurologic outcome regardless of intraventricular involvement and volume of the hemorrhage.

Trajectories for Freehand-Guided Aspiration of Deep-Seated Spontaneous Intracerebral Hemorrhage

Although external landmarks and trajectories for external ventricular drainage have been described for the freehand-guided method, no standard trajectory has been reported for deep-seated intracerebral hemorrhage (ICH). This article presents a freehand-guided catheter insertion technique for deep-seated spontaneous ICH using external landmarks. Freehand-guided hematoma aspiration using Kocher's point and the external auditory canal as landmarks was performed in 32 patients with a diagnosis of spontaneous ICH in basal ganglia treated between May 2015 and July 2018 at the author's institute. In computed tomographic images, the mean actual to planned catheter tip distance was 16.1 ± 7.7 mm, the mean right-left deviation was 4.6 ± 5.2 mm, the mean anterior-posterior deviation was 11.1 ± 9.5 mm, and the mean superior-inferior deviation was 8.7 ± 4.4 mm. On largest hematoma slice, the mean distance from hematoma centers to inserted catheter was 9.8 ± 4.9 mm, and the mean horizontal and vertical distances were 4.0 ± 4.7 mm and 7.7 ± 4.8 mm, respectively. In 29 of the 32 patients, all the catheter holes contacted hematomas, whereas in the other 3 patients, 1 or more holes were in contact with brain parenchymal tissue. For patients with basal ganglia hemorrhage, freehand-guided catheter insertion and hematoma aspiration with subsequent fibrinolysis is a feasible procedure that shortens procedural times. The described technique could be used as an alternative method because it can be performed when the patient is in a critical state without additional equipment.

Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery.

Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery. A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were analyzed retrospectively. Clinical characteristics, imaging features, and postoperative complications were compared. Univariate and multivariate regression analyses were applied to identify imaging factors associated with ER. A significant difference in ER was observed: 78.4% in patients treated with neuroendoscopic surgery, 33.6% in patients treated with burr-hole drainage, and 82.5% in patients treated with craniotomy (p < 0.001). Similar results were observed for operative time (p < 0.001). Five cases (12.5%) of rebleeding were found in patients treated with burr-hole drainage (p = 0.020). No significant difference was found for pneumonia, intracranial infection, gastrointestinal bleeding, hospital mortality, hospital stay, expenses, 3-day Glasgow Coma Scale (GCS) scores after surgery, or GCS at discharge. The CT imaging feature, the island sign (p = 0.004), was observed as an independent factor correlated with lower ER for neuroendoscopic surgery. The benefits and drawbacks of surgical treatments confirmed they have their own indications, and neuroendoscopic surgery may be relatively beneficial for BGH treatment. The island sign was an independent factor affecting ER for neuroendoscopic surgery. Therefore, comprehensive assessment of clinical data, especially the island sign, should be performed preoperatively in BGH patients.

Bilateral traumatic basal ganglia haemorrhage, a rare entity

Aims. Traumatic basal ganglia haemorrhage is rare entity but post traumatic bilateral basal ganglia hematoma is even extremely rare and was earlier presented as case reports. Its incidence is about 3% after a closed head injury however, the incidence is higher in post mortem studies.&#x0D; Material &amp; Methods. Out of 1485 head injury patients admitted to our institute from January 2012 to January 2019, there were 9 cases of traumatic bilateral basal ganglia haemorrhage. The incidence of traumatic bilateral basal ganglia Haemorrhage in our series is 0.61% which is very less compared to previous literature.&#x0D; Results. There were 6 males and 3 females; age ranging from 19 to 50 years (average 32 years). Patients with hypertension, history of drugs abuse, history of coagulopathy, with doubtful history of trauma or unknown mode of injury were excluded from the study. The mode of injury in all the patients was road traffic accidents. Average follow up was 9.54 months. Outcome was assessed by Glasgow outcome Score. In 8 out of 9 patients, outcome was good. One patient died. All the nine cases were managed conservatively.&#x0D; Conclusion. We report nine cases from a single institute which to the best of our knowledge is the largest series in world literature. Prognosis is variable and dependent on many factors. The prognosis of TBGH is favourable if not associated with other disorders like hypertension, diabetes mellitus, and coagulation disorders or diffuse axonal injury.